I know, most of you have already figured out why I oppose national health care. In a nutshell, I hate the poor and want them to die so that all my rich friends can use their bodies as mulch for their diamond ranches. But y'all keep asking, so here goes the longer explanation.
Basically, for me, it all boils down to public choice theory. Once we've got a comprehensive national health care plan, what are the government's incentives? I think they're bad, for the same reason the TSA is bad. I'm afraid that instead of Security Theater, we'll get Health Care Theater, where the government goes to elaborate lengths to convince us that we're getting the best possible health care, without actually providing it.
That's not just verbal theatrics. Agencies like Britain's NICE
are a case in point. As long as people don't know that there are
cancer treatments they're not getting, they're happy. Once they find
out, satisfaction plunges. But the reason that people in Britain know
about things like herceptin for early stage breast cancer is a robust
private market in the US that experiments with this sort of thing.
So
in the absence of a robust private US market, my assumption is that the
government will focus on the apparent at the expense of the
hard-to-measure. Innovation benefits future constituents who aren't
voting now. Producing it is very expensive. On the other hand,
cutting costs pleases voters this instant. This is, fundamentally,
what cries to "use the government's negotiating power" with drug
companies is about. Advocates of such a policy spend a lot of time
arguing about whether pharmaceutical companies do, or do not, spend too
much on marketing. This is besides the point. The government is not
going to price to some unknowable socially optimal amount of pharma
market power. It is going to price to what the voters want, which is
to spend as little as possible right now.
It's not that I think
that private companies wouldn't like to cut innovation. But in the
presence of even rudimentary competition, they can't. Monopolies are
not innovative, whether they are public or private.
Advocates of
this policy have a number of rejoinders to this, notably that NIH
funding is responsible for a lot of innovation. This is true, but
theoretical innovation is not the same thing as product innovation. We
tend to think of innovation as a matter of a mad scientist somewhere
making a Brilliant Discovery!!! but in fact, innovation is more often a
matter of small steps towards perfection. Wal-Mart's revolution in
supply chain management has been one of the most powerful factors
influencing American productivity in recent decades. Yes, it was
enabled by the computer revolution--but computers, by themselves, did
not give Wal-Mart the idea of treating trucks like mobile warehouses,
much less the expertise to do it.
In the case of pharma, what an
NIH or academic researcher does is very, very different from what a
pharma researcher does. They are no more interchangeable than
theoretical physicists and civil engineers. An academic identifies
targets. A pharma researcher finds out whether those targets can be
activated with a molecule. Then he finds out whether that molecule can
be made to reach the target. Is it small enough to be orally dosed?
(Unless the disease you're after is fairly fatal, inability to orally
dose is pretty much a drug-killer). Can it be made reliably? Can it
be made cost-effectively? Can you scale production? It's not a viable
drug if it takes one guy three weeks with a bunsen burner to knock out
3 doses.
Once you've produced a drug, found out that it's active
on your targets, and produced more than a few milligrams of the stuff,
you have to put it into animals, then people. Does your drug do
anything in animal studies? Does it do too much, like, say, killing
the patient? How about humans? Oral dosing is just the start. Does
your drug actually get somewhere after it's swallowed, or do the
stomach/liver chew it up? Is there any way to wrap it in a protective
package long enough to let it reach its target? Do clinical trials
show efficacy compared to placebo, or other drugs? How big is the
market (in other words, how many people want it, how badly, and how
much of an improvement is your drug)?
This is the stuff
academic pharma doesn't do, and as you can see, without it, you don't
have a drug; you have a theory. What the NIH does is supremely
valuable. But so is all that "useless" effort at the pharmas.
Now,
maybe government institutions could be made to produce innovations; I
certainly think it's worth trying Dean Baker's suggestion that we
should let the government try to set up an alternate scheme for drug
discovery. Prizes also seem promising. But I want to see them work
first, not after we've permanently broken the system. The one industry
where the government is the sole buyer, defense, does not have an
encouraging record of cost-effective, innovative procurement.
At
this juncture in the conversation, someone almost always breaks in and
says, "Why don't you tell that to an uninsured person?" I have.
Specifically, I told it to me. I was uninsured for more than two years
after grad school, with an autoimmune disease and asthma. I was, if
anything, even more militant than I am now about government takeover of
insurance.
