Health Care Reform - Universal/Public Option

[CamEdwards]

Originally Posted by RainMaker

So it's about speed. Couldn't we just loosen the requirements for becoming a doctor so that we get more doctors and thus more speed? I mean if it's all about speed, who cares how good they are?

Strawman much? Arles said he would start with timely care. Are you suggesting that there is no real need for ease of access and timely care for procedures?

[RainMaker]

Originally Posted by CamEdwards

Strawman much? Arles said he would start with timely care. Are you suggesting that there is no real need for ease of access and timely care for procedures?

I'm asking how do you gauge the success of a health care program. That when people say "our system is better than Canada", I'm asking what criteria they are using to judge the two systems.

Arles said speed. There are many ways to increase speed without increasing costs.

[Klinglerware]

But with that being said, 20-25% of doctors practicing in the United States are foreign-born.

The reasons behind that number are of course, complex. But it could point to issues surrounding whether the American medical school system produces enough doctors to meet the country's health care needs, and whether that is even a problem.

[flere-imsaho]

In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.

If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. "Waiting is definitely a problem in the U.S., especially for basic care," says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy.

All this time spent "queuing," as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries.

There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.

The Commonwealth survey did find that U.S. patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F. Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference," he says.

The Commonwealth study did find one area where the U.S. was first by a wide margin: 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close.

http://www.businessweek.com/magazine...8/b4042072.htm

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.

http://www.commonwealthfund.org/Cont...can-Healt.aspx


And here's a crapload of data on screening rates and surgery wait times for cancer patients in Ontario: http://csqi.cancercare.on.ca/cms/One...5&pageId=40979

[molson]

Those arguments go both ways. If the U.S. is so horrible at health care, why do we think they'll be magically better when they try to cover EVERYONE. If the issue is not enough supply - how exactly is that remedied by increasing demand?

[JonInMiddleGA]

Originally Posted by molson

Those arguments go both ways. If the U.S. is so horrible at health care, why do we think they'll be magically better when they try to cover EVERYONE. If the issue is not enough supply - how exactly is that remedied by increasing demand?

Because now the government will be more involved and, as we all know, they're here to help.

[Edward64]

My argument is that US healthcare is better for people that have insurance. However, by default, if someone does not have insurance, inbetween jobs, not insurable because of preexisting conditions, prohibitive costs etc. then its pretty obvious to me that Canadian healthcare is better.

[flere-imsaho]

Originally Posted by molson

Those arguments go both ways. If the U.S. is so horrible at health care, why do we think they'll be magically better when they try to cover EVERYONE. If the issue is not enough supply - how exactly is that remedied by increasing demand?

If anything, these studies point out that the private-care-only paradigm employed in the U.S. is neither cost-effective nor scalable, two accusations often leveled at single-payer systems. Conversely, these 5 other countries analyzed by the Commonwealth Fund (and probably a good number more) have shown that various forms of single-payer systems can not only be cost-effective on a national scale, but can have a high level of efficacy.

Mostly, though, I posted those links because I was looking for some data to puncture the myth that people wait forever in single-payer countries for critical treatment and that they don't in the U.S. In my experience, it's a myth largely based on anecdote, to be honest, but I'd welcome well-researched evidence supporting the converse.

[flere-imsaho]

Originally Posted by Edward64

My argument is that US healthcare is better for people that have insurance.

See, I wouldn't even go that far. As many of us know, there's a fair amount of health insurance in the U.S. that results in less effective health care for the individual than these other single-payer examples.

[molson]

Originally Posted by flere-imsaho

the private-care-only paradigm employed in the U.S..

The U.S. has a what now?

We have the most massive public healthcare system in the world.

[flere-imsaho]

Forgive me - I didn't get a lot of sleep last night.

Change that to "the health care system in the U.S."

Thanks.

[Warhammer]

I have to take issue with Flere's second quote. Several of the items mentioned: quality, access, efficiency, equity, and healthy lives, can be affected by issues other than the care received. Healthy lives is more of a lifestyle choice than anything else. Equity is based upon the amount spent on the healthcare. Access would depnd on a variety of factors. Basically the only two items that are based upon the actual care received is quality and efficiency, and based upon my last few visits to the emergency room, efficiency was affected by the sheer amount of people who were going there for a stuffy nose.

The problem with the debate is that rather than elevating any one's health care, it is going to bring everyone's care own to the lowest common denominator.

[flere-imsaho]

Well, arguably these other countries have systems whose lowest common denominator equals something near our median, at a lower cost.

Look, if the argument is that this can't happen in America because Americans are lazy and dumb, or Americans won't stand for spending extra in taxes on it, or Congress can't craft decent legislation for it, or the lobbying powers won't let it happen, then just come out and make that argument.

But making the case that it can't work here because it doesn't really work in other countries is somewhat dishonest, being that it rests on the use of anecdotes ("There's a guy in the UK who waited 4 months for surgery") as opposed to actual data (and a view of the comprehensive whole of that data). Nevermind the fact that it certainly doesn't ring true with anyone who's actually lived in one of these countries. Now I understand that the anecdote-driven argument is exactly how opponents are going to attack it, because the majority of Americans can't look past the soundbites, but let's aim a little higher at FOFC, please?

[Warhammer]

Originally Posted by flere-imsaho

Well, arguably these other countries have systems whose lowest common denominator equals something near our median, at a lower cost.

Look, if the argument is that this can't happen in America because Americans are lazy and dumb, or Americans won't stand for spending extra in taxes on it, or Congress can't craft decent legislation for it, or the lobbying powers won't let it happen, then just come out and make that argument.

But making the case that it can't work here because it doesn't really work in other countries is somewhat dishonest, being that it rests on the use of anecdotes ("There's a guy in the UK who waited 4 months for surgery") as opposed to actual data (and a view of the comprehensive whole of that data). Nevermind the fact that it certainly doesn't ring true with anyone who's actually lived in one of these countries. Now I understand that the anecdote-driven argument is exactly how opponents are going to attack it, because the majority of Americans can't look past the soundbites, but let's aim a little higher at FOFC, please?

My anecdote comes from my uncle that lives in London, but I'm not going to get into it. I think I have mentioned it elsewhere on the boards.

To me, it is a matter of efficiency. What is more efficient? Giving my money to the gov't, having them go through whatever process they do, and then send the money to my doctor, or going to the doctor of my choice and paying him the fees? Or shopping for a plan that fits my needs, pay them, and they pay the doctor?

