Pharyngula

Stories like this one about private insurers operations are one good reason.

Reuters reported on Thursday that WellPoint, the largest U.S. health insurer by enrollment, was using a computer algorithm that automatically targeted patients recently diagnosed with breast cancer, among other conditions.

The software triggered an immediate fraud investigation by the company as it searched for excuses to drop coverage, according to government regulators and investigators.

WellPoint has excuses. One that is almost reasonable is that they automatically scan claims for pre-existing “conditions that patients would likely have known about when they applied for insurance, but insisted it does not single out women with breast cancer.” Which is only almost reasonable until you think it through and realize that they’re admitting that they do actively search for reasons to deny coverage to women with breast cancer, and that their other justification is that they do the same thing for everyone on their plan who comes down with a disease.

I know. They just want to make a profit for their shareholders, and they take it for granted that they profit more if they deny health care to people in need. It seems to me that that is the problem, though: relying for health care on companies that have an incentive to not provide health care doesn’t sound like a smart move.

To be fair, WellPoint has published a lengthy counterargument. They do point out that they have a lot of clients and they do have detection and prevention programs in place, which is good; nowhere do they refute the news report that they “automatically targeted patients recently diagnosed with breast cancer, among other conditions.” In fact, they’re basically admitting it, and all they say that’s relevant is that they do not single out women with breast cancer. Which the original article did not claim.

There is one small piece of WellPoint’s letter that is unintentionally amusing.

Madame Secretary, a three-story pink ribbon hangs in the lobby of our Indianapolis headquarters for many reasons.

I hate those stupid ribbons for everything: they seem to be more a blind and completely empty acknowledgment of a problem with no solution or even any real effort behind them. Want to claim you support something? Slap a magnetic ribbon on your car. Done. If you really want to pretend you care, put up a three-story tall ribbon in your lobby. Is anyone impressed?

Comments

  1. #1 Kamaka
    April 23, 2010

    The software triggered an immediate fraud investigation

    No surprise there.

    Where’s the fraud investigation into “we gladly take your money until you’re in need of serious medical intervention”?

  2. #2 Noir The Sable
    April 23, 2010

    I’ve always found those ribbons to be a little on the obnoxious side. Sure, yeah, I understand if you’re wife or your mother or your sister’s aunt’s second-cousin’s mailwoman has breast cancer, or if you’re REALLY putting an effort into it, but to have a huge one emblazoned somewhere easily visible for little to no reason is kinda like going HAY LOOKIT ME IMMA GUD PARSON.

  3. #3 FossilFishy
    April 23, 2010

    If you’re trying to refute the echo-chamber accusations about the comments here I suspect that this topic is a good one. Not sure if it’ll top the computer game/art debate but it should give it a good run.

    As a Canadian now living in Australia I have to say that socialized medicine has never let me down. I can’t imagine what it must be like to get sick and then find that your insurance company has decided that you’re not covered. Talk about kicking someone when they’re down.

  4. #4 t3knomanser
    April 23, 2010

    Health insurance should simply be illegal to sell. We don’t need the government providing it. It simply shouldn’t exist.

    And thus far, none of the changes in the US are really trying to do anything about the fact that health care is run by a cartel. Really, the government is simply trying to put the vaguest boundaries on how vile the cartel can be.

    Just eradicate the cartel. Declare their line of business illicit, and watch how the health care industry re-adjusts into reality.

  5. #5 Caine, Fleur du mal
    April 23, 2010

    Is anyone impressed?

    I’m not. I don’t care if people slap ribbons all over the place, it bothers me if that’s all they do, however. I’m more grateful than I can say that I have good medical insurance and am not stuck with an HMO.

  6. #6 Kamaka
    April 23, 2010

    WellPoint shares fell 0.7 percent on Friday to $57.98, compared with a 0.9 percent rise for the Morgan Stanley Healthcare Payor index. The shares are off more than 17 percent from a year-high of $70 in late January, dampened by uncertainty over how deeply the reforms will impact its business.

    Here it is, PZ’s point made plain. This is one crazy way to deliver healthcare.

    And the “reforms” fall FAR short of making the system more rational.

  7. #7 Mr Ashy
    April 23, 2010

    I’m confused here. I thought private health insurance companies funded everything they are asked to, no avoidance, no trying to get out of it, no looking to see if the treatment is vale for money.
    I thought it was only the government run schemes and their death panels that ever tried to avoid paying for something.

  8. #8 alysonmiers
    April 23, 2010

    Instead of installing a 3-story pink ribbon in their lobby, perhaps they could use that money to pay for their clients’ healthcare. You know, kind of like those clients are paying for health coverage, or something.

  9. #9 randydudek
    April 23, 2010

    Pfft. Ribbons. Everybody who’s anybody knows that in order to really change something you have to copy and paste a status update in Facebook.

    Between the status updates and prayer, I am currently cancer free.

    Oh. And the doctors and nurses. With all of the help mentioned above I almost forgot about the people who actually did something for me.

  10. #10 I H Spedding
    April 23, 2010

    National Health Service, anyone?

  11. #11 valeofaldur
    April 23, 2010

    You mean buying a cute/funny bumper sticker from company to put on my car doesn’t mean I’m actually making anything like significant impact on the suffering of a described group?

    I’m shocked. Shocked I say!

    But the line they printed was so very clever!

  12. #12 SlantedScience
    April 23, 2010

    The rest of the civilized world is laughing at your attempts to take care of your poorest civilians.

    The UK, France, Germany, Ireland, Canada, Brazil: we all chuckle at the fact that your poorest citizens are unable to access anything resembling decent, life-saving health resources.

    Whilst spending billions – for clarity, here it is in uppercase – BILLIONS of dollars per year on unnecessary military operations.

    Face it: you are a rich kid, with tons of money but no idea what to do with it. You’re kind of spoilt, so you blow your allowance on bullying poorer kids – Iraq, N Korea, Somalia – while sucking up to other children with money – Israel, Europe, China.

    Have fun with healthcare reform; the rest of the developed world will leave somebody at the next checkpoint to see how you’re going…

  13. #13 idiotiddidit#5116d
    April 23, 2010

    PZ, how dare you? The invisible hand knows all and by the magic of perfect markets, determines what is right and wrong, by definition. Do not question the hand!

    [A small dog tugs at curtain, revealing an intermingling of politicians and business leaders greasing palms and patting backs. The levers of power protrude from a steam-punk control deck; stacks of legal documents prop up the status quo. ]

    Pay no attention to the man behind the curtain! …

  14. #14 Nerd of Redhead, OM
    April 23, 2010

    Slanted Science. Still full of shit. Still irrelevant, still off topic. What a loser…

  15. #15 Dianne
    April 23, 2010

    I’ve said this before, but it’s still true: it’s easier to deal with an indifferent government bureaucracy than a malicious private bureaucracy. Not that you don’t have to be careful with an ostensibly government program…Medicare HMOs for example. Medicare HMOs aren’t allowed to refuse to take people because of health problems. So they get around that by requiring participants to show up every so often in person and having offices on the 3rd or 4th floor of buildings with no elevators…and amazingly enough few really sick people enroll in their plans. Go for standard Medicare, parts A and B, if you’re of the correct age.

  16. #16 RNA Helix
    April 23, 2010

    Have fun with healthcare reform; the rest of the developed world will leave somebody at the next checkpoint to see how you’re going…

    Arbitrary and unsupported ad hominem attacks are at best unproductive.

  17. #17 RNA Helix
    April 23, 2010

    The insurance companies are the problem and the government isn’t going to fair much better using the same model.

  18. #18 WowbaggerOM
    April 23, 2010

    Nerd, I agree that Slantedscience has indeed been nothing put an asshat every other time he’s posted here, but on this occasion he’s pretty much hit the nail on the head.

    It could, of course, be nothing more than broken clock syndrome…

  19. #19 Jillian Swift
    April 23, 2010

    It boggles my mind that there are folks out there who defend this crap, saying a business has a right (really? A right?) to make a profit.

    Yeah, easy to say ’till you’re the one getting tossed under the buss, hmm?

  20. #21 pipkin1972
    April 23, 2010

    @Slantedscience
    As someone who lives in the U.K and is grateful for our NHS-i’m not laughing at anyone less fortunate and most people i know were following what was happening in the U.S hoping for a better system.
    I dont like to make quick judgements but your use of ‘you’ and ‘your’ when you are talking about a nation of millions as if everyone is of the same mindset.(in response to a article that is critical of the current system) only shows you up as a complete ignoramous.
    BTW your use of the word ‘we’,people like you do not speak for me or the majority of sane rational people.

  21. #22 SlantedScience
    April 23, 2010

    Wowbagger: “Even a stopped clock tells the right time twice a day”.

    You’re quite right: I’ve been an annoying piece of work – correct in all cases, but still annoying to the precious regulars – but this time I speak a universal truth.

    Which is, the US is playing catchup with the rest of the world when it comes to healthcare. They have absolutely no idea how genuinely universal healthcare works, and they are held immobile by the insurance/pharmaceutical companies.

    It will take years to bite your way out of the spiders’ webs.

  22. #23 John Morales
    April 23, 2010

    Wowbagger, I for one don’t “chuckle” at the inequitable US health care system.

    IOW — I’m not part of the Slanty’s “we”.

  23. #24 Nerd of Redhead, OM
    April 23, 2010

    It could, of course, be nothing more than broken clock syndrome…

    Since I couldn’t understand what he was saying (very long day), I could give him that. But next time, he will be wrong, and we know it. His most intelligent idea would be shut up and stop posting. I doubt if he is that smart…

  24. #25 Sk8man
    April 23, 2010

    While our health care system here in Canada isn’t perfect, it’s reasons like this article that remind me how lucky I am to live in such a great country.

  25. #26 William
    April 23, 2010

    Best option would be to provide subsidies for individuals and to establish a public option, and if those individuals choose for-profit insurance then they must deal with the consequences. It’s a trade off – cheaper premiums but a higher risk of getting the shaft. The new HC plan did the subsidies part well enough, but not the public part.

    Another option would be to simply lay down some rules that essentially say, “If company X wants to receive the business of subsidized individuals, they must follow these guidelines: *insert non-dickish stuff here*”

    That being said, non-profit groups are typically full-blown atrocious with money – please do not pass off public health insurance as a panacea.

  26. #27 Insightful Ape
    April 23, 2010

    Come on libertarians…the socialist assault on the free market needs to be stopped…like yesterday…
    Cue libertarian trolls 3…2…1

  27. #28 SlantedScience
    April 23, 2010

    #24, Nerd of Redhead: you’re welcome.

    My occasional swoops into important subjects – as opposed to baiting regulars – will impress the shit out of you.

    I think this is needed: ;-)

  28. #29 Nerd of Redhead, OM
    April 23, 2010

    will impress the shit out of you.

    Nope, not impressed. Stupid is as stupid does. And you are stoopid…

  29. #30 Nerd of Redhead, OM
    April 23, 2010

    SS, you want to impress me? Apologize for your past behavior, including your homophobia. Explain why you were wrong for a complete apology.

  30. #31 mick.carroll
    April 23, 2010

    It is a very odd situation that exists when a company is formed for the purpose of making a profit. A genuine business model sees a company form around a product or a service for which there is a market. In an ideal world the company that provides the best product or service will be the most successful and consequently make the most profits as they can ask more for their quality product. What has occurred in the the Health Insurance space is unlike anything else. Companies have been formed – or calved off from other organisations, not to deliver a quality service, but to maximize profit. A free market should not ever tolerate rampant profiteering because it limits the spending power of the consumer to spend in other sectors, it concentrates money in economic ‘dead zones’ and fails to deliver a useful product or service.

    I’ll back PZ on this – it is better to start from a position of no-profit health care insurance and work outwards from there. I think there is a place for profit making in the medical arena but not at the most basic levels where the concentration of effort and resources needs to be on good health outcomes for patients not profit outcomes for shareholders.

  31. #32 Ichthyic
    April 23, 2010

    I’ve been an annoying piece of work – correct in all cases, but still annoying to the precious regulars

    ignorance begets arrogance.

    suggest you look up what Dunning-Kruger effect is.

    Looking forward to your participation in the next Survivor Pharyngula.

  32. #33 ursa major
    April 23, 2010

    Part of the fun with insurance is that reimbursement criteria are trade secrets. The patient does not have access to them; the doctor does not have access to them. If you do not know the criteria you do not know what and when the insurance company will pay. In what other business would it be legal for a company to sell something and refuse to say what they are selling?

    I worked in manged care for a little while and one of the things which bothered me was the instructions we were given. If the weekly profits were lower we were to interpret the reimbursement criteria strictly, but if the weekly profits were up we could interpret the criteria more generously.

    Screw the insurance companies.

  33. #34 cgranade
    April 23, 2010

    I think I’ll take the usual position of supporting those pink ribbons. They’re a kind of consciousness raising (to borrow a phrase from Dawkins) that has largely been successful– having breast cancer is no longer something that cannot be mentioned in polite company. Having that level of openness helps patients cope, and it helps make funding research a much easier sell.

    Mind you, I do think that in some sense the ribbons have succeeded, and thus really aren’t important anymore, but I have to like anything that gets KitchenAid to make a pink mixer. That thing is awesome.

  34. #35 Ichthyic
    April 23, 2010

    Face it: you are a rich kid

    unless you mean a kid who has maxed out the credit card (all of them), then you’d be wrong here, too.

  35. #36 WowbaggerOM
    April 23, 2010

    Slantedscience, repeated attempts to ‘bait regulars’ will lead to PZ banning you. Either be genuine or fuck off.

    John Morales – you’re right; the US health system is certainly no laughing matter. Quite the opposite.

  36. #37 Ichthyic
    April 23, 2010

    Explain why you were wrong for a complete apology.

    meh, save it for a Survivor Challenge.
    :)

  37. #38 Nerd of Redhead, OM
    April 23, 2010

    the US health system is certainly no laughing matter. Quite the opposite.

    I really think that the government could institute health insurance using the present premiums from the companies and workers, and still give better performance than the for profit companies since they don’t have to rake in 10-15% off the top. That would definitely expand the coverage for other folks, like the self employed and unemployed…

  38. #39 Ichthyic
    April 23, 2010

    I can’t imagine what it must be like to get sick and then find that your insurance company has decided that you’re not covered.

    heh. try getting sick as an immigrant without residency yet in a country that has socialized healthcare.

    no coverage whatsoever, and you get to groan as you look out the window and see everyone else around you gets it all for free.

    *sigh*

    I recall the doc that performed the last surgery on me here being surprised out how much it actually costs.

    he never had to think about it before.

  39. #40 jafafahots
    April 23, 2010

    I totally hate those meaningless, ineffective magnetic car ribbons, and to fight them I joined a Facebook group opposed to them.

  40. #41 SlantedScience
    April 23, 2010

    Wowbagger#36: I admire PZ’s aims, but don’t care for his acolytes.

