Socialized Medicine

oldpbnoob wrote: Since we are discussing the American HC system, I would think it very relevant to discuss what Americans consider a standard of living. Do American want to live in 1000sq foot home, drive a Yarus or the bus, reduce to 1.5 kids, and have their parents live with them until they die? No.

Very fair point.  Clearly we should judge American "standard of living" by American standards.

What I meant to point out was that, to a large extent, the reason why Northern European houses are smaller than American houses has less to do with wealth than with other factors, such as culture.  I know plenty of Europeans who think it is offensive to live in an oversized house.  For them, it is a matter of preference rather than cost.

That said, cost is certainly an issue for real estate, but here we run into an apples and oranges issue.  Real estate is always unique, and many factors set the price.  A crappy little 700 sq.ft. apartment on Manhattan will cost you a million bucks.  That will buy you a mansion on a multi-acre spread in an exclusive neighborhood here in Milwaukee.  That doesn't necessarily meanthat New Yorkers have a lower standard of living than Milwaukeeans.

But I digress.  Back to healthcare.

I get what you are saying about streamlining health care and reducing costs, but I do not think socializing the entire system is the answer. In order to have such encompassing social programs, you must have a government that is huge, and the only way to pay for it is by..... taxes.

Define "huge" government?  Do you measure by dollars or employees, or something else?  I do not believe that a single-payer system has to be government operated, even if it is government funded.  Lots of government dollars go to programs with hardly any government employees.

And what is wrong with taxes?  I just want to lower costs.  If I could trade my $1,500/month payment to an insurance company for a $500/month tax increase, I would be silly to decline, yes?  Money is money, and a lower payment is a lower payment.

And I do not beleive the government is good at social programs. Look at welfare, unemployment, child services and yes the school systems. Heck, look at NASA and the military. Most government agencies are filled to the brim with waste and poor spending choices.

And yet, even so, the military does the job for less than Blackwater.  Public schools spend less per student than most private schools (and not just the super-duper prep schools).

And for the others - NASA, welfare, unemployment, child services, and heck the military too - if the government wasn't to do it, who would?  How would these services ever get provided WITHOUT the government?

That fact of the matter is that some these practically require significant government involvement.  Would the interstates have been built without government involvement?  The space shuttle?  Child protective services? Energy transmission grid?

The reality is that there has been major and necessary government involvement in just about every significant infrastructure project ever, since the beginning of time.  Great Wall of China?  Government project.  Columbus' Westward trip to East India for spices?  Government funded.  Our near-100% literacy rate?  Government.  Satellite TV, GPS?  Government, government.  The Pyramids?  Government.  Hoover Dam?  Government.

Maybe some of these would have gotten done eventually purely by market forces, but there just are some things that government can do faster and better than the market ever could.  Most of these things relate to infrastructure and "social services."

And healthcare belongs in that bucket.

And back to the point, Americans do not want to give up their 2.5 kids, 1800 square foot houses, two cars,  boats, jet skis, credit cards and on an on and on..   Are there problems with the current system? Yes. Is completely socialzing the system the answer? IMO, no. Now granted, I listened to the Obama speech a short time ago and some of what he is saying makes sense. If he is truly trying to push through a system where people with existing coverage can keep it and any new programs will be paid for by savings from streamlining and such, awesome. But anything that increases my overall taxes, I am not in favor of. Period.

And I don't want to give those things up either (not for healthcare insurance, anyway).  But like I said, your fixation on taxes alone without consideration of the total financial result is misguided.

But more importantly - this word "socialization" is another big part of the problem.  I outlined above what I think any system needs.  "Socialization" isn't on the list.  I think a single-payer government system is probably the best way to get there, but that is a means, not an end.  But let's look at the ends and the costs:

First, and most importantly:  True universal coverage. 

Now, I will admit that I personally find this to be a moral imperative, regardless of cost issues.  But moral issues aside, I also think this is our biggest cost sink.

Universal coverage sounds expensive, but it is almost guaranteed to be CHEAPER than what we have now.  That's right, more will cost less.  This is true because of what I mentioned earlier:  we already have universal coverage, just incredibly inefficient universal coverage.

Dealing with the guy who rolls in to the ER in the middle of a heart attack is expensive, and right now that's on the taxpayer's dime (assuming no private coverage).  So we are already paying for this guy.  So my suggestion is that instead of waiting for him to have his heart attack, we pay for annual checkups.  This will catch his heart issues early.  We then pay for his heart medication.  As a result, we don't have to pay for his heart attack, and we save buckets of money.

Same thing for pre-natal care.  Good pre-natal care leads to fewer problem deliveries.  Problem deliveries are far more expensive than a couple of ultrasounds - not to mention the cost of child unnecessarily born with brain damage.  So let's get ALL pregnant women proper pre-natal care, and we'll save buckets of money.

This list goes on forever.  Any physician will tell you that early treatment is easier and cheaper than late treatment.  Right now we (the taxpayers) are paying for the late treatment but not the early treatment.  How is that a good financial plan?

So let's get full universal coverage and save some money.

As for the rest of my list - well, it's basically the same analysis. 

On a separate note - just because this is how I am, I went back to look for private health insurance.  This time I filled out the form online indicating that I currently had no insurance and had been uninsured for more than 60 days.  I also added a random collection of pre-existing conditions.  No cancer, HIV, or heart problems, just common treatable problems with prescription drugs attached:  Herpes and ADD.

And then I waited.

