Pajamas Media

69 Comments

1. roy:

Excellent article. Very good information in a short article. Welcome to a “new” author.

Jun 15, 2009 - 2:35 am 2. Dennis:

Interesting and informative; you have put your finger on the root of the problem. Dare I add the twisted logic adn failure of the subject people are the result of Governmnet Education where history is twisted or ignored! The yourn today do not know of Stalin or the horrors he imposed upon the ‘People.’ They know nothing about economics, let alone economic systems.

Jun 15, 2009 - 3:58 am 3. pH-DependentNeocon:

Almost ONE-HALF of the uninsured in the US are NOT US CITIZENS! (http://www.census.gov/prod/2007pubs/p60-233.pdf)

That means that only 7.5% of US Citizens lack coverage…and roughly half of those are under the age of 35, or can afford coverage but choose not to.

Why should we pay for the Shoes of those that CHOOSE to go barefoot (certainly they know of their own choice)?

Jun 15, 2009 - 4:12 am 4. Alan Forrester:

One reason that many people in the US lacks health insurance is that in any given state the state government mandates what an insurance plan must cover. This means that, for example, many men must buy health insurance that covers them in case they need a pap smear. If people could pick and choose among different plans that cover them for different problems then cheaper plans would be available and more people would be covered. Also, health insurance plans cover people for many things that arguably should not be insured against at all, that is, minor, relatively inexpensive, medical procedures. See Arnold Kling’s book “Crisis of Abundance”.

Jun 15, 2009 - 4:30 am 5. Peter Lairo:

Point well made.

Conservatives will need to find a way to combine free market principles with worker/citizen protections if they want to be significantly better (and not just have a different paradigm) than the left.

From another recent (partial) “convert”.

Jun 15, 2009 - 4:33 am 6. juno:

They might have some trouble, when those who have the shoes [and I'm not talking about those with private insurance... I mean the large voting bloc of people on Medicare] and those who are just about to get some shoes [the Boomers], learn that these plans mean they end up with flip-flops at best.

Stopping the metaphor here, there’s really not much in it for the seniors. They’ve got theirs for now, and the Medicare financing problem means that if you dump a whole bunch more people into the system, there’s going to be explicit or implicit rationing. As you say, this may look pretty good to the younger people who don’t have health insurance, but this is going to be a literal killer to the seniors.

Hip replacement? If you’re over 80, forget about it. You weren’t going anywhere anyway, right? Cancer treatment? Look, you’re 82, you’ve already lived a full life, why don’t you just go home and die.

Promising people that they’ll get something they don’t have is pretty potent politically, but even more potent is the fear of what you already have being taken away. And it’s from a group that is already more likely to vote than younger people.

Jun 15, 2009 - 5:05 am 7. Grover:

Cynthia, GREAT article; I fear you are right! When the ‘Plan’ fails, and it will fail, will the ‘unwashed masses’ blame the Left?

Jun 15, 2009 - 5:50 am 8. SLK:

What surprises me is how conservatives don’t mention one of the worst problems ailing our health care system, which is overlawyering. Our health care costs would be MUCH lower if we had serious tort reform, disallowing hyper-rewarding of people who were the victims of medical mistakes.

We could probably cut our costs in half, or more, if we could get those lawsuits under control.

And medical malpractice lawyers should actually get behind tort reform, as well. After all, once the government takes over health care, no one will really be able to sue the All-Powerful State for malpractice. They’ll be out of a job.

Jun 15, 2009 - 6:22 am 9. betheweb:

Having just crossed over into Medicare/Medicaid, I now find that procedures and prescriptions I could get a year ago with no hassles are either unavailable to me or I have to kick up a big fuss, write a bunch of letters, and get other levels of government involved. It will only get worse. Boomers Beware.

Jun 15, 2009 - 6:53 am 10. RobertG:

Yes Boomers Beware! And keep your powder dry-it is going to get a lot worse.

Jun 15, 2009 - 7:12 am 11. The Shadow:

betheweb – I’s say you need to burn your medicare card and buy private health insurance

Jun 15, 2009 - 7:31 am 12. The Shadow:

Cynthia – It sounds like you never understood what liberalism was about and now have set up the straw man of communism as an easy target to knock down ignoring the question of what Obama is trying to do.

Jun 15, 2009 - 7:34 am 13. Self-hating Boomer:

Boomers Beware!

Hate to break the news to you, but we’re the problem, not the solution.

Jun 15, 2009 - 8:19 am 14. Delia:

I’ve been to a doctor about 10 times in the last 20 years of my life [not counting my midwife or dentist].

I don’t run to a doc for every sniffle or sore throat. We pay in cash when we do visit a doc. Maybe we are just lucky *knocks on wooden head* but, we just don’t get sick that often! I look young for my age [or for ANY age]. I’ve had people ask me if I was my daughter’s *YOUNGER* sister. My husband still jokes that I have an ‘aging’ painting of me hidden somewhere in our house.

When I tried to ‘off’ myself in 2007, the E.R. overnight cost was around $2,500.00 and we paid it in full within a 6 month span. That bill that showed up each month was a painful reminder of how ’stupid’ I was for trying to take my own life.

Anyway, I don’t want ‘health insurance’. THAT should be a choice too. Being forced to choose health insurance at all is NOT a CHOICE.

Jun 15, 2009 - 8:34 am 15. trapper:

Polls continually show that most people (84% by one recent poll) are satisfied with their current health insurance and level of health care. Where is the demand for this “reform”? Just as with Bush’s prescription drug Medicare reform, demand for reform exists only among politicians and political elites.

Jun 15, 2009 - 8:45 am 16. arhooley:

The case I keep making to my liberal friends is the one about the DMV vs. the Automobile Club, public vs. private schools (which option did the Clintons and the Obamas choose for their daughters?), the IRS vs. anything you or I could dream up, and other iterations of government vs. private institutions. One of my lib friends actually did admit that the tidy little Swedish model might not translate to the U.S.

Jun 15, 2009 - 8:50 am 17. Joe Noory:

Cynthia,

I can tell you as a former resident of East Germany, that you are completely correct. That is EXACTLY how US society was portrayed, and mainly in terms of racism related stories and also a function of being enraptured by any photograph depicting a panhandler. The obsession our own activists had and have with that same tired over-emphasis on whatever is going wrong without respect to teh scale of it has been reinforced by the effect that the communist domestically-intended propaganda had on western Europeans who fluidly engage/exchange in US activis culture. It reinforced it.

Here’s the rub: in the outskirts of east Berlin, one would see begging, albeit extremely well concealed begging as it would lead to arrest otherwise. The still extant Lutheran Churchs DID INDEED organize charity for the baldy off (which all were told didn’t exist), and the racism that communist block Europeans directed at african foreign residents (mainly students,) as well as darker/hairier/less conventionally northern looking europeans, such as Bulgarians, was more bigotted than it’s counterpart at any given time in the US. They did not have the carthatic benefit and reminder of a civil-rights movement, but they did have a great deal of ‘brotherhood of nations’ propaganda that they ignored.

What DID go unmentioned was the resentment harbored between eastern Europeans for one another which, while generally formed itself around the envy of who was living better off in some way that they heard of over the transom from one another, was expressed in tribal, nationalist terms. They suffered from far more sectarianism than anyone would like to admit.

Jun 15, 2009 - 9:08 am 18. Dave:

I like the idea that the Government should have to at least do medicaid/medicare with some level of fiscal competence before they a) destroy the private market that is currently subsidizing much of the health care quality that people getting government paid for care benefit from and b) take away our choices that does a great deal to drive health care quality.