But you can also turn this around: why don't you
tell some person who has a terminal condition that sorry, we can't
afford to find a cure for their disease? There are no particularly
happy choices here. The way I look at it, one hundred percent of the
population is going to die of something that we can't currently cure,
but might in the future . . . plus the population of the rest of the
world, plus every future generation. If you worry about global
warming, you should worry at least as hard about medical innovation.
The
other major reason that I am against national health care is the
increasing license it gives elites to wrap their claws around every
aspect of everyone's life. Look at the uptick in stories on obesity in
the context of health care reform. Fat people are a problem! They're
killing themselves, and our budget! We must stop them! And what if
people won't do it voluntarily? Because let's face it, so far, they
won't. Making information, or fresh vegetables, available, hasn't
worked--every intervention you can imagine on the voluntary front, and
several involuntary ones, has already been tried either in supermarkets
or public schools. Americans are getting fat because they're eating
fattening foods, and not exercising. How far are we willing to go
beyond calorie labelling on menus to get people to slim down?
These
aren't just a way to save on health care; they're a way to extend and
expand the cultural hegemony of wealthy white elites. No, seriously.
Living a fit, active life is correlated with being healthier. But
then, as an economist recently pointed out to me, so is being
religious, being married, and living in a small town; how come we don't
have any programs to promote these "healthy lifestyles"? When you
listen to obesity experts, or health wonks, talk, their assertions boil
down to the idea that overweight people are either too stupid to
understand why they get fat, or have not yet been made sufficiently
aware of society's disgust for their condition. Yet this does not
describe any of the overweight people I have ever known, including the
construction workers and office clerks at Ground Zero. All were very
well aware that the burgers and fries they ate made them fat, and
hitting the salad bar instead would probably help them lose weight.
They either didn't care, or felt powerless to control their hunger.
They were also very well aware that society thought they were
disgusting, and many of them had internalized this message to the point
of open despair. What does another public campaign about overeating
have to offer them, other than oozing condescension?
Of course,
the obese aren't the only troublesome bunch. The elderly are also
wasting a lot of our hard earned money with their stupid "last six
months" end-of-life care. Eliminating this waste is almost entirely
the concern of men under 45 or 50, and women under 25. On the other
hand, that describes a lot of the healthcare bureaucracy, especially in
public health.
Once the government gets into the business of
providing our health care, the government gets into the business of
deciding whose life matters, and how much. It gets into the business
of deciding what we "really" want, where what we really want can never
be a second chocolate eclair that might make us a size fourteen and
raise the cost of treating us.
I realize that to most people,
these are airy-fairy considerations that should be overridden by the
many "practical" considerations of the awesomenes of central health
care. Well, I'm actually pretty underwhelmed by that awesomeness, for
reasons I'll happily elaborate elsewhere. But not here, because
fundamentally, to me, the effect on the tax code and the relative
efficiency of various sorts of bureaucracy are mostly beside the
point. The real issue is the effect on future lives, and future
freedom. And in my opinion, they way in overwhelmingly on the side of
stopping further government encroachments into health care provision.
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Jul 28 2009, 3:03 pm
Why I Oppose National Health Care
Comments (130)
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Hard to disentangle this incredible mix of paranoia, ignorance, and sheer sloppy thinking. I'll leave it to others with more time than I have. Please grow up, Megan, do some reading, maybe visit a foreign country.
What I often am taken aback by is this blind faith in the free market.
So much of our health/medical research and innovation comes from our heavily subsidized Public Universities and the "private" universities that receive special tax exempt status. At the same time those private universities receive grants from the NIH, EPA, FDA, DOD, and other government organizations that I'm not thinking of right now.
Those same government departments do their own in-house research to improve our quality of life. If we go to a public option, how will that change?
Let the free market bring us the Ipods and HDTVs. I'd rather have rationing occur when there simply isn't enough to go around, rather than have rationing because it doesn't serve a profit margin.
For a society that is productive and efficient, give me the same folks who purchased Louisiana and Alaska, created the Tennessee Valley Authority, put a human being on the moon, helped end the Great War and World War II, connected our cities and rural areas with the most vast ground transportation system in the world, etc. etc.
The same people I work with in the National Guard.
...and if the Public Option fails (as long as its given a fair shot) then we can but this public/private debate to bed.
