You can always make this point about any individual issue, but the problem is that there is a nearly limitless supply of worthwhile causes, obviously they couldn't pay for all of them.
Being bothered by the mere fact that an individual has $5 billion, however, is an entirely different issue.
Singer addresses this, in a way. But Singer takes a moral position, and would have us all giving much more money than we (probably) do.
Your issue might be different. One might say that though there's not a duty to provide such charity, there nevertheless seems to be something wrong with people not stepping up to the plate, as it were.
I would at least suggest that the price tag is likely to be significantly lower for the state than an individual. After all, the state already has people and bureaucracy in place. Still, it would seem that an individual or individuals might work with the state on tackling this problem. Another issue might be that no one has thought of doing so, which brings up the problem of social consciousness, or lack thereof.
I think the fact that 250,000 kids have no health insurance and 12 people each have one billion dollars, in the same state, is enough reason to be upset, even if you don't think the latter should be taking care of the former. (i.e., last paragraph of 1.)
Wait, this is this new plan where Ogged says something reasonable and we all just jerk his chain, isn't it? OK.
I do think there's an argument to be made that perhaps we should be willing to tax those extremely wealthy individuals at a higher rate in order to guarantee the ability to fund programs that make sure children have access to health care, especially if the state is going to make it illegal for children to have a full-time job with benefits.
There was a case made for Universal Heathcare in the Washington Monthly last summer, which proposed, basically, getting rid of medicare and medicaid, and thereby saving billions on bureaucracy. Then a tax is levied instead of paying directly for health insurance. In return, everyone gets a voucher for insurance, and can go with whatever insurance company they like.
I think that the appropriateness of your reaction depends on whether Illinois has a graduated income tax. If it's a flat rate, then it's bothersome, but I think that provision of decent health care is a basic state responsibility which should not be dependent on charity. (There will always be charity at the margins; providing housing for people who need to get specialist treatment in another city is a good example of that.)
One of the criticism of Medicare part D is that it subsidises the middle class and the rich, but that's only a problem, because so many people paying FICA taxes don't have insurance. If we thought of some of our taxes as basic social insurance, it would be fine--put in according to ability to pay, take out according to need (without extra means testing).
Isn't this Rawlsian sorrow, resulting from our judgment of a society by the way it treats the least of its people? Therefore our opinion of its comfortable people drops when we know how its uncomfortable fare?
There was a case made for Universal Heathcare in the Washington Monthly last summer, which proposed, basically, getting rid of medicare and medicaid, and thereby saving billions on bureaucracy.
Right. Because only the government has bureaucracy, while private insurance companies are friction-free conduits of money to health care providers.
And on the main post -- yes, you're absolutely right for it to bother you. It bothering you is not the end of the conversation on how it should be resolved, but it's a disgusting situation.
If your point is "why now? why isn't this take care of already?" I'm with you. Given our cumulative wealth, we should be able to take care of children. And should have done it long ago.
If your point is that these folks should just pony up and fork it over so the state should do it, when did you sign on for libertarian paradise? If it's that people shouldn't be so rich, you've lost me.
I don't mean to derive a specific remedy from the facts. But people sometimes don't want to admit that something is totally fucked up when all possible remedies seem bad. It seems worthwhile to say, "this is fucked up." Being able to articulate what's fucked up about it might be good. It might be that the two facts really don't have anything to do with each other; or that the conditions that make it possible for individuals to be so rick make it more likely that we can solve the lack of health coverage for kids. Open mind, and all that. But it sure seems fucked up.
Being able to articulate what's fucked up about it might be good.
My favorite way of putting this is, the U.S. spends more on private health insurance than other countries do on public health insurance -- which is to say, we spend more money on a bureaucracy that exists to deny us coverage than other countries do on bureaucracies that exist to extend coverage.
We don't actually need to debate universal health care, do we, unless baa comes back? Our government spends as much per capita on health care as governments in countries that don't have universal health care, and we don't have universal health care. We've just got the worst health care system of any of the advanced democracies. It hurts business too; it even took down Bill Frist. What's notable about the Illinois situation is the way it hits us between the eyes with injustice, not the fact that our health-care situation is in fact suboptimal.
You know, the universal health care thing is really funny.
I've been out collecting signatures for a ballot initiative in Massachusetts that would significantly expand MassHealth, improve the benefits, and make private health insurance more affordable.
There are all kinds of weird dynamics when it comes to getting people to sign. Young single men usually blow past me, but those accompanied by a girlfriend are wife will generally sign.
Sometimes it's hard to convince really liberal types, because they want to go whole hog and set up a single-payer in Massachusetts. (I think that the existence of Medicare and Federal matching for Medicaid would make this difficult.)
But I also got a really odd answer from one woman who did, ultimately, agree to sign.
BG: Would you like to sign a petition to put affordable healthcare on the ballot?
W: Sure, as long as it's affordable and not universal.
(The bill in question would cover about 350,000 people out of a population of 500,000 uninsured.)
BG: No, it's not, in fact, universal, but why are you opposed to universal coverage?
W: Because those systems ration care.
BG: I'm not sure that that's true. The French get more doctors' visits, and it costs less. (Maybe I should have mentioned Switzerland.)
W: The French system is terrible; they refuse to treat people. I work at Fancy Teaching Hospital and we get smokers from France with lung cancer who are denied treatment under their system.
I got her signature and moved on, but, really, what can you say to that?
The government has to subsidize private insurance companies because otherwise those insurance companies would make it impossible to create a universal system -- because, naturally enough, they don't want to be put out of business.
"Rationing care" is a funny worry. I wonder if those people have ever had a claim denied.
I don't think it is true. She's just met a small sample of very rich people who have chosen to come to the U.S. for treatment.
There are also ethical questions surrounding the aggressiveness of treatment in the U.S. In New York city, there are an awful lot of expensive bypass surgeries performed on very old people who do worse as a result of surgical intervention. For those people pharmaceuticals would probably be a better choice, and it would cost less.
Sam K--According to Ted Barlow, and most other sources I've seen, pretty much every universal system, yes. In comments Lemuel Pitkin says that the problem is that insurance companies create a lot of bureaucracy, take profits, and put a lot of resources into trying to shift costs onto other aspects of the health-care system; he doesn't give evidence, though, so I don't know how true this is. (There's also quite a bit of libertarian and-a-ponyism from other parties in comments.)
I can't read--I took Sam K to be asking if all universal systems are cheaper, rather than if they all deny care. Of course our system denies care all over the place, starting with the uninsured. What Adam said about the subsidies to insurers--Yglesias has said that the main divide in health care proposals is between those who realize that the current interested parties are evil and must be destroyed, and those who don't.
I find persuasive the argument in Lindert's Growing Public that public health spending improves public health; it's short and runs pp. 257-262, you can flick through it on amazon if you want to. If you really want to get into the nitty gritty of this issue, the OECD data makes a good place to start.
And I used to work at a health insurance company. We ration care here, too, even if you have insurance. If you get a treatment that must be pre-approved as necessary without getting that pre-approval (and the doctors never know and will advise you anyway that it's fine, it's covered, come in on Tuesday) your claim will be denied and you will be left with the bill.
I quit working in health insurance after a few too many cases like that crossed my desk.
I've long said that when The Revolution™ comes and I take my rightful place as benevolent despot, the insurance executives will be the first ones up against the wall. Blindfolds and cigarettes will not be covered; those remain out-of-pocket expenses.
There was a case made for Universal Heathcare in the Washington Monthly last summer, which proposed, basically, getting rid of medicare and medicaid, and thereby saving billions on bureaucracy. Then a tax is levied instead of paying directly for health insurance. In return, everyone gets a voucher for insurance, and can go with whatever insurance company they like.
That's insane. Medicare/medicaid has around a 3% overhead, the lowest any private insurance company comes in is around 6% (and they go much higher than that). Medicare has no marketing costs, no shareholder profits to pay and enjoys huge economies of scale.
That's exactly right, msw. Health insurance companies are not in the business of providing healthcare. They are in the business of 1) shuffling paperwork, and 2) extracting a layer of profit for their shareholders from said paperwork shuffling. Increasing the role of a fundamentally parasitic industry is an ass-backwards way of containing costs.
Also, re: 32 & 34, it's been my experience that in many cases the doctors themselves are as much to blame.
