A frightening ‘first’ has been acknowledged in a recent Kaiser Family Foundation and Health Research Educational Trust. It seems that for the first time in United States history, the cost of health insurance for a family of four now exceeds the yearly income of a minimum wage earner.
The LA Times has reported on this survey, that gives the amount of $10,880.00 as the cost for insuring a family of four, whereas the income for a minimum wage earner is $10,712.00. Tragically, this rise in costs of premiums has also seen a dramatic downward shift in the amount of businesses offering health insurance plans to their employee’s, which helps illuminate why it is that we are seeing so many people dropping off the insured statistic grid in the United States.
“When we consider that it is small business that drives the economy … to have that engine resting on the backs of millions of uninsured workers is a bad proposition for the U.S. economy,” said Peter Lee, president of the San Francisco-based Pacific Business Group on Health, an alliance of employers that buys insurance for big companies.
“This has to be seen as a wake-up call to policymakers and healthcare providers, as it puts an increasing burden on an already frayed safety net.”
Interestingly enough, most people would like to point the finger at litigation as the primary reason for this, but more information is emerging that shows the symbiosis between insurance companies and health care providers is causing a huge portion of the inflated costs. What are often referred to as ‘usual and customary costs’ paid to health care providers by insurance companies are at this point far less than the amount charged for the services, and it is being speculated that medical providers are in turn trying to make up the difference by ordering unnecessary tests, or office visits.
Regardless, the tag line of the reporting article rang menacingly true to me:
“We’re in a new universe of healthcare coverage, where it is a commodity only for the wealthy,” said Jerry Flanagan, with the Foundation for Taxpayers and Consumer Rights, a Santa Monica consumer rights group.
Insurance is a fundamentally and profoundly stupid model for rationing health care.
No amount of legislation or economic infighting between various players on the field will change that.
On a related note, the folks who got the tar kicked out of them when they tried to get Measure 23 passed haven’t learned their lesson. NOTA love ’em… :p:
http://hopeoregon.org/
Every person from a civilized first world country I’ve ever met, and some from less prosperous countries, has been flat out horrified by the number of uninsured people in America.
How much ya wanna bet that this DOESN’T shut up the fundies who complain that families should give up luxuries (and quasi-necessities) in order to get by on one income so the female adult of the family can be a stay-at-home mom?
And how much ya wanna bet that said fundies will NOT understand, or care about, the fact that high health insurance costs make it even harder for low-income families to afford another child, which is a huge factor in many of the abortions said fundies keep screaming about?
But then, why lower health insurance costs when you can deny them abortion and birth control and thereby push them deeper into poverty—after all, they wouldn’t be having so many babies if they weren’t having sex, which as we all know is only for well-off couples who use it for making nice white babies that don’t feed off the welfare state. (sarcasm)
Nothing blows & sucks at the same time quite like conservativism.
I’m not only horrified, I’m stunned. Everyone in Ontario is complaining about a new premium we have to pay, and how long you have to wait in Emerg, waiting over a hear for non-life threatening surger (like a knee operation) etc. etc.
Do these people not see what is happening a few hundred kilometers south of us?
Oh, I think their so-called opposition –ie Biden, Lieberman, et al– who are up to their necks in Insurance and Pharma $$$$, are just as hateful. Hell, many of them are emeshed in these organizations;Either coming to office straight from ’em or going straight to ’em after leaving office–sometimes it’s both. [scowl]
If you really want to know why we don’t have healthcare reform in this country, spend an evening at Opensecrets.org and look at how much these fuckwits are being paid to let us all twist in the wind for the sake of corporate mega-profits.
I wish some modern merry prankster would start a national campaign to get every Senator’s and Congressperson taxpayer-funded healthcare yanked. We could call it something like “Amendment 28: Feel THIS Pain, You Assholes.”
Grrrrrr…
wookie: It’s worse than you think. One of the quasi-secrets of health care in the US, especially public health care in the US is that there are waiting times here too. I have insurance yet the first appointment I could get for a simple physical exam is mid-November. Non-emergency surgeries such as knee replacements generally take 2-3 months to set up. For people with medicaid or no health insurance the wait is even longer. I used to work at one of the better public hospitals in NYC. I routinely had to schedule patients for MRIs 6 months in advance of when they would need them. An emergency MRI could usually be obtained by some combination of argument (ie the patient needs an MRI today to confirm cord compression), bad behavior (ie screaming at the radiologist in charge of scheduling slots for the MRI), threats (ie threatening to call the NYTimes and tell them that sub-standard care was being provided) and/or bribes (ie homemade cookies in exchange for an MRI for the patient today rather than in 6 months.) All of this was not necessary because the radiologists were unreasonable, but rather because they did not have enough resources (ie MRI slots) to accomedate everyone’s requests. So one had to be persistent and sometimes obnoxious to ensure that one’s patients got proper care. Of course, that meant that non-emergencies got pushed even further back.
alsis: I like your plan. After all, if public health insurance is a bad thing for those living below the poverty line then surely it is a bad thing for congresspeople as well. We must rescue our senators, representatives, and president from the evil socialist health care they currently suffer under. Let the free market take care of them.
