The inevitability of health care rationing
This WSJ article points out that:
The private groups [who have announced their “cooperation” with Obama’s health care cost-cutting] are calculating that they can better influence this year’s bill if they’re “partners” instead of villains. They’ve no doubt seen what happened to Wall Street and Chrysler bondholders. All the same, they must surely know they have made a Faustian bargain that in time will result in price controls and restrictions on care.
Obama’s extreme hardball tactics with the auto companies have put health care (and everyone else on whom he’s set his sights) on notice: you can do this voluntarily, or we can twist your arms. But in the end you will do it, and then we will take over because you won’t be doing it to our satisfaction.
As for the rest of us—well, if you liked managed care and “utilization reviews” you’ll love ObamaCare. The article quotes Obama’s budget chief Peter Orzag, who’s keen on what’s called “comparative effectiveness research,” which studies:
…the patterns of clinical practice to determine which drugs and treatments work best. The Administration thinks it can use such analysis to weed out wasteful or unnecessary care by paying more “if the treatment has been shown to be effective and a little less if not,” as Mr. Orszag recently told the New Yorker.
A little less? Don’t count on it. Not to mention the start-up costs of the overhaul.
In addition, one of the things we most want from our doctors is to be treated as the unique people we are. My strong hunch is that the results of such studies tend to be contradictory, confusing, and ever-changing, as is true of so much medical research. And when the cost-cutters are in charge of medical decisions (even—or maybe especially, with the help of such research), there’s trouble ahead.
Cost reductions and hard choices of this sort are inevitable, of course, except for the super-rich. But I’d rather those decisions be made by my doctor—or even my insurance company, which I at least ostensibly have chosen after mulling over my options—than by the government. How about you?
I had a long post written and decided it really boils down to this: “comparative effectiveness research” is an ugly euphemism for government-imposed rationing of medical treatment. On the other hand I suppose they could save a lot of money by removing months or years from medical school curricula, if the doctors won’t be responsible for formulating their treatment plans.
Finally, the Marxists are going to have in this country what they have salivated over for so long: the power over life and death. Pretty heady stuff, eh?
I’m several weeks into recovery from a nastly little bout of cancer. Being basically healthy all of my life It was a real eyeopener watching our healthcare industry up close and personal.
It is a big lumbering machine blundering along with no one in charge. There are several layers of operation spinning in thier own orbits. The big surprise? it works rather well. Medical treatment is an incredibly subtle thing, an art as much as a science. I am ever so thankful I have received the bulk of my care before Obama “fixes” it.
They are blowing smoke
, we will be recieving substandard care in the future. The only market principles we are going to see effectively used will be rationing by what ever name.
We are individuals with different strengths and weaknesses. I relatively young, 50 yrs. old, strong and in good shape. I have been the poster boy for rapid recovery yet I’ve had many setbacks too. Having government beancounters judging treatment effectiveness through accounting practices is ridiculous. I could go on but I think anyone who has ever applied for a building permit or had thier license renewed can judge the effectiveness of public sector experts themselves.
And his projected savings are just numbers pulled out of thin air with no bearing what so ever on reality. A majority of the country voted for change, well be careful what you wish for.
So how will we ever get new treatments like, say, the breakthroughs anticipated from stem cell research? By definition, we won’t know how well the treatments will work so will the government pay for them to be tried?
Anyone who thinks that the government, whether Obama or anyone else, can ‘fix’ healthcare is in for a rude awakening.
Amused Observer, here’s hoping for your swift and complete recovery.
Oops! Sorry I messed up the citation it ends after awakening.
There it is again if the above one doesn’t work.
As Jon Stewart once noted, it’s one thing to let your doctor make the decisions, but what if you don’t have a doctor?
Health care costs in the United States have been rising at twice the rate of inflation for years. We spend 17 percent of our GDP on health care, more than 50% higher than Canada, and almost twice that of the United Kingdom, yet our life expectancy is lower than that of most industrialized nations; far lower than Japan, for example, which spends about half what we do per capita.