My 10-year-old sister broke her wrist last year, so my dad, who is uninsured, called several urgent care clinics to find out what an x-ray would cost. They were all comparable, but the place he finally chose said it would cost between $75-100. After the x-ray and the Dr. determined that the wrist was, in fact, broken, the bill came to ~$450 (fuzzy memory). My dad asked for an explanation, reminding them that they had quoted him $75-100 over the phone earlier that day. "Well, sir, the x-ray came back positive." Apparently that makes a difference, now. He found out later that what he was paying for was 90-day "after-care" --but, if you'll recall, this is a broken bone, and THERE IS NO DAMN AFTER-CARE. Urgent care can't set the cast, and the brace won't do.
What's worse is the next Dr. required new x-rays the next day. ugh.
msw--I prefer single-payer too, but there is the Alain Enthoven argument which says that true managed care, which is not about cost shifting but actually helping people to manage chronic diseases and get the best care at an effective cost, works best when there's some competition. (He's all for restrictive networks and is having a big argument with Michael Porter on this point.)
I don't think that we can leave everything to the doctors in a fee for service system, and navigating the health care system is extraordinarily complicated on your own.
Back surgery is way overdone, and a lot of the people report that their back pain is worse. So if a back surgeon, who stands to benefit financially from the procedure, tells me that I need back surgery, I'll take advice with a grain of salt.
I've got a question for the rest of you though. Do any of you talk to your friends and family offline about your dissatisfaction with the current system. A lot of my friends aren't quite yet willing to make the leap. Some of them fear the bureaucracy. My godmother's a bit like this, although she's incredibly liberal and will probably come around. She works for Harvard which has its own HMO on site, and she's been very happy with the care she's gotten there. I don't think that medicare for all would have to destroy company specific clinics.
I do think that we need to do a lot more persuading at the local level. There are limits to what we can do at the state level now, but I think that we can work ob pushing the citizenry so that they'll demand something better, and I think that person-to-person interactions are a big part of that.
Like head-over-heels. I don't know about you, but I spend most of my time in that position.
This is getting into griping about insurance rather than policy arguments (for the record, slol's 18 and apo's 39 are dead on) but what really burns me about interacting with the system is the way, as described in the last couple of posts, that coverage is made so complex that it can easily be denied because the doctor put in the claim wrong.
I just had a claim for my daughter's yearly physical denied, because they only authorize one physical a year. Of course, this is her first physical this year -- apparently a visit to the pediatrician for an actual illness earlier in the spring was mistakenly billed as a physical. Now, I have no way of straightening this out -- the doctor has to -- and if the doctor tries to bill me for the visit (which she hasn't yet) I plan to point that out to her. I'm not actually out any money on this one, but man am I annoyed.
This summer, we were vacationing down at Hilton Head Island, when Noah (at the time ~6 months old) came down with an obvious case of pinkeye. No problem, Tobramycin drops for a week and it's over. Been there, done that with the first kid. Except we were in South Carolina, which means our North Carolina pediatrician can't just phone in a prescription for the $6 bottle of eyedrops because, you see, the two states only have 11 of 13 letters in common.
So we go to the local Urgent Care, fill out an absurd number of forms, wait an hour or so, and the doctor comes in. He takes one glance at Noah and says, "He has pink eye. Here's a piece of paper I signed so you can go get a six-dollar bottle of Tobramycin drops. That will be $105, please."
I'm a grad student who's significantly more liberal & more educated than my parents. I keep trying to convince them that universal healthcare makes economic and moral sense, but I encounter this odd resistance to anything smacking of socialism. As much I tell them costs are lower, quality of care will not decrease, etc, they simply don't believe me. I really don't know what it is, as my parents are really middle-of-the-road politically, and it was Bush's handout to pharmaceutical companies (oops, I mean "prescription drug reform") that finally pushed them into being openly critical of him.
I certainly do. People usually tell me to stop talking about healthcare once I roll out some of my stories and ask them why it is that in America, land of plenty, we can't keep people from dying of easily treatable diseases.
Then again, most people tell me to stop talking after about twenty minutes.
And you could tell the doctor you won't pay the bill- many people do. And then it ruins your credit. That is what happens to a lot of bankrupt people- medical bills trigger about 50% of bankruptcies. Of course we've tightened that loophole so that people who get cancer while uninsured are stuck not answering their phones and tearing up bills unread because they can't pay them.
We have a great health care system! The best in the world! If you don't ever get sick enough to worry about the lifetime cap on your insurance, if you have it.
I prefer "ass over teakettle" though I can't for the life of me figure out how it came to have its current meaning. I think it's especially well-used for falling in love.
Oh winna, I know that it could ruin my credit, but I'd get a lawyer to write threatening letters, and I'd contest it, because it was the damn doctor's fault.
Matt: I can't visualize that position -- all I'm coming up with is on your knees, with your head flung back. Which, although certainly abandoned looking, doesn't seem to convey having just fallen in love much.
And SG: That's been one of the greatest victories of the right. Perfectly reasonable, normal people look at social democratic programs and think "Social Democracy=Socialism=Communism=Soviet Russia=Omigod, Joe Stalin's gonna come git me and throw me in the gulag." God only knows how we're going to fix it.
I think you have to in midair for it to work. And what you said in the second half of 56, plus there's this weird belief that private companies are always just more efficient. Well, maybe they are more efficient at some things, but those things are not necessarily connected with delivering service to customers (one day I will be blogging my experiences with U-Haul, hoping that it will do them some harm).
LB, regarding your second point: Now that we are starting to see people of voting age who are not old enough to remember a time when the Soviet Union existed, I wonder if this argument will start to loose traction. Socialism ain't the boogeyman that it used to be. For all that I criticize GWB's War on Terror rhetoric, I thank my lucky stars that Osama bin Laden never came out in favor of universal health care.
We need Tia to write the script for the re-education camps, although that might be in conflict with some ethical duties she'll learn about in her psychology program.
My favorite joke about the health care system comes from Matthew Holt's health care blog. He's been writing up the strike against Sutter Health in California and the fights over whether they ought to be considered a non-profit, since they are raking in more dough than almost anybody and don't actually seem to be offering much in the way of charity care.
This is a real gem:
Meanwhile, on the issue of giving free care to the uninsured (or not, as the case seems to be) Sutter is now pointing out that it thinks it gives lots of charity care because it "writes off" some $40m a year in discounts that it gives Medicaid and Medicare off its charges. After you pick yourself up from rolling on the floor laughing about that one, there is the slightly more serious issue that they raise which is that everyone else does it (or actually, doesn't do it). "Everyone else", in this case, of course means Kaiser.
I love their new definition of charity, and Sutter is known for very aggressive collection practices too. They sued a bunch of people who signed on to a class action related to the excessive fees they charge the uninsured.
These are a little old (10/03), but the American people aren't as against universal coverage as anecdotal evidence might suggest:
"Which of these do you think is more important: providing health care coverage for all Americans, even if it means raising taxes, OR, holding down taxes, even if it means some Americans do not have health care coverage?"
Coverage For All: 79%
Holding Down Taxes: 17%
Unsure: 4%
"Which would you prefer: the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance, OR, a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?"
It might be relevant to point out that my parents live in Texas.
Also, I really don't see this knee-jerk negative reaction to socialism getting better in my generation. I think a lot of Reagan's nonsense has trickled down to become conventional wisdom among folks my age (mid-20s). I know people who would argue that private companies are a priori more efficient than government. Maybe being from Texas just makes me pessimistic.
Joe D--Most people support universal health coverage, and they have for a long time. That doesn't seem to be the problem. The problem is getting them to vote out the legislators who won't provide them with something decent and replace them with some who will.
There's also a huge disinformation marketing campaign. I guess there were polls during the Clinton healthcare fiasco where people all said that they were against the Clinton program, but when the details of it were described they all said that they supported that sort of plan.
I think the motivation behind that Washington Monthly keep-the-insurance-companies plan was expressly partly, and probably covertly wholly (how many adverbs can I fit into this sentence?) to try to create a coalition of interests that would unite behind a plan for universal coverage, and they thought that insurance companies would be powerful enough to scuttle anything that did them in.