If we want to talk about extending coverage to all kids under a certain age that are not covered by a plan, I can get behind that. However, I cannot get behind any legislation regarding anyone over the age of 18.

I also have another issue with this, the healthcare industry accounts for something like 20% of our total GDP. I refuse to let the government control 20% of the economy.

[albionmoonlight]

The Democrats' Endgame Revealed!!!:

[Edward64]

Oh well.

No health care vote before August break, top Democrat says - CNN.com

No health care vote before August break, top Democrat says - CNN.com
WASHINGTON (CNN) -- The Senate will not vote on health care reform legislation before the August congressional recess, Senate Majority Leader Harry Reid said Thursday.

"We'll come back in the fall," Reid said at a Capitol Hill news conference.

"I think that it's better to have a product that is one that's based on quality and thoughtfulness rather than trying to jam something through."

The Nevada Democrat did make clear that he believes the critical Senate Finance Committee can come up with a deal and pass health care legislation in committee before leaving for the August recess.

I guess if the House and Senate Finance Committee can come up with something in Aug, its still a pretty good timetable.

[molson]

Harry Reid is awesome for standing up to Obama's ridiculous "deadline"

[Arles]

Originally Posted by flere-imsaho

In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.

Not sure how the information below supports this assertion..

If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter.

FYI, Boston is the only major city with universal health care. The fact that they have the longest wait hardly supports the above assertion.

Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. "Waiting is definitely a problem in the U.S., especially for basic care," says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy.

The average wait for knee surgery in Canada is 17 weeks. So, 17 days is "as long or longer" than 17 weeks. Interesting claim.

Let's also not forget that most countries with universal coverage have between 2% and 15% of the population of the US.

Again, for the 85+% (going by CBO numbers) that have health insurance, most have quicker access to doctors, faster surgery, fairly low costs (co pays in the $15-20 and out of pocket caps) and access to atleast comparable (if not better) service than those in Canada, England or other countries. Where the US gets slammed is for their emergency room load in poor areas (something that comes with 300 million people + undocumenteds) and the care/cost for the 15% who don't have insurance. But, for 75-85% of the US population, their level of care is vastly superior to Canada. And, instead of bringing that 15-25% up to the level of the rest of us, people want to bring the 75-85% with good health care options down a notch to help the 15-25% who lack good options.

[RainMaker]

Originally Posted by Arles

Again, for the 85+% (going by CBO numbers) that have health insurance, most have quicker access to doctors, faster surgery, fairly low costs (co pays in the $15-20 and out of pocket caps) and access to atleast comparable (if not better) service than those in Canada, England or other countries. Where the US gets slammed is for their emergency room load in poor areas (something that comes with 300 million people + undocumenteds) and the care/cost for the 15% who don't have insurance. But, for 75-85% of the US population, their level of care is vastly superior to Canada. And, instead of bringing that 15-25% up to the level of the rest of us, people want to bring the 75-85% with good health care options down a notch to help the 15-25% who lack good options.

It's vastly better because it's faster? And costs are not low. Health insurance is quite pricey, which doesn't even include co-pays and co-insurance.

You keep saying how our system is so much better but the only reason you seem to have for it is that we're faster. Speed is nice and all, but there is a lot more to it than that.

[Arles]

The reasons we are better than Canada or England are:

1. Most surgeries are completed almost 10 times faster (2 week ave compared to a 17 week ave). For lesser surgeries and cosmetic procedures, the wait can range from 2-3 weeks in the US to 2 years in the other countries.
2. The quality of work for those surgeries is equal if not better (ie, success rate, recovery rate, quality of repair, ...).
3. The cost to the insured customer is about the same when it comes to price (co-pay + out of pocket limit vs. taxes paid in universal system)
4. Quicker access to primary care doctors and specialists (between 2-3 times faster after the initial call).

Again, I fail to see where a normal PPO-insured US citizen is worse off than a normal British or Canadian citizen.

And waiting 1000% longer for surgery is slightly different than just saying "we're faster". It's like saying an F-18 is "faster" than a riverboat. When dealing with orthopedic injuries and severe knee/shoulder/joint issues, waiting an extra 2-3 months can lead to a ton of damage in day to day life that may not be able to be repaired. Not to mention the lost wages, exercise/health issues and quality of life impact. That's not just an issue of being "faster".

[RainMaker]

Originally Posted by Arles

The reasons we are better than Canada or England are:

1. Most surgeries are completed almost 10 times faster (2 week ave compared to a 17 week ave). For lesser surgeries and cosmetic procedures, the wait can range from 2-3 weeks in the US to 2 years in the other countries.
2. The quality of work for those surgeries is equal if not better (ie, success rate, recovery rate, quality of repair, ...).
3. The cost to the insured customer is about the same when it comes to price (co-pay + out of pocket limit vs. taxes paid in universal system)
4. Quicker access to primary care doctors and specialists (between 2-3 times faster after the initial call).

Again, I fail to see where a normal PPO-insured US citizen is worse off than a normal British or Canadian citizen.

And waiting 1000% longer for surgery is slightly different than just saying "we're faster". It's like saying an F-18 is "faster" than a riverboat. When dealing with orthopedic injuries and severe knee/shoulder/joint issues, waiting an extra 2-3 months can lead to a ton of damage in day to day life that may not be able to be repaired. Not to mention the lost wages, exercise/health issues and quality of life impact. That's not just an issue of being "faster".

Isn't health the most important factor when judging a health care system?

[Arles]

I'm not following your argument? Are you saying that people in Canada or England have access to better health care than insured people in the US?

I listed the four major factors in health care (quality of work, access, cost, speed) and stated that US PPO members are better off than Canada/Britain citizens. Are you disputing that notion? If so, please explain.

[JPhillips]

Originally Posted by Arles

The reasons we are better than Canada or England are:

1. Most surgeries are completed almost 10 times faster (2 week ave compared to a 17 week ave). For lesser surgeries and cosmetic procedures, the wait can range from 2-3 weeks in the US to 2 years in the other countries.
2. The quality of work for those surgeries is equal if not better (ie, success rate, recovery rate, quality of repair, ...).
3. The cost to the insured customer is about the same when it comes to price (co-pay + out of pocket limit vs. taxes paid in universal system)
4. Quicker access to primary care doctors and specialists (between 2-3 times faster after the initial call).

Again, I fail to see where a normal PPO-insured US citizen is worse off than a normal British or Canadian citizen.