By every measure we have a vastly more expensive health care system than any other country, yet we don’t have vastly longer lifespans to show for it. Costs keep rising at well above inflation, year after year. Something has got to give.
The real guts of healthcare are the people who make it work: the physicians/surgeons, the researchers, other medical personnel, and the companies that take big risks to have the breakthroughs in treatments, drugs, and technologies.
I believe we are going down a very bad fork in the road. It will cost lives. Many lives.
If the socialists are “concerned” about their estimated 40 million people without coverage, then you find a way to get them coverage. You don’t put in place a system for 300+ million people when you only need a solution for 40+ million.
But this is the “hopey-changey” that the 53% wanted. I predict that within the decade most of these people will learn what it feels like to experience real guilt for their stupidity and sloth.
Mitsu, that’s a false correlation. We don’t know whether some flaw in our health care system is the reason our lifespans aren’t longer. We aren’t identical to Japan in all ways except our health care system. It could be what we eat, how much we eat, how much we smoke, how much we drive, how much we exercise, or some other cultural difference that hasn’t occurred to us yet and has nothing to do with the availability of socialized health care.
Look, I think we ought to have some sort ofd system to make sure people who lose their jobs or who (like one of my children) are working in a job that doesn’t provide health insurance can get some temporary, basic coverage at an affordable rate. But it’s a far cry from that sort of safety-net mending to handing the whole system over to the federal government, which has already got control of enough of my life, thank you very much.
I’m taking a drug that most people who use it still die within 5 years… but it seems to work for me. Hmmmm, I wonder how that would have worked out with a new system.
FredHjr Says:
“If the socialists are “concerned” about their estimated 40 million people without coverage”
PS
Thats another bogus number btw.
Thomass,
I know it’s a bogus number, but I used it because it’s the number they use. The Marxists want all the power to design the Utopia their Brilliance has concocted. They love to have the power over us to decide who is going to live and who is going to die.
They want to kill human beings in utero and they want to kill human beings at the end of life. Life that is inconvenient to them, that gets in the way, they want to be done with it. Monsters… all of them, without exception.
“Rationed care” goes hand-in-hand with “cost effectiveness,” and both can be traced back to utilitarianism and its godfather, Jeremy Bentham. At 61, my “good” for “the greatest number” declines each day as I approach the category of a “useless eater.” It appears that my end will come not with a bang, but with a whimper – the whimper concerning the cost to society of keeping me around vs. the benefits of not doing so. “These pills will keep him alive, but they cost $250 each and he needs four a day and he’s over 60. The people in accounting say to pull the plug.” And that’s that.
Park those auto plants down south, no Union goons, just people that want to work; superior product at a lower price.
Mitsu, is lifespan THE criterion? Presumably (Insty and his anti-aging cohort notwithstanding) there’s an absolute limit to human lifespan; life *expectancy* is, of course, another matter, and that’s been dramatically extended in the last hundred years or so in the entire First World and lots of the developing world too. And then there’s the subjective measure: quality of life. I’m 42. When I go to Europe – yes, even Europe – and see my agemates, unless they’re wealthy, I tend to look LOTS younger than they do – more like their 35-ish. My mother is 65; she looks ten to fifteen years younger than her European agemates, again unless they’re rich. Neither of us looks unusually young for Americans – but put us up against people of similar ancestry and a similar socioeconomic group, but with rationed dentistry and triage-based health care, and we look and act – and are able to be active – like people considerably younger than our age.
That’s one alternative measure. There are others, especially at the medical margins. Is a person with Stage 4 breast cancer really worth treating, after all?
Jamie that is absolutely nonsense. I am European, German in fact and I can tell you my relatives and I look a whole lot younger, heathier and fitter than those outrageously out of shape and obsese Americans. Health care will be rationed. You bet! But that is not a change. Right now it is rationed in that only the weathy can afford it. Is that morally right? If you are born as the child of a poor white trash person, do you deserve inferior care on average?
