Yes, I know, the two are not mutually exclusive, but I still think it's a good title. The latest bit of evil idiocy? More fanning of fears about health care reform. Don't misunderstand, there's plenty of potential pitfalls to health care reform, but Rush is an idiot. He calls it "Five Freedoms You'll Lose Under Obamacare". Let's see what he's talking about.
I'll let you in on his absurdist intro just for the fun of it:
One of the best points that anybody could make in describing the uniqueness and greatness of this country, do you realize that the history of the world is tyranny? The history of the world is dictatorship. The history of the world is dungeons and torture chambers. That's why this country is so unique.
Multiple Choice:
"Guantanamo isn't a dungeon because:"
A) It isn't underground
B) Cheney says it's really a "Freedom Field"
C) Only bad people are imprisoned
OK, moving on to health care. Rush says of we Americans, "who's going to vote for torture, who's going to vote for tyranny, who's going to vote for dictatorship? But we did. We did. And you see it slowly encroaching. " He's not talking about the Bush administration's suspension of habeus corpus or any such real tyranny. He's talking about the Obama administration---just in case you weren't sure.
Anyway, his list of Five Freedoms is really his riff on a CNN piece, so while the FF's are not unique to him, his analysis certainly is.
Freedom 1: Freedom to choose what's in your plan.
The federal government will impose a minimum list of benefits that each plan is required to offer. ... Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization." Many states require these "standard benefits packages" and they're a major cause for the rise in health care costs along with tort reform.
Of course, that has nothing whatever to do with an individual freedom. Most Americans have no "freedom" to choose what their health plan covers. Most Americans get their health care from their employer or the federal government (Medicare). An employer does not typically give you a choice other than perhaps between an HMO and a fee-for-service plan. This is different from "choosing what's in your plan". Companies offer plans, you choose the plan. Hair transplants are not a commonly covered entity. But there are services that people wish they had but do not, such as coverage for female oral contraceptive pills. Typically, states may impose coverages based on what patients and providers demand. One person's hair transplant is another's dialysis. This is a much more complicated topic than The Great Oversimplifier would have you believe. It's really about rationing.
Freedom 2: Freedom to be rewarded for healthy living, or pay your real costs. That doesn't sound like a freedom at all, but like a benefit. Currently, many health plans offer rewards (such as reduced premiums) to people who quit smoking, check their blood pressure, etc. This is becoming the norm. But what Rush is really upset about is risk-pooling. Insurance works by taking a large number of people, having them all pay into the system, and using that money to pay for the needs of the members. Inevitably, some members will use more services, some less. Insurance doesn't work unless the pool contains lots of healthy people. To allow healthy people to pay significantly less defeats the purpose of insurance.
Freedom 3: Freedom to choose high-deductible coverage. What's that, like freedom to get involuntarily sodomized? High-deductible plans may help drive people to more economically-driven health behaviors, but what it really does is discourage people from seeking preventative and proactive care. (I'm also not sure whether or not any plan that gets passed will forbid this; it may be true, it may not be.) Patients are not economic rational actors. When you're sick, you are irrational. High-deductible plans are idiotic.
Freedom 4: Freedom to keep your existing plan. I don't know how many Americans care whether or not a health care reform bill will preserve this "freedom". Most Americans just want decent coverage, regardless of who provides it. And what does this freedom mean? Let's say a small business, under the new plan, is given a choice between providing coverage to employees or paying an additional tax and letting them go with a public or other private option. That's a market-driven decision. That's capitalism. If private insurers can't keep their overhead down and compete, then that's the way it is.
Freedom 5: Freedom to choose your doctors. This is perhaps the most ridiculous "freedom". First of all, if you're not insured, you can't choose any doctor. And do you know what plan has the most "freedom of choice"? That's right, it's the government plan, Medicare. Any provider can choose to participate in Medicare, and most do. The most restrictive choices are by HMOs provided by employers as part of their "lower tier" insurance (see Freedom 3).
People don't understand health care, and this makes them easy targets for ideologues. Let's face it: Rush Limbaugh, Glenn Beck, Barack Obama---none of these folks is going to have a problem getting care. The rest of us have a horse in this race, and it's time to start paying close attention to the facts.
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Evil.
This was a poll, right?
Dumber that your shoe, especially if you have dumber than average shoes.
I'm surprised that he didn't mention the freedom to keep your grandmother, since the latest meme is that healthcare reform will lead to euthanasia of old people.
May I please be excused from my "freedom to get involuntarily sodomized"?
Are you an American? A real American? Cuz real American's don't just give up their freedoms.
I honestly don't have much stake in the health care debate. Why? Because my major health concern is severe anxiety. Currently, what I get is pretty limited and lousy. Under a government, what I would get is limited and lousy. When it comes to problems with your brain, be they developmental or emotional, our health care system is failing.
Try reading it again with an eye to those who really do have those "freedoms:" large corporations. After all, that's the fundamental unit of American society.
What always floors me is this notion that if we provide medical coverage for everyone, that you're somehow going to "lose" your "freedom of choice". You always have the freedom of choice. If you have the money, you can chose any doctor you want, whether you have insurance or not. If you don't have the money, and you don't have insurance, then you have no choice at all.
But you won't have the freedom to spit on all those losers who don't have any health care options at all. It's not where you are that counts nearly so much as where you are relative to others.
âHigh-deductible plans are idiotic.â
I'd like to seem some evidence for that statement. Especially considering the number of bloggers who work in ER and say they are overwhelmed by patients with no insurance (i.e. no deductible) who come in for colds, minor aches, etc. Making people pay for service would weed out a significant number of people who should be seeing a primary care physician or just waiting a few days for their cold to go away.
