I would like to point out, once again, that after the diagnosis it is no longer insurance. Insurance is pooling of risk. Once one is diagnosed, the risk ratio is 1:1.

The only way insurance works is a mix of healthy and unhealthy in a given population. It is a "bad deal" for the healthy while they are healthy, but since one really can't control when one becomes unhealthy most people are willing to part with some dough to cover that risk.

If one is already unhealthy, asking for someone else to pay for your medical care is not insurance, it's charity.

This is not to say that insurance is the best way to pay for healthcare. That is another debate.

Health care coverage is a better term.

In Massachusetts, the rule was that pre-existing conditions had to be covered if you had not had a lapse in coverage of more than 60 days. If you had, I think it was a six month wait, but we've got guaranteed issue, os there's no high risk pool.

can't buy coverage through the free market, you can qualify for the state high-risk pool...which won't cover your cancer for 6-12 months.

But you'll surely be in a position to be able to use a lot of health care by then. What a lucky ducky you'll be!

How is this anything other than crazy?

If one is already unhealthy, asking for someone else to pay for your medical care is not insurance, it's charity.

How about old people who failed to save enough? Also charity? There must be a market-oriented solution to the problem of surplus people.

There must be a market-oriented solution to the problem of surplus people.

Soylent green futures.

1: true enough, but high-risk pools are not being advanced by left-wingers as an alternative to private insurance. They are instead being advanced by right-wingers as a supplement that will allow us to keep our system of private insurance, by taking care of the people private insurance fails to cover. But saying, OK, private insurance won't cover you when you're actually really sick, but don't worry, we have a charity pool that will do that would make the ridiculousness of the whole thing obvious.

that would make the ridiculousness of the whole thing obvious

You see, I think it should be made obvious. There is no getting around the fact that health care is expensive. Always has been. The question then becomes how best to pay, and what limits we will put on that spending.

re: 8

It's not really that expensive. Most EU countries pay 10% or below of GDP. That's a substantial chunk of money but it's not that substantial a chunk of money.

Well, ttaM, that seems expensive to me. Probably worth it, but expensive. There is way too much talk about "affordable", which translates as inexpensive. Ain't gonna happen.

re: 10

The US currently pays 15% or more.

10% of GDP sound expensive? To pay for healthcare for everyone in the country? Really?

Re 8: The problem is that the insurance companies make a literal killing out of the US system, and they don't want that to stop just so that Americans can have better health care than Cuba.

11: Yeah, but think of all the value we get for our extra 5%. Universal coverage, a fit and healthy population, flexibility when changing employers, worlds longest life spans.....

Or not. But at least the bureaucrat standing between me and my doctor doesn't work for the government.

12 nails it. The health insurance industry has nothing whatsoever to do with delivering healthcare. They are in the business of moving paper around in order to extract a profit for their shareholders. It's a purely parasitic industry that deserves a swift and merciless death.

When I think about the HMO and insurance company bureaucracies running in our health care system, and then read the speeches seriously talking about protecting patients from the government bureaucracies that socialized medicine would represent, I revert to my belief that the US is a failed nation thrashing around madly like a spastic brontosaurus, taking out everyone in sight during its death throes.

Half McCain's campaign is either misrepresentations of fact or self-contradictory, or both.

The health insurance industry has nothing whatsoever to do with delivering healthcare

I wish that more people (read all) understood this. Insurance is just one way to pay for healthcare, and not a very efficient way at that. But even a government sponsored UHC plan would still be insurance.

re: 15

That's how it looks from the outside, fwiw.

To make 15 perfectly clear: McCain's individual statements are rarely internally self contradictory as far as I remember, but with increasing frequency what he says at noon contradicts what he said at 10:00.

15: Apatosaurus, John. Get with the times. The Brontosaurus model was discontinued.

The Brontosaurus model was discontinued.

Why? Does it really matter what the name of the oil was before it became oil? Next you'll be telling me Pluto is not a planet. (I know. Pluto's a dog.)

20: Wikipedia gives a sanitized description of the story. The harsher version is that O.C. Marsh stuck a fake head on an apatosaurus body in order to claim he had discovered a new species.

21. Cool. Thanks rob. It looks like a Hydrox, Oreo thing to me. Funny what sticks in the public conciousness.

But I don't understand why, given that it was a fake, they gave brontosaurus the boot instead of apatosaurus. Brontosaurus is one of the five canonical dinosaurs - brontosaurus, stegosaurus, triceratops, pterodactyl, and T-Rex. Those are the dinosaurs they had when I was a kid. All these "apatosaurus" and "velocoraptor" types are bunch of johnny-come-latelies. This is indeed the same bullshit they pulled with Pluto.

23: Here is a take on it from Cecil Adams including the whole wrong head business. Heads aside, apatosaurus got there first, 1877 vs 1879.

I think the Ankylosaurus is a part of the original small plastic cannon too.

A lot of the dinos that have just recently made their way into the toy world are pretty cool. Maiasaura cared for its young. Parasaurolophus had a great big trumpet sticking out of the back of its head.

25 and plesiosaurus. There are seven canonical dinosaurs, one for each habit of highly effective people.