Another mroon using the "blind faith" arguement. The faith placed int he Free-Market is non-existant as what this man clealry did was provide excellent and reasonable arguements that are founded upon thousands of years of human existance. The Free-Market is perfect get ove rit and stop beign a retrograde fascist twit. We do not have a free-market system in America but a severely "regulated" (hampered), controlled, taxed, and misallocated resources by governemnt interference in insurance and many other industries. Add to that the crippling lawyer gangs roving aorund with one dishonest pos lawsuit after another that jacks up the costs fo eveyrthing from medicine to surgeries.
Add to that the rest of our economy that has been held back and destroyed by leftist evil for 80 years now from the Fed to the Income tax to ANWR to all the other prohibitions against businesses from produicing real wealth and well we would be able to affor da lot more than we can now.
I find it amusing fools like you ignore the greatness and innovation of the market which is repsonsible for all technology and practices that have saved so many lives and increased the lifespan of people drastically from only 200 years ago. But of course you probably will lie and point to Cuba's expected lifespan which of course a fabricated bunch of garbage as you can clearly refute from talking to any refugees the sheer amount of disease, death, and illness that plagues that socialist shithole that is full of malnourished and the dying. But yea you keep regurgitating mindless lies and bullshit "statistics" rpovded by your masters. The reality is as always different.
PS I have had a tremendous amount of experience with healthcare in this country jsut from 3 members of my family and how they passed away. We have depsite the DEms and left worst intentions still a greta ability for the market and doctors to provide comfort, treatment, and assistance far more than any other country. Escpeially places like GB and Canada were thousands each year are denied treatement and sent home to die and thrown on gigantic waiting lists were they died in droves beofre receiving any treatment whatsoever.
That's awfully bitter of you. I don't know what mroon means but I'm sure its an insult.
Well if you're not happy with the "blind faith" argument, let's talk about the countless inadequacies of the free market paradigm.
1) Asymmetrical/Imperfect Information -
Free Market requires perfect information for each individual to be able to reach equilibrium price. This never happens, particularly related to a high volume of misinformation, puffery, and the individuals inability to navigate the massive volume of information efficiently.
2) Negative Externalities/failure to internalize true costs -
A great example is pollution. So rare is it the case where a company will add the cost of pollution they put in the air into something like an airplane ticket. Hence a need for government intervention to serve a common interest such as clean air, which is unfortunately a public good.
3) The fallacy of the rational person -
No one can even begin to assume that everyone purchases things rationally. Do you think about the marginal utility of purchasing products such as one brand name jelly over another?
4) National/Regional Monopolies -
We simply need them, like public goods, because the fixed cost to start up and the barriers to entry are too significant to allow for competition - see utilities
5) Free Market inability to provide public goods -
A public good is something that benefits an entire community but there is an impossibility for the provider to recoup an adequate, if any, profit. Examples, national defense, roads, universal education, etc.
Dude, I can go on but you sound pretty bitter with the name calling, something I'm sure you wouldn't have the courage to do in person.
No reason will convince you. these technological advances that you talk about (of which you give no examples) are more likely than not brought about through some public assistance.
Your typing makes me thing you may be drunk so I probably should not take you too seriously.
Mosley, your anger and pettiness will consume you if you don't relax, take a deep breath and appreciate your country, its representative government, and all it provides you.
Of course, there is a possibility that you were not educated in public school or were educated in a private one that received no tax breaks that you were brought to on buses that had no safety/emission standards that drove on roads you built yourself, spent your entire life drinking from a water source that was drilled from your private well that was completely protected by your own efforts, ate food you grew yourself that was irrigated by your exclusive source of water, etc. etc.
Life must have been very tough never relying on institutions larger than yourself for basic necessities.
Wow, hey don't hesitate to pile on the condescension man. "Please grow up... do some reading, maybe visit a foreign country." Real classy. My guess is that Megan has done plenty of reading in her time. I'm not sure I understand why visiting a foreign country is relevant to her knowledge on the issue, but I wouldn't be surprised to find out she's done that as well.
I think Megan's piece was cogent and well-done. There wasn't any paranoia or ignorance. If you disagree with her, great, but there's no reason to be such an ass about it.
Cogent? Really? Then perhaps you could summarize it in, oh, say a hundred words. Or two hundred, even. The take-away seems to be that universal health care would lead to the government taking away your chocolate eclairs. And medical research would stop. Or something.
Otto West: Don't call me stupid.
Wanda: Oh, right! To call you stupid would be an insult to stupid people! I've known sheep that could outwit you. I've worn dresses with higher IQs. But you think you're an intellectual, don't you, ape?
