Hard Truth about Health Care Reform
    By Josh Witten | August 25th 2009 09:53 AM | 16 comments | Print | E-mail | Track Comments
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    Having a negative health care experience does not mean you know anything about reforming health care or health insurance.  If I get run over by a car with bad brakes, does that mean I know how rebuild a car?

    Oh yeah, and if those with bad/no health insurance should be for a public option because it is in their personal interest, why shouldn't those with good health insurance be against reform in their own personal interest?  At what income level does it self-interest shift from a moral good to an unforgivable evil?  I need to know.  As a graduate student, I have pretty good health care, but minimal income; and I would hate to take up an unforgivably evil position in my own self-interest.


    Gerhard Adam
    Why would you put this in terms of good or evil?  Self-interest is understandable.  What isn't understandable is the number of people that appear to be acting AGAINST their self-interest.  The vast majority of people do not pay for health-care themselves and obtain it as a benefit through their employer.  If they lose their jobs, or become ill and are dropped (or find they can't enroll because of pre-existing conditions), then they suddenly become interested.

    I'm concerned when I hear people talking about socialism instead of health-care.  This tells me that they aren't thinking of the issue but rather responding to the spin.  However, it is also problematic when people want to argue against government involvement when so many depend on it for items ranging from Social Security to Medicare and Medicaid.  Often this is also couched in misunderstandings where people assume that they've "paid into" Social Security as if it were some sort of retirement or investment plan.

    The simple reality is that our current system is inadequate for a large number of people.  Whether it gets fixed is going to depend on people getting serious about the dialog and not simply responding with knee-jerk reactions they get from media pundits.
    Mundus vult decipi
    It is ingorant to think that this goverment is not working in it's own self intrest when they speak of health care reform. There are issues that they will not approach. This health care reform is about money , not about care to the American people. Social Security was established because of the depression in the 1930's the majority of people had no retirements as the majority of the country were farmers. With the banks failing and the farms failing these people were without anything to support them. Social Security which was not suspose to be used for general taxes or for idenity, establish a retirement accout to give an assistance to the people as they got older because they had no way to establish retirement , and the depression most retirement was used to maintain living. Then the Democrates changed the using of Social Security funds and placed them into the general tax fund so the funds that were personal retirement accounts so they could increase goverment programs. Thank you Mr. Carter. After aquiring the Social Security funds the monies paid by the American people and their employers became the greates growth tool the goverment ever received.
    There is not one single state that has been able to operate Workers Comp where the Workers Comp does not operate in the red. That is a program that is less than 1/50 th of the health care. It is 100 percent supported by the employers, and covers every employee. If the states can not controll Workers Comp , how can anyone think that the Federal Goverment can run Health care.
    To run health care , they would have to set the wages of every doctor , every health care provider , and determine what the value of their services would be.
    They would have to remove all private insurance to insure that the funds of the insurance are sent to the federal goverment to recieve the profits of these companies.
    They are not talking about 100 percent coverage, they are not talking about the bottom line as to what would be offered to the American people .
    They are talking about increases to employers, massive increases that will cost the American taxpayers large increases in purchasing finished good. ( Hidden taxes and still taxes)
    That are talking about increasing the government with massive programs.
    There are massive fees in the bill to special intrest groups .
    Personally I do believe that I should be able to make a living without giving up my standard of living. But this program is a direct attack on the working people of the United States, to increase government control through ecomonic means.

    Gerhard Adam
    Personally I do believe that I should be able to make a living without giving up my standard of living.
    Then you'd better hope you don't need health care.
    Mundus vult decipi
    Gerhard Adam
    A typical average hospital room costs about $850 - $1000 per day.  Who's kidding whom here?  This is nothing short of robbery, because as a patient I'm expected to pay for every piece of equipment that the hospital may order or need.  There's no way such an expenditure can be justified based on the room and the staff necessary to help somebody get bed-rest.

    Mundus vult decipi
    But it's not a clean argument for something.   Heck, I lived on a farm when I was a kid and I tried to argue with my dad that I shouldn't have to weed the rows of onions because I did not eat onions.  His response to me (a menacing look and reaching for a belt) was  accepted but unconvincing.  And a belt is what the government must use too.
    Before I moved to California, I had both a doctor and a dentist who did not take insurance.   They kept their costs pretty reasonable due to less paperwork.  In California, that is not possible because the culture here is anti-business so the malpractice insurance is too onerous to think about keeping costs moderate.  

