Public perceptions and the GOP health coverage bill
I’m going to start with a bunch of questions.
Have you noticed how hard it is to figure out what to call the Republican efforts to replace (or shall we say modify) Obamacare? The natural solution is “Trumpcare,” but you could just as easily call it “Ryancare,” at least so far. However, in a little while the Senate will chime in, and then the bill won’t just represent Ryancare, although “McConnellcare” will never fall trippingly off the tongue even if the Senate manages to pass some version of it (which is somewhat in doubt at this point).
I actually prefer “GOPcare,” but I don’t think that name will ever catch on. And if the MSM has its way (see today’s coverage, for example, or the Times’ editoral “The Trumpcare Disaster”), the entire concept won’t catch on with the American people. Just compare the negativity expressed now in the MSM to the euphoria that greeted Obamacare—both of which are bills with major flaws, attempting to deal with a conundrum that is essentially insoluble—and you’ll see how much fear and loathing is already being stoked for the GOP version, even though this is the temporary first effort.
The goal on the part of the Democrats and the MSM (but I repeat myself): to frighten people—nay, to terrify them—and to have it result in Congress changing to Democrat hands in the next election.
Another question—have you noticed how the concept of health insurance has morphed, so that by now these bills (Obamacare or Whatevercare) are routinely referred to as providing health care? This was originally the way the left referred to them, which was a purposeful (and successful) effort to spread and solidify the idea that the federal government should be guaranteeing health care rather than regulating health insurance, and that without Obamacare people wouldn’t have health care and would be dying in the streets. Now it’s not just the left talking that way; it’s standard to refer to health care in reference to these bills.
That’s not a semantic point—it’s both a cause and a reflection of the dilemma the GOP faces. When Obamacare was passed, we heard a lot about how bills like this are impossible to repeal, because once people get used to them there’s no turning back. Now the GOP is trying to turn things back, and they probably have the power to do so, since they control both legislative houses and the presidency. But having the power to do it doesn’t mean that doing it will work. That’s because the public has gotten used to the idea that Obamacare provided health care, and that changing it is a tremendous threat to their ability to get medical treatment.
Another problem is that the private health insurance system of individual coverage that Obamacare dismantled has been—well, dismantled. Can the GOP put Humpty Dumpty together again, even if it wanted to and even if the public wanted them to? One can understand why the GOP might be reluctant to go back to the type of coverage that will provide the Democrats and the MSM (but I repeat myself) with many sad medical anecdotes to pin the idea of heartlessness on the Republicans. As it is, there will be plenty such anecdotes availiable no matter how much the GOP tweaks and improves the bill.
Here’s a quote from J.J. Sefton at Ace’s that encapsulates the problem:
Health insurance and health care are now seen as human rights, so naturally they must be guaranteed- no, they are GRANTED to you by the government! And any attempt to take away your human rights will result in “thousands dying in the streets!” For the benefit of the mal-educated (few here, thankfully), logic dictates that as crucially important as health care and insurance are, they are goods and services just like anything else and you get what you can afford to pay for. It’s up to individuals to take responsibility for themselves and make the right choices in their lives. It is not my responsibility to pay for others dissolute lifestyles and irresponsible choices. Okay, you’ve had your laugh for the day.
Unfortunately, health care and insurance are not “goods and services just like anything else.” Some goods and services are a matter of life and death and some are not, and that first type are considered different for that reason. Our society has come to the point that we don’t tolerate people going without those things (as Sefton of course understands, which is the reason for the sarcasm in the passage), and even before Obamacare there were laws (for example EMTALA, passed in 1986) that made it illegal for hospitals to turn anyone away for inability to pay. That law (and please read up on it if you’re not aware of it) was transformative, and reflected a point of view about medical care that predated Obamacare by almost 25 years.
In that Sefton quote there’s another problem, which is the idea that people get sick because of their dissolute lifestyles and irresponsible choices. Of course, sometimes they do. Smoking, for example, is one of the best examples of that, as is alcoholism, although we all know smokers and alcoholics who live to a ripe old age. But although it’s nice to have the illusion of control over whether we get sick or not, we most definitely do not, even if we make what’s considered sterling life choices that are supposed to maximize good health. Illness and injury are no invariable respecters of our efforts, and it’s folly to think they are.
