Recently I had a passionate discussion with a friend about health care reform. You know where we stand on this blog: It immoral and uncivilized and expensive to have a for-profit health care industry. Everyone should have complete coverage, and it should be paid for from a common fund of taxdollars, paid directly to providers for the widest range of services, at fair rates which encourage the best people to go into health care, and an emphasis should be placed on getting people as much preventative care as possible. Right there, you save billions. I further posit that the elimination of a couple of military boondoggles like Star Wars will fund the start-up of such a program without significant immediate tax increases, although I favor taxing the shit out of health insurance companies and executives too. They are sitting on trillions that people paid for care, and frequently never got.
Now, my friend told me that “we can’t just eliminate insurance companies overnight” and cut them the fuck out of health care altogether. He argued that if we were to do so, millions of investors would lose value in their stock portfolios, not just “investor class” people but municipalities and retirement funds, who are heavily invested in insurance companies. He also argued that many insurance company workers would lose their jobs, and together a quick death to for-profit health insurers, that would mean real economic upset for all.
You can probably guess my reaction.
But I suppose I can see his point, but I think smart policy planners could find a way to offset some of this, and I will even admit that if there is no other way, I support a “phased” withdrawl, in which people are given time to change out their investment portfolios over some period of time. I would also support limited and temporary subsidies to former insurance workers as they train for or look for new jobs. Workers, not golden parachute, billion dollar compensation package-getting execs. They can fuck off and die.
However, you can see why I believe what I do, as you read this bit from Mass doctors, who are at the front of “health care reform.” My guy, Edwards, really blew it by going along with the consultant’s advice and not his wife’s, because people don’t want this kind of “reform.” If he’d been brave enough to say so plainly from the get go, he would’ve done better than he has so far in various races, media blackout or no. Americans are dying, screaming out for real health care reform. Not this shit:
Over 250 Massachusetts doctors have signed an open letter to the country warning that the health reform model enacted by Massachusetts is failing and that a single payer program is the only alternative.“It is urgent that the rest of the country know that Massachusetts is a living laboratory for the health care reforms being pushed in California and by the Obama/Clinton/Edwards campaigns. Right now the Gov. Romney/Massachusetts’ plan gets a failing grade on the ground,” said Dr.Rachel Nardin, Assistant Professor of neurology at Harvard Medical School.
An Open Letter to the Nation from Massachusetts Physicians:
Early Outcomes from Massachusetts’ Health Care ReformWe write to alert colleagues and the nation to the disturbing early outcomes of Massachusetts’ widely-heralded approach to health care reform. Although we wish that the current reform could secure health insurance for all, its failings reinforce our conviction that only a single payer program can assure patients the care they need.
In 2006, our state enacted a law designed to extend health coverage to virtually all state residents. Political leaders in other states as well as several Democratic presidential candidates have embraced this model.
Massachusetts’ law mandates that uninsured individuals must purchase private insurance or pay a fine. The law established a new state agency to ensure that affordable plans were available; offered low income residents subsidies to help them buy coverage; and expanded Medicaid coverage for the very poor. (Immigrants are mostly excluded from these subsidized programs.) Moneys that previously funded free care for the uninsured were shifted to the new insurance program, along with revenues from new fines on employers who fail to offer health benefits to their workers. In addition, the federal government provided extra funds for the program’s first two years.
Starting January 1, 2008 Massachusetts residents face fines if they cannot offer proof of insurance. Yet as of December 1, 2007 only 37% of the 657,000 uninsured had gained coverage under the new program. These individuals often feel well served by the reform in that they now have health insurance. However, 79% of these newly insured individuals are very poor people enrolled in Medicaid or similar free plans. Virtually all of them were previously eligible for completely free care funded by the state, but face co-payments under the new plan. In effect, public funds for care of the poor that previously flowed directly to hospitals and clinics now flow through insurers with their higher administrative costs.
Fuck
the poor, it’s the motto of our time, no matter what the party, eh?
Among the near poor uninsured (who are eligible for partial premium subsidies) only 16% had enrolled in the new coverage. And barely 7% of the uninsured individuals with incomes too high to qualify for subsidies had enrolled according to the official state figures. Few can afford premiums for even the skimpiest coverage; the lowest cost plan offered for a couple in their fifties costs $8,200 annually, and carries a $2,000 per person deductible.