I've often wondered whether we shouldn't have a period where individuals can buy into medicare and get a tax deduction for the premium. if the drug benefit were a bit better (and I've got a few thousand dollars worth of drug expenses annually myself), I'd totally opt for that. It would make travel within the U.S. a lot less complicated and provide continuity of coverage if I moved somewhere.
Once more people saw that as an option, the insurance sompanies would have a lot less power. They can stick around, but they have to compete with medicare.
This is all a totally theoretical discussion anyway, since we've got to (a) get a Democratic congress and (b) get a Democratic president for any of this to happen, all of which will (c) happen on the 12th.
64: I'm not your generation, but I get that sense too. A friend said that a lot of her students took "But it's socialism!" to be a reductio of any position. This in a bluer place than where I am. I had some students at UWM who were sympathetic to Marx, some very much not, but those were college students, y'know.
Have I complained lately about how Texas doesn't insure its employees for the first three months?
71: I don't get part (c), but otherwise, well, duh, yes. I would hope that more Democrats would make health care the centerpiece of their campaign and win on that. Very few of them seem willing to do that.
It's just a very good idea to provide health care coverage to children. It's cheap, effective, and it's the right thing to do.
As for "universal health care," as my economist friends tell me, it all depends on what 'single payer' means. The desirable aspects of a health care system seem to me to be (in no particular priority):
1. Supports medical innovation
2. Has incentives for cost-effectiveness for both consumers and suppliers, and is efficient at the 'systems' level
3. Minimizes free-rider problems
4. Provides access to care for the poor and unlucky
I get the sense that everyone here thinks the US does not maximize these attributes correctly, and that every other country does it better. I am unsure of this. In particular, I do not believe the evidence supports the proposition that the US health care system is markedly less efficient than other Western nations. And I think we should be very, very concerned about changes in the US health care market that have the potential to reduce medical innovation. (obviously, free well-baby visits do not have that potential)
But OK, let's just stipulate that the French health care system is 20% more efficient than the US one. Does this imply that the US could switch to that system and reap windfall benefits. I suspect the answer is no. By way of anlogy: French public schools are awesome. This accomplioshment, however, is supported by a culture of respect for learning, respect for teachers, and widespread support for central government programs. Further, France is more homogenous demographically, has less immigration, and is (I believe) less rural than the US. This leads me to suspect that merely duplicating French organizational and financial structures would be unlikely to produce similar results in the US.
1. I'm curious about efficient at the 'systems' level because (a) I don't know what that means, and (b) I'd think we want it to be efficient at all levels, to the extent possible (i.e., why is the systems level more important than other levels).
2. Also, I'm not sure what "free-rider" means in a scheme of universal healthcare.
And baa--not everybody should be too cost conscious. My Dad stopped taking his heart medicines at one point, because he was symptom free. (The doctor never explained what te drugs were supposed to do.) Of course, he landed in the hospital with a heart attack. The Blue Cross insurance that we had covered the hospital bill, but it didn't pay for the drugs.
Also, I'm not sure what "free-rider" means in a scheme of universal healthcare.
I swear, there's a woman living in Chicago who goes by a dozen different names, visits a dozen different doctors when she has a cold, riding around in a Cadillac that she paid for with the reimbursement checks she receives from her HMO.
I think that the appropriateness of your reaction depends on whether Illinois has a graduated income tax.
It's my understanding that tax wonks have some time now accepted that we effectively have a flat tax in this country. Dick Gephardt has been talking about this for awhile, and the case was also made by David Johnston in his Perfectly Legal.
Right. Because only the government has bureaucracy, while private insurance companies are friction-free conduits of money to health care providers.
I think you misunderstand. There are extesnive medicare and medicaid bureaucracies a big part of whose job is to decide who gets covered, who doesn't, and for what. This is the money that would be saved under universal health care.
79: Beats me. I could probably get supplemental insurance if I weren't disorganized and irresponsible, and I don't have any preexistings, but if you or someone in your family is sick I think you can't afford to take a job at a Texas school (except UT, which seems to have a workaround). Another new faculty type thinks this is designed to break continuity of coverage.
I do not believe the evidence supports the proposition that the US health care system is markedly less efficient than other Western nations
We rank first by a wide margin in per capita health care expenses and near the bottom of first world nations for pretty much every health care-related measure. What evidence would it take for you to support the notion that other countries are getting markedly more health care bang for their buck?
I should note that I'm probably more sympathetic to (what I assume is) baa's position than many people here. There are significant problems with our health care system, but there are also a lot of good things about it, too. It represents something like 15 percent of our economy (early '90s figures), and we should tread really, really lightly when dicking around with it.
One of the good things about some the Il. proposal is that its incremental; also, it covers kittens, so it's hard to be against it. (Isn't this precisely what Dean proposed? He gets less credit for being right about pretty much everything than I would have thought possible.)
Presumably you should be able to get COBRA from your last job?
And Michael: If the private insurance companies are doing anything at all in the Wash Mo universal-coverage-through-vouchers system, they're making decisions about who gets covered by them for what. (If they aren't making such decisions, they aren't doing anything at all -- just taking a cut of the voucher as it goes from the gov't to the health care provider). Those decisions are going to require bureacracy, which will be just as wasteful as the one they currently have. I think Tia's probably right -- the only policy reason to involve private insurance companies in universal health care is as a bribe to them not to prevent it.
LB--Sure COBRA's an option if your previous employer was big enough, but if Weiner had gone to Texas straight out of graduate school and been covered by a non-employer student plan, then COBRA wouldn't have applied.
Plus you'd have all these non-network coverage issues. Me, I don't think that I can live anywhere other than Mass or NY where you can buy community rated coverage.
There are significant problems with our health care system, but there are also a lot of good things about it, too.
Compared to the systems in other industrialized countries, what? My understanding of the facts (I'm not claiming a lot of knowledge here, and could be convinced I was wrong with data) is that we don't have a lock on technical innovation compared to other countries. What else do we get that they don't, that you worry about losing?
we should be very, very concerned about changes in the US health care market that have the potential to reduce medical innovation
Well, speaking as a fellow who works in the pharmaceutical development field, let me toss out some figures, because I hear that objection raised all the time in my industry.
CMR International estimates that worldwide pharmaceutical R&D rose to a record $53 billion last year, representing about 17% of worldwide pharmaceutical sales. This is the highest percentage of any industry (computer software and services runs about 10-11% of total sales).
53B is a big figure, but in perspective, that's a bit over half a year's spending on Iraq for us to completely subsidize the entire global pharmaceutical industry. Needless to say, even under the very most generous national health plan, we won't be required to subsidize the entire planet's pharma industry, or even just the American one.
I'm wholly unconvinced that setting up a single-payer health plan is going to pose a problem regarding medical innovation.
The canadian healthcare system is probably the best we can hope for because of the geographic issues you mention. It is still way better than the US system.
Support of medical innovation has two parts: development of new medical technologies and spread of new medical technologies. The first part needs to be strongly supported but the second part need only be supported if the new medical technologies work well for the costs. Just as agricultural credits for biofuel isn't really energy innovation, misallocation of healthcare money to marginally effective high tech solutions isn't really medical innovation.
I don't thionk that France is more ethnically homogeneous than the US. They have Algerians and other colonials, Bretons, Alsatians, Basques, provincials, and refugees from verious areas. The long-time minorities are pretty suppressed and assimilated, though.
That shit ain't cheap. Even when offered, a hefty chunk of working America can't afford it. We couldn't when the missus took an extra two months off beyond the approved period after the baby was born, because it was something along the lines of $400/month, and we were down a salary to begin with.
Luckily, no car crashes or serious illnesses before she went back to work.
And I never understood the 'ethnically homogenous' argument, anyway. How does the existence of Hmong refugees make universal health-care unworkable? Are we literally talking about the expense of hiring translators, or what? Because the health-care system we have now doesn't have all that many Hmong translators, and universal coverage, even with insufficiently culturally/linguistically sensitive providers would still be an improvement.
(My tone here is dismissive, because I don't understand the argument at all. I'm sure there's something substantial to it, I just don't get what.)
Well, I didn't come straight out of grad school, but I could've got COBRA from my last job if I'd applied. A lot of this is irresponsibility (and adverse selection, market proponents)--in this case I had taken the assurances that benefits were more or less normal and was shocked to find out that they didn't cover me for three months. By that time the COBRA deadline was past. Plus what BG said, Wisconsin insurance doesn't travel well to Lubbock. Also, COBRA costs money, and I didn't get paid between June 1 and Oct. 3, while incurring a lot of moving expenses (this is pretty typical when you switch academic jobs).