Just as one small example, I became a chronic pain patient in my very early forties after a lifetime of exercise that included yoga (in fact, one of my injuries was sustained from swimming, supposed to be so very good for you). I didn’t smoke or drink, and for the most part stuck to the recommended diet and was the recommended weight. I remember, during the height of my pain decade (which lasted about twelve years), listening to some woman expound on how she never got sick because she took good care of herself. If I’d been a more aggressive person—and not been in so much pain—I might have gone over and punched her, I was so angry.
That’s a digression, but it also illustrates how emotional these issues are for everyone, and how the idea of personal responsibility can be used as a cudgel to blame the sick. If the GOP is perceived as the party doing that, it will not go well for them.
Yes the thinking that only people who lead dissolute lifestyles are going to get sick and die is a little odd. Last I heard, everybody at some point does get sick, like really really horribly sick, and then, dies. It is such a downer. And usually it’s really really expensive there at the end. Which I guess if you’re going to die soon, it’s not that bad for you to run up a huge bill, cause you’re not here anyway. It’s like running out on a big restaurant bill. Dine and Ditch. It does leave your dining companions to pay the check, however. Which in this case us I guess your family.
i can see why everyone gets upset about this. There’s no good answer.
Still, insurance companies are out of control. Doesn’t Ann Coulter suggest getting rid of the law that won’t allow health insurance to cross state lines? Whatever that law is called? the one passed by the Democrats like fifty years ago or so? So the way it is now if you buy health insurance, then get a chronic illness, that will weaken and then kill you, (happens to the best of us, apparently. So awful!) you cannot leave the state and keep your insurance. Apparently you are stuck to that same policy in that same state until you die. This
sounds utterly bizarre to me.
And yet, the super smarties on TV who are always talking about how dumb Trump is, never bring this up. Do they not know about this law? And that it seems quite wrong? Should I tell them? I think I will. “Dear Ms. Maddow, there is this law that seems wrong and harmful……thoughts? sincerely yours, Deep Cover”
Ms. Coulter says quite often, that if people could move around, from state to state, the insurance companies would come up with insurance plans that would compete with each other and then become more affordable for the people who are going to get really sick and then eventually die. Which I guess is everyone. (So upsetting!)
I think Ms. Coulter should talk to Ms. Maddow on TV about this.
Cernovich says that the GOP should totally stay away from 0-care… and let it implode on its own… which will happen no later than 2018.
0-care floats on funds looted from Freddie Mac and Fannie Mae. ($300,000,000,000)
So the whole affair is a fraud as big as Credit Mobilier of America.
blert:
That approach would cause a host of problems, too. Heartless promise-breakers, who purposely let the healtcare ship go under just to avoid taking responsibility…
DC created socialized medical care for those of us over 65 way back in 1965. You have no choice but to participate. Of course many of us 65 and over also have private supplemental insurance, but for the most part you are stuck with medicare. The ‘progressives’, dating back long before 1965, have dreamed of total federal control of medical care.
The gop will tweak obamacare here and there, but for the most part it will not mean much in the long run. Single payer here we come.
DeepCover:
The question of allowing health insurance to cross state lines is nowhere near as simple as that.
See this, for example. It’s not just a question of regulations, it’s a question of economics and the peculiarities of health care. See also this.
As to the dissolute life fallacy, I highly recommend Susan Sontag’s “Cancer as Metaphor.” Great book by a liberal. No politics; just research and writing.
“Last I heard, everybody at some point does get sick, like really really horribly sick, and then, dies. It is such a downer. And usually it’s really really expensive there at the end.”
This might just be me – a combination of my views bolstered by the fairly horrific experience of watching a person close to me suffer before their inevitable death – but why is it expected, or even considered a Good Thing, to expend vast amounts of heroic care in the hopeless final weeks/days/hours of a life that cannot be saved? I realize that it’s a tiny sliver of a line surrounded on all sides by slippery slopes to things that actually are bad (euthanizing people who aren’t done with life) but I fail to understand this.
