I recently read someone semi-jokingly insinuate that he is waiting for Broder to retire, but cannot remember where.
Well, he's a real Democrat, and a good and interesting and informative writer. I've just never seen him take a position on anything that wasn't as conservative (in the cautious, rather than the right wing, sense) as one could be while remaining a Democrat.
I'll like Drum, too, but your parents would be better advised to read Dream Democrat Mark Schmitt. As he points out, politicians' fears about the political effect of advocating UHC are not senseless. (He's still for it.) There are people who think Hillary killed the Clinton WH's power by focusing on health care too early in his Administration (and by the way she ran it.)
I'm not sure that that is true, LB. If it were the case, the state of MA would be passing a much better bill than the one they are passing now ($295 per employee without healthcare? that's like 4 months of my payment into my health plan...). The fact of the matter is that the tax revenue for UHC has to come from somewhere, and a lot of people won't like it if that somewhere is out of the coffers of companies. Oddly enough, I wonder if there is some critical mass of buying power at which the cost of healthcare (to the state, company, or individual) decreases. Would it be better to have companies pay their healthcare money to the state? To me, it's interesting, but I have no clue as to whether it is actually the case, and I am doubtful that there would be any way to test this.
Furthermore, if everyone were insured by the state, we'd end up in the same situation as England, where the rich have private insurance. Better doctors will, if the law allows them, start accepting only (or a majority of) privately insured patients.
5 being said, I'd love to have universal health insurance. I think helping the less fortunate with insurance, like many things, creates a better environment for everyone to live and do business.
Oddly enough, I wonder if there is some critical mass of buying power at which the cost of healthcare (to the state, company, or individual) decreases. Would it be better to have companies pay their healthcare money to the state? To me, it's interesting, but I have no clue as to whether it is actually the case, and I am doubtful that there would be any way to test this.
My understanding is that this is both measurable and uncontroversially true. Single payer systems get more measurable care for less money than we do.
end up in the same situation as England, where the rich have private insurance. Better doctors will, if the law allows them, start accepting only (or a majority of) privately insured patients.
This is not so much a problem. Doctors are technicians, not wizards -- if single payer health care gives everyone access to decently competent practitioners, there's not a thing wrong with the richest 5% of the population buying access to the best 5% of the doctors. After all, that's what happens now.
Thanks, LB. Way to ruin my reservations.
From what I understand, the UHC plans being advocated for the U.S. are a bit different from the British NHS. Over there, the doctors are, for all intents and purposes, employees of the state. It isn't national health insurance so much as national health care.
Essentially, the government would just be paying the insurance premiums of everyone, funded by tax revenue. It wouldn't make too much of a difference for people who already have insurance, but everyone would be covered, and overall it would probably be cheaper, since you're risk pooling across a very large group.
As for my first point LB, I was more wondering if the payment per company for health insurance for their employees (say, $1500 a year or whatever) would be more than they have to pay if the state became the single payer health care.
As for your second rebuttal, there's really no way to fix this situation anyhow. The crappy doctors will always have patients because there just aren't enough doctors to go around (given that there's a three day week for doctors).
Yeah, while I'm not terribly well informed on this, my understanding is that (a) any UHC system produces better outcomes than ours, but (b) French-style systems of single-payer health insurance, coexisting with private care produce better outcomes than British-style single-provider systems.
I thought Britain had a coexistant private provider system as well.
Might, I'm ignorant -- what I meant by British-style is that the UHC is provided through a government agency rather than through government payments to private providers.
And here's another reason why it will have difficulty passing: point 11a, LB. Better for whom? Better for the population as a whole, perhaps, but not better for the upper class, I think. And we all know who pols care about.
14: Well, I'm the upper class, income wise. I make (laughably, when one considers what I do all day) a shitload of money. And my insurance is miserably annoying and unpleasant. Everyone's insurance is miserably annoying and unpleasant. When Buck needed some elective surgery a while back (bad knee), he had great insurance, and he waited months and didn't get as much physical therapy as he probably needed.
So if there are people happy with our current system, they're richer than I am. From an income point of view, that's a very small group.
Is "Buck" short for "Buck Naked," Costanza's porn pseudonym, or is it an homage to Magic Johnson?
It's a version of his premarital last name, chosen for maximum butchitude. He doesn't ask for much, so when he complained that 'Mr. Breath' sounded dumb, and asked to be referred to as 'Buck', I figured what the heck.
Hm... I've never had problems with my insurance. Then again, I'm 23, and never had any ailments that I've really needed to go see the doctor about (I think I broke my nose in October, and it looks like it, but when I went to the doctor, I didn't ask about it beyond getting some anti-bacterial rub for the crescent shaped cut. This was 2 or 3 weeks later).