I piss on Helpy's elitist so-called dinosaur.

Parents of small, dinosaur-obsessed children need How Do Dinosaurs Say Goodnight?. Very sweet, potentially helpful bedtime reading.

I told my beloved grandnephew that the yawning hippo's mouth was big enough to eat him. The next time he saw the yawning hippo he told me it could eat me too.

Ankylosaurus I can grudgingly accept into the cannon. Plesiosaurus I cannot. That is not a dinosaur, that is the Lock Ness Monster. Different category entirely.

No way. If you're going to take Ankylosaurus, you've got to take Diplodocus, Oviraptor, Iguandon and Plesiosaur, and there goes the whole fucking neighborhood. You were right in 23, Spike. Stand firm, and don't let in the B-list dinosaurs.

Brontosaurus, you're a fucking fossil. Don't let the door hit you in the ass on the way out.

ARE YOU LOOKING AT ME?!!
http://cgi.ebay.com/MARX-DINOSAUR-BRONTOSAURUS-1950s-TOY-PLASTIC_W0QQitemZ20

23 is correct, but it's responsible for getting this fucking song, which my little sister sang incessantly in first grade, stuck in my ahead:

"Tara pterodactyl,
Bertha brontosaurus,
Trini the triceratops,
Stanley stegosaurus.

Tom tyrannosaurus,
He is carnivorous,
Sing it one more time and
Join in the chorus."

When I was a kid (in the late 70s) and my best friend and I played dinosaurs, he was an ankylosaurus and I was a stegosaurus.

Of the fact that his family were immigrants and mine were native-born, make what you will.

I distinctly remember having a little yellow plastic ankylosaurus, so I will let it into the cannon. But ankylosaurous is definitely the Ringo of that band.

Also, we don't call him "ankylosaurus", we call him "little spikey dude."

It's well established that the second-smartest dinosaur is the Therizinosaur.

Somewhere lost in the internet, The Editors have an excellent essay defending the anklyosaurus. Spikes on his eyebrow!!

I just went looking for the Thagomizer cartoon and was pleasantly surprised to find it's become standard terminology.

I would like to point out, once again, that after the diagnosis it is no longer insurance. Insurance is pooling of risk. Once one is diagnosed, the risk ratio is 1:1.

Not true. Once one is diagnosed, it may be clear that some treatment is necessary, but what treatment(s) and for how long remains uncertain.

2: The "no exclusion of pre-existing conditions if you haven't had more than a 60-day gap" thing is the rule for private insurance as mandated by HIPAA. It'd be insane for the rules to be different for government insurance. (That's not to say they're not different, of course.)

27: Curse your sudden but inevitable betrayal!

but what treatment(s) and for how long remains uncertain.

Which is why it's nice to have those decisions safe in the caring hands of the insurance professionals.

Worshipped Di: Once it is known that the patient is unhealthy, it is no longer insurance. The event has occurred. I agree that the course of treatment and thus the payout has yet to be determined.

We have nibbled around the edges with things like waiting periods for pre-existing conditions, but these are usually mandated by law in response to political pressure. The waiting period when one signs up in a new plan is to somewhat alleviate IBNR (incurred but not reported).

Worshipped Di: Once it is known that the patient is unhealthy, it is no longer insurance. The event has occurred. I agree that the course of treatment and thus the payout has yet to be determined.

No, you still don't know which melanoma patients will rack up $20,000 in bills in a year and which will rack up $2,000,000.

Worshipped Di: Once it is known that the patient is unhealthy, it is no longer insurance. The event has occurred. I agree that the course of treatment and thus the payout has yet to be determined.

We have nibbled around the edges with things like waiting periods for pre-existing conditions, but these are usually mandated by law in response to political pressure. The waiting period when one signs up in a new plan is to somewhat alleviate IBNR (incurred but not reported).

OK, that was weird. You guys are conflating insurance with payment responsibilities. They are not the same. You can not buy fire insurance once your house catches on fire, whether or not the fire department contains the fire in the kitchen or your house burns down. The amount of the loss is not the question.

But people get sick and get better all the time, and others don't. John McCain has had cancer in the past. He doesn't appear to now. Do you think he's "on fire" in the sense of it being incoherent to talk about his having health insurance against recurrences?

You can't neatly divide people into the sick and the healthy, as if people got sick once in their lives, and were "sick people" forever after.

They are not the same.

To be fair though, health insurance really isn't the same as fire insurance either.

It is muddled, but this entire approach to providing health care is muddled, so it's fairly natural.

So, TLL, you would agree that "private insurance" often doesn't really work anything like actual insurance, in the technical sense?

Once it is known that the patient is unhealthy, it is no longer insurance. The event has occurred.

This assumes that health or not health is an either or thing. Once a diagnosis is made, you are insuring a different risk, but you are still insuring a risk.

If you agree, it would be wise to avoid leading people to think that you're talking about one when you're talking about the other. Given how confused the terminology is, you might need to take some pains to do so.

LB- cancer is in remission, not cured. Chronic disease is one of the reasons that lawmakers mandated coverage for "pre-existing" conditions. A leg is broken or it is not. The appendix comes out. The child is born.