Back on April 24th my mother had open heart surgery at Catholic Medical Center in Manchester, NH for an aortic valve replacement. She also nearly died after the surgery while still in the OR because she had a several inch long blood clot in her heart. So, they opened her up again and got it out. We had two miracles that day, since the surgery was high risk, given how bad her condition was. That explains why I have not been on neo’s blog much in recent weeks, as she was hospitalized at Exeter Hospital for almost a week before they sent her over to CMC. They had to get her kidney functions stabilized so she could have a cardiac catherization.
Four of my five siblings are, like me, Republicans. My parents are lifelong Democrats, and so is one of my brothers. Anyway, those of us who are conservatives were talking the other day about socialized medicine and what it will mean. I told them that under socialized medicine they would never have done the surgery on Mom. She would have been put on the morphine drip and would have been dead within days. Why? Because she’s 75 and was not in good health.
Irony of ironies: the head surgeon who did the work is a doctor named Charlesworth and he began his career in Toronto. Obviously, he came down here to CMC because he could make more money and have more control over his practice. I’m sure he’s looking at what the voters have done last November and is amazed and worried.
A system that decides that fetuses and old people are not worth saving is a very shitty, evil system.
Several nutsos have posted their healthcare ignorance here. Mitsu is one. Health care is more than managing populations. Healthcare systems that deny the obvious fact that bell-shaped curves exist in every population are immoral; people with the same diagnosis are not all alike.
The tired old arguments about Canada cheaper but just as good are cited by folks who deal with issues only superficially, and really don’t think the ill are worth caring for, as long as they themselves are well.
Jamie with his medical margins is another. Healthcare progress is made very incrementally. Stage 4 Hodgkins was fatal, often rapidly, 100% of the time 40years ago. Today Arlen Specter lives in complete remission. I have treated Stage 4 breast patients who have lived for 10-14 years. They didn’t complain about their prolonged longevity.
It is the moral responsibility of each physician to push back at the medical margins, not to wash their hands of the patients with a shrug of their shoulders.
Tom,
Socialized medicine is a violation of the Hippocratic Oath, is it not?
The Marxists would have let my Mom die. I am convinced of this beyond a doubt, which only heightens my sense of hatred for their ideology. As if ten years of my younger life in their company was not enough to teach me what they are really like.
Thank you, Tom.
Tom: Good post. My husband is a physician. In the last few years, he has noticed that most of his patients arrive at his office with reams of information they obtained from the internet about every potential disease they might have and treatment potentially available. It is hard to believe that they will be satisfied with the government’s “one size fits all” solution.
From Reuters: “A New York doctor is offering flat-rate health care for the uninsured for $79 a month, but he has run afoul of state insurance regulations in a case that challenges the established norms of the U.S. health system.”
article here: http://www.reuters.com/article/domesticNews/idUSTRE5467KE20090507?feedType=RSS&feedName=domesticNews&rpc=76
Thank you for calling me a “nutso”, Tom. Reasoned argument at its best.
I like your quote here:
>It is the moral responsibility of each physician to push back
>at the medical margins, not to wash their hands of the
>patients with a shrug of their shoulders.
An interesting remark, given the fact that our health care system, vastly more expensive than any other in the world, manages to completely leave out of the picture 16% of the population who are completely and totally without health insurance of any kind. Among those who do have health insurance, many live under the restrictions of their HMO, which typically require extensive pre-approval of procedures, denial of procedures deemed by the HMO to be “unnecessary”, and many other rationing factors, including many well-publicized instances of insurance companies coming up with bogus reasons to cancel the policies of people who get sick. How “moral” is that? Sure, in theory these people could get health insurance from someone else — unless this is the only plan offered by their employer and they can’t afford the sky-high premiums of alternative private insurance.
Of course lifespan isn’t the only measure of health care effectiveness. But for a system that spends twice as much as Japan per capita, we sure don’t have a hell of a lot to show for it.
Health care costs are about to bankrupt Medicare and are the single biggest factor in future budget deficits. We have a serious, growing problem with out of control health care costs. I find it difficult to believe that there’s no way to control health care costs without “rationing” — do you think the system is as efficient as it could possibly be? I think what is happening is that people feel the need to have health care and thus the insurance companies and medical establishment have gotten used to ratcheting up costs by twice the rate of inflation year after year, without really spending much time on serious efforts at cost control. Rationing is hardly the only way to control costs — there are also efficiencies to be gained in lowering overhead, improving medical information technology, streamlining the process of managing benefits, etc.