And waiting 1000% longer for surgery is slightly different than just saying "we're faster". It's like saying an F-18 is "faster" than a riverboat. When dealing with orthopedic injuries and severe knee/shoulder/joint issues, waiting an extra 2-3 months can lead to a ton of damage in day to day life that may not be able to be repaired. Not to mention the lost wages, exercise/health issues and quality of life impact. That's not just an issue of being "faster".

I don't want to defend Canada and England as they are at the bottom end of single payer systems, but your third point is very wrong. You have to add premiums paid by the employee and the employer to total cost and when you do that we pay much more per person than either Canada or England.

[Galaxy]

Originally Posted by RainMaker

Isn't health the most important factor when judging a health care system?

I'm not sure what you mean.

If being obese, not staying fit, smoking and drinking, and eating unhealthy is what you mean, then even the best health care system in the world won't save you.

[Galaxy]

Interesting pieces from this article:

"A World Health Organization survey in 2000 found that France had the world's best health system. But that has come at a high price; health budgets have been in the red since 1988.

In 1996, France introduced targets for health insurance spending. But a decade later, the deficit had doubled to 49 billion euros ($69 billion)."

"Government influence in health care may also stifle innovation, other experts warn. Bureaucracies are slow to adopt new medical technologies. In Britain and Germany, even after new drugs are approved, access to them is complicated because independent agencies must decide if they are worth buying.

When the breast cancer drug Herceptin was proven to be effective in 1998, it was available almost immediately in the U.S. But it took another four years for the U.K. to start buying it for British breast cancer patients."

The Associated Press: Europe's free, state-run health care has drawbacks


http://www.npr.org/templates/story/s...oryId=92419273
Interesting piece on the French system.

[Gary Gorski]

Originally Posted by Arles

The reasons we are better than Canada or England are:

1. Most surgeries are completed almost 10 times faster (2 week ave compared to a 17 week ave). For lesser surgeries and cosmetic procedures, the wait can range from 2-3 weeks in the US to 2 years in the other countries.
2. The quality of work for those surgeries is equal if not better (ie, success rate, recovery rate, quality of repair, ...).
3. The cost to the insured customer is about the same when it comes to price (co-pay + out of pocket limit vs. taxes paid in universal system)
4. Quicker access to primary care doctors and specialists (between 2-3 times faster after the initial call).

Again, I fail to see where a normal PPO-insured US citizen is worse off than a normal British or Canadian citizen.

And waiting 1000% longer for surgery is slightly different than just saying "we're faster". It's like saying an F-18 is "faster" than a riverboat. When dealing with orthopedic injuries and severe knee/shoulder/joint issues, waiting an extra 2-3 months can lead to a ton of damage in day to day life that may not be able to be repaired. Not to mention the lost wages, exercise/health issues and quality of life impact. That's not just an issue of being "faster".

Reason number one alone is why this is a horrible, horrible idea. We had a young man from Poland who lived in our house while he went to college here. He would tell us plenty of stories about how people would be in need of very serious medical procedures and they got put on long waiting lists. He told us people would try to "bribe" doctors with gifts like bottles of vodka (yes, that's what he told us) in order to get in faster. My dad has a broker who has family in Italy and he said someone in the family needed major heart surgery so they said no problem...and said they would fit him in eight or nine months later. Instead they found a doctor who would do it for them if they paid him a few thousand dollars, which they did, and it was done the next day.

This is exactly what is going to happen in this country. The very wealthy will use their money and influence to avoid the long waits and the rest of us who cannot do that will receive much worse health care than we have now in order to provide "free" care for everyone. I don't know how legislators in our country can look at the model as it works in other countries and not see the major flaws in it. It's not like this is just some idea they're kicking around that hasn't been tested - it's in place in the world and it's an inefficient and expensive system.

I think its a noble thought that we should provide health care for everyone but this isn't the way to do it. How about the government work on a solution that affects just the 15% who don't have insurance and leave everyone else alone? Like Arlie said, lets pull those 15% up - not make things worse on the other 85%.

[RainMaker]

Originally Posted by Arles

I'm not following your argument? Are you saying that people in Canada or England have access to better health care than insured people in the US?

I listed the four major factors in health care (quality of work, access, cost, speed) and stated that US PPO members are better off than Canada/Britain citizens. Are you disputing that notion? If so, please explain.

I'm saying that if you are judging a health care system as a whole, isn't the overall health of the country the ultimate end result? That the ultimate goal of a health care system is to allow people to live as long as they possibly can.

I mean if we were judging NFL teams, we wouldn't say the best one was the fastest or strongest team. We'd say the best one was the one that won the Super Bowl.

[Galaxy]

Originally Posted by RainMaker

I'm saying that if you are judging a health care system as a whole, isn't the overall health of the country the ultimate end result? That the ultimate goal of a health care system is to allow people to live as long as they possibly can.

I think that is a tricky situation.

Should an older person, say they are 70-something, get highly-expensive care that will extend their health for two or three years (such as a transplant surgery, cancer, ect.) at the cost of taxpayers? How long do we allow for life-saving treatment on older people, even if it doesn't really improve how they are? End-of-life treatment is one of the highest costs in health care.

[RainMaker]

Originally Posted by Galaxy

I think that is a tricky situation.

Should an older person, say they are 70-something, get highly-expensive care that will extend their health for two or three years (such as a transplant surgery, cancer, ect.) at the cost of taxpayers? How long do we allow for life-saving treatment on older people, even if it doesn't really improve how they are? End-of-life treatment is one of the highest costs in health care.

It's real tricky. I'm for a public/private hybrid. The public should be for basic health care and life saving treatment. If you are 85 and are hit by a car, you'd be covered. If you are 85 and need a hip replacement, the public option wouldn't cover you. You'd have the right to go the private route and do it, but a hip replacement would not be seen as basic health care at that age on the public plan.

I do think it does get tricky when it comes to life threatening issues and pulling back health care coverage. Does a 75 year old not get cancer treatment vs a 50 year old who has smoked 2 packs a day his whole life? I don't think we can ever get to a situation where we say "let that person die" because he is older. There are certainly treatments that can get pulled back with age though.

This would never happen, but I'd definitely have penalties and such for those who don't have healthy lifestyles. It could be as simple as a tax cut for individuals who meet a certain set of health guidelines by an accredited physician. Or those who are getting a regular checkup and doing the regular tests that their age requires.