Everyone should read the recent New Yorker article regarding insurance and moral hazard, and the catastrophic consequences this supposed relationship between the two has in the area of health insurance and health care in America. Basically, the premise is that large swathes of health care “demand” are for useless services. Therefore, to be uninsured is a good thing, because then one has incentive to marshall one’s resources wisely. Although the article does assert that this is a silly premise, it does not get to the main point: 95% of demand for health care services is driven not by patients but by health care providers who, one would think, are at least be somewhat more informed than their patients regarding what is wasteful and what is necessary. And yet, it is to assuage provider demand that is at the heart of regulatory “solutions” to curtail any means for rationing care on the basis of necessity. I am not defending the principle of rationing, just noting that it is insane to adopt the default form of rationing that is currently afoot: to deny care on the basis of inability to pay and on no other basis whatsoever.
I am not defending the principle of rationing, just noting that it is insane to adopt the default form of rationing that is currently afoot: to deny care on the basis of inability to pay and on no other basis whatsoever.
Two problems here.
First problem is theoretical – if you don’t defend the principle of rationing, then you’re pretty much stuck in wishful-thinking land and everything you say or think will be valueless in finding workable tradeoffs. There is more demand than there is service. Therefore, there will be rationing; the only question is how.
Second problem is empirical. People with an inability to pay, by and large, are not the locus of the health care crisis in America. The genuinely poor have Medicare and Medicaid, which, while not spectacular, are adequate for health care needs. The genuinely well-to-do either insure themselves against all hazard (fiscally stupid but emotionally satisfying) or pay cash as needs arise (fiscally smart but emotionally draining for some).
The locus of the rationing problem falls mainly on the lower-middle-class – people too rich for government bailout and too poor to be able to comfortably insure themselves.
That premium number looks awfully high to me–is it for private, individual insurance rather than through a group? And for what kind of coverage? My employer pays about $600 a month for good coverage for my entire family (I don’t pay any part of the premium).
The locus of the rationing problem falls mainly on the lower-middle-class – people too rich for government bailout and too poor to be able to comfortably insure themselves.
I think that you understate the problem. I don’t believe that it falls mainly on the lower-middle-class. I believe that it falls on anybody who is not solidly upper class who has a family member get sick.
I believe that I am solidly middle class, if not upper-middle class. Yet, when my wife fell ill, I went from having lots in savings & extra dollars left from every paycheck to $80k in debt and no money left after paying bills. And we have insurance. I don’t believe that this is an unusual situation.
“Basically, the premise is that large swathes of health care “demand” are for useless services. Therefore, to be uninsured is a good thing, because then one has incentive to marshall one’s resources wisely.”
But do the proponents of this theory have health insurance? If they do one might suspect that their sincerity was somewhat lacking.
Let me be clear: those who make health policy (for instance, those who passed and are now pushing HSAs as a solution to health care costs) believe that individual patients (or consumers of health care) have influence over health care expenditures on their behalf. This may be true at the margins, but unfortunately, these “consumers” tend to avoid expenditures that are necessary as well as those that are not. But the larger point is that you could only believe that consumer awareness is necessary if you believe that lack of consumer awareness leads to a suboptimal result — which is to say, unnecessary expenditures and “irrational” consumption patterns.
So the official “policy” is to celebrate individual decisions to forego expenditures. It is an unspoken policy. Because although it underlies such initiatives as HSAs, it cannot be voiced out loud. Out loud, we have things like the patient bill of rights, and so on, which respond to “unofficial” private (i.e., insurer based) efforts to control consumption, and which only help those who are “over”insured. So we have two policies: active support of provider dominated consumption decisions for those who are insured, or overinsured, and tacit support for “underinvestment” in health care for everyone else — those who are underinsured (high deductible plans, what have you) or uninsured (pay out of your own pocket).
This leads to gross disparities in the provision of care, a byzantine set of rules for private and public payers alike (as well as providers) that are expensive to administer, and a generally less healthy population, certainly a large subset of people who forego health enhancing care.
You are free to delude yourself that it does not. My father was an uninsured cancer patient and he was chased out of more than one emergency room while seeking a diagnosis for his pain.
