Thus Spake Zuska

In the contentious health care reform debate that has raged on lo these many months, one of the cries of protest we’ve heard has centered around how we might be infringing upon the rights of young, healthy American citizens. Young healthy people don’t need to access the health care system the way old folks [who, we know, Obama wants to shovel in front of death panels] do! Young folks should not be forced to waste their precious dollars on health insurance premiums for coverage they don’t really need just because you libruls think that would help bring down the cost for everybody else! That’s SOCIALISM!!!!!!!!!! Next you’ll be wanting to take mah gunz away!

Yes, by all means, let’s talk about the relationship between guns and health insurance. Specifically, how available guns are for sick fucks who want to kill random women as punishment for the perceived sins of all women who have refused to date them. Versus, say, the lack of availability of health insurance for young women who have aged out of their parents’ insurance policy and who have the bad luck to be gunned down by sick fucks who want to kill random women as punishment for…etc.

My sister is a member of the fitness club where that shooting took place. It was just chance that she was not there, and not in that fitness class, the night the shooting took place. My gratefulness for her safety has been tempered by my sadness for the women who were killed and injured there.

Well, just imagine my thoughts today when I talked to my sister, and she let me know what was going on for one of the women who was shot at the fitness club. The young woman had recently graduated college and therefore had “aged out” of coverage on her parents’ health insurance. She did not have coverage provided through a job. I can’t tell you why she didn’t purchase coverage on the open market – because it was out of her financial reach, because she didn’t think she needed it (being young and healthy), who knows, maybe she had a pre-existing condition that made it impossible for her to get it (see my next post). Whatever, she didn’t have health insurance.

She is left with a hefty, hefty bill from the hospital due to the surgery and other treatment she needed because some sick fuck asshole came into her fitness club and shot her while she was minding her own business, exercising, trying to maintain her own health.

So her friends and family recently sponsored a friggin’ car wash to raise funds to pay her hospital bills. Yes. A car wash.

My sister asked: what’s the difference between throwing five or ten dollars into the can at the car wash to help this young woman out, versus what we might be doing if we all paid a bit in taxes to make sure that everyone had adequate health insurance coverage? If you are willing to help out at events like this, why don’t you want to help out with your taxes to make sure that people don’t have to go around begging for help to pay for their hospital bills? Why, she asked, can’t we all just acknowledge that we are all in this together, and that we need to take care of each other?

Here’s my guess: you throw ten bucks in the can at the young shooting victim’s car wash, and you feel virtuous; you feel you have helped someone who “deserves” your help. You are participating in the mythology of “we all take care of ourselves and we don’t depend on gov’mint handouts”. But, you pay taxes to insure that everyone has access to adequate health insurance coverage, and the rightwing nutjobs convince you that you are a dupe who has been made to fund the lazy, brown- and black-skinned no-good-niks who are destroying America as you know it, and who will thank you for your efforts by raping your daughters and looting your homes if given half a chance.

In my next posts I will talk more about the myth of young healthy people not needing insurance, and about the myth of “being able to take care of ourselves”.

Comments

  1. #1 Dan J
    August 26, 2009

    You know, once in a while I have to conclude that you are one-hundred-percent correct. How frickin’ blind are these idiots who continue to drag out the BS about how bad socialized medicine is, how it’s going to cost us more, how the care quality is going to deteriorate, etc., etc.? Thanks for being another voice for reason, Zuska.

  2. #2 John
    August 27, 2009

    Because it isn’t throwing $10 in a can once and a while to help someone you know. Its throwing $100′s in the can every month, to help out anyone and everyone, who may have never payed a penny in.

    We’re already doing the same thing with social security. That money is probably never coming back to me. yet i pay into that thing every month.

    I like how you turned this whole “health care” into a personal drama, anti gun, and racism post.

  3. #3 Chris Evo
    August 27, 2009

    >>That money is probably never coming back to me. yet i pay into that thing every month.

    Do you plan on living into old age? If you ever get a vaccination, or get screened for cancer, or get any injury too big for a regular bandaid and some over the counter painkillers, then you’ll see that money come back to you.

    Most of my friends and family are uninsured, though I’m lucky enough (for now) to have coverage under a fairly generous plan. I would drop any benefits my current plan has over an American NHS in an instant if it meant I knew the people I see every day are more likely to live into old age. I don’t want to watch the people I love fade away because they can’t get to coverage that could easily be paid for in any other civilized nation in the world, and I don’t want to die because some Libertarian idealizes the most corrupt industry in America above the government.

  4. #4 0111010101
    August 27, 2009

    In the communist countries people have money but they do not have services. In the USA people have services but they do not have money. Which is worse?

  5. #5 EdithKeeler
    August 27, 2009

    How appalling (living in a country with universal health care, the resentment towards it in the US is bizarro world to me.)

    If the car wash doesn’t cover it, I’m sure a lot in the blogosphere would like to contribute. The feminist blogs I read covered this incident extensively, and I’m sure a lot of people would like to help. Without wanting to add to her and the family’s to do list which I’m sure is extensive, a PayPal account posted here and a few other places might be an idea.

  6. #6 volcanista
    August 27, 2009

    Zuska, this post is great, thank you for writing it. I had no idea about the woman at the club who didn’t have insurance, and it’s just horrible she wasn’t covered when she got shot. (And 0111010101, nice false binary there. There are more choices than those.)

  7. #7 Joshua
    August 27, 2009

    The problem with government run healthcare is those who WILL abuse the system. The people who the system would benefit most already abuse it greatly. The health care insurance system in the US needs to change, but that is not the way to change it. If most Americans are paying for coverage, they will use it. We will see a collapse of one of the largest PRIVATE industries in the country because of this. What happened to capitalism??

  8. #8 daedalus2u
    August 27, 2009

    Joshua, how can one “abuse” health care? By using it?

    By choosing to have a disease so that one can obtain treatment for it?

    Please give a few examples of the “abuse” of health care, so we can evaluate if “abuse” of health care will ever be a significant drain on resources.

  9. #9 Miss Cellania
    August 27, 2009

    If we were to ever take the insurance company profit factor out of the health care system, we’d all be surprised at how affordable those taxes and/or bills will be. PLUS, if everyone were covered, bills would not have to be inflated to cover the cost of care for the uninsured/underinsured/declined/bankrupted. They would not have to be inflated to cover the margin that insurance companies refuse to pay.

    If my income were taxed at 50%, it would still be cheaper than buying insurance on the open market for my family.

    This is such a sad story. I hope a lot of people hear about it.

  10. #10 Joshua
    August 27, 2009

    You may not have much experience visiting state and federally funded hospitals. The only personal experience I have is when I was young. Any time the ER was visited for actual emergencies there would be many instances of people coming to the ER for diarrhea, headache, paper cuts, etc. Just because it is available. Many times this is for attention a free meal or other non-medical reasons and delays care to other patients who should be a higher priority.
    Another instance of this is the pregnant mother who fakes labor just to get the boyfriend to come home. I assure you this happens much more than you would imagine. Ask a physician at one of these hospitals. There are many people who do exploit the system in this way and with government sponsored healthcare it will beat most hospitals and will be the norm.

  11. #11 Mike Haubrich, FCD
    August 27, 2009

    Yes, Joshua. In order to prevent drama queens from getting their boyfriends’ attention (which is what all women are, aren’t they, drama queens?) we need to prevent people with heart conditions from being able to afford remedial care so that they can be rushed to the hospital in an ambulance when their heart fails; so we can then send them home with giant bills that they will never be able to pay and still not able to pay for remedial care or medications that could have prevented it in the first place.

    I have attended and donated at several fundraisers for people who needed money and help to pay medical bills, and while their families were grateful for the donations, they should never have had to hold those fundraisers in the first place.

    When I worked as an estimator for an insurance restoration (home repairs on insurance claims,) one of the male subcontractors fell of the roof and broke both legs and cracked a vertebra. Since he was a self-employed contractor in a field that is risky, so that his insurance premiums would have been greater than his profits he had no insurance coverage. Not being employed, he was not eligible for workmans’ compensation. He was well and truly fucked by our wonderful Free Enterprise system. So, yes, Joshua, even men need health insurance coverage.