I watched members of a family seek to pursue every possible avenue to extend (for a few days? Weeks?) the life of an elderly person who had suffered terribly for years from a debilitating condition. The person, in neverending pain and all but bedridden, was long past ready to go and had told close family members so, but when a critical and insurmountable medical emergency finally happened, somewhere near $100,000 was spent on a surgery with a 0% chance of a successful outcome. It was a demanding surgery on a fragile, elderly person in poor health, so surviving the surgery itself was in doubt and even if it was “successful” (ie, the patient not dying today or tomorrow from the emergency condition) there was 0% chance they would ever go home from the hospital – their remaining life would be spent trying to recover from this surgery and keep on living through the underlying condition. The doctors said as much at the time, yet it was done anyway. This person was in agonizing pain after the surgery and was sent straight to a hospice where death came a few days later without any meaningful return to consciousness.
You wouldn’t do that to your dog. Why do we think it’s a “right” – and not just a right, but a something that everyone needs to pay for – to inflict it on ourselves and our loved ones?
Maybe this is a digression but two points.
1. Back in the day, healthcare was cheap. My mother saved everything and from her check registers and bills, the bills from the hospital and the doctor for my birth was crazy cheap even adjusting for inflation. Part of the reason was I was born at a hospital owned by the Sisters of Mercy.
Even to this day, all of Omaha’s hospitals are run by non-profits; mostly religious organizations. Non-profit has a legal meaning and it only means the organization doesn’t pay taxes as long as it provides charity care but with so much money sloshing around there is plenty to hand out to top managers and rent collectors.
Bergan Mercy hospital was owned by the Sisters of Mercy. I recall sitting in church about 20 years ago and a nun was asking for money for the retirement of the nuns. I was thinking what about the hospital?
Creighton had St. Joseph’s hospital. The main purpose was to teach the medical students and nurses but it also provided millions in uncompensated care for the poor and to victims of the gun and knife club. St. Joe’s was eventually sold and merged with Bergan and is now part of something called CHI (Catholic Health Initiatives) out of Denver.
When the late Fr. Schlegel was president at Creighton he told me he was glad to get rid of Creighton’s minority stake in St. Joe’s as all it did was lose money and tied up capital. And, of course, he was committed to the charity care and St. Joe’s always did way more than anyone else in Omaha. He was smart to cut the loses and focus on the core mission of education.
To some extent the much higher costs of medical care are well worth it. Our great drugs are a prime example. Part of the problem is that there is no price competition because some one else is paying the bill. Also, how much is life worth?
2. Health care and health insurance is just is too complicated and time consuming in addition to being wildly expensive. I’ve come to the conclusion that it can never be fixed. Recall the buddy of the Clintons who was going to fix everything. And then the MIT prof and the wizards that put together Obamacare. Complete failures.
I think it is unfixable.
To think one works an entire life and if one doesn’t go quickly then the health care creditors get it all.
KG:
There are stats on the ineffectiveness and great expense of much medical care on the elderly at the end. People are emotional and hope for miracles, but some of it can be borderline unethical. The thinking probably is that Medicare or an insurance company is paying so just do it.
The late Fr. Schlegel died of pancreatic cancer. Even after all of these years about zero progress has been made on pancreatic cancer and he knew it. So instead of chemo, surgery or radiation he went on a victory tour to Rome to meet the Pope, Omaha (to meet me), San Francisco and all of his favorite haunts. His final stop was Omaha for hospice care. Final destination was heaven. JPS, SJ did it right.
I’m highly doubtful that the trends toward ever more socialized medicine can be reversed. As the emotional content drowns out all reason.
There’s a reason why Lenin declared socialized medicine to be “the Capstone of the Communist State”. A ‘right’ is something that cannot be taken away from the individual. If it can be revoked, then it’s a privilege.
Health care is made up of products and services and must be paid for by someone. Socialized medicine takes from those with the ability to pay and gives to those without. It is an perfect example of “from each according to their ability, to each according to their need”. That is unsustainable, as Venuzuela is currently demonstrating.
Without fail, that path leads to tyranny. America is trading security for liberty. It will have neither.