Not that I'm saying Texas is doing anything uniquely horrible--just a bit of sneaky cost-shifting, if you're on the ball enough to get your own insurance bought. As I said, I bear a lot of responsibility for not buying insurance. It's just mega-chintzy, and an insult, and really could hurt people who are coming from jobs where for whatever reason they don't have COBRA. Also, note the adverse selection.
students took "But it's socialism!" to be a reductio of any position.
I can relate my experiences from the student side: In classes where Marx was actually read, there was near uniformity against, but mostly on the grounds that his arguments are really bad and don't support his conclusions without false suppressed premises.
But support for Rawls or quasi-Rawlsian welfare stat liberalism was very high, even in the class where the professor suggested that a lot of Rawl's support comes from the timing of the publication of Theory of Justice, rather than what it actually says.
1) My parents are much like singular girl's; moderate on some things, but puzzlingly resistant to the idea of universal health care, even though throughout their own lives they've often had no or minimal health coverage. One of the specific points of resistance is the scary stories out of Canada and the UK of long, long waits for MRIs and knee replacements.
And there are shortages and long waits; but these aren't due to rationing or the inability to pay for it, but due to a shortage of nurses and doctors. (Admittedly, perhaps indirectly caused because those nurses and doctors can make more in the U.S., but that's not what's frightening my parents.)
One of my friends was amused by an American friend who was afraid to go to a UK hospital because of 'socialized medicine'.
2) baa's 100% right that people will be more thrifty if they have to spend their own money to go to the doctor (rather than clogging up emergency rooms). What it means is you wait. If the kid has a 103 degree fever, you bathe them with rubbing alcohol and give them water and popsicles and wait.
I am unconvinced, however, that this is a good thing; like apostropher's pink-eye story, there are many illnesses that do require a doctor, and treatment isn't the result of someone's mommy panicking. $105! for a normal childhood illness! And really, it is sad hearing your sister cry and apologize to your mom for going to the university clinic (tons of pain, possible flipped ovary) because she knew it cost mom money.
Cost-consciousness may end up costing you overall in the long run; if you're feeling fine and skip your physical, then the doctor doesn't catch that your cholesterol is high, so you don't catch the problem early enough to prevent the heart attack.
3) The Canadian system relies heavily on subsidies of pha
You can always make this point about any individual issue, but the problem is that there is a nearly limitless supply of worthwhile causes, obviously they couldn't pay for all of them.
Being bothered by the mere fact that an individual has $5 billion, however, is an entirely different issue.
Posted by Matt F | Link to this comment | 10- 6-05 10:35 PM
I admit that I don't see why you're upset.
Posted by SomeCallMeTim | Link to this comment | 10- 6-05 11:02 PM
Singer addresses this, in a way. But Singer takes a moral position, and would have us all giving much more money than we (probably) do.
Your issue might be different. One might say that though there's not a duty to provide such charity, there nevertheless seems to be something wrong with people not stepping up to the plate, as it were.
I would at least suggest that the price tag is likely to be significantly lower for the state than an individual. After all, the state already has people and bureaucracy in place. Still, it would seem that an individual or individuals might work with the state on tackling this problem. Another issue might be that no one has thought of doing so, which brings up the problem of social consciousness, or lack thereof.
Posted by Michael | Link to this comment | 10- 6-05 11:06 PM
I think the fact that 250,000 kids have no health insurance and 12 people each have one billion dollars, in the same state, is enough reason to be upset, even if you don't think the latter should be taking care of the former. (i.e., last paragraph of 1.)
Wait, this is this new plan where Ogged says something reasonable and we all just jerk his chain, isn't it? OK.
Posted by Matt Weiner | Link to this comment | 10- 6-05 11:07 PM
I just want to say that if people get tax rebates for Hummers, I should get tax rebates on philosophy books.
Posted by Michael | Link to this comment | 10- 6-05 11:13 PM
Even more awesome is if some billionaire in Illinois decided to buy me my Amazon wish list.
That's probably not up there with getting poor kids health insurance, though.
Is there a universal-health-care grassroots movement, anyway?
Posted by Michael | Link to this comment | 10- 6-05 11:29 PM
I'll just sit around and talk to myself.
dum de doo...
Posted by Michael | Link to this comment | 10- 6-05 11:33 PM
I'm still awake! But I think Ogged is just going to find his heart broken, following this piece of legislation.
Posted by Armsmasher | Link to this comment | 10- 6-05 11:49 PM
I do think there's an argument to be made that perhaps we should be willing to tax those extremely wealthy individuals at a higher rate in order to guarantee the ability to fund programs that make sure children have access to health care, especially if the state is going to make it illegal for children to have a full-time job with benefits.
Posted by Adam Kotsko | Link to this comment | 10- 7-05 12:02 AM
There was a case made for Universal Heathcare in the Washington Monthly last summer, which proposed, basically, getting rid of medicare and medicaid, and thereby saving billions on bureaucracy. Then a tax is levied instead of paying directly for health insurance. In return, everyone gets a voucher for insurance, and can go with whatever insurance company they like.
Posted by Michael | Link to this comment | 10- 7-05 12:41 AM
I think that the appropriateness of your reaction depends on whether Illinois has a graduated income tax. If it's a flat rate, then it's bothersome, but I think that provision of decent health care is a basic state responsibility which should not be dependent on charity. (There will always be charity at the margins; providing housing for people who need to get specialist treatment in another city is a good example of that.)
One of the criticism of Medicare part D is that it subsidises the middle class and the rich, but that's only a problem, because so many people paying FICA taxes don't have insurance. If we thought of some of our taxes as basic social insurance, it would be fine--put in according to ability to pay, take out according to need (without extra means testing).
Posted by bostoniangirl | Link to this comment | 10- 7-05 5:04 AM
Isn't this Rawlsian sorrow, resulting from our judgment of a society by the way it treats the least of its people? Therefore our opinion of its comfortable people drops when we know how its uncomfortable fare?
Posted by slolernr | Link to this comment | 10- 7-05 7:07 AM
There was a case made for Universal Heathcare in the Washington Monthly last summer, which proposed, basically, getting rid of medicare and medicaid, and thereby saving billions on bureaucracy.
Right. Because only the government has bureaucracy, while private insurance companies are friction-free conduits of money to health care providers.
And on the main post -- yes, you're absolutely right for it to bother you. It bothering you is not the end of the conversation on how it should be resolved, but it's a disgusting situation.
Posted by LizardBreath | Link to this comment | 10- 7-05 7:40 AM
If your point is "why now? why isn't this take care of already?" I'm with you. Given our cumulative wealth, we should be able to take care of children. And should have done it long ago.
If your point is that these folks should just pony up and fork it over so the state should do it, when did you sign on for libertarian paradise? If it's that people shouldn't be so rich, you've lost me.
Posted by cw | Link to this comment | 10- 7-05 7:41 AM
I don't mean to derive a specific remedy from the facts. But people sometimes don't want to admit that something is totally fucked up when all possible remedies seem bad. It seems worthwhile to say, "this is fucked up." Being able to articulate what's fucked up about it might be good. It might be that the two facts really don't have anything to do with each other; or that the conditions that make it possible for individuals to be so rick make it more likely that we can solve the lack of health coverage for kids. Open mind, and all that. But it sure seems fucked up.
Posted by ogged | Link to this comment | 10- 7-05 7:50 AM
I can't fathom why universal healthcare for kids would be at all controversial, but then again, I'm a soak-the-rich liberal.
Posted by Joe Drymala | Link to this comment | 10- 7-05 8:04 AM
Good thing I can't ever run for public office now, after 16.
Posted by Joe Drymala | Link to this comment | 10- 7-05 8:05 AM
Being able to articulate what's fucked up about it might be good.
My favorite way of putting this is, the U.S. spends more on private health insurance than other countries do on public health insurance -- which is to say, we spend more money on a bureaucracy that exists to deny us coverage than other countries do on bureaucracies that exist to extend coverage.