At many if not most F/T minimum wage jobs, there is no health care programs at work, unless you have been there at least a year or longer. If at all. And that’s if they don’t jack around with your work hours to keep you below that magic number that will qualifiy you at the end of the year. Or if you stayed a year b/c many minimum wage jobs have high turnover.
So minimum wage earners haven’t been able to afford health insurance and many haven’t received it for ages now. When I was in the minimum wage job market, I wasn’t insured. I couldn’t afford it. I was hardly the only one. That was a while ago, too, before this study.
I guess those that did this study and are touting its results just figured it out….what people in the minimum wage labor force have known for quite a while now.
At many if not most F/T minimum wage jobs, there is no health care programs at work, unless you have been there at least a year or longer. If at all.
For many if not most F/T minimum wage jobs, the economic product of the individual is not sufficient to reimburse a care provider for substantial medical care.
How, as a society, we intend to deal with the problems that stem from individuals’ economic output being insufficient for their needs, is a complex question. It’s bigger than just healthcare; a F/T minimum wage job won’t pay for college, either.
Jake, just repeat after me:
[Boxer the Horse:] I WILL work HARDER ! [/Boxer the Horse]
Jake:
I believe that I am solidly middle class, if not upper-middle class. Yet, when my wife fell ill, I went from having lots in savings & extra dollars left from every paycheck to $80k in debt and no money left after paying bills. And we have insurance. I don’t believe that this is an unusual situation.
Sorry, missed seeing this comment the first time go around.
Yeah, this isn’t an unusual situation. Nor is it really a problem for the government. You are a person with (I presume from context) private resources, including the ability to sustain debt. A member of your family needed expensive care; you were able to finance the fraction of the cost that your insurance didn’t cover; the person received the care; and now you’re paying off the services she received. Where’s the problem? TANSTAAFL.
I can see why you’d be unhappy with owing $80k on a new liver or whatever it was (and I hope your wife has made a full recovery, btw) – but I don’t see where it’s a government problem, or even particularly a problem with the health care system. What fix do you envision that would make your unhappiness go away? Socializing the whole system would mean that you didn’t have to pay that 80K – but you’d have paid 30K more in taxes by now, and another 120K in taxes downstream. You’re better off with your loan payments. Get rid of insurers and go to fee-for-service? You’d have the capitalized value of your previous premium payments, but your debt would be a lot larger. (Of course, your behavior might have changed in the last instance and you’d have ended up better off, net, but its hard to make predictions about that sort of thing.)
The real problem for our society is the guy who’s in your same situation but who makes $32k a year as a teacher somewhere. He has the insurance, but not the ability to cover the 80 large that insurance didn’t cover – and he’s way too well off to quality for Medicaid. He’s the guy who’s boned.
Smells like glue in here. :/
Yes, Robert, let’s “socialize” the whole system (or give people the option to opt in to such a system). You know, like “social security” and “Medicare.” Medicare was created because there was a complete market failure in the provision of health care to the elderly. Like today’s minimum wage workers, their “economic productivity” did not permit them to continue to purchase health care and it wasn’t worth it to anyone else to do so on their behalf (save for an elect group that had collectively bargained for the privilege). So we as a society decided that it would be better not to just let them die.
And it’s not clear that a collective system would be less efficient, more expensive, less beneficial and on and on. Currently, as a nation we (1) spend more per capita and on an absolute basis than any other non-developing country; (2) lag behind almost all non-developing and a few developing countries in important health measures; and (3) tolerate gross disparities in care as a result of lack of access via insurance (and sometimes even when you have insurance).
Our chief medical insurance program for the uninsured is bankruptcy. I realize that there are entrenched interests, but I believe there are ways that we could begin to address the plight of the uninsured. As for Jake, that is a more vexing problem — let’s just say that more than a few workers with the option to choose between private insurance and Medicaid opt for the latter, which seriously limits the opportunity for so-called “balance billing” by health care providers.
Barbara:
Until October 14th, it is. :p After that, perhaps we can have ritual public floggings for the stupid folk who thought they had a right to healthcare even without the aparent requirement of an income at the high end of six figures. I think parading them naked through the streets would be fun, too. If they’re too sick to walk, they can be pulled along in tumbrills.
BTW, post 18 was mine. Sorry for any confusion. Just trying to treat Robert’s customary pseudo-Randian yakking with all the respect it deserves.
Sure, I can sustain the debt. For now. The problem is that the situation that my family has found itself in for the last 6 years is a situation that most people/families will find themselves in at some point. Unless they are fortunate enough to die in an accident or a from a massive, unforeseen heart attack, etc. So, yeah, I’d rather pay more in taxes each year than build up an $80k debt carried at 8 to 18 percent interest for 10 to 20 to 50 years. Even if I wind up paying more in taxes in the long run, it is a debt that is more manageable when paid a known amount each year. But the thing is, we got off cheap w/ only $80k in debt (no hospitalization was required). The other problem, of course, is that health insurance plans are getting to cover less & less while patient out of pocket cost is getting higher and higher as time goes on. Where do we end up with this system?