    I’ll just comment when I like, if that’s okay?

  41. #42 attorney
    April 23, 2010

    The letter to Secretary Kathleen Sebelius references a press release WellPoint put out in response to the news article. That press release effectively addresses many of the points made here. Not saying it’s perfect, but the letter to Secretary Sebelius was clearly a political document, whereas the press release actually addresses the points and inaccuracies of the Reuters story. It should be part of the discussion here.

  42. #43 Ken
    April 23, 2010

    How dare you imply that those car ribbons don’t help anyone! I feel confident that I could find scores of Chinese magnet manufacturers who benefit greatly from them.

  43. #44 jafafahots
    April 23, 2010

    I was hit by a pickup truck, the guy’s insurance was supposed to cover related bills for life.

    For ten years they denied claims. Then after ten years they denied more claims, saying that the “case was closed” because there hadn’t been any claims in ten years.

    Then they claimed they lost the file, claimed other things, etc. etc. etc.

    I’m now disabled. On SSD, Medicare, Medi-Cal. I have okay health coverage as a result, all of it “government controlled” and none of it covered by the insurance company that was paid to do that.

    (Of course, not ALL of my medical costs would have been their responsibility, as I have other medical problems, but…)

  44. #45 Ichthyic
    April 23, 2010

    The new HC plan did the subsidies part well enough, but not the public part.

    most republicans, and many conservative democrats, refused to vote for the bill if it had any inkling of support for a public health care option. It was one of the major sticking points that delayed the vote to begin with.

    sad.

    of course the conservative spinmeisters like Beck and Limbaugh made sure their fans got an earful of “how bad it would be if the government actually got into the healthcare business”, which consisted of nothing but irrational scare tactics and a parade of strawmen crayoned to look like the actual health care plan.

    as to whether there was influence to garner such spin from the current health care insurance industry, of course there was. Just like when Clinton tried this during his presidency.

    This, however is to be expected. Businesses will naturally look to protect their own interests in whatever legal (and not so legal) means are available to them.

    the disappointing part is really how gullible most people apparent are, in that they swallow all the spin without question.

    …and we end up with teabaggers.

  45. #46 ecpaulsen
    April 23, 2010

    Madame Secretary, a three-story pink ribbon hangs in the lobby of our Indianapolis headquarters for many reasons.

    What they neglect to say is that it is coated in a very sticky glue and is meant to capture and kill breast cancer patients like a mile high no pest strip.

  46. #47 Ichthyic
    April 23, 2010

    I’ll just comment when I like, if that’s okay?

    you just keep tellin’ yourself that.

    *rubs hands with glee*

    yes, very much looking forward to the next round of Survivor.

  47. #48 SlantedScience
    April 23, 2010

    @Nerd of Redhead #30, who said:

    “SS, you want to impress me? Apologize for your past behavior, including your homophobia.”

    No apologies for past behavior: your leader regularly calls for you all to go to a website and try to crash it. Hence, he’d be a terribly thin-skinned hypocrite to be upset at this little guy coming here and speaking bullshit.

    I’ve no idea what the “homophobia” tag means. Please let me know what sentence you’ve removed from context to show this. I’m off to bed, but see you tomorrow?

    USA rocks, in many ways. Healthcare ain’t one of them.

  48. #49 KOPD
    April 23, 2010

    we all chuckle at the fact that your poorest citizens are unable to access anything resembling decent, life-saving health resources.
    Chuckling about human suffering and death? How very commendable. Your mother must be proud.

  49. #50 WowbaggerOM
    April 23, 2010

    Slantedscience wrote:

    I’ll just comment when I like, if that’s okay?

    No, it’s not okay; as I’ve told you, you’ll get banned. It’s as simple as that. Check out the dungeon and you’ll see that coming here to annoy commenters – without adding anything – is something PZ doesn’t like.

    Understand?

  50. #51 Ichthyic
    April 23, 2010

    No apologies for past behavior: your leader regularly calls for you all to go to a website and try to crash it. Hence, he’d be a terribly thin-skinned hypocrite to be upset at this little guy coming here and speaking bullshit.

    unrelated.

    I’ve no idea what the “homophobia” tag means.

    you’re living in denial.

  51. #52 KOPD
    April 23, 2010

    Damn broken blockquote tags. I thought I previewed that. I think it’s pretty obvious that the first sentence was the quote and the rest is mine.

  52. #53 RamblinDude
    April 23, 2010

    ?relying for health care on companies that have an incentive to not provide health care doesn’t sound like a smart move.

    And yet, there?s a whole army of Walmart shoppers out there ready to fight you tooth and nail if you try to change the system.

  53. #54 Steven Dunlap
    April 23, 2010

    @attorney #42

    From the press release in question:

    such software is used to look at a series of diagnostic codes meant to capture conditions that applicants would likely have known about at the time they applied for coverage. We do not single out breast cancer or pregnancy.

    Next please re-read PZ’s post. He covered this point. And it appears you missed it. Even if true that Reuters is incorrect, even if the bean counters at WellPoint do not single out women with breast cancer, they do look for “pre-existing conditions” then kick those patients to the curb.

    This is the point. If you notice signs or symptoms of a deadly disease during a period in your life in which you lack health insurance, the tea-bagger, libertarian, neocon and Health Insurance Industry’s response is:

    DIE! Unemployed SCUM, DIE!

    Most people in the U.S. do not support this, but somehow it remains policy.

  54. #55 tonysidaway
    April 23, 2010

    I thought America had finally voted for a decent health care system, or hasn’t that been enacted yet?

  55. #56 iwoolf
    April 23, 2010

    As you clearly point out, private health scams can never give as good care as socialised government-run universal health care. Outside of the lies about “death panels”, nobody has managed to find the rational argument against poor people getting access to health care, and everyone else paying less for better outcomes.

    Sadly in Australia, although we have socialised universal government-run health care, the government has deliberately legislated a “gap” that is not supported by universal health care SOLELY to allow a local Health Insurance consortium to leech profits from the public. The idea is that if you can afford the premiums then you’ll pay less for “gap” health care than if you’re poor. If that worked, then the health insurance companies wouldn’t make a profit. Its a rigged gambling game.

    If our politicians won’t kill off the private health insurance scam from a love of the class system and the loss of jobs if private health insurance was made obsolete, I don’t know how a nation like the USA that is gullible enough to believe in death panels and entrenched in unaffordable health care scams as the only possible model can easily shake it off. I hope the US government some day can be brave enough to save trillions of dollars from the budget by spending billions on universal health care like you have in Hawaii.

    If I lived in the USA, with my health issues, I’d be dead several times over.

  56. #57 randydudek
    April 23, 2010

    I thought America had finally voted for a decent health care system, or hasn’t that been enacted yet?

    We elected a wave of politicians largely on the promise of a decent health care system. Then, through the magic of our political system, the party removed from power was able to hold the health care plans hostage until what was recently passed was a plan that seems to be hated by just about everybody.

  57. #58 idle.pip.verisignlabs.com
    April 23, 2010

    And if you don’t even want to pretend like you care, just say “they are in your prayers” when asked. Or actually do pray, and get nothing.

    Honestly tho, why does the “breast cancer” tag immediately embolden anyone? I’m sure this wouldn’t have gotten as much attention without the “they target breast cancer” tag line.

    This isn’t really a problem under your american system. The old one, anyways. Its why “pre existing conditions” can’t play a part in getting health care any more. The new system you guys are getting isn’t perfect, but its a lot better then the slimy tactics that they have been using in the past.

  58. #59 pipkin1972
    April 23, 2010

    @slantedscience
    “this little guy coming here and speaking bullshit”

    Sorry but you don’t score any points just because your an honest bullshitter.

  59. #60 Joshua Cain Hardy
    April 23, 2010

    I guess the big question would be – Are a disproportionate number of breast cancer claims fraudulent?

    I don’t find their denial that they “don’t target women with breast cancer” portion to be all that unreasonable. The people at the company probably went into a panic attack. They also have to address how the report is going to be perceived by the general public.

    In fact, they’re basically admitting it, and all they say that’s relevant is that they do not single out women with breast cancer. Which the original article did not claim.” – P.Z.

    < I take that back a little. P.Z. was wrong-ish. Here is the line from the article.

    In a letter dated April 22 to Angela Braly, WellPoint’s chief executive, Sebelius said she was “surprised and disappointed” to learn from a Reuters report that the company had targeted women with breast cancer for aggressive investigation with intent to cancel their policies.

    That could be taken either way. A casual reader could confuse targeted and singled out. Especially a few hours after she read the article. As I say wrong-ish.

  60. #61 phoenixwoman
    April 23, 2010

    Speaking of bullshitters, our old buddy Dennis “DMabus” Markuze is at it again, this time polluting the threads over at Respectful Insolence. And no, he hasn’t miraculously got saner since PZ banned his ass (and the rest of him) from this site.

  61. #62 randydudek
    April 23, 2010

    why does the “breast cancer” tag immediately embolden anyone?

    Yeah, all I have is a yellow Livestrong bracelet.

    On one hand, you’re right that breast cancer does get more attention than other types of cancer or other non-cancer diseases. But just because this would have gotten less attention had it been first detected that they were targeting people with, shit I don’t know, glaucoma, it wouldn’t make the action any less heinous.

  62. #63 kiyaroru
    April 23, 2010

    #12 Slanty

    The UK, France, Germany, Ireland, Canada, Brazil: we all chuckle at the fact that your poorest citizens are unable to access anything resembling decent, life-saving health resources.

    No.
    The only people chuckling at the difficulties of others are the sociopaths. I have never found it amusing that other people are in pain.
    I am Canadian, born here in 1955. Universal health-care has been a part of life for as long as I have been aware. Kinda like garbage collection, electricity, water, police and fire-fighters. Why anyone would NOT want this baffles me.

  63. #64 Free Lunch
    April 23, 2010

    Blue Cross and Blue Shield were founded as not-for-profit organizations by doctors and hospitals to help further their ability to provide health care to more people. The managers who turned those companies into Anthem/Wellpoint, for-profit institutions, usually by bribing legislatures with large donations for things like state medical schools (but less than the value of the company to the managers) have completely perverted the entire purpose of the companies.

    There is no reason not to force the executives to give back all they have taken.

  64. #65 happy_heyoka
    April 23, 2010

    What bugs me with the debate in the USA is the conflation of healthcare and business; ie: that healthcare (overall) should actually be a for profit sector.

    You can believe in the “invisible hand” and also want to have a reasonable way to enable your citizenry to get through life with a minimum of pain and suffering.

    In fact, it’s probably worth your while as a nation to have them alive and well and buying consumer goods into their 80s.

    Insurance seems like such a scam – as an Australian not involved in the healthcare system and not privately insured, it seems to me that our federal medicare levy system works ok (you pay around 5% of your income, some money comes from the 10% “Goods and Services Tax”)…

    For that money we get reasonably cheap (or free if you’ve got chronic health issues or have low income) visits to doctors, hospitals, psychiatric care, palliative care etc.

    We also have federal price fixing scheme for approved pharmaceuticals; I know for a medication I was taking regularly it was US$30 per month for me to buy here and around US$170 per month (had to get buy while on vacation in USA). Same drug, same label, same factory, same etc. Go figure.

    And yes, politicians from the state and federal government regularly fight over how the money gets divided.

    And I’m not arguing at all that nurses and doctors and others involved should do it for love – for all those that call it “socialism” there are plenty of doctors who drive a benz and own investment property…

  65. #66 William
    April 23, 2010

    This, however is to be expected. Businesses will naturally look to protect their own interests in whatever legal (and not so legal) means are available to them.

    the disappointing part is really how gullible most people apparent are, in that they swallow all the spin without question.

    Agreed. There is a big difference between pro-market and pro-business, but the two are often confused. Pro-market is generally works better than the alternatives, provided incentives are aligned. As you point out, this really isn’t at all what the common opposition to the public plan – it’s pro-business, protecting the giants from the competition the public plan could have provided, sold with lies and slander. There’s nothing capitalist about it.

  66. #67 JohnnieCanuck
    April 23, 2010

    Lots of people in other countries fear the US and quite a few hate them as well. Perhaps some of these would laugh at the embarrassment they might perceive inequitable US health care to be, if they knew of it.

    As to those in countries on Slanted’s list, I don’t believe it. Not even a significant minority is aware of the extent of the problem in the US, let alone laughing.

    What you won’t find is envy. We may not be happy when we have to wait for optional procedures or tests, but we wouldn’t ever want to switch places with American Healthcare consumers. Which is to say, Slanted is pretty much right in the last two paragraphs of his comment @ 22.

    Healthcare is another one of those pick any two out of three kind of problems:

    High quality, immediate access or affordable.

    For the amount of money spent per capita in the US on Healthcare, the outcomes for most Americans should be better than in most first world countries, not worse.

  67. #68 Steven Dunlap
    April 23, 2010

    Just to give some perspective, talking about health insurance as a separate issue from health care: no one has ever provided a rational explanation for the fact that the countries with national health care systems with some sort of “public option” spend only a little over half as much per capita as the U.S. on healthcare but have better health outcomes.

    Source: Healthcare American style

    Oh, and the press release from WellPoint boasts that “Less than one-tenth of 1 percent of our individual members’ policies were rescinded.” That’s one-tenth of 1 percent too many. If they keep defending their position that way they won’t have any toes left by Monday.

  68. #69 randydudek
    April 23, 2010

    for all those that call it “socialism” there are plenty of doctors who drive a benz and own investment property

    I’ve talked to many a nurse and doctor this past year, and every single one I’ve come in contact with had been in favor of a universal health care system.

  69. #70 keeperofthepies#bd89a
    April 23, 2010

    Wanna show that you support conservation?

    Buy duck stamps!

  70. #71 John Morales
    April 24, 2010

    randydudek,

    I’ve talked to many a nurse and doctor this past year, and every single one I’ve come in contact with had been in favor of a universal health care system.

    I’ve found many people confuse non-profit with volunteer work.

    Nerd @38 makes a good point.

  71. #72 jcmartz.myopenid.com
    April 24, 2010
  72. #73 bart.mitchell
    April 24, 2010

    I suggest we all start wearing a ribbon for atheism.

    Its the Invisible Ribbon. Just like the Invisible Pink Unicorn, it’s really there! You just can’t see it unless you believe really really hard.

  73. #74 F
    April 24, 2010

    Yo, SlantedScience, that’s trillions (or more than one trillion, anyway). You could also go with hundreds of billions. But don’t forget that on this side of the pond, billions are an order of magnitude off (your thousand-millions).

    No argument with the actual content of your post, though.

  74. #75 Autumn
    April 24, 2010

    I’ve said it before, and I’m not proud of my fellow citizens when I hear it, but the thing that really drives opposition to health care in the USA is the absolute disgust that many wealthy people have when they think that they may recieve the same treatment as a poor person.