The reality is that Obama’s plan is not going to get rid of doctor choice or private health insurance. Note that in Canada private health insurance is still available as an add-on if you choose to pay for it. The same is going to be the case with any plan we manage to pass in the United States. While single payer does massively simplify the overhead of managing health care, it is politically unpalatable here, and I personally think that the costs are worth the benefits of retaining some competition in health insurance. Nevertheless if there was a better place for some government intervention I can’t think of it. Health care does not function like a normal commodity where supply and demand can be relied upon to determine cost — people want health care so they’re willing to pay as much as the medical establishment wants to charge, no matter how high that price goes.
A side note — it’s certainly true that the United States does get some benefits from our sky-high health care costs — for example, we have one of the highest cancer survival rates in the world, a distinction we share with France and Japan. However, both France and Japan manage to get this while spending about half what we spend per capita. In terms of overall health and longevity, however, we come in far behind France, Japan, and most other major industrialized nations.
Another point worth noting is that France’s system allows for great freedom in doctor choice, a freedom far exceeding that enjoyed by most Americans who must either choose a doctor covered by their plan (often quite restricted) or face exorbitant fees or no coverage whatsoever. Universal coverage does not have to mean reduction in doctor choice — in fact in our case one can argue that most Americans have less choice in choosing their doctor than do the citizens of France, despite the fact that France’s system is far cheaper than ours.
Petit Says:
May 12th, 2009 at 9:49 pm
“Jamie that is absolutely nonsense. I am European, German in fact and I can tell you my relatives and I look a whole lot younger, heathier and fitter than those outrageously out of shape and obsese Americans. Health care will be rationed. You bet! But that is not a change. Right now it is rationed in that only the weathy can afford it. Is that morally right?”
A: Not really. I’m Hungarian and I look better / younger than my cousins (re: back over there) who are near my age… and I have a chronic illness in the severe stage* (and I still look better!). 🙂 But nice pulling out of the fat Ami cliché.
B: BS. About 10 million people are not eligible for some kind of medical coverage… but they’re not all ill / in need of it. Even if it were 10% of that (which it is not) that’s 1 million not covered in need of service… out of how many people? We don’t need to throw our superior system under the bus when we can simply cover those last people falling through the safety nets. Because otherwise, our healthcare system is better.
* I think its turning around btw but I blame the pills for my constant and numerous grammar errors.
Mitsu Says:
“Universal coverage does not have to mean reduction in doctor choice”
It does not have to but it probably will… to save money. Like the UK, it will probably end up with an HMO model with a primary care provider to act as gatekeeper to the specialists…
In the end, public care will involve all the worst aspects of private care now….
BTW, we should just demand more choice in private care plans. Like demand that PPO higher deductible plans be offered. We end up with HMO plans because people carp about co pays… and HMOs either eliminate or come closest to eliminating them… I’d go with PPO… but a lot of people feel put out by being asked to pay their first few grand out of pocket… but its a bad deal to with HMO… Sort of the low introductory credit card rate of health care…
At least when my doctor or insurance company screws up, I have some legal recourse.
Best of luck suing ObamaCare.
Someone explain to me why they excoriate HMO’s as being run by unknown and faceless beancounters, when they offer us much the same bargin an count it as a blessing?
Nobody goes without health care if they need it. And that is completely independent of their ability to pay or whether they have insurance.
Those of us who do pay for our care is charged to cover for those folks. Some of them are indigent, some choose not to pay for insurance, some are illegal immigrants who just show up.
But none of them are turned away.
But if you want to see socialized health care as done by the USofA, look no further than the VA system.
The real test of ObamaCare will be if upper echelons of the federal government will be subject to ObamaCare. My guess: Congress will exempt itself, the judicary and certain portions of the executive branch.
Now, if they subject themselves to ObamaCare, I might be willing to give it a listen.