Otto West: Apes don't read philosophy.
Wanda: Yes they do, Otto. They just don't understand it.
@ Red: Regarding your advice that Meghan visit a foreign country, I lived and worked in the UK for 4 years. The US healthcare system is far superior. My wife, who is British, is horrified at the thought of British-style healthcare in the US.
@ Coolhanddave: I'm often taken aback by blind faith in the state. Comparing the experience of dealing with a market institution vs. a gov't institution, one wonders how anyone can have more faith in the latter than the former.
Fine, except that no proposal for "British-style healthcare" is on the table. So she can be "horrified" all she wants, but she may as well worry about monsters under the bed.
Sir,
I have faith in the institution that provides rule of law and an education for so many regardless of their starting point.
Better idea, Red, you move out of this country and stop forcing the socialist crap sandwich down our throats. I you like socialism - go to Europe and get in queue - it is so stimulating to be part of the five year plan but it will not work here.
Red's comments are the perfect illustration of Megan's argument. Red contemptuously labels Megan as not "grown up" because she disagrees about health care. Do we want the government to decide who is a "grown up" and who is not?
Wow what a lyiung piece of shit. You thwrow out a paranoid smear, compeltely embarrassing yourself by demonstrating your complete lack of ability to understand the meaning of the fucking word. Paranoia is what liars like you do with no evidence suggesting so called "fears" of what never happens, apply that to free-market, Bush, Patrtiot Act etc. etc. all the typical left-wing hysterics that flow from your uneducated mouths.
"Visit a foreign coutnry" Why? When so many of these foreigners COME HERE to receive healthcare becauser their fascist hellhole states deny them healthcare? Canada and GB send tens of thousands at least over year per year to save their lives while otherwise in GB/Can they would be dead. We have the best quality in the world, and provide everyone with hellcare depsite the gtovernment interference so why on earth would we wan't to descend into complete bankruptcy, failure, and murdering people old young and especially babies(at an even more appaling rate concerning babies, Socialist shitholes endorse the murder of the innocent and weak as in children even more aggressively and mandate it many times becsause they can't afford through their poverty inducing system and polciies to keep up. CHINA, CUBA, NK, GB, Canada and other garbage countries)
http://www.youtube.com/watch?v=3EPd2i4Jshs
Canadaians speak...Krugman the fascist Enron crony PWNED
Wow, Red. Ridicule. And no time for substance. Shame. How convenient. It added so much to the discussion. Thanks for dropping by with your hit and run.
Alinsky Rule #5: Ridicule is man's most potent weapon." There is no defense. It's irrational. It's infuriating. It also works as a key pressure point to force the enemy into concessions.
I must say, this is some of worst nonsense I've read on Megan's blog - a blind faith in markets, and a misplaced distrust of government. A rebuttal of her main points here:http://www.thedailybanter.com/tdb/2009/07/ludicrous-arguments-against-socialized-medical-care.html
Yes, Megan, come visit Britain and see how what you are stating actually understates just how screwed up the National Health Service really is here.
And 'Red' is correct, you need to read more books: I recommend "The Welfare State We're In", which is very much on-topic.
More Americans need to travel more and read such books and be a lot less wilfully blind and parochial. State directed medical care is monstrous both morally (yes I realise most do not care if money is taken by force from other people) and practically (which is the only argument most do care about).
Much as state subsidy corrupts education and research, it does the same for medical care for all the reasons you state. Britain is a case study is why the USA would be crazy to follow the mess we have here in the UK.
Hey Red, I've worked (and seen health care services first hand) in Great Britain, Germany, Canada, and visited some European and Asian countries as well.
I wouldn't want to get really sick in any of them, but sure, they are good at dealing with common ailments.
I've not yet been to Singapore, but from my reading of Bryan Caplan, apparently they can get the same superior outcomes as the U.S. does at a quarter of the GDP share:
http://econlog.econlib.org/archives/2008/01/singapores_heal.html
Here's to solutions, not ideologies and demagogues. Cheers!
I note that 95% of these are not comments on Meghan's article, but rather complaints about her being contrary to the commenters' ideology.
How very like the complaints made by so many of the liberal left: they refuse to argue rationally but will only name-call! We deserve an inteligent conversation on this topic which will change forever our lives.
OK, so here's a reply to Megan's article.
