Public Health Care

A good step on the road to civilization though is clean water.

what if i was poor and living here?

disclaimer: of course there are problems w/ health care in canada that need to be addressed and of course it costs a lot, but what could be a better use of taxes than health care and education?

note: taxes may be lower in the US but the cost of living is not. $1 US in Los Angeles = $1 CAN in Vancouver. unless you are buying beer.

universal health care good. and it is a good use of government.

universal human right? in any country w/ government it should be.

this reminds me of something:

NON-UNIQUENESS! NON-ORTHOGONALITY! OVER COMPLETE! SICKNESS!

so... the state of play on obamacare. not real promising. seems like they're going to pass something this year, and it will expand coverage, which is good as far as it goes, but it's probably going to leave the insurance companies and drug companies firmly attached to the teat (with new infusions of public money to boot). which means everything will just get more expensive and we'll be back in a few years fighting about how to pay for it all.

biggest danger is probably that obama's plan is unworkable in the long run, setting the stage for the next republican president or congress to "reform" it by scrapping employer-provided health care entirely and setting everyone loose with a $5,000 check to buy individual coverage in the "marketplace" (which was essentially mccain's proposal).

I would like everybody who's always relied on employer-provided healthcare, especially those in congress, to go out and purchase their own healthcare. Marvel at the wonderful options! Look at all the great deals. Have fun with incompetent bureaucracies without having an HR dept. to help you out.

Can someone post an article, any article, explaining the ways in which insurance companies make out like bandits? The first step to true significant reform is to change the relationship between the insurance companies and doctors.

Alfred those articles are few and very fucking far between, even at the Great New York Times - you'll get passing mention of "fair payments" and "fee for service" but no basic explanation or investigation of why American health care costs are so much higher than anywhere else in the world.

This is maybe the best I've found - http://www.nybooks.com/articles/22798

But even it doesn't explain as much as I'd like it to.

For instance this graf seems to start getting somewhere:

The delivery of care and the use of health resources would be the responsibility of organized multispecialty groups of salaried physicians and other health professionals, which would include adequate numbers of primary care doctors.

The question I have is: why would this reduce costs? Why doesn't it exist already?

alfred -- some interesting details in here. it's a little stunning, and says a lot, that 3/4 of people driven bankrupt by health costs actually have some form of insurance.

the basic problem, obv., is that insurance companies have an incentive to deny coverage. the economics of the system as it's structured are just perverse, with predictable results.

tracer did you read the atul gawande article in the nyer about the county in texas with the highest healthcare costs in the country?

Yeah! That article you just linked is fabulous by the way, I remember reading it. That kind of stuff needs to keep coming day after day and week after week - there's a million stories in the naked city - alongside historical analysis of how the health care industry became the bloodsucking hosebeast that it is today.

Ooh! Link, please.

Whoops I meant to say the article TIPSY linked is fabulous. And it is.

The NYer article (which is maybe not quite as good) is here - http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

the gawande article is great, tho more about doctors than insurance companies. of course, the doctors are responding to the incentives established by the fee-for-service model of both insurance companies and medicare/medicaid. one problem with the whole morass obviously is you have all these vested interests -- insurance cos., doctors/hospitals, drug companies -- who are often actually at odds with each other, but who all for various reasons oppose real reform of the system. the insurance companies love the idea of everyone being forced to buy insurance, but don't want any public option at all. just like the drug companies love the medicare drug benefit but have so far managed to legislatively keep the government from negotiating prices. and doctors like the ones in gawande's article are all in favor of reforming the insurance companies so they don't have to fight with them all the time, but they don't want any kind of cost control or mandates for best-practices.

my main impression is that, having traveled so far along with such a flawed system, the only reasonable option would be to scrap it and start over. but that obviously won't happen, so whatever does happen is going to be at best a somewhat better version of a terrible system. at least until nobody can pay for anything anymore and people are dying because of it (in greater numbers than they already are). it's pretty depressing.

Ugh. This is what I get for throwing out New Yorkers too hastily.

x-post Sadly I think what TM said in the 2nd paragraph there is completely 100% on the money.

leonhardt i think is pretty good today:

Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.

...The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.

We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.

In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.

