Bush on health care

I just thought of something.

If Bush just told uninsured people to go to the emergency room for care, didn't he just "authorizing it"?

Doesn't that make him responsible for paying for it?

If Bush got a bill for all the uninsured medical care from each ER in the country until he "clarifies" his statement, how long before he "clarified" it?

It's irresponsible to stop the quote there. The next sentence seems to imply that this thinking is not "wise". Krugman's rebuttal is convincing, but we gain nothing when you tear down this strawman. Please, make sure you post a little more substance, a little less PZ.

There's no need for clarification from Bush. As Orac notes, the law already is clear that the ER must treat those who wander in. It's a obscene caricature of "universal access," but it's what we've got -- for now.

"Patients without health insurance ... could be much more cheaply dealt with by a primary care physican."

Here's an idea! Let's just pass a law mandating that primary care Physicians must treat everybody, regardless of ability to pay.

Surely not only more cheaply, but better as well. Your GP is going to be aware of any chronic or long-term conditions you have, and can review your medication as required.

Chi, there was nothing "wise" about anything he followed that statement up with, so it's probably a moot point anyway. Regardless, to encourage people to go to the ER as their primary "health access" is ridiculous. What I still don't understand, however, is how he is "for" S-CHIP, and yet he'll soon be vetoing its expansion, instead causing fewer children to be insured. That's what most people would refer to as "against."

Chi: "It's irresponsible to stop the quote there....Please, make sure you post a little more substance, a little less PZ."

Welcome to the interweb, where folks can travel a series of tubes with a tap, when responsible bloggers leave a handy, highlighted hyperlink. If one gives the link - as Orac did here, as PZ does - then why complain?

If PZ selectively pasted quotes, and then, in his accompanying post, interpreting the in a way that seriously twisted the intent of the author, that is a legit complaint. I have seen this happen only very rarely with PZ, and, when pointed out, he usually corrects and/or clarifies in response.

OTOH, the villianous enemies of rational discourse and critical thinking are notorious for quote-mining plus deliberate misprepresentation of the quoted person's views plus lack of links.

Um...before you mandate that I see anyone, regardless of ability to pay, tell me how I'm going to pay my rent and myself and my employees in that model.

The mind boggles. Orac is attacking an argument that Bush has not made. Bush is saying that it is unacceptably unwise to be content with people going to the emergency room as their primary care. The post misinterprets the stance as the opposite, because he couldn't be bothered to parse an admittedly garbled speech.

As for PZ, I'm attacking the amount of substance in this post. I haven't noticed PZ selectively quoting either.

Also, it's possible to be "for" S-CHIP but against the expansion. The position some seem to be taking is that the current subjects (children of poor parents, without health insurance) should be taken care of by the State, but that they expect better off parents to be responsible for it. Sounds like progressive taxation, to me, an idea which I thought had no small number of champions on the 'Tubes.

In Pennsylvania recently, they increased the income limit that a parent(s) can have, and still qualify their children to recieve insurance through SCHIPS. The expansion is so that all children receive health insurance. The expansion does not cover the parents themselves. It is desgned for those families that due to one or more family members having a chronic or serious condition, makes it nearly impossible or unaffordable for them to purchase insurance on the private market.

Actually, I believe the expansion makes sense, economically. SCHIPS avoids the problem of working parents giving up their jobs simply so they can qualify for Medicaid when a serious or chronic illness strikes one of their children. A working parent with a child on SCHIPS is better than an entire family ending up on Medicaid, which also means providing them with welfare benefits and food stamps.

Some of Bush's remarks in his speech aren't too bad. But he's naive about the current state of individual health insurance in this country. Believe me, private insurers are not salivating at the thought of providing coverage for children of the working poor.

An odd thing about the transcript of Bush's speech is the inclusion of 'Laughter' and 'Applause' sprinkled throughout the text. Makes it seem like a theatrical performance, not a presidential speech. Makes one wonder if Bush's handlers have 'cue cards' for the audience, just like those used when a sitcom is taped before a live audience.