    When South Africa lost its white privilege protection through Apartheid and the Mandelas convinced Parliament to enact socialized medicine, all of a sudden the darkies were taking their children to the doctor for the slightest sniffle, and the conservatives said “See what we told you? Those people were just waiting to abuse the system.” What they should have done instead was to wait until they had infected more darkies and then rushed to the emergency room with advanced, feverish cases of influenza or strep, nearly dead and needing heroic measures.

    Right, Joshua?

    Zuska can puke on your shoes, if she likes. This is her blog. I’ll merely be content with calling you an elitist pig.

  12. #12 Comrade PhysioProf
    August 27, 2009

    Z, why do you hate America?

  13. #13 rebenectomy
    August 27, 2009

    Joshua, if a woman is faking labor to get her boyfriend to come home, how would this be a drain on the ER resources? Surely once he’s home the fake ends, job done, mission complete, check and mate – no need for the trip to the hospital. Plus I can safely say that any proposed health service needn’t worry about wasting precious dollars being duped by these awful fakers, a five minute examination would indicate if labor was underway or not, I doubt they’d have to contact NASA or anything. Otherwise the subsequent non arrival of the baby should be a dead give away.

  14. #14 Zuska
    August 27, 2009

    Oh, you can’t trust those whining pregnant women. They’d probably go so far as to fake deliver their own babies ahead of schedule just to dupe their boyfriends.

    A hearty shoe-puking for Joshua and for John, a Rugged Individualist who is sure to never grow old, get sick, or need the aid of another human being in any manner whatsoever. Why, I doubt he drinks water from a faucet, drives on roads paved by the city or state, or shits in a toilet that drains to a municipal sewer system! Nosiree, he probably dug his own well, maps out and paves his own personal highway system, and built his own personal composting toilet. Probably as a child he nursed himself and changed his own diapers, too! He just sounds like the kind of guy who has never, ever needed another human being in his life, and I don’t see why the rest of you readers can’t take his example and be more like him! I expect if he ever does get old and feeble, he’d be the kind of dude to launch himself off on an ice floe to die, assuming there were any ice left at that point, rather than impose on another human being to care for him. If you weren’t born incredibly rich and completely, utterly self-sufficient in every manner, like John, it is your own damn fault.

  15. #15 EdithKeeler
    August 27, 2009

    Here in Australia, we have a universal health care system AND a private health insurance industry. I have private cover ($15 a week) myself to cover ambulance costs and dental visits and the occasional other thing, which aren’t under Medicare. I’m quite sure private operates parrallel to public in most systems of universal care around the world.

    It’s true that one genuine issue is hospital emergency rooms dealing with issues that should be looked at by an ordinary GP (like, colds and flus not hysterical pregnant laydeez. WTF), and the govt has proposed various ways to deal with this such as “GP super clinics” attached to hospitals where people with non-emergency health problems can be directed, freeing up the emergency staff. Any system of a certain size and serving so many people is going to have issues. There is no perfect system, and all of them have pros and cons. But I for one would rather have the problems of our system, than those of America’s.

  16. #16 muhr
    August 27, 2009

    I read that Sodini left his estate to the University of Pittsburgh, but that the UoP doesn’t want it. The UoP should redirect the money to Sodini’s victims.

  17. #17 JJ
    August 27, 2009

    @Josh
    Isn’t the main reason why people abuse the ER is because they do NOT have health insurance and cannot legally be turned away from the ER? Your logic seems flawed

  18. #18 G
    August 27, 2009

    If wishes were fishes, we’d all live in the ocean…The US at 300+ million, has one of the highest populations of industrialized nations in the world. We also have one of the, if not highest, populations of illegal immigrants. Holding up the examples of Great Britain, Canada, Australia, and other European nations is flawed for that reason alone. Not to mention the horror stories of the first two mentioned countries (long wait times, rationed care, patients being turned away and advised to die).

    An overbearing financial debacle like socialized medicine will only add to the US healthcare problems. The Congressional Budget Office, not taking into account Obamacare, has predicted a $10 TRILLION deficit by 2019. (I’m sure someone will blame GW Bush, so go ahead and get your jollies, even though the man has been out of office for 7 months)

    Taxes? I promise you it won’t be 50% of your income if Obamacare passes, it will look more like 60%.

    Have you noticed that Obama’s key words have changed, since opposition has taken shape and his poll numbers have plummeted? It’s now called “Health Insurance Reform.” Yeah, you can call horse s*** “Strawberry Cheesecake”, but I’m still not taking a bite.

    And I find it disingenuous that opposition to Obamacare has been boiled down to a racial issue – especially when Dr. Alan Keyes and other noted black conservatives are against it. Oh by the way, a BLACK MAN WROTE THIS POST. Just thought you’d like to know…

    Many people have read or tried to read the nebulous and ever-changing 1,000+ page healthcare reform Bill, and have voiced their opposition. In short, and you folks across the pond can call us all the names you want, WE DON’T WANT SOCIALIZED MEDICINE, and Obama and all his arrogant minions don’t seem to want to listen. There are many more solutions available, but our “messiah” who promised bi-partisanship has his fingers firmly planted into his big ears…

  19. #19 Cara
    August 27, 2009

    Any time the ER was visited for actual emergencies there would be many instances of people coming to the ER for diarrhea, headache, paper cuts, etc. Just because it is the only health care available to them.

    Fixed that for ya.

  20. #20 Vince Whirlwind
    August 27, 2009

    The writer of the above post is inspired by dogma, not fact.
    Europe is crawling with illegal immigrants, so that’s not a problem only the USA has to face.
    There is no question though that in the USA, healthcover costs per capita are vastly more than they are elsewhere, AND a far lower proportion of people can access it AND healthcare outcomes are inferior in terms of life expectancy, infant mortality, and any other normal WHO measure.

    The rubbish about “people being turned away to die/rationed healthcare” is just that – rubbish. In fact, it’s more more than just rubbish – it’s projection, because it’s the US system which does this.

    On top of all this, you have business and industry in the USA absolutely crippled by the need to pay the ever-inflating costs of medical insurance for their employees – money which is effectively diverted from healthcare straight into the Bermuda bank accounts of health insurance company boards of directors.

    I am (as others above) absolutely bemused by americans’ insistance on getting ripped-off by their appalling system of healthcare – but then again, that’s the country which generates (among all the good things) Creationism, global warming denialism and all that weird-arsed christian fundamentalist idiocy.

  21. #21 Nico
    August 27, 2009

    Heaven forbid the riffraff and the unwashed get affordable care.

    I’m astounded that good people can only afford as much care as their friends can rally and fundraise. Serving up spaghetti dinners and car washes to cover astronomical medical bills incurred as a result of violence? Talk about a kick in the head, kicking people when they’re down.

    I’m flummoxed to understand why people think for profit care is the solution. I honestly do think it washes down to “i don’t want the poor/needy/black/ethnic/ to have to hobnob in MY space.”

    ( no one goes to the ER for a papercut. If they did that here in Canuckistan, you’d get sent home and told to quit acting the fool.)

  22. #22 Gerry L
    August 27, 2009

    I woke up early this morning and was half-listening to the radio — a progressive talk radio station. Apparently, OK Senator Tom Coburn, who is himself very well insured but is dead set against any form of government-run healthcare option, has offered to help any individual who is uncovered and is having difficulty getting healthcare. Just contact his office, he said. He’ll help you out because that’s what America ia all about: neighbor helping neighbor. So tell your sister’s friend to get on the phone and call Tom Coburn. Certainly he’ll want to help.

  23. #23 Mike Haubrich, FCD
    August 28, 2009

    Gerry – Sen. Coburn isn’t part of the government, is he?

  24. #24 konrad_arflane
    August 28, 2009

    Taxes? I promise you it won’t be 50% of your income if Obamacare passes, it will look more like 60%.

    Highly unlikely. After all, we’re only talking about healthcare. I live in a country with free public health & geriatric care and education, as well as state-subsidized kindergartens and creches, maternity leave, libraries, etc. etc. etc., and only the very highest tax bracket pays anything like 60%, and then only of the part of their income that puts them in that bracket.

    The US would have to screw up monumentally to use that much money solely for healthcare.