Jun 15, 2009 - 9:17 am 19. Anneke:

“The scare scenarios of delays and rationing look pretty good to the tens of millions of people who now experience a much more deadly form of delays and rationing.”

It’s not necessarily the uninsured or the underinsured that we need to worry about. There’s another group of folks we need to worry about: the insured (with good health care benefits) who just don’t want to pay ANYTHING for premiums, split premiums (where the employer pays a portion), co-pays, etc. I have two relatives who are retired union employees. They have pensions, own property, have the resources take vacations. They are not poor. They have excellent employer-based health care benefits for which they must pay a reasonable amount toward the premium. It’s disgusting to listen to these two b**** about having to pay that premium and having to co-pay ($15) for office visits and medications, knowing that what they’d rather do with that money is “donate” it to the local Indian casino. There is a significant number of people in the country who have an entitlement attitude: they want what they want when they want it and who ends up paying for it be damned.

Jun 15, 2009 - 9:19 am 20. The Shadow:

Delia:

I wonder what you would do if you came down with cancer and you did not have health care insurance? Emergency rooms have to take you even if you do not have insurance, but what about chemotherapy. The whole idea behind insurance is to spread the cost and the risk.

Jun 15, 2009 - 9:25 am 21. Kriska:

My husband and I are self-employed and have to purchase our own insurance. Our insurance company just recently changed carriers which resulted in a big jump in premiums and now can no longer use our same Doc’s. Even though I am not satisfied with paying out the wazoo for insurance that I’m not satified with, at least I have insurance. I strongly feel that Obama’s plan would result in us being taxed more than our premiums run and we would be denied coverage because of pre-existing conditions.

Jun 15, 2009 - 9:30 am 22. Pat:

Love this article, Cynthia! It hits exactly what has been bothering me since the campaign.

Good job!

Jun 15, 2009 - 10:25 am 23. Delia:

20. The Shadow:

“I wonder what you would do if you came down with cancer and you did not have health care insurance? Emergency rooms have to take you even if you do not have insurance, but what about chemotherapy. The whole idea behind insurance is to spread the cost and the risk.”
~

Shad, if we had paid for med-insurance for the past 20 years we’d have gotten SCREWED royally. I am a very healthy person. I work-out, eat right, don’t smoke and it shows both in my visage and by my blood work-up. I’m healthy as a frickin’ horse [whatever that means lol].

Why should I pay for coverage when I’m perfectly healthy? Even when I’ve needed dental care that costs thousands of dollars we have PAID it in full.

I went to a live Carrie Fisher show in Seattle with people coughing [even with the swine flu virus going around] and I was perfectly fine. I’ve learned how to strengthen my immunity by natural means. I’m a believer in homeopathic treatments. Where would *I* fit into the grand scheme of things if I wanted to opt for ‘natural’ treatments vs. drugs that will damage my liver and kidneys etc.?

I don’t like ‘traditional’ medicine. I just DON’T. I gave birth to a perfectly healthy daughter with a MIDWIFE and NOT a doctor. I had no DRUGS or PAIN KILLERS. I gave birth the ‘old-fashioned’ way. It didn’t kill me, it made me stronger.

Jun 15, 2009 - 10:31 am 24. Jim Baker:

Universal health care is one of my rights as an American! I can’t wait until a new fishing boat is one of my rights as an American, too! We all have the right to have stuff, you know. Hell, we all have the right to have everything we want. Doesn’t it say we have the ‘right to life, liberty, and the possession of everything’? ….sheesh…

Jun 15, 2009 - 10:57 am 25. Geoff:

“I wonder what you would do if you came down with cancer and you did not have health care insurance? Emergency rooms have to take you even if you do not have insurance, but what about chemotherapy. The whole idea behind insurance is to spread the cost and the risk.”

Probably the same thing she would do when chemotherapy was deemed too expensive for the universal health care budget -die.

Oregon has already given us a taste of what Obama thinks will be an improvement for America- just google Barbara Wagner and Oregon Health Plan to find out what compassionate liberalism really means.

Jun 15, 2009 - 11:04 am 26. mshatto:

#12 – Shadow – You said “Cynthia – It sounds like you never understood what liberalism was about and now have set up the straw man of communism as an easy target to knock down ignoring the question of what Obama is trying to do.”

Please answer these questions.

1) What is modern liberalism about?

2) What is Obama trying to do? What are the effects?

Thanks

Jun 15, 2009 - 11:20 am 27. bryan:

My problem is not under-insured or not insured. It is the cost of our insurance and that even though healthy, we are victims of rationing.We are business owners and have one 5 year old child. We buy insurance on the open market and have no way to get in a group. Just got our 2nd increase this year alone. $1,111.15 per month is what we pay. No dental or maternity. I know. Insane.

If I change insurance we’ll be subject to “pre-existing condition” limitations for any health condition we have experienced in our lives. So much for choice. What good is choice if my choosing another carrier means the couple of things I might need coverage for won’t be insured for at least a year.

My wife had a c-section with our first child. Our carrier won’t cover a c-section again. Apparently the ultimate pre-existing condition. Her OB can’t support her on a vaginal birth without risking losing his professional liability insurance. The ultimate in rationing. All true. All from the best insurer in our state. Blue Cross/Blue Shield.

How much higher is my policy going to go? It has risen $240 per month in just 3 years. What is going to stop them from dropping me if something serious happens to one of us? It just happened to some friends of ours. They can’t get insurance any more. They REALLY need it.

The free market has done a crap job of containing costs and providing/insuring that my family has the coverage we need. I am always told that we pay a higher price for RX’s because we don’t want to stiffle drug research. How is it fair that Americans should shoulder the whole burden. Other countries negotiate better pricing. Why can’t my insurer do the same? We should cover everyone elses end of this stick. We definitely get the sh*tty end of that one.

I keep hearing that we have the best health care sysytem in the world. OK. It still needs to get alot better in my book. The free market seems to be looking out for the interest of the free market. If they don’t start looking out form my interests, I’ll be looking for our government to make them.

Jun 15, 2009 - 11:23 am 28. The Shadow:

mshatto:

The state should provide the environment that allows private capitalism to florish. However, it also has an obligation to insure that the poor and dispossed are supported and given the opportunity to overcome the disadvatiges they are born into.

As a Catholic; I will quote from an essay on John Paul II – not exactly a communist

“Pope John Paul II’s encyclical, Centesimus annus, published in 1991, echoes in many respects faithfully the sentiments of Rerum novarum. There are to be found in it many warnings about the power and size of the State. The Pope continues to support redistribution to provide for basic needs, although, once again, the main responsibility for ensuring adequate incomes is placed on private-sector bodies – employers and unions. Centesimus annus contains a general comment on the Welfare State which speaks for itself

In recent years the range of such [government] intervention has vastly expanded, to the point of creating a new type of State, the so-called ‘Welfare State’. This has happened in some countries in order to respond better to many needs and demands, by remedying forms of poverty and deprivation unworthy of the human person. However, excesses and abuses, especially in recent years, have provoked very harsh criticisms of the Welfare State, dubbed the ‘Socia lAssistance State’. Malfunctions and defects in the Social Assistance State are the result of an inadequate understanding of the tasks proper to the State…

Note that ‘society’ is not used as a synonym for ‘State’ or ‘government’ – rather, quite the opposite. In Catholic social teaching, there is a very strong emphasis on, and consciousness of, the State as something quite distinct from civil society and not merely an extension of it.