[Galaxy]

Originally Posted by RainMaker

It's real tricky. I'm for a public/private hybrid. The public should be for basic health care and life saving treatment. If you are 85 and are hit by a car, you'd be covered. If you are 85 and need a hip replacement, the public option wouldn't cover you. You'd have the right to go the private route and do it, but a hip replacement would not be seen as basic health care at that age on the public plan.

I do think it does get tricky when it comes to life threatening issues and pulling back health care coverage. Does a 75 year old not get cancer treatment vs a 50 year old who has smoked 2 packs a day his whole life? I don't think we can ever get to a situation where we say "let that person die" because he is older. There are certainly treatments that can get pulled back with age though.

This would never happen, but I'd definitely have penalties and such for those who don't have healthy lifestyles. It could be as simple as a tax cut for individuals who meet a certain set of health guidelines by an accredited physician. Or those who are getting a regular checkup and doing the regular tests that their age requires.

Like I said, it's really tricky. That's why this whole health care debate is so tough and not an easy fix in so many ways.

[BishopMVP]

Good article on the tricky aspects of why health care costs so much in certain areas McAllen, Texas and the high cost of health care : The New Yorker

Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen. An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.)
Was the explanation, then, that McAllen was providing unusually good health care?
...

Apologies if this was previously posted - I didn't read all 10 pages.

[Klinglerware]

Originally Posted by BishopMVP

Good article on the tricky aspects of why health care costs so much in certain areas McAllen, Texas and the high cost of health care : The New YorkerApologies if this was previously posted - I didn't read all 10 pages.

I did hear about this case on the radio. McAllen is an extreme case, since the culture was pervasive, from what I heard in the radio: if you were a doctor in McAllen, you had to play the game. But it isn't all that unusual for doctors to own for-profit medical businesses outside of their own practice. It's starts getting tricky when your side business is struggling: for example, if you own an in-house lab, you start thinking in terms of meeting quotas. You hit your quota but then it becomes a gray area whether all the patients actually needed all the tests you ordered.

[Grammaticus]

Originally Posted by RainMaker

I'm saying that if you are judging a health care system as a whole, isn't the overall health of the country the ultimate end result? That the ultimate goal of a health care system is to allow people to live as long as they possibly can.

I mean if we were judging NFL teams, we wouldn't say the best one was the fastest or strongest team. We'd say the best one was the one that won the Super Bowl.

Of course not, when you expect to have some freedom of choice in your lifestyle, then people can make choices on how to live their lives. That will not result in the healthiest population.

We have the luxury of choosing a bad lifestyle.

[RainMaker]

Originally Posted by Grammaticus

Of course not, when you expect to have some freedom of choice in your lifestyle, then people can make choices on how to live their lives. That will not result in the healthiest population.

We have the luxury of choosing a bad lifestyle.

These other countries don't get to choose?

[Galaxy]

Originally Posted by RainMaker

These other countries don't get to choose?

Isn't that what he is saying? Other countries tend to have better lifestyles in terms of dieting/eating, staying fit, and stress.




Medicaid falls short just as some need it most - The Elkhart Project- msnbc.com

Holes in the safety net: Medicaid falls short just as some need it most

By Tom Curry and JoNel Aleccia
updated 1 hour, 55 minutes ago
GOSHEN, Ind.—

For weeks now, 2-year-old Ashley Soto's hair has been falling out in clumps and bunches.

Doctors at the Maple City Health Care Center, a neighborhood clinic where the toddler's family receives most care, couldn’t diagnose the problem. The child needed to see a specialist, but no local dermatologist would agree to accept Medicaid, the government’s safety net plan. Instead, Antonia Mejorado, 33, has to drive nearly two hours to see a dermatologist willing to treat her daughter's potentially serious illness.

“There is not a doctor around here that takes Medicaid,” said Mejorado, whose husband, Osvaldo Soto, 33, has recently seen his hours cut to almost nothing at a local mechanic shop.

When workers get laid off and lose their health insurance, the medical insurance plan that covers some 60 million poor, elderly and disabled people, is a critical safety net. At no time is Medicaid more needed than during an economic downturn. Yet it’s also precisely during a recession that Medicaid’s shortcomings are clearest.

Medicaid, the second-largest item in most state budgets, after education, is funded jointly by the states and the federal government, with the federal government matching state dollars by as much as 76 cents to every 24 cents of state money. Wealthier states bear a bigger share of their Medicaid costs than poorer states do.

But in a recession, state revenues sink at the very time that more unemployed people sign up for Medicaid.

Over the past year, enrollment in Arizona, for example, has increased by 13 percent. It has jumped by 100,000 in the last four months alone. Medicaid enrollment in Alabama has been increasing at 5,000 per month for the last six months. In Indiana, enrollment rose by more than 17,000 between January and April, up about 9 percent from the previous year. In the stimulus bill passed last January, Congress rushed $30 billion to the states to keep Medicaid afloat, with an increase in the normal federal matching fund formula.

The Recovery Act’s additional Medicaid money accounts for nearly two-thirds of all the stimulus funds going to the states in the current fiscal year, according to the Government Accountability Office.

But even as states get their Medicaid windfall, some needy people complain that they’re not getting care under the program, because they are not eligible due to their states’ restrictive rules, or because they can’t get to see a doctor even though they are signed up for Medicaid.

About one in five physicians say they are not accepting any new Medicaid patients, largely because of low payments or delays in reimbursements, according to the Center for Studying Health System Change in Washington, D.C.

‘A lot of things are scary’
Ashley Soto, the 2-year-old with unexplained hair loss, is eligible for Medicaid because she was born in this country. The child’s parents, who are from Mexico, are not. Her mother worries that a serious diagnosis could mean more long days traveling the 75 miles between Goshen and Michigan City, Ind.

“A lot of things are scary — not having a doctor nearby in case something happens to her,” said Mejorado, who is also the mother of three other children ages 17, 14 and 14 months.

The problem is that low reimbursements and complicated, time-consuming paperwork have left many physicians wary of the program, noted Cindy Hayes, director of physician services for Elkhart General Hospital in nearby Elkhart, Ind. Some clinics in the region have stopped accepting Medicaid completely, while others have waiting lists for appointments. At Elkhart General, hospital officials have worked hard to reopen Medicaid access to pregnant women who need prenatal care, plus labor and delivery services, she said.

“We rely on reimbursements from other payers to compensate for Medicaid,” said Hayes. “We’re taking our fair share.”

Some doctors who have stopped accepting Medicaid patients say that it’s not that they don’t want to see them, it’s that they can’t afford to anymore.