I have high deductibles on all of my insurance. $10,000 on health, no dental, no optical, $5,000 on homeowners, $2,000 on my current car, $5,000 on my plane. I save several thousand dollars every year. I've had one major loss on an uninsured car but overall I'm way ahead.
We go to the doctor when we need to. We don't go when we don't need to. If I had a low deductible for the same cost I'd probably go to the doctor more often, but I doubt if I'd be healthier. My teeth would be a bit cleaner since I'd probably go every six months instead of 9 months. I'd do the skin cancer screening a bit more often and I'd probably get a few moles removed 'just in case' they could turn cancerous, but not much would change in my overall health.
With low/no deductible, health care will be rationed on the basis of who is willing to wait the longestâmuch like in the ER waiting room now. With a deductible set high enough to matter, rationing won't be as much of an issue.
I've got anecdotal evidence. I've been on every major service and every major outpatient level of care in the last year. In my limited experience, patients who came to the ER or the OR with catastrophic conditions (IE, MI, stroke, sepsis, osteomyelitis) were more likely to come from the uninsured/self pay population, and the high deductible population.
To be clear, this statement is actually retarded. You need to have absolutely zero knowledge of healthcare to think that this is a coherant argument. Uninsured people don't come to the ER with minor complaints because they have no deductible. They come to the ER with minor complaints because they can't see a PCP, because there are shortages of PCPs and as PCPs are already having a hard time keeping doors open, PCPs generally pick patients who can pay for their services.
Making people pay more makes people use less healthcare services preventatively, this is true. It also makes them more likely to come to the ER with catastrophic complaints.
50 years of 5 4 dollar prescriptions for hypertension and 50 years of PCP and cardiologist appointments is orders of magnitude cheaper than 1 million dollars for 1 year of keeping a CHF patient alive on a LV assist pump.
Ah, so the crux of the matter is that this is about justifying your choices? Well by and large, doctors think your choice is stupid. Deal with it.
And if you had stage 2 hypertension, your deciding to go to the doctors when "you need it" would mean you'd be screwed. hypertension is genreally asymptomatic until you have end organ damage. So a hypertensive who only goes to the doctor when they feel they need it is a hypertensive who dies young, and sufferingg. Also expensively.
And you know how much about medicine? So I should trust your personal doubt because? I hate know-it-alls who think having read a few blogs means they understand medicine, the economy, and the healthcare system all at the same time. It's arrogant as all get-up.
Right now healthcare is rationed by giving it to those with the most money, or most expensive conditions. We don't pay for cheap prescriptions and primary care, we do pay for catastrophic failures that have poor outcomes, and cost alot of money.
I disagree with your assertion that a deductible set high enough will decrease wait time based rationing. Setting a deductible sufficiently high would just mean we don't save money.
The real way to healthcare savings in the long term is primary and secondary prevention stopping people from getting to chronic conditions like end stage hypertension, diabetes, CHF.
JScarry, with low deductibles, people will go to the doctor instead of the ER. The cost of one ER visit is about 25 doctor visits.
That high deductible might seem like no big deal to you, but to someone living paycheck-to-paycheck, it could mean choosing the medical bill, the prescription meds, or the rent.
JScarry - You have a $5000 deductible on your plane? What about your yacht? And your ski chalet? Please tell us more about how your high deductibles are not limiting your ability to get regular botox injections and dental veneers. Ass.
How is calling commenters "idiots" and other names contributing to dialogue on health care reform? When I hear someone using ad hominem, their level of credibility declines.
The Perfect Solution to Senior Health Care
While discussing the upcoming Universal Health Care Program with my sister-in-law the other day, I think we have found the solution. I am sure you have heard the ideas that if you're a senior you need to suck it up and give up the idea that you need any health care. A new hip? Unheard of. We simply can't afford to take care of you anymore. You don't need any medications for your high blood pressure, diabetes, heart problems, etc. Let's take care of the young people. After all, they will be ruling the world very soon.
So here is the solution. When you turn 70, you get a gun and 4 bullets. You are allowed to shoot 2 senators and 2 representatives. Of course, you will be sent to prison where you will get 3 meals a day, a roof over your head and all the health care you need!!! New teeth, great!!! Need glasses, no problem. New hip, knee, kidney, lung, heart? Well bring it on. And who will be paying for all of this. The same government that just told you that you are too old for health care. And, since you are a prisoner, you don't have to pay any income tax.
I really think we have a Perfect Solution!!!
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Don't take it so seriously even though it is the truth. criminals do get better treatment than their victims.
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As for choosing my own doctor, I will continue to do that. When a government or insurance company starts telling you what doctor to see, then it's time to get rid of that entity and replace it with something that offers freedom of choice. I will remain with the doctor I have been going to all my life as long as he is in business. If the government don;t like it they can kindly kiss my hairy white ass.
Remember the HMO nightmare?
My mother had to drive nearly 200 miles to get cancer treatments when she could have gone 43 miles instead. She should have met the creator of that rule and shoved that fat insurance guide up his rich communist ass after beating him with a iron pipe.
Coummunists like that deserve violent agressive tortuous slow painful deaths. If the government brings back those kind of rules, I hope a damned asteroid strikes the democrat headquarters and the White House. Fuck socialism and fuck this communistic health care shit. I hope it burns in hell along with its creators.
Wow. That was so...incoherent. Rebellious not so much, batshit insane, yep.
What a ignorant pile of goat shit.