This encyclical continued not just to be critical of certain outcomes of capitalist economic systems – problems such as those of consumerism, materialism and drug abuse which may perhaps be discussed in later seminars – but it also emphasised the role, as a guarantor, of systems of social insurance: in other words, private or voluntary collective arrangements of providing for need in times of unemployment. It also laid out very clearly the importance of having a sound legal and monetary framework and efficient services for a proper market economy to exist. The activity of the market economy cannot be conducted in an institutional, political or juridical vacuum. On the contrary, it presupposes sure guarantees of individual freedom and private property as well as a stable currency and efficient public services.

It then goes on to lay out what the principal task of the State is: not redistribution, not a big role in economic life, but rather provision of this framework within which individuals will find themselves better enjoying the fruits of their own labours.

These statements from Catholic social teaching have been chosen collectively to illustrate particular points. Certainly as I have already mentioned, Catholic social teaching has plenty of criticisms for the outcome of a market economy and sees legitimate room for debate about how those defects should be addressed.”

Jun 15, 2009 - 11:44 am 29. Rusty:

Cynthia, excellent comments. Different approaches to the same end are good to hear because no one has all the answers.
Obama is like a credit card junkie that can’t stop rolling up debt with no plans to pay for it

$1.5-trillion is the current price tag on Obamacare and we all know that whenever Washington tells us how much something is going to cost that you have to double or triple that amount. Can you imagine what this complete annihilation of our health care system is going to cost and that just to get to a system that ultimately rations healthcare. How is this a good deal for America?

Ok, so let’s give Obama and the Democrats the benefits of the doubt and say this move from our quality healthcare system to their rationed healthcare system will cost $1.5-trillion. Then let me throw this out for you to pounder as well.

In his New York Post article this morning, Michael Gray outlines figures from David Walker, the former US Comptroller General, who says that the federal debt is nearing $55 trillion and if you add in what is owed on the state and local levels along with personal household debt, it ratchets our debt up to $75 trillion.

Walker estimates that our overall debt level in this country means a family of four owes $1 million on that debt.

So there are two huge strikes against the Democrats Obamacare plan. One, we move from the a quality care system to a rationed care system and two, the trillion dollars of new debt will bury each of us even further into debt.

Now Mr. President, how is this going to help lower our out-of-control deficits????

Jun 15, 2009 - 11:52 am 30. The Shadow:

Delia, Delia , Delia – Would that life were so simple! My wife was equally health, but ended up with three different cancers. I would hope that that never happen to you, but no amount of good living will protect you from bad genetics. The principle of insurance is to spread the risk. You might never need coverage, but you might end up with problems that cost millions of dollars. No medicine and no coverage is an enourmous gamble taht no one can really afford to take.

Doctors don’tknow everything but they know a hell of a lot more than I or any layman does and the good ones know the limits of their knowledge

Jun 15, 2009 - 11:54 am 31. Kriska:

27. bryan

I’m also a business owner and in the same boat. FYI–I CAN’T switch insurance companies because of pre-existing conditions. I was told this twice today by two different agents. If I can’t get insurance through the private sector, I’m assurred the government won’t cover me either. I’m not sure about you, but I’m not sleeping well!

Jun 15, 2009 - 12:12 pm 32. HonestJon:

I have a few thoughts on this subject that I would like to share.

First of all, I am of the opinion that the real issue here isn’t “health care” it’s health insurance. If you get sick and go to the doctor, you will receive care. If you don’t have insurance, however, you’ll have to pay for all of it yourself. Medical bankruptcy, anyone? (I’m referring to you, Delia) Now, all of these medical insurance companies are for-profit. That’s one of the roots of the problem. They’re not in the game to provide care, they’re in it for the money. They couldn’t care less about your health! This is a major problem. IMHO, all medical insurance providers should be non-profit entities. I’m sure a lot of folks who read and comment on articles here will disagree with this opinion.

Next, we have a pretty big problem with illegal immigrants who largely don’t have any sort of insurance. So, they get sick, go to the hospital, receive care, and walk away from the costs. The hospital has to eat those costs and here’s how: They raise the costs for all procedures. So, in effect, the rising cost of premiums is, in part, due to non-payers. Somebody is already paying for these walkaways and if you have private insurance, it’s YOU. What needs to happen in this instance, is that if an illegal gets treatment in an American hospital, then the government of Mexico (or wherever the illegal came from) should be billed. Harsh, I know! But practical. (Since when is it our healthcare system’s/government’s/taxpayer’s responsibility to provide free care for non-citizens?)

So, what if the person in question is an American citizen and doesn’t have insurance and can’t pay? Who pays then? If you have insurance, YOU DO! (after they declare bankruptcy or give a fake name/SocSec #, that is) If a person is on Medicare/Medicaid/etc who pays? If you pay taxes, YOU DO! So, in effect we’re already paying for all of these costs.

Another problem (I remember McCain mentioning this during a debate last year) is that insurance can’t be bought across state lines. That limits competition and forces buyers to not be able to get the best deal offered. This is REALLY BAD! I just can’t figure out how such a regulation came about unless it was for some political reason…

Now, I’m no expert but this problem has been allowed to become such a tremendous burden on health care providers/hospitals/taxpayers that something has to be done. The problem is that now it’s the government that’s going to be doing the deciding.

A final thought: I’ve read a lot of commentary/opinion about this issue and seem to be running into one argument frequantly that is, IMHO, incorrect. The argument goes: If government gets involved, “health care will be rationed.” Well, it already is rationed to a certain degree meaning that if you have private insurance somebody is making decisions about what sort of procedures/prescription drugs you can receive as well as which doctors you can see. I wish somebody (more in-the-know than I am) would further explain this “rationing” argument so that I understand it better.

regards

Jun 15, 2009 - 1:09 pm 33. Delmar Jackson:

I am self employed at a barely subsistence level and pay $3300 a year for coverage. My insurance never seems to pay for anything and goes up twice a year. As much as I hate the idea of Government healthcare I am starting to be in favor for two reasons.
One, maybe I wil finally get some ’shoes’:

Two, as an immigration conservative National healthcare that included the twenty million illegals and the tens of millions more relatives that would come almost instantly would be the end of our country. National Healthcare for all would cause a revolution by those having to pay for all this crap. You can not have unlimited immigration and National Health care. A choice would have to finally be made or a Civil war begun. Once immigrants outnumber citizens they would vote themselves into our pockets and there will be no way to stop them, better to force this issue now while there is still a moment left.

Jun 15, 2009 - 1:10 pm 34. The Shadow:

Mshatto – Since interest rates are near zero and nto working, the only way to get investment is for the government to step in for the short term. The other major initiative is healthcare. THe cost is choking american industry and we have nearly 50 million without insurance. Studies have shown that models like the Mayo clinic are twice a efficient as many local systems. In the inner cities, primary care providers cannot pay their bills because medicaid pays as little as $19 a visit. They have left the care of the poor to the emergengy rooms which cost on average $1000 a visit. Yet that is where many of the poor goto get their healthcare. Medicare covers the elderly who in terms of percentage are the sickest and private insurance covers thos who are the healthiest. The system does not work. I believe a public option would help get the cost down if combined with a system that encouraged the rise of Mayo type systems. This is what Obama is trying to impliment

Jun 15, 2009 - 1:17 pm 35. Jim Baker:

If people were spending their own money for doctor visits you can bet health care costs would go down. People don’t seem to have any interest in getting the most bang for the buck as long as it is insurance company bucks. If doctor visits were on a cash basis, doctors wouldn’t charge as much as they do, if for no other reason than, because they wouldn’t have to have three or more clerical workers on staff just to handle the insurance payments. And don’t forget this, doctors are in the business of curing diseases, so you can bet they will find a disease to cure when you go to see them. Catastrophic health care insurance is all most of us need. But, no matter what, your family’s health care should not be one of my family’s concerns.