Medicaid reimbursement rates can be as much as 40 percent lower than those for private insurance, according to John Holohan, the director of the Health Policy Research Center at The Urban Institute, a Washington think tank.

Michigan, for example, recently announced a 4 percent cut in payments to doctors, dentists and hospitals who treat Medicaid patients. The move prompted a new exodus of doctors who’ve decided to limit care.

"I love what I do, but I can't keep getting cuts from Medicaid," Dr. John Pfenninger, a family physician in Midland, Mich., told the Associated Press. "It's time to say no. "

Eligibility varies from state to state
Under current law, Medicaid eligibility varies from one state to another. In several states, eligibility is set at less than 100 percent of the federal poverty line, which is $22,050 for a family of four. Poor children are eligible for Medicaid; their parents often aren’t. And childless adults are usually ineligible.

Dwindling revenues have led more than a dozen states to cut payments to doctors and hospitals or to propose cutting eligibility or benefits. Only the injection of the stimulus money has kept the states from cutting even deeper.

But the states face a “cliff” when the Medicaid stimulus money ends on Dec. 31, 2010 – and state revenues may not have resumed growing by that time.

“You are now seeing in some states the loss of 40 percent of their tax revenue, and if we don’t see start to see an upturn pretty quickly, then you very well could see a devastating impact on Medicaid programs next year,” said Alabama Medicaid Commissioner Carol Steckel, who serves as the chair of the National Association of State Medicaid Directors.

Without a dramatic improvement in economic growth in the next 12 months, Steckel said, “You’re going to have the perfect storm of the loss of the stimulus money and an economy that hasn’t made its way out of the basement yet.”

One of that things that most worries state Medicaid directors, says Steckel, is the time lag between the unemployment rate and increase in Medicaid enrollment.

“For unemployed adults, it generally takes them about three to six months to work their way through COBRA (the law that allows unemployed people to temporarily take part in their ex-employer’s health plan) and unemployment insurance. And then they start popping up on our rolls. Then it takes another six to 18 months for them to get re-employed and to fall off our rolls after they get a job where they are getting employment-based insurance.”

Fight to fix Medicaid
Even though it has gotten relatively little attention, fixing Medicaid is at the heart of the health insurance bills that Congress is debating.

After all, whatever else “health care reform” might mean, insuring the uninsured has been the reformers’ perennial demand. And since most of the uninsured are low-income people, expanding Medicaid is the most efficient way to help the uninsured.

Congress seems likely to expand Medicaid eligibility nationwide, perhaps up to 150 percent of the federal poverty line, or $33,075, for a family of four.

This would cost about $500 billion over 10 years and would increase enrollment by 20 million people, or by about a third.

Under the House Democrats’ bill, the newly eligible people would be paid for entirely by the federal government. The Senate Finance Committee has yet to unveil its bill, but its first proposal, released in May, was for the federal government to pay for all the newly eligible for Medicaid beneficiaries through 2015, and then phase in the states paying their costs according to the current matching fund formula. Congress is also likely to change the matching fund formula so that federal dollars would automatically start flowing to states as soon as a recession hit, rather than waiting for Congress to act.

Divisive issue
Increasing Medicaid eligibility is a contentious topic for governors and state Medicaid directors.

Colorado’s Democratic Gov. Bill Ritter told the Denver Post that at a recent meeting of several governors with Health and Human Services Secretary (and former Kansas governor) Kathleen Sebelius, “Our only point was that a significant Medicaid expansion should not operate as an unfunded mandate for the states.”

While some states are supportive of a wider Medicaid reach, others don’t think their budgets could absorb any increase, says Ann Kohler, director of the National Association of State Medicaid Directors.

“For states, that’s the biggest question on this whole health care reform: how is the match going to come?” said Carolyn Ingram, who runs New Mexico Medicaid program. “The House bill gives a 100 percent match to the states which is great, but I’m not sure the Senate bill is going to be that generous.”

Steckel argues that the added burden of paying for more Medicaid beneficiaries would be more than some states could bear.

“Even with probably one of the most bare-bones Medicaid programs in the nation on both eligibility and benefits, we still are consuming 30 percent of our state’s general fund,” Steckel said of Alabama's program. “And that is at the expense of other necessary and vital services — such as corrections, public safety, mental health, public health, human resources. All of those have to absorb bigger cuts because of the Medicaid budget.”

Steckel says she fears states will be strained to the point of deciding they can’t support the federal Medicaid program any longer and might even opt out.

“Congress needs to allow states the ability to manage their programs in the most efficient manner,” Steckel said. “The surest way of not accomplishing that goal is to put mandates on the states that require us to do things that may not make sense for a particular state.”

In Alabama, an income of 150 percent of the federal poverty level goes farther than in New York, so residents there would be more able to afford health insurance. "This is why there should be a recognition of the differences between the states in health reform,” she said.

But Ingram said that the comprehensive health insurance reform that Congress is planning will help the states “because you will start to see a smaller amount of uninsured people. It’s how Congress is going to implement it that we’re watching very carefully.”

If Congress enacts an overhaul of health insurance which includes a requirement that all Americans must have insurance, Ingram said, “You’re going to see people coming out of the woodwork to get that coverage."

For states, it will make all the difference if the federal government — not state taxpayers — pays those new costs.

[Surtt]

If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. "Waiting is definitely a problem in the U.S., especially for basic care," says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy.

All this time spent "queuing," as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries.

Um,...
Anyone else see a problem with the logic here?

[RainMaker]

Originally Posted by Galaxy

Isn't that what he is saying? Other countries tend to have better lifestyles in terms of dieting/eating, staying fit, and stress.

Isn't that all part of health care too?

[Galaxy]

Originally Posted by RainMaker

Isn't that all part of health care too?

I'm confused by your statements.

[RainMaker]

When I look at health care in our country, it isn't just about doctors and wait times. It's the health of the country as a whole. A healthier country means less costs. The end game for any health care plan is to get our people to be healthier and live longer. If we can accomplish that, other statistics are moot.

I don't want to believe an imaginary line to the North of us is the difference in living a healthy lifestyle and an unhealthy lifestyle. I have to believe that they are doing something better than we are. Is it being able to see a doctor every year regardless of income and insurance coverage that helps that? Is it education at a younger age?

Just about every major industrialized nation has a better life expectancy than us. They also pay much less for their health care. That isn't to say that we should copy their system, but to dismiss it is wrong. They are doing something better than us and it's in our best interest to figure out what.