I thought maximum butchitude derived from the "The ...-ster" construction, though all the old spinsters tell me otherwise.
I've lived under both systems, so have some personal insight into the Canadian vs. American health care. And I've also had (peripheral) professional involvement in the industry. I've always had good coverage in the US, so never faced a personal worry about being unable to pay for care.
For what it's worth, I think that a) Both the Canadian and American systems are broken in deep systemic ways b) the Canadian one is easier to fix and c) the worst problem that both systems (and this generalizes I expect to all `first world' systems) face is essentially unsolvable, and becoming more apparent.
This latter problem is that the available technology and treatment is outstripping our ability to pay for it, and that a fundamental shift in approach will have to be taken in deciding when *not* to treat things.
Canada pays quite a bit less for a similar level of care, on average. Of course, averages don't tell the whole story. I suspect it is quantifiably verifiable that if you are very rich you will have better care in the US, if you are poor you will have better care in Canada, and the trade-offs are less obvious elsewhere. I also suspect that where you live is a strong factor in both countries (perhaps dwarfing the inter-country differences?).
I'll second SCMT's link to Mark Schmitt. I like Drum, but Schmitt is quite insightful and much more knowledgeable about the legislative nuts and bolts. The Franke-Ruta (Tapped) post he refers to is also worth reading.
Health care that's not tied to the job is the one big thing that American workers need to make their way through and succeed in a disruptive, chaotic economy.
I completely agree with Scmitt on this, but I also count myself as someone with good insurance, kids, and friends my age who are facing serious illness for the first time. I'll be really worried about the personal costs of any transition away from employer funded health care. The details matter a lot, and the last 6 years have done an enormous amount to undermine our collective confidence in the ability of the government to execute something on this scale.
Following on #21, if GFR doesn't start getting gigs on any or all of the television shows as a Dem counterpoint to the various Republican pundits (instead of, for example, the fatuous Joe Klein), there should be Senate hearings.
With the untimely passing of Minnesota Senator Paul Wellstone, I became unable to name a national-level Democrat whom I deemed a good, sensible person. Please tell me I'm wrong.
I also suspect that where you live is a strong factor in both countries (perhaps dwarfing the inter-country differences?).
I'm not sure this is true for Canada. My uncle who lives in the Yukon was recently treated for skin cancer. The local doctors made the diagnosis, sending samples out of territory, I think, and then he was treated with full-hospice-care in Vancouver. If he'd been in America, this treatment would probably have bankrupted them (he'd been a very modestly successful self-employed businessman); in Canada, though, the only real worry was recovery.
Also, saiselgy has had some very good contributions on the tricky decisions in health care advocacy.
This post reads as f it was originally meant for some other weblog or something. Are there Unfogged readers who don't know who Drum is?
I figure it's possible to be familiar with Drum without having the same estimation of him as last-on-the-bandwagon that drove the post. The point wasn't "Hey, there's someone out there advocating UHC, what a good idea", it was "If even Drum is advocating UHC, it's got to be safe."
"c) the worst problem that both systems (and this generalizes I expect to all `first world' systems) face is essentially unsolvable, and becoming more apparent."
I'm not sure what your're thining of, but I've never heard any continental european health care system as being in crisis, or having serious problems.
I think there's no question our healthcare system is broken; see. The question is, are we going to let a Republican Congress / administration "fix it" the way they fixed Medicare or the way they want to fix Social Security, or are we going to stand up for doing it proper? Results here depend critically on framing the debate properly. And yes, Hillary RC bollixed this up but big-time back in the early 1990s, not by taking on healthcare per se but by handling it almost as badly as is conceivable.
(I say "almost" because, after all, the Bush administration redefines how badly is conceivable.)
There is evidence for the inefficiency of the US system: US life expectancy/health care spend ratio lags most OECD countries, for example. The overall assessment of system efficiency, however, is more complicated.
Here's one nice post on the difficulties of addressing the issue. Here's another.
How about "Lizardmaster"? "Buck" is a little corny.
Or I suppose, "Lizardpartner".
Not "Fang". That ended badly.
30: Hm. The inefficiency of our system is something I have mentally filed as well established empirically -- I'll have to do a little research to satisfy myself now.
31: Lizardmaster? I think not.
Jackmormon: It is certainly true in Canada. There has been a bit of noise in recent years about quality of care in rural Ontario vs. S-W Ontario, for example. However (as your anectdote supports), that doesn't mean you won't recieve treatment at all. The standard of care is lower though, for a variety of reasons (lack of local GPs, travel costs, lack of specialists, etc.)