Posted by slolernr | Link to this comment | 10- 7-05 8:18 AM
We don't actually need to debate universal health care, do we, unless baa comes back? Our government spends as much per capita on health care as governments in countries that don't have universal health care, and we don't have universal health care. We've just got the worst health care system of any of the advanced democracies. It hurts business too; it even took down Bill Frist. What's notable about the Illinois situation is the way it hits us between the eyes with injustice, not the fact that our health-care situation is in fact suboptimal.
Posted by Matt Weiner | Link to this comment | 10- 7-05 8:19 AM
Ah, nicely put before me, slol.
Posted by Matt Weiner | Link to this comment | 10- 7-05 8:19 AM
My favorite way of putting this
Damn! That's so well put, I'll be stealing it, thanks.
Posted by apostropher | Link to this comment | 10- 7-05 8:24 AM
What if, as I believe, many of the so-called "children" are actually adult midgets? Does that change any of your intuitions, comrades?
Posted by SomeCallMeTim | Link to this comment | 10- 7-05 8:32 AM
tax those extremely wealthy individuals at a higher rate
Hey, good idea! Oh, wait.
This is why I am not a republican.
Posted by silvana | Link to this comment | 10- 7-05 8:35 AM
You know, the universal health care thing is really funny.
I've been out collecting signatures for a ballot initiative in Massachusetts that would significantly expand MassHealth, improve the benefits, and make private health insurance more affordable.
There are all kinds of weird dynamics when it comes to getting people to sign. Young single men usually blow past me, but those accompanied by a girlfriend are wife will generally sign.
Sometimes it's hard to convince really liberal types, because they want to go whole hog and set up a single-payer in Massachusetts. (I think that the existence of Medicare and Federal matching for Medicaid would make this difficult.)
But I also got a really odd answer from one woman who did, ultimately, agree to sign.
BG: Would you like to sign a petition to put affordable healthcare on the ballot?
W: Sure, as long as it's affordable and not universal.
(The bill in question would cover about 350,000 people out of a population of 500,000 uninsured.)
BG: No, it's not, in fact, universal, but why are you opposed to universal coverage?
W: Because those systems ration care.
BG: I'm not sure that that's true. The French get more doctors' visits, and it costs less. (Maybe I should have mentioned Switzerland.)
W: The French system is terrible; they refuse to treat people. I work at Fancy Teaching Hospital and we get smokers from France with lung cancer who are denied treatment under their system.
I got her signature and moved on, but, really, what can you say to that?
Posted by bostoniangirl | Link to this comment | 10- 7-05 8:43 AM
Is that true of all (most) systems with universal coverage? And why is that?
Posted by Sam K | Link to this comment | 10- 7-05 8:59 AM
In return, everyone gets a voucher for insurance, and can go with whatever insurance company they like.
why should the gov't subsidize private insurance companies? I so don't get this.
Posted by mcmc | Link to this comment | 10- 7-05 9:01 AM
The government has to subsidize private insurance companies because otherwise those insurance companies would make it impossible to create a universal system -- because, naturally enough, they don't want to be put out of business.
"Rationing care" is a funny worry. I wonder if those people have ever had a claim denied.
Posted by Adam Kotsko | Link to this comment | 10- 7-05 9:07 AM
Sam K,
I don't think it is true. She's just met a small sample of very rich people who have chosen to come to the U.S. for treatment.
There are also ethical questions surrounding the aggressiveness of treatment in the U.S. In New York city, there are an awful lot of expensive bypass surgeries performed on very old people who do worse as a result of surgical intervention. For those people pharmaceuticals would probably be a better choice, and it would cost less.
Posted by bostoniangirl | Link to this comment | 10- 7-05 9:09 AM
Sam K--According to Ted Barlow, and most other sources I've seen, pretty much every universal system, yes. In comments Lemuel Pitkin says that the problem is that insurance companies create a lot of bureaucracy, take profits, and put a lot of resources into trying to shift costs onto other aspects of the health-care system; he doesn't give evidence, though, so I don't know how true this is. (There's also quite a bit of libertarian and-a-ponyism from other parties in comments.)
Posted by Matt Weiner | Link to this comment | 10- 7-05 9:12 AM
I can't read--I took Sam K to be asking if all universal systems are cheaper, rather than if they all deny care. Of course our system denies care all over the place, starting with the uninsured. What Adam said about the subsidies to insurers--Yglesias has said that the main divide in health care proposals is between those who realize that the current interested parties are evil and must be destroyed, and those who don't.
Posted by Matt Weiner | Link to this comment | 10- 7-05 9:15 AM
I find persuasive the argument in Lindert's Growing Public that public health spending improves public health; it's short and runs pp. 257-262, you can flick through it on amazon if you want to. If you really want to get into the nitty gritty of this issue, the OECD data makes a good place to start.
Posted by slolernr | Link to this comment | 10- 7-05 9:20 AM
I would vote for you, Joe. Especially after 16.
And I used to work at a health insurance company. We ration care here, too, even if you have insurance. If you get a treatment that must be pre-approved as necessary without getting that pre-approval (and the doctors never know and will advise you anyway that it's fine, it's covered, come in on Tuesday) your claim will be denied and you will be left with the bill.
I quit working in health insurance after a few too many cases like that crossed my desk.
Posted by winna | Link to this comment | 10- 7-05 9:25 AM
Damn Winna--If the doctor told me that they'd gotten pre-approval and hadn't, I'd tell him that I wouldn't pay his bill.
Posted by bostoniangirl | Link to this comment | 10- 7-05 9:30 AM
I've long said that when The Revolution™ comes and I take my rightful place as benevolent despot, the insurance executives will be the first ones up against the wall. Blindfolds and cigarettes will not be covered; those remain out-of-pocket expenses.
Posted by apostropher | Link to this comment | 10- 7-05 9:38 AM
You realize, apostropher, that it's only out of love that I'm compelled to note your daily homicidal urges?
Posted by ogged | Link to this comment | 10- 7-05 9:40 AM
Don't make me stab you in the neck, homes.
Posted by apostropher | Link to this comment | 10- 7-05 9:41 AM
repressed* daily homicidal urges.
Posted by Sam K | Link to this comment | 10- 7-05 9:42 AM
There was a case made for Universal Heathcare in the Washington Monthly last summer, which proposed, basically, getting rid of medicare and medicaid, and thereby saving billions on bureaucracy. Then a tax is levied instead of paying directly for health insurance. In return, everyone gets a voucher for insurance, and can go with whatever insurance company they like.
That's insane. Medicare/medicaid has around a 3% overhead, the lowest any private insurance company comes in is around 6% (and they go much higher than that). Medicare has no marketing costs, no shareholder profits to pay and enjoys huge economies of scale.
Posted by msw | Link to this comment | 10- 7-05 9:45 AM
That's exactly right, msw. Health insurance companies are not in the business of providing healthcare. They are in the business of 1) shuffling paperwork, and 2) extracting a layer of profit for their shareholders from said paperwork shuffling. Increasing the role of a fundamentally parasitic industry is an ass-backwards way of containing costs.
Posted by apostropher | Link to this comment | 10- 7-05 9:53 AM
Also, re: 32 & 34, it's been my experience that in many cases the doctors themselves are as much to blame.
My 10-year-old sister broke her wrist last year, so my dad, who is uninsured, called several urgent care clinics to find out what an x-ray would cost. They were all comparable, but the place he finally chose said it would cost between $75-100. After the x-ray and the Dr. determined that the wrist was, in fact, broken, the bill came to ~$450 (fuzzy memory). My dad asked for an explanation, reminding them that they had quoted him $75-100 over the phone earlier that day. "Well, sir, the x-ray came back positive." Apparently that makes a difference, now. He found out later that what he was paying for was 90-day "after-care" --but, if you'll recall, this is a broken bone, and THERE IS NO DAMN AFTER-CARE. Urgent care can't set the cast, and the brace won't do.
What's worse is the next Dr. required new x-rays the next day. ugh.
Posted by Sam K | Link to this comment | 10- 7-05 9:54 AM
People keep saying "ass-backwards" like it's an obviously bad thing.
Posted by ogged | Link to this comment | 10- 7-05 9:54 AM
msw--I prefer single-payer too, but there is the Alain Enthoven argument which says that true managed care, which is not about cost shifting but actually helping people to manage chronic diseases and get the best care at an effective cost, works best when there's some competition. (He's all for restrictive networks and is having a big argument with Michael Porter on this point.)