Rebellious Conservative
Read this: In societies with real healthcare systems (i.e. not the USA) you do not lose your choice of personal physician. S/He costs less to see though. Healthcare costs less in those societies. Healthcare works better in those societies. Comprared with what you have now there is practically no downside.
No communist would have ever come up with HMOs. It would be republicans who came up with HMOs.
Healthcare costs less in those societies. Healthcare works better in those societies.
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Especially when you have to wait three months for a test and another three to six months for a specialist and another three to six months for the siurgery and another 17 weeks for a follow up all to be told in the end "you are not cost effective". go home and die in peace.
Yep, healthcare in socialist countries is wonderful.
I was calling the people who came up with HMOs communists becuase they made all the rules of which doctor you could and could not see - taking away personal choice and freedom. Republicans and democrats? Who cares? They are both crooks, liars, beggars, and whores.
Rebellious/Poltergeist
I'm not clear about your arguments. Your mom went through a nightmare with an HMO and that means you want HMOs, right? Or HMOs are communists so the White House should be destroyed? Or countries with longer life expectancy and more available health care are denying care to sick people? Maybe you should brush up on your rhetorical skills. Dick and Jane books might be useful.
Typical goatfuckery from a brainless Limbaugh talking point doucherocket. He can't even properly repeat what his favorite radio pundits tell him---or are the voices really coming from the radio?
I'm confused, where is that true? For what test? For what operation? Just how many people get told to go home and die?
I'm confused because, the alternative you seem to be espousing is what we do now, a system that means that I've had to tell lots of people to go home and die because they didn't have the right kind of insurance, or because they forgot to tell their insurance company about a visit to a dermatologist for dermatitis, and now they have an expensive condition, the insurance company uses recission to remove them because "the law doesn't force us not too."
Sorry for posting here. Since this was an article on scienceblogs, I thought there would be rational discussion. I guess not.
About as rational as it gets. Noone here is going to call you an idiot without rationally pointing out the error of your ways first. Of course this discussion was more or less rational until a guy with a plane and a high deductible and an Unfriendly Ghost went off the deep end.
Senator Frankin said it all: "Rush Limbaugh is a Big Fat Idiot."
I'm confused, where is that true? "
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Sweden, Finland, Canada, Cuba, Venezuala, U.K. France, Austria, Norway, Australia, China, North Korea, Iran, Iraq, Sudan, South Africa, Latvia, Ireland, Scotland, Russia, Turkey, Libya, Columbia, Nicargua, Brazil, Peru, Switzerland, Poland, Latvia, Spain, Finland, Italy, Greece, California (San Francisco), Massachusetts, etc.
Should I keep going?
People, realize something:
The so called univerals nightmare crap that our dear leader is forcing down our throats is based on a similar sytem that San Fransisco had and it broke the city and the state of California. The so called universal health scare system did not work in massachusetts very well either. it has not worked anywhere it has been tried. What makes you think it will work here? It will bankrupt America and kill senior citizens as well as minorities (Planned Parenthood must have endorsed it).
You think the economy is bad now? Wait til your wages decrease in value and you start paying $20 for a loaf of bread. It's coming. it's inevitable with this bill.
See when I said "where is that true?" I was implying that you don't know what you're talking about, and you don't know anything about wait times in those countries. Perhaps you could back up your assertion.
I realise now that this was too subtle, my most sincere apologies.
Also, I don't really see how you're claiming that universal healthcare hasn't worked in Mass. Nor do I see you giving even a vague reason why the status quo would be better.
Hi, I'm Canadian.
I get to choose my own doctor. I don't tend to go to the doctor for every little ache and pain because I'm not out-of-pocket for the visit. I go once a year for a check-up and again if something really needs attention. Yes, I had to wait a while to get in with a dermatologist once, but it wasn't such a big deal seeing as the time I felt a lump in my breast I was gotten in for a mammogram the same day. When my father was diagnosed with cancer, he was in treatment the same week - and he didn't have to worry about how we were going to pay for it. As it turned out, he and his illness weren't cost-effective at all, but there was never a question whether he would receive treatment, no more than it would be (or less so, methinks when I hear about recission!) in the US.
There is a system of triage here for non-life-threatening surgeries - knee and hip replacements, arthroscopy, etc. There are waiting lists, and those who are in more serious need get put ahead of others, so some people do wait a long time. Less populated regions have longer wait times because of a lack of specialists, but from other posts here, it seems that is a difficulty faced in the US as well.
I don't get the agonizing about "freedom" that goes on when Americans talk about health system reforms. I have every freedom any American has when it comes to health.
And because there will be inevitable comments about overtaxed Canadians, here's our federal Canadian income tax rates:
0%: $0 - $9,600
15%: $9,601 - $35,595
22%: $35,596 - $71,190
26%: $71,191 - $115,739
29%: $115,740+
Now, let us compare federal tax rates for an American:
10%: $0 - $7,300
15%: $7,301 - $29,700
25%: $29701 - $71950
28%: $71951 - $150150
33%: $150151 - $326450
35%: $326450+
They're comparable, and I don't pay for health insurance on top of it all.
JScarry, I also choose a high deductible on my car insurance. Do you really think that's the same as health insurance? I choose whether, how much and how fast to drive, whether I park in dodgy areas or pay more for secure car parks, and so on. All these things are within my control, and in the event of a freak accident my maximum loss is the value of the car.