The strange thing is that a “socialized” system seems to work better for every other 1st world country than our “privatized” system works for us.
Also, no matter how much you pay in taxes for a socialized plan, it follows you wherever you go– None of this bullshit I went through when I quit my job in hopes of doing something that didn’t make me want to bash my head against the wall on a regular basis. By quitting, I immediately went from having paycheck deductions for insurance that added up to the low hundreds every year– to the “option” of shelling out $500 a month if I wanted to be insured at all. I dodged that bullet by marrying. Now my husband pays for spousal coverage which doubles his original health costs to $600 a month. In return, I’m shouldering the house payments by myself at a much more tolerable $460 or so.
Funny, that. The money I make at the moment temping more or less covers the house payment, a credit card payment, and a few small bills. I still can’t actually afford to go to a physician for anything routine until I find full-time work again. So in essence I went through all of this b.s. simply for the chance to obtain a piece of paper that says I’m still insured if I have an accident or if my chronic illness suddenly sprouts actual symptoms requiring treatment.
Coverage, of course, is still utterly at the whim of the insurer. Recently, they told my partner that a leg infection he contracted while we were visiting friends in a remote part of Washington State wasn’t covered– because he drove an hour to the nearest town with a doctor. They think he should have driven three hours to Seattle or seven hours back to Portland in order to find one of their listed doctors. Never mind that it was a weekend and he was running a fever and in pain. Nope. Sorry. They pocket your money by the truckload and then haggle at you nonstop for the “crime” of being on vacation when the bug gets you. Charming people.
Fuck it. I made 27K a year when I left my job. You could have half that in taxes for a promise that I’d always be covered no matter what my job, marital status, or income status was. Take it, please. I’m fucking sick and tired of a basic right being used to trap people in a social strata or job they can’t abide and to punish them if they dare to knaw a fucking leg off and escape. If I were in a same-sex relationship and/or had a couple of kids, I’d still be there, miserable and counting second by second the twenty-odd years between me and retirement.
… who thought they had a right to healthcare
“Health care” is a label/construct that references the provision of goods and services – physical capital, and people’s time.
How can anyone have a presumptive right to the capital goods and the time of other people?
How can anyone have a presumptive right to the capital goods and the time of other people?
Well, under current US law, children have a presumptive right to the capital goods and time of other people.
Robert, “health” is not a capital good. Ergo, neither should “healthcare” be. One of the worst things our society has ever done to its people is to treat it like one.
When you’re ready to talk to and about human beings as if we had rights that didn’t wait until we made $500K a year to kick in, get back to me. Meanwhile, buzz off. Go find someone lying in a hospital bed with cancer whose family is about to be foreclosed on and give them your spiel. See if the relatives about to end up on the street give you a better reception than you’re going to get here.
Well, under current US law, children have a presumptive right to the capital goods and time of other people.
Indeed. Children.
As opposed to adult citizens.
Robert, “health” is not a capital good. Ergo, neither should “healthcare” be.
Your premise is cognitively incoherent. “Health” – in the sense of “ownership of a body in good working order” is indeed a capital good.
Your conclusion is similarly inadequate. Healthcare is provided by people using their time and their capital goods. MRI machines are not built by pixie dust. A healthcare delivery system that is not attuned to economic reality is not sustainable.
When you’re ready to talk to and about human beings as if we had rights that didn’t wait until we made $500K a year to kick in, get back to me.
I am happy to talk about human beings and our extensive panoply of rights any time you would care to, Alsis. I have a coherent and workable theory of rights that is internally consistent and empirically applicable; you do not appear to be in the same position, and whenever a “rights” discussion starts, you mask the inadequacy of your theoretical position with rudeness.
Go find someone lying in a hospital bed with cancer whose family is about to be foreclosed on and give them your spiel.
My “spiel”? My spiel is that we need to find ways to prevent the family from being foreclosed on; the economic system that’s made Cuba into a world powerhouse seems an unlikely candidate, but I’m open to discussion on the subject.
The strange thing is that a “socialized” system seems to work better for every other 1st world country
Depends on who you ask. The nice lady waiting six months for a new hip in London might disagree. Countries aren’t unitary entities; there are twenty million individual stories, not one “better/worse” dichotomy.
It is certainly true that a socialised system produces a different set of tradeoffs than does a more market-oriented system. Our own hybridized and bastardized system is very difficult to analyze in terms of its tradeoffs, because there is so much market distortion and perverse incentivization.