Jun 15, 2009 - 1:19 pm 36. The Shadow:

Delmar:

I hate to let you in on this, but you already pay for anyone who goes to an emergency room and cannot pay. The law says they have to be treated. I have not seen any statistics, but I think that the percentae of the poor who are illegals and who go to the emerency room is tiny cmpared to the rest of the poor. So stopping illegal immigration even is you could would not come close to solving the problem.

Jun 15, 2009 - 1:37 pm 37. DavidN:

Ms. Yockey,
I think you’re missing one key ingredient here. Rush Limbaugh, our evil genius on the radio, used to have a quote he would spout periodically: “They [the Democrats or liberals] don’t think Communism has failed; they merely think the right people (themselves) haven’t tried it yet.” In our society, there’s a natural reaction, when someone sees something wrong with our government: either something the government is doing wrong, or something it should be doing, but isn’t. People almost never see the government doing something, and think to themselves “Why is the government involved at all? They have no place here.” As a result, the health care system in this country will be “reformed” by our government, because no one has the nerve to say that they won’t do a very good job. Any example of government incompetence will automatically provoke a response that they “won’t make that mistake again.” Instead, of course, they’ll find a new way to screw things up, and do it much worse than incidents in the past. Once we’ve given them the control, there will be no turning back: endless phalanxes of government bureaucrats will contribute buckets of money to their congessmen to make sure that their jobs are safe. Once you go bureaucrat, you can never go back. We’ll be stuck, and twenty years from now we’ll be reading about the guy who went into a hospital for a bad headache, had his foot amputated by the doctors, and can’t sue, or get his old job back. No one will care, because government costs will be so high that the government won’t be able to compensate *all* the victims of government mistakes. And then we’ll be completely done.

Jun 15, 2009 - 2:07 pm 38. JED:

I still want to see the pie chart that shows the distribution of the $2.5 trillion annual American health care costs. Then we could debate a real issue and sing from our choirs off of the same page. First the problem and then the answer.
Otherwise, I refer to the two definitions of a politician: 1. They invent a problem and offer the only solution if you pay them. 2. They see a parade and run to the front to show leadership.

Jun 15, 2009 - 2:32 pm 39. VA Teacher:

As so many have noted, the problem isn’t access to health care. Everyone has access. The question is paying for it. This is clear from the arguments the President is making, which mostly revolve around the problem of escalating cost and the need to control those costs.

What’s less clear is how this is going to work. If people are paying less out of pocket, they will seek to utilize more services (that’s Econ 101). So where does the savings come from?

It’s not enough to point out that our current system has waste and inefficentcy. It obviously does, but how do we know that the new system will be so much less wasteful and more efficient as to cover the increased utilization and still achieve major savings? Wishing doesn’t make it so. In fact, the track record for government health care reforms/programs is quite the opposite. They end up allocating resources according to political criteria (squeeky wheel/lobbyist gets greased) and often become less efficient. In fact, we need to take a step back and realize that “efficient” means different things to different people. _I_ might think that Viagra and hip replacements for 95 year olds is wasteful, but 95 year olds, Viagra manufacturers and hip replacement surgeons probably have a different opinion. Who should decide? What makes advocates of reform so sure they’ll be happy with the decisions that get made?

We also hear a lot about how prevention is cheaper than treatment. That may be true, as far as it goes, but think for a minute. The two preventable conditions that cause the most medical problems are obesity and smoking. Does anyone really think that people smoke or are obese because they haven’t had access to preventive care? If an obese person shows up at the doctor what is the doctor going to do? 1) He’s going to say “You’re obese” (I think obese people already know that they’re obese.) 2) He’s going to say “Reduce your caloric intake and get some exercise.” (Again, this won’t be a revelation…they already know.) As far as smokers, it’s true that nicotine gum is expensive, but you can get it over the counter and pay for it with what you save on cigs. And yet people still smoke.

So we’ll be paying for more doctor visits, but where’s the savings? I see costs rising; not falling.

We hear a lot about people who have symptoms, but put off going to the doc until they show up at the emergency room for an advanced condition. The argument is, if they had insurance they would go to the doc sooner. Is that really true? Or do they put off going to the doc because they can’t afford to take time off work, have other responsiblities, are scared of the diagnosis, or just don’t give a damn about their health? What makes people think that the savings here will so overwhelm the added cost of hypochondriacs who overutilize because its “free”?

It seems to me that the health care system is incredibly complex. Even simple problems need to be evaluated, triaged, treated and followed up. More complex problems need to be diagnosed, a sometimes extremely difficult and time-consuming process. (Ever show up at the doc complaining of an unspecific headache or general tiredness? It can take years to figure something like that out.) And finally, who is going to be responsible for mistakes? (Because there WILL be mistakes…lots of mistakes if your plan for saving money is to add more gatekeepers to the process.)

It seems to me that there are two ways to go:

1) Assume that the big brains in Washington, working through the political process, can design the most efficient, least wasteful system that maximizes consumer satisfaction and minimizes costs. That’s the Obama plan. Based on everything we know about how government programs operate, what are the odds that this will work out? Or is it more likely that putting everyone in one system is just a prelude for future “cost controls” which will be more palatable because everyone is hit equally. (Or at least, according to their political clout).

2) Instead of trying to devise a one-size-fits-all healthcare system, we can let government provide a basic, minimum level of “free” care with the costs paid by taxes; and then let people use their own money to buy insurance for a highter lever of care for high cost/low probablity events (what used to be called “major medical”). Regular annual type expenses should be paid out of pocket by people with their own after-tax money, either fee-for-service or HMO style. This is pretty much how we handle food and housing in this country, why should health care be any different? If you want more than the minimum, pay with your own money. Or not. Your choice.

One final point. The unspoken assumption of most of these health care plans is that (collectively) we can afford to give everyone in this country high-quality medical care. Given that the definition of “health care” changes every day (new treatments, new drugs, new procedures); are we really sure that this assumption is valid? What evidence can the proponants provide to prove that it is? And what are we going to do if it isn’t?

Jun 15, 2009 - 5:09 pm 40. Eric:

Health Savings Accounts (HSAs) are the answer.

Eliminate state rules on health insurance and create a truly national market.

Employers need to, over time, start paying employees the cash value of their insurance coverage and ask that employees enter the insurance market to purchase their own insurance.

Everyone should have an HSA at a minimum.

Policies should be made available with high premiums and low deductibles and low premiums and low deductibles. It should be up to the consumer. The HSA rules should be written to favor low premiums and high deductibles because this type of policy drives lower use of problems that could be resolved by a trip to the drugstore instead of the ER.

The poor can have their HSAs subsidized and be given the same deal private HSA contributors have, i.e. whatever money isn’t spent you get to keep. The HSA card can only be used for medical expenses.

The free-market is the ONLY means for lowering health care costs.

Jun 15, 2009 - 5:58 pm 41. Eric:

Meant to say:

“Policies should be made available with high premiums and low deductibles and low premiums and HIGH deductibles.”

Jun 15, 2009 - 5:59 pm 42. Eric:

And any “poor” person with a cell phone, cable TV, and a pair of Air Jordans on his feet should not be given any subsidy. We have to demand accountability and responsibility from the “poor”.