[BishopMVP]

Originally Posted by Klinglerware

I did hear about this case on the radio. McAllen is an extreme case, since the culture was pervasive, from what I heard in the radio: if you were a doctor in McAllen, you had to play the game. But it isn't all that unusual for doctors to own for-profit medical businesses outside of their own practice. It's starts getting tricky when your side business is struggling: for example, if you own an in-house lab, you start thinking in terms of meeting quotas. You hit your quota but then it becomes a gray area whether all the patients actually needed all the tests you ordered.

McAllen is clearly the extreme case, but it brings up how much of a gray area there is in what care is necessary, and also how incentives will distort any system if people using it are immoral.

For my personal anecdote, I went to the doctor last week for the first thing other than a physical since 1992 after I suffered a concussion and whiplash from a soccer game. I iced it down and took a lot of aspirin the first couple days after it then talked to a trainer I know 3 days later and he confirmed what I thought. Unfortunately that night I started getting intense pain from muscle spasms when I tried to sleep so I went to the doctor next morning with no appointment or calling ahead. The receptionists weren't happy about it, but the doctor saw me within 20 minutes, confirmed what I knew, sent me to get an X-ray anyways and prescribed a longer-lasting painkiller and a muscle relaxant. Other than the CVS experience being a bit exasperating (probably exacerbated by the lack of sleep and constant nexk pain), leading me to say fuck it and pay the $40 for the medication instead of waiting for her to call the insurance companies involved, it was simple and easy. Now 5 days later my neck is still a little sore, but not to the point it bothers me or I need the medication at all. The X-rays came back normal, were unnecessary as I pretty much knew at the time, and looking back were probably the type of excessive testing they decry in the article. At the same time, I was scared (the neck and head aren't things you mess around with) and certainly wouldn't have been opposed to X-rays or CAT scans or whatever else if he suggested them at the time.

Now, I really don't know much about my doctor or the facility I was treated at, and I definitely don't think they were being immoral, but it's almost exactly what they talk about in the article. He could have sent me home with the medications and told me to come back if it didn't get better, but I'm still glad he didn't. I'm not really sure I want a bureaucrat either at an HMO or government level deciding whether I can get one or not.

[GMO78]

As a Canadian I hestitate to get involved in an American political discussion but because Canada has been mentionned that I'll add my opinion, for whatever it's worth.

First, do not have a government monopoly of Health care like we have in Canada. It doesn't work. Government monopolies have never worked. There are numerous examples so I won't give specific examples.

What does seem to work in many cases is to have basic government healthcare competing against private healthcare. This keeps the government healthcare honest and more efficient because they must compete against private companies.

Perhaps what could be done is to have an investigation or commission to study other healthcare systems in Western Europe and other parts of the world (if this hasn't been done already). Make sure all viewpoints are on the commission and publish all the findings, for all viewpoints.

If the U.S. does go with government healthcare then everyone must pay a premium or tax, not just the wealthy. This premium or tax must be explicitly for healthcare only and healthcare must only be funded from it. That way everyone knows how much healthcare costs and if healthcare costs go up then everyone feels the pain.

I hope I've helped at least a small bit in the discussion and I hope you make a wise choice.

[albionmoonlight]

FiveThirtyEight: Politics Done Right: Obama, Democrats Flunking Health Care Sales Pitch

Obama, Democrats Flunking Health Care Sales Pitch


by Nate Silver @ 2:20 AM

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As I've made clear on a couple of occasions, I think there has generally been too much panic over the process of getting a health care reform bill before the Congress. Given a bill as expensive and complicated as this one, and the number of disparate constituencies both within and outside the Democratic Party, it is not surprising that the details are taking some time to negotiate. Efficient negotiating processes necessarily will involve a lot of brinksmanship, necessarily will tend to be resolved at the last minute, and necessarily will have their up days and down days along the way.

The one thing that might have sent things down a different course is if President Obama had tried to preempt the negotiations by taking a more hands-on approach and placing a particular bill before the Congress. I had thought this was a good idea, although the Beltway conventional wisdom would disagree, and there would certainly be risks to the White House in trying to loop the Congress out of the process. We'll probably never know who was right. But given that the White House didn't take that course, everything that has proceeded since has been fairly normal.

There are also debates about health care, however, taking place outside of Washington, in living rooms and convention halls and bowling alleys all across America. These debates will come to take on more import as members of Congress return home for the August recess and begin to speak with their constituents. I do not think the Democrats have been holding their ground in these sorts of debates. In fact, I think they are losing them rather badly.

There is a long history of support for the concept of major health care reform, something that has not really changed to this day. As recently as last week, a USA Today/Gallup poll found 56 percent in support of Congress passing a "major" health care reform bill this year, versus just 33 percent opposed.

However, that does not mean the particular bills being debated by the Congress are popular. Since Memorial Day, there have been ten polls that asked whether the public supported what was identified as the Obama, Democratic, or Congressional health care "plan". I put "plan" in quotation marks because there still isn't "a" plan; instead the Congress is debating between several different plans. With that said, what the public thinks of as the Obama/Democratic plan has been steadily gaining opposition:



The obvious thing to point to is the increase in the number who say they are opposed to the Democratic "plan". What may be just as important, however, is that the Democratic plan was never was all that popular to begin with. A GQR poll back at the end of May put support at only 46 percent -- although then, just 33 percent were opposed. The Democrats, indeed, may not have recognized early enough that some persuasion was going to be required in order to get a majority of the public on board. And they have since lost their plurality. The support numbers have held basically steady -- the problem is that virtually all of the undecideds have come around to oppose the plan.

About a month ago, Stan Greenberg and James Carville, who were bystanders in the Clinton administration when the 1993-94 health care effort failed, put out a memo outlining five things that Obama and the Democrats would have to do in order to sell health care. Let's evaluate their performance on each of these five planks, and assign it a letter grade:

1. Voters need to hear clearly what changes health care reform will bring. Never losing health insurance when you lose a job or get sick, power shifted from insurance companies to people, reduced costs for you and your family, business and country.

The key adjective in the above statement is "clearly". It certainly does not seem to me that there's been much clarity in the Democrats' explanations of what health care reform will mean for the average American -- how can there have been when key elements of the plan are still being debated? Grade: F.

