Monday, August 17, 2009

If our health care situation were reversed

For a minute, let's imagine we had a health care and health insurance system under which everyone was covered and everyone had access to a doctor or dentist when they needed it. Let's say this system was affordable for nearly everyone, and help was provided for those who couldn't afford it. Let's say that if you had a health insurance plan you liked, you could keep it indefinitely, regardless of changing jobs or moving. Let's say that if you decided to buy or switch insurance, you couldn't be denied because of a pre-existing condition.

So that's what we have currently in our pretend world. Now let's say we want to switch to a plan where not everyone is covered -- pretend roughly 47 million people would no longer have health insurance of any kind. Those people could only see a doctor if they could pay out of pocket or if they visited an emergency room. Let's say this plan we want to switch to isn't really affordable for many people, and even those who have health insurance often can't afford their medical bills because prices are so high and insurance is covering less and less. Let's say that you lose your insurance plan if you switch jobs or lose your job or move to another state. Let's say that if you try to buy a health insurance plan, insurance companies could deny you because you have something like diabetes.

How fucking stupid would we as a country sound if we had the first plan and changed to the second? ("Very fucking stupid" is the answer.)

Our health care system needs to be fixed. Get out of the way and let it get done. Politicians, I'm looking at you. Grow a pair, stand up to the lobbyists, and work for the citizens you represent. To the crazy town-hall folk (FOX News included): Shut. Up. Your stupidity is downright embarrassing.

(And for more on the frustration of the health care reform debate, check out American Razor's aptly named post, "Frustration.")


Matt Osborne said...

Praises! The tinfoil-hattery is ready to jump the couch any day now. When it's time to argue the substance instead of the flimflammery, this is a great frame to speak with.

davidgs said...

Well put. Here's what I said to President Obama:

Anonymous said...

Your view is unrealistic. This is a country built on capitalism. Why should any business, healthcare included, be forced to provide their business to everybody, regardless of whether or not they could pay? What if people can't afford to go out to dinner--can't we force the restaurants to provide them food?!?! What about those who can't afford to buy an HD TV--can't we force the manufacturers to provide them one, even if they don't have money?

eD said...

If everything was as the 'let's say' in the first paragraph I completely agree. Only problem is reality. Nowhere has our government ever shown any aptitude at all for managing costs and making things affordable.

The fact that you don't write the check directly does not make it free or even affordable.

Give me an example of a health care system in our country that DOES work and is affordable and I am with you. Strangely we say 'because the government run health care we currently have is going bankrupt we should extend it to everyone!'

That just makes no sense.

Disclaimer: This comment was written by a real person not planted, influenced or coached by any political or industry representative.

Rosie said...

Anon, your health isn't a business. It's your life.

eD, I'm guessing you're not on board with Medicare, the care we provide our veterans or the government-provided health care plan our federal government enjoys?

Unknown said...

First I applaud the president for actually pursuing so passionately a promise he made during his campaign: I truly respect him for that, but the campaign is over and now we need to face reality.

Now Rosie, Everything in a capitalist society is a business; doctors and nurses need to be paid and healthcare IS a limited resource: we cannot give away this limited resource. Additionally, we cannot even afford this stuff right now. Understood we want to do the nobel thing, which is great, but we have to be realistic: maybe we can put in legislature to keep the insurance companies honest, but we cannot just give away free insurance to everybody.

In closing here are two additionally points that we may want to think about in this very passionate discussion:

Insurance companies need to make a profit and they have to make tough decisions. Hard as it may be to accept, they have to say no in order to survive.

The Welfare Program: Aaah Welfare, public assistance etc. these have been some of the most over-abused public services for which American taxpayers must foot the bill. 'tis not outside the realm of possibility to think that the same will not happen with Universal health.

That's my take, please fell free to rebut my points as I really would like to know if I am overlooking anything, And finally with regard to my rhetoric, please do not misunderstand my point, I want this thing to work--if we can afford to do it.

Razor said...

I just wanted to chime in and say this comment:

"What about those who can't afford to buy an HD TV--can't we force the manufacturers to provide them one, even if they don't have money?"

Might be the dumbest goddamn thing I've ever read. Congrats Anonymous, you've raised the bar on ridiculous... unfortunately you've lowered the bar when it comes to intelligence and common sense.

eD said...

Rosie: Not true. But I am in my mid-thirties and have spent my politically-conscious life hearing that medicare will fail by the time that I get old enough for it. And did everyone forget the VA health care scandals of just 2 or 3 years ago?