My health, OTOH, has been crappy enough to keep me out of normal school/work since I was 13, which came completely out of the blue with no warning signs. I'm lucky enough to live in a civilised country where I can see a doctor of my choice, for free, within 48 hours at worst (this isn't quite the case where my parents live actually, their practice is oversubscribed and you usually have to see whoever's available that day. It's a wealthier area than where I've been living). I've had to wait a while for appointments to see consultants, but that's because none of my problems are life-threatening. Anyone with a serious problem normally gets seen quickly, which pushes those of us who can wait a bit further down the queue. Of course, if you're too important to wait to get your bunions removed you can always choose to pay for private care. This is how things work in most of the western world.
There's a lot that could be done better in the UK system, of course there is, but last time I checked the UK still had better life expectancy than the US whilst spending a much smaller %age of our GDP on healthcare.
Semi O/T, if anyone has any refs on the benefits of active management of diabetes/hypertension/long term health conditions, I'd be grateful.
@Poltergeist/sockpuppet: Sorry for double-posting, but just out of interest the CIA World Factbook life expectancy rankings for the countries you listed (after removing the second mentions of Finland and Latvia, and Scotland is part of the UK. And why no mention of Germany or the Netherlands?) -
Sweden 10, Finland 37, Canada 8, Cuba 55, Venezuala 103, U.K. 36, France 9, Austria 27, Norway 24, Australia 7, China 105, North Korea 170, Iran 132, Iraq 144, Sudan 204, South Africa 209, Latvia 119, Ireland 47,
Russia 162, Turkey 122, Libya 57, Columbia 114, Nicargua 128, Brazil 121, Peru 138, Switzerland 11, Poland 75, Spain 23, Italy 19, Greece 26.
US 50. Please note that's worse than everwhere in the western world except Latvia and Poland (EU average rank is 41) and it's not much better than some places in the middle of wars. What was your point?
WhiteCoat Tales @ #10
Actually, a high deductible/low premium catastrophic care strategy is very cost effective -- if you can afford the day-to-day routine expenses out of pocket, they average less than insurance. Which is not surprising since the actuaries know what they're doing and make a profit besides.
The problem comes if you don't have the financial surplus to pay for run-of-the-mill medical on top of your private airplane. Just one $500 surprise can start a cascade of bounced checks, missed payments (with penalties) etc. In which case the differential value of money makes insurance for even minor medical worthwhile.
The whole "socialised medicine" thing is a beat-up. Virtually every advanced economy with a universal health insurance scheme does better for cheaper than the US.
I'm Australian. Our health care system is cheaper than the US, we have longer life expectancies, lower child mortality and our waiting times are much the same as the US. For much cheaper. You can have longish (but not life threatening) waits for *elective* surgery. But anything life threatening and you are in. Of course, if you go to emergency with a cold expect to be seen after the car crash and heart attack victims. And we get to see our own doctors. Remote towns are problematic as we can't convince young doctors to live in the middle of a desert.
Also Denialism blog did a whole series of posts looking at
actual objective data on the performance of "single payer" systems.
UK, Canadian and New Zealand systems
http://scienceblogs.com/denialism/2009/05/what_is_health_care_like_in_th.php
for comparison Australia
http://scienceblogs.com/denialism/2009/05/whats_health_care_like_in_aust.php.
(see the rest of the series too. Very informative)
I think that the answer is C, all of the above: Rush is evil AND dumber than your shoe. No insult to your shoe intended.
Especially when you have to wait three months for a test and another three to six months for a specialist and another three to six months for the siurgery and another 17 weeks for a follow up all to be told in the end "you are not cost effective". go home and die in peace.
A few anecdotes about my experience with insurance companies:
1. Getting tests: If a patient has state medicaid or no insurance, any test can be obtained immediately, no bureaucrat looking over your shoulder. If a patient has insurance, a 1-6 week delay can be expected. If you're lucky. If you're unlucky they'll simply deny a necessary test.
2. Medications: Many insurance companies will not pay for expensive outpatient medications. For example, temodar, which is part of the standard of care treatment for glioblastoma (a particularly nasty form of brain cancer.) In short, the insurance company tells the patient to "go home and die in peace." Oddly enough, it is the drug companies that frequently play the white knight in these cases, offering free or reduced cost drug to patients who can't afford to buy the meds.
3. Delay in referral to specialists: This is a slightly altered event to comply with HIPAA, but...A few weeks ago I got a consult on a patient who, very unusually, had a potentially curable stomach cancer...at least it was potentially curable 7 weeks ago when the consult was sent. Disturbed by the delay, I went to the administrator who handles new patient scheduling and asked what had happened. It turned out that she had received the consult about 6 1/2 weeks ago (I won't pretend that the hospital doesn't have delay of its own) and had been trying since then to get permission from the insurance company to schedule the visit. For a patient with biopsy proven cancer. To an oncologist.
Some days, I'd rather just see only patients without insurance. Ok, so you don't get paid for them, but at least you don't have to deal with the insurance companies looking over your shoulder. By contrast, medicaid and medicare are quite reasonable: they just throw a huge book of guidelines at you and after that stay out of the way.
JScarry/Sockpuppet - Instead of living in a parallel universe populated by Limburgh talking points, why not look at what Charlotte (UK) and 24Fps (Canadian) are actually saying about universal healthcare, since they and I actually use it.
Here in the UK, we spend about 9% of our GDP on health, the US spends closer to 16%, yet everyone is covered (and with lower admin costs). I do have choice (to a large extent) over which GP I'm with, I can go private if I want, I can see the doctor as many times as I need without cost, and drug costs are far less than the US. As Charlotte points out, its not perfect, but it ain't bad.
On the other hand, you want a system which :
Denies you access to healthcare if you can't afford it, or puts you under huge financial pressure if you barely can.