Jun 15, 2009 - 6:00 pm 43. Tri Geek:

The ONLY answer to reduced health care costs is TORT REFORM. Until that is taken care of, nothing else should be considered. So, how many people out there think Obama will even consider Tort Reform? Of course he won’t. He, and all the libs are total stooges for the trial lawyers.

Jun 15, 2009 - 6:37 pm 44. Well Educated Cad:

Very good comments all around- except the one about ” doctors will find some disease” to make money. Horse Hockey! I do know plenty of chiropractors, dentists, herbalists and maybe a few doctors that might do that but most of us are too naive and nice to do that. Some things to think about however-
1) We already have socialized medicine- in the VA, Medicare and Medicaid. And it sucks. That’s why we doctors are so against it. We’ve seen it and it’s terrible. We’ve also had the government make a LOT of promises to us- that they never intended to keep.
2) Amen about the insurance companies. They are 100% about profit, not care. The CEO of United Insurance is retiring with a $800,000,000 retirement package- and who do you think paid for that? You and I. Blue Cross boasts of a yearly profit of over a Billion a year. Take them out of the picture and costs will drop.
3) Illegal aliens are indeed a problem. Especially when they have that first baby here (”anchor baby”) and then the entire family gets to stay. I am always astounded how many are on Medicaid as well when they are ILLEGAL! We are being forced to pay for our own destruction.
4) If you take the entire health care bill for the entire US and divide it by the number of taxpayers, no matter how you slice it or manipulate it, we all still pay that price in one form or another. I actually like the idea of a national sales tax, since then EVERYONE would be paying taxes. Of course, it would just open another can of problems.
5) I see massive Medicaid waste everyday and the government does nothing to stop it. Of course, I mean by the patients on it. The Hispanics loan their medicaid cards to illegal friends who then pretend to be that family. ( “Wow Jose! You gained 27 pounds since last week and grew 7 inches!”). Since there is no co-pay on Medicaid, I see people all the time in the ER everyday who just saw their doctor THAT MORNING and “aren’t better yet”!!!!! Or have taken their kids to 3 different ER’s and doctors that day. Or called an ambulance for a mosquito bite or their child has a fever of 99 degrees.
When the government can run the VA, Medicare and Medicaid efficiently, only then will I have any faith in them to run the rest of it. I won’t hold my breath.
And Delia- you are insanely lucky with your midwife. Last week, once again, we had a midwife dump a lady outside of the ER doors half dead with a dead baby hanging half way out of her and told her not to tell anyone who she was. We see this all too often. When problems happen in delivery, they happen fast and you only have three minutes before the baby starts having brain damage. I made sure we had our child in the hospital near the Pedi ICU just in case.
And I just celebrated last week getting health insurance for the first time in 8 years – being selfemployed and with pre-existing conditions sucks. No one will touch you at any price. I only got it thru my wife’s job….

Jun 15, 2009 - 8:01 pm 45. Well Educated Cad:

Oh- I forgot. We did pass Tort Reform in Texas and it massively cut costs. The lawyers are still screaming.

Jun 15, 2009 - 8:02 pm 46. Canadian-know-it-all:

Here’s a scary thought. As far as I know, every country which has Universal Health care (notably Europe and Canada) also has developed a very aggressive euthanasia movement. The reason is simple; cost. Not that anyone says that.

The majority of health care goes to the aged and infirmed; is it any wonder that liberals what to “unburden” these same people from the cares of this world?

Jun 16, 2009 - 12:06 am 47. Chileno:

Offering something to those who have nothing is a powerful political tool. It’s how demagogues or communists gain power among frustrated the masses, especially in desperate times. To those with no shoes, even flip-flops look good.

How do demagogues pay for these offerings? Usually through taxes (or government debt, essentially, deferred taxes), which promote “wealth distribution.” Like modern-day Robin Hoods, they finance their utopian dreams by making the rich pay “their fair share.” But wealth distribution is no substitute for wealth creation. Even Robin Hood could only steal so much. Eventually, the rich will either run out of money or have moved away, and the poor will have consumed what little was given to them, (and those in power will have embezzled/mismanaged the rest), leaving everybody worse off. .

What do demagogues ask from the masses in return? The “authority” to enact the laws to promote their grandiose dreams. It’s the Huey Long “share the wealth” approach to government, which ultimately leads to authoritarianism and corruption. The poor are willing to give away their useless freedoms for the shoes they need to survive. It’s a story repeated time and again, in countries like Cuba, or Venezuela, to terrifying results.

So yes, free shoes, even flip-flops, sound great to those with no shoes at all. But they must understand that their flip-flops come at the expense of selling the shoe factory, an unsustainable economic model that eventually will leave everybody shoeless again.

The shoeless must be helped.. But the secret to lifting up the poor is not finding new means of income redistribution, it’s finding new means of income generation: jobs, small and large businesses, etc. That’s something socialism can’t create.

In the words of Calvin Coolidge: “Don’t expect to build up the weak by pulling down the strong.”

Jun 16, 2009 - 1:25 am 48. The Shadow:

Canadian – You have just given us an example of the fallacy post hoc ergo propter hoc

Jun 16, 2009 - 8:18 am 49. fred:

Shadow,

I am sorry to hear about your wife having had cancer. Truly. And as a Catholic, I too am concerned about how we can maintain and provide a basic social safety net for the less fortunate in our society. I used to be on the Marxist Left many years ago when I was a Jesuit seminarian, but I underwent a kind of evolution in my thinking and have arrived at where I am now.

American citizens who are poor or who work for employers that don’t provide health insurance or do not pay for part of it are, especially if they don’t earn much, stuck in a bad place. People in between jobs can get caught in a bad place too, especially if they are older workers who were laid off precisely because the corporation wanted to offload benefits’ costs. I know some who worked for Fortune 500 companies and were productive and good employees, but were let go because the company wanted to hire younger people whose benefits would cost less. All the way around, there are gaps in the system through which people slip. Especially those who have pre-existing conditions.

My concerns also extend to these three worries:

1. A government run program will bankrupt the nation at a time when the deficits are exploding as far as the eye can see.

2. Steep rises in taxation – and it will reach much farther down the income ladder than $250K. It’s unavoidable, because there are not that many people you can go to the well for for more money. The bottom 50% of the population pays virtually no taxes. This is not sustainable.

3. I am very concerned about rationing of care, the constriction of R&D money for medical technologies and new drugs.

I am skeptical The One and his bureaucrats can do a balancing act that will not dampen the growth of the economy as it pursues its goals. Nothing I’ve seen so far convinces me that he and his people are outside the box of the typical zero-sum thinking about the economy.

Jun 16, 2009 - 3:37 pm 50. Kriska:

fred,

I do agree with your worries.

From previous posts,you know my situation (self-employed, rise in insurance premiums, reduction of benefits, pre-existiting conditions, can’t use previous Drs./ can’t find a Dr.-therefore $5000/year out of pocket for out of network–hubby has to have out-patient proceedures performed 2-3x/per year, etc.–therefore I’ll have to pay $5000/year + Rx’s out of pocket each year for the rest of our existance.)

I thinkg the whole problem to this so called “crisis” is “slackers” who have no intention to pay, not the poor or folks faced with hard times! I going through some hard times and have hospital bills. We all are going through hard times. God Bless my Hospital!! They bend over backwards to help me with a payment plan that I can afford that works for both of us–they also will write off 25% if I pay the balance of what my insurance didn’t cover within 30 days. In two prior experiences with ER’s when I was(young)unemployed or uninsured, hospitals were always willing to work with me–sure, maybe it took me several years to repay, but I was never harrassed, denied treatment and I PAID MY DEBT! Even during hard times, there is no excuse to not make an effort to pay!