2. Build a narrative around taking power away from the insurance companies and giving it to people.

There's been some of this from rank-and-file Democrats, but very little from Obama, who seems strangely resistant to populist rhetoric. I'd thought, frankly, this was one of the real advantages that Democrats had going into the legislative process: big business is very unpopular because of the economic collapse, and there might even have been some way to parlay negative sentiments about AIG -- an insurance company -- into skepticism about the motivations of insurers in general. But we haven't seen very much of this from the highest-profile Dems. Grade: D+.

3. The president and reform advocates have to explain concretely the changes that will mean lower costs.

There's been a lot of assertion of this, but then, there's that key modifier, "concretely". And the Democrats don't seem to be winning this argument. I know the Rasmussen polls have been pretty bearish on health care reform (and most other Democratic initiatives) in general, but their numbers on cost control are especially poor -- only 23 percent expect the cost of health care to go down under the Democratic proposals, versus 53 percent who expect it to go up.

It's not very difficult to understand why the public thinks as they do. They hear about cost control -- and then, they hear that the impact on the deficit is going to be a trillion dollars. Talk about cognitive dissonance. What Obama and the Democrats probably need to do is to delineate the two parts of the proposal: acknowledge that creating a guarantee of universal coverage will cost money, and laud it as a worthy goal -- a moral imperative, even. Then explain that the other parts of the bill will save money, although not quite enough to offset the costs of providing universal coverage. Maybe you need some Ross Perot-style charts and graphs to do this.

I think the public is sophisticated enough to comprehend this argument, and I think that it might be a winner. In this month's Kaiser Foundation tracking poll, 45 percent started out saying that $1 trillion is "about the right amount" or "too little" to be spending on health care, versus 42 percent saying "too much". When, however, Kaiser stipulated that "spending this amount would mean nearly everyone in the U.S. would have health insurance coverage", support rose to 57 percent. This argument was more persuasive to people than a another one Kaiser advanced about reducing long-term costs.

The White House clearly concluded somewhere along the way that arguments about cost containment were more persuasive than arguments about universal coverage. The problem, again, is that the arguments about cost containment won't make any sense to people unless you're also selling the arguments about universality -- not when the bill has a $1 trillion price tag. Grade: F.

4. Show all voters and seniors that there are benefits for them, including prescription drugs.

This probably has to count as another failure. Plans for health care reform are not very popular with seniors. Obama has talked in passing about closing the Medicare Part D "donut hole", but it hasn't been a central focus of the debate, nor is it clear if this will be addressed in whatever bill ultimately comes out of Congress. Having some kind of "prize" to show to seniors could be a big help. Grade: D-.

5. All of these points should be made with the dominant framework that continuing the status quo is unacceptable and unsustainable.

This is the argument we've heard most frequently from Democrats and one that they're probably winning. Indeed, all the Republican talk about the need for "bipartisan" reform somewhat reinforces this point: there are very few people will to go on record describing the status quo as acceptable.

However, none of this will necessarily encourage the public to have much confidence in the particular solution to the status quo that the Democrats are advancing. Winning this point, in other words, is a necessary condition for the passage of health care reform, but hardly a sufficient one. With that said, Democrats should probably be making more of the fact that Republicans have yet to offer their own version of health care reform. Grade: B+.

* * *

Overall, that works out to a grade point average of1.06, or a letter grade of a straight 'D'. And that frankly seems generous when looking at the situation more holistically. If this were a pass-fail class, the Democrats would probably deserve a failing grade.

The strategy from here, at least, seems relatively clear (although "clear" is not the same thing as "easy"). Firstly, the Democrats need a plan that will be the focal point of their sales efforts. It doesn't necessarily need to be the plan that will eventually be voted upon by the Congress, but it does need to have specific answers on key details like the public option, the employer mandate, and the funding mechanism. Until the Democrats have a plan, they are unlikely to gain ground with the public on health care reform. This, by the way, is why it is potentially a significant setback if the House in fact does not vote on health care before the August recess -- far more so than if the Senate hadn't voted. If the House approved a health care bill, that would give Democrats a plan to talk about through the recess, regardless of what the Senate chose to do later on. But without either chamber having approved a plan, they'll continue to be drowned in a sea of process stories.

If and when the Democrats are at the stage where they have a plan to frame the discussion, then President Obama needs to give a speech. Not a town-hall forum, and not a press conference. And not multiple speeches. A speech. A "big" speech, and probably a somewhat long speech. A make-or-break speech in prime time on a busy television night. Preferably one from the Oval Office, or perhaps in front of a joint session of Congress -- not some bullsh*t at a steel mill in Toledo. This is not as risky as it sounds, since the President is very good at delivering big speeches. But he's probably only going to get one shot.

Until then, I don't think Obama can go completely into hiding, but there is definite risk of overexposure. The President is not as popular now as he was a few months ago, and he's being associated with a still-unformed health care "bill" that definitely isn't all that popular and in fact may be dragging his numbers down. It might be better for the President to preserve some of that political capital and to rely on some of the more persuasive members of Congress, Joe Biden, Katheelen Sebelius, and under ideal circumstances the Clintons, to do his bidding for him in the meantime, in conjunction with a some grassroots action and a robust advertising effort.

The best thing that health care has going for it is that it doesn't necessarily need to be all that popular to pass. Congressional Democrats will simply have to acknowledge that, while the passage of a bill might not do them any favors in the near-term, its failure would almost certainly be much, much worse. But I'm not sure that Democrats had to find themselves in this lose-lose position in the first place. And I'm not sure that they can't find their way out of it, if they start to take more heed of what the public really needs to hear about their health care bill.

I think that this is spot-on. I mean, I am a self-identified liberal, and I am still more concerned than excited about what the Dems are going to do. And I am certainly confused by it, because no one has actually said what they really plan to do. (Like Jon Stewart said, stop telling me what Health Care Reform will be like, and start telling me what Health Care Reform is.)

And, if I am on the fence about this, then I think that spells trouble for the Dems. I mean, I voted for Kerry for goodness sake. I should not be a hard guy to convince on a major Democratic issue like this.

It will be interesting to see what happens over August.

[flere-imsaho]

Paul Krugman pointed to this from his blog, suggesting that some skepticism regarding the CBO's numbers on health care might be warranted.

[Dutch]

Like Jon Stewart said, stop telling me what Health Care Reform will be like, and start telling me what Health Care Reform is.

HAHAHAHAHA!

Wait, that's not funny.

[Galaxy]

Originally Posted by RainMaker

Just about every major industrialized nation has a better life expectancy than us. They also pay much less for their health care. That isn't to say that we should copy their system, but to dismiss it is wrong. They are doing something better than us and it's in our best interest to figure out what.