It would be interesting to have a discussion of what tradeoffs we can bear and how we ought to structure them; such a discussion is difficult among folk who equate a recognition of the existence of tradeoffs with a malicious desire to unhouse the cancer-ridden.
Where’s the problem?
The problem is that health care is not market-driven. It’s based on a pricing model where those who have good health insurance (i.e. high-paying jobs or unionized jobs) have most of the cost absorbed. It’s also based on the insurer denying health care reimbursement as long as possible. And worst from a libertaran POV, the recepient of the health care is NOT the customer; the employer is.
“Legal representation” is a label/contsruct that references the provision of goods and services – physical capital, and people’s time. How can anyone have a presumptive right to the capital goods and the time of other people?
Therefore, people who have been arrested have no right to legal representation. Right, Robert?
Robert said:
I have a coherent and workable theory of rights that is internally consistent and empirically applicable
Excellent! Glad to hear it. So…how do we work things so that folks who need health care can get it? How do we make sure the poorest person is treated with the same regard and care as the richest person?
People — working people of all incomes — pay a boatload of money to fund (1) Medicare for the elderly; (2) Medicaid for the poor; (3) NIH and all manner of research related institutions to come up with yet more “good lifesaving stuff”; (4) the tax-free status of innumerable health care institutions; (5) tax preferred status for insured employees and their employers who are in a favorable tax position vis a vis those who can’t or don’t offer insurance. THEY — WE — ARE PAYING ROBERT!!! WE JUST AREN’T GETTING MUCH IN RETURN. STOP THINKING OF THIS AS A RIGHTS VERSUS RESPONSIBILITIES ISSUE AND START THINKING OF IT PRAGMATICALLY AS A MATTER OF SANE SOCIAL POLICY!!!
“Legal representation” is a label/contsruct…Therefore, people who have been arrested have no right to legal representation. Right, Robert?
That is correct.
However, as a society, we are historically extremely suspicious of the power of the state to oppress the individual through legal means. Accordingly, we have decided to provide the economic resources necessary to secure legal representation for those who are not able to afford its cost on the open market. Because that market is not always perfect, and because of the very high potential costs to individuals who cannot obtain representation, we go so far as to collectively hire some lawyers and make them available as a pool resource for the indigent.
This collection of privileges and accommodations may be expressed shorthand as a “right”, but it is not a right in the sense that, say, free speech is a right. I can say whatever I want to say to Mythago; I cannot force her to represent me in court.
So…how do we work things so that folks who need health care can get it? How do we make sure the poorest person is treated with the same regard and care as the richest person?
Well, the first question is a reasonable one. I’d say fee for service for most routine care, universal catastrophic private coverage + HSAs (with premium subsidies provided for the poor), guaranteed loans for the middle-class who can’t swing a crisis, and lavish cash subsidies for the elderly poor, orphans, and others from whom no contribution is reasonably to be expected.
The second question is easily answered: we don’t. Bill Gates will get better regard and care than you will; the end. This is not peculiar to a capitalist system; in the USSR, Lenin got better regard and care than did the kulak in the gulag, the end. Even in the peaceful-harmonious-utopia-of-love, the good-looking nice guy will get better regard and care than the vicious asshole guy, the end.
STOP THINKING OF THIS AS A RIGHTS VERSUS RESPONSIBILITIES ISSUE AND START THINKING OF IT PRAGMATICALLY AS A MATTER OF SANE SOCIAL POLICY!!!
Stop thinking, more like it.
Any consideration of social policy which is not grounded in a rational understanding of rights and responsibilities is a doomed enterprise. Why should we waste lifespan being deliberately stupid about a complex issue?
Because that market is not always perfect, and because of the very high potential costs to individuals who cannot obtain representation, we go so far as to collectively hire some lawyers and make them available as a pool resource for the indigent.
That’s not quite correct. “We” must provide legal representation to those accused of crimes if they cannot afford a lawyer (except for extremely petty crimes) because of the Sixth Amendment, not because of market forces. That is indeed based in a right, even though there is no Sixth Amendment right to a particular lawyer.
“We” also provide some minimal government-funded legal assistance in the form of Legal Aid, which has a number of restrictions on what it can and can’t do. It’s a stretch to call this a “pool resource for the indigent.” Note also that despite the very high potential costs of litigation to individuals who aren’t indigent, but still can’t afford legal representation, we do not provide any pool of lawyers, nor do we appoint lawyers to represent people in civil matters. i.e., outside of criminal proceedings, you have no right to a lawyer.
(Oddly, although contingency-fee representation is something you’d think free-marketers would adore, conservatives are perpetually trying to kill it. I’m sure I don’t have to explain why.)
“Conservative” and “Free market” aren’t synonyms.