  75. #76 deriamis
    April 24, 2010

    It’s even more disturbing than just this.

    You might be interested to know that Medicare will no longer pay an ambulance service to take someone to their dialysis appointments. Ok, so not all of them need an ambulance all of the time, but they won’t pay for any service to transport them to life-saving treatment, even when it is literally their only recourse. Why? Because some people and services bilk the system for money, even the reputable ones who have been providing proof of medical necessity for years must be doing the same.

    Your tax dollars at work, folks. Even the federal government is moving towards HMO-style care.

  76. #77 Branston
    April 24, 2010

    One way to look at it is to say they are actively looking for reasons to deny coverage. Another way to look at it is that they are carrying out their legally mandated anti-fraud measures to find people who have failed to disclose material information and in the process attempted, or succeeded, in defruading the company.

  77. #78 Ichthyic
    April 24, 2010

    countries with national health care systems with some sort of “public option” spend only a little over half as much per capita as the U.S. on healthcare but have better health outcomes.

    actually, here in NZ my experience has been that even when you have to pay full price for care (as I do, since I’m not resident yet), the cost is still 1/3-1/2 what it is for the exact same products/services back in the States. That includes:

    Hospital Stays
    Surgical Procedures
    pharmaceuticals and prescriptions (which are actually as cheap as 1/10th for some things as they are in the States)
    Doctor visits
    Emergency Room costs
    Xrays and sonograms.

    seriously, this is from personal experience over the last 4months getting treatment for a temporary liver condition here.

    I can directly compare it to the time I had gallstones back in the states, and went through the public health care system there.

    everything is minimum half the price.

    so… that suggests to me there is a HUGE markup on medical goods and services in the states that is nothing but middleman profiteering.

    I’ve never actually looked into it, but I can’t figure out why else the costs would be so different, given that everything else is equal (no insurance coverage, paying full price, etc.)

  78. #79 percyprune
    April 24, 2010

    “Less than one-tenth of 1 percent of our individual members’ policies were rescinded.”

    0.01 certainly sounds small. I wonder if that is there full recission rate.

    I ran some back-of-envelope numbers 18 months back, based on the CEO of Assurant’s 0.5% recission rate that he announced at the Congressional hearings. It throws up some disturbing results for healthcare customers in the 1% of most expensive treatments. I figured that if you were one of those in the top 1% by cost of treatment, you had something like a 1 in 9 chance of losing your coverage.

    Now, my figures may have been way off, and were based on a number of assumptions that could have been false. However, it seems to me that any recission system driven by profit motives will target those people on the most expensive rather than least expensive treatments, and that the greater your need of coverage, the greater the chance the system would fail you.

    Here’s a good table of health care expenditure by population in the US. Can Conservative doubters please tell me how even a small recission rate would not affect those who use healthcare the most?

    http://www.ahrq.gov/research/ria19/expriach1.htm

  79. #80 FossilFishy
    April 24, 2010

    Ichthyic: That sucks. What kind of visa are you on? My provisional spousal visa here in Australia entitles me to full benefits. Mind you, I’ve never read the fine print.

  80. #81 strange gods before me ?
    April 24, 2010

    Tony, I don’t know if I would call it decent. The only good part is that preexisting conditions are ignored. Most of it doesn’t go into effect until 2014.

  81. #82 blf
    April 24, 2010

    I’ve talked to many a nurse and doctor this past year, and every single one I’ve come in contact with had been in favor of a universal health care system.

    That was also the case when the NHS was introduced in the UK. Now, it’s precisely the opposite: Very few want a return to private-only care.

  82. #83 GeorgeFromNY
    April 24, 2010

    What bugs me with the debate in the USA is the conflation of healthcare and business; ie: that healthcare (overall) should actually be a for profit sector. (Happy)

    I agree, for slightly different reasons.

    To wit: The basic, atomic element of capitalism is the sale (or exchange, if you prefer). In order for market efficiency to work, both parties of the sale must have equal, or close to equal, powers of refusal.

    Buyer and seller both must be able to walk away from the sale if the terms are not acceptable. This pushes producers to be responsive to consumers’ needs and means, and the loyalty of consumers to efficient and responsive producers enables long-term financial security and profit.

    Now, with health care – both emergency and preventive – this relationship breaks down completely. A buyer who is sick, wounded or in pain has a diminished or negligible power of refusal. The seller, in turn, has no reason to price his services competitively or strive for efficiency; he can charge whatever he likes. What is the buyer going to do? Shop around while he suffers? Die?

    Add to this the extremely bureaucratic nature of the health care industry and its enormous barriers to entry, and what kinds of competition can you really have?

    In most American states, there are only two or three top-level insurance providers. Sometimes there’s only one. You can’t have a free market with only one store.

    This doesn’t mean that outright government control of the health service industry is the only remaining option… but I agree that things must change.

  83. #84 SteveV
    April 24, 2010

    SS #12

    The UK, France, Germany, Ireland, Canada, Brazil: we all chuckle at the fact that your poorest citizens are unable to access anything resembling decent, life-saving health resources.

    Some may, but the overwhelming majority of us are not sociopaths, you arrogant turd. The NHS is almost the same age as me and I’m afraid that (until recently) I’ve thought about it in the same way that fish think about water – not much. Now, however, I see how lucky I am. This does not lead me to chuckle at others misfortune.
    Is the contraction of your handle significant?
    On another point, I have pointed out before that Insurance Companies are equivalent to Bookmakers but wihout the latters honesty. Some healthcare insurers seem to be at the shit end of even that shitty spectrum.

  84. #85 Jeeves
    April 24, 2010

    blf

    That was also the case when the NHS was introduced in the UK. Now, it’s precisely the opposite: Very few want a return to private-only care.

    Nye Bevan had a tough time convincing the doctors to accept the NHS in 1948, thankfully now the BMA, as you rightfully state, is one of the staunchest defenders of the service.

    Unfortunately current Tory plans for hospitals to become “staff-led cooperatives” is the first step to rolling back Nye Bevan’s accomplishment and giving us the American system. We must never take the NHS for granted, there are people, invariably the most wealthy (like multi-millionaire David “Call me Dave” Cameron) who would happily sell off the NHS to the highest bidder.

    Margaret Thatcher wanted to do exactly that, and Cameron is nothing but Thatcher-lite. He’s more dangerous because, whereas Thatcher was always upfront about her aims, he hides them behind a facade of concern and spin. It’s taken 13 years to repair the damage done by Thatcher, and although I don’t agree with all the changes (the PFI, massive increases in management staff and the creeping organisational change to a more corporate atmosphere), as both a heavy user of the NHS and an NHS employee I can see the difference that Labour have made.

    We must not be complacent, nor look at the US situation and believe that the same could not happen here. It can and will the moment we let our guard down.

  85. #86 jukkalattu
    April 24, 2010

    I hate those stupid ribbons for everything: they seem to be more a blind and completely empty acknowledgment of a problem with no solution or even any real effort behind them.

    I wonder if there’s a ribbon for anti-ignorance, that would surely be an instant hit amongst Creationists an other, making them effectively immune to any accusations of scientific illiteracy.

    “What do you mean my arguments against dna proof is faulty? Don’t you see this Anti-Ignorance Ribbon I’m wearing?!”

  86. #87 Dianne
    April 24, 2010

    Hey, do any of you lawyer types out there know if you can sue your insurance company for blocking claims excessively making it difficult to get care?

    I’m not, in general, a big fan of using lawsuits to control bad behavior: the punishment is too random and can be both excessive and inadequate, but right now we don’t seem to have anything else to keep them in line.

    Even apart from the major acts of evil like this one, virtually all insurance companies seem to go in for harassment and blocking in minor ways…Like this insurance company I was dealing with a while ago that was demanding justification for a medication. Ok, it was an off label (if very standard and well documented) use, but it was a refill of a medication that the patient had been on for several months already. We’d already played this game once. Furthermore, the rules were set up so that the first person to see the application for the medication was forced to disallow it and make it go into appeals…which couldn’t be finished in less than3 days-three working days. As a result, a patient with a disease that kills in months was without adequate medication for several days. I blame myself partially for not realizing that there would be a delay and making sure she had overlap, but I blame the insurance company more for setting up ridiculous rules.

  87. #88 Colin
    April 24, 2010

    At least in the US the name is “health insurance”. You’re aware that you’re subscribing to a system that bets on all of you not getting sick at the same time, in order to generate a profit.

    In South Africa, we get the very misleading term “medical aid” (as a noun). However, even we have free healthcare (theoretically there’s a token payment, but if you’re unemployed it’s free). The quality, however, is highly variable, and people who can afford “medical aid” pay the premiums for private-practice medicine.

  88. #89 danielm
    April 24, 2010

    …and people wonder why I shudder in horror everytime some dipshit retard spouts the words “socialism” and “medicine” in the same breath, or even just asserts (between slack-jawed drooling and window-licking, obviously) that the ‘merkin healthcare system is superior to the british, canadian and (generally) european one.

    yes, heaven forbid that healthcare providers should see the health of the patient as the primary driver!

  89. #90 Walton
    April 24, 2010

    Unfortunately current Tory plans for hospitals to become “staff-led cooperatives” is the first step to rolling back Nye Bevan’s accomplishment and giving us the American system. We must never take the NHS for granted, there are people, invariably the most wealthy (like multi-millionaire David “Call me Dave” Cameron) who would happily sell off the NHS to the highest bidder.

    That’s simply hyperbolic nonsense.

    No one in Britain advocates “the American system” of healthcare provision (which is not a “system” at all; it’s a confused mish-mash of private, federal, state and local overlapping systems, which is why it’s so grossly inefficient). Nor does anyone in Britain advocate ending the principle of universal healthcare. It is a strongly-held, and rightly-held, principle in Britain that everyone, regardless of financial means, should have access to basic healthcare.

    But there are legitimate debates about the most efficient means of providing it. And I don’t see anything wrong with decentralising healthcare provision, giving more control to front-line healthcare staff rather than Whitehall bureaucrats, and allowing the private sector to become involved where this is the most efficient solution.

  90. #91 Jeeves
    April 24, 2010

    Dianne

    I’m not, in general, a big fan of using lawsuits to control bad behavior: the punishment is too random and can be both excessive and inadequate, but right now we don’t seem to have anything else to keep them in line.

    Trouble is, there’s a legal obligation on publicly traded companies to maximise returns for their shareholders. So, you could be suing companies for doing what they are legally required to do.

    If you legislate that they can’t override the wishes of the patient’s doctor, can’t deny based on pre-existing conditions and can’t withdraw coverage after a limit has been reached, then the companies will either fail or raise the premiums beyond what the average person could reasonably afford and totally deny coverage to those who are poorer still.

    Nationalisation is the best option. Bring all healthcare into the public sector, employ your state-monopoly to lower the cost of drugs and set staff salaries at the national level (there are no starving doctors in the UK). Cover all legal residents to the same standard for a fee that is means-tested and mandatory.

    On the providers side, you stop over-treating and over-testing. You also need to provide a single routine point of access through a general practitioner who will concentrate on preventative medicine, and end self-referral to specialists. If you have a problem your first port of call would be your GP’s practice, and they would decide whether a specialist visit is necessary. You don’t need a dermatologist to look at every mole or rash, or a paediatrician to treat your kid’s cough or an ENT to treat your ear infection.

    As far as I can tell none of your main parties even considered this kind of reform, and Obama ruled out “single-payer” without even debating it. It’s weak sauce, and I don’t know why you guys with your much vaunted 2nd Ammendment aren’t revolting against what is essentially the corporate take over your country. You act like you’re the land of the free but in actual fact, you’ve traded that years ago for an SUV and a cheeseburger.

    I say all that despite the fact that I love the USA and think that on the whole Americans are some of the nicest and most generous people on Earth (as long as you don’t talk politics or religion).

  91. #92 Jeeves
    April 24, 2010

    Walton

    And I don’t see anything wrong with decentralising healthcare provision, giving more control to front-line healthcare staff rather than Whitehall bureaucrats, and allowing the private sector to become involved where this is the most efficient solution.

    The slow privatisation and the insertion profit generation into healthcare provision is the way in which the NHS will be destroyed.

    The decentralisation is the first step on the road, and anyone who denies that is either disingenuous, looking to profit or, quite frankly, stupid.

  92. #93 Walton
    April 24, 2010

    The slow privatisation and the insertion profit generation into healthcare provision is the way in which the NHS will be destroyed.

    The decentralisation is the first step on the road, and anyone who denies that is either disingenuous, looking to profit or, quite frankly, stupid.

    You assert this, but you don’t substantiate it.

    I get fed up with the scaremongering of the British left about NHS reform. Healthcare provision isn’t all-or-nothing: it doesn’t have to be all public-sector or all private-sector. We can mix both public and private provision, in partnership, to create a better-quality system. Introducing some market incentives into the system will not “destroy the NHS”.

    At times, left-wing rhetoric about the NHS verges on the religious. They talk as if Aneurin Bevan were the Messiah of healthcare, and the NHS were some sacrosanct institution in which we can never change or reform anything lest terrible things befall us. This kind of thinking is just as irrational in healthcare as it is in religion. Rather, we should use evidence-based practice to make the system as efficient, high-quality and cost-effective as possible.

    Many other developed countries have a social-insurance-based health system, where government funds healthcare and ensures that all citizens can afford access to it, but the actual provision of healthcare is largely in the hands of the private and non-profit sectors. I wouldn’t necessarily advocate going over to that system, but we can learn things from it.

    You are drawing a false dichotomy: we are not restricted to either having Bevan’s idea of a uniform centralised system run from Whitehall, or a completely private for-profit system. There are other possibilities, and we should rely on actual evidence, rather than ideological rhetoric, in deciding how to reform the system.

  93. #94 Walton
    April 24, 2010

    Nationalisation is the best option. Bring all healthcare into the public sector, employ your state-monopoly to lower the cost of drugs and set staff salaries at the national level (there are no starving doctors in the UK). Cover all legal residents to the same standard for a fee that is means-tested and mandatory.

    That’s insanely authoritarian. It would mean expropriating the property of thousands upon thousands of existing healthcare providers. Not to mention creating a whole new huge bureaucracy at the federal level, which would be grossly inefficient and would pay no attention to local needs.

    America is not Britain. It has five times the population, a far greater land area, and a huge diversity between states in terms of culture, economy, politics, and needs. What you are proposing would be nothing like the British NHS; it would be more equivalent to having a pan-European health service, which any fool can see would be a completely insane idea.

  94. #95 Jeeves
    April 24, 2010

    Walton

    That’s insanely authoritarian. It would mean expropriating the property of thousands upon thousands of existing healthcare providers.

    So? The status quo isn’t working and the reform that is currently on the table is completely worthless.

    America is not Britain.

    American exceptionalism, the standard defence against any sort of major change in America.