  25. #25 gb
    August 28, 2009

    Hi

    I live in australia and today I had to go to the doctor. The consultation cost $60. After the consultation I went to the medicare office and they gave me $32 back. Like EdithKeeler I also have private health insurance paid for by my partner’s employer and that’s for dentistry and optical and stuff like that. Australia’s per capita health care costs are way less than the USA. I really do not understand why americans are so petrified of the government funding health care. We are just as free here as you are, and we don’t have to worry about having to find thousands to pay for medical emergencies. So I really don’t mind paying my medicare levy on my tax. It’s so worth it.

  26. #26 Luna_the_cat
    August 28, 2009

    G: I live in the UK, I grew up in the US and still have family there, I am intimately familiar with both taxes and healthcare in both countries, and you speak complete bullshit.

    I pay less here in the UK than I would pay in the US, there are very few “horrendous waits” even for specialists (although admittedly longer for non-urgent issues), people are NOT “turned away and advised to die” (that only happens in the US when insurance companies decline to cover things like cancer treatment), and no-one ever has to fear bankruptcy from medical bills, no matter what happens here.

    I cannot say the same for friends and family in the US.

    And, for your information, yes, there is a huge issue of illegal immigration into Europe, primarily from Africa. The US has no monopoly on this. Nevertheless Europe’s healthcare systems are so far coping.

    And…having a government-run insurance option is NOT “socialized medicine.” Get over it, for chrissake. If you can’t even identify things accurately (much less tell the truth about factual issues), why the hell should anyone take you seriously?

  27. #27 BdN
    August 28, 2009

    Are all the roads in USofA owned by private companies ? Because I sure wouldn’t like to ride on those darn socialzied bitumened alleys!!!

  28. #28 FormerComposer
    August 28, 2009

    Can we please get a notarized and binding contract from everybody who spouts off against government involvement in healthcare that they will: 1) never enroll in Medicare or Medicaid until they are already dead and then agree that since being dead is a pre-existing condition, they will not be covered, 2) agree to pay cash in advance for any unscheduled use of municipal ambulance, fire, police or emergency vehicles, 3) agree to pay at least the triple the cash rate of #2 plus interest (charged at the highest rate allowed under our current credit card usury limits) if they cannot pay cash in advance, 4) agree to pay cash in advance for any use of hospital ER services except for the hours of 8am to 6pm for which the ER services required payment will be triple the standard rate since they should have seen an available physician instead, 5) as with #3, triple the rates of #4 if not paid in advance, 6) agree that company health benefits are of benefit to themselves and without them they could negotiate correspondingly higher salaries for which they would have to pay taxes and therefore further agree to pay such tax amount even if they have “company benefits”.

    I’m sure I’ve forgotten something ….

  29. #29 rebenectomy
    August 28, 2009

    “We also have one of the, if not highest, populations of illegal immigrants.”

    Good Grief.

    Once upon a time in a far off land, a country was suffering tough economic times. A costly war had left their currency almost worthless and the people lived in a state of fear, paranoia and a growing sense of injustice. Then a long came a small man with a loud voice who was able to give comfort to the masses by stating that all their problems lay with a group of people, a group of people who were not the same race as them, who were deemed ‘inferior’ and who became the ultimate scapegoats and punching bags for a nation that was steeped in uncertainty and looking for an outlet.

    It worries me deeply just how many posts I’ve read recently (not just here btw) from people against the proposed bill who feel that ‘illegals’ are somehow responsible for the current economic crisis and that a universal health care system will somehow pander to them. The atrocities committed by the Nazis were born of the same climate of fear, irrational finger pointing and hysteria that is festering in the US and parts of Europe at the moment, medical reform is sadly one aspect that has been hijacked by the scaremongers…I’ve no doubt that immigration, education et al will soon come under the same dubious blanket as people continue to worry about the security of their jobs and homes.

  30. #30 speedwell
    August 28, 2009

    It’s possible I may need to move to the UK for work (it’s not settled yet). I looked up health care for immigrants and nationals of other countries. As far as I can tell, it takes months to years to qualify for the same level of healthcare at the same cost as naturalized or native people, and I’d be a legal immigrant. Is this really the case or am I misreading something?

  31. #31 rebenectomy
    August 28, 2009

    Speedwell: As a foreign national with a working visa you should be able to qualify for full NHS if you are issued with a National Insurance Number or equivilent, but you would need to talk to your employer about how you are getting paid and to which government you are paying your taxes. If you are not issued with a National Insurance number and you are not covered, you would need to discuss private cover (someone like Bupa work on reasonable pay related scales). Some NHS services are free to all (ER, Family Planning, treatment for high risk diseases etc) and there will be regional variations depending on whether you are in England, Scotland, Wales or Northern Ireland in terms of what you’re entitled to. For example Scotland and NI have, or soon will be moving towards free prescriptions, while England has a standing charge of about £7 per script. You may find this website helpful
    http://www.adviceguide.org.uk/index/family_parent/health/nhs_charges_for_people_from_abroad.htm

  32. #32 Kyle
    August 28, 2009

    How is this any different then if she failed to insure her car?

    Why am I supposed to feel sorry for a young able bodied person who chose not to get insurance?

    I do sympathize that health insurance for a single person without employer coverage is more expensive than it should be. Its an easy fix though- make individual health care expenses tax deductable.

  33. #33 Zuska
    August 28, 2009

    Kyle, with all due respect, you are an idiot.
    “Tax deductable” doesn’t help if you don’t make enough money to take advantage of tax deductions. People who don’t have health insurance, don’t have it because it’s prohibitively expensive, or what they can afford to buy doesn’t really cover anything, or, like my friend’s daughter, can’t keep what she actually had and was paying for, because once she used it, the health insurance company said “oh, you appear to have an illness. We aren’t going to allow you to renew your policy.”

  34. #34 the doctor's wife
    August 28, 2009

    Kyle,

    If health care insurance, like car insurance, was mandated by governments, I imagine it would suddenly and coincidentally become more affordable.

    The tax-deductible thing for health care expenses isn’t workable — mainly because health care expenses for major surgeries and hospitalizations can rapidly outstrip tax bills.

    Our young daughter had foot surgeries a few years ago due to a birth defect, and due to complications in her case we had to take her to an out-of-network surgeon; our COPAY was $20,000. That was with insurance. Add up the costs of care for someone like the young woman described in the post, and I’m sure it topped $100K, which would be way above any tax bill she might have had, as a low earner.

  35. #35 Mike
    August 28, 2009

    I love the way people say “in communist countries” they had money but no services. let’s point out a few misconceptions

    1. In those communist countries they DID have health insurance, ask anyone from Poland, Hungary, Russia, former East Germany, former Czechoslovakia, and the list goes on. While the services were not as good at the US or perhaps modern, but they were available.

    2. After years of Communist control these countries overthrew their overlords and decided that democracy was a better way. BUT THEY KEPT HEALTH INSURANCE universal. As a matter of equality. If you believe in equality, then one would automatically think that the same level of service should be available to all. That is not the case here in the US. You get the best care if you can pay for the best policy. It is also very wrong when the richest and the poorest have healthcare and everyone in between are struggling to fine an insurance policy that they can both afford and will actually benefit them.

    3. Finally, the issue of ingenuity and advances worked quite well in Russia and other countries. It was Russia that became advanced in Radio keretotomy (sorry of misspelling) the precursor to Laskic. I am very glad because I was able to see for the last 22 years. So ingenuity does not slow in a former communist country.

    Now, I agree, It is really poignant that the writer is correct, we would rather give 5.00 to a car was rather than pay for a health care program out of our taxes that we would benefit? And it is always the middle class and poor who are willing to do so. The rich, do not care. They are concerned merely with preserving their riches in a bank where it stays lifeless and motionless. Money does not do anything sitting in a vault. Now, I am not for soak the rich policies. However, after the last 8 years I think they could contribute some of that bootle they took during the Bush years.

  36. #36 EdithKeeler
    August 28, 2009

    One bright spot for my American friends is that if and when you get universal health care, they won’t be able to ever take it away. Here, it has bipartisan political support even from the conservatives. (I believe the same in the UK) Even those more extreme conservatives who might have ideological objections to the whole idea have to shut up about it to ever get elected. The previous conservative govt was more intent on chucking money at the private companies but that’s as far as they can go. The middle and working class conservative voters they depend on to ever get govt will let go of Medicare from their cold dead hands. So, if you get it I’m sure the critics now will come around quickly.