Thanks for your explication of the legalities surrounding the right to representation, Mythago. Interestingly, despite this being framed specifically in the Constitution, it’s (by your description) a pretty weak right.
What does that imply for the “right to healthcare” argument?
How do you propose preventing the family from being forclosed on?
There’s no need to move to Cuba-style socialism in order to have full health coverage; France’s health care system uses a mix of maket driven forces and government guarantees to make sure that everyone is covered. France has cheaper health care and better measurable health outcomes, than the US does, and patients have more freedom to choose their own doctors and get the treatments they need – even if they don’t have much money.
Here’s how The Economist, hardly a pro-socialist magazine, describes the French health care system:
Is it perfect, or free? Of course not. No system is perfect. But the advantages of the French system over the US system are enourmous. For a more detailed description of the Fenchie way, see this post by Ezra Klein. And, aside from the paritculars of the French system, it does establish that in the real world, it is entirely possible to have a workable health care system that provides high quality health care and real choice to consumers, at a lower cost per capita than in the US, and with better outcomes.
Regarding the “waiting periods” complaint, it is true that some countries with socialized medicine appear to have longer waiting periods than the US. (In fact, for poor poeple, the US often has the longest waiting period of all – waiting until you think you can afford it, or until things have gotten so bad that there’s no choice but an emergency room – but that sort of wait is ignored by statistics, alas).
But what conservatives don’t mention is, some countries with socialized medicine (such as France and Germany) have virtually no waiting periods.
Waiting periods are caused by market-driven medicine, which naturally forces the poor to wait, but also by factors that have nothing to do with socialism vs. market forces – factors like how many hospital beds there are, and how old the population is. There’s no reason socialized medicine has to have waiting periods – at least, not in wealthy countries.
Angry Bear has a post quoting some actual statistics, rather than anecdotes, on the waiting period question.
I highly recommend all of Ezra’s health care posts for folks interested in this topic.
In representative democracies, in practice, people end up having the rights that they, acting collectively through their government, choose to grant themselves (or that earlier generations chose to grant them).
Right now, there is no universal right to health care in the US; but there could be, if we collectively, through our representatives, decide that’s what we want.
Interestingly, despite this being framed specifically in the Constitution, it’s (by your description) a pretty weak right.
No, it’s a very strong right. That is, if the “right” you mean is to have a lawyer when you’re being accused, and held over for trial, by the government its own bad self:
There’s no “right” to healthcare in the Constitution, though as Amp points out, that can be changed.
Depends on who you ask. The nice lady waiting six months for a new hip in London might disagree
The nice lady in London can get private medical insurance (from around £20 a month) that pays out if she has to wait more than 6 weeks for NHS treatment. (When I say “pays out” I mean, no co-pay.) Or she can get more expensive insurance that doesn’t have the 6 week clause, or a middle-expense one with a co-pay element.
(And anyway the nice lady in London will probably be offered a choice of an op at a major teaching hospital with say 3 months’ wait, or a faster one elsewhere.)
Not that I want to defend our system as against the French of German ones; they’re better.
Amp, if you’re going to go around making reasonable posts with facts and links and stuff, then where’s the fun?
You ask How do you propose preventing the family from being forclosed on?
I’d work it the same way that student loans work – you can damage your credit rating if you fail to repay, but they won’t come and take away your house. If your health problems keep hammering you, then there should be a gateway into the Medicaid system so that you can avoid ending up on the street.
The French system is indeed an interesting model; of course, you don’t mention that the Economist article, far from being a paean to its glories, is discussing how it’s doomed, doomed, doomed. I note with cynical satisfaction (satisfied cynicism?) that the French are now making the doctor the gatekeeper for specialists and followups “to save the system” – just as we moved to managed care to cut costs. Nobody wants to ration, but there has to be a mechanism in place.
I have to admit I haven’t read the entire Economist article; I got the quote from the “Political Animal” blog. But I’m not surprised the Economist takes that view, since they’re big free-market fans.
That systems change is not proof of failure; all systems change over time, after all.
The French are adding some cost-containment, which will make their system less great in some ways but more affordable; on the other hand, the basic thing I admire about their system, which is that every single person can afford the medical care they need with much less waiting and bureaucracy than I’ve seen in the USA, will remain true. And I’d much rather have a doctor as a gatekeeper than a HMO looking for excuses to deny me treatment.
Going back to my original point, the international evidence makes it clear that universal, mostly government-paid health care is possible and has been made to function well in the real world.
HSAs are an interesting idea. They’re still pretty new to me, so I’m not sure what I think of them yet, but on the face of them they seem better than much of our current system. A lot would depend on how they were implemented, of course.
the French are now making the doctor the gatekeeper for specialists and followups “to save the system” – just as we moved to managed care to cut costs
The Canadians still use this system, for all I know–they certainly did fifteen years ago when I lived in Ontario.