    It has five times the population, a far greater land area, and a huge diversity between states in terms of culture, economy, politics, and needs.

    Bullshit excuse.

  95. #96 Steven Dunlap
    April 24, 2010

    @ Walton and Jeeves

    The British NHS is not the only possible model for a national health care program. Canada has its Health Care service administered by the provinces, for example.

    2nd, the myth of the “inefficient” government. The overhead for most HMOs expressed as number of dollars per $100 of reimbursement runs about $15-$18. Kaiser, the most cost-effective of them, runs an overhead of about $12-$13. Compare this the Medicare and Medicaid which for decades have run at $3.

    Government will be inefficient if Republicans sabotage the system and Democrats roll over and let them do it. My favorite example of this was when Fearless Flightsuit put a neocon economist and a former HMO executive in charge of the VA hospitals. They ran the VA hospitals like an HMO. Then Michelle Bachman et al touted the monumental failure and the scandal that started at Walter Reed Hospital as proof that government-run health care does not work.

    This is like forcing a farmer to put foxes in charge of the chicken coop then complaining that chicken coops are inherently inefficient money losers.

    Also, can anyone provide a rational explanation for why countries with some form of the “public option” have Per Capita costs of only a little over half of the U.S. but better outcomes? (See above for source).

  96. #97 Sam72
    April 24, 2010

    The program is not a custom algorithm- its software!! “WellPoint Inc. uses a computer algorithm that automatically targets every policyholder recently diagnosed with breast cancer. The software triggers an immediate fraud investigation on the policyholder, as the company searches for a basis to rescind a policy, such as fraudulent misrepresentation or omission of material information. This software is used to review a series of diagnostic codes meant to capture conditions that applicants would likely have known about at the time they applied for coverage.” http://en.wikipedia.org/wiki/Rescission

    Just as financial companies rely on “credit reports” to establish credit for customers, insurance companies utilize “medical report” files to assess the health, insurability, and price ratings for individual health insurance applicants. The Federal laws FCRA and FACTA, which govern the credit bureaus Experian, Equifax, and TransUnion, also regulate the nationwide specialty insurance reporting agencies the Medical Information Bureau Inc (MIB), Ingenix Inc., and Milliman Inc.

    All health insurance applicants and policyholders should request an annual copy of their “medical report” files from the three major specialty nationwide consumer reporting agencies to ensure they aren’t overpaying for insurance or in danger of policy rejection or rescission for reported pre-existing conditions.

  97. #98 Naked Bunny with a Whip
    April 24, 2010

    @Steven Dunlap: Moral of the story: Don’t put people running on a “government is bad” platform in charge of the government. The conflict of interest is obvious.

  98. #99 EngineerChick
    April 24, 2010

    Just for the record, I have had Blue Cross health insurance for the majority of my adult working life (after graduating college). I have always had to go the PPO route as I have had many health issues, starting with fibrocystic disease of the breasts to cervical cancer. Mind you, one day I have a dream of opening my own restaurant. However, I cannot get insurance on my own without working for a large corporation, so that is what I do.

    Recently I had to have back surgery. It started out like this…

    I went to the doctor because I was having horrible upper back and neck pain and I couldn’t lift my left arm. I was also having pain in what seemed to be several joints in my body. Being as I had before had a high Rheumatoid Factor, he sent me to a Rheumatologist who told me I had fibromyalgia and ruined a year of my life on pain meds, Cymbalta and anything else you can imagine putting someone on. I went to him about 5 or 6 months in and told him I was losing the ability to use my left hand. I kept dropping dishes when I did the dishes at night, and I could barely handle being at the sink for 10 minutes. I would be in excruciating pain. Oh, you are having a flare, here, up your dose from 30mg of Cymbalta in the morning to 60mg in the morning and at night. Whoa. I can tell you, if anyone has taken this horrible drug it ruins your life. Anyhow, 6 weeks later, still having problems, and now I am having trouble walking and can’t even open cat food cans. Still, more drugs pushed at me.

    So, I decided to go on my own and try to see a back doctor. Well, the ones “in network” I could get into would take between 1 and 2 months to get in to see, if they would even see me at all. So, a trip back to my GP (of 18 years, I have been with him since I was 16, and my mom 5 years before that) gets me sent in for a CT scan of my upper and lower back. So, it turned out I had 2 slipped disks and a ton of swelling in my cervical spine, and literally one disk pushing on my spine. No wonder I was losing the ability to use the left side of my body. He immediately refers me to the best spine specialist he knows – who happened to be “out of network” but isn’t a problem since I have a PPO.

    So, he sees me THAT VERY DAY. Takes a look at my images and says he needs an MRI before he can even begin talking about the type of surgery I will need. We set everything up, he gets the approval for the surgery from Blue Cross, and I am going into this thinking, my max out of pocket for “Out of network” doctors is $6k. Seems a reasonable amount to get my life back after the year of hell I have been through. He does the surgery to remove the disk pushing on my spine, places in a piece of cadaver bone in its place, and adds in the plate and screws to hold it all together. I wake up from surgery in some of the worst pain I have ever experienced, and the first thing I notice is that the pain I had throughout the left side of my body for the last 2 years is COMPLETELY GONE. What’s better, I have no lasting nerve damage from the disk crushing my spine. This is the best outcome I could have hoped for, I was off work for 3 months, and went back in January.

    In March I get a bill for $34,000. I call the insurance company and file a grievance, they have paid all of $1700 toward the surgery. The come back and deny my claim again. Why??? Because they say…

    Prior Approval does not guarantee Payment for those services

    So, it isn’t bad enough I lost a year of my life to an “IN NETWORK” doctor who fed me drugs while I was in increasingly more pain every day. Now, I get the treatment I needed so I could continue with my life and be a productive part of society again and not live off the government, now I have to fight to get the damn bill paid. Anyone know a good lawyer in California?

  99. #100 mwsletten
    April 24, 2010

    Steven Dunlap said:

    The overhead for most HMOs expressed as number of dollars per $100 of reimbursement runs about $15-$18. Kaiser, the most cost-effective of them, runs an overhead of about $12-$13. Compare this the Medicare and Medicaid which for decades have run at $3.

    Medicare runs a low overhead because there is almost no oversight to prevent fraud, waste and abuse. President Obama’s healthcare overhaul is supposed to be funded, in part, with $500 billion recovered from said Medicare fraud, waste and abuse. Let’s see how those overhead numbers compare when the feds start properly policing Medicare like the for-profits do (if they ever can).

    Also, can anyone provide a rational explanation for why countries with some form of the “public option” have Per Capita costs of only a little over half of the U.S. but better outcomes? (See above for source).

    I didn’t see your source for this. As far as I know many people from the countries often named as exemplars still come to the US for medical treatment. Why would they do that if outcomes are lower here than in their home countries?

    The reasons for the high per capita cost in the US are manifold; if we knew why there wouldn’t be a need for debate in finding a solution.

  100. #101 Jadehawk, OM
    April 24, 2010

    I didn’t see your source for this. As far as I know many people from the countries often named as exemplars still come to the US for medical treatment. Why would they do that if outcomes are lower here than in their home countries?

    I fucking hate this lame canard.

    Rich people come to the U.S. because one thing the U.S. does excellently is coddle and pamper those with more money than they know what to do with.

    Other people travel because certain very rare specialities or brand-new procedures are practiced at only one or two hospitals in the world, and sometimes these hospitals are in the US.

    Medical tourism is far more common out of the US than to the US though, by an order of magnitude.

  101. #102 Jadehawk, OM
    April 24, 2010

    Let’s see how those overhead numbers compare when the feds start properly policing Medicare like the for-profits do (if they ever can).

    oh yeah; that’s what we need. Medicaid and Medicare being purged as thoroughly as private insurers, who drop babies because they’re too big and which consider spousal abuse a pre-existing condition[/sarcasm]

  102. #103 Jadehawk, OM
    April 24, 2010

    The reasons for the high per capita cost in the US are manifold; if we knew why there wouldn’t be a need for debate in finding a solution.

    you do know why, you just don’t like the answer, because government can never be the answer; St. Ronald said so. Morton’s demon at work.

  103. #104 attorney
    April 24, 2010

    @#54

    I wasn’t agreeing or disagreeing with anything PZ (or anyone else) wrote. I was simply pointing out that there was more information available than was being discussed.

    And yes, I did read PZ’s post, along with the letter and the press release. It appears that, between us, I am the only one who did (or, if you did read it, you didn’t understand what you were reading). The WellPoint computer algorithm isn’t used for excluding applicants with pre-existing conditions. It’s used for identifying conditions that people ALREADY COVERED knew they had and LIED ABOUT on their applications. Or, as they WellPoint press release put it, “conditions that applicants would likely have known about at the time they applied for coverage.” And, as the law puts it (quoted in the press release), “material misrepresentations.”

    That’s why the algorithm is applied only to “members,” i.e., people already covered. And that’s why fewer than 0.01% of members have had their coverage rescinded. You really think only 1 person in 1,000 had pre-existing conditions? Of course not. It’s just that most people were HONEST about them when they applied for coverage.

    Health insurance companies would love to cover pre-existing conditions. Unfortunately, the law makes it economically impossible to do so.

    The problem is, when you have a particular condition, it is no longer a “risk” that can be actuarially accounted for (i.e., demographic risk multiplied by cost). There is no “demographic risk” if you already have the condition–the insurance company knows it’s going to be paying the entire cost for that particular condition.

    For example, let’s say you’re a 35-year old male with certain demographic characteristics. You apply for a health insurance policy. The insurance company determines the probabilities that you will encounter certain health issues, multiplies each of those probabilities by the cost of treating that health issue, and adds up all of those products to determine your premium. If the probability of your contracting lung cancer is 2%, and it costs $50,000 to treat lung cancer, coverage for lung cancer will make up $1,000 of your premium. (Obviously, this example is very simplified.)

    However, if you already HAVE lung cancer, the probability that you will have lung cancer is 100%. Thus, the ENTIRE COST of treatment for lung cancer ($50,000) would be included in your premium, to make it actuarially sound.

    Which would be fine, if the company were allowed to charge the premiums that would be required to cover this guaranteed loss. The company could charge you the appropriate premium, or it could offer a lower premium that would exclude coverage for the lung cancer, and you could choose which you wanted. Unfortunately, the company is prohibited by law from charging such premiums. The only solution for them is either to exclude the condition from coverage (even if the person is willing to pay for it), or, where exclusion of a pre-existing condition is not permitted, to exclude the individual from coverage altogether.

    Some people, of course, try to get around this obstacle by simply not informing the insurance company of such pre-existing conditions. The WellPoint “algorithm” is used to identify such fraud. WellPoint builds in certain safeguards, such as a review panel and an appeals process, to make it as certain as possible that only real cases of fraud result in rescission of coverage.

    And, as the WellPoint press release pointed out, of the three people discussed in the Reuters piece, one (Robin Beaton) was incorrectly identified as having her coverage rescinded by WellPoint rather than another company, and another (Patricia Reilling) was not dropped because of her breast cancer. (The Reuters article says that she was dropped “shortly after” she learned she had breast cancer, implying that was the reason for the rescission. Reuters dropped all references to Ms. Beaton in the “corrected” version of its story, but left in this misleading implication. Ms. Reilling refuses to sign a waiver allowing WellPoint to comment on her case, which it currently cannot due because of federal privacy laws.)

  104. #105 ckitching
    April 24, 2010

    now I have to fight to get the damn bill paid. Anyone know a good lawyer in California?

    Something really needs to be done about this. The fact that certain people can abuse the legal system essentially for free is a big problem. Between the salaried corporate attorneys to the parasite malpractice lottery lawyers, there’s more than a little waste here. The funniest (or saddest) thing is probably the fact that the legal industry is playing both sides in these things.

    Of course tort reform is a Republican platform thing, and sometimes it seems they only support it because a large portion of Democrat funding comes from lawyers.

  105. #106 Dianne
    April 24, 2010

    Nationalisation is the best option.

    I agree. However, people in the US can’t even consider having the OPTION of having public health insurance without hyperventilating. Nationalized health care isn’t going to happen any time soon. So I’m trying to figure out what can be done with what we have.

  106. #107 Dianne
    April 24, 2010

    Some people, of course, try to get around this obstacle by simply not informing the insurance company of such pre-existing conditions. The WellPoint “algorithm” is used to identify such fraud.

    I don’t see how. Unless the available information is vastly misleading, the alogrithm isn’t flagging cases where people filed for serious medical issues within, say, one month of obtaining insurance (or some other cut off). That sort of alogrithm I could see as reasonable: one might suspect that a supposedly healthy person who obtains insurance for the first time and suddenly is critically ill might have had an inkling that something was wrong when they signed up. It’s not always true but it’s a reasonable thing to investigate. But investigating the possibility of fraud in, say, a 50 year old woman filing a breast cancer claim 20 years after she first obtained insurance is, at best, a waste of corporate resources. At worst…as stated in the post.

  107. #108 Ichthyic
    April 24, 2010

    We can mix both public and private provision, in partnership, to create a better-quality system. Introducing some market incentives into the system will not “destroy the NHS”.

    Walton, did you entirely miss my little presentation about the differences in costs between the States and New Zealand?

    that can ENTIRELY be attributed to the introduction of “free market” HMO’s.

    sorry, but you’re really fooling yourself if you think that privatizing the NHS is going to help lower costs, and thus be a boon to healthcare consumers in the UK.

    they’ve pulled the wool firmly over your eyes.

  108. #109 Kemist
    April 24, 2010

    heh. try getting sick as an immigrant without residency yet in a country that has socialized healthcare.

    Here it is for mandatory all non-residents long-time visitors -such as students- to get private health insurance. Foreign students normally get it via their university. That’s how my best friend got her cancer treatment covered, and obtained her residency while undergoing chemotherapy.

    There are still non-covered tourists who sometimes visit our hospitals, get treated, and never pay their bill. Our health care system loses millions that way.

  109. #110 Dianne
    April 24, 2010

    try getting sick as an immigrant without residency yet in a country that has socialized healthcare.

    I spent time in Germany, probably the country with the oldest public health insurance system in existence, a few years ago. I had health insurance through a US-American company but ended up paying out of pocket for a few minor problems (UTIs, new prescription glasses, allergy meds, that sort of thing.) The reason I could pay out of pocket was that the socialized medical system kept costs down to a level that it is possible to simply pay for minor medical care. 50 Deutschmark* for an office visit and maybe 5 for the prescription…it simply wasn’t worth getting the bill translated and submitting it to my insurance.

    The moral, such as it is, socialized medicine can help you even when you’re not covered. I’d probably still owe money if I’d tried that trick in the US. No, I’d still be waiting to be seen: I’ve never been able to get an appointment in the US as fast as I could there-and I have health insurance.

    *25-35ish dollars, if I remember the exchange rate at the time correctly.