Blert
The Fannie and Freddie money just went into general funds so it did fund Ocare and the entire government. But the Dems are spinning that accounting fact as some kind of live. The money was never designated to OCare.
Giant scandal. Obama and Geitner nationalized the mortgage industry without any compensation.
And don’t get me going on Bob Corker.
If a deity is so rigid, so unforgiving that you would be sent to a horrible place to be tortured for eternity with no mercy just because you take the “Coward” way out to relief yourself or your love one from meaningless insufferable pain, that is not a very Kind and loving Creator, and I don’t think he can ever be pleased no matter how devoted you think you have followed the rules he passed down. He probably could have find some tiny fault in your lifetime to deny you entrance to his kingdom. Even if by some luck you did manage to earn his acceptance, i don’t think it would be as great a place to be as you believed it to be.
neo: “But although it’s nice to have the illusion of control over whether we get sick or not, we most definitely do not, even if we make what’s considered sterling life choices that are supposed to maximize good health.”
Just so. I’ve been hard at trying to eat right, exercise, have regular checkups, etc. since I began flying for the airlines and had to pass a physical every six months to keep my job.
Well, it got me to age 82 in pretty good shape, but in the last two years I have been diagnosed with colon cancer (surgically cured) and wet macular degeneration (undergoing treatment), which are both diseases that run in families. (They have a strong genetic correlation.) No matter what I did I was probably going to get these diseases eventually.
I’m thankful to have had Medicare and to be able to be treated. However, major surgery and treatments have shown me how much weaker and vulnerable I am at my age. Each passing year is going to mean that much less margin for recovery from any illness or accident.
My wife and I are doing a lot of thinking and planning about end of life issues. Neither one of us want to be kept around as mere shells and are making sure that won’t happen by drawing up final health care directives – legal documents that cannot be ignored when the time comes to make life or death decisions.
As for the state of our health care system. The care is pretty good. Some hospitals and doctors are better than others, but all in all pretty good.
The big argument revolves around how it’s all going to be paid for. Charles Krauthammer is of the opinion that Obamacare has changed the mindset of Americans that health care is a right. He may be correct. What seems passing strange to me is that a program that covers at most 22 million people out of a population of 320 million can become such a cause celebre’. The 9-11 million who became covered by Medicaid under Obamacare’s rules can continue on Medicaid until at least 2020 when their states have to make decisions about how to continue to fund the program. So, they have some breathing room. It is the 11 million or so individual policy holders that may have problems unless insurance companies step up to the plate with offerings of policy choices that are affordable and acceptable.
Anyway, when I compare the House bill with Obamacare, I see some positive changes, but it is only a first step. Much more would have to be done further down the road to create a more market driven, patient friendly system.
There is a lot of confusion and misconception on how pre-existing conditions will be protected under the obamacare re placement, the following is from USA TODAY
https://www.usatoday.com/story/news/politics/2017/05/04/fact-check-pre-existing-conditions-debate/101283530/
Allow insurers to price policies based on health status in some cases. The current law does not and the original GOP bill would not allow insurers to set premiums based on health status. But the amendment would allow it for those who do not maintain continuous coverage, defined as a lapse of 63 days or more over the previous 12 months. Such policyholders could be charged higher premiums for pre-existing conditions for one year. After that, provided there wasn’t another 63-day gap, the policyholder would get a new, less expensive premium that was not based on health status. This change would begin in 2019, or 2018 for those enrolling during special enrollment periods.
Don’t believe the liberal lies, Pre-existing conditions are protected as long as you maintain a coverage with no gap in the past year. even in any unexpected event that you will be charged more for you premium due to existing conditions the longest they can do that is a year, the state established high risk pool fund will kick in to help out during this period and the premium will get back to normal if you maintain a continuous coverage for a year. This is I believe just a mechanism put in place to prevent someone trying to cheat the system by purchasing coverage only when they get sick.
Really excellent health/care/insurance commentary from Neo, here and prior posts. However…
Neo lived right and had a serious ailment for 12 years, so she is, to some extent, a statistical outlier. Real insurance is perhaps intended to accommodate her. But in our modern society, for every one of her, there are maybe 5 people who would have had good health, if they had lived right, but they didn’t and they don’t. (That is all relative to the good or bad genetics that you started with, plus exposure to environmental factors.) And while Neo’s 12 years probably felt like an eternity, many of those others may have chronic issues for 20 or 40 years. Talk about blowing up the budget.