Moreover, the state’s cost for subsidies is running $147 million over the $472 million budgeted for fiscal year 2007. Meanwhile, collections from fines on employers who fail to provide coverage are 80% below the original projections. The funding gap will widen in future years as health care costs escalate and insurers raise premiums. Already, state officials speak of making up the shortfall by forcing patients to pay sharply higher co-pays and deductibles, and by slashing funds promised to safety net hospitals.
While patients, the state and safety net providers struggle, private insurers have prospered under the new law, and the costs of bureaucracy have risen. Blue Cross, the state’s largest insurer, is reaping a surplus of more than $1 million each day, and awarded its chairman a $16.4 million retirement bonus even as he continues to draw a $3 million salary. All of the major insurers in our state continue to charge overhead costs five times higher than Medicare and eleven-fold higher than Canada’s single payer system. Moreover, the new state agency that brokers private coverage adds its own surcharge of 4.5% to each policy it sells.
A single payer program could save Massachusetts more than $9 billion annually on health care bureaucracy, making universal coverage affordable. But because the 2006 law deepened our dependence on private insurance, it can only add coverage by adding costs. Though politically feasible, this approach is already proving fiscally unsustainable. The next economic downturn will push up the number of uninsured just as the tax revenues needed to fund subsidies fall.
The lesson from Massachusetts is that we still need real health care reform: single payer, non-profit national health insurance.
So don’t take it from me, take it from those who are in the “reformed” environment right now, and can tell you how poorly it works. It doesn’t, unless you count “making rich insurance companies richer.”
Yes, the health care problem is “complicated,” but so is making a light, flaky crust that is not too sweet and has enough buttery taste. It took me some time, but eventually I learned how to do it. I think that the next Democratic president should start listening to all those smart people who actually work in health care and know what is effective. Not the $400/hr consultants who will someday be $750/hr consultants for an insurance lobby.
For-profit health care always, always mean someone dies, so someone can make a little (or a lot) more money. It’s just that simple. There are plenty of ways to make money without killing people to get it. I think a vast majority of Americans understand this. Why don’t the candidates? Don’t they want to win, big, and have a mandate and support of a nation that would make them invulnerable to any attack? ’Cause that’s what it will be like for the first politician brave enough to ride this wave.
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I don't think you even have to cancel Star Wars, health care
when reorganized to actually provide care rather than deny it, should cost less than what we’re spending on the present misbegotten clusterfuck. Figure up how much people are paying in premiums now, plus whatever dribbles are actually contributed by companies/employers. Spend that in taxes on the SP system. I bet you wind up with everybody treated and money left over. Let’s explore how this could be:
I’ve never worked for an insurance company and don’t know where to go to get the numbers on how many employees they have who work entirely in the “health care” divisions. Which is an important point right there: most insurance companies sell a wide range of products besides healthcare denial: life, car, homeowners, business ins. of various sorts, etc. This would seem to suggest that these other divisions could absorb a fair percentage of those laid off once single-payer comes online. If not, well, like auto workers are told, sucks to be you. Go back to jr. college and get retrained as a plumber or something.
Or they could go to work for the government! Medicare isn’t going to be able to administer the system for the entire (vast majority anyway) population; they will need to staff up. More employment generated.
But there’s a whole ’nother group of workers to be considered here: the 3-5 people who work in medical offices who do nothing but negotiate payments from insurance companies. Think of all the effort, brainpower, energy and time that is soaked up in the struggle to get what’s supposed to come automatically. The delays, the anguish, the attempts at double-billing patients, the mortal struggle to pry loose the dough from insurance bastards for whom every claim paid is a tick off their yearend bonus. But I digress.
But after single payer comes in those workers are, praise the Lord, largely superfluous. We’re suddenly back to the days when you have a doctor and a secretary, who makes appointments and manages the business. And doctors could go back to something radical like practicing medicine instead of spending half the day on the phone trying to get procedures approved.
Yeah there will be complications. But if you figure out how much fluff and bullshit is built into the system now, the obscene salaries at the very top are the least of the coinage to be shuffled around. The shareholders in ins. companies are not going to be suddenly stricken with destitution.
One other thing…those who are being dragged kicking and screaming to the point of admitting that Single-Payer is coming sooner rather than later have a tendency to yell “BUT WE GOTTA HAVE TORT REFORM FIRST!!” so as to save doctors from horrible malpractice losses.
Have they ever considered that the majority of the motivation for malpractice suits isn’t piggy greed but the fact that if you’ve been screwed by a medical procedure gone wrong, whether it’s the doc’s “fault” or not, that settlement is the only means you’re going to have to pay for medical care for the rest of your life? With single payer that suddenly ceases to be so much of a motivation, eh?