  110. #111 Ichthyic
    April 24, 2010

    The reason I could pay out of pocket was that the socialized medical system kept costs down to a level that it is possible to simply pay for minor medical care. 50 Deutschmark* for an office visit and maybe 5 for the prescription…it simply wasn’t worth getting the bill translated and submitting it to my insurance.

    yup. see my similar experience at #78.

    for those that commented on it, here in NZ a spousal (partnership) permit has to be applied for, like any other, it’s not automatic, and still requires all the same health and background checks. until everything is finalized, you’re still on the hook for any medical expenses incurred.

    still waiting on my partnership application, over 6 months now from when i first submitted it.

    I’ve incurred around 14K in expenses, but if it was the States, that would have been 30-40K easy.

  111. #112 mwsletten
    April 24, 2010

    Jadehawk said:

    Medicaid and Medicare being purged as thoroughly as private insurers, who drop babies because they’re too big and which consider spousal abuse a pre-existing condition[/sarcasm]

    Finding $500 billion in savings from Medicare is part of President Obama’s plan to revamp America’s healthcare system. It will be interesting to see if the government’s methods for preventing fraud, waste and abuse are as palatable as the private sectors.

    Medical tourism is far more common out of the US than to the US though, by an order of magnitude.

    Reference? This is news to me…

  112. #113 Walton
    April 24, 2010

    Ichthyic,

    Walton, did you entirely miss my little presentation about the differences in costs between the States and New Zealand?

    Yes – apologies, I didn’t read the whole thread before posting. In my defence, I had a three-hour mock exam this morning (yes, on a Saturday) and don’t have tons of mental energy to spare.

    that can ENTIRELY be attributed to the introduction of “free market” HMO’s.

    sorry, but you’re really fooling yourself if you think that privatizing the NHS is going to help lower costs, and thus be a boon to healthcare consumers in the UK.

    I wouldn’t advocate privatising the whole NHS, not by a long shot. Rather, I advocate continuing with Private Finance Initiatives and decentralising the administration of the system.

    In no way do I support a move to “American-style” healthcare. The US’s healthcare problems are unique. (And health insurance in the US is far from a “free market”; it’s an artificially-created oligopoly.)

    As I said, I support maintaining the principle of universal healthcare in the UK. Everyone should have access to basic healthcare, and government should fund care for those who couldn’t otherwise afford it. But I just think we should stop being haunted by the ghost of Aneurin Bevan, and look to see whether we can create a more efficient and more patient-focused system through structural reforms.

  113. #114 Nerd of Redhead, OM
    April 24, 2010

    MSLetten, reality is news to you.. Back to killfile for terminal insipidity…

  114. #115 Jeeves
    April 24, 2010

    Walton

    Everyone should have access to basic healthcare

    And what exactly constitutes “basic healthcare”?

    I suspect it’s a turn of phrase used by people who have absolutely no knowledge or understanding of the subject, but are pretty certain that they themselves will never have to find out the hard way. The “I’m alright, Jack” brigade.

  115. #116 penfield
    April 24, 2010

    It disturbs me that the good professor has so little understanding of what insurance is. It is not Wellpoint that pays for healthcare, but their customers, and they have a legitimate and laudable interest in the control of costs, so as to keep premiums affordable. It would appear that Obama is determined that insurance companies should go broke providing more coverage without raising premiums. Then we will all go broke when the government attempts to provide healthcare in their stead. I do not regard this as an improvement.

  116. #117 Nerd of Redhead, OM
    April 24, 2010

    Another liberturd…Swoon…

  117. #118 Jadehawk, OM
    April 24, 2010
  118. #119 mwsletten
    April 24, 2010

    Jadehawk, I believe you are accusing me of confirmation bias while ignoring your own false equivalence. The kinds of cases I’ve read about (and was referring) include people who travel to the US to avoid a waiting list for non-urgent, but nonetheless required, procedures provided by the state-run medical delivery system in their own country. Cases like the high-ranking Canadian official who chose to travel to the US for a procedure that is readily available in his home country.

    As far as I know, elective surgeries — which seem to comprise the bulk of the medical tourism referenced at the two links you provided — are not covered by private insurance here in the US. Are these kinds of procedures covered by the state-run health care systems of the UK and other European countries?

    I am aware that large numbers of people from all over the world travel to certain Asian countries for elective cosemetic surgery. These are consumer-friendly free markets — less government regulation — where providers compete for business; consumers there get a great deal more for their money, which makes travel for those kinds of procedures very attractive.

    Even here in the US elective medical procedures have seen a tremendous drop in price while prodecure efficacy has increased. Consider elective vision correction. Procedures such as Lasik and PRK are not normally covered by insurance, and outside of licensure and obligatory sanitary regulations, the government stays largely out of the way of providers. Laser eye surgery is readily available nationwide in the US. Customers can often have an appointment for surgery within a week. The FDA reports around a 95% success with Lasik surgery, and competition has driven prices so low as to make the procedure available to all but the indigent.

    People traveling to pay less for elective medical procedures is an argument for a free market, not a state-managed market.

    Indeed, I wonder how medical delivery and costs would fare if our government were to allow more free-market principles to work here? Ideas such as competition across state borders, and allowing consumers to shop between providers instead of those chosen by their government-mandated, employer-provided insurer?

  119. #120 chicagomolly.myopenid.com
    April 24, 2010

    “If you really want to pretend you care, put up a three-story tall ribbon in your lobby. ”

    And when we pretend to care, we’re cost-effective. We used the cheapest material we could find, and we hired non-union labor to put it up.

  120. #121 Feynmaniac, Chimerical Toad
    April 24, 2010

    I didn’t see your source for this. As far as I know many people from the countries often named as exemplars still come to the US for medical treatment. Why would they do that if outcomes are lower here than in their home countries?

    The outcomes are good if you have the money. Ify ou are a rich person living abroad the US health system is the best. If you are a poor American it absolutely sucks.

    Also, here’s the WHO’s ranking of health care systems. The US finishes 37th. Places like France, Canada, and the UK which have government-run health care finish ahead.

    The kinds of cases I’ve read about (and was referring) include people who travel to the US to avoid a waiting list for non-urgent, but nonetheless required, procedures provided by the state-run medical delivery system in their own country.

    And it’s far, far more common to have US citizens coming here to Canada to see a doctor because they simply can’t afford to see one in the US. They often use a Canadian relative’s health card. It’s a huge problem because it ends up costing a lot of money.

  121. #122 Feynmaniac, Chimerical Toad
    April 24, 2010

    mwsletten,

    I didn’t see your source for this.

    His source is at #68:
    http://www.salon.com/news/feature/2009/09/08/healthcare_data

    Here is another one that showing that the US spends more per capita on health care than any other OECD nation:

    http://www.oecd.org/dataoecd/46/33/38979719.pdf

    It spend $7290 (US) per capita. The second highest, Norway, spent $4763 (US) per capita.

  122. #123 jay.sweet
    April 25, 2010

    I know. They just want to make a profit for their shareholders, and they take it for granted that they profit more if they deny health care to people in need. It seems to me that that is the problem, though: relying for health care on companies that have an incentive to not provide health care doesn’t sound like a smart move.

    Bingo. Setting up a setup where corporations can make more profit by denying coverage, and then getting mad at the corporation, would be analogous to smashing your new flat screen TV with a hammer and then getting angry at the hammer. True, it’s slightly different because there are people behind the decisions in the case of the corporation, but the diffusion of responsibility makes that somewhat irrelevant.

    The corporation is a useful tool to a social democracy: few entities can match their ability to optimize. Problem is, the only thing a corporation can ever optimize for is short-term profit (not even long-term profit, as the banking collapse has demonstrated). If you can craft your regulations so that a corporation’s short-term profit tends to coincide with the long-term improvement of society, that’s major win. And this has been achieved in some industries.

    You can never achieve that with health care, not any way that I can see. I think it’s because of the delay between purchase and value delivered. If I buy an XBox from Best Buy, and while I am paying for it they invent some crazy rule that means they don’t have to give me the XBox even after I pay them, I walk out of the store. They cannot increase profits by denying delivery of the product to their customers. Insurance companies, on the other hand, can invent some crazy rule that means they don’t have to cover my health condition, and I may already have forked over thousands or even tens of thousands of dollars to them while I was healthy. They can increase short-term profits by refusing to deliver the product to the customers. And that’s a recipe for market failure.

  123. #124 mwsletten
    April 25, 2010

    Feynmaniac, I don’t argue the US spends more per capita on health care than any other country, I argue against the statement that outcomes here are worse than other countries. Two points:

    1) I’m not surprised the richest country in the world spends more for health care than any other. I think we spend too much and the rising costs are making it harder for less well off people to access basic care, but I disagree that government control of the health care system is the way to fix the problem of rising costs. The current health care reform bill is certainly not the answer.

    2) The WHO ranking you referenced is ten years old. Why hasn’t it been updated? Because the WHO no longer ranks health care systems. The WHO now says ranking health care systems is a complex task beyond the agency’s capabilities. I would submit there were many flaws in its last attempt; flaws which have been clearly debunked.

    The two most-often cited stats to support the 37th ranking for the US are infant mortality and longevity. Critics of the WHO’s ranking system have pointed out these two statistics are heavily influenced by factors which have little to do with the quality and availability of health care.

    The single largest factor affecting infant mortality rates in the US is low birth weight. Since prenatal care is available pretty much universally in the United States thru programs like Medicaid and CHIP, there must be something other than the quality and availability of medical care influencing the problem. Studies I’ve read suggest the high rate of teen pregnancy in the US skews the infant mortality rates because the number one risk of teen pregnancy in the US is low birth weight. Why? Teen mothers often either don’t know they are pregnant, or refuse to admit they are, which contributes to poor prenatal care. Pregnant teens are also far less likely to make the kinds of lifestyle changes necessary to ensure a healthy baby. These factors have more to do with the quality of education (which the government is already repsonsible for) than the quality of health care which is readily available to indigent teen mothers.

    Likewise, longevity stats are a poor measure of the quality of health care. Take the stats at the Salon article for instance: Diseases causing death where the US ranks #1? Heart disease, diabetes and cancer. Leading causes for these diseases? Obesity and smoking. How are these related to the quality and availability of health care? These are lifestyle choices that the majority of Americans agree their government has no business regulating (so far).

    I would argue, in fact, the OPPOSITE position of the WHO as regards longevity stats. That US citizens remain within a year or two in life expectancy of the rest of the world — despite our smoking and obesity rates — says a great deal about the efficacy of our health care system.

    And it’s far, far more common to have US citizens coming here to Canada to see a doctor because they simply can’t afford to see one in the US.

    This is a new one on me; I’ve not heard this is a problem for the Canadian health care system. Perhaps this has contributed to Canada’s struggle to contain health care costs along with the rest of the world; it’s per capita costs have more than doubled since 1997 despite a nationalized health care system…

  124. #125 Dianne
    April 25, 2010

    Cases like the high-ranking Canadian official who chose to travel to the US for a procedure that is readily available in his home country.

    So what? Sarah Palin’s family used to go to Canada for health care. The question is is the number of US-Americans traveling to Canada versus Canadians traveling to the US for health care vastly different? If so, why?

  125. #126 Dianne
    April 25, 2010

    Diseases causing death where the US ranks #1? Heart disease, diabetes and cancer. Leading causes for these diseases? Obesity and smoking.

    Well…not exactly. In fact, no. Many cancers (i.e. the hematologic malignancies) have little or no relation to smoking. Obesity increases the risk of type II diabetes but not type I. Likewise, both smoking and obesity increase the risk of heart disease (if by heart disease you mean coronary artery disease and not, say, rheumatic heart disease), but they are by no means the only conditions related to the development of heart disease. Other factors, including genetics, other lifestyle issues, stress level, income, etc play major roles in risk of development of all the listed diseases as well.

  126. #127 David Marjanovi?
    April 25, 2010

    a pan-European health service, which any fool can see would be a completely insane idea

    Why?

    Already today my Austrian health insurance is accepted in France.

    Also, can anyone provide a rational explanation for why countries with some form of the “public option” have Per Capita costs of only a little over half of the U.S. but better outcomes?

    One reason is that governments elsewhere negotiate prices with the pharma companies. They are such big customers that they can afford to do that, and so can the pharma companies.

    Another is the waste described in comment 99.

    And finally, the US health insurance companies make a profit. This must fucking come from somewhere!

    Prior Approval does not guarantee Payment for those services

    What the fuck! How can that possibly be legal!!!

    Health insurance companies would love to cover pre-existing conditions.

    Yeah, riiiiight.

    However, if you already HAVE lung cancer, the probability that you will have lung cancer is 100%. Thus, the ENTIRE COST of treatment for lung cancer ($50,000) would be included in your premium, to make it actuarially sound.

    Isn’t the very idea of an insurance to spread the costs among people, so that nobody goes bankrupt from having whatever calamity the insurance is against?

    Which would be fine, if the company were allowed to charge the premiums that would be required to cover this guaranteed loss. The company could charge you the appropriate premium,

    and nobody except the super-rich could fucking afford it!!!

    Why isn’t this obvious?

    Unfortunately, the company is prohibited by law from charging such premiums.

    A lame attempt in keeping health insurance affordable.

    The only solution for them is either to exclude the condition from coverage (even if the person is willing to pay for it), or, where exclusion of a pre-existing condition is not permitted, to exclude the individual from coverage altogether.

    Or to have everyone have insurance from birth, like it’s done in real First-World countries.

    There are still non-covered tourists who sometimes visit our hospitals, get treated, and never pay their bill. Our health care system loses millions that way.

    [citation needed]

    Medical tourism is far more common out of the US than to the US though, by an order of magnitude.

    Reference? This is news to me…

    I can’t provide one, but I can tell you about the spam I get. It’s about “cheap meds” from alleged pharmacies in Canada and/or Mexico. Evidently, large amounts of US citizens can’t afford their own medicine in their own country.

    Yes – apologies, I didn’t read the whole thread before posting. In my defence, I had a three-hour mock exam this morning (yes, on a Saturday) and don’t have tons of mental energy to spare.

    No. If you haven’t read an entire thread, you can’t add to it. You… just… can’t.

    >

    Then we will all go broke when the government attempts to provide healthcare in their stead.

    Then why, moron, is there any country other than the USA and China that isn’t bankrupt yet?

    Do you even notice what you’re writing?

    Have you no shame?

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234298/

    Thanks, bookmarked!

    I’m not surprised the richest country in the world spends more for health care than any other. I think we spend too much and the rising costs are making it harder for less well off people to access basic care, but I disagree that government control of the health care system is the way to fix the problem of rising costs. The current health care reform bill is certainly not the answer.

    Why do you disagree, and why is it certainly not the answer?

    Obesity and smoking. [...] These are lifestyle choices that the majority of Americans agree their government has no business regulating (so far).

    (That doesn’t mean governments can’t do some helpful regulation there, though. But I digress.)