Which greatly increased the chance of having to go to an ER for what should be primary healthcare (thus increasing costs), and turns simple conditions into complex ones.
Which has huge admin costs and actually gives you almost no negotiating power with your provider, despite all the talk of 'choice'.
Which costs you about 50% more in terms of GDP, but actually means that you live shorter lives.
By all means do what you want, but if there was a 'Consumer Report' for healthcare, do you think that the US system would be a best buy? I doubt it.
Obama should do a Matt Santos and just put everyone on Medicare, or at the very least, threaten to unleash Rahm with a baseball bat - with the message that either they will pass healthcare or they'll need it.
@D.C.
Valid point.
I guess I'm playing the percentages game. In an america where the average person has a negative savings rate, I felt that high deductible plans are viable for so few people, yet hyped and advertised as a good idea to to many people, that it would end up deceptively sucking alot of people in.
The problem is, that I'm not concerned about the insurance situation of someone who can afford their own plane - they can obviously afford insurance at that point.
Actually, for the relatively young and healthy (e.g. you or my kids) a high deductible catastrophic plan with a medical savings account is a very good combination. The MSA is tax-deductible and for most the MSA just accumulates beyond the policy deductible. The savings relative to the premiums for higher-end policies will usually pay for the MSA in the first year.
They also totally suck for people with chronic conditions, because they negate the shared-risk aspect for anything but accidents. Those with employer plans -- the ones who are most likely to benefit from high-deductible plans -- are also the ones who get better ones at no extra cost. My employer, for instance, doesn't even offer a legally-qualified high-deductible plan. Annoying, since I'm one of the people who would benefit from one.
Or, as he said, self-insure for minor expenses.
The high-deductible plans are a good deal -- but mostly for people in the upper income ranges like our lawmakers and the people they know. The fact that none of them actually use plans like that because their employers provide even more coverage at no extra cost isn't their problem, now is it?
As for the working stiff whose health insurance costs a quarter of his family's income -- if he weren't such a loser he'd have a better job with good benefits, wouldn't he?
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The story is in the numbers, but nobody's telling it. Health care sucks up 16% of the US GDP, and it's spread pretty evenly across the population. Income isn't even distributed anything like evenly, which makes health care a highly regressive burden on those least able to pay for it.
Just my two cents about the horrible, horrible, horrible health care over in the evil, evil, evil (and BTW godless) EU.In this particular case Germany.
I am paying around 8 percent of my income for a healthcare plan. OH, the horror!
I chose the doctor as I friggin please. My insurance does not even have the right to tell me, who I chose as my primary healthcare provider. The Lord help us!
Drugs are fully covered, but sometimes I have to resort to generica, if available. And I have to pay between 5 and 10 Euros for a prescription. As I am diabetic my weekly dose of insulin plus other medication otherwise would cost me around 50 Euros/week. The fainting couch, quick!
Dental coverage: YUP, I see the dentist twice a year and pay......NADA. I have to pay 50% of the costs for crowns. Implants and veneers are NOT covered. The smelling salts!
Waiting for tests to be done? Never had that.
In Germany we have 3 doctors per 1000 people compared to 2 in the US. The number of hospital beds/1000 people is triple the number in the US. The overall mortality is lower, especially for poor people.
And this is what pisses Rush off? Pheew, either he really is dumber than your average sneaker or he is an evil communist agent payed to eradicate the health and wellbeing of the US population.
Gluecypher: I've "suffered" through the German health care system too. It's just awful! I've never had to wait more than a week to get a (non-emergent) appointment with a doctor, had (minor) emergencies taken care of within a couple of hours-at an office, not an ER-and been so traumatized by the ophthalmology care that ever since I've insisted on getting my glasses in Germany (I visit here regularly so it's not as hard as it sounds). I might also add that I got vaccinated against FSME which caused me to become autistic or turned me into a newt or something like that.
Better health care would greatly increase my freedoms. The reason I didn't go to grad school right away was because my mom's insurance stopped covering me the day I turned 23, and I had to get a job just for the coverage. If I knew I had guaranteed health care, I would have gone straight to grad school. I could manage to scrape enough together for rent with just my savings account and a part-time job. But I would not be able to afford my multiple medications, or a plan that would cover if them (assuming I could even find a plan that would cover pre-existing conditions).
Right now I'm at a terrible job and looking for a new one. Every day is terrible. I would have just quit and lived off my savings until I could find a new job, but the problem here is health care. If I knew that I had guaranteed health care, I would have the freedom to put all my time into finding a better job. I would have the freedom to start my own company, which I would love to do. But I don't have those freedoms. I had to delay my education and work at a terrible job because I am dependent on them for health care.
Slight correction, you're paying 16% of your income for the health care, it's just hidden as a split between you and your employer so it doesn't look too bad on your paycheck. It does look that bad on what your employer gets to see on the books.
Compare that to US cost. On a 100k income, the German pays 16k. Here your normal health plan will cost you maybe 8 - 10 k, and leave you open to 5 - 10 k in deductibles/out of pocket. Comes out even for most families at least in that income range.
The big difference is for low income folks, who get the German insurance for 5k a year, with little out of pocket, while the US family is stuck with the same 8 - 10k. Plus, the German insurance is guaranteed acceptance, instant enrollment, and no cap on services, not bound to keeping your job, and no prior conditions. And that's the part that's missing in the US, and maybe will come with Obamacare.
Unfortunately, that means JScarry and Michelle Bachmann have to wait longer at the doctor's, all that scum with insurance will now want equal treatment, like they earned it.