There are goods and services that are essential to life and there are the non-essentials. I would argue that food, drink, and shelter from the elements are more essential than healthcare. A couple hundred years ago, a good weapon was probably much more essential for most people than the minimal healthcare available. Nowadays, folks no doubt believe their smart phones are essential.
It is always a mistake to take product category X and declare it too special for normal markets and commerce,… unless the goal is complete authoritarianism over a greatly diminished category X.
Even a well designed insurance program is a form of socialism and with its concomitant flaws. But as long as the things being covered are statistically rare and cumulatively not too expensive, the positive outweighs the negative.
I am reminded of the classic film Double Indemnity. It is great from the film noir point of view, but it really has a tremendous amount of detail on the life insurance biz too. Written by Raymond Chandler, directed by Billy Wilder.
Final point. The entirely cogent point has been made many times, that the people won’t tolerate their right to healthcare being rolled back. I say maybe.
But we will never find out if that is true, because the GOP establishment will never let any of it happen. If it did, some giant corp. ox would be gored and they can’t tolerate that. The pawl will never be lifted from the liberal ratchet wheel.
J.J.,
We too have created legal documents for the end. We have no wish to linger on when the end is near. Pain relief yes, but nothing beyond that. Although mostly an optomist, when comes to the issue of medical care I am a pessimistic that the future holds the possibility of a free market, competitive medical system. Or even a quasi-socialized, capitalist mix. We will be under a taxpayer subsidized (plus lots of borrowed money) system within a decade or less.
A majority wants ‘free’ medical care.
A majority wants ‘free’ medical care.
Not sure that’s the case as much as what Cornhead said above: “Health care and health insurance is just is too complicated and time consuming in addition to being wildly expensive.”
Parker: “A majority wants ‘free’ medical care.”
I did some cursory research. We are all aware of Great Britain’s National Health Service Disaster, or should be.
Sweden is a poster model for “social welfare” with Cradle to Grave medical Care. Well they pay for that in a couple of ways. One way is restricted access. A study in 2007 showed that the waiting time for surgery exceeded 3 months in over one-half of the cases. It is reasonable to expect that the influx of indigent immigrants since the report has put even more pressure on the system. Of course, they also pay through confiscatory taxes; 57% personal income, 25% sales tax, 31% corporate contribution to SS. They pay with other life-style adjustments that most Americans would not tolerate; home size averages 893 sq ft.
Canada is held up as a model for the U.S. Some authorities cite the long wait times for medical service, other authorities deny that it exists. Well, there are statistics available. I found some at a Canadian TV services web site that state that across Canada, the average time to see a specialist is 20 weeks. It varies from province to province, with New Brunswick the champ at 38 weeks. Individual procedures vary–orthopedic surgery, which suggests relief of pain, averages 38 weeks (about 9 months for the math challenged). Ophthamology (cataracts? doesn’t specify.) is seven months (28.5 weeks). Oh yes, the Canadians pay for this service in hard currency as well. The average cost for health coverage for a single person is $4,200 per year; for a family of four, $11,700.
There is really too little discussion of the trade-offs that come with the notion of government guaranteed health care. But, we have our feet on that slippery slope.
I agree with Parker, and others, about the foolishness that too often surrounds end of life decisions. I suspect that guilt plays a significant role. I see the same thing with family pets, (and horses, oh yes, horses) who are clearly at the end; and have no quality of life at all–whatever that means for animals. Personally, I just hope to go whenever I become a burden.
Ann,
There is no ‘health insurance’. Health can not be insured. Medical care insurance is possible (so far) but it does not guarantee health. One is healthy and eventually unhealthy. Sometimes unhealthy begins at or before birth, sometimes it happens at 110. No matter when it occurs, it happens. It can not be insured. One might have a Cadillac policy, but it does not insure one will be healthy.
And yes, a majority does want ‘free’ medical care.