As we’ve all said a brazilian times each, there is no need to reinvent the wheel here. Go to Europe for chrissakes, take notes everywhere, come home and buckle down on getting it going here. I nobly volunteer to join the party as a disinterested observer of great wisdom and stature and the favor of blog and man. :)
Insurance companies exist to deny care
I know it sounds impossible… but IIRC, Krugman wrote somewhere that doing away with the denial systems saves enough billions that you could just pay for the care of those who can’t get it.
Now at this point the wingers start screaming “moral hazard,” which seems to imply that people would rather spend time in the hospital when they’re not sick instead of, oh, getting loaded and messing around. Or playing golf. So much for the party of ideas.
[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
gawd, you people are so crazy and irrational. i don't know
why anyone bothers to read this lousy blog.
actual solutions? numbers that add up? savings? coverage for all? my goodness, put down the crack pipe and run away from yet another of the stupidest posts of all time by a wild eye CT foil bunny…
great points, both of you. thanks for reminding me about the ’tort reform’ angle and its nonpropagandic reality, xan. i’d forgotten to expect that one.
Healthcare comment without links, alas
because I’m just not up to it in the moment but the numbers are solid - - - trust me. :-)
The difference in overhead between insurance companies and Medicare is about 30%. For the same dollars in, however collected, we could cover everyone and increase preventive treatment and diagnostic care. That last part is key, because another 20% or so of our healthcare dollars are spent treating preventable illness or disease that would be much cheaper to treat if diagnosed earlier.
Preventive medicine, starting with universal prenatal care and early childhood nutrition, will over a lifetime be repaid 10:1 in avoided healthcare cost never mind the increased productivity that comes from a healthy populace.
The tough nut comes 20 years down the road, when the babyboomer bulge starts getting old. In the US we spend half, that’s 50%, of our current healthcare dollar on prolonging death - the futile struggle to turn a six-month fatal diagnosis into nine months of treatment and greater pain followed by the same inevitable death. We just can’t afford to keep doing that. The best we will be able to do is try and prolong life, a moral choice that will be difficult for Americans to accept.
My feeling is that this last truth is the reason that politicians don’t want to engage in responsible discussion; nobody is going to like hearing it. The reality is we will have to deal with the numbers anyway. Better if you’re in politics to have denial of death-prolonging services be seen as the “fault” of faceless insurance companies against whom you can rail and not a result of your own universal single-payer policy, even though the neccessity is inevitable.
Apologies for the lack of links, if anybody asks I’ll ferret them out.
"Human resources"
There is a view that human flesh was put on this earth solely in order that profit might be extracted from it.
That view is the source of the nine months of “treatment” hooked up to machines and tubes and pills and noisy teebees — wringing the last drops of profit out of pain and fear.
[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
About that last six months...
That one is really a bitch, whether looked at from the cold hard perspective of economics or the touchy-feely avoidance of pointless suffering angle, or the plain fact that nobody wants to die one single solitary breath sooner than they have to.
Anybody remember the ST:TNG ep on this subject? Guest star was David Ogden Stiers of all people, played a brilliant scientist on board Enterprise to work with Dr. Crusher on something I forget. They were charging along just fine (not to mention falling in luuuuv, ick) and he gets a “oh, in case you forgot, you’re scheduled to die next week” call from home.
Exposition is: planet had such good universal healthcare (hmmm) a few centuries back that that last-six-months thing was driving the world to bankruptcy. So it was agreed that, in order to avoid inequity, birth certificates would henceforth come with an expiration date as it were, at age 60 or thereabouts. You got together with your friends and family and had a nice or religious or raucous or whatever kind of wake you wanted, then drank the hemlock or somesuch and croaked. No muss, no fuss, no suffering. They called it The Resolution iirc.
And about that “guaranteed preventitive care”…want to bet that comes with mandatory regular drug testing? Especially for nicotine? Holy crap, you can’t expect Society to pay for your years of fucking emphysema and heart disease can you? Get caught with that in your system…and what? Banned from healthcare until you can pee clean again? What if that Mandatory Every Six Month Test For Everything suggests you’ve been consuming too much alcohol? Or anything illegal whatever?
Speaking of TV SF, that old series “Sliders” had some scenarios along this line too. One time they slid into a new world and hadn’t eaten in awhile. Gimli goes up to a sandwich stand and orders a big ol’ cheezeburger. Kid at the counter demands to see his cholesterol certificate, since it would otherwise be illegal to sell him such a harmful thing.