When I read this, I hear Megan listing all the reasons she opposes a system that *no one in the U.S. Congress has proposed.* The TSA exercises a monopoly on airport security. The British NIH is a single payer healthcare system, effectively a monopoly on the provision of healthcare in the U.K. Where, in any of the proposals working their way through Congress, is anyone proposing that the U.S. government healthcare system become a monopoly or a single payer system? What's been proposed so far is a public "option".
If your argument is that the public option will drive out other providers, then make THAT argument. Or, since she's already made that argument (and left me entirely unconvinced), then at least state it as a given up front: "Since I think the current proposal will eventually create a single-payer healthcare system -- let me tell you all the reasons why I think that's a bad system."
To entirely ignore the issue, and thereby the actual bills in Congress, is, indeed, sloppy, and renders most of this post irrelevant. Even worse, by responding to proposals no one is proposing, Megan effectively caricatures the proposals that ARE being made, and thereby evades and obscures the relevant issues to be debated.
The reason I hate seeing this from Megan is that she's one of the few conservative voices of any stature who can rationally argue a conservative viewpoint. And as a very moderate liberal, if you think I trust Pelosi and crew to solve our healthcare problems, you're wrong. We need measured, conservative voices in this debate. Megan's should be one of them, and this post ain't it.
Regardless of any theoretical innovation maybe not incurred in the future, what’s clear is that right now we in the US pay a vast amount of money (far greater than any other industrialized nation) for healthcare that is not in any meaningful way “better.” Or to put another way, your argument against some type of universal coverage is predicated on continuing with a system that is demonstrably inferior at the really important stuff in favor of potential tiny incremental “innovations.”
It’s time for pundits around the US to stop treating universal coverage as some sort of a dangerous flier or an idea, every other industrialized nation has some version and every one of them spends less than we do and every one achieves functionally equivalent outcomes – we are not reinventing the wheel here.
If your argument is that the cost paid for results delivered demonstrates that the US system is "inferior" how will changing from a private to government run/managed system change that on it's own ?
Whether it is an insurance company or the government managing it the simple fact is that money paid out cannot exceed money taken in. When it does you have a few choices; raise costs, increase efficiency or reduce payouts. There really is no other option. The increase efficiency option is not something normally equated with the government so that pretty much leaves door #1 or door #3.
The one thing I've never seen and I think it's key to entire argument is a simple pie chart that breaks down where each health care dollar is spent. If we want to have an honest debate about this issue and what the best solution is we should start with the facts. If we don't we'll simply change who pays, when and how but not necessarily the how much part.
The basic premise of McArdle's argument is wrong--current health care reform proposals do not change the current system of health care choice and delivery. Medical staff are public employees in the British system, which is a nationalized HEALTHCARE structure, whereas majority of medical care US will remain in the private market, albeit with the possibility of a publicly subsidized national health INSURANCE plan to compete with private plans. So, the way health care is chosen, delivered and paid for remains the same; the health care reform goal is to reduce growing costs through the introduction of a competing public plan, icentives that promote better outcomes, versus volume/complexity of care, and reducing the number of uninsured. The forces that compell innovation would not be usurped.
current health care reform proposals do not change the current system of health care choice and delivery.
Yes they do. You don't have to drop your current insurance immediately. BUT, if you move out of state, leave your job or your insurer needs to raise your premium, you must either choose the government "option" or the government plan sold through the "exchange".
whereas majority of medical care US will remain in the private market, albeit with the possibility of a publicly subsidized national health INSURANCE plan to compete with private plans.
This plan will not allow doctors to take private payments and you cannot privately pay for an MRI if you want it.
icentives that promote better outcomes,
Yes, let's look at those incentives. The doctor will be paid more if the outcome is better. So, the doctor has incentive to treat only patients he assesses to have a higher probability of a better outcome. The patient who is really sick and most in need of care will be less profitable for the doctor and the doctor has incentive to neglect him. If you punish the doctor for neglect, then doctors will select only patients that have high probability of favourable outcomes and refuse to even treat the sickest patients.
OK Atlantic, you can get rid her now...
Wow, what a sprawling, incoherent post that was. You were even more militant against nationalized health care when you have (had?) an autoimmune disease and no insurance? So, you're just admitting you're certifiably insane? Got it.
You seriously think all research into developing drugs to combat serious illness would stop immediately if the government provided a public option?
Or, more specifically, if our health care system went from being 25% publicly-funded to 40% publicly-funded, it would destroy the drug companies?