We really need a corollary to Godwin’s Law that applies whenever Righties bring up Cuba to proclaim that all social programs everywhere automatically belong in the dustbin of history.
Call it Hayes’ Corollary:
Whenever the bloodshed, misery, poverty and oppression caused by left totalitarianism are mentioned in a discussion, at least one leftist will mischaracterize the statement in a desperate attempt to spin away the mountains of corpses his or her philosophy has littered through history.
Although that corollary might not have been exactly what you had in mind.
Amp, HSAs are insanely great, but they don’t work for poor people.
One idea I’ve seen bandied about is that the gummint should blow off Medicare and Medicaid and instead make whacking great contributions to the HSAs of people beneath certain income thresholds. That way the poor folk have complete control over their health expenditures (thus preserving self-budgeting), aren’t left without assistance, and can’t spend the money on whiskey and guns.
Where that runs into a problem is that it creates an imbalance in the terminal care for poor elders and rich elders. One reason the managed systems of Europe have a better cost structure is that they don’t spend gazillions trying to keep 90-year olds alive. With this system, we’d still have rich elders blowing through huge amounts to hold on for another six months, but poor elders would be unable to afford that care, HSAs or no, and would just die. That might cause emotional distress in the hyper-egalitarian set – and, of more concern to me, among the families of poor elders. (“Why are they just letting grandma die?!??”)
[snort] Yeah, Robert. Capitalism hasn’t left behind any bodies. Whatever. But of course, you don’t want to talk about the merit of the social contract in this country, so of course every last bit of it = Cuba. [Yawn.]
Get a life.
Compare the French health care system today to that in 1929, courtesy of George Orwell.
HSAs sound like an interesting idea, but only for healthy people of middle income and above, so they can self-insure themselves and be able to take a very-high-deductible policy in case of serious health problems. It’s less useful for people who need to watch every penny, who expect to need much medical care, and encourages people to not get early treatment, since they’ll pay out of pocket. Here’s a good example of HSAs in practice insuring public employees.
As the article says, HSAs weaken insurance pools by drawing out healthier people, or people who believe they will be healthy, increasing premiums for people who choose standard health plans.
National health insurance will do exactly the opposite, by spreading the risk over a larger group of people – 290 million. The basic rule of insurance is that larger pools mean smaller risks – why not make a pool of everyone in the United States (or even include other countries to make the pool larger still?)
And I’m going to propose a law, similar to Godwin’s Law, decreeing that anyone who mentions Cuba in response to comments about social democracy or national health care loses the argument. People who bring up apocryphal waiting periods in other countries also lose the argument.
Most people do believe (wrongly or not) that there is a “right” to health care, but that it is not necessary to “fund” it except for those for whom the “market” has failed. Hence Medicare and Medicaid were created. However, as one of my professors said to me, the concept of being “medically indigent” is now widespread, and applies to more and more people. If you want to reserve government solutions to those for whom the “system” has failed, then you would now have to include most minimum wage workers, and probably people who are earning 3, 4, or even 5 times that amount depending on their family size and other factors. In other words, there are very few of us who are not medically indigent.
The government is already paying for at least 50% of health care expenditures in one form or another. Direct payouts through entitlement programs are most of it but certainly not all. The question is how much any of us taxpayers is getting in return, and it doesn’t seem like it’s much, and it’s virtually nothing for those who pay taxes but don’t have insurance.
If we want health care to be a right all we have to do is make it one. There’s nothing sacred about our current concept of rights.
I noticed a reference or so to the German model of healthcare. I think my cousins in Germany have private health care insurance, but the system that was in place when I was living there 23 years ago was a quasi-rationed system. My host family, who worked for a newspaper, got a coupon book quarterly. Each coupon was good for one member of the family to go to one doctor or specialist as many times as needed for that quarter. So my 4-member host family had enough coupons for each of them to see a primary caregiver and for two of them to see a specialist and for two of them to see a dentist each quarter. While I was living with them, they ran out of dental coupons for that quarter because (if I remember correctly) the two who needed their checkups had already had them but a third needed a root canal two weeks before the next quarter began. I don’t know if there was an alternative for them (they were blue-collar workers), but they decided to wait until the next quarter to get the coupon before scheduling the root canal. So I guess the system worked OK for them as long as they were fairly healthy, but if they suddenly had to consult multiple specialists about something, I could see where it could stretch out for months. I had a student coupon book and never had any trouble getting in to see a dentist or an allergist – about the same level of service I had in the U.S., as far as I could tell. But then, I was pretty healthy and didn’t have any significant problems.