  37. #37 kissmypineapple
    August 30, 2009

    Semi-off-topic: Most counties in the US have a victim services department housed within their county attorneys office. Within that, most have a victim compensation program, and that program can cover medical bills. In Arizona, where I work as a crime victims advocate, our comp program can cover up to $20,000, which, in the grand scheme of things is a drop in the bucket, but is still nothing to sneeze at. Call your CAO, and ask if this money is available.

  38. #38 Swulf
    August 30, 2009

    G@18:

    You have no idea what the f**ck you are talking about as regards to health care in Great Britain. So why don’t you keep your mouth shut as far as that is concerned?

    The health care provided to UK residents by the National Health Service is generally extremely good. Indeed, for *certain* cases there are long wait times (a member of my family had a wait of several months for a hip replacement, for example). However, in general, as far as the vast majority of people needing care are concerned, treatment is prompt, free-at-the-point-of-delivery (yes, all British people in employment pay taxes to fund it), and of good quality. Urgent care is particularly good in this regard. We are NOT suffering from a third-world, Socialist system. So kindly stop perpetrating that bullshit when you have no experience in it.

    If you ever travel to the UK, and are ever sick there, you will have just cause to be grateful for the NHS, and your tune may change. In the meantime, admit your ignorance and remain silent on what you know nothing about.

  39. #39 Tom Rooney
    August 30, 2009

    #18

    In short, and you folks across the pond can call us all the names you want, WE DON’T WANT SOCIALIZED MEDICINE, and Obama and all his arrogant minions don’t seem to want to listen.

    Yeah, we want to get rid of Medicare, the Veterans Health Administration, and we want to start paying taxes on the fraction of our health insurance premiums paid by our employer and we want to start paying taxes on prescriptions and medical costs. ‘Cause otherwise its SOCIALISM, which is bad.

  40. #40 Tom
    August 30, 2009

    WE DON’T WANT SOCIALIZED MEDICINE, and Obama and all his arrogant minions don’t seem to want to listen.

    The August 2009 poll conducted by The AARP, National Journal and Penn, Schoen & Berland shows strong support for universal health coverage–86 percent, including 93% of Democrats, 87% of Independents, and 78% of Republicans.

    Your “we” is little more than a shrill after school club.

  41. #41 becca
    August 30, 2009

    “Another instance of this is the pregnant mother who fakes labor just to get the boyfriend to come home”
    Wow, that works?
    As a recently-pregnant woman who didn’t ask her boyfriend to leave the lab until she got to the hospital and found out she was 6cm dialated, I’d have as much right as any human being to be mad at women who did what you accuse. And I still don’t give a fuck. You are a petty, ridiculous, vile, inhumane monster to use that as a reason to argue that people don’t deserve healthcare.

  42. #42 Veltyen
    August 30, 2009

    http://www.nationmaster.com/graph/imm_imm_pop_imm_as_per_of_sta_pop-immigrant-population-immigrants-percentage-state

    I love nationmaster.

    USA is #40. Note that this is all immigration – not just “those damn illegals” as I suspect that many places in the world don’t make that differentiation.

  43. #43 George
    August 31, 2009

    Interesting how you pivot from requiring individuals to purchase health insurance (bad idea IMHO), to everyone paying a small tax so that everyone could be covered by the government (good idea, IMHO).

  44. #44 Chip
    August 31, 2009

    It’s called personal responsibility. After I finished my MS, I was able to purchase a low-cost insurance plan through my University’s alumni foundation that covered major medical and catastrophic injury expenses. Most people (especially us young folks) don’t plan to get shot, get in a traffic accident, etc. That’s what the insurance is for. It’s sounds callous, but she should have purchased a similar plan (and so should every transitioning college grad). It’s part of becoming a responsible adult.

  45. #45 Cylinsier
    August 31, 2009

    A-fucking-men, Zuska.

  46. #46 Laura
    August 31, 2009

    Sure, Chip. My son has a congenital condition and his medication can run $200,000/year. He’s reaching that post-college age, and can’t purchase insurance for his pre-existing for all the tea in China. Where does “personal responsibility” come into it for him?

    According the the US insurers, he can just curl up and die.

    You and your cronies are beyond disgusting.

  47. #47 Laura
    August 31, 2009

    I meant “according to the US insurers.” Sorry for the typo. It happens when I’m mad.

  48. #48 ABM
    August 31, 2009

    “If the car wash doesn’t cover it, I’m sure a lot in the blogosphere would like to contribute. The feminist blogs I read covered this incident extensively, and I’m sure a lot of people would like to help.”

    And this points out the problem. What if that uninsured shooting victim wasn’t a young woman shot by a misogynist, but a grumpy, sexist, racist old man with no friends who didn’t attend church and was generally unliked by all his neighbours? He doesn’t get helped out because of who he is? I doubt the feminists or the Presbyterians or whoever would be setting up a car wash to pay his bills.

    An actual social safety net only cares that you are a citizen. That’s pretty important.

  49. #49 Chip
    August 31, 2009

    Laura – save the drama. The person in question was apparently young & healthy, at least healthy enough to be at the gym working out. Sure, she didn’t plan to be shot. Just like folks don’t plan to get into a car accident on the way home from work or have their home destroyed by a storm. That’s what insurance is for, to cover your ass in the event of major unforeseen losses.

    As for your situation, and the health care system in general, I don’t think anyone would disagree that our current system is in need of some major reforms. The debate just comes in how to go about doing that. I would agree that we need some sort of safety net to assist those who are unable to provide for their own care (such as in the case of your son), However – healthy young folks should purchase some sort of major medical plan to cover them during transitions between college/jobs. These plans are widely available and are relatively inexpensive, and in the unlikely event of a tragic accident, you wouldn’t be left stuck pulling yourself out from under a mountain of debt.

  50. #50 Carl n Minnetonka
    August 31, 2009

    What about capitalism?

    Most industrialized countries are capitalist systems. The United States is the only one without a universal / single-payer healthcare system.

    Why? Most countries employ the economic concept of utility to insure they have a strong economy and country. Utility, involves providing those services necessary for people and business to function optimally for the betterment of the country, its people and economy, as they go hand in hand.

    Utility, which some call socialism by confusing politics and economics, includes roads and bridges, electric, water and sewage systems, police and fire departments, a military, customs and immigration, inspectors and regulators, etc. The United States employes utility or “socialism” if you insist, but again is the only industrialized nation that ignores the ecomonic utility of healthcare, and it shows in the GDP.

    There is only so much money in an economy, and all the money is spent somewhere. It is measured as the Gross Domestic Product.

    The United States spends a staggering 17 percent of its GDP on providing healthcare, while the rest of the industrialized world spends around 10 percent. A single-payer system here could free 7 percent of economic might for use in other segments of our depressed economy.

    By the metrics, our spending 70 percent more on healthcare than our chief global competitors isn’t providing a very good return, unless you are running an HMO. We are paying more and as a people are getting much less in healthcare and other economic benefit.

    Capitalism and healthcare don’t mix.

    Captialism is intended to provide efficiency in markets. If more than 20 percent of your poeple don’t have healthcare and you are paying double for it than your competitors, it is not only inefficient, it is stupid.

    Having a profit-driven healthcare system, even without the incentive to not pay claims for higher profits isn’t efficent. Putting greed between healthcare and a person is immoral. Does capitalism have to be immoral to be profitable? I would hope not, but it sure has become that way.

    Are we getting our monies worth with the current system? It depends on which system you are in. We have more than one.

    So, how much do we get back for what we pay in?

    Efficiency in healthcare delivery systems is measured by the medical loss ratio ratio (MLR). The MLR ratio tells us how much of each dollar is paying for losses–healthcare, and how much is overhead (administration, non-healthcare related expenses, and profit).

    Medicare, Medicaid and the VA have an MLR of about 97 percent, meaning 97 cents out of a dollar goes for healthcare and three cents is absorbed by overhead.

    HMO’s have an MLR of about 80 percent, meaning their overhead is 20 percent, most of which is profit going to Wall Street and the HMO management.

    Today’s cooperative healthplans, like the Mayo Clinic, have a MLR of around 91 percent.

    Single-Payer makes economic sense, besides being the moral choice.