You can't just throw stats out like and say it's better. We need to quantify those stats (which people fail to do). A big reason I think is that it's lifestyles. The Japanese, who has the highest life expectancy, have an extremely healthy diet. Europeans seem like they have a transportation lifestyle that promotes walking and eating fresh, healthy food. Health care doesn't do anything if you don't take care of yourself.

Also, we have a nation of 300-some million people in comparsion. Throw in all the free health care we give to illegals, it's a lot of people to cover. We have the private insurance people who have to pay to make up for those have Medicaid/Medicare and no insurance (free). We don't have any malpractice protection. We also used our health care system for every little thing.

[flere-imsaho]

Just a reminder that those of us sitting here with out good PPO or HMO plans aren't necessarily "fully covered" by our insurance companies.

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission.

...

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

[flere-imsaho]

Originally Posted by Galaxy

You can't just throw stats out like and say it's better. We need to quantify those stats (which people fail to do).

OK, I'm confused. How does one "quantify" stats? Do you mean "qualify" stats? Because that's what people have done. They've taken a look at the data and concluded that these other systems have a higher level of efficacy than our system.

But I don't think that's what you mean:

A big reason I think is that it's lifestyles. The Japanese, who has the highest life expectancy, have an extremely healthy diet. Europeans seem like they have a transportation lifestyle that promotes walking and eating fresh, healthy food. Health care doesn't do anything if you don't take care of yourself.

So you mean "qualify" in the sense that these other single-payer health care systems operate in a context more conducive to their success than such a system would in the United States. Basically the contention here is that Europeans and Japanese (and Australians, and Kiwis, and Canadians) are more predisposed to healthy lifestyles than Americans, and this is a major reason why they can have single-payer and it can be cost-effective.

Which leads us to:

Also, we have a nation of 300-some million people in comparsion. Throw in all the free health care we give to illegals, it's a lot of people to cover. We have the private insurance people who have to pay to make up for those have Medicaid/Medicare and no insurance (free). We don't have any malpractice protection. We also used our health care system for every little thing.

Amongst political scientists there's an old and popular belief (almost a dictum by this point) that the greatest single barrier the U.S. has to the implementation of any quasi-socialist programs is no, not the former existence of Communism and the Soviet Union, but is the much older concept of "Rugged Individualism".

One premise upon which the U.S. was founded was the clear and powerful protection of individual liberties, and the protection of these has remained strong throughout its history. The U.S. has also always been a nation that has glorified self-reliance. For much of its history self-reliance was crucial, given the far-flung locales in which people could reside in a relatively sparsely-populated country (and some of this even exists to this day). It's always been a nation that admires the self-reliant individual ("Yankee ingenuity", "Live Free or Die", "You can have my gun when you can pry it out of my cold, dead hands") and sneers at those who need help ("How many times do we need to save France from Germany?" "Canada's the 51st state").

So it's not surprising that while the Europeans reacted to the industrial revolution by finding ways to collectivize the generated wealth (to an extent) to support their countries as a whole, Americans preferred instead to allow individuals to succeed wildly, even at the expense of others.

This is why people in lower tax brackets vote against tax increases for the rich, for instance.

So, to tie this back to health care.... I tend to be of the opinion that single-payer will never fly in the U.S. because the majority of Americans (or, at the very least the majority of consistently enfranchised Americans, to say nothing of influential entities) have a firm and constant belief that everyone should be able to provide for themselves and their families just fine and if they can't, they're essentially less-worthy people who don't really deserve to be helped, and certainly not at the expense, even minor, of those who work hard, or at least appear to do so, to succeed in the system.

This, to me, is the bottom-line for many of the anti-health care reform arguments.

[lynchjm24]

There were some great tidbits in the news the last couple days.

The WSJ had an article about how you keep people who leave the hospital from being readmitted. It centered on a 75 year old woman who had heart issues. They told her when she was discharged not to eat hot dogs as the sodium would cause fluid build ups. She went to a 4th of July picnic and... had a hot dog. She ended up back in the ER and admitted the next day. She said that she didn't care if it killed her, she was having a hot dog on the 4th of July.

If that is your attitude why exactly are we providing you anything? If you value a hot dog so highly that you will be admitted to the hospital over it should we be paying to admit you to hospitals?

I don't remember which paper, but it was about a rally in South Carolina where a 70 year old retiree told a senator that 'he didn't want the government putting their hands in his Medicare'.


I stand by the problem with health care in this country is that it's citizens are stupid.

[lynchjm24]

Originally Posted by flere-imsaho

So, to tie this back to health care.... I tend to be of the opinion that single-payer will never fly in the U.S. because the majority of Americans (or, at the very least the majority of consistently enfranchised Americans, to say nothing of influential entities) have a firm and constant belief that everyone should be able to provide for themselves and their families just fine and if they can't, they're essentially less-worthy people who don't really deserve to be helped, and certainly not at the expense, even minor, of those who work hard, or at least appear to do so, to succeed in the system.

This, to me, is the bottom-line for many of the anti-health care reform arguments.

If only this were true. It's a shame it flies in the face of our reality. There are hundreds of programs that help the poor. Minor expense? Do you have a job and a family? Minor expense my ass.

Saw some great notes on taxes in Connecticut. 14% of the state income tax is paid by the citizens who live in Greenwich. Stamford, Greenwich, New Caanan and one other town pay 24% of the state income tax. Just a minor expense for a tiny percentage of the population.

If you can't support a family you shouldn't have kids.

My friend's brother in law and his wife have 5 kids from their prior relationships. These two idiots have had a house foreclosed on, a car repossessed and other financial issues. They still spend like idiots, for example driving a BMW they bought with their tax return (i.e. earned income credit, you know one of those programs that don't exist to help the poor).

This family already had 3 dogs, which is ridiculous in it's own right. However, he had to adopt a pit bull as well. Of course the pit bull decided yesterday to bite the lower lip off an 8 year old. This poor kid already has a bunch of scars from when he was attacked by a bulldog when he was an infant. So, the health system is now going to absorb the cost of this poor kid's inpatient stay and a bunch of plastic surgery as they try to fix his face, all because this jackass needed a pitbull.

Note that when Americans lived by what you wrote it rose to be the greatest nation in history. If only we could get back to those values instead of this ridiculous sense of entitlement.

[JPhillips]

When, exactly, was this great golden age of America?