I don't think that we can leave everything to the doctors in a fee for service system, and navigating the health care system is extraordinarily complicated on your own.
Back surgery is way overdone, and a lot of the people report that their back pain is worse. So if a back surgeon, who stands to benefit financially from the procedure, tells me that I need back surgery, I'll take advice with a grain of salt.
I've got a question for the rest of you though. Do any of you talk to your friends and family offline about your dissatisfaction with the current system. A lot of my friends aren't quite yet willing to make the leap. Some of them fear the bureaucracy. My godmother's a bit like this, although she's incredibly liberal and will probably come around. She works for Harvard which has its own HMO on site, and she's been very happy with the care she's gotten there. I don't think that medicare for all would have to destroy company specific clinics.
I do think that we need to do a lot more persuading at the local level. There are limits to what we can do at the state level now, but I think that we can work ob pushing the citizenry so that they'll demand something better, and I think that person-to-person interactions are a big part of that.
Posted by bostoniangirl | Link to this comment | 10- 7-05 9:58 AM
People keep saying "ass-backwards" like it's an obviously bad thing.
Also, if you fall head-over-heels, exactly how is that different from normal?
Posted by slolernr | Link to this comment | 10- 7-05 10:00 AM
They're figures of speech, like "You're sure earning your pay today, peasant."
Posted by Matt Weiner | Link to this comment | 10- 7-05 10:04 AM
I'm down on figures of speech this week.
Posted by ogged | Link to this comment | 10- 7-05 10:06 AM
Like head-over-heels. I don't know about you, but I spend most of my time in that position.
This is getting into griping about insurance rather than policy arguments (for the record, slol's 18 and apo's 39 are dead on) but what really burns me about interacting with the system is the way, as described in the last couple of posts, that coverage is made so complex that it can easily be denied because the doctor put in the claim wrong.
I just had a claim for my daughter's yearly physical denied, because they only authorize one physical a year. Of course, this is her first physical this year -- apparently a visit to the pediatrician for an actual illness earlier in the spring was mistakenly billed as a physical. Now, I have no way of straightening this out -- the doctor has to -- and if the doctor tries to bill me for the visit (which she hasn't yet) I plan to point that out to her. I'm not actually out any money on this one, but man am I annoyed.
Posted by LizardBreath | Link to this comment | 10- 7-05 10:06 AM
This summer, we were vacationing down at Hilton Head Island, when Noah (at the time ~6 months old) came down with an obvious case of pinkeye. No problem, Tobramycin drops for a week and it's over. Been there, done that with the first kid. Except we were in South Carolina, which means our North Carolina pediatrician can't just phone in a prescription for the $6 bottle of eyedrops because, you see, the two states only have 11 of 13 letters in common.
So we go to the local Urgent Care, fill out an absurd number of forms, wait an hour or so, and the doctor comes in. He takes one glance at Noah and says, "He has pink eye. Here's a piece of paper I signed so you can go get a six-dollar bottle of Tobramycin drops. That will be $105, please."
Posted by apostropher | Link to this comment | 10- 7-05 10:06 AM
I spend most of my time in that position.
You need to spend more time at the Banana Lofts then.
Posted by apostropher | Link to this comment | 10- 7-05 10:09 AM
Longtime lurker here...
I'm a grad student who's significantly more liberal & more educated than my parents. I keep trying to convince them that universal healthcare makes economic and moral sense, but I encounter this odd resistance to anything smacking of socialism. As much I tell them costs are lower, quality of care will not decrease, etc, they simply don't believe me. I really don't know what it is, as my parents are really middle-of-the-road politically, and it was Bush's handout to pharmaceutical companies (oops, I mean "prescription drug reform") that finally pushed them into being openly critical of him.
Posted by singular girl | Link to this comment | 10- 7-05 10:11 AM
So the implicature is "head directly over heels, with the rest of your body off to the side somewhere," isn't it?
Also, is it used for anything other than falling in love anymore?
Posted by Matt Weiner | Link to this comment | 10- 7-05 10:13 AM
I certainly do. People usually tell me to stop talking about healthcare once I roll out some of my stories and ask them why it is that in America, land of plenty, we can't keep people from dying of easily treatable diseases.
Then again, most people tell me to stop talking after about twenty minutes.
And you could tell the doctor you won't pay the bill- many people do. And then it ruins your credit. That is what happens to a lot of bankrupt people- medical bills trigger about 50% of bankruptcies. Of course we've tightened that loophole so that people who get cancer while uninsured are stuck not answering their phones and tearing up bills unread because they can't pay them.
We have a great health care system! The best in the world! If you don't ever get sick enough to worry about the lifetime cap on your insurance, if you have it.
Posted by winna | Link to this comment | 10- 7-05 10:13 AM
Nonscientifically, I'd say no. For actually falling, you do get "arse-over-teakettle" in Britain, which is rather more vivid.
Posted by slolernr | Link to this comment | 10- 7-05 10:15 AM
I prefer "ass over teakettle" though I can't for the life of me figure out how it came to have its current meaning. I think it's especially well-used for falling in love.
Posted by apostropher | Link to this comment | 10- 7-05 10:16 AM
Oh winna, I know that it could ruin my credit, but I'd get a lawyer to write threatening letters, and I'd contest it, because it was the damn doctor's fault.
Posted by bostoniangirl | Link to this comment | 10- 7-05 10:17 AM
Jinx!
Posted by apostropher | Link to this comment | 10- 7-05 10:17 AM
Matt: I can't visualize that position -- all I'm coming up with is on your knees, with your head flung back. Which, although certainly abandoned looking, doesn't seem to convey having just fallen in love much.
And SG: That's been one of the greatest victories of the right. Perfectly reasonable, normal people look at social democratic programs and think "Social Democracy=Socialism=Communism=Soviet Russia=Omigod, Joe Stalin's gonna come git me and throw me in the gulag." God only knows how we're going to fix it.
Posted by LizardBreath | Link to this comment | 10- 7-05 10:17 AM
I think you have to in midair for it to work. And what you said in the second half of 56, plus there's this weird belief that private companies are always just more efficient. Well, maybe they are more efficient at some things, but those things are not necessarily connected with delivering service to customers (one day I will be blogging my experiences with U-Haul, hoping that it will do them some harm).
Posted by Matt Weiner | Link to this comment | 10- 7-05 10:21 AM
God only knows how we're going to fix it.
Re-education camps.
Posted by apostropher | Link to this comment | 10- 7-05 10:22 AM
Which aren't even a little like gulags. (heh heh heh)
Posted by LizardBreath | Link to this comment | 10- 7-05 10:22 AM
LB, regarding your second point: Now that we are starting to see people of voting age who are not old enough to remember a time when the Soviet Union existed, I wonder if this argument will start to loose traction. Socialism ain't the boogeyman that it used to be. For all that I criticize GWB's War on Terror rhetoric, I thank my lucky stars that Osama bin Laden never came out in favor of universal health care.
Posted by My Alter Ego | Link to this comment | 10- 7-05 10:28 AM
LOL, apostropher.
We need Tia to write the script for the re-education camps, although that might be in conflict with some ethical duties she'll learn about in her psychology program.
My favorite joke about the health care system comes from Matthew Holt's health care blog. He's been writing up the strike against Sutter Health in California and the fights over whether they ought to be considered a non-profit, since they are raking in more dough than almost anybody and don't actually seem to be offering much in the way of charity care.
This is a real gem:
Meanwhile, on the issue of giving free care to the uninsured (or not, as the case seems to be) Sutter is now pointing out that it thinks it gives lots of charity care because it "writes off" some $40m a year in discounts that it gives Medicaid and Medicare off its charges. After you pick yourself up from rolling on the floor laughing about that one, there is the slightly more serious issue that they raise which is that everyone else does it (or actually, doesn't do it). "Everyone else", in this case, of course means Kaiser.
I love their new definition of charity, and Sutter is known for very aggressive collection practices too. They sued a bunch of people who signed on to a class action related to the excessive fees they charge the uninsured.
Posted by bostoniangirl | Link to this comment | 10- 7-05 10:30 AM
Bah, Humbug!