You're right, Chi. He does think it's unwise for people to just go to the emergency room.

He thinks they should all get private insurance instead.

After all, if they peasants run out of bread, they can just eat cake, right?

PalMD -

There are several different models of universal health insurance around the world. Doctors still get paid in all of them. Plus, if you are an employer, you don't have to think about health plans.

Chi -

The current US healthcare system is about as expensive and inefficient as it is possible to be; and Bush is essentially defending the status quo.

Healthcare is one of those things that simply dosen't fit well with a free market model. To illustrate:

If you want a TV, you have a huge range of options, varing by size, cost, features, whatever, including a second hand market. So you can always find a compromise between budget and wants; unless you are absolutely broke, in which case you do without. Hence a free market in TVs works very well, with a large choice including 'buy nothing'.

Contrast healthcare; there is a much narrower range of treatment options for a given condition, no discount options, and, crucially, severe penalties including death for the 'buy nothing' option. So the individual has very little choice about how much they pay, and this amount is unrelated to their personal circumstances (Actually, it may well be inversely related, since the very young and very old have the greatest need and the least income). Furhermore (and crucially) no one actually *wants* healthcare - people don't just turn up at hospitals asking for a leg amputation..

In a private system, of course, this problem is compounded because better and better risk assesment means that those who need healthcare most pay the most; or more likely get priced out.

Pure market economics dictates that a significant chunk of the population be turned away from hospitals to die on the street, thus adjusting supply and demand. This is generally regarded as politically unacceptable, so in the US there are a whole set of compromises, the net result of which is that the system ends up far more complicated and expensive.

Universal insurance systems are simpler and generally fairer; rationing by clinical results vs. cost, as opposed to ability to pay, gives far better value for money in healthcare. Of course, the fact that it makes many profit making entities redundant means that there will be ferocious lobbying against such a system (As you can see in the US).

The one proposal *for* something (rather than against "federalization" of health care) Bush made in his speech was for increased use of health savings accounts.

Now if anyone would like to tell me how poor or even middle-class individuals are supposed to accumulate enough money in these accounts to pay for the various medical treatments they and their children can expect to have, I'd love to hear about it.

We have such accounts, along with high deductible health plans, as the only coverage option where I work. I vividly recall a fellow employee, the single mother of a teenager, with a hacking cough and hardly able to breathe one day, resisting her boss's pleas to go to the hospital. Spending the vast difference between the money in her HSA and the level of the deductible for her family plan (plus 20% coinsurance after the deductible is met) was just not an option if she wanted to continue saving to send her son to college, which is her dream.

The only way to see such coverage as a solution for those currently without reasonable financial access to medical treatment is not to care about them as people. But then, the speaker was Bush. Q.E.D.

What Joshua said. Even in the whole quote Bush is absolutely using emergency room care as a resource for those who fail to get private insurance. And that its availability makes public healthcare plans unnecessary. He quite clearly makes the excuse that those who cannot get private insurance don't deserve a family physician.

Andrew, To calculate an efficiency, you need to specify a goal. Something is only "inefficient" if resources are "wasted" not delivering what ever the goal is. Since Bush's "goal" is to generate profits for private insurance companies, it it the medical care itself that is the "inefficiency".

The ideal private insurance is gold plated, premium, expensive insurance for healthy people who never use it. That way all the premiums become profit.

Jud -

Someone should tell these people that the whole *point* of insurance is to share the risks and stop people getting floored by low-probability/high-cost events. If people put the same amounts into health savings accounts as needed for health insurance, then those who did get nasty illnesses (Cancer etc.) would still end up bankrupt and homeless.. but a whole new financial services industry would be created AND those people could be taken off the 'uninsured' figures. But if they are for people who can't afford insurance, it is just window dressing.