Oldflyer,
I know of no nation that provides equitable, efficient medical care. We have been on the slippery slope since 1965. The slope gets more slippery month by month, year by year. Be glad you are old; pity your children and grandchildren.
I follow the health care issue closely. And I think it CAN be fixed. After a lifetime of different plans what I would like to see is true catastrophic insurance (remember when it was called major medical?) with unlimited HSA’s AND price transparency. Over the last 25 years I have had a few serious health incidents; C-section, breast cancer and a kidney stone. Honestly, I think an option like that would have saved me money – and that’s with out the downward price pressure such a system would create. The savings from 25 years with low premiums with a catastrophic plan would have vastly outweighed the 2-3 years when I would have maxed out my deductible. What we have now is not Insurance. It is Pre. Paid. Health. Care. And it’s VERY expensive when you consider that I pay over $1200.00 a month and in a typical year I get one mammogram, have one appointment with the dermatologist to check for skin cancer, and see my primary care physician maybe once or twice, when I need antibiotics for a sinus infection or a small wound from pruning roses. This is about $500.00 worth of care a year and that is at today’s inflated prices. Which my company is paying close to $15000,00 a year for. And I still have a $6,000.00 deductible!
Will it get fixed? The solutions aren’t really that complex. But I don’t hold out much hope – there is so much cost shifting going on that I am afraid commonsense reforms will break too many rice bowls.
And as for single payer… No. Based on my personal experience with Canadian health care.
For a while, my family and I spent the winters in Whistler, BC. One day not long after Christmas, I found a lump in my breast. When it didn’t go away after a week or two I went to a doc in town for a consult. He took my history (ridiculously healthy, non smoker, runner – 48 years old, clear mammo six months prior) felt the lump and said; ‘Don’t panic, that’s not what a cancerous lump feels like. It’s most likely a benign cyst.’ Fast forward 5 months later at my regular doc in Hawaii’s office. ‘Don’t panic, he says, while scribbling on his note pad, that’s not what a cancerous lump feels like. But we like to image everything so take this – handing me the scrip he just wrote out – down the hall and they’ll check it out.’ And thirty minutes later I knew I had cancer.
Hindsight being 20/20 and all, I probably should have driven 5 hours to Seattle and gotten a mammogram that January. I would have avoided chemo if I had been diagnosed earlier. But I didn’t, and anyway, what woman doesn’t want to believe a doc when he tells her ‘your lump is not cancer’?
So now you know, they don’t ‘image everything’ in Canada – that’s how they save money. Even though I went to a private doc and paid cash, the idea of sending me to get a ‘just in case’ mammogram wasn’t on this doc’s radar. Fun fact – baseline mammograms aren’t given to women in Canada until age 50. Many, many women get breast cancer in their late 40’s. I suppose I shouldn’t carp about having to have chemo, if I was a Canadian citizen, I’d be dead. So when I hear people ask why we can’t have a system like Canada’s, well…
Now, to be completely fair, I have Canadian friends who have been very well served by the system. In both cases, they had children with sudden and serious life threatening conditions. One couple had a young teen in a skiing accident, and one had a twenty something who developed a spinal abscess. Both kids received fast, top notch care and were made whole. On the other hand, Michael Buble recently brought his 4 year old son to Los Angeles for cancer treatment. A few years back, the Premier (their President) came to the US for heart surgery.
So, trauma – good, cancer, heart surgery – not so good. What are the odds you’ll get cancer or heart trouble vs. a skiing accident?
And another thing!
Notice how the term ‘individual market’ keeps coming up? As if that is where all the problems lie. Why do we even have an ‘individual market’ and an ’employer market’? Why isn’t it all one big market and we all own our own plans? There is nothing to stop employers from contributing $$ to our plans – or there wasn’t until Obamacare came along.
It’s ludicrous that we depend on employers for our plans. It limits choice and makes coverage dependent on employment. My company recently hired a new VP of Sales and a major issue was what health plans we could offer him. We had to go out and get a plan from another provider just for him. This is ridiculous – he should own his own plan – and it’s going to get worse since the younger generation – even the well paid ones – change jobs frequently. Also, wouldn’t it be better to have the risk spread out over the total population? Well, maybe not – if you are an insurance company. If you are an insurance company it’s probably pretty nice to insure a group of people who are working – after all, if they can make it to work every day, they can’t be that unhealthy, right? Nice work if you can get it. But this throws healthy people without access to employer group plans into groups with people who are too sick to work – thus raising their rates.