Barbara,
There is also the consideration that all government employee’s get insurance, which sort of goes hand in hand with the implication that it’s both necessary and in many ways a ‘right’. We could play games with words about rights, but ultimately I think Alsis hit the nail on the head by addressing the social contract. Do we all have a right to be covered under the implied necessary social contracts that our country views as valuable, or not.
I had always thought that health was covered under “Life, Liberty & the Pursuit of Happiness.” Color me surprised that that the right to pursue good health without unfettered market forces deciding all the particulars of that pursuit is even debatable. In a purely for-profit system, there is inevitably a conflict between the pursuit of the citizen’s happiness and the corporations’ pursuit of profit. Does anyone who has to navigate our system for more than a few years really not notice that ?
I still think that single-payer is the way to go.
http://www.pnhp.org/facts/what_is_single_payer.php
If not, there ought to be enforceable caps upon the profits of drug companies and insurance companies. They already use tax dollars to fund their efforts in the first place. Why should we have to shovel Medicare and Medicaid funds directly into their greedy maws to get them to do their damn jobs, particularly if this money comes with no regulatory strings attached other than that they “provide care” ? What’s to stop them from providing piss-poor care to the patients and pocketing the difference ? Besides which this “solution” does nothing to adress the woes of folks who don’t qualify for these services in the first place.
If we can’t have caps, we ought to at least give city, state, and county governments the right to collectively bargain for lower rates and drug prices just as Unions do now. Even my Union was facing a battle royale every time contracts came up as prices kept rising;More and more costs in the form of paycheck deductions and higher co-pays were being borne by the members as the years went by, though this was nothing compared to the cost of COBRA, as I tried to point out above before Robert tried to divert me into helping him re-enact the Cold War so he could get his usual trollish jollies.
Tim Nesbitt, Oregon’s head of the AFL-CIO, was hostile to Measure 23 when it was before the voters, over the objection of several members of his own executive board. I still think Nesbitt is an asshole. Not only because he reinforced the “I got mine” attitude that makes it hard for Unions to look like they give a damn about any worker outside their charmed circle, but because if every institution in the state could bargain in the same way the Unions could, it would likely act to stabilitze skyrocketing costs;Maybe even drive them down. “We must all hang together or we will certainly all hang separately,” –isn’t that how the old saying went ? :D
At this point, Pharma and insurance companies own the debate, and they own the public servants who are supposed to be looking out for us. That has to change.
As far as I can tell, Robert’s argument could be equally well applied to the provision of education, highway maintenance and repair, police services, fire and emergency rescue services, water and power, and almost every other system either subsidized or directly run by the state in every first-world country.
Why do things by half measures? Move to Papua New Guinea, the paradise of the free market!
But what do I know: I’m a Canadian and I know nothing of the joys of private insurance.
Hmmm….just curious, jrochest – what is the procedure if you need to go to the doctor? How about if you need emergency or urgent care, or if you need a prescription, need to visit a specialist, or minor surgery?
We’re told that doctors are fleeing Canada in droves, and you have interminable waits for specialist visits or surgery…
Yes, I hear Haiti has very low taxes too and an unfettered free market system as well. Of course, what one saves in taxes probably more than one spends for body guards and who knows whether they’ll be honest when it matters.
We’re told that doctors are fleeing Canada in droves, and you have interminable waits for specialist visits or surgery…
Yes, “we” were told this back fifteen and twenty years ago, too. “We” probably wonder why it is, with our Thank God It’s Not Canadian health-care system, that we too have waits for specialist vists (hell, for generalist visits). I never waited as long in Canada to see a doctor as I do here.
Quite right of you to question the myth Aaron brought up. In fact, more doctors returned to Canada this year than left it – for the first time in 30 years.
I don’t ever wait to see my doctor. But then again, that’s because I pay him cash, because I’m too poor to afford to “insure” my health.
I had the same wait for doctors when I was uninsured as when I was insured. Personally, I think that has more to do with medical staff than the doctors themselves.
Doctors move from Canada to the USA because of simple economics. Getting a medical degree in the US is incredibly expensive – so expensive that no one would be willing to take on medical school debt if they weren’t expecting to make very high earnings after they become a doctor.
In Canada, in contrast, medical school is much less expensive, and doctors saleries are much lower.
Given that set-up, it’s no surprise that Canadian doctors are often tempted to practice in the USA. In every occupation, people are attracted by the prospect of higher pay.
Of course, Canada is an exception – the US has trade barriers limiting the numbers or simply forbidding doctors from most other countries from practicing medicine in the US. If we didn’t have those trade barriers, the marketplace would force doctor pay down, and American medical schools would be forced to find ways to lower tuition or go out of business.
Good idea. Let’s do it. Free markets forever!
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