I am not trying to defend private insurance as a wonderful gift to all mankind. It has become such a hodgepodge of mandated coverages and hidden profit centers as to be meaningless.

John McCain has had cancer in the past. He doesn't appear to now.

Or so the mullahs would have you believe.

LB- cancer is in remission, not cured.

So? Do you know that McCain's cancer is going to cause a dime's more worth of medical costs before he dies? I don't think you do. What makes the coverage he buys so that he doesn't have to personally cover those costs, if they occur, different from the insurance a 'healthy' person buys against medical costs they might or might not incur in the future>

48: That's true, but if that's the case, then government-sponsored universal health care coverage doesn't count as insurance under your definition, since there's no question of buying into the risk pool (you get it through residency, usually.)

TLL, I think the oppressive liberal majority here at unfogged would be perfectly content to dispense with bogus health "insurance" alltogether and move straight to a single-payer system funded out of general revenues. Then no one can game the system by waiting until they get sick to buy coverage!

How about it, you on board with us?

Good thing I didn't sign my name to 58, so the pwnage by Cala was less painful that way.

I am on board with single payer, but the devil is in the details. My fear is that a decent system will be designed, but then Congressman Smotz (I. Me) will carve out an earmark, special district, procurement boondoggle that ends up breaking the system. Something for nothing will be the motto of the Department of Taking Care of You.

The things TLL is talking about are arguments in treating medical care as a public service or public utility. Private insurance based medical care ideally would insure only those who needed it least. It would just even out the odds for the people who are basically lucky already.

Do you know that McCain's cancer is going to cause a dime's more worth of medical costs before he dies? I don't think you do

I am not an actuary but I play one on TV. Citizen McCain's premiums would go up on the anticipation of increased expenses, but then he would write a nasty letter to the editor about his evil insurance company.

During the 25 years when I had medical insurance I was successfully treated twice -- penicillin for a sore throat and a steroid for tendonitis. (Plus a few inconclusive exams and a lot of eyeglasses.) Right around when I might start to need it, at age 56 I lost it when I retired. My luck has held so far. In three years I'll have medicare, and right now I have state insurance.

Do you know that McCain's cancer is going to cause a dime's more worth of medical costs before he dies? I don't think you do.

There's no need to resort to bogus arguments like this one when the straightforward case for UHC is clearcut. And this argument is truly bogus. Look, insurance companies know how to identify and deselect adverse risks. That's the essence of their whole business model. OF COURSE someone who has been diagnosed with cancer will have, actuarially speaking, a higher expected claim loss than someone who has not, ceteris paribus. This objection that there is not a binary distinction between "sick" and "well" is a red herring. Insurance companies have reams of data that allow them to spot an individual along the continuum. The diagnosis of a medical condition puts an individual in a different underwriting category that demands different pricing. In TLL's terms, the risk event has already happened.

That's why the Grand Bargain on UHC will ultimately have to specify guaranteed issue, community rating and a coverage mandate (or their functional equivalents).

If we are not going to some sort of single payer, I would prefer to see a pre-tax medical savings plan with a catastrophic backstop reinsurance at $25,000 or so. Earned income tax credit for those who can't afford the annual contribution (ie, feds put some money in your med savings account). No more workplace based insurance. Let's move past 1943.

The trouble with McCain's plan is that it moves towards eliminating workplace based insurance without any guarantee that people who will lose their insurance will be able to buy it. The market for individual insurance is obscene, and I'm not sure McCain gets that a healthy 50-year-old with a perfectly good health history is practically uninsurable.

Tell me about it! I'm an independent contractor, and my insurance four me and my family runs over $1500 per month, mostly for me.

I'd be screwed under 65, but I agree that employer provided care is not the way to go.

Man, we go through all the trouble to transform a wonky health care thread into a thread about cool dinosaurs, and then it goes right back to wonky health care. Priorities, people!

Google search for "wonky dinosaurs" brings us to this John Updike article for last December's National Geographic.

You know, I used to have romantic notions about living in Alaska. But every time I see pictures of Wasilla, I am disabused of them. What a craphole.

Dang, wrong thread...

John Updike writing about dinosaurs has a pretty high kick-ass quotient.

Are we still talking about health insurance? Because far and away the shittiest thing about private health insurance, in my mind (and yes, that's extraordinarily stiff competition) are the coverage limits. A family friend is dying of cancer, and has been given about 4 more weeks to live. They only discovered the cancer about 6 months ago. She reached the caps on her coverage about a month ago, and the out-of-pocket expenses since then have been devastating her family's finances. She's leaving behind a husband with relatively low earnings and no savings and two young kids (5 and 2). So now she's faced with decisions like whether to buy morphine to help her through the crippling pain in her last few weeks, or try to go without so the kids can still maybe have Christmas this year (once mommy's gone).

The very idea that someone who is obviously in dire need of expensive care (since they're reached their goddamn coverage limit) can suddenly find themselves effectively uninsured is quite frankly unconscionable. And these are the "lucky" ones, who have insurance in the first place.

It's the best system in the fucking world, yes sir.