Tweedledopey,
I've been working on this healthcare stuff in Massachusetts as part of the Greater Boston Interfaith Organization. The $275 per head charge is not as good as the payroll assesment, but it's an important step.
Right now, employers who buy insurance in MA pay a surcharge to fund the free care pool. Health Care for All's ballot initiative wanted to remove that surcharge and make the freeloading companies whose employees tend to avail themselves of the free care pool pay in. It was about equity between businesses.
The other alternative is the bill that Senate President Travaglini rammed throught that would require individuals to buy insurance (probably a high-deductible policy) without any contribution from their employers. Call your state senator today!
(You can find out who that is by going to wheredoivotema.com.
If it's Jehlen, her telephone number is 617-722-1578.
David, re:
"I'm not sure what your're thining of, but I've never heard any continental european health care system as being in crisis, or having serious problems."
I wasn't meaning to suggest that continental europe is in the same boat as north america in terms of current health care crisis, sorry if I was unclear about that.
What I was pointing out, and this really does apply pretty much across the board, is that we are getting quite good at creating expensive new treatment (and screening) methodologies. Not that `do everything possible, always' was *ever* a real option in health care, but the med-tech increases of recent decades are making some very tricky cost/benefit analysis acutely neccessary, especially with aging populations in many countries. How various other health care systems handle this is something I can't speak to.
Well, BG, I'm probably leaving the state before any of this gets passed into law (more on that in a week or so). But the individual health care for people over 18? Holy shit what a bad idea. I think Traveligni said something along the lines of "MA kids who decline to take insurance should take it, because they can afford it with less expenses (such as a house). I mean, it's really no problem for people making 50, 60 thousand a year." I almost reached through the radio (WBUR) and slapped him for being so completely out of touch with the job market.
34 - I totally read that as Where-Do-I-TiVo-Ma.com?
Isn't there a pro-business argument to be made here. Something like, "Boohoo, our businesses can't compete with firms from Japan and Europe, because those firms are unburdened by the cost of health care and pensions for their aging workforces."
Indeed there is, and a powerful one at that.
Drum has been making it for a while, I believe.
(I would guess that the post to which these comments are attached discusses this, but if the Washington Monthly provides a way to get from the comments to the post they haven't told me about it.)
Weiner:
What kind of pain do you have to be in to want to read the comments to Political Animal?
Oops, that post was by Ezekiel Emanuel, but this Drum post sounds similar themes, while asking why actual business leaders aren't on board.
But there's also the argument that boo hoo we have the "strongest economy in the world(TM)," and our companies should be willing to pay for this.
Just because a few of our companies are floundering doesn't mean that all of them are. Walmart sure as hell isn't. Exxon sure as hell isn't. Will it cause a decrease in investment in US companies? Perhaps. Will it cause a healthier, both fiscally and physcially, work force? Probably.
The fact of the matter is that we can't compete with Europe and Asia in a few industries there's a higher cost of labor in the US and some industries have seen a lack of American innovation (I'm looking at you, car companies!).
43: Who read them? I was doing a google search on WM for "business" and "health care," and that's what I got.
Can we please delete 42? Thanks.
Just in case it wasn't clear: 44 was to the parenthetical in 41.
Thanks, eb! (I eventually just went to the archive link.)
36: TD, are you leaving the state this week? Because this week is when everything is going down. It's an important deadline, because the state could lose over $300 million in Medicaid reimbursements if they don't provide HHS with a plan to expand the insured. They would lose the money in July, but Leavitt needs 120 days or so to review any proposal--and Mitt needs to sell it to him.
The House Bill included an individual mandat too, but it was going to look at what was affordable and provide subsidies.
I like Kevin Drum but wtf? (Although in fairness, I've only read Gaddis' first book on the Origins of the Cold War.)
I kept meaning to leave this comment and kept not doing it, but I just got reminded: I don't think the universality of advocacy of a position among liberal bloggers means it's safe to run on. Liberal bloggers are wonky and can look at some numbers and say that national health insurance makes sense, which it does. But most voters are not so wonky, fear radical change, and are easily swayed by "you won't be able to choose your doctor" type scare tactics. This isn't to say that Democratic politicians shouldn't push for single payer; they should, but I still think it's politically fraught.
52: It's not so much the unanimity among liberal bloggers -- it's that Drum, specifically, has bought in. He seems so reliably cautious, that if he's saying UHC is electorally workable, that we can probably get away with nationalizing the steel industry as well.