  127. #128 'Tis Himself, OM
    April 25, 2010

    I disagree that government control of the health care system is the way to fix the problem of rising costs.

    The Director of Medicare is a Level III Federal Executive making $167,000 per year. The CEO of Wellpoint had total compensation in 2009 of $13.1 million. So government run health care would have a definite savings of almost $13 million.

  128. #129 mwsletten
    April 25, 2010

    Dianne, my comment was meant to counter the suggestion that health care in the US is somehow substandard compared to other countries. As I am not aware of any definitive studies, I make no claims to specific knowledge about who travels where for what procedures. I only suggest that there ARE people who travel to the US for medical care that is available in their own country.

    Given its problems, the WHO ranking is obviously not a good reference as an honest evaluation of health care systems. And the fact that people are traveling to the US for health care tells me there is no lack of confidence in US health care among the world’s population.

    There have been many studies comparing treatment outcomes across countries for different types of medical problems. In some, US facilities fare better, in others, foreign facilities fare better. To my knowledge, the differences are never particularly striking. As far as I know, no definitive study has determined the level of care at US medical facilities is sub-standard compared to the rest of the world.

    Regarding the medical statistics, I didn’t claim smoking and obesity were the ONLY factors contributing to disease in America, I said they were the leading causes. Lung cancer causes by far the greatest number of cancer deaths in the US, and the leading cause of lung cancer is smoking. Coronary heart disease is the number one cause of death in the US. Among risk factors, the CDC lists:

    Inactivity
    Obesity
    High Blood Pressure
    Cigarette Smoking
    High Cholesterol
    Diabetes

    My point is that lifestyle choices, not poor health care, are by far the biggest factors affecting the number one cause of the disease which happens to be the number one cause of death in the US. Even the factors you listed have little to do with health care efficacy.

    If you are, as I suspect, a medical professional, then you know that Type 2 diabetes accounts for some 95% of cases in the US. As you noted, obesity is the number one risk factor for the development of Type 2 diabetes.

  129. #130 mwsletten
    April 25, 2010

    Why do you disagree…

    There is no study I am aware of that proves socialized medicine will control costs. There are a great number of people who believe this to be the case, but nothing definitive believers can point to and say ‘here’s the proof.’ If that were the case there wouldn’t have been a year-long debate.

    Further, as I noted in my post vis a vis Canada’s per capita cost for medical care, costs for ALL countries have been rising — even in those countries where medicine has been socialized.

    …and why is it certainly not the answer?

    Because Obama’s own administration says his plan will not save money.

  130. #131 mwsletten
    April 25, 2010

    ‘Tis Himself said:

    The Director of Medicare is a Level III Federal Executive making $167,000 per year. The CEO of Wellpoint had total compensation in 2009 of $13.1 million. So government run health care would have a definite savings of almost $13 million.

    I make no attempt to defend executive compensation for health insurance companies, but I will point out it is but a tiny drop in the bucket compared to the total spent on health care in America. It is certainly nowhere near the $500 billion President Obama expects to save in Medicare fraud, waste and abuse.

    Further, as far as I know, there is nothing in the newly enacted health care reform law that limits executive compensation for private insurance firms.

  131. #132 mwsletten
    April 25, 2010

    Evidently, large amounts of US citizens can’t afford their own medicine in their own country.

    And this is a result of government price controls that limit competition.

    As I said before, people shopping for better prices outside their own country is an argument for free market principles.

  132. #133 Dianne
    April 25, 2010

    MWS:
    Smoking rates are lower in the US than most places in the first world. The US is actually not bad in terms of its public health movement toward decreasing the smoking rate. So the US has worse health care outcomes despite the advantage of lower smoking rates. Not a shining endorsement of the US system.

  133. #134 Feynmaniac, Chimerical Toad
    April 25, 2010

    I’m not surprised the richest country in the world spends more for health care than any other.

    It doesn’t just spend more in absolute terms. It spends most per capita. Health care in the US is also a larger percentage of the economy of any OECD nation (it’s 16% of the US economy while for second place, France, it’s 11% ).

    That US citizens remain within a year or two in life expectancy of the rest of the world — despite our smoking and obesity rates

    For smoking rates the US is lower than Japan and many European countries that finished ahead in life expectancy and in the WHO ranking (e.g, France, the UK, Spain, Germany, the Netherlands, Norway, etc.). (Source)

    Also, the US has a life epectancy of 78.2, which makes it 38th in the world. Japan, France, and Spain finish with 82.6, 80.7 and 80.9, so it’s a little bit more than two years in some places with an even higher smoking rate. (Source)

    Because the WHO no longer ranks health care systems. The WHO now says ranking health care systems is a complex task beyond the agency’s capabilities.

    The task is indeed complex, but you simply can’t ignore the empirical evidence. The rest of the industrialized world has universal health care and have shown better results than the US. There is no evidence that more “free markets” would lead to better results. In fact, quite the opposite.

    These ad hoc explanations of yours, which lack evidence, are unsatisfactory.

    (I will respond to your other points in greater detail later when I have more free time.)

  134. #135 https://www.google.com/accounts/o8/id?id=AItOawnIOM7E1COYryEQtIb0ErmXlTEuXvdorFE
    April 25, 2010

    Well.

    I cannot possibly answer every relevant post; therefore I’ll just try to describe how the situation is here in Germany (as I notice nobody really did this).

    Mind you, I don’t claim to be an expert in the subject matter, so it’s entirely possible I have misunderstood something. I just live here (and feel fairly well provided for with my Type I Diabetes, especially when I hear stories from US acquaintances. I’ve seen part of what my insurer pays, and it’s not funny.)

    Now.

    First of all, what may astonish some people given the discussion so far, apart from public employees, there is no government-run insurer. Maybe that might make the system more attractive to some US people?

    As far as I understand, the law divides people esssentially into three classes (it’s more complicated than that, but that’s too much for this short article). There are people who must have insurance; if their income is below a certain level, then they typically have a “Pflichtversicherung” (obligative insurance?) with a carrier who specialises in that stuff. (There are quite a lot of them, so there is competition.) Above that level, they usually have a “Privatversicherung” (private insurance); there are complex rules about which people are allowed to chose and when. And then there are people who are not obligated to have any insurance whatsoever; I believe those are mostly self-employed people, though I’m not entirely sure. Anyway, as far as I can tell, all employees (except public employees, the state – as so often – does their own thing) and all unemployed people are among the first two classes.

    Now, I understand the main way this works is that the government essentially decides what the obligative insurers have to cover, and who they have to take; and there’s currently a unified premium (in percentage of income) that’s distributed among those insurers, and only under certain circumstances are they allowed to also ask for some extra premium if they can’t do without, which currently some do and some don’t.

    Obviously the rules are looser for private insurers. My mother has had the same private insurer since she started teaching (and at least via my father also public-employee insurance, makes for interesting squabbles between the two insurers sometimes); I’ve used the obligatory option since I started working – frankly, I don’t see myself changing to the private version unless I absolutely have to.

    Mother’s private insurance has a bad habit of not wanting to pay for stuff. I never had that problem. Mother has to first pay, then send the invoices to the insurers to get some part of her money back. I have to pay a small contribution (10? per quarter year for doctor’s visits, 10% but no more than 10? for most prescriptions) and the invoice for the rest goes directly to the insurer. (And if that’s more than one or two percent (depending on some details) of my income, then I can switch to pay that percentage directly instead. It’s essentially meant as a hurdle to keep people from creating costs unless they actually need it.)

    There are problems, of course.

    For one, Germany has rather high prices for medicamentation compared to the rest of Europe; one consequence of that is that there’s quite a bit of re-importing going on, and also some insuerers contract with alternate producers to get better prices. When you get this cheaper medicine, you usually don’t have to pay those 10%; for a short while I could get Greek reimports from the exact same French pharma enterprise without paying a contribution. (I’m told the reimporter went out of business shortly thereafter.)

    For another, private insurers work on a completely different price scale. Every procedure for someone who is privately insured is quite a lot more expensive that what the obligative insurers pay.

    Third, allowing self-employed people to go uninsured is based on the faulty premise that they tend to have enough money to be able to self-insure, which means that the poorer members of that class tend to have problems when they get seriously sick and they weren’t bright enough to acquire some insurance on their own.

    Oh, and fourth, because of cost, there’s no obligative insurance for glasses or dentists. Which means that quite a few private insurances have rather sparse covering there, as well. (I don’t know about other stuff related to the eyes.)

    If I get sick on vacation, my insurance still has to pay, but it is often necessary to get prior approval, and if you want someone to pay for transporting you home, you need an extra (private) journey insurance. Oh, and one result of these rules is that some people go to some other nations for a medical procedure if it’s cheaper there (or, of course, if it’s one of those only available in a few places). After all, the insurance still pays, if with a little more paper shuffling.

    Paper shuffling is minimal if the other nation is an EU member; after that, it gets tricky.

    I’m sure there’s a lot more that could be said, but I think this is already long enough, and I spent enough time on it.

  135. #136 Carlie
    April 25, 2010

    Evidently, large amounts of US citizens can’t afford their own medicine in their own country.

    And this is a result of government price controls that limit competition.

    Then you’d be in favor of a government option, right? That’s the competition that had the insurance industry quaking in its boots so much that they managed to coerce Congress to eliminate it.

  136. #137 Nerd of Redhead, OM
    April 25, 2010

    I think of all the savings apparent in the public option:
    Elimination of health insurance profits.
    Elimination of high salaries for insurance executives and salesmen.
    Elimination of hospital profits.
    Elimination of the need to so many different forms at both the doctor and hospital areas.
    Suddenly, there is room to enlarge the program significantly without changing the present contributions by employers and employees due to these savings.
    Since everybody is covered, hospitals can reduce their charges to just recover their real costs, as at the moment they must treat people who can’t necessarily pay, and that is recovered from those with insurance. More savings, more coverage. Not a hard equation.

  137. #138 mwsletten
    April 25, 2010

    Dianne said:

    …the US has worse health care outcomes despite the advantage of lower smoking rates.

    I used smoking as an example of a factor that affects longevity not accounted for by the WHO rankings. Does anyone have access to a science-based study that shows poorer outcomes for smoking-caused lung cancer treatments in the US?

    Feynmaniac said:

    [The US] doesn’t just spend more in absolute terms. It spends most per capita.

    Yep. The more disposable money you have the more you are willing spend (waste) on over-priced health care. Why is this confusing?

    Feynmaniac said:

    There is no evidence that more “free markets” would lead to better results. In fact, quite the opposite.

    I’ve not argued that free markets would lead to better results, I’ve argued that proof showing socialized health care leads to better results is lacking. I’ve argued that the ‘evidence’ most use to bolster a position favoring socialized medicine — namely the 2000 WHO rankings — is easily shown to be incomplete and poorly researched.

    The majority of the US health care system has been socialized for many years now. Those programs have done nothing — as far as I know — to control costs or improve outcomes.

    Further, I’ve suggested high cost is the primary factor limiting access to health care in the US, and that free markets might do a better job of controlling costs. The health care reform law just passed was supposed to address to major concerns: access and cost. I don’t think anyone — including President Obama and the Democrats — seriously believes our new health care reform law will accomplish anything substantive in the area of controlling costs.

  138. #139 Feynmaniac, Chimerical Toad
    April 25, 2010

    I used smoking as an example of a factor that affects longevity not accounted for by the WHO rankings.

    If you do include it than the US would only finish worst since the smoking rate is lower than most of the industrialized world.

    Yep. The more disposable money you have the more you are willing spend (waste) on over-priced health care. Why is this confusing?

    I’m not sure if we are talking past one another or what. I was reponding to your claim: “I’m not surprised the richest country in the world spends more for health care than any other.”

    Did you mean richest in an absolute sense or in a per capita sense? If absolute than that would be irrelevent since the reference was looking at the per capita costs. If relative, than it’s far from clear that the US is the richest per capita. In fact, Denmark, Norway, Luxembourg, and Switzerland all have a higher GDP per capita* and yet spends more than 50% on health expenditure per capita than each of them.
    ____

    * Not a perfect measure, I know. However, I think it does show that the high spending on health in the US has more to do with profits of insurance companies than with better care.

  139. #140 Dianne
    April 25, 2010

    Does anyone have access to a science-based study that shows poorer outcomes for smoking-caused lung cancer treatments in the US?

    Lung cancer is by no means the only disease associated with smoking. Smoking causes more morbidity and mortality per user than about anything this side of snorting radioactive twinkies. However, if you get lung cancer, your odds of surviving 5 years are pretty similar in the US versus other first world countries…just at many times the cost. Will post links later if anyone interested…in something of a hurry now.

  140. #141 Nerd of Redhead, OM
    April 25, 2010

    just at many times the cost.

    All due to the inability of Medicare to negotiate with Big Pharma over their pricing…

  141. #142 negentropyeater
    April 25, 2010

    mwsletten,

    Yep. The more disposable money you have the more you are willing spend (waste) on over-priced health care. Why is this confusing?

    When you look at this graph, it’s easy to see that Americans pay about 50% too much for health care, even taking into account the fact that they have a slightly higher average income than most OECD countries.

    I’ve not argued that free markets would lead to better results, I’ve argued that proof showing socialized health care leads to better results is lacking.

    The evidence is the graph above coupled with the fact that the WHO shows a much better ranking for countries with “socialized” (stupid word when most medical practitioners in France are self employed) healthcare such as France which is #1 on said ranking and spends 50% less as a % of GDP. Even if you dispute this study, the fact that the US is the only outlier on this graph and the only country without Universal Healthcare and/or a public option/ single payer system as well as what you have written here:

    There have been many studies comparing treatment outcomes across countries for different types of medical problems. In some, US facilities fare better, in others, foreign facilities fare better. To my knowledge, the differences are never particularly striking. As far as I know, no definitive study has determined the level of care at US medical facilities is sub-standard compared to the rest of the world.

    …is sufficent to show that universal coverage and a public option is what works best.

    I’ve argued that the ‘evidence’ most use to bolster a position favoring socialized medicine — namely the 2000 WHO rankings — is easily shown to be incomplete and poorly researched.

    “easily shown to be icomplete and poorly researched” ? Please do do…

    In any case, there is no evidence whatsoever that the US healthcare system gives better qualitative results than France’s (and there’s evidence that is gives worse results) but it costs about 50% more as a % of GDP.

    It’s not difficult to understand why privately run for profit healthcare will irremediably drive costs higher than a publicly run one:

    1. bargaining power of buyer/seller (patient/provider) is absent, unlike with other types of purchase decisions (eg buying a car or a detergent) : people rarely have the time, possibility, or information to shop around for treatment.

    2. healthcare providers / private insurers / heathcare industry have every incentive to make sure people spend more on healthcare : their salaries will be higher, profits which are a % of revenues will be higher. Why do you think American medical doctors make on average three times more money than their European counterparts (when average income of the population is only 10 to 20% higher).