And now I’m going to be taxed more to pay for the slackers when I’m having hard financial times myself.

P.S. Yes Mr. Obama, I sent my 2nd quarterly tax payment yesterday and it is in the mail! I hope it is enough to cover another date in NYC.

Jun 16, 2009 - 5:10 pm 51. Chileno:

In order to offset the cost of covering the current 45 million uninsured, Obama hopes to cut $313 billion from Medicare. So cash-strapped hospitals will now be asked to receive less per Medicare patient.

How will hospitals keep afloat with less per-patient reimbursement? Either by overcharging those of us who can pay, cutting services (e.g. less staff, not offering costly therapies/procedures), or increasing volume (more patients per nurse/physician). So yes, if Obamacare legislation passes, be prepared to pay more and receive less.

Jun 16, 2009 - 10:46 pm 52. Caestal:

I work in the health care system, not in a medical capacity but in more of a clerical/admin role. I can say definitively that much of our work, and thus our expense, is cause specifically by Federal standards and paperwork we have to comply with due to our accepting Medicare, even if the patient is not a Medicare patient. Many of our procedures are driven by government standards, and a lot of things that should be decided by doctors are instead decided by rules made years ago by people not involved in the treatment end of medicine. I have seen patients who came in and had to be put on one-to-one nursing care classified as “observation” patients rather than inpatient, because that is all that the Medicare charts show they should be charged at.
I can’t help but suspect that the people who brought us Medicare will not be the answer to keeping rising medical costs down.

“no amount of good living will protect you from bad genetics.” Ain’t that the truth. People like me who have diabetes would be dead pretty quickly without access to relatively frequent medical care. I come from a family where diabetes runs on both sides. It is not a lifestyle issue, it is not something I did, it is something that happened. From the standpoint of society, if I don’t get medical treatment because of lack of insurance, it is not that big a deal — I die, my family is bankrupted, nobody else is probably dragged down with us.
However, if someone has (for instance) the flu and doesn’t get treatment because of lack of insurance, chances are they will spread it far and wide, and if it were the mythical deadly pandemic that people see swine flu as, many people would die from it. At the least, it is in the public interest to see that either medical insurance or affordable health care is available pretty much universally.

I just wish there were somewhere besides the government we could turn for it…

As far as President Obama’s promise that we would be able to keep our current coverage and doctors if we want, he didn’t mention the correlary to that: You will still have to pay for the new system,whatever it may be, whether you use it or not.

Jun 17, 2009 - 12:38 am 53. Paul -Indiana:

Having Health Care and having Health Insurance are not the same. You can go to a doctor when you wish, but you may have to pay [shudder] your own bill.

Jun 17, 2009 - 5:27 am 54. The Shadow:

Fred :

#1 is an assertion – If you bother to read Atul Gawande’s article, you can start to see how to control costs. We already have rationing for teh 50 million Americans who do not have health care. I had to go to the emergency room a couple of years ago. They held me overnight. The bill before the insurance deduction as $9,500. After the deduction it was $3,500. If I were uninsured I would have been liable for the former amount. That is insane.

I believe we as a country have a moral obligation to make sure everyone is covered. What is your postion -Let them eat cake?

No system is perfect, but ours is broken. The administrative expense is 15% higher than the one in Canada. We are on a collision course with the current system. What are your solutions?

One of the problems is that there are too few family docs. Medicaid pays them too little; so the poor go to the emergency room where the average cost is over $1,000 per visit

Jun 17, 2009 - 6:53 am 55. fred:

Did you read the first paragraph of #52 Caestal, Shadow? Also, my wife is an occupational therapist and she has a LOT of paperwork that both she and the admin. assistants have to do for the government for medicare patients. It’s costly and time-consuming, plus they get a reduced amount of reimbursement that the rest of us pay as an offset when non medicare patients are charged for services. And that’s just the tip of the iceberg.

Now, Shadow, Ms. Sebelius from Kansas does have a constructive idea worth something, for the government plan. Instead of the government directly being in the business of health care, form non-profit health insurers (which Blue Cross/Blue Shield used to be in the days before Anthem bought most of them out) that people can buy into, and these will compete with the for-profit insurers. The non-profit plans won’t have the marketing overhead that the others have, plus they won’t have the outrageous, top heavy salaries and bonuses like what the Anthem executives make.

But the fact is that the opt-out penalties that the government is going to impose on employers is going to easily encourage companies to just offload their employees’ health insurance on to the government, since the tax penalty will be much less than the cost of private insurance. Large corporations actually like this idea and many are lining up behind it. The net effect of this is that a lot of private insurers are going to be forced out of business.

All of us will experience rationing, and most of it will be foisted upon the elderly. Thus, my 75 year old mother, who just had emergency aortic valve replacement back in April, will be given the morphine drip. I am one of those people who has bad genetics. I have had both hips replaced, my left one when I was 45 in the year 2000, and my right hip in 2006. My father has had his right one done and will soon need his left one replaced. I have inherited this condition and some day may need my right knee replaced. It is likely, if the current government run program is not substantially retracted in the future, I will have to wait a very long time for that knee replacement when I need it. And I also have Meniere’s Disease and part of the diagnostic battery required a brain MRI with dye. I’m lucky I had that done a couple of years ago, and won’t need the MRI in the future under the government plan.

I would prefer it if a solution could be found to cover the uninsured and those with pre-existing conditions, rather than one which will put us all in a government run, rationed program, that is heavy with compliance paperwork and bureaucratic decisionmaking. But I’m afraid that is not what is going to happen.

Jun 17, 2009 - 7:27 am 56. Paul -Indiana:

#45. Is there a link to what was done in Texas? I hadn’t heard about tort reform in Texas.

Jun 17, 2009 - 8:30 am 57. The Shadow:

Fred:

Having paid the bills for my mother who was seriously ill for 5 years and had private insurance, I don’t see that the paperwork in a private system is less onerous than a public system. Why are the per capita administrative cost of the Canadian system 15% less than ours. That would be a saving of 300 billion dollars a year. Rationing happens under any system where you are allocating scarce resources. Again read Gawande if you want the truth.

Youseem to think any Government system is sinister and uncontrolable. One other tale – I have to wear braces for my condidtion. My policy pays for the braces but not the orthotics you need to make the braces effective. Cost $380. Fortunately, I can afford to pay. What if Ican’t. I would be stuck with braces that are unusable.

How do we get care to the urban poor. In Camden, no family doc wants to go there because they would have to depend on medicaid patients where the fee for a visit can be as low as $19. How do we fix that system? Do you really want to make that into a profit system where the insurance companies ern a hefty profit. Where is the benefit in that?

You want to trust a for profit system where the goal is to earn a profit. I work in a for profit system and believe me they might give lip service to other lofty goals but when the rubber meets the road their obligation is to meet the shareholders expectations.

Jun 17, 2009 - 9:03 am 58. Well Educated Cad:

If The Annointed One would first show me that he can “streamline” Medicare, Medicaid and the VA system FIRST, then there is a faint possibility that he can run the rest.
Somewhere in Chicago, a community is missing it’s Organizer.

Jun 17, 2009 - 9:29 am 59. Hotpatch 6:

I am selfish!! I like my private medical insurance and gladly pay that premium. I am not a fan of MEDICARE but the premiums are withheld, so I have no choice. I am a disabled veteran with service-connected disabilities, but will not go anywhere near the VA hospital! (Too much like Obamacare will be). So what obligates me to pay for someone else’s healthcare, whether citizen or non-citizen? I am NOT willing to do that. Period.