    An equitable and efficient use of the country’s capital begs for a single payer system.

    Efficiencies of single-payer extend beyond paying less for the healthcare we get. Its efficiency would naturally be applied as it is in other countries to workers’ compensation insurance and medical malpractice insurance. It would remove the bureaucratic nightmare of insurers standing in the way of healthcare for injured workers and reduce litigation, bringing down overall costs.

    Single-Payer also enables entrepenuers and small businesses (Main Street) to better compete with the corporations (Wall Street). Changes in laws over the last 25 years have put more and more of our eggs in Wall Street. Less regulation has led to Risk-Free Capitalism with the introduction of TARP (the Wall Street bailout plan implemented by Bush-Paulson=Bernake), and that I call socialism for the wealthy.

  51. #51 lawl
    August 31, 2009

    Chip, you’re wrong. First of all, “relatively inexpensive” is a crock. Second of all, not pulling oneself “out from under a mountain of debt” is also wrong. I broke my arm while I had insurance through my employer. Through various “discount” schemes and what not I ended up paying over $2000 out of pocket (over 30% of total cost) instead of what the insurance policy claims (10% after deductable). If that weren’t bad enough, it turns out that I would have ended up ahead if my employer paid money to me instead of to the insurance company. That’s just 2 years of employment and still the insurance company was ahead after preventative care AND a broken arm.

    Your willingness to ignore the fact that virtually every other developed nation has solved this problem with govt healthcare is very sad. Why don’t you take 5 minutes to look at which organizations give the biggest donations to GOP congressmen? Idiot.

  52. #52 Carol
    August 31, 2009

    Chip: Many “apparently young & healthy” people CANNOT get insurance. When I was at that stage of my life I *was* young & healthy, but still struggled to pay for the most minimal regular coverage. My husband and I worked part-time, temp and contract work, and we never knew if we’d have to borrow money to make rent – there was no slack, and we did go uninsured for at least a year once. Meanwhile, several of our friends had already been told they were “uninsurable” in the individual-plan market at that time, due to diabetes, arthritis, etc – even though they were up, walking around, and working jobs – just crappy jobs like me and my husband had, that didn’t offer group benefits.

    You cannot say that any random person walking down the street is free of a “pre-existing condition”.

    One of my employees at the company I ran was an insulin-dependent diabetic. When I started a group plan for us, that was the first time he’d been able to get on insurance since he’d left the military years before. He was “apparently young & healthy” too.

    Use your brain a little.

  53. #53 Laura
    August 31, 2009

    Sure, Chip – I’ve seen those policies. Lure people in with low premiums, and until they have a problem, they won’t realize that there’s a cap on what they’ll pay for xrays, a cap on days in hospital, a cap on “usual and customary” doctor fees (which somehow are never anywhere near the amount of the fee actually charged)….

    Not to mention that in a case such as that of the young woman who was shot, they’ll probably argue that the perpetrator is responsible for the bills, and refuse to pay.

    So any healthy young person with a low-paying job and minimal discretionary income looking at at, say, a $5000 deductible which they can’t hope to pay anyway, is certainly justified in thinking that the insurance is a waste of money they don’t have.

    As for my “drama:” Thanks loads for admitting that “our current system is in need of some major reforms.” But it’s self-righteous, self-satisfied individuals such as yourself that have kept us waiting for it since my son was an infant. And right now he can’t afford to wait much longer.

  54. #54 jc
    August 31, 2009

    ABM@48:”He doesn’t get helped out because of who he is? I doubt the feminists or the Presbyterians or whoever would be setting up a car wash to pay his bills.”

    AHAHAHAHAHAH! WHATABOUTTHEMENZZZZZZZZZZZZZZZZZZZZZZZZZ!!
    You get the d00d prize. One bucket of puke, coming right up!

  55. #55 Charlotte
    August 31, 2009

    Chip @49 – *sigh*. For many, many pre-existing chronic health complaints, going to the gym and eating properly are the best possible things a responsible person can do for their health. I don’t know what this particular young woman’s situation was, but neither do you.

    I’m in the UK, and the car wash thing seems similar to the situation with some of the ‘Donors Choose’ education projects to me. Taxes in the US are lower, but many people are left without access to basic services. The costs, for the lucky, are paid by friends, relatives, and middle class folk like you tend to find on Scienceblogs, whilst most of the wealthy are cushioned from these problems. It’s an indirect tax on the soft-hearted and those who can’t easily afford it.

  56. #56 Steve
    August 31, 2009

    Maybe if this girl had exercised personal responsibility through getting an education and taking care of her body, she wouldn’t have had to force hard-working responsible citizens to submit to her socialist charity.

  57. #57 Jay_C
    August 31, 2009

    I’m glad your sister was not hurt in the attack Zuska. It goes without saying that this was a horribly sick sub-human that did this…
    The woman that the carwash is being held for aged out, and either chose not to buy insurance (she instead chose to pay to join a gym)…That is common. Or she had a preexisting condition. In the first situation, sometimes you roll the dice and the numbers aren’t in your favor. In this specific case, I’d rather give her the money through personal through a car wash, or just through good old fashioned charity (get nothing in return), than through my money being wasted on a Government bureaucracy. At least I know my hard-earned money is going directly to the victim I want it to and not in the “big bucket” for everyone else, and I can’t choose who it goes to. In fact, here at work one of the workers in our building had a kid that was in a horrible car accident, the family had insurance, but needed a little extra to pick up the remainder. Complete strangers gave to the cause.
    As far as the latter situation, you are right, there are *some* folks that do need assistance (pre-existing conditions, can’t afford it even though working hard AND it’s not offered at work, disabled and can’t work) That being said, that number is not anywhere near 45-50,000,000 people. Where are they getting these numbers? As for the rest of us,(you know the majority that don’t fall into these relatively uncommon buckets) personally I am happy with my plan and don’t want to have to join a plan that has to meet ahem, “government quality criteria”. The health care reform plan moving through the House essentially outlaws the private individual medical insurance market. On Page 16 of the House’s 1,018-page reform legislation, the bill states that once the bill became law, insurers would no longer be permitted to sell new private individual coverage. Insurance companies that wish to stay in business will have to operate in the government’s health care exchange. But the exchange will not be a private market. It will be a program in which Americans can buy individual plans from private companies in competition with the public option provision that will provide taxpayer-subsidized coverage.
    But that’s only part of the story. The exchange will be a highly regulated clearinghouse of providers that meet the government’s standards. Only those providers that follow Washington’s stringent guidelines will be allowed to operate effectively putting all the others out of business. The government, through an unelected health choices commissioner, will set premiums, dictate benefits, determine deductibles and establish coverage. Exchange participants will be required to insure anyone who asks to be covered and to accept all renewals. In effect what you will have is total government control of the medical system.

  58. #58 Laura
    August 31, 2009

    Jay_C: You say that you don’t want your money “wasted” on a government bureaucracy.

    However, if you now have insurance (which you say you are happy with) you are “wasting” about 30% of your premium on a private bureaucracy whose cost in the next few years is GUARANTEED to escalate to the point where you may not be so happy.

    No one is outlawing the private insurance market (though in my opinion, they deserve to be outlawed). They are simply being required to stop their discriminatory practices. The government’s “stringent guidelines” which you dislike so much may very well keep you from having your coverage, ahem, dropped if you’re stupid enough to get, say, cancer.

    You say you don’t like an “unelected health choices commissioner”? Who do think elected the bureaucrats in your insurance company who are making health choices for you right now?

    And what, exactly, is wrong with providing insurance to anyone who wants insurance and accepting all renewals? Would you prefer that the insurance companies can choose to not renew you if you become sick? Or would you prefer that the government be the one to provide insurance only to those people that the insurance companies don’t want, thereby subsidizing the companies by letting them cherry-pick the less expensive patients and dumping them on the government when they become less lucrative?