Posted by baa | Link to this comment | 10- 7-05 10:35 AM
These are a little old (10/03), but the American people aren't as against universal coverage as anecdotal evidence might suggest:
"Which of these do you think is more important: providing health care coverage for all Americans, even if it means raising taxes, OR, holding down taxes, even if it means some Americans do not have health care coverage?"
Coverage For All: 79%
Holding Down Taxes: 17%
Unsure: 4%
"Which would you prefer: the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance, OR, a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?"
Current System: 33%
Universal Program: 62%
Unsure: 6%
Posted by Joe Drymala | Link to this comment | 10- 7-05 10:36 AM
It might be relevant to point out that my parents live in Texas.
Also, I really don't see this knee-jerk negative reaction to socialism getting better in my generation. I think a lot of Reagan's nonsense has trickled down to become conventional wisdom among folks my age (mid-20s). I know people who would argue that private companies are a priori more efficient than government. Maybe being from Texas just makes me pessimistic.
Posted by singular girl | Link to this comment | 10- 7-05 10:42 AM
Joe D--Most people support universal health coverage, and they have for a long time. That doesn't seem to be the problem. The problem is getting them to vote out the legislators who won't provide them with something decent and replace them with some who will.
There's also a huge disinformation marketing campaign. I guess there were polls during the Clinton healthcare fiasco where people all said that they were against the Clinton program, but when the details of it were described they all said that they supported that sort of plan.
Posted by bostoniangirl | Link to this comment | 10- 7-05 10:42 AM
Bah, Humbug!
Claim denied!
Posted by Ghost of Healthcare Future | Link to this comment | 10- 7-05 10:45 AM
Most people support universal health coverage, and they have for a long time
You'd think there would be some sort of political party that would capitalize on this kind of discontent with our current system.
Posted by Joe Drymala | Link to this comment | 10- 7-05 10:46 AM
Now you're just smoking crack.
Posted by LizardBreath | Link to this comment | 10- 7-05 10:50 AM
I think the motivation behind that Washington Monthly keep-the-insurance-companies plan was expressly partly, and probably covertly wholly (how many adverbs can I fit into this sentence?) to try to create a coalition of interests that would unite behind a plan for universal coverage, and they thought that insurance companies would be powerful enough to scuttle anything that did them in.
Posted by Tia | Link to this comment | 10- 7-05 10:51 AM
I've often wondered whether we shouldn't have a period where individuals can buy into medicare and get a tax deduction for the premium. if the drug benefit were a bit better (and I've got a few thousand dollars worth of drug expenses annually myself), I'd totally opt for that. It would make travel within the U.S. a lot less complicated and provide continuity of coverage if I moved somewhere.
Once more people saw that as an option, the insurance sompanies would have a lot less power. They can stick around, but they have to compete with medicare.
Posted by bostoniangirl | Link to this comment | 10- 7-05 10:55 AM
This is all a totally theoretical discussion anyway, since we've got to (a) get a Democratic congress and (b) get a Democratic president for any of this to happen, all of which will (c) happen on the 12th.
Posted by Joe Drymala | Link to this comment | 10- 7-05 10:55 AM
64: I'm not your generation, but I get that sense too. A friend said that a lot of her students took "But it's socialism!" to be a reductio of any position. This in a bluer place than where I am. I had some students at UWM who were sympathetic to Marx, some very much not, but those were college students, y'know.
Have I complained lately about how Texas doesn't insure its employees for the first three months?
Posted by Matt Weiner | Link to this comment | 10- 7-05 10:59 AM
71: I don't get part (c), but otherwise, well, duh, yes. I would hope that more Democrats would make health care the centerpiece of their campaign and win on that. Very few of them seem willing to do that.
Posted by bostoniangirl | Link to this comment | 10- 7-05 11:00 AM
It's just a very good idea to provide health care coverage to children. It's cheap, effective, and it's the right thing to do.
As for "universal health care," as my economist friends tell me, it all depends on what 'single payer' means. The desirable aspects of a health care system seem to me to be (in no particular priority):
1. Supports medical innovation
2. Has incentives for cost-effectiveness for both consumers and suppliers, and is efficient at the 'systems' level
3. Minimizes free-rider problems
4. Provides access to care for the poor and unlucky
I get the sense that everyone here thinks the US does not maximize these attributes correctly, and that every other country does it better. I am unsure of this. In particular, I do not believe the evidence supports the proposition that the US health care system is markedly less efficient than other Western nations. And I think we should be very, very concerned about changes in the US health care market that have the potential to reduce medical innovation. (obviously, free well-baby visits do not have that potential)
But OK, let's just stipulate that the French health care system is 20% more efficient than the US one. Does this imply that the US could switch to that system and reap windfall benefits. I suspect the answer is no. By way of anlogy: French public schools are awesome. This accomplioshment, however, is supported by a culture of respect for learning, respect for teachers, and widespread support for central government programs. Further, France is more homogenous demographically, has less immigration, and is (I believe) less rural than the US. This leads me to suspect that merely duplicating French organizational and financial structures would be unlikely to produce similar results in the US.
Posted by baa | Link to this comment | 10- 7-05 11:00 AM
Of course let's be cautious, but let's not be so cautious as to do nothing. The current system blows donkey.
Posted by Standpipe Bridgeplate | Link to this comment | 10- 7-05 11:05 AM
The unspoken conclusion of the phrase is "of never".
Posted by Joe Drymala | Link to this comment | 10- 7-05 11:06 AM
baa:
1. I'm curious about efficient at the 'systems' level because (a) I don't know what that means, and (b) I'd think we want it to be efficient at all levels, to the extent possible (i.e., why is the systems level more important than other levels).
2. Also, I'm not sure what "free-rider" means in a scheme of universal healthcare.
Posted by SomeCallMeTim | Link to this comment | 10- 7-05 11:07 AM
And baa--not everybody should be too cost conscious. My Dad stopped taking his heart medicines at one point, because he was symptom free. (The doctor never explained what te drugs were supposed to do.) Of course, he landed in the hospital with a heart attack. The Blue Cross insurance that we had covered the hospital bill, but it didn't pay for the drugs.
Posted by bostoniangirl | Link to this comment | 10- 7-05 11:11 AM
Also Weiner, that sucks about Texas not covering its employees for the first three months. How are people supposed to maintain continuity of coverage?
Posted by bostoniangirl | Link to this comment | 10- 7-05 11:14 AM
I swear, there's a woman living in Chicago who goes by a dozen different names, visits a dozen different doctors when she has a cold, riding around in a Cadillac that she paid for with the reimbursement checks she receives from her HMO.
Posted by Joe Drymala | Link to this comment | 10- 7-05 11:15 AM
I think that the appropriateness of your reaction depends on whether Illinois has a graduated income tax.
It's my understanding that tax wonks have some time now accepted that we effectively have a flat tax in this country. Dick Gephardt has been talking about this for awhile, and the case was also made by David Johnston in his Perfectly Legal.
Right. Because only the government has bureaucracy, while private insurance companies are friction-free conduits of money to health care providers.
I think you misunderstand. There are extesnive medicare and medicaid bureaucracies a big part of whose job is to decide who gets covered, who doesn't, and for what. This is the money that would be saved under universal health care.
Posted by Michael | Link to this comment | 10- 7-05 11:19 AM
79: Beats me. I could probably get supplemental insurance if I weren't disorganized and irresponsible, and I don't have any preexistings, but if you or someone in your family is sick I think you can't afford to take a job at a Texas school (except UT, which seems to have a workaround). Another new faculty type thinks this is designed to break continuity of coverage.
Posted by Matt Weiner | Link to this comment | 10- 7-05 11:19 AM
and that every other country does it better
Every? No. Many? Undeniably.
I do not believe the evidence supports the proposition that the US health care system is markedly less efficient than other Western nations
We rank first by a wide margin in per capita health care expenses and near the bottom of first world nations for pretty much every health care-related measure. What evidence would it take for you to support the notion that other countries are getting markedly more health care bang for their buck?
Posted by apostropher | Link to this comment | 10- 7-05 11:21 AM
Or other Texas state job, natch. Well, I guess you extend COBRA beyond the summer till December (adjust as necessary for non-academic-year employees).