I have an evil mind and can think of all sorts of potential horrids. How about the various tests coming on the market for genetic disorders? Now they’re optional, be they for the breast cancer gene (huge false positive/negative rate on the tests, and the genes don’t really don’t impact 90% of the cases anyway) or Huntingtons/Lou Gehrig disease? (that one works well and a positive is a sentence of hideous death. Most people don’t take it.) Which of those will be mandatory, and how long will it take somebody to come up with a fee to hack into the system and scrub out your positive result?
Lotsa possibilities to keep in mind as we’re designing the system. Especially given the mindset of the people running the show now in the regulatory recesses of the bureaucracy. No point in setting up a system that amounts to a medical/surveilance tyranny worse than the political one we’re currently living under.
contrarian moment on health care
bio sez:
The tough nut comes 20 years down the road, when the babyboomer bulge starts getting old. In the US we spend half, that’s 50%, of our current healthcare dollar on prolonging death - the futile struggle to turn a six-month fatal diagnosis into nine months of treatment and greater pain followed by the same inevitable death. We just can’t afford to keep doing that. The best we will be able to do is try and prolong life, a moral choice that will be difficult for Americans to accept.
fuck that. everyone, all of us, each of our mothers, our decrepit fathers and overweight sisters, deserves “prolonged” health care at end of life. seriously, who cares if we “waste” resources on prolonging a healthy, active, mentally fit end of life for those who’ve paid (ha i first typed ’pain’) in their whole lives as honest taxpayers and hard workers. no, i put my Foot Down.
the “huge drain” of caring for the old, dying, the inconveniently sick and expensive, isn’t really a huge drain. again, beating this (not dead, but grandma will be) horse: star wars. you want to pay for endless drams of “wasteful” care on the dying, sick and old? there you go. the rest of us “in system” can work out the pay schedule and tax reality that will support the cheaper, more efficient preventative care described above. but grandma doesn’t have to be ’cut off’ when her insurance runs out, nor unplugged b/c “no one” wants to see her go on. while paying for it.
blah blah, prolonging life “too far” pain, suffering, kevorkian is an Angel of Mercy, blah. yes, people shouldn’t be in pain. no, i’m not willing to say we shouldn’t, or can’t, give to utmost care to our elderly. some of you know why i’m a bit Militant about this now. but no.
the focus of our anger/discussion/new policy should be, simply and for reason of basic math: what can we eliminate, to give all americans a health care plan like those in congress have (for life)? it’s more “doable” than you think, no sad, depressed, ignored, forgotten old people need die in the making of this better stage in our economy.
libertarians: think of it as a jobs issue. you want more people to have more opportunity to work and make money and be rich. for some, that starts with caring for granny, even while her grandkids are too busy off founding the new taxfree paradise with their untaxed gains that are the result of their brilliant genius. or are you going to wipe her ass, when medicare won’t fund inhome fulltime nursing care? or do you just not think about that?
corrente: the gentle and the brutal
xan and CD, like peas n cornbread. shuck n jive. cats and dogs, living together. did i stress: living?
heh. nice post, grrl. gtma, or sort of gtma.
Xan and CD, sittin' in a tree....
k-i-s-s…er, I mean, hashing out the details of the redesign of American healthcare provision systems.
:)
My perspective on this matter—the one you’re going through, although i gather the many details are different—comes from watching first a brother and then, many years later, a husband die of cancer. If I could have cut off their last six months I would do it in a heartbeat. Of course the bitch of it is that you don’t know what date to count back from in advance, now do ya?
You do have some sort of respite care available, hon, do you not? Gotta get that. Otherwise there will be two people crashed out and yet another party will have to come in to care for the both of ye….
getting rid of the skimmers, and the "problem" of unequal cost
Laws arent going to help end-of-life issues, only the culture can effectively change that (or morally change that, I’m not sure which).
I totally agree about the immorality of the health care industry. Profitting from the illness and death of human beings in such a manner is obscene.
That said…
There is a difference between providing government-run health care and in forcing everyone to pay for health insurance; the first involves paying taxes which go directly to health care (however “inefficiently”, as conventional wisdom has it), while the second involves paying taxes to a middle man who skims off some cash/profit before providing some kind health care (and by now we all know how well that system works).