  59. #59 Rosie
    September 1, 2009

    This has only come to my attention today , I had heard nothing of this here in the UK . I would like you all to know that YES our health service may be flawed , tell me how something that big would not have problems . But . There is no way that anyone is refused treatment and told to go away and die . From personal experience I know that our doctors in the main are the best in the world and cannot understand how so many of your citizens can be so selfish as to refuse to contribute a small percentage of their income for the common good . I just hope that those people never need help that they cannot afford

  60. #60 Judith
    September 1, 2009

    There are sure a lot of comments, and I did not have time to read them all, so maybe this has been brought up already. I am responding specifically to the problem of the victim not having health insurance. In New Mexico they have a fund for victims of crime, and it can be used in any way the victim wishes. We had a 92 yr. old woman who had been raped,a horrendous crime. She had as part of the Victims Crime Bill over eighty thousand dollars to help with care. The woman was on Medicare so they likely paid the hospitalization. The woman injured in the shooting at the health club might get something similar under the law in Pennsylvania. Seems that would have been brought to her attention, but since so many injured the criminal law staff who apply such monies may not have talked with her yet. Hope she fnds some relief in the victims funds. Just a thought I hope might help.

  61. #61 Jay_C
    September 2, 2009

    Laura, first, who is to say that it won’t be worse under a Government plan (not just tax-wise, but quality-wise as well) at least we know what we have now. Second, that is part of the reform that I am on board with. Finding ways to cause premiums to go down in the current private system, I agree they premiums are high, but they are not GUARANTEED to escalate if we reform the current system (not re-invent the wheel), and the alternative in my opinion is not worth it.
    No, I don’t want an “unelected health choices commissioner”, and without question if they are working for the Government! That is the difference between private industry and the government, the private industry is there to make a profit, to make shareholders and customers happy. Anyone that works for a private business is unelected (unless elected by the board). But the balance between weather their customer base is happy AND weather they turn a profit are what determine whether they stay there or not. In government, they can do a bad job, and still get a raise. (Especially if they are not elected, and therefore unaccountable to the citizens.
    As far as your questions to me about providing insurance to anyone who wants insurance and accepting all renewals? I already addressed those points above, (you just either didn’t see those points or choose not to address my arguments as you have no response that would further your monolithic view of “Healthcare for all”. Reform is needed for sure, but not a complete “reboot” of the system. We have an existing structure, let’s reform it, and not throw the baby out with the bathwater.

  62. #62 Laura
    September 2, 2009

    I’m sorry I can’t answer all your arguments, since they are so convoluted that I can’t tell where to begin. But I’ll try a few.

    Suffice to say that the people screaming the loudest about “we want to reform health insurance, but not your way” are the ones who were in power for the past 8 years (12, if you consider control of Congress) and somehow couldn’t be bothered to take the trouble to reform anything.

    And “who is to say that it won’t be worse under a Government plan”? Just look at Medicare, which is a government plan. Overall, it’s subscribers are a lot happier with it than the rest of the population is with their private plans (or lack of one).

    And though I DID read your arguments above, I can’t see where you addressed the points about providing insurance to anyone who wants it and accepting all renewals, because it seemed that you were arguing AGAINST legislating those provisions. Perhaps your lack of coherent writing reflects a lack of coherent thought processes.

    And it’s laughable to say that people in government can do a bad job and still get a raise, but people in private industry can’t. What about all those CEOs who drove their investment firms into the ground while taking home multi-million dollar bonuses? And are you trying to tell me that if I don’t like my insurance company because they denied me coverage for something I thought should be covered that I can pick up and go to another company? PUH-LEEZE! As though in that situation I could find another company to cover me! Not to mention now I have the dreaded pre-existing condition!

    “We have an existing structure”? No, we don’t. We have a crazy quilt of private insurance companies, each with their own rules, that exist to deny care, rather than provide it.

    I’ve worked for years as a physician both in the US and Canada, and I’ll take Canada any day, as will all the Canadians I’ve dealt with. They look at the lies being told about the Canadian system in the US media, and think we’ve all lost our minds. Tommy Douglas, who was responsible for implementing universal healthcare in Canada, was thought to be the greatest Canadian of all time according to according to a 2004 Canadian Broadcasting Corp. poll. If you go to
    http://www.youtube.com/watch?v=gqpFm7zAK90
    it will give you an interesting perspective on the process.

  63. #63 Jay_C
    September 3, 2009

    Thanks for the personal Jab regarding my “convoluted arguments”, It is well know that in debat that those with limited facts tend to resort to such tactics.
    You still fail to notice that I want reform Laura. Just because you repeat the meme the last administration didn’t “do anything about it” doesn’t mean there aren’t those with legitimate concerns that were not on board with many of the last administrations plans. (I’m a Libertarian, not a Republican). Just in case you meant go down the Republican / Democrat road. Let’s nip that argument path in the bud right away.
    You say “Just look at Medicare, which is a government plan”. Sure, overall, its subscribers are a lot happier”. And that may be true, but it doesn’t excuse how broken Medicare is financially. It is a fiscal disaster. Especially in these times.
    Again, I’ll keep it simple; here is where I addressed the points about providing insurance to anyone who wants it and accepting all renewals. I said reform is needed, but not under the current plan. This is one of those areas that need reform, I agree. Clear enough?
    You said “it’s laughable to say that people in government can do a bad job and still get a raise, but people in private industry can’t”. No, I didn’t say that. I said the former, not the latter. Private industry does the “same thing” all the time (Look at GM, etc.) via the government rescues we just had, in fact, the government (once again) enabled their bad behavior. You asked “what about all those CEOs who drove their investment firms into the ground while taking home multi-million dollar bonuses?” You provide a perfect example of what I just said. Obama and his administration once again enabled those “investment firms” bad behavior. My point being that if Government took themselves out of the dealings of GM, investment firms, etc, then the free market principles I mentioned in my previous post would be able to work as they should: (the balance between weather their customer base is happy AND weather they turn a profit are what determine whether they (the executives) stay in power or not. It is all based on performance (if the free market is allowed to function as it should, and businesses are allowed to fail).
    In government, (and now, apparently if you are a big enough business, they can do a bad job, and still get a raise.)
    No, I’m not telling you that if you don’t like your insurance company because they denied you coverage for something you thought should be covered that you can pick up and go to another company? Again, another area that needs to be worked on in the current system. (why will you not concede that I am not totally against reform?)
    You said, we don’ have an existing structure? Yes we do, you can call it a “crazy quilt of private insurance companies”, each with their own rules that exist to deny care, rather than provide it. But I still hold that there are areas that can be reformed. “Quilts” can be repaired.
    Thank you for your service as a physician. Your opinion is noted, but…Britain and Canada control costs in a certain way: They set budgets for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to push off elective surgeries to a lower priority level. A 2001 survey by the policy journal “Health Affairs” found that 38% of British and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%.
    So Americans will continue to brag that no one waits, and Canadians and Britons will continue to brag that no one goes without. Somewhere in the middle is the happy medium. We should shoot for “the perfect”, but we can’t get there by rushing through multi-thousand page bills that nobody reads. Let’s take what is good about what we currently have, and build upon it, methodically, thoughtfully taking stock in fiscal responsibility while at the same time trying to get the most bang for our buck. That requires time, and transparency with an eye on hawk-eye on budgets. Most American voters believe that reform can happen without a public option.

  64. #64 Jay_C
    September 3, 2009

    sorry for the typos in the last post, forgot to spellcheck. (not sorry for the substance) :)

    To add to what I wrote above…Free market prices are flexible, negotiable, and respond to consumer choice. Prices set by the government are inflexible, non-negotiable, and respond only to lobbying, or to the whims of the government bureaucrats who set the prices or do the rationing. Free market prices send signals to produce more or less of things, according to consumer demands. By comparison, government rationing only reflects what the politicians want.
    Healthcare responds to free market prices, or to government dictates, in exactly the same way as all other goods and services.

    Americans have won 11 Nobel Prizes in Medicine in the last 10 years, 26 in the last 20 years, and 39 in the last 30 years. No other country even comes close to this. What’s left of free-market pricing in America is keeping the health care of the entire world afloat. Healthcare procedures not covered by government programs, or by government-distorted insurance policies, show us that true free market pricing could give us ever-improving care at ever-lower prices (which is part of the reform I am for!). In addition, in a free market, if you can’t afford the cost of a treatment, and can’t find a cheaper alternative that’s nearly as good, your doctors may decide to lower the cost, or even provide the treatment pro bono. But will doctors be as flexible and generous when healthcare decisions are dictated by the federal Comparative Effectiveness Board, and there are fewer doctors seeing more patients because prices no longer reflect market realities? If free market prices are really the same as government rationing, then why have societies run by government rationing and price fixing always had shortages and long lines? Why did the Soviet Union fail? Why did the post-WWII German Economic Miracle begin precisely when the German authorities abandoned government rationing, over the protests of the occupying powers? It’s a simple fact: human beings have experimented with government rationing and price-fixing over and over again, always getting the same catastrophic results.