One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.”

and that's how i think the debate ought to be framed, as the interests of citizens vs. all the people sucking money out of the system and jacking up the costs. obama has sort of said that, but he's also been trying to cajole and/or buy off the insurance companies and the AMA, so he's pussyfooted a bit on what's actually wrong with the system. but without really, forcefully making the case for what's wrong, it's hard to build momentum or get consensus on changing it.

i was sort of hoping that the lesson to take from the clinton '93 experience was, you have to be willing and able to fight back against the vested interests. but it seems the lesson that people like rahm emanuel took was, you can't beat the vested interests, so you have to join them.

it's beginning to seem like the strategy of letting congress shape the legislation was a giant mistake. conventional wisdom is that clinton alienated congress by coming up with his own plan as a fait accomplit, so daschle told obama: you gotta let congress take the lead, and the credit. but the circumstances were very different then. clinton had already made some mistakes, was already seen as an upstart outsider (unlike obama, who has already served in national office) and didn't have the overwhelming mandate oabama does. who know though, such talk is just pissing into the wind.

Can someone post an article, any article, explaining the ways in which insurance companies make out like bandits? The first step to true significant reform is to change the relationship between the insurance companies and doctors.

shannon brownlee's overtreated is probably the best read for this - shes pretty clear on the interrealtionship btw insurers and providers, how this fucks up incentives and why they both have a vested interest in keeping a situation going that doesnt benefit the public.

also: http://www.dartmouthatlas.org/ is key

conventional wisdom is that clinton alienated congress by coming up with his own plan as a fait accomplit

maybe he alienated Congress by the way he came up with his own plan.

"Giving Congress the lead and the credit"...oh fuck that just sounds so awful, true or not.

actually, I'd say the way to get public healthcare done is by using not only the bully pulpit, but backroom knee smashing. The political process for creating anything this reaching is absolutely bound to be ugly, and strongarming is probably the only way it's gonna get done.

Time to see all the vaunted Chicago-style politics take the forefront. That is, if Obama even has it in him.

dandy i agree completely. who gives a shit if it's ugly. i'd sacrifice obama's second term for 100% coverage of americans if that's what it took. (not to mention that actual 100% coverage with less paperwork and bureacracy would also stand a good chance of making the democrats trusted on domestic policy for generations.)

I'm all for twisting arms, but I don't know what "100% coverage" would cost or whether it addresses, again, my concerns about the ways in which insurance companies and doctors milk each other. I prefer replacing one massively cumbersome bureaucracy with another, not creating another.

it's going to take an asshole on the level of LBJ (or Cheney, if he ever had that much juice) to get fundamental reform passed (and let's just call it "fundamental reform", rather than "draconican replacement"). Obama hasn't picked a hill to die on and my suspicion--like virtually all modern pols--won't. Worse, he hasn't figured out how much political capital he has to spend.

And while I don't think much of Kevin Drum:

http://www.motherjones.com/kevin-drum/2009/07/how-market-healthcare-reform

God this is depressing.

zero fucking political courage anywhere

unless of course, it's scripted, televised, and pimped for re-election purposes

I like that Drum article but - sorry. It's too late. Republicans have been pushing their frameworks for years. Libs are just coming up with this now?

I mean, apart from Kevin Drum's 2007 blog post.

i think we're going to get expanded coverage, but if there isn't at least the beginning of structural change then all the expanded coverage is going to do is funnel more money into the same stupid system. i mean, expanded coverage is something, it's not insignificant, but there needs to be a muscular public-option plan, some serious incentives for mayo-style "patient-centered" practices and some kind of best-practices mandates (not just polite recommendations). i'm really depressed that apparently nobody's even really pushing for letting medicare negotiate directly for drug prices. if we can't even do that ...

(i do think a bill will be passed, tho, good bad or ugly. too many pundits -- not to mention republicans and a lot of democrats -- are still living in 1993.)

if there isn't at least the beginning of structural change then all the expanded coverage is going to do is funnel more money into the same stupid system

funny this reminds me of something... what is it.. oh yes, the bank bailout

what's weird about the current moment in politics is that it opens up room for republicans on the LEFT

they will never go there, but nu-tory david cameron (the next british prime minister) has been making head-fakes in this direction very consistently now, out-doving labour on iraq, out-greening labour on the environment

Matt Taibbi's new RS story a must-read.

quick question, does public option still have a chance?

xpost topline? i'm allergic to taibbi

Among Republicans, 62% say the government should stay out of Medicare
http://tpmdc.talkingpointsmemo.com/2009/08/poll-republicans-think-government-should-stay-out-of-medicare.php

Plenty of people could - and almost certainly were - indicating a preference that the government should not monkey around with Medicare, change it, etc.