Not even. My employer got rid of the HMOs a few years ago in a cost-cutting measure. Yes, that's right. I have a salaried job at a major multi-national corporation, and all of my healthcare options have at least a 20% co-pay for any non-routine procedure. Including the deductible, it cost me about $2500 to pay for my son's birth. :/
Well, high-deductible plans can actually be the right choice for some people. A couple co-workers of mine do high-deductible... in both cases, both them and their spouses are in good health, they either have no kids or all the kids have grown up and moved out, and they have enough savings to cover the deductibles should an emergency arise. The high-deductible plan allows them to pay into a flex spending account that rolls over year-to-year, which after just a few years accrues enough to cover the deductible several times over. It saves them boatloads of money, and they are still, in effect, fully covered should they suddenly need a lot of medical care.
It's a terrible option for families or individuals in poor health or people without a lot of savings, but that doesn't mean it's inherently bad. I'd actually readily support the gov't plan offering a high-deductible option to those who want it.
The one healthcare-related "freedom" I do believe in is the freedom to seek out private insurance or pay out of pocket if you want to. For me, this is a human rights issue, just as much as the provision of universal healthcare is a human rights issue.
So I would definitely oppose a Canada-style system on ideological grounds. But that's totally irrelevant, because nobody is pitching a Canada-style system. As I understand it, most European countries (and Australia) allow private insurance in addition to the government insurance, and they are getting along just fine.
And as far as that ridiculous argument that private insurance companies will go out of business if they have to compete with gov't insurance... um, first of all, I don't believe that for a second; and even if I did believe it, then I would be even more gung ho to get gov't healthcare setup, because if that were true it would mean that the private insurers were hopelessly incompetent!!!
Re: having to wait for an appt. A friend whose son had a sudden bout of temporary paralysis (could not move one side of his body for several hours) was told she should take him to a neurologist, because it could be something serious. The quickest appt. she could get was in TWO MONTHS. Where did this happen? Why, the good ol' US of A, of course.
The thing about Rush is that he really doesn't let reality get in the way of his blather.
I love the freedom of choice bullshit. Who really has any freedom here now, other than perhaps the self-employed in perfect health? The rest of us get what our employer's HR department negotiates, and heaven forbid our priorities differ from theirs. And our choices in how we choose and negotiate with our providers, and what procedures we might undergo, are also limited, because unless you're talking about cosmetic surgery and such the insurance is the payer, we get what they're willing to pay for, and it can be very difficult to persuade otherwise with cash (although, of course, after the insurance agrees to pay something your cash will also be used for the balance billed of the price you were never allowed to see).
Without proper regulation of the insurance carriers, I can easily see this situation getting worse under Obamacare. I have my fingers crossed. The situation now -- without fail having to pay out of pocket for uncovered balances I can neither know in advance nor negotiate personally -- drives me away from health care, but I am healthy and relatively young. In 20 years I probably won't be able to put my head in the sand to the same degree...assuming some undiscovered melanoma or breast cancer doesn't get me between now and then.
#42
But where do you draw the line? Do you allow people with money to pay for a kidney that other people would have to wait on a long list for? Do you allow doctors to accept more money privately to schedule appointments weeks or months in advance of what a person who goes through the publicly-funded system would get? Unless you have safeguards to ensure that the rich aren't getting better care than the poor, the human-rights issue potentially becomes one of life for those who can afford it and death for those who cannot. I don't know about you, but I don't think anyone has a right to better care just because they earn more money. This is not ethical. Where the ethics become interesting is whether someone whose condition is provably unrelated to a bad lifestyle choice should get better care than someone whose condition is caused or enhanced by such a bad choice, or even the whole triage question, do you prioritise the ones who have a better chance of making the most of the privilege? I can see an argument for different standards of care here, but a person doesn't have a right to better care because they can afford it.
I am a Canadian, and there are a lot of people in this country who want to go that way, but most of them are Albertans (and we know how much they HATE socialism). I also know that there are a lot of Americans in politics and the media who throw around claims at how horrible our "socialised medicine" is, but they are full of shit. I have some direct experience with our system, having spent several weeks in the hospital once with a serious injury, and the fact that I did not pay any money to anyone, and that the taxes I pay are actually a bit less than those I would pay as an American making the same salary, is worth any potentially wasted money due to people visiting doctors at every cough and sniffle. Perhaps you Americans should stop wasting money starting wars that you can't finish eh?
(sorry, cheap shot, I know, I couldn't help myself :p)
Apparently this meme originated in Fortune Magazine. (Pardon if someone already pointed this out: I haven't read all the comments.)
Great post, PalMD. And I do like the title.
See? The system works as it should.
A right to it? No. On the other hand, barring a truly oppressive police state you're not going to stop them from being able to afford things that we can't afford to offer everyone.
So why try? If Michael Jackson wants to hire a private physician, what social purpose is served by forbidding him to do so? How do you plan to keep him from visiting an offshore cruise ship where the glitterati get private care?
Before you start worrying about the fact that the rich can afford warmer clothing in the winter than the poor, how about we start by just making sure that the poor have clothing, period?
@volcanoman:
See, that's where we differ right there. When I look around me, it seems that the rich and/or powerful will always get a better deal than the poor and/or weak. This is still the case even in Canada, it's just that you have to be rich enough to seek care outside the country and pay completely out of pocket. You haven't eliminated inequity, you've just stirred the pot around a bit in a way that does not seem at all productive to me, and probably even counter-productive.
I might even go so far as to ask whether it might be desirable that there are stark advantages to having money vs. not having money, but I am a bit of a social capitalist, so those who reject the capitalist premise will likely disagree with me due to fundamental differences in worldview that are not really worth debating at this time.