  65. #65 Laura
    September 4, 2009

    I’m sorry, but it’s getting a little tedious arguing with someone who continuously presents faulty assumptions and nonsensical nonsequiturs as facts.

    For example, “Obama and his administration once again enabled those “investment firms” bad behavior.” Umm, no; their bad behavior was enabled by lack of regulations; the CEOs took home their obscene bonuses while their companies were going down the drain BEFORE government had anything to do with anything. They would have kept their millions even if the companies had failed. And, by the way, they were bailed out BEFORE the 2008 election, not to mention before the 2009 inauguration. I suspect Obamaphobia here.

    For another example: If government “rationing and price-fixing” … “always” gets “catastrophic results” then why is it that all the industrialized nations except the US manage to provide healthcare to their citizens with better results than the US?

    Then we have: “Americans have won 11 Nobel Prizes in Medicine in the last 10 years, 26 in the last 20 years, and 39 in the last 30 years.” Nobel prizewinners do not work in the free market; they work for educational institutions, usually funded by government grants.

    And “What’s left of free-market pricing in America is keeping the health care of the entire world afloat.” Huh?

    Sorry, but I have a day job, and can’t continue this exercise.

    Let’s cut the crap and put it this way:

    System #1: When I worked in the US, patients would come in and present their insurance cards; we would call the insurance company and wait on hold for 30 minutes (if we didn’t get disconnected) to verify that they had officially chosen me as their primary care physician. They might pay a copay, or they might pay a percentage of the fee, for which they would be billed after the insurance had done its part. I had to write notes that described a certain number of body parts, or a certain number of aspects of a particular body part, or a certain number of descriptive terms for the symptoms of the one or more body parts, all of which would be added up to determine how much the visit was worth. The bill would go to my billing service which took 8% of receipts, since the hardware and software for electronic billing with dozens of different boxes to be filled in, but filled in differently for each of the dozens of different insurance plans which my office participated in, was too onerous to be handled by a solo practice. Then the “explanation of benefits” would arrive, and I might be told that the insurance had paid, say 80% of the charge that the insurance said they would pay (as opposed to 80% of the charge I was actually charging), and I had to bill the patient for the 20% which, even though it might at this point cost more in staff time and postage to send the bill than the bill was worth, had to be done or I would be accused of fraud, since not billing the balance would mean that my charges weren’t really what I said they were, although the insurance wasn’t paying what I said the charges were anyway. Or maybe the insurance company would say that they wouldn’t pay because it was a pre-existing condition, or it wasn’t a covered benefit, or we hadn’t received prior authorization. Or they might want copies of the records before they would decide whether to pay. Or they might decide that I was no longer one of their participating providers, and the patient would have to go find another doctor, and I would have to copy the chart to send to the new doctor, for which I would not be paid. If I needed to send the patient to a specialist, we would have to look up which specialist were participating providers for that particular insurance, and get prior authorization. Certain tests also required prior authorization. All of this required hours on the phone. And sometimes the specialist would be a participating provider, but the specialist would be in a non-participating hospital, or would send the patient for xrays which ended up being read by a non-participating radiologist, or sometime the radiologist was participating but the xray machine was not.

    And then there were the patients who did not have insurance.

    System #2: Now I work in British Columbia, where everyone has a “care card.” When they come in, we take down the number on the care card. I can send the patient to any specialist. There is one form to fill out for billing, and the fees are negotiated between the government and the medical society. There are no copays, no deductibles, no percents. I don’t have to employ an army of people to sit on hold with insurance companies.

    And everyone is insured.

    And you’re telling me that tinkering with System #1 (let’s make it MORE complicated!) is preferable to System #2.

    Right.

  66. #66 Jay_C
    September 4, 2009

    I’m just answering all your questions Laura… (far be it for you to do the same for me, It looks as though you’ve been out cherry-picking my statements you THINK have an answer too, and forgetting the rest. If you need to stop debating, I’ll take the concession from you, thanks!
    You said, “Umm, no; their bad behavior was enabled by lack of regulations; the CEOs took home their obscene bonuses while their companies were going down the drain BEFORE government had anything to do with anything. “
    Do you even know what “enabling” means Laura?  Don’t get me wrong, the private companies did plenty wrong, but handing them big fat checks, with my money (yes, I have a job too Laura) to “fill up their coffers” as I see it, is enabling them. I’m sure most reasonable people would agree with me on that one.
    Second, you said.. if government “rationing and price-fixing” … “always” gets “catastrophic results” then why is it that all the industrialized nations except the US manage to provide healthcare to their citizens with better results than the US?
    Do you really mean to tell me that we don’t provide healthcare to our citizens with better results than the rest of the world? I’m not sure what your definition of “better” is, but, I’ll put one example out there (there are many in my opinion).. Outcomes for Breast Cancer Mortality rates. Seems like a biggie to me. Take a look at snippets from an article below, I cut out some info on Japan since we are comparing Canada and the US specifically and I cut out some other irrelevant…
    “Researchers found that USA has the best score with 5 years of survival rate for breast cancer at 83.9% and prostate cancer at 91.9%. …
    …UK reported 69.7% survival rate for breast cancer, 40% for colon and rectal cancers for both for men and women, and 51.1% for prostate cancer. Rates varied significantly for different regions in UK.
    Canada and Australia reported significantly high rates for almost all cancers……
    Researchers suggest that such a huge difference in cancer survival rates depends upon access to health care. Most countries have necessary means to detect cancers and time and provide with proper treatment, but not all patients are able to pay for diagnosis and treatment. “
    Just in case you accuse me of taking things out of context or something, Here is the full article:
    http://www.emaxhealth.com/51/23285.html
    Then you said…Then we have: “Americans have won 11 Nobel Prizes in Medicine in the last 10 years, 26 in the last 20 years, and 39 in the last 30 years.” Nobel prizewinners do not work in the free market; they work for educational institutions, usually funded by government grants.
    But which country? The US… I never said I was against government grants for research. You forget (yet again) that private businesses (business and citizens taxes are the ones that GIVE THEM the money to do their research through the government…) If we are so “backwards” in our thinking in the US, then how is it that we generate such wonderful medical scientists? That’s what I mean by “what’s left of free-market pricing in America is keeping the health care of the entire world afloat.”
    Giving me you take on your personal experiences in “system 1” and “system 2” is fine Laura, but cannot be confirmed. Let’s work with facts that can be knowable, Ok?
    But…I read both system 1 and 2, and after all your rambling you’re just telling me that system 2 is “easier” so we should do it that way. NOTHING that is worth doing right is “easy” And throwing money at a government program is the “easy way out”.

  67. #67 Brian
    September 4, 2009

    @54 jc:
    Uh… perhaps you and I read ABM’s comment differently, but I do not think ABM was saying what you think ABM was saying. Just saying.

  68. #68 jc
    September 4, 2009

    Brian, the inquiring mind wanted to know if the situation were **reversed** to a: scumbag male getting shot up by another scumbag male. Um, yeah, I got it, loud and clear. WATM.

  69. #69 Julie Stahlhut
    September 4, 2009

    About six years ago, I had major surgery to correct a chronic pain problem. The condition was tentatively diagnosed in November of 2002. I was referred to a specialist who saw me a month later. A month and a half after that, I had a diagnostic procedure done in a hospital. Two weeks after that, I had an invasive test done to determine whether I needed additional preparation for surgery. While all of this was going on, I called another specialist’s office for a second opinion. I knew this specialist personally, and she had encouraged me to call for an appointment. When I called (in early February) her staff said they might be able to squeeze me in some time in August. So I went ahead and had the surgery, in March of 2003, three and a half months after the initial diagnosis.

    This all happened in a city in Michigan that has a medical-school campus, two teaching hospitals, and lots and lots of physicians and surgeons. I had private medical insurance at the time.