Jun 17, 2009 - 1:13 pm 60. The Shadow:

Hotpatch 6 – I hate to let you in on this secret, but you already do. The emergency rooms cannot by law turn anyone one away. So, if you hav a cold and do not have insurance you can get treated in the ER. It will only cost $1000. So you pay for that already. If we funded more family docs we might be able to get those people treated for a lot less. That is one way to lower the overall cost of healthcare and extend coverage. Of course if you just want to stick you head in the sand – go right ahead

Jun 17, 2009 - 2:15 pm 61. The Shadow:

from Krugman

I know it’s a tough competition, but this just might be the most hypocritical thing I’ve seen in the past year:

On Monday, Sens. Jon Kyl (R-AZ), Mitch McConnell (R-KY), and Pat Roberts (R-KS) introduced the “Preserving Access to Targeted, Individualized, and Effective New Treatments and Services (PATIENTS) Act of 2009,” a new bill prohibiting Medicare or Medicaid from using “comparative effectiveness research to deny coverage.”
How bad is it? Let me count the ways.

1. Politicians who rail against wasteful government spending are taking action to prevent the government from reining in … wasteful spending.

2. Politicians who warn that the burden of entitlements is killing the federal budget are stepping in to block … the single most painless route to reducing the growth of entitlements.

3. They’re doing it in the name of avoiding “rationing of health care” … but they’re specifically addressing taxpayer-funded care. If you want to go out and buy a medically useless treatment, Medicare won’t stop you.

4. These same politicians are, of course, opposed to efforts to expand coverage. In other words, it’s evil for government to “ration care” by only paying for things that work; it is, however, perfectly OK, indeed virtuous, to ration care by refusing to pay for any care at all.
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Jun 17, 2009 - 6:48 pm 62. fred:

Shadow, I saw this coming over twenty years ago when I met my wife and began to learn about the health care industry. Medical schools and societies made a decision a long time ago to restrict the slots in the med schools.

It isn’t just a shortage of primary care physicians. It’s a shortage of ALL physicians, specialists as well as PCP’s. And that shortage is going to make rationing a solid fact, not mere conjecture. People need access to surgeons as well as PCP’s where they live. Making people wait many months or even years is not going to cut it and you will see quite a political backlash against the system when that happens.

If they put this system in place, and I assuming it is a done deal, the details have to be worked out, and when my Dad needs his left hip replaced and they make him wait a year or more for the surgery I am going to be furious. And if years down the road I need a knee replacement and I have to wait years in a queue I will be extremely angry.

If the government wants to cut down on expensive diagnostics using technology, it will result in wrong diagnoses, the correct treatments not done, and even people dying. I guarantee you that hell hath no fury than the people harmed by this bureaucratic insensitivity. The doctors are not going to like it too.

I still think Ms. Sebelius is on to something about creating non-profit insurance companies, cutting down on the exhorbitant overhead of marketing and gargantuan executive salaries. In my opinion, doctors are worth their pay. Administrators and managers less so. Kinda the way I look at pay structures in a university or college. The administrators make waaaay more than the professors do, and add less value overall.

Jun 17, 2009 - 7:41 pm 63. Chileno:

Here’s some interesting facts: U.S. government programs (Medicare/Medicaid/SCHIP/VA) already account for over 45% of health care expenditures, directly covering 28% of the population (83 million), including the elderly, disabled, children, veterans, and some of the poor. Some form of government-run public healthcare is essential, to cover those unable to help themselves, and to stop the spread of diseases which could affect not only the uninsured, but all of society, like STDs, TB, or influenza. But socializing the rest of medicine will create an inefficient bureaucracy that would respond to political manipulations, not costs. Expenses would rise faster, not slower.

Instead of focusing on who controls healthcare costs, we should be focusing on why they have risen, and how to make them drop.

Why have costs risen so fast? A 2008 Congressional Budget Office report stated that hospital and physician costs are the largest proportion of expenses, and “most of the long-term growth in total healthcare spending has resulted from growth in either or both of these categories… About half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology.” Rising healthcare costs are mostly due to technological advances, as well as the high cost of labor (much of medicine, unlike other fields, CANNOT be mechanized). Here’s a link to the CBO report: http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

Administrative costs for private insurance, though on the rise, still only represent 12% of premiums. So while some savings could come from cutting administrative costs (e.g. streamlining the billing/claim process by standardizing forms/payment rules/codifications, making the entire process electronic), it would still not be enough. Tort reform, to reduce the direct and indirect legal costs (including unnecessary tests ordered more for lawyers’, not patients’ benefit) could do the same. Making all insurance carriers non-profit is an interesting option, though I don’t know if legally the government can force them to do so. More competition (from out-of-state carriers) could drive down premium prices.

All these measures are good, but they all focus on cutting the costs of supplying medicine. So long as the demand for medicine rises, so will the need to supply more (and incur in greater cost). Some medical complications are inevitable (we all get older, or get sick at one time or another). But what about avoidable medical complications? A substantial portion of the rise in healthcare use is due to complications from smoking, or drinking/eating in excess. The exploding diabetes epidemic we are witnessing is mostly not due to “bad genes,” but to bad eating/exercising habits. I personally would advocate higher sin taxes (alcohol and smoking, and also snacks and soft drinks), to help curb these behaviors, and make those who continue to engage in them pay a higher premium. We should all take care of our own health. Those individuals unwilling to do so (who continue to smoke or eat/drink in excess) should NOT be refused government benefits or treatment. But shouldn’t we find a way they put in a little more into the collective pot? If I was told not to smoke, but kept smoking, why should you have to pay for my lung cancer treatment? Believe me, if people didn’t smoke, or eat/drink in excess, half the hospital beds would be empty.

Ultimately, the cost of healthcare will still be expensive. You can’t get world-class healthcare on a shoe string. We must find ways to cut the runaway cost of supplying medicine. But the government can use its tax leverage (education programs don’t seem to be enough…) to foment healthier living, and drop the runaway demand for medicine as well. Each one of us must pay their share. But those who incur in greater risk should pay a greater cost.

Jun 18, 2009 - 6:43 am 64. Thalpy:

Your observation that “it doesn’t look like many liberals will realize in time how desperate Obama has made them by destroying the economy in as many different ways as he can. They will be frightened into believing “any port in a storm,” and go along with his plan to make the U.S. a socialist country” is an excellent one. Belief that we will hang or drown together makes everything “all better” isn’t comforting at all. It shouldn’t give them comfort either.

Jun 18, 2009 - 7:05 am 65. JED:

#63 Chelino

You have the best handle on this situation which I have yet seen.
We know the lie that they are selling “health care” wherein in fact they are enabling poor health.
Imagine in your wildest dreams that Obama on his next info-mercial talked like a doctor from his bully pulpit and scolded the audience for their risks and self abuse, and expensive habits.

Jun 18, 2009 - 3:55 pm 66. Chileno:

#65 Thanks for your comment!

Unfortunately, The One, that Great Reconciliator, would couch any vice scolding with some form of moral justification. I can hear him now: “We must condemn the cigarettes that people smoke. But we must understand the cravings, the anxieties of modern life that drive people to smoke! I couldn’t disown the smoker any more than I could disown my vice-filled grandmother…”

Jun 18, 2009 - 9:17 pm 67. Philip Dhingra:

It’s juvenile to call it “socialist medicine.” Why don’t I call the conservative way “capitalist medicine.” What I love about capitalist medicine is how efficient it is. Check out this graphic:

http://healthyarguments.com/stats/pct-spending-vs-age.gif

Get it straight: capitalist medicine is inefficient. Double-check that graphic if you’re confused.