See what I mean about simple solutions and rice bowls?
And please, let’s not even get started on ‘mandated coverage’. More cost shifting.
Neo says, “Unfortunately, health care and insurance are not ‘goods and services just like anything else.’ Some goods and services are a matter of life and death and some are not, and that first type are considered different for that reason.”
I quite disagree.
That just doesn’t make sense, in terms of Economics. Some of the comments here have gone on at length about ‘wasting’ money on the elderly, the incurable. That is purely an economic argument, though disguised by hand-wringing about irremediable suffering. End it, don’t spend it.
All health care is about life and death. Sometimes a modest risk proves fatal. Sometimes a flu can kill a non-vulnerable person, like the 30 year-old chief medical resident at a Boston hospital quite recently, whose autopsy was unrevealing. He died healthy except for the flu.
The thinking that health care and insurance for it are different from other services is precisely what is pushing us inexorably into single-payer. NHS, the largest employer in the UK, here we come! We’ll all have the Ezekiel Emanuels making the decisions for us, based on Quality-Adjusted Life Years, which is code for denying care, as is done in the UK.
A UK court just gave a hospital the authority to end a child’s life over the wishes of its parents.
Follow the money. It will lead you to the tyrants.
Frog:
I was not talking about economics at all, I was talking about the subject matter of this post: public perceptions, and public emotions. The post is about attitudes: what the public has come to believe.
So I quoted Sefton, who was speaking economically and who realized that no one was thinking economically about health care anymore. That was why he sarcastically wrote “Okay, you’ve had your laugh for the day” after he made the statement about health care and insurance being goods and services like anything else. He knew this was a statement which, however economically sound it might or might not be, was simply unacceptable to the public today.
I was explaining that, not only does the public perceive them as rights, but that some goods and services are indeed more vital than others. Health care is one of them. Food happens to be another. That’s one of the reasons we have a welfare system now and food stamps: the public no longer considers it okay to have people starve, and no longer considers that they should bear the consequences of their failure to provide for themselves and/or their children by having those families and children starve.
They are considered basic (food, clothing, shelter, and now health care). Education, too, which is why we have public education.
And that is why our system is indeed changing to a more leftist one.
The public believes what the Lucifer’s Own tells them to believe.
The Confeds told the people that they were fighting for state’s rights, and Robert E Lee left his post to join his own state’s military, even though he didn’t like slavery.
The ability to manipulate and mind control humans, isn’t all that difficult once you reach a certain level of knowledge, ruthlessness, and wisdom.
About 20 years ago I knew a family in New Jersey whose daughter was born with a congenital condition that required a lot of medical attention. The parents were self employed and purchased their own health insurance.
The problem was that the insurance rules in that state, at that time, said a congenital disorder counted as a preexisting condition. They had to buy a special policy for the daughter that cost them $20,000.00 a year.
I also knew another man, same time period, who lived in Long Island, also self employed, who bought his own health insurance too. He moved and there was a mix up with bills the mail. In that short time, he came down with Lymphoma. But the insurance refused to pay for the treatment, which was over $100,000. They said it a preexisting condition on the grounds that his coverage had ‘lapsed.”
I was also self employed and purchased my own furiously expensive health insurance, as soon as it was allowed under law. (Self employeds couldn’t even buy it!). It always pissed me off that self employed people couldn’t take a tax deduction for the expense, it was considered a luxury.
Anyway, lucky I had it, got cancer at 30. Although I could only afford the luxury of the NYC hmo HIP, whose motto seemed to be, “cheaper to let ’em die.”
“A majority wants ‘free’ medical care. (parker)
Not sure that’s the case as much as what Cornhead said above: “Health care and health insurance is just is too complicated and time consuming in addition to being wildly expensive.”” – Ann
Ann and Cornhead – Excellent point.