Love the way Mitsu bitterly complains about cost-control measures undertaken by HMOs in one breath, then proclaims in the next that nobody will undertake any cost control efforts, then insists that when government does the cost control things HMOs are doing now, everything will be just scrumptious.
Mitsu, when you say “we sure do not have a hell of a lot to show for” what we spend on health care, you reveal yourself as so blindly determined to see only the negatives that the “nutso” label starts to look fair. Tell me about the ground-breaking medical research done in France and Japan that has revolutionized cancer care, or Parkinson’s care, or neonatology over the past few decades. Oh wait, you say they mostly use ours? Because they have no incentives to do their own? And because our medical knowledge is free to them? But that couldn’t possibly explain why our health care system costs more than theirs. Nope nope. Ours costs more becase . . . because it costs so much, that’s why! And we get nothing for it, nothing!!
Come on Mitsu. Ours costs more because we get so doggoned much, not because we are getting nothing. I myself am walking around cancer-free today because my doctor ordered a test in my early 40s, based on my family history, that I would not ordinarily have had for 10 or 20 years and that revealed, sure enough, a ticking time bomb. He had to fight my HMO for approval but he got it, and I’m damned lucky he did. How much luck do you suppose he would have had fighting a government bureaucrat with a mandate for beancounting? Yes, the spiraling costs are a terrible problem that must be solved. But good God, how can you imagine that handing the system oer to the GOVERNMENT going to fix that? Have you checked out the deficits lately? We are not exactly talking about people who know how to control spending. Yes, we must do something should be done to make coverage more accessible for that group — which I inhabited for years — but arguing that the whole system needs to be dismantled because some aren’t in it is like arguing that all the automakers should be nationalized because some people can’t afford a car. (Oh wait . . . )
I know somebody in Ireland right now who learned over a month ago from her doctor that a lump in her breast is “highly suspicious” and “very worrying.” She is STILL WAITING for her biopsy. It hasn’t even been scheduled yet. Boy oh boy, I just can’t wait to wait like that for imperative medical care. Finally, we will be getting a hell of a lot for our money!
sorry for mid-post incoherence. By “that group” I meant, of course, the uninsured. I type too fast sometimes.
I should add that if my friend awaiting the biopsy in Ireland were here in the US and uninsured, she would have had the biopsy by now and being treated if she needs it. Yes, she would be frantic about how she’s going to pay for it — and that’s bad — but she would be GETTING TREATED. It is a canard to claim that the uninsured do not get medical care (as the European who posted here apparently believes, with her comment that “only the wealthy” get care here.) Yes, they probably get less care than they need because they postpone care out of financial concern, and I fully agree that that is a bad thing which we need to fix. But our hospitals do not turn away the uninsured.
I would much rather be worrying about how to pay for my biopsy than about when the hell it is going to take place and how much damage is going on inside my body while I wait for it.
there are really only three factors when considering healthcare: quality of care, access to care, and cost of care.
in the US, quality is usually not a problem.
in the US, access to care isn’t much of a problems either to the majority of the population. most medium to large hospitals provide free care all the time. rural areas may have problems with access and availability to hospitals but the US population has long shifted to urban areas. one can make an argument that access to preventative care is a problem but the real benefit of preventative care to those who do get it are of uncertain benefit anyway. And ultimately utilization of preventative care is a cultural issue (we don’t actively pursue preventative care) rather than an access to care issue.
the real issue is cost. ultimately there are only two ways to reduce cost. one is to decide to use less (a significant precentage of our health care is spent in the last 30 days of life). the other is to be told to use less, either by the provider or the payor. while some cost savings can be had through efficiency, there really isn’t that much fat to trim. any cost saving is more than offset by the administrative cost of compliance with regulations that doesn’t improve care.
when you get down to it, i would rather decide to forgo treatment than to be told i cannot have it. and that is exactly what will happen when there is a single payor like the government. they will restrict some care in order to save cost, and will prevent those who have the cash to pay for it themselve as this will generate an impression of rich vs poor care.