As I said, give me one example of something that actually works and I'm for it. (Unfortunately I don't take other countries programs as evidence, give me something here.)

Rosie said...

Lionel, thanks for the comment. I agree it would be a good thing to do something to keep insurance companies honest. However ...

Why do insurance companies need to make a profit? What if they were nonprofit? Not everything in a capitalist society HAS to make a profit. Why do people keep assuming profit must come before your health? Wouldn't this be one of the few times it would make sense to say profit does not get to come first? That's not to say insurance or health care would have to be free of charge; just charge what is needed to cover expenses.

I fail to see why profit is a must in this case, and I don't understand why more people aren't uncomfortable with health insurance companies making millions of dollars off, say, people suffering from cancer.

As for welfare and the possibility of abusing universal health care ... well, first of all, universal health care isn't being discussed. That's not an option right now, not even close, so the notion of it being "abused" matters not. Secondly, I am curious as to how someone would "abuse" universal health care. Go to the doctor too much? Sounds like a completely unnecessary worry to me.

Rosie said...

eD, do you not think Medicare works? Or the VA? Or our federal elected officials' health care program?

Even if those things don't work in your opinion, the excuse of "it never works" really only means "it hasn't worked yet." I can't even imagine where we'd be as a country if we gave up every time someone said "well, that's not going to work, so don't even bother."

Razor said...

If Medicare and the VA are so inefficient, then why aren't Republicans running on that platform? Because they know they'd be voted out of office in a New York minute.

The programs aren't without flaw, but that doesn't mean they can't or don't work.

eD said...

Rosie: Our elected officials do enjoy a great health care system. And honestly the Vets and Medicare recipients get great care as well. But remember, the crucial part of this is getting costs down. Medicare is a pyramid scheme that will crash under the weight of the baby boomers. The VA scandal from a couple years back was basically that we weren't spending enough.

As I keep saying, give me an example that works, and I am all for expanding it. But in absence of an effective, affordable test case means just implementing a full-blown solution is a disaster waiting to happen.

Details on the plan are very sketchy, but it seems right now that abortions wont be covered. While it is completely understandable that the ancient 3rd rail of politics is avoided, birth control is one of the most cost effective things possible. On the other end, so is physician assisted suicide.

These things will obviously be expanded to in the future. And why not lap bands? Being over-weight is another huge medical issue.

One real problem here is simple freedom. Are you comfortable with the government deciding to tax you 20% more because you're 20lbs overweight? (Keep in mind how ridiculous the 'ideal' weight charts are) or maybe because you enjoy a few drinks on a Friday night? How about them having a copy of your DNA?

I realize now I am getting into the tinfoil hat camp, but if you look at it from a 'we need to keep costs down' standpoint and rationing is not allowed (the American people will rightly riot) it becomes pretty likely they will come up.

Look at schools. Sure there are private ones, but they are small and few in comparison. The government schools suck and most people do not have much of a choice other than to consider home schooling. While not the same thing it is a glimpse of what can happen if we get this wrong.

Notice how the problem is always that they need more money, but giving more money never seems to fix anything. It is 'too important' in the average American's minds to worry about costs. Except that is what will crush the country, we already have ridiculous debt.

As for Lionel's comment about profit, the thing is we aren't taking over the ENTIRE health care system. New drugs, new treatment, and new equipment all are very expensive to research, test and build. The people that do this work have worked hard in the scientific and medical fields to do things people did not believe possible just a couple decades before. These people DO deserve to be paid well for their work, and this type of capitalist competition is arguably what motivates innovation in the first place. Without addressing these costs, you simply will not make any real dent in costs no matter how much you cut doctors prices. On the doctor's side, the malpractice insurance is significantly raising costs due to our sue-happy culture, but people reject limiting lawsuits and awards for the same reason they don't like the possibility of sending innocent men to death so what do you do?

We should have the best health care in the world. The problem is that is expensive. Our government in particular is more polarized and special interest focused. I worry this means that when push comes to shove, it is the American people that will suffer.

I say fix medicare (they are actually working on it, they have lowered reimbursement significantly enough that my mother who is a nurse was telling me many doctors refuse to see medicare patients) then when the care is good and the costs are balanced, THEN expand it to those that cant afford it, (maybe start with rolling it into unemployment to cover the gap?) not everyone. If it works great then the American people will ask for it.

Forgive the long comment, but finally I would like to say that through almost my entire 20s I was without health care. I was an independent contractor and could have afforded it, but I was young and invincible. I do not believe people like that should not really be counted in the '46 million Americans' statistic.


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