    Competitition is what is supposed to drive costs down in a free market, but a free market with no possbility of proper competition (and I’m not talking only about insurers, but also providers) actually drives costs up.

    A strong public option is the only efficient source of competition that can drive costs down.

  142. #143 Feynmaniac, Chimerical Toad
    April 25, 2010

    Me @ 139,

    and yet spends more than 50% on health expenditure per capita than each of them.

    That should read: “and yet the US spends more than 50% on health expenditure per capita than each of them.”

  143. #144 mwsletten
    April 25, 2010

    negentropyeater said:

    1. bargaining power of buyer/seller (patient/provider) is absent, unlike with other types of purchase decisions (eg buying a car or a detergent) : people rarely have the time, possibility, or information to shop around for treatment.

    On what do you base this claim? Where do people get the time, possibility or information to shop around for any consumable? Many companies make a good living publishing and selling information about which consumer products are best based on cost/performance ratio, pure performance, economy, engineering, numbers of reported product failures, etc, etc, etc. Are you suggesting the same type of comparitive data can’t be produced for medical treatment options/facilities/providers?

    Hogwash.

    The only reason we don’t have companies producing such information for public use is because no one would buy it. There’s no need for it in the US since we migrated years back to a third-party payment system where the user never needs to know how much something costs — insurance covers it. And because insurance companies are paying for the service they do the research to determine which treatment options provide the most bang for THEIR buck.

    Eliminate insurance and put consumers in charge of actually paying for the treatment and I guarantee people will get educated in a hurry. See my example @119 re vision correction surgery. No insurance, little government involvement, 95% success and continuously decreasing cost since the procedures were first introduced. Both providers and consumers benefit greatly.

    2. healthcare providers / private insurers / heathcare industry have every incentive to make sure people spend more on healthcare : their salaries will be higher, profits which are a % of revenues will be higher. Why do you think American medical doctors make on average three times more money than their European counterparts (when average income of the population is only 10 to 20% higher).

    Exactly — see my response above. There is no need for individuals to research the costs when it’s ‘covered.’ This makes it easy to hide excessive charges and pass them on with higher premiums spread around to everyone. ESPECIALLY when consumers can’t even choose between insurance providers.

    It’s the perfect government-mandated-ever-increasing-medical-costs storm.

    The problem is eventually people get too greedy.

    For a fun thought exercise imagine how much an oil change would cost if you never actually paid out of pocket because your auto insurance covered it…

  144. #145 Feynmaniac, Chimerical Toad
    April 25, 2010

    That US citizens remain within a year or two in life expectancy of the rest of the world — despite our smoking and obesity rates — says a great deal about the efficacy of our health care system.

    As mentioned, smoking rates are lower in the US. As for obesity, indeed the US finishes number 1. However, do you have any evidence that this difference in obesity rates alone accounts for the lower life expectancy?

    Studies I’ve read suggest the high rate of teen pregnancy in the US skews the infant mortality rates because the number one risk of teen pregnancy in the US is low birth weight.

    Citation needed.

    This is a new one on me; I’ve not heard this is a problem for the Canadian health care system.

    This is not news to people who work in the Canadian health care system. In fact, we had to redesign our health cards in Onatario to lower the costs of Americans coming over and fraudulently using the system.

    There are a great number of people who believe this to be the case, but nothing definitive believers can point to and say ‘here’s the proof.’ If that were the case there wouldn’t have been a year-long debate.

    Pfft, please. There was a year-long debate because the insurance companies and the Republicans did everything they can do kill health care reform. They wouldn’t believe a mathematical theorem if it would lead to the insurance companies losing profit.

    And the fact that people are traveling to the US for health care tells me there is no lack of confidence in US health care among the world’s population.

    Sigh. First, again, the US health care system is good for the super rich. That’s why they go there. For the rest of the population it blows. The fact that your health care system treats a small number of rich foreigners well and a large number of poor natives bad is nothing you should take comfort in. Second, if you are comparing people travelling for health care you would also have to account for the people who leave the US because of the system. Third, comparing it to the rest of the world is ridiculous. If you really want a to make a comparison at least start with industralized nations. Lastly, as Jadehawk mentioned, many go to the US because they have some rare illness or disease and the one place that has specialists that could help happen to be in America.

  145. #146 Dianne
    April 25, 2010

    This post is getting pretty far off the front page, but just wanted to add this study of breast cancer survival in the US and Canada.

  146. #147 mwsletten
    April 25, 2010

    Feynmaniac said:

    …do you have any evidence that this difference in obesity rates alone accounts for the lower life expectancy?

    No, but neither did the WHO bother to study the issue either. That’s my point. There are obviously factors — lifestyle choices, the level of violence in the society, hell, even the amount of traffic — that affect longevity rates besides quality of health care.

    There was a year-long debate because the insurance companies and the Republicans did everything they can do kill health care reform.

    Maybe you didn’t hear the news — the private health insurance industry supported Democrats’ health care reform effort. Why wouldn’t they? They got 30 million new government-guaranteed customers and perpetual profits.

    US health insurance companies are not private companies anymore than public utility providers are private companies. They exist and operate under a similar level of government regulation, supervision and protection. They’ve been that way for quite some time.

    Click here for teen pregnancy issues discussed at the NIH.

    Sigh. First, again, the US health care system is good for the super rich. That’s why they go there.

    Finally, we are in agreement. The quality of care provided by US health care facilities is as good as anywhere in the world. A strong argument can be made the best care in the world can be had in America.

    For the rest of the population it blows.

    This I don’t agree with, because I don’t think you are being precise. Your complaint is not one of quality, it is with the way health care services are administered, delivered and paid for in America. I believe the current system hides actual costs from people and leaves it up to insurance companies to choose procedures, providers, medicines and facilities. The hidden costs are passed along to consumers in the form of higher premiums. The profit motives of the insurers result in fewer choices. This won’t change with the new health care reform law; people will still be insured by the same companies.

    The problem, as I see it, is ultimately one of rising costs, and it isn’t isolated to the US. Health care costs are rising all over the world. Two things are working to ensure this will continue to happen: 1) Populations are aging, and 2) $new$ life extending medicines and procedures are developed almost daily. As people become aware of them they will demand access to these $new$ medicines and procedures. Absent some mechanism to limit that access — you can’t change the laws of supply and demand — the overall costs will continue to rise all over the world.

    Some seem to think government should be the ultimate arbiter of who gets what treatement, while others think the market should.

    Based on past performance in those sectors where it has been involved, I happen to believe government is ill suited to administer such a large, complicated industry — especially where so much money is involved. That much money tends to make every decision political, and I find the idea of such very personal decisions being politicized distasteful.

    Based on past success in just about any industry sector you can name, I happen to believe better care will get to more people at a lower cost using market-based principles, mostly because when people have a choice they vote with their wallets. I use the segments of the medical care industry in America where the government is least involved (routine eye care, dentistry, etc) for examples.

    There will ALWAYS be super-rich people who will get the best of the best care no matter what system is in place. Like those who travel to the US when they believe they can get better care than their own government will provide them.

  147. #148 John Morales
    April 26, 2010

    mwsletten:

    US health insurance companies are not private companies anymore than public utility providers are private companies.

    Not to be crude by referring to the post topic, but the issue is not private vs. public companies, but for-profit vs. non-profit companies.

    In both cases, employees get paid, but one has an overhead the other does not.

    IOW, the issue is whether there is sufficient incentive for health insurance such that the profit-margin is necessary for its existence.

    I submit there is, based on world-wide data (more than sufficiently cited above).

  148. #149 John Morales
    April 26, 2010

    (sigh) Above, change “there is” to “there isn’t”, so that it makes sense.

  149. #150 Ichthyic
    April 26, 2010

    If that were the case there wouldn’t have been a year-long debate.

    o ye of little imagination.

    are you really sure there weren’t reasons for stalling the vote on this that had nothing to do with legitimate debate?

    really?

    If so, I say you didn’t pay attention, this time, or the years during which the Clinton administration tried to overhaul healthcare.

  150. #151 Ichthyic
    April 26, 2010

    the private health insurance industry supported Democrats’ health care reform effort.

    you didn’t look very closely.

    they only supported the conservative democrat version, where there was no public option.

    not surprising, really. who would want to compete with a govt. subsidized business…

  151. #152 Ichthyic
    April 26, 2010

    Based on past success in just about any industry sector you can name, I happen to believe better care will get to more people at a lower cost using market-based principles

    then you’re an ignorant fucker.

    *shrug*

    you would hardly be alone in the States.

  152. #153 Ichthyic
    April 26, 2010

    mostly because when people have a choice they vote with their wallets.

    hardy har har!

    man, if you really believe that you are entirely delusional.

  153. #154 Feynmaniac, Chimerical Toad
    April 26, 2010

    Maybe you didn’t hear the news — the private health insurance industry supported Democrats’ health care reform effort.

    The insurance companies spent a lot of money fighting it:

    America’s healthcare industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other reforms promised by Barack Obama. The campaign against the president has been waged in part through substantial donations to key politicians.

    While their bribes and propaganda campaign worked they were however opposed to what was originally being proposed.

    Finally, we are in agreement.

    What? I basically said the same thing in #121.

    A strong argument can be made the best care in the world can be had in America.

    Only if you add the qualifier: “if you have the money”.

    Your complaint is not one of quality, it is with the way health care services are administered, delivered and paid for in America

    Of course.

    This won’t change with the new health care reform law; people will still be insured by the same companies.

    There are a lot of problems with the health care bill. However, it’s at least a step in the right direction.

    Based on past performance in those sectors where it has been involved, I happen to believe government is ill suited to administer such a large, complicated industry — especially where so much money is involved.

    Again, every other industrialized nation has shown you’re wrong. They do it cheaper and they don’t leave out 15% of the population. The US system is good however far absurdly large profits by insurance companies.

    That much money tends to make every decision political, and I find the idea of such very personal decisions being politicized distasteful.

    Very personal decisions in the US are being based on profit. That’s much worse.

    Based on past performance in those sectors where it has been involved, I happen to believe government is ill suited to administer such a large, complicated industry

    Based on past success in just about any industry sector you can name, I happen to believe better care will get to more people at a lower cost using market-based principles

    Really? Government run firefighters are worst than the private ones of long ago? US troops in Iraq are much better than the troops of private companies? How about private prisons which do everything they can to cut costs? Is welfare worst than private charities?
    Also what will stop a monopolies from forming? What will stop these monopolies from crushing any potential rivals?

    Oh, and this contradicts your statement “I’ve not argued that free markets would lead to better results”.

    mostly because when people have a choice they vote with their wallets.

    I prefer democracy. At least in a semi-democratic state the people have a direct say in how things are run. In companies the share holders have a say. This sort of system leads to oligarchies.

    There will ALWAYS be super-rich people who will get the best of the best care no matter what system is in place.

    Probably. The question becomes then what do we do for those 95% who aren’t super-rich?

    (I’m not sure how David Marjanovi? is able to make so many of these long, blockquote-filled comments.)

  154. #155 attorney
    April 26, 2010

    @127

    >>>>Health insurance companies would love to cover pre-existing conditions.

    Yeah, riiiiight.<<<<<

    As thoughtful and well-reasoned as your response here is, it reveals that you don’t understand how health insurance companies make money. The vast majority of their profits come from investment of premium income between the time it comes in as premiums and the time it goes out as benefits.

    Thus, if you have a pre-existing condition that will cost $50,000 to treat, the insurance companies would love to collect that $50,000 up front, make some money investing it, and pay it back out when the time comes. It would essentially be free money to them.

    Obviously, buying “insurance” in this situation doesn’t make much sense, unless you lack confidence in your ability to save, believe the cost of treatment will increase dramatically in the near future, or are looking to protect that lump sum from creditors.

    But the insurance companies would love to do it if they were allowed to. They’re not allowed to.

  155. #156 mwsletten
    April 26, 2010

    Government run firefighters are worst than the private ones of long ago? US troops in Iraq are much better than the troops of private companies? How about private prisons which do everything they can to cut costs? Is welfare worst than private charities?

    Firefighting agencies are controlled by local government, not the feds, and these involve nowhere near the amount of money health care does. That’s not to say such agencies haven’t had their share of scandal.

    The military, considering its mission, is a very well run and (mostly) efficient organization. Having served for 20 years, I can tell you with certainty there is much room for improvement when it comes to waste, but given its ultimate mission of destroying things, there is likely room for disagreement there. The military, however, is not the problem, the problem (as always) is the amount of money involved, and that means politics.

    If you think the appropriation system for our warfighting equipment is in any way well-administered or efficient, then you haven’t studied it much. We could probably pay for a national health care system many times over with money wasted in this system. An example is the C-17 program. The USAF said a couple of years ago it had enough aircraft even though the full number hadn’t been purchased according to the original contract. Yet the USAF is still buying C-17s, mainly because congresscritters and senators in districts where the plane is built won’t allow the people who know what they need to make the decisions. This only one example; extrapolate across the board for pretty much EVERY major military weapon system.

    State and federal prisons are another area where there is tremendous waste and abuse — especially state prisons. Government workers on average earn higher salaries than private sector workers and enjoy gold-plated benefits including life-long pensions. Many of the worst off states are facing severe and unsustainable budget shortfalls due primarly to unfunded worker benefit and pension plans. In Illinois where I live the state will be $120 billion in the hole by July of this year. California would likely have folded last year without the huge influx of Federal stimulus money.

    A strong argument can be made that this situation has developed mainly because politicians made political deals with the unions providing labor for public-sector jobs despite not actually having the funds to pay for them.

    Politics and the free market rarely mix well. This is not new information; it is the primary reason the folks who wrote the constitution worked so hard to limit the power of the federal government.

    Also what will stop a monopolies from forming? What will stop these monopolies from crushing any potential rivals?

    There are already anti-trust regulations in place in America. EFFECTIVE government regulation would have ensured those laws were written to prevent too-big-to-fail banks. Government regulation, however, is rarely effective when it is based on politics…

    Oh, and this contradicts your statement “I’ve not argued that free markets would lead to better results”.

    I’ve still not argued that free markets would lead to better results than other countries, mainly because I believe, by and large, as long as they have access to adequate facilities and medicine, health care professionals the world over provide the best care they can no matter how they are compensated. Providers in America have access to some of the best facilities and medicines. The problem in America isn’t one of substandard care, it is one of high costs which limits access for the poor. I’ve argued that free-market principles will better control costs, just as they have in those market segments where they’re applied (see examples in my post above), which SHOULD tend to make care more available to more people.

    Again, every other industrialized nation has shown you’re wrong. They do it cheaper and they don’t leave out 15% of the population.

    I assume you mean ‘better’ and ‘cheaper’ than the US, and I might agree with you if the US healthcare system were actually based on free-market principles; it is not. Over 60% of the health care delivered in America is paid for with tax dollars, and the majority of the remainder is a third-party payment system where the consumer has few or no options when it comes to medicines/procedures/providers. Since they have no real options, there is no incentive for consumers to research and shop — the core principles of a free market.