This rush to insult Republicans, and the glee with which it's done, is no credit to TPM.

just read the taibbi piece. damn.

A new FT editorial says this about the public option:

If designed and subsidised as the party’s activists hope, it would herald Medicare for all, which the country does not want and moderates in Congress will not support. If forced to act as an ordinary competitor, as Mr Obama says it would be, it is beside the point.

This is kind of how I feel about it TBH. Which is it, anyway??

so a thought on the public option:

1. The United States has the best university system in the world. Seriously. By any measure.
2. Cal hasn't put Stanford out of business yet; UMass hasn't forced Harvard to shut its gates.
3. Cal State hasn't put Cal out of business yet.
4. Santa Monica Community College hasn't put Cal State out of business yet.

What am I missing?

i don't know why the health insurance threads are so hard for me to search for but i'm sick of using the republicans thread to discuss health insurance reform - they don't deserve it

anyway i thought this was pretty classic TPM lolz. here it is, the entirety of josh marshall's riveting halth care vote liveblog:

10:58 PM: With amendments and procedural mumbojumbo out of the way, the actual vote is about to get underway.

11:01 PM: Not too much to talk about on a final vote live blog. Currently at 196 for, 29 Dems voting against.

11:03 PM: Currently ten more votes needed and 14 Dems still to vote. Presumably they're going to do this on a straight 218, just like in the Clinton years. No 'wasted' votes.

for those of you keeping score at home that's one (1) incorrect prediction backed up by spurious assumptions and one (1) busted idea for a good post

by the way, i was wondering:

if the house bill passes in the senate without significant changes, i.e. it retains the concept of an insurance exchange, a public option, banishment of preexisting conditions, and keeps subsidies for those on the public exchange - how long will it take for republicans to start trying to take credit for it?

Agreed about this being the more appropriate thread. In that light, I'll ask here what I asked on the GOP thread. Does anyone know if the claim made in this MyWay news article is correct, and if so, the reasons why it is correct?

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private companies.

cbo sez:

The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees.

"management of utilization" is code for denying coverage.

which raises the question: so this means private insurers will STILL be able to engage in all their various shenanigans to deny coverage to people??? or is the cbo comparing the envisioned public plan with the actually-existing private plans available now - which will have to change pretty dramatically if the house health care plan passes the senate.. so that costs may end up sort of being the same?

Can't imagine the CBO is comparing the public-option to private-plans post-passage of the bill. For one thing, the bill limits the ability of private insurers to deny coverage due to pre-existing injuries.

But the "administrative costs" point doesn't address the "cost of premiums" question. I thought one of the major advantages of a public option is that its premiums would be low, and therefore either drive-down -- or at least keep in check -- the premiums charged by private insurers.

the public plans will have a less healthy pool of people because they will not be utilizing every chiz under the sun to deny coverage to people and cherrypick healthy customers, which private insurers - even though constrained - will continue to do, via marketing and a million other tricks.

That makes sense. But if that's the case, how will a public option pressure private-insurers to lower their premiums?

indeed

More on this notion. I'm not sure about it. Something seems wrong.

In any event, even if the public option premiums are higher (because it's attracting a sicker population of insureds), wouldn't it still have the effect of driving down private premiums? If private insurers "cherry-pick healthier people," and in the process push somewhat sicker people -- who might have been able to secure private coverage at an earlier point -- toward the public option, won't that leave a healthier pool of private insureds, resulting in less costs for private insurers, and possibly lower premiums for private insureds?

(OTOH, I've never heard of a private insurance company voluntarily lowering premiums.)

yeah lol at the idea that any savings would be passed along

I've been out of town and w/o internet for the past few days, and someone texted my friend saying "They're passing health care". Is there any site that has a list of what this bill they're voting on does?

overview: http://www.washingtonpost.com/wp-dyn/content/article/2009/11/03/AR2009110303238.html

detail and analysis: http://www.cbpp.org/cms/index.cfm?fa=view&id=2973

thanks a lot. was hoping for the same myself.