FredHjr: Yes, socialized medicine is a flagrant violation of the Hippocratic oath. But it is becoming irrelevant. The Mitsus are big in academic medicine; just read the “Perspectives” in the New England Journal. They’re better than ipecac in inducing vomiting.
The Mitsuvian Left is politicizing everything, glossing over, misrepresenting, and just ignoring facts that conflict with their agendas. They cloak themselves in humanitarianism while choking the humanity out of the rest of us.
Tom,
Your input on this forum, as a physician, is very much appreciated.
Doctors Goldberg and Charlesworth at CMC, Manchester, NH gave my Mom at least a 30% chance of not surviving the surgery. If she also had blockages (which amazingly she did not have) that bad odds would run to 50%. I am absolutely certain that under socialized medicine my Mom would have been given the morphine drip and we would have spent a few days watching her fade away.
Now, almost three weeks later, she is in rehab. It is going to be a long road back for her, but we had a far different Mother’s Day than what we were anticipating. All because of a talented surgeon, cardiologist, staff, and prayer. Oh my, now I’ve gone and done it. I mentioned prayer and God and the Blessed Mother… Major sin, as far as the metaphysical materialists are concerned.
Anyway, despite warnings from within the profession itself about shortages of physicians and surgeons, and the inevitability of rationing and long waits for procedures, the Marxists are going to go forward with this.
On all of the important issues of the day, the collectivists use a heavy hand to bare knuckle their will on the rest of us.
FredHjr:
There are few greater joys than snatching a patient like your Mom (God bless her! and her endurance) from the jaws of death. Being a doc allows such natural highs. Being a Marxist only allows one to revel in one’s false self-rectitude. They will rob us of the joys of achievement in all human endeavors.
I gravely regret my past tolerance of ideological diversity. The Gramscians are not just wrong. They are mean-spirited little Pol Pots. But they have defined the rules of the game, and I have become ready to get down in the mud and fight just as dirty as they do.
First of all, a lot of the cost of health care can be attributed to high administrative costs associated with our hugely complicated system of private health insurance. It’s also driven up by the fact that the uninsured often use the emergency room for “health care” which costs far more than it would if they had ordinary health insurance and could afford to go to doctors more regularly. Health care costs are also driven up by the fact that the underinsured and uninsured wait before they go in for treatment, meaning the resulting treatment is often more expensive than it would have been had they gone in earlier. There are also severe moral problems with our system: I personally knew someone who had some chest pain but decided to wait to go to see a doctor because she was going to get a job in the fall that would have health coverage … she died a few weeks later of some sort of heart failure, in her sleep. She was in her mid-20’s.
We also pay our doctors more in our country than doctors make in other countries.
Regarding cost controls related to use: studies have also shown that hospitals in major cities often use vast numbers of consulting specialists for a lot of conditions yet they show no improvement over care provided to people living in smaller cities for the vast majority of conditions. Clearly there are some efficiencies to be gained here. The problem with HMO’s, however, and their cost control efforts, is that they often do things like cancel your coverage entirely if you get a major illness, and you are also restricted to use just doctors within the HMO’s network, which may well be a small fraction of the total number of doctors available. If you get new insurance you’re often not covered for “pre-existing conditions” which are precisely the conditions you ought to be covered for. These problems clearly need to be addressed.
We are the only major country to have no form of universal health care. We spend vastly more than other countries, and we are still a country in pretty poor health, overall. Will THE GOVERNMENT be able to do something about this? Well yes, I don’t happen to believe that the private sector is always better than the government — I think the government can and should get involved in certain areas and it does a better job than the private sector on its own.