Daedalus -

There's several approaches.. you can offer insurance to those who might get ill, but simply refuse to pay until taked through several levels of court action, you can include so many riders in the small print that no treatment of any kind whatsoever is actually covered, you can make sure that claiming is a kafkaesque nightmare that no ill person will ever succeed in, outsource call centers to countries where english is not even a second language (or job requirement), direct claimants to a website which freezes, crashes and/or installs a virus on the claimant's computer whilst tring to process a claim, shift mailing addresses without forwarding, and (as the final blow) start a TV advertising campaign based on how easy it is to claim.

Jud -

Someone should tell these people that the whole *point* of insurance is to share the risks and stop people getting floored by low-probability/high-cost events. If people put the same amounts into health savings accounts as needed for health insurance, then those who did get nasty illnesses (Cancer etc.) would still end up bankrupt and homeless.. but a whole new financial services industry would be created AND those people could be taken off the 'uninsured' figures. But if they are for people who can't afford insurance, it is just window dressing.

Daedalus -

There's several approaches.. you can offer insurance to those who might get ill, but simply refuse to pay until taked through several levels of court action, you can include so many riders in the small print that no treatment of any kind whatsoever is actually covered, you can make sure that claiming is a kafkaesque nightmare that no ill person will ever succeed in, outsource call centers to countries where english is not even a second language (or job requirement), direct claimants to a website which freezes, crashes and/or installs a virus on the claimant's computer whilst tring to process a claim, shift mailing addresses without forwarding, and (as the final blow) start a TV advertising campaign based on how easy it is to claim.

Chi, I don't think you understand what I'm saying about being against S-CHIP. Currently, there is a $5B budget for this with another $5B over the next 5 years. If this were to be vetoed, the number of children covered would actually go down due to rising health care costs.

On the other hand, Congress proposed $35B in funding over the same period, adding coverage for an extra 3 million or so kids. What's more, this would be funded in part by severe taxes on cigarettes. What is Bush thinking? This seems so logical to me as to be a no-brainer.

Then again, I have no political agendas, so what do I know?

Andrew: a brilliantly accurate summing up of the benefits of universal health care. Thank you.

A couple of personal notes. My sister-in-law recently needed to be treated for ovarian cancer. The treatment -- a combination of surgery and chemotherapy -- went well, and she is now cancer-free. (And, Orac, my apology for not updating you since you were kind enough to answer a question or two I had.)

Her care was quick, obviously competent, and cost her nothing, because she was fortunate to have moved across the border to western Canada some years ago. Meanwhile, another blogger recently told about a friend of his, also with ovarian cancer, who had, finally, managed to scrape together the $2400 she needed for the first PET scan, but needed another she didn't know how to pay for before treatment could even begin.

I have more, but that's for the next comment.

"PalMD" says:

Um...before you mandate that I see anyone, regardless of ability to pay, tell me how I'm going to pay my rent and myself and my employees in that model.

Ever hear of the UK's NHS? Or of France's system? (There are others as well, as Andrew says, but those two are the only ones I have any experience with.)

The doctors, doctor's staffs, et al. are all paid, can and do pay rents, and provide professional quality care and advice. Their ability to provide, and my ability to receive, treatment and advice does not depend on my insurance or employment status or wealth or family contentions or legal status or any of the other factors used to deny people health care and services in the USA.

Without appearing insolent, It would be appreciated, since Dr. Orac doesn't think much of the current administrations' attitude toward health care (with which I concur), if Dr. Orac might comment on the health care plans proposed by 4 of the presidential candidates (Edwards, Clinton, and Obama on the Democratic side and now Guiliani on the GOP side).

Chi said that Orac had taken Dubya out of context, so here's the entire paragraph:

The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room. The question is, will we be wise about how we pay for health care. I believe the best way to do so is to enable more people to have private insurance. And the reason I emphasize private insurance, the best health care plan -- the best health care policy is one that emphasizes private health. In other words, the opposite of that would be government control of health care.

I submit that the best health care is one that emphasizes public health -- in which we rate well below most other industrial democracies.