    As I’ve mentioned a couple of times now, the segments of the US health care system where free-market principles apply have resulted in a continuous decline in costs without compromising (and in some cases, improving) the quality of care.

    The question becomes then what do we do for those 95% who aren’t super-rich?

    The super-rich probably comprise much less than 1% of the population if you consider the entire planet, and the answer is there is likely nothing you will ever be able to ‘do’ about it. The amount of money such people have allows them to wield a level of influence you and I (and the rest of us peons) can’t imagine. Even in countries where the law prohibits private compensation for health care these people find ways to get what they want.

    Whether this is right or wrong is the source of much debate…

  156. #157 mwsletten
    April 26, 2010

    John Morales said:

    …the issue is not private vs. public companies, but for-profit vs. non-profit companies.

    There is no such thing as a true not-for-profit private company. Even with so-called not-for-profit private charities, I guarantee you someone is making money. Nobody except the bored independently wealthy works for free. But I digress…

    The reality is you can exchange profit vs non-profit with private vs public. Public organizations are purportedly not-for-profit, but as with the private ones, someone is getting paid.

    Ichthyic said:

    are you really sure there weren’t reasons for stalling the vote on this that had nothing to do with legitimate debate?

    I didn’t say that all debate was legitimate, only that clear, unassailable evidence would have won out over the political rhetoric.

    The problem is those on the fringes of their particular political persuation often confuse their rhetoric with unassailable evidence…

    if you really believe that you are entirely delusional.

    Thank you for adding substantively and intelligently to the discussion…

    then you’re an ignorant fucker.

    Citation?

  157. #158 Ing
    April 26, 2010

    “There is no such thing as a true not-for-profit private company. Even with so-called not-for-profit private charities, I guarantee you someone is making money. Nobody except the bored independently wealthy works for free.”

    Unsubstantiated Assertion+argument from ignorance+no true Scotsman.

    WHOA TRIPLE COMBO!

  158. #159 mwsletten
    April 26, 2010

    Ing, prove me wrong. Give me an example of a private company providing a product or service where no one involved in providing those products or services is getting paid.

  159. #160 Nerd of Redhead, OM
    April 26, 2010

    Yawn, ideologues are so boring. And wrong…

  160. #161 Stephen Wells
    April 26, 2010

    Incidentally, SlantedScience @48 seems to say that he thinks PZ’s frequent line, “crash this poll”, means “crash the website of this poll.”

    Could it be that the current chewtoy has spent all this time getting het up about evil PZ’s heavy-handed ways without bothering to understand the difference between “crash a car” and “crash a party”? Tragically stupid.

    mwsletten apparently doesn’t understand what “not-for-profit company” means, but this is not the least of his issues.

  161. #162 negentropyeater
    April 26, 2010

    mwsletten,

    I assume you mean ‘better’ and ‘cheaper’ than the US, and I might agree with you if the US healthcare system were actually based on free-market principles; it is not. Over 60% of the health care delivered in America is paid for with tax dollars, and the majority of the remainder is a third-party payment system where the consumer has few or no options when it comes to medicines/procedures/providers. Since they have no real options, there is no incentive for consumers to research and shop — the core principles of a free market.

    First, it’s not 60% but 40%.
    Second, what you refuse to understand is that healthcare is not “a market” that meets the requirements of one where patients can be incentivised to “research and shop”:
    1. as long as you have a third party payment system (ie AN INSURANCE). Unless you are willing to defend the position that we should just abolish health insurance, whether private or public.
    2. My uncle just had a heart attack. I think he should have “researched and shopped” for the best price/quality hospital to receive treatment when it stroke him. Or maybe he should have carried a few prospective visits prior to this asking for their prices, “can you tell me how much it will cost me in case I have a generic heart attack, you know the kind that might strike me”?
    Do you realise how ridiculous that is? This is not like buying a car !

    As I’ve mentioned a couple of times now, the segments of the US health care system where free-market principles apply have resulted in a continuous decline in costs without compromising (and in some cases, improving) the quality of care.

    [citation needed]

    The amount of money such people have allows them to wield a level of influence you and I (and the rest of us peons) can’t imagine.

    That wasn’t the question. The question was, what do you do with the 95% of the population that doesn’t necessarily have the cash lying on their bank account to pay for a major surgery/procedure in case they get unlucky and need one ? Do you understand why your ridiculous free market ideology doesn’t solve this problem?

    If you believe in social justice, which I do, every one should have the right to receive the best possible treatment in case they are not so lucky, independent of their wealth or general health condition.
    Or will you argue like Glenn Beck or Rush Limbaugh that only those who can afford it should receive adequate care?

  162. #163 mwsletten
    April 26, 2010

    Stephen Wells said:

    …mwsletten apparently doesn’t understand what “not-for-profit company” means…

    You know, you’re right; my cynicism got the better of me with that not-for-profit comment. There are certainly many people who volunteer their time for many different worthwhile endeavors, and not all of them are independently wealthy.

    If I offended anyone with that statement I sincerely apologize.

    The point I was trying to make is not-for-profit is a political construct, not a factual one. By granting or withholding tax benefits the government defines what a not-for-profit organization is — and it rarely means that no one is allowed to profit.

    Even in countries where socialized medicine is the law of the land those providing the medicines and services are getting paid.

    …but this is not the least of his issues.

    Please, enlighten me, oh mysterious, perspicacious one.

  163. #164 David Marjanovi?
    April 26, 2010

    The Director of Medicare is a Level III Federal Executive making $167,000 per year. The CEO of Wellpoint had total compensation in 2009 of $13.1 million. So government run health care would have a definite savings of almost $13 million.

    <head style=”explode”>

    Further, as I noted in my post vis a vis Canada’s per capita cost for medical care, costs for ALL countries have been rising — even in those countries where medicine has been socialized.

    Doesn’t change the fact that they’re still unaffordable for tens of millions of Americans.

    …and why is it certainly not the answer?

    Because Obama’s own administration says his plan will not save money.

    If you really want to call Obama’s plan “socialized medicine”…

    Evidently, large amounts of US citizens can’t afford their own medicine in their own country.

    And this is a result of government price controls that limit competition.

    <headdesk>

    CRASH

    <headfloor>

    You are denying the existence of the rest of the world. Don’t you notice?

    Austria has zero competition, the Republic is the only health insurer (unlike in, say, Germany), the government negotiates prices with the pharma companies, and fucking everyone can afford their medicine! Did someone shit into your brain?

    Further, I’ve suggested high cost is the primary factor limiting access to health care in the US, and that free markets might do a better job of controlling costs.

    They add to the costs ? it’s called profit.

    Again, look at the rest of the world.

    Some seem to think government should be the ultimate arbiter of who gets what treatement, while others think the market should.

    Everyone who’s sick should get treatment.

    Over here, everyone who’s sick gets treatment.

    In the USA, everyone who’s sick and can afford it gets treatment.

    What have I overlooked?

    Based on past performance in those sectors where it has been involved, I happen to believe government is ill suited to administer such a large, complicated industry — especially where so much money is involved. That much money tends to make every decision political, and I find the idea of such very personal decisions being politicized distasteful.

    This kind of belief that can only be sustained as long as evidence is actively ignored is like religious faith.

    There will ALWAYS be super-rich people who will get the best of the best care no matter what system is in place. Like those who travel to the US when they believe they can get better care than their own government will provide them.

    And?

    We’re not trying to abolish the bourgeoisie like the USSR and China did. We’re trying to abolish the proletariat, like Sweden.

    I’m not sure how David Marjanovi? is able to make so many of these long, blockquote-filled comments.

    You’re learning :-)

    Easy: I find something I want to comment, I copy it and hopefully remember the number of the comment, I scroll down and paste it, I comment it, I scroll back up and continue reading. I’m too autistic to notice how much time this eats up.

    This comes from the way I behave in mailing lists: I hit “reply”, delete the stuff I don’t want to reply to, and put my replies under the relevant quotes ? the results look like my blog comments.

    Oh, and, I’m a touch-typist. I look at the screen while typing, so I catch almost all typos before I submit… and I type fast.

    The vast majority of their profits come from investment of premium income between the time it comes in as premiums and the time it goes out as benefits.

    Good point, you’re right I overlooked this. Thanks.

    Politics and the free market rarely mix well. This is not new information; it is the primary reason the folks who wrote the constitution worked so hard to limit the power of the federal government.

    What? Why do you think they were concerned about the market?

    There is no such thing as a true not-for-profit private company. Even with so-called not-for-profit private charities, I guarantee you someone is making money. Nobody except the bored independently wealthy works for free.

    What do you mean? “Not-for-profit” means the revenue is equal to the expenses, so that no profit remains. The expenses include the salaries, which are fixed or anyway don’t depend on the revenue.

    I didn’t say that all debate was legitimate, only that clear, unassailable evidence would have won out over the political rhetoric.

    :-D :-D :-D :-D :-D :-D :-D :-D :-D :-D

    This is wishful thinking on the same level as “bourgeois capitalism will inevitably transform into socialism, which in turn will inevitably transform into communism = paradise on Earth”.

  164. #165 mwsletten
    April 26, 2010

    David Marjanovi? said:

    CRASH


    My, you like drama don’t you!

    You are denying the existence of the rest of the world.

    Your comment was in reference to Americans who travel to obtain meds for less than can be obtained here in the states. My response is factually correct. Regulatory rules here in the US allow pharmaceutical companies to substantially control consumer costs for their products independent of normal market controls. Other than this fact means certain drugs can be obtained cheaper outside of the US border, what does this have to do with the rest of the world?

    Over here, everyone who’s sick gets treatment.

    You mean everyone who’s sick gets a share of the available treatment. It is not an infinite supply and your government decides who gets what.

    Talk about wishful thinking…

    “Not-for-profit” means the revenue is equal to the expenses, so that no profit remains. The expenses include the salaries, which are fixed or anyway don’t depend on the revenue.

    In a perfect world you would be correct. In reality “not-for-profit” means exactly what the government defining it says it means, including what is reasonable compensation for those providing the service. Many people make handsome salaries working for not-for-profit organizations.

    Fact: One of the world’s richest organizations is not-for-profit, and it provides a great deal of health care here in the United States and abroad. In the US alone the Catholic church boasts 600 health care facilities. According to the American Hospital Association there were more than 15.4 million emergency room visits and more than 86 million outpatient visits to Catholic
    hospitals in 2003.

    The insurance industry, many doctors’ groups and other health care professionals make tidy profits working for Catholic hospitals.

    Not-for-profit can be good, but it can also be abused. It all depends on who is making the rules…

  165. #166 Jadehawk, OM
    April 26, 2010

    You mean everyone who’s sick gets a share of the available treatment. It is not an infinite supply and your government decides who gets what.

    Talk about wishful thinking…

    oh stop pretending like you know what the fuck you’re talking about. The distribution of available health resources is better with socialized healthcare, and all mortality and morbidity statistics support this.

    Everybody gets taken care of, and no one needs to die just because they’re poor. That’s how it works with socialized medicine. You can pretend like 45000 deaths every year are a fair price for shorter waiting lines, but sane humans disagree.

    And btw, you asked me above if all medical costs, even the non-necessary ones, are covered. Yes, they are. I paid 50DM to get the bridge of my nose straightened. It was a non-necessary but helpful OP, and my insurance paid for all of it.

    It also paid for all my sports injuries (including refunding cab rides to and from the doctor), illnesses, birth control etc.

    The only thing I’ve ver had to pay for myself was Hep B vaccinations, because we completely fucked up and didn’t get them before I turned 18, when they’d have been free.

  166. #167 Jadehawk, OM
    April 26, 2010

    In a perfect world you would be correct. In reality “not-for-profit” means exactly what the government defining it says it means, including what is reasonable compensation for those providing the service.

    that’s the fucking point. and this is not the same as “volunteering”, which you claimed above.

  167. #168 Nerd of Redhead, OM
    April 26, 2010

    Yawn, the liberturd never gets it, and must always try for the last word for his morally bankrupt economics. He is so wedded to the the concept of capitalism, he never can understand the concept of public good, be it roads or medical care. Doesn’t say much for his intellect, if he can’t see why the public sector may be more efficient, without the need for profit, in certain areas than the private sector. And more responsible to the people. Oops, there’s his problem…

  168. #169 mwsletten
    April 26, 2010

    Jadehawk said:

    that’s the fucking point. and this is not the same as “volunteering”, which you claimed above.

    I’m not sure what you’re getting at here. I acknowledged my statement about volunteering was over the line. Are you suggesting you agree with all government definitions of ‘not-for-profit?’

    Everybody gets taken care of, and no one needs to die just because they’re poor. That’s how it works with socialized medicine.

    You seem to be getting overwrought about something I never said. I’ve never claimed the US health care system is superior to Germany’s, only that I don’t believe socialized medicine is the best answer here. I’m glad you are happy with your health care system; I have no problem with your country’s continued reliance on it.

    You and others keep comparing the US to various countries with socialized health care systems around the world as if I claim the “non-socialized” system in the US is better. In fact, I’ve stated more than once the US system IS primarily socialized — it is not based on traditional free-market principles. Aside from the 60 some percent of healthcare covered by Medicare and other government programs, it is a poorly-stitched-together hodgepodge of insurance providers who have no competition in their individual markets. This is not a free market.

    You can pretend like 45000 deaths every year are a fair price for shorter waiting lines, but sane humans disagree.

    I’ve disputed the Harvard study previously. It was conducted over the course of more than a decade, but no follow up was done once a respondent completed the survey. In other words, once someone claimed not to have insurance it was assumed they had not insurance for the entire time period of the study. Because we’ve allowed insurance to be tied to employment here in the US people often experience periods where they lack insurance. There was no effort to account for this in the Harvard study.

    oh stop pretending like you know what the fuck you’re talking about. The distribution of available health resources is better with socialized healthcare, and all mortality and morbidity statistics support this.

    Based on what data? Is there valid comparison on which you may base such a statement? As far as I know a free-market based health care system doesn’t exist in any modern society.

    Nerd, you yawn a lot. Maybe you should get more sleep…

    He is so wedded to the the concept of capitalism, he never can understand the concept of public good, be it roads or medical care.

    ‘He’ served two decades in the military service of my country — I think ‘he’ has a handle on the concept of ‘public good.’

    Doesn’t say much for his intellect, if he can’t see why the public sector may be more efficient, without the need for profit, in certain areas than the private sector.

    Yes, your blisteringly intelligent and witty (yawn) commentary has been far too much for me…

    Be that as it may, I’ve never suggested the public sector can’t be more efficient than the private sector. I’ve just noted that for whatever reason it rarely happens here in America.

    There is a reason Bill Clinton privatized many traditionally government functions during his eight years in office…