    This is NOT AT ALL UNUSUAL in the U.S. — it’s an artifact of physicians’ schedules, among other things. My mother has had similar experiences in a city in New England. Twenty years earlier, it took me nearly two months to schedule an inpatient dental surgery in Boston. I’ve had the opposite experience when I needed minor surgery in my current city in western New York (had something scheduled within two weeks) but the point is, there’s a HUGE spread in the amount of time it can take to schedule non-emergency surgery in the U.S., even if you have insurance. (Which I’ve always carried, as has my mother.)

    So why are people trying to panic us with the idea that it might take a few months to schedule a knee replacement in Canada or the U.K? It’s not all that different here!

  70. #70 J.
    September 4, 2009

    Ha ha. Awesome. Thanks for this.

    I’m one of those same young folks in the transition period after being kicked off my dad’s insurance. I’m working full time (though, according to conservatives, I must be a lazy bum if I don’t have insurance) through a temp agency that pockets extra money by not providing benefits to employees. I’m lucky enough to be in a state with a pretty good (though still slightly expensive) state plan that I just joined.

    ‘Cause, you know, random shit that happens and isn’t even my fault or responsibility is still my responsibility.

  71. #71 Charlotte
    September 5, 2009

    Jay_C, cancer survival rates aren’t necessarily a good metric. While the UK could clearly improve, some of the high rates in the US are driven by high rates of testing, which isn’t always justified by the scientific evidence. Prostate cancer, for instance, is usually slow to develop, so if it’s detected early then 5-year survival rates are going to be extremely high. OTOH lots of people are going to have the test when they’re negative, and some are going to have unpleasant treatment for tumours that would never develop to the stage where they’d cause problems.

    On most measures, including life expectancy and maternal and infant mortality the US’s record is abysmal – especially given your expenditure. I leave it as an exercise for the reader to count how many of the countries that rank above the US have universal health care.

  72. #72 Brian
    September 5, 2009

    @jc

    Well, yeah, but no. It was certainly not a whine about the plight of men in an imaginary parallel situation. At least, not that I read. Rather, ABM’s point seemed to me that while it is fortunate that the victim in question has a support network that may, at least in part, help, the problem with the current system in the U.S. is that such support cannot be counted on for all. To wit, a reprehensible d00d. Recognizing that is not at all to minimize the tragedy/travesty of the young woman who was shot. It seems a particularly churlish move on your part to baselessly mock ABM so.

    If I read ABM right, the only sensible solution is one that provides a social “safety net” for all, regardless of sex, attitude, etc. The only thing that should matter is that one is a citizen.

    Not sure what WATM means.

  73. #73 Jay_C
    September 6, 2009

    Thanks for the thoughtful response Charlotte (unlike some others here). I all but conceded that I may have picked a bad example, not being a doctor, I just picked a medical problem that seemed prevalent / important to people around me.

    You said “Prostate cancer, for instance, is usually slow to develop, so if it’s detected early then 5-year survival rates are going to be extremely high. OTOH lots of people are going to have the test when they’re negative, and some are going to have unpleasant treatment for tumors that would never develop to the stage where they’d cause problems.

    That’s the rub, isn’t it…. I know that doesn’t keep costs down (which I concede is a problem), but without a better way to keep the statistics just as positive as they are now in the United States, what other suggestions does the world have? I really don’t see any.. If we simply just “cut down on the frequency of tests”, or “force them to magically be cheaper” the statistics would start to get worse, as quality of care would decrease.

    As far as what you say regarding life expectancy and maternal and infant mortality. I hear that arguemnt a lot..

    Would you agree that any medical problem we bring up here should contain an actual interaction with the health care system, it should measure something that the health care system can actually affect and finally, the statistic should be collected consistently across countries?

    The first part, one should have contact with a health care professional, be it a doctor, nurse, lab technician, etc. A stat measuring the rate of cancer survival satisfies this, since diagnosis and treatment of cancer requires health care professionals. OTOH, a stat measuring for example, the rate of car accidents would not work as a criteria since health care professionals are not essential to identifying car accidents.

    For the second part, Some stats assume interaction with the health care system, but the problems they measure are not ones on which the health care system can have any meaningful impact. For example… the rate of “cancer incidence”. This stat assumes interaction with the health care system, however, an “incidence” of cancer cannot be known without the diagnosis of a health care professional, there is little a health care system can do about the rate of cancer. Rather, cancer incidence is affected by factors such as genetics, diet, lifestyle, etc. So, to be a good measure of the effectiveness of a health care system, a stat, I would think, should measure a phenomenon that health care professionals can actually affect.

    Finally, a stat must be collected consistently across countries. This seems simple, but is complicated. Different countries use many definitions of health phenomena. This leads to some countries leaving out a segment of their population from the collection of a stat while other countries add in those types of folks. When this happens, cross-national comparisons are largely meaningless. Therefore, for measures of health care systems across countries to be meaningful, there should be little to no variation in how statistics are collected.

    Life expectancy is not a very good stat for figuring out how good a health care system is, because it fails the first criteria of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die “in their sleep,” in a car accident or of some medical ailment before an ambulance ever arrives. If someone dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic.

    Initially, infant mortality looks to be a good one. It assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility. It also fills the second item of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn. If infant mortality were accepted as an adequate measure based on those two criteria alone, then you are right, the U.S. health care system is one of the least effective in the industrialized world. However, the U.S. follows that definition that “an infant, once it is removed from its mother and then “breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles… is considered live-born regardless of gestational age.”, many other nations do not.

    http://unstats.un.org/unsd/demographic/products/dyb/dyb2002/NotesTab04.pdf

  74. #74 daedalus2u
    September 6, 2009

    JC#73, huh? The major problem the US is facing is tens of millions without health insurance and so with no access to health care and you only want to count adverse effects where there is an interaction with the health care system? To repeat Barney Frank’s question, “on what planet do you spend most of your time?”

    A major determinant of infant mortality is the quality of prenatal care. If the first interaction the mother has with the health care system is when she goes to an emergency room in labor, it is too late to do good prenatal care; too late to give her prenatal vitamins, to late to check for gestational diabetes, Rh incompatibility, and lots of other things.

    The lack of access to prenatal care is a major factor in infant mortality. A day in a neonatal ICU costs a gigantic amount. The best place for a premature infant is still inside their mother’s womb, i.e. for them not to be born prematurely. Denying pregnant women prenatal care increases costs because caring for premature infants costs so much. It also has a worse outcome.

    This is why US health care costs more and has worse outcomes. It is being penny wise and pound foolish. Saving pennies by spending nothing on prevention and lots to fix problems after they happen which results in higher costs and worse outcomes. The reason this happens is because the pennies go to someone who doesn’t pay the cost of the bad outcomes, not the medical costs of the bad outcomes or the bad health consequences of the bad outcomes.

    The only way to fix that is to ensure the cost of the bad outcomes is born by those who pay (or not) for preventative care. That can’t happen now with private insurance because they will dump patients before it does. Then they save the pennies but the big costs are paid by others.

    Single payer fixes that immediately.

  75. #75 daedalus2u
    September 6, 2009

    JC, just to reiterate the flaw in how you want to look at the effectiveness of US health care, if the woman who was the subject of this post didn’t get any care because she didn’t have insurance and died abandoned in the gutter because the ambulance drivers wouldn’t take her without payment, you would say her death shouldn’t “count” as an adverse effect of the health care system because she didn’t have any health care.

  76. #76 Jay_C
    September 6, 2009

    You are missing the point daedalus2u. Life expectancy and infant mortality are inadequate comparative measures for health care systems. Life expectancy is influenced by a host of factors other than a *health care system*, while infant mortality is measured inconsistently across nations. Again, am all for financial reform, and liked Obama’s idea about a system where pribate insurers could compete with ieach other across state lines. but neither of these measures (life expectancy and infant mortality) provides the United States with conclusive guidance on *health care policy*, let alone serve as reliable evidence that a system of universal health care or a single payer option should be implemented in the United States.

  77. #77 Margaret
    September 9, 2009

    I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

    Margaret

    http://cardrawing.net

  78. #78 kiramatalishah
    January 28, 2010

    Often we forget the little guy, the SMB, in our discussions of the comings and goings of the Internet marketing industry. Sure there are times like this when a report surfaces talking about their issues and concerns but, for the most part, we like to talk about big brands and how they do the Internet marketing thing well or not so well.

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