I want to emphasize that Obama’s plan is NOT a single-payer system like England’s. It retains competition in health insurance and if you don’t want the government plan you’re free to use your current private insurance.
the administrative cost has very little to do with private insurance. the administrative cost has alot more to do with maintaining compliance with JHACO, OSHA and other quasi governmental organization that seek to impose arbitray standards in order for hospitals and health care facilities to maintain acreditations. so people are hired to deal with these organizations, people are hired to walk around and make sure compliance regulations is being adhered to, and people to talk to other people to maintain compliance.
the other major cost of healthcare is the cost of protection against liability. too much is being done to cover liability risks; too many tests, too many consultants. but since the lawyers control liability, and they are the ones becoming politicians, it is unlikely this will change. another aspect of the liability risk is the fact that patients wants more, demand more. they want a CT when plain films or ultransound would do. they demand MRI and the data for utility and effectiveness remain ambiguous.
physicians salary are not part of the cost. physican salary rise has been negligible compared to the cost of healthcare increases. physician salary account for less than 10% of healthcare cost.
when the government gets into healthcare, being the gorilla in the room in term of size and power, they will in essence set the standards for both service and coverage. already many insurance companies are following medicare/medicaid lead on what they will pay and will not cover. so it won’t matter if there are other payors or not, the result won’t be much different.
finally, when the government becomes a HMO, it will control cost just like any private HMO, by limiting care. that is how most costs will be controlled when third party pay rather than we ourselves out of pocket.
“The problem with HMO’s, however, and their cost control efforts, is that they often do things like cancel your coverage entirely if you get a major illness, and you are also restricted to use just doctors within the HMO’s network, which may well be a small fraction of the total number of doctors available. If you get new insurance you’re often not covered for “pre-existing conditions” which are precisely the conditions you ought to be covered for. These problems clearly need to be addressed.”
Most states have already addressed these problems with laws prohibiting or at least controlling the practices you cite. New York, for example, restricts limitations on pre-existing conditions, prohibits excluding people from getting insurance at all because they have such a condition, and requires insurers (not just HMOs) with preferred-provider lists to have a mechanism whereby an insured can use a provider who’s not on the list by demonstrating a need.
In particular, I’d like to see the data supporting your claim that HMOs “often” cancel policies because the insured gets a major illness. In New York State, that’s illegal (it’s called guaranteed renewability). I’d be surprised if there are many states — if any– where this is not prohibited. Which states still allow it? How often does it occur in those states, on an annual basis? Links, please.
I’d love to see the data on which you base your idea that the government can do a “better job” than the private sector on its own when it comes to controlling health care costs. Is this based on Medicare, maybe? Have you looked at the cost of its prescription plan? Or Medicaid? Have you tried to find a doctor who will do the paperwork it requires and accept the payment it will offer in a major city? Many of the poor who turn to emergency rooms for basic care instead of private doctors HAVE INSURANCE in the form of Medicaid but have to go to the ER because they can’t find doctors who will accept it. How are you going to make those doctors take the reduced payments Obama’s system will require when there’s still a private system in existence that will pay them what the market will bear?
In my state, one reason insurance is becoming unaffordable is that the state government keeps adding requirements to what insurers must cover — acupuncture, chiropractic treatments, extended hospital stays after childbirth, cripes, for all I know, they’ll add homeopathy before too long. The result is that those who could maybe afford a Hyundai if insurers were allowed to sell it are told they must buy a Rolls Royce or do without. The effect of government involvement in this case is to escalate the increasing cost of coverage.
Once again you have supplied no data showing a causal relationship between the cost of our health care system and our “pretty poor health overall.” As already pointed out to you more than once, just because the two things co-exist does not mean that one causes the other. But if we’re going to talk about correlation as if it meant causation, please show me some data that overall health improved in Britain after the arrival of the National Health or in Canada after they instituted their system. Maybe it did. If so, I’d certainly like to know more about it.
Mitsu:
What do you do? Do you earn more in the US than you’d be paid in other countries?
That your acquaintance died is sad, but HER fault, not the “system’s” or her lack of insurance. It’s denial, and folks with insurance die of it too.
The real problem with health insurance is that people want it to cover everything. That’s not insurance. And there is no mechanism today in any heathcare scheme for rewarding better results or stimulating competition.
When I called you nutso, it was due to your willful ignorance. You think of yourself as very smart, doubtless, but lack critical thinking in the true sense.
FredHjr – I thought this:
You don’t put in place a system for 300+ million people when you only need a solution for 40+ million.
was a perfect line and I am going to shamelessly steal it for my blog post on this.
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