In about ten minutes I got a phone call.  Now, granted I have a sample of one, and I applied online for cheap insurance, but still - holy cow.  I felt like I was buying real estate in Florida and a used car at the same time.  First I had to get through the "how mucha wanna pay?" round.  Seriously - he asked me how much I wanted to pay, and what I could afford to pay.  I tried to get him to give me some numbers, but that was tough.  I eventually broke through (after being ridiculed for wanting to pay only $100/month), and he started giving me some numbers.  The cheapest he came up with was $229/month in premiums, for something he called a "cash bonus program," and it would cover everything, including my pre-existing conditions.  I thought that sounded great, and asked for details.

Well, he proceeds to tell me all about this insurance.  Now, I am a lawyer working in finance.  I work with complex financial structures every day.  Heck, I design complex financial structures.  I understand insurance.  I asked lots of questions.  And despite that, after 20 minutes of this my understanding of the policy he wanted to sell me was minimal.

But here is basically what he was selling:  I would have very low copays.  Good.  But that bad part was that this "insurance" basically had superlow caps on EVERYTHING.  Hospital stay?  Max $250/day.  ER visit from an accident?  $2,500 max.  Prescription drugs?   This part I couldn't understand fully, but it was not going to be a whole lot.  So I guess by "covering my pre-existing conditions" he meant that they would contribute a few bucks towards the drugs and pay a little more if actual sickness occurred.

Not only was this the worst insurance in the world, it basically wasn't health insurance at all.  Without insurance a car accident would bankrupt me.  With this insurance, a car accident would bankrupt me.  Awful, awful stuff.  And somebody less persistent than me would never have figured that out, and would have thought they were buying good and useful insurance.

Anyway, at the end of the schtick he asks me if I want to pay with mastercard or visa.  That caught me off-guard, even after the sales-pitch I had just had.  But yes, he wanted me to sign up right there.

So I told him I needed to do some comparison shopping first, and asked for a number I could call back, and an emailed copy of the policy, or a summary of the terms.

This is when the real fun started.  He first told me that only customers can see the policy and the terms (he said that with a straight face), so he couldn't email me anything - but more importantly, why wouldn't I just buy right now?  He went into full used-car salesman mode.  He suggested that I was just embarrassed that I couldn't afford it (he kept coming back to that).  He suggested that my kids could get sick and die tomorrow, so I should sign up immediately or I was a horrible father.  He pointed out that my pre-existing conditions were so horrendous that there was no way anybody else would possibly cover me, and I should be happy he was even still talking to me.  Besides, the name of his company was "NATIONAL Health Brokers" or something like that, which clearly meant that is there was a better plan he would know about it.  No point in calling around, because he knew what the best plan was (because he worked for "NATIONAL" - why else would they be called "National?").

And so on.  He berated me, belittled me, mocked me, practically threatened me, for a good ten or fifteen minutes before I gave up.  He then gave me a number and hung up.

Whew.

But I barely had time to catch a breath before I got a call from another agent at "NATIONAL!" following up to see if they could answer any questions.  I told him he had the wrong number (I had used a fake name in my online application as well).

Over the next 24 hours I got at least two dozen calls, from different area codes, from "NATIONAL!" wanting to talk to my fake alter ego.  I kept telling them wrong number, but they were undeterred.  My phone now appears to finally have quieted down.

So, wow.  Granted that this was budget insurance I was shopping for, but talk about the ugly underbelly of capitalism.

Wow that sounds like a pleasant, fullfilling, and safe system. I'm sure the elderly and undereducated love it.

Rofl, I wish I knew peter parker in real life.

Great stuff.

A lot of preventable diseases can be prevented or delayed by personal responsibility. Our high perventage of overweight people is directly coralated to heart issues. And the invividual can be more responsible in diet and other personal healthcare issues and Doctors are not required except for inexpensive annual checkups. Like mentiond the overweight individual in a hospital gown standing in the outside smoking area smoking through his trac(sp) hole should not be my problem financially.

Sit in any ER and just watch an 8 hour shift, and ask yourself if the percentage of ptroblems presented are directly associated with personal health choices. Even accident victims, the result of drunk driving, gunshot wounds due to drug problems, the 450lb heart attack victim, the HIV positive individual going into final stage AIDS, etc. Each are the result of poor personal choices. And by some peoples logic, I should be financially responsible for these problems.

oldsoldier wrote: A lot of preventable diseases can be prevented or delayed by personal responsibility. Our high perventage of overweight people is directly coralated to heart issues. And the invividual can be more responsible in diet and other personal healthcare issues and Doctors are not required except for inexpensive annual checkups. Like mentiond the overweight individual in a hospital gown standing in the outside smoking area smoking through his trac(sp) hole should not be my problem financially.

Mack wrote: I vote we cut our costs by letting those that are suffering from the consequences of poor personal decisions pay the penalties for those decisions by themselves.  (Whether that penalty is in additional personal medical costs, reduced quality of life or a shortened lifespan can be left up to the sufferers personal choices and financial status.)

Bolt3 wrote: I don't think every single service has to utilize a for-profit business model.

Even in true socialist or communist nations and societies the individual still believes that "everything must make money" be it done legally or in a "black market" enviornment. If doctors can not make the money they feel they should in a "universal" health care system, do not believe for a second that a "black market" form of medical care will become where care of a higher grade than "authorized" by some government beauracracy will become the norm. Underground medical care, ie abortions before legality, or legal drug underground markets are not unique to the american marketplace.
These imdividuals preaching a form of governmental health care fail to realize that it will only cause less availability as patient to doctor ratio increases, and longer waits for space and care become the norm, and a thrieving "black market" in medical care will begin, as Doctors frustrated with government run medicine conditions and turn in licenses to work underground for better conditions, for them and patients that have the ability to pay.

Edited by Peter Parker - 25 July 2009 at 5:14pm