We spend the most out of any developed country and yet we don’t see the benefits. Why is that? More free market isn’t the answer.

I understand the purpose of calling it socialist medicine. It’s to evoke long lines and rations. It’s to conjure up images of government inefficiency (like waiting at the DMV or Post Office).

That’s clever. But what about the inefficiency of capitalist medicine?

How about the long lines you will face 20 years from now when you’re in court trying to fight your insurance company for coverage. Or what about rationing of decent nursing homes for your parents because they simply aren’t affordable in this country. Why are hospitals so crowded in America? It’s because capitalist medicine is taking us for a ride.

FACT: capitalist medicine is inefficient.
FACT: socialist medicine is not.

If you’re confused, re-read.

Jun 20, 2009 - 9:42 pm 68. Chileno:

#67: “Why are hospitals so crowded in America? It’s because capitalist medicine is taking us for a ride.” Hogwash. Hospitals are full because there is a rising demand for hospital beds, due to the combined graying of our society and our terrible health habits, as demonstrated by the obesity and diabetes epidemics we currently suffer.
“FACT: capitalist medicine is inefficient.
FACT: socialist medicine is not.”
It may be juvenile to talk about socialized medicine, but it’s ignorant and naïve to think socialized medicine will solve our problems. And just because you wish something with all your might and WRITE IT IN UPPER CASE doesn’t make it so. In America, socialist medicine is no more efficient than capitalist medicine. If the government were so efficient, why not offer Medicare as an open enrollment insurance (competing against private insurers) and let the consumer decide which is better? If Medicare was so efficient, why were Advantage programs created, whereby Medicare (in order to cut costs) is essentially subcontracting itself out to private insurers?

Do you really think government-run medicine can be more efficient than the private sector? How has it done so far? 45% of US medical expenditures are already spent by the government, through Medicare/Medicaid/VA/SCHIP. Has it proven itself more efficient than the private sector? No. The President’s Council of Economic Advisors recently stated that “nearly 30 % of Medicare’s costs could be saved without adverse health consequences,” implying 30% of Medicare’s spending is a waste, a proportion similar to that suggested for private insurance companies. Liberal pundits proudly assert that Medicare’s administrative costs are only 2-3%, much lower than the private insurance companies. Yet that number belies many hidden costs not attributed to Medicare (as fee collection, fraud investigation) that other government branches undertake on behalf of Medicare. The percentage is also low because Medicare payouts are so high. As the denominator grows, the relative size of the numerator shrinks.

The reason the government (and the private sector) have been unable to rein in expenditures is because the rise in costs is, for the most part, NOT due to company inefficiency. As Americans become older and fatter, healthcare utilization has risen. There’s also a greater array of services, drugs, and technologies available, whose use (and misuse) is fomented by the US fee-for-service healthcare model. Little is done to discourage waste, in the form of unnecessary tests or expensive drugs. Why would healthcare professionals offer unnecessary tests or technologies? Given that these tests offer the professionals reimbursement, additional protection against lawsuits, and greater patient satisfaction (as often the patients demand them), they may ask, why NOT offer them? Would politicians legislating for socialized medicine change this? Given the millions spent in lobbyists by the insurance industry, drug companies, and even professional organizations like the AMA, the answer is no.

So unless we overhaul the entire fee-for-service model, or decide to curb expensive technologies/services/drugs, things won’t change much under socialized medicine.
We will simply be transferring exorbitant healthcare costs from the private to the public sector.

What do we mean when we say the government should provide healthcare? It sounds almost noble to say, let the government pay for universal healthcare. But how does the government pay for this? Payroll taxes? Income taxes? Corporate taxes? Given that the underclass pays few of these taxes (43% of Americans pay no federal income tax at all), “let the government pay for it,” essentially means, “let the corporations/rich/even middle class pay for it.” This, coupled with our fee-for-service model, could prove a costly mix, as more people will be offered more services which they themselves need not worry about paying for. How will you discourage overuse? Costs will continue to skyrocket.

The secret to lowering healthcare costs is not who pays for it, but understanding what we are paying for. Streamlining the system, allowing for greater competition, or even making companies non-profit, could all help reduce costs to a certain extent (and it’s doubtful that making all of medicine government-run could do any better). But until we curb the increased demand for healthcare, and contain the rising supply of services offered, our healthcare costs will continue to rise.

Jun 22, 2009 - 11:58 pm 69. Houston Hound:

#3 & #44 – GREAT comments! Our current healthcare system is in dire need of an overhaul; however, the government is NEVER the answer. Everything it touches ultimately ends up reeking of incompetence, fraud, abuse, corruption, etc. (e.g. Social Security, Medicare, Medicaid, FEMA, TARP, bailouts, stimulus #1 and the list goes on). There will never be a perfect solution due to the complexity of the system. A good start would be for everyone to acknowledge this and get focused on the changes that would have the greatest positive impact, tort reform across the board and once and for all addressing our illegal immigration issue.

If all of the illegal immigrants left there would be billions saved to direct to needs of poor US citizens. We don’t have to go around and round-up 12+ million illegals either. If our federal gov’t. would enforce the current laws and fine the heck out of companies hiring illegals the jobs would dry-up because it would not be to the benefit of these companies to hire them anymore since the savings they were enjoying by paying below market wages would be eaten-up by fines. Additionally, just because someone goes to the emergency room doesn’t make it an emergency; therefore, our hospitals should be able to turn away any illegals who are not truly experiencing an emergency. If our gov’t. would quite misinterpreting the 14th Amendment there would be no issue of “anchor babies” which is also very costly. Why our gov’t. thinks it is more important to take care of people who stole their way into this country rather than our own is beyond my comprehension. I feel compassion for these people seeking a better life, but bottom-line we can not take care of the world. Mexico has harsh laws it enforces regarding illegal immigrants yet it dares to tell us what to do regarding its citizens who have illegally entered the US and set-up residence.

As a nation we have the right to decide who we want here and it should only be people who have something to contribute not take from this country. We have plenty of US born takers; we don’t need anymore. On that note it leads me to another point that falls in line with what #3 said. There are way too many people who add to the approx. 46 million uninsured that choose to be uninsured. I for one am tired of being reminded of the rights of others, but what about when their rights infringe upon mine? They have the right to use their money for whatever they choose, including not choosing to buy insurance. Now I’m supposed to feel sorry for them because they don’t have insurance? We budget our money to include the necessary insurances for our security, but others can buy the latest, greatest gadgets and toys for their kids and say they can’t afford insurance. We have become a nation of unaccountable, irresponsible, entitlement-minded babies and it’s SICKENING.

Lastly, why is everyone, including our government so focused on the small percentage of people not covered at the risk of the majority who are covered? Private health care may not be perfect, but it is definitely superior to public (for the reasons I noted above). If I have to accept the liberal, Democrat run House, Senate and White House because the “majority” voted them in then they should have to accept that the “majority” have and prefer private health care. The Obama administration and other liberals in office want us to believe it’s their bleeding hearts at work for the “poor,” but instead it is really about bigger government, power and greed- plain and simple. I hope and pray that more citizens of this great nation open their eyes, speak-up and get their reps and senators to see the light before it’s too late.
Note to Obama Supporters: Finger Weg Du Sozialists!!!

Jul 11, 2009 - 4:20 pm

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