The primary objection that Republicans (and Republican-like Democrats) have to government health care is that, like any tax-supported enterprise, the wealthiest citizens will pay more for the same service as the poorer ones do. This is why Republicans are trying so hard to push school vouchers (the true goal of NCLB), and why they support so enthusiastically the building of toll roads. If they could figure out how to charge per use on everything the gov’t does, they would do it. See, if health-care is insurance-based, then everyone pays “equally” for it, whether they make $20,000 or $20,000,000. Change to a tax-based system, and your medical payments will be based on percentage of income, not raw dollars. Poor people will “get something for (practically) nothing”, while the Rich will pay much more than they currently are for the same care.
Never mind the hidden benefits of such a system, America thinks only in terms of the ledger book these days, and it takes vision to see beyond the numbers, and courage (or morality) to believe that there is something beyond the money those columns of numbers represent.
Our current brand of Republicans (not necessarily conservatives, but Republicans) are selfish and anti-society; they dont really care about society at large, just their own narrow portion of it. This is quite obvious not only by their actions, but often even in their words. Until the public figures this out and removes them completely from power (or at least puts a check on that power), America will continue to decline.
Utmost care
I’ve been putting off this discussion for some time here, although I’ve had it with others multiple times over the past decade. It seems that there is always someone dear who is near death, and that makes end-of-life discussions all the more difficult. I’m not a stranger to the issue, and I have both empathy and sympathy for everyone going though it. My father died from emphysema, from diagnosis to his death was almost eight years; I am grateful for every day of that time and I would not have wanted him to try and stay for even one more. Please don’t think of me as cold or dry and academic on this, at all. I have buried far too many loved ones to be indifferent.
The distinction I’m drawing is between prolonging life, which is good and desirable and the cost for potential gain is societally manageable. Prolonging death, however, is very expensive, nearly always futile, and the return – all aspects considered, especially including the patient – is far too often a net negative. In America, as distinct from every other nation in the world, we have become unreasonably enamored of technology. We believe that there is an answer to every problem if only we spend enough money, if only we use the latest techniques, if only we hook up the machines and never turn them off.
As a former colleague, emphasis on former, once expressed it: “We can charge whatever we want for this product because nobody ever shows up at the hospital and says ‘Take care of my loved one the cheapest way possible.’” Dying in America is big business, and most of that money is spent on offering false hope, making false promises and extracting every possible penny along with every possible scrap of knowledge. The knowledge gathering is at least partially earnest and honorable; some of it is even potentially useful. The money-grubbing is not.
Taking care of each other is what we should be about, as citizens yes but really just as decent human beings. Expending tens to hundreds of thousands of dollars to prolong the inevitable, to dose and cut and mechanize and debilitate and strip people of the last shred of dignity in their dying for the sake of a few days more is not, my opinion, taking care of them. Other people may feel otherwise, but the impending unaffordability will arrive regardless.
I certainly was not arguing against “prolonging a healthy, active, mentally fit end of life” or that “caring for the old, dying, the inconveniently sick and expensive” is a huge drain or that euthanasia is a rational choice except in very rare instances. People should certainly be cared for, and provided with everything they need to live out their lives as fully and as happily as possible.
I only wanted to point out that as we discuss the needed changes in health care in this country, we will need to consider the limitations along with the promise – and there are limitations. We cannot, for instance, afford to spend over a hundred thousand dollars on a liver transplant and follow-up care to gain two months of life for a cancer-ridden chronic alcoholic like, say, Mickey Mantle.
If this issue is too difficult at this time, we should let it go.
Xan, an all-inclusive health care system means just that, regardless of behaviors or genetic determinants. None of the Western national health care programs make any such distinction and there is no reason to assume the same system is somehow unattainable here. We need to respect our concerns, certainly, but we don’t need to let our fear of failure get in the way of our goals.
CD, I’m not your contrarian on this, truly I’m not. Do please take care of yourself, along with caring for others.
Eyes on the prize: a dKos diary worth reading
A nice feature they have over there is the “rescued diaries” list, for items that either got caught in a crush and scrolled off, or had headlines which didn’t attract the readership they should have, or whatever.
This one is a must-read for anyone who has plowed through this post and comments to this point. It’s what one doctor’s office person went through to get one prescription to one patient paid for by the insurance company and dispensed as directed by the pharmacy.
Not to give away the ending but hours were spent on this case and at last writing it still has not been resolved, i.e. the patient does not have the medication.
One teensy little example of an area where single-payer will, without doubt or question, save money and improve life.