It may be / probably is that both are true.
If something is “free”, then it is naturally axiomatic that demand is nearly unlimited.
But “healthcare” (yes, really medical care) “insurance” (yes, it is much more than pure insurance) and the medical industry as a whole are almost mind numbing to get ones arms around.
Yet, we don’t feel there is a need to have that level of understanding of say, the banking industry, the airline industry, or other very complex service industries.
Perhaps it is all because they don’t hold the “matter of life and death” in potential outcome that the medical service industry does, as Neo rightly points out.
Few are willing to contemplate their eventual demise, even when faced with a terminal diagnosis, let alone to understand the ins and outs of this industry.
So, the matter is ripe for fear and concern (or FUD), and, coupled with complexity, it is a quagmire to navigate politically, leaving the entire topic open to demagoguery.
With a vast majority of population who are very much on board with major government marketplace intervention in one form or another to begin with (across a variety of issues), unlikely we’ll see a free market solution anywhere in the near future.
.
Some like to say it is really all about who lives a good healthy life vs those who make bad choices.
Aside from Neo’s point about it just not being so clear cut so, I’d like to add that if we follow the money, it very much appears that age is the main factor in our public expenditure.
Public expenditure (total expenditure minus private insurance – much of which is employer subsidized – and out of pocket expenditure) is at 51% of the total spend.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Age-and-Gender.html
Based on that, it appears that the per capita “subsidy” is:
0 to 18…….$1.8K
19 to 44….$1.9K
45 to 64….$3.5K
65 to 84….$11.7K
85+…………$23.6K
And the percent of public spend in each cohort relative to its percentage of the total population is (i.e. public spending % of total, divided by population % of total):
0 to 18……49%
19 to 44….49%
45 to 64….90%
65 to 84….299%
85+…………600%
Public Spending is clearly heavily weighted towards age, with the dramatic increase to 3x and 6x the average, from 65 onwards, and represents 47% of all Public Spending on this.
Can all this expenditure be chocked up to poor living choices?
Frankly, if one doesn’t end up living forever, something will eventually cause their end, in a surprising variety of ways…
http://www.worldlifeexpectancy.com/usa-cause-of-death-by-age-and-gender
.
It is rather easy for us who may be on the older side and, having survived to now, attribute that to our life choices. There is certainly some truth to it, but in general that is not where most of our “health care” tax money is spent.
How many, who make these calls here, have been actively convincing their aged cohort to give up Medicare, in return for a more “market driven” solution?
Yet, those are the folks who most, evidently, are the beneficiaries of this type of public expenditure.
They are also a large voting segment of the population, and had been mostly trump voters in 2016 (17% of all trump’s votes, with 14% of the population).
http://college.usatoday.com/2016/11/09/how-we-voted-by-age-education-race-and-sexual-orientation/
How are y’all successfully selling that idea?
Are you selling it?
Big Maq:
There are several reasons why someone promoting a more free-market solution with Obamacare wouldn’t be promoting it for Medicare.
They are mostly practical reasons. Medicare has been in operation for so long that there truly is no turning back that I can see. In addition, our tax system (payroll taxes in particular, and/or the self-employment tax) are structured to pay for a significant portion of Medicare (particularly true of Part A, which is the hospital benefit), and between that and the actual premiums people pay for Medicare they feel they’ve directly earned it (see this for the statistics). If you changed that at this point there would be an enormous furor and most people would find it completely unacceptable.
The other reason is that, although Medicare is a huge tax expense, it actually works pretty well for most people. So to propose putting it back into the private sector would be political death. Not gonna happen, period.
You are correct that it would be philosophically consistent for those talking about Trumpcare and advocating less government intrusion into the health insurance business to propose the same thing with Medicare. But it’s a waste of time, because there is zero chance of its happening.
Esther:
Twenty years ago is ancient history in terms of the pre-existent condition rules. By the time Obamacare was passed, the rules had changed on that in many, many states. For example, by that time New Jersey was, by law, a guaranteed-issue state (see this), which means there was no refusal allowed for pre-existing conditions.
Thanks Neo, the husband and I were debating on what that meant. It’s hard to understand an issue when even the definitions change.