On specific points:
This is a toughie, but my general answer would be that clearly organ donation is one of those things better managed by the government than by the private market. So the general answer would be, no, ideally organ donor pools would be run by a government agency or managed by a private agency under a gov't mandate with very strict and specific regulations. Now, as to two private individuals going outside of the pool and making a consenting-adults financially transaction... I dunno. I could probably be persuaded either way.
I think this is an easy one. In my ideal system, doctors who accept patients through the publicly-funded system would be required to provide those patients with the same level of treatment and scheduling as those with privately-funded insurance. Being caught giving preferential treatment to patients from a particular insurance company in exchange for compensation from that company would be right up there with insurance fraud, and would get your license revoked (with possible jail time) right quick. At least, that's how I'd do it, If I Were King(TM).
On the other hand, if a doctor wants to only accept patients with private insurance, they can do what they want... but that's going to vastly reduce their possible patient pool, so I would imagine this is not really a concern -- except for the rare Doctor-to-the-Stars types, but as DC Sessions points out in #48, even Canada's system can't put a stop to that type of thing.
Whole-heartedly agreed! As I said, my opposition to Canada's system is mostly an ideological one, in the sense that I find it horribly unfair to tell someone they can't go arrange their own medical care if they want to. For the most part, your system up north does just fine -- certainly better than our broken-ass patchwork of a so-called healthcare system!
Furthermore, if I were convinced that Canada's everything-goes-through-the-gov't approach was the only workable method of achieving universal healthcare, I would gladly let my ideological concerns fall by the wayside (in much the same way that I am willing to compromise my very strong ideological feelings about free speech in the old fire-in-a-crowded-theater type of scenario).
But I don't think I need to make this compromise. Australia's system also performs quite well, and I have no ideological objections to it. That's the ideal for me: one or more universally available gov't-run healthcare options, with subsidies to allow low-income families to buy into it, operating alongside the existing system (or rather, what the existing system would be forced to transform into if people were given one or more sane low-cost choices...)
There is no such safeguard, nor should there be. There is nothing immoral/unethical about paying for more service, with one caveat. If your payment for better services is done in a less than above the board way or in a way that DIRECTLY impacts someone else (for example, making someone else cancel an appt), then it is unethical.
A multi-tiered health system is not unethical. Once everyone has a basic level of care (whatever that may be), the rest are free to do as they can for themselves.
Is Rush Dumber than my shoe or just evil?
He's evil. No one could possibly be as dumb as he pretends to be.
@Volcanoman again: Hah! A couple hours ago I made a joke about Albertans in another thread. When you mentioned it again here I assumed it was the same thread and you were just riffing on that. Nope. I guess we agree on more than we think. :)
Alberta: Canada's Texas.
Hrm, in #50, PalMD says exactly what I was trying to say in #49, except in about a tenth the words. heh... Anyway, well said.
FWIW, if ObamaCare goes through, it's highly likely I would switch to it. I'm going effing broke from deductibles and co-pays right now, and I chose the most comprehensive plan my employer even offers.
It's nice that with a PPO I can choose my own doctor and don't have to get referrals, but an $800 deductible plus 20% of the cost of any non-routine procedures (e.g. like my wife giving birth) is a lot of damn money. I think I've got close to a grand in unpaid medical bills at the moment. :/
So I'm definitely not one of those idjuts whose like, "The gov't program will be bloated and inefficient!" The programs my employer buys into are already the maximum level of bloated and inefficient. If ObamaCare turns out to be even worse, well, that would be quite a trick...!
A prime example being cosmetic surgery. I would hope that a publicly-funded system would set a high bar for authorization of cosmetic surgery [1], but anyone who isn't a hardcore prude is going to object to people having nose (or boob) jobs out of pocket.
[1] e.g. authorizing corrective and reconstructive but not cosmetic -- admittedly that's a bit extreme.
Sorry, PalMD, to be spamming your blog with comments, but I have one more thing to say.
Volcanoman worries that, taken to its logical extension, a multi-tiered system of healthcare will result in some people living because they had enough money, while some will die because they didn't.
But this is already true for a bazillion other reasons that have nothing to do with healthcare. What about the low-income family who can't afford a new car with the newer safety features, and ends up dying in a fiery wreck that they might have survived if they had airbags and crumple zones and the like? Continuing the automotive theme, you are aware that better-rated infant car seats cost more money, right? I can tell you in no uncertain terms that some non-zero number of babies will die this year because their parents didn't have enough money to afford a top-of-the-line car seat.
Living below the poverty line has been shown to cause stress, and stress is well-known to exacerbate all sorts of conditions.
Poverty-stricken areas also tend to be higher crime. I can assure you that a non-trivial number of people will be shot to death this year because they couldn't afford to move to a nicer neighborhood. (This problem is far worse in the US of course, but Canada is not immune)
Surely one injustice does not justify another, that's not what I'm trying to imply. I'm just saying that unless we want to go in a completely totalitarianist socialist* direction (and we all know how well that works out...), it will always be the case that some will live and some will die because of their means. Welcome to the bloody mess that is planet Earth.
* I want to make it very clear that "socialism" is not a dirty word for me, any more than "capitalism" is a dirty word. On the other hand, complete socialism is at least as stupid of an idea as laissez-fair capitalism. When I referred to a "completely totalitarianist socialist" government, I was referring to the Soviet Union, pre-Xiaoping China, etc... not to European governments, which practice a form of social capitalism. Hell, as much as conservatives would be loathe to admit it, the US practices social capitalism, and has since at least the 1930s, though clearly emphasizing the capitalism part more than our European and Canadian counterparts...