    I assume people who lament the high cost of hospitals also do not give blood.  It will be $1000 a pint even if you donate it for free.   Regardless, hospital room costs will not go down under a government health plan.  It's in defiance of every single government plan ever created to think it will go down for this special one.   

    Hospitals are one of few industries where competition makes prices go up - if hospital A orders a 4D GE sonogram, hospital B must also, they think.    That mentality, coupled with a sense of entitlement on the part of people who do not understand what the word insurance means, have driven costs up.
    Gerhard Adam
    I understand, and as you know from other posts, I don't believe we should have insurance at all.  Let the hospitals/doctors deal directly with patients and see where it goes.  Most especially, we should eliminate the health insurance companies since their participation only ensures costs stay high because they're paying.

    Then we'd reach a true market solution and see what problems, if any, still remain.
    Mundus vult decipi
    I'm not an American citizen, but it is impossible not to hear about your discussion over there. From an outsider that is covered by the state, it seems pretty scary not knowing what and even if, you have a health coverage. (Our health system is far from flawless, but we are all covered no matter what precondition we have or whether we have a job or not)

    It seems pretty cynical to me that companies are able to take and advantage of your situation and when you are in a weak position (being ill) you also have to worry about getting medical aid and/or going bankrupt.

    I found these fact pages from the White House twitter feed.

    Hidden costs

    Denied Coverage

    Whether you pay for health care to a private company or the state cover your costs, it would be good to know that you will receive medical aid no matter what, when you turn ill.
    Bente Lilja Bye is the author of Lilja - A bouquet of stories about the Earth
    I think you make a good point.  The exaggerated 47 to 60 million number is thrown around a lot and it's always framed in societal terms, like  young people who don't want or need health insurance now should pay for it anyway because they'll want it when they get old and they can make someone else pay for it.   It's like fraternity hazing, where you get hazed as a freshman knowing you get to do it next year, except this hazing never ends until you die.

    I am 25 years away from social security age and absolutely convinced I will never get it, though I have maxed out that tax pretty much every year I have worked.

    There is actually only about 5% of the population that is uninsured and simply cannot afford it.  Obviously any civilized society does not want old people and children dying from lack of health care but that does not mean breaking health care that works for 95% of people and having a government even less efficient than the uncompetitive private companies doing it.
    Gerhard Adam
    Hank, one of the problems with the young people scenario, is that this is precisely how insurance companies offset the costs of coverage by getting premiums from people that don't use it.  You can't be in business if you collect "x" amount of dollars and are expected to pay out "10x" in benefits.

    This is precisely why insurance companies are doing their best to minimize risk and doing all the things that people find wrong.  The young person may not think they need the insurance now, but they will certainly feel different when they get a diagnosis that puts them into the pre-existing conditions scenario.  That's why the entire process needs to be looked at.

    In addition, it isn't right that, as an individual, I should have to compete for premiums with large corporations that get a discount because of their volume.  Let every individual pay their own share and force the insurance companies into a bonafide supply/demand model with consumers.  In addition, it isn't right that doctors and hospitals can charge whatever they like simply because insurance companies pay for preapproved procedures.  This also creates an inequitable supply/demand model which causes prices to keep going up.

    As I've said before, if doctors and hospitals had to deal with patients directly for payment, you can bet there would be a whole different set of incentives to make money.  As it stands, they can shrug their shoulders and act indifferent because they know their outrageous prices will be honored.
    Mundus vult decipi
    The uninsured aren't the only reason. I have a healthy family of 5, a very moderate income, and decent but high-deductible insurance. Health costs are the primary thing killing our budget. If one of my kids got seriously sick before I finished my postdoc, I would be financially screwed for a long, long time. People with insurance who do get seriously sick are being financially ruined in this country. That's just wrong.
    why shouldn't those with good health insurance be against reform in their own personal interest?
    I disagree with the premise that, to improve health care for those who need it, we have to break it for everyone else. That's simply not what happens in most serious proposals for health care reform, and it's not what happens in other countries that spend less money for better health outcomes. The current system is unsustainable. Many people have decent insurance, but the trend is for employers to drop the coverage because costs keep rising. On my plan, my premiums have steadily increased and my coverage has significantly decreased in just 3 years. If you have decent insurance now, you may not have it 2 years from now. The fact is, we spend a lot of money for mediocre outcomes. It's not the case that we have the best health care system in the world, and our problems aren't limited to the 5% (or whatever it is - that number isn't right) without insurance.
    I think according to the WHO, the US has the 36th or 37th best health care in the world.