Yeah, the way the news is, all I could find was the guy bringing his baby in, nothing about the bill itself.

http://www.jsonline.com/news/wisconsin/109572274.html

We already have a health care system where people “select from a menu of insurance plans. Their consumer choices would drive a continual, bottom-up process of innovation. Providers could use local knowledge to meet specific circumstances.” It’s called the individual market, there are tens of millions of people in it, and it’s a complete failure.

baseline scenario demolishes brooks - http://baselinescenario.com/2011/06/07/when-you-dont-need-to-worry-about-facts/

am i the only person on this board who actually receives this (via, err, romneycare)?

Tennessee used to have TennCare, which i was on, but i don't think it really exists any more

oh I see it does, but it's just the state Medicaid program now

I was on a fairly decent plan until I missed a couple of payments and got dropped to Celtic care, which is the lowest tier of service. I'm still provided with catastrophic/ER coverage, but my PA is practically on the other side of the state, and I need his referral for basically ANY type of service. But his office is excellent at providing this over the telephone, and it's a good stopgap service.

what's a PA?

why is the lowest level of care called "Celtic"?

Because 'Masshole' was too obvious?

PA = physician's assistant. first line of coverage b4 doctor

i can always pay $39 to go to urgent care at the hospital for immediate coverage, but if there's any specialist needed, i will be required to travel to either the PA or my physician to get the referral. very convoluted: wd. much prefer a competent nurse with a checklist.

Suzy, what??? as in, Boston Celtics? Is that really the first thing that comes to mind? not people from Ireland, Wales, Scotland, Brittany, Cornwall, Man, and Galicia, or even the fine football club in Glasgow, but some bloody basketball team? how did you lot get to run the world again?

LOL Tom, remy bean's in Massachusetts! Next you'll be telling me I'm a bad person for thinking Fran Tarkenton before Norse sagas when someone says 'Viking'.

:D I did consider that possibility, but felt like blithely ranting anyway

and who the fuck is Fran Tarkenton? Did he play for Widnes?

smh

okay lol

http://news.yahoo.com/s/yblog_thelookout/20110621/ts_yblog_thelookout/man-robs-bank-to-get-medical-care-in-jail

hmmm. i guess our health care system really is messed up

oops this was already posted. d'oh.

where?

Knew it was going to be that when I saw the thread bump.

oops

no frogbs I mean I posted it elsewhere but missed that you posted it here first

Oh. Well then can we talk about it?

by all means

well for starters:

Some people who need medical care but can't afford it go to the emergency room. Others just hope they'll get better. James Richard Verone robbed a bank.

Earlier this month, Verone (pictured), a 59-year-old convenience store clerk, walked into a Gaston, N.C., bank and handed the cashier a note demanding $1 and medical attention. Then he waited calmly for police to show up.

He's now in jail and has an appointment with a doctor this week.

Verone's problems started when he lost the job he'd held for 17 years as a Coca Cola deliveryman, amid the economic downturn. He found new work driving a truck, but it didn't last. Eventually, he took a part-time position at the convenience store.

But Verone's body wasn't up to it. The bending and lifting made his back ache. He had problems with his left foot, making him limp. He also suffered from carpal tunnel syndrome and arthritis.

Then he noticed a protrusion on his chest. "The pain was beyond the tolerance that I could accept," Verone told the Gaston Gazette. "I kind of hit a brick wall with everything."

Verone knew he needed help--and he didn't want to be a burden on his sister and brothers. He applied for food stamps, but they weren't enough either.

So he hatched a plan. On June 9, he woke up, showered, ironed his shirt. He mailed a letter to the Gazette, listing the return address as the Gaston County Jail.

"When you receive this a bank robbery will have been committed by me," Verone wrote in the letter. "This robbery is being committed by me for one dollar. I am of sound mind but not so much sound body."

Then Verone hailed a cab to take him to the RBC Bank. Inside, he handed the teller his $1 robbery demand.

"I didn't have any fears," said Verone. "I told the teller that I would sit over here and wait for police."