Rush Limbaugh is dumber than rocks; my shoes are really cute, smart, even. They are insulted that anyone would compare them to this cretin.
On the "4-bullet-prison plan" detailed in the comments: some governments are finding that it is less expensive to parole inmates with major medical conditions; you can listen to/read the story from this morning at http://www.npr.org/templates/story/story.php?storyId=111208372
"Is Rush dumber than my shoe, or just evil?"
That's a false dichotomy: he is BOTH dumber than your show AND evil. As well as being obnoxious.
Thanks for the response, James, and I think you're right, we do agree on a lot more than that upon which we disagree. But the problem isn't limited to access to good doctors. I would characterise the systematic problem as being ideological: when you treat health care like a business, the profits come before the responsibility to the patients.
If a doctor makes a private agreement to provide a more dedicated care for a higher price to someone who pays them directly, than this is the business only of the people involved, or so you would argue. But medicine isn't just a profession, it's a public service, and for a doctor to go down that path (and I don't disagree that it should be an option), he/she should be required to renounce all public funding of their education, present and future, and to repay any public monies they have received in the past, including salaries as interns and residents at public institutions, by working for free in public hospitals until their debts are settled. Furthermore, they should, as you suggested, be limited to those patients with whom they can strike private deals. Also, these people, their patients, should still have to pay the same tax portion to governmental health care as those in their income bracket who stay within the public sphere. If people can opt out of the governmental system to lower their taxes, the private insurance companies will do everything in their power to take advantage of idiots; when you make medical care into a risk-management business, there will always be gamblers. That doesn't mean that private insurance companies should be disallowed, just that the government guarantees a good standard of care regardless of whether you hire one. The government should NOT compete, because competition creates a business mentality in something that is a public service. But the insurance companies should still be able to ply their trades promising a better level of care and access to doctors in a different pool. I wouldn't even care if they started businesses that did diagnostic tests and treatments, as long as these businesses could not receive public money or have access to patients from the public system.
I think that in this case, you would find that most people would stay in the system that they pay for whether they use it or not, and with the financial support of a nation's tax system, the government could meet a much better standard of care than the bottom 1/3 economic bracket in the USA get today.
I know that even Obama can't work this kind of magic, but any system which forces the public system to compete with the private system is doomed to failure in America, the land where people believe in competition like they believe in God, while the corporations hijack the government so that they compete from a disadvantaged position from day one.
If Michael Jackson wants to hire a private physician, what social purpose is served by forbidding him to do so?
He might still be alive if he'd depended on standard of care medicine instead of having his own personal anesthesiologist put him to sleep with propofol every night. Which overall would probably be a social good, unless maybe some of the nastier rumors about him abusing boys are true.
Michael Jackson aside, more expensive medicine is not always better medicine. If everyone has access to standard of care medicine then anything more (i.e. private insurance) becomes something of a gamble rather than a clear advantage in terms of life expectancy or health.
Therefore, as long as everyone is guarenteed access to standard of care medicine, I don't have any real problem with people being allowed to have private insurance that gets them things like private rooms or maybe quicker scheduling of purely elective procedures (as long as they don't bump medically necessary surgeries for people on public insurance). However, I don't see the lack thereof as a major human rights issue. I don't see anything inherently wrong with the Canadian system, but think that something more like the German system might be more politically feasible in the US. Either works reasonably well and so the choice is more one of social preference than justice.
Michael Jackson was a rather ill-considered choice, wasn't he?
A better one might be that of the team docs for professional athletes. Whichever illustrative examples we pick, you and I seem to be on the same page: guarantee everyone quality medical care within reasonable limits [1] and allow private consensual arrangements over and above as long as they don't interfere with the guaranteed care of others.
[1] I don't think this needs defense here. Please correct me if I'm wrong.
#61
I am with you on this too, as long as "over and above" means "in addition to". If physicians and insurance companies, who have not benefitted directly from public money (and therefore who don't have a public duty) want to make arrangements with private citizens who are not satisfied with the guaranteed care they are entitled to from public institutions, they should be free to do so.
Any system that treats public health as a business is going to see decisions being made to address the interests of profitability rather than the interests of the patient, unless there is significant, independant oversight. But even with oversight, doctors would have to fight tooth-and-nail for the foreseeable future, as every new administrator is going to promise to cut costs and offer more efficient care that will inhibit them from acting in the best interests of their patients. But a private health care system that is not assisted by public money, or in competition with public services is fine by me. The costs would be prohibitive to all but the richest people because, in theory at least, the only revenue the private system would have would be user fees and whatever private money is involved in the startup costs, whereas the public system would have billions of dollars in annual tax revenue. Hospitals, forced to choose between all of that government revenue, or an uncertain private future, should fall in line pretty quickly.
It might be worth noting that that although you are perfectly free to have private treatment here in the UK (unlike Canada), you cannot mix and match. Your private or NHS, not both at the same time, although I've seen plenty of once wealthy patients switched to the NHS to continue their treatment after their insurance or funds ran out. Its reasonable to stop people to simply buy their way to the front of the line and then go free from then on, although there will always be some hard cases.
On the other hand, the vast majority of private patients are actually seen in NHS hospitals, since that's where the expertise is (the extra monies made from the private patients goes back to the NHS) - our private hospitals really don't have ICU's or any of the backup services that the large NHS hospitals do. So even going 'private' isn't really all that private, not that the healthcare industry will admit it.....