Posted by Matt Weiner | Link to this comment | 10- 7-05 11:22 AM
I should note that I'm probably more sympathetic to (what I assume is) baa's position than many people here. There are significant problems with our health care system, but there are also a lot of good things about it, too. It represents something like 15 percent of our economy (early '90s figures), and we should tread really, really lightly when dicking around with it.
One of the good things about some the Il. proposal is that its incremental; also, it covers kittens, so it's hard to be against it. (Isn't this precisely what Dean proposed? He gets less credit for being right about pretty much everything than I would have thought possible.)
Posted by SomeCallMeTim | Link to this comment | 10- 7-05 11:23 AM
Nationally televised primal screams sometimes make people want to redirect due credit.
Posted by Tarrou | Link to this comment | 10- 7-05 11:27 AM
Presumably you should be able to get COBRA from your last job?
And Michael: If the private insurance companies are doing anything at all in the Wash Mo universal-coverage-through-vouchers system, they're making decisions about who gets covered by them for what. (If they aren't making such decisions, they aren't doing anything at all -- just taking a cut of the voucher as it goes from the gov't to the health care provider). Those decisions are going to require bureacracy, which will be just as wasteful as the one they currently have. I think Tia's probably right -- the only policy reason to involve private insurance companies in universal health care is as a bribe to them not to prevent it.
Posted by LizardBreath | Link to this comment | 10- 7-05 11:27 AM
LB--Sure COBRA's an option if your previous employer was big enough, but if Weiner had gone to Texas straight out of graduate school and been covered by a non-employer student plan, then COBRA wouldn't have applied.
Plus you'd have all these non-network coverage issues. Me, I don't think that I can live anywhere other than Mass or NY where you can buy community rated coverage.
Posted by bostoniangirl | Link to this comment | 10- 7-05 11:30 AM
There are significant problems with our health care system, but there are also a lot of good things about it, too.
Compared to the systems in other industrialized countries, what? My understanding of the facts (I'm not claiming a lot of knowledge here, and could be convinced I was wrong with data) is that we don't have a lock on technical innovation compared to other countries. What else do we get that they don't, that you worry about losing?
Posted by LizardBreath | Link to this comment | 10- 7-05 11:31 AM
we should be very, very concerned about changes in the US health care market that have the potential to reduce medical innovation
Well, speaking as a fellow who works in the pharmaceutical development field, let me toss out some figures, because I hear that objection raised all the time in my industry.
CMR International estimates that worldwide pharmaceutical R&D rose to a record $53 billion last year, representing about 17% of worldwide pharmaceutical sales. This is the highest percentage of any industry (computer software and services runs about 10-11% of total sales).
53B is a big figure, but in perspective, that's a bit over half a year's spending on Iraq for us to completely subsidize the entire global pharmaceutical industry. Needless to say, even under the very most generous national health plan, we won't be required to subsidize the entire planet's pharma industry, or even just the American one.
I'm wholly unconvinced that setting up a single-payer health plan is going to pose a problem regarding medical innovation.
Posted by apostropher | Link to this comment | 10- 7-05 11:34 AM
You can't get COBRA for school-related insurance? That stinks. I had no idea.
Posted by LizardBreath | Link to this comment | 10- 7-05 11:36 AM
"completely subsidize" [R&D for] "the entire global pharmaceutical industry"
Posted by apostropher | Link to this comment | 10- 7-05 11:36 AM
RE 74
The canadian healthcare system is probably the best we can hope for because of the geographic issues you mention. It is still way better than the US system.
Support of medical innovation has two parts: development of new medical technologies and spread of new medical technologies. The first part needs to be strongly supported but the second part need only be supported if the new medical technologies work well for the costs. Just as agricultural credits for biofuel isn't really energy innovation, misallocation of healthcare money to marginally effective high tech solutions isn't really medical innovation.
Posted by Joe O | Link to this comment | 10- 7-05 11:36 AM
I don't thionk that France is more ethnically homogeneous than the US. They have Algerians and other colonials, Bretons, Alsatians, Basques, provincials, and refugees from verious areas. The long-time minorities are pretty suppressed and assimilated, though.
Posted by John Emerson | Link to this comment | 10- 7-05 11:38 AM
Re: COBRA.
That shit ain't cheap. Even when offered, a hefty chunk of working America can't afford it. We couldn't when the missus took an extra two months off beyond the approved period after the baby was born, because it was something along the lines of $400/month, and we were down a salary to begin with.
Luckily, no car crashes or serious illnesses before she went back to work.
Posted by apostropher | Link to this comment | 10- 7-05 11:40 AM
And I never understood the 'ethnically homogenous' argument, anyway. How does the existence of Hmong refugees make universal health-care unworkable? Are we literally talking about the expense of hiring translators, or what? Because the health-care system we have now doesn't have all that many Hmong translators, and universal coverage, even with insufficiently culturally/linguistically sensitive providers would still be an improvement.
(My tone here is dismissive, because I don't understand the argument at all. I'm sure there's something substantial to it, I just don't get what.)
Posted by LizardBreath | Link to this comment | 10- 7-05 11:42 AM
Well, I didn't come straight out of grad school, but I could've got COBRA from my last job if I'd applied. A lot of this is irresponsibility (and adverse selection, market proponents)--in this case I had taken the assurances that benefits were more or less normal and was shocked to find out that they didn't cover me for three months. By that time the COBRA deadline was past. Plus what BG said, Wisconsin insurance doesn't travel well to Lubbock. Also, COBRA costs money, and I didn't get paid between June 1 and Oct. 3, while incurring a lot of moving expenses (this is pretty typical when you switch academic jobs).
Not that I'm saying Texas is doing anything uniquely horrible--just a bit of sneaky cost-shifting, if you're on the ball enough to get your own insurance bought. As I said, I bear a lot of responsibility for not buying insurance. It's just mega-chintzy, and an insult, and really could hurt people who are coming from jobs where for whatever reason they don't have COBRA. Also, note the adverse selection.
Posted by Matt Weiner | Link to this comment | 10- 7-05 11:47 AM
students took "But it's socialism!" to be a reductio of any position.
I can relate my experiences from the student side: In classes where Marx was actually read, there was near uniformity against, but mostly on the grounds that his arguments are really bad and don't support his conclusions without false suppressed premises.
But support for Rawls or quasi-Rawlsian welfare stat liberalism was very high, even in the class where the professor suggested that a lot of Rawl's support comes from the timing of the publication of Theory of Justice, rather than what it actually says.
Posted by washerdreyer | Link to this comment | 10- 7-05 11:56 AM
I really should read me some Rawls.
Posted by Joe Drymala | Link to this comment | 10- 7-05 11:57 AM
Read Political Liberalism, it's short and clear, and gives you all the basic ideas in Theory of Justice.
Posted by ogged | Link to this comment | 10- 7-05 11:58 AM
I really should read me some Rawls.
You should just book him for your next corporate event.
Posted by apostropher | Link to this comment | 10- 7-05 11:59 AM
1) My parents are much like singular girl's; moderate on some things, but puzzlingly resistant to the idea of universal health care, even though throughout their own lives they've often had no or minimal health coverage. One of the specific points of resistance is the scary stories out of Canada and the UK of long, long waits for MRIs and knee replacements.
And there are shortages and long waits; but these aren't due to rationing or the inability to pay for it, but due to a shortage of nurses and doctors. (Admittedly, perhaps indirectly caused because those nurses and doctors can make more in the U.S., but that's not what's frightening my parents.)
One of my friends was amused by an American friend who was afraid to go to a UK hospital because of 'socialized medicine'.
2) baa's 100% right that people will be more thrifty if they have to spend their own money to go to the doctor (rather than clogging up emergency rooms). What it means is you wait. If the kid has a 103 degree fever, you bathe them with rubbing alcohol and give them water and popsicles and wait.
I am unconvinced, however, that this is a good thing; like apostropher's pink-eye story, there are many illnesses that do require a doctor, and treatment isn't the result of someone's mommy panicking. $105! for a normal childhood illness! And really, it is sad hearing your sister cry and apologize to your mom for going to the university clinic (tons of pain, possible flipped ovary) because she knew it cost mom money.
Cost-consciousness may end up costing you overall in the long run; if you're feeling fine and skip your physical, then the doctor doesn't catch that your cholesterol is high, so you don't catch the problem early enough to prevent the heart attack.
3) The Canadian system relies heavily on subsidies of pha