The teller was so frightened that she had to be taken to the hospital to be checked out. Verone, meanwhile, was taken to jail, just as he'd planned it.

Because he only asked for $1, Verone was charged with larceny, not bank robbery. But he said that if his punishment isn't severe enough, he plans to tell the judge that he'll do it again. His $100,000 bond has been reduced to $2,000, but he says he doesn't plan to pay it.

In jail, Verone said he skips dinner to avoid too much contact with the other inmates. He's already seen some nurses and is scheduled to see a doctor on Friday. He said he's hoping to receive back and foot surgery, and get the protrusion on his chest treated. Then he plans to spend a few years in jail, before getting out in time to collect Social Security and move to the beach.

Verone also presented the view that if the United States had a health-care system which offered people more government support, he wouldn't have had to make the choice he did.

"If you don't have your health you don't have anything," Verone said.

The Affordable Care Act, President Obama's health-care overhaul passed by Congress last year, was designed to make it easier for Americans in situations like Verone's to get health insurance. But most of its provisions don't go into effect until 2014.

As it is, Verone said he thinks he chose the best of a bunch of bad options. "I picked jail."

I really dont understand the US resistance to better healthcare for all, and I've tried hard to understand.

We have both public and private coverage here. And private insurance, one buys themselves - so yes, you do pick and choose from competing companies and plans for what cover suits you best. This, I imagine, drives at least some premiums down on competition alone.

And if you can't afford that, the Medicare system covers everyone for a lot of basics, like seeing a GP (although its very hard to find completely-free GPs anymore unless you're on a low income card), going to the hospital, etc. Not so sure about ambulance coverage and I know dental's not covered.

When I was out of work breifly a few years ago that enabled me to hold a low income "healthcare card" while I was looking for a new job. In that window I had to have a CT scan that would have set me back about $600 were I working. I got it for free.

One time in Mexico I had gotten ridiculously sick, had to go to the hospital and was dreading it so much. But really, there's hardly any paperwork, you get in, you pay about $20, you get a shot in the ass, and you're cured. I dread to think of what it must be like for a Mexican visiting America and trying to get healthcare here. My wife has had to go to see someone twice here - one for the immigration exam (in which she got 4 shots and her blood pressure taken - total bill = $600, not covered by insurance obviously) and one for slightly chipped tooth, something that would cost $10 to fix in Mexico, which ended up costing around $200, complete with questionairre asking such vital questions as "what color is your tongue?"

asking such vital questions as "what color is your tongue?"

Yep. So if you answer "incorrectly", they can claim you have some different, underlying disease that renders your coverage null and void.

So it looks like the CDC is doing a major purge and replacing all the qualified, mainstream public health officials with RFKJ's lackeys & 'MAHA' kooks

Can anyone recommend a 'shadow' CDC for reliable, evidence-based public health information? Obv thinking of covid/vaccine info but also just reliable, general public health info? New England Journal of Medicine or something like that?

well, here's my answer

California, Oregon and Washington ally on vaccines in rebuke to Trump’s CDC

Three Democratic governors create West Coast Health Alliance amid growing turmoil at HHS under RFK Jr

The governors of California, Oregon and Washington announced on Wednesday the creation of a West Coast Health Alliance aimed at safeguarding access to vaccines, amid growing turmoil at the nation’s top public health agency under the leadership of Robert F Kennedy Jr.

Just putting this here so it doesn't get swallowed in the politics thread.

https://apnews.com/article/florida-childhood-vaccines-mandate-eliminate-desantis-363323dcdd3811ca9ad7def5f9a30fb2

Ladapo didn’t give a timeline for the changes but said the department can scrap its own rules for some vaccine mandates, though others would require action by the Florida Legislature. He did not specify any particular vaccines but repeated several times that the effort would end “all of them. Every last one of them.”

nuts

if that recent outbreak among Texas Mennonites has demonstrated anything, measles is very, very contagious.. and what do elementary school kids do? Fall on each other, spit at each other, play on the monkey bars with each other... this is really bad policy and I think they'll find this out very shortly

let's face it, sometimes the public needs a nudge here and there

if they wanna bring back Confederate monuments, might as well bring smallpox back as well, why not