    You make good points; but the invalid argument that you are not making, but other advocates do is that it is ok for the disadvantaged to be motivated entirely by self-interest, but not for those who are currently in a decent position.  Your argument does an excellent job of blowing up this false dichotomy.  It just took twice as long as my brief and inflammatory post.
    but the invalid argument that you are not making, but other advocates do is that it is ok for the disadvantaged to be motivated entirely by self-interest, but not for those who are currently in a decent position
    In the naive bubble I live in, I like to dream that somewhere out there is a rational solution to providing good health care that for everyone doesn't depend on conflicting self-interest. But I have a tendency to get delusional on these things. And yes, any comment I make is on average twice as long as anyone else's (except yours, Gerhard!). I can't help it. :)
    Gerhard Adam
    ...and neither can I :)
    Mundus vult decipi
    Gerhard Adam
    The fact is, we spend a lot of money for mediocre outcomes.
    That's true.  The problem is that too many people think that health care is some governmental conspiracy instead of looking at the issues and trying to come up with solutions.  The simple reality is that a significant number of countries can provide this care and the U.S. is either too stubborn or stupid to address it.  I'm astounded when people want to criticize some of the other countries, and yet somehow everyone in those nations gets treated and gets care.  In this country you can be bankrupted or simply prohibited from coverage by a pre-existing condition and that seems to be OK.  It is a travesty when people have individuals in a local community collecting money to help some family pay the hospital bills for a sick child.  This country should be ashamed that it lacks the ability to provide such care.

    Additionally, I don't know why people are so concerned over whether insurance companies will be able to make a profit and stay in business.  I couldn't care less.  Whatever made someone think that was a legitimate business model if they couldn't collect enough premiums to pay the bills.  It is the epitome of foolishness to assume that because a business exists that it necessarily represents the only way in which such situations can be accommodated. 
    Mundus vult decipi
    Additionally, I don't know why people are so concerned over whether insurance companies will be able to make a profit and stay in business.
    I certainly agree with this.    But what should not happen is insurance companies are limited in how they can be competitive.   The post office boondoggle is a perfect example.   They love to claim they get no tax money while leaving out that they are a government-protected monopoly.   FedEx cannot deliver a first class letter by law so the post office has no competition and they're still federal employees so they can't be fired.    Get ready to pay more.

    What may happen in health care is similar to what I have talked about in my 'if we give every house a chef' example, where you end up with a McDonald's fry cook and worse food for higher cost; doctors will go private, hospitals will go private, and the rich will still have good health care while the 5-7% who have none get an improvement ... but everyone in between gets worse care than they have now, as a trade off for expensive 'access.'
    Gerhard Adam
    But what should not happen is insurance companies are limited in how they can be competitive.
    What limit?  Health insurance companies have never been competitive.  That's part of the problem.  They have a captive audience and consequently dictate the terms of the health care debate in this country.

    As you also know from my response to your "every house a chef" example, not every house needs Wolfgang Puck either.  Part of the problem is that doctor's feel that they can charge outrageous amounts of money for nothing.   When one of my daughters was young, I had to get an appointment for a "consult" with a doctor regarding a tonsillectomy.  After waiting nearly six hours to see this guy, he tells me that "it's really up to me" regarding this decision.  For this, he wanted to charge me $150 for the visit.  It's this kind of nonsense that gets people upset about health care and I suspect I'm not the only individual with such stories.  There are other stories that illustrate that this isn't unusual (like the $120 fee for a doctor saying that we should just wait to see our regular doctor). 

    Why should this be considered acceptable?  In truth, I'm getting to where I don't even care what happens just so long as something is shaken up.  Perhaps if we tweak enough parameters, a possible approach will manifest itself.
    Mundus vult decipi