The author seems to forget the pharma is a collection of business entities, not a force bent on saving human lives. Pharma's target market isn't the sickest of the sick, but the people with money. This is why they will continue to find new ways to treat erectile dysfunction, but are less excited about, say, HIV vaccines. Furthermore, a lot of time, energy, and resources are spent on "me-too" or "follow-on" drugs, which are minor modifications on existing drugs so that a company can jump in on that market share. I hardly consider that major innovation.
The same goes for the private insurance market. I hear a lot of complaining about how the bureaucrats are going to decide what kind of treatment you get, but the nation is forgetting that a businessman is currently making those decisions- and he has to worry about ending the quarter with a profit. 15% or more of the premiums we pay to protect ourselves in times of sickness is pocketed as profit, not spent on health care. Therefore, I would much rather see an agency with less overhead and no need to worry about stockholders decide what is covered.
Businessmen have to worry about going out of business. Bureaucrats don't.
Smashing sez: I hear a lot of complaining about how the bureaucrats are going to decide what kind of treatment you get, but the nation is forgetting that a businessman is currently making those decisions- and he has to worry about ending the quarter with a profit.
If you don't like your insuror (or your employer gets fed up with those decisions), the solution is to get another insuror. But under ObamaCare -- which, as Russ Feingold and even Obama have admitted, is a Trojan horse for single-payer -- you would not have any alternative. No, thanks.
Hmmm. How many drugs have come from government labs and agencies? Ever look at the market cap of non-US pharma lately? It's not pretty. For instance, besides MDS Inc which is 0.06% of the TSX 60, the Canadians pretty much really on US innovation and patent protections (the flip side which is patent expiries which affords cheap access) for their improving drug pipeline.
Non-US market caps:
Novartis (NVS) Switzerland 100.15B
GlaxoSmithkline (GSK) Great Britain 98.06B
Sanofi-Aventis (SNY) France 87.31B
Those three are bigger than all but JNJ and Pfizer. Other important non-US companies:
AstraZeneca (AZN) Great Britain 67.77B
Teva Pharmaceutical (TEVA) Israel 45.42B
Novo Nordisk (NVO) Denmark 36.27B
% of company sales that are earned in the US:
NVS: 36%
GSK: 40%
SNY: 31%
AZN: 43%
TEVA: 58%
NVO: 33%
The Canadians and the Europeans do rely, to a great extent, on the US for innovation in that they're free riders on the high prices we pay for drugs. That's an unpleasant reality and we can argue about how to address it, but there's no doubt that the profits available in the US both fuel and pay for drug innovation. If we were to cut our drug prices to European/Canadian levels and they maintained their prices, investment into new drugs would wane.
This is not unusual. 49% of JNJ's sales are non-US, as are 61% of Pfizer's. These are all global companies.
@coprario: The US makes up less than 5% of the earth's population and is responsible for 30-60% of sales for all the pharma companies mentioned...
In addition to things Megan mentioned above, I am concerned about how willing government is to jump to conclusions well before any good science has been done, let alone settled. Just look at the carbon bill.
Something like 95% of diets fail miserably. Just two years later the poor dieters are fatter than before they tried to diet. That's pretty conclusive evidence to me that we don't actually know what is causing the current obesity crisis (or we're right on the cause but wrong on the cure). I wouldn't put it past government to leap to an incorrect conclusion, legislate some massive 'cure' for everyone based on some popular diet or another, and make us all worse.
This is just another spin on why innovation is important. I'm waiting for the weight-loss theory that works every time, for every person.
Food satisfies an emotional need, not just a physical one.
Dieting deprives you of things you could otherwise have, and that give you immediate psychological and emotional satisfaction.
The only advantage of dieting is that in future you will be healthier and thinner. However, it takes a huge amount of self-deprivation to receive any tangible results.
I went from 250 pounds to 198 pounds and didn't notice anything really different about myself or my body. I was still, well, fat. It's deeply discouraging to notice no difference, while continuously having to look at, say, some chocolate or pizza you really want and not eat it.
Few have the self-discipline to keep up diets in the long term. The only way for them to succeed is if you figure out foods that you can switch to that you still enjoy. This is essentially impossible for most people, since there are precisely zero diet foods that taste better or even as good as the original they are emulating.
If we could tell our bodies simply not to use the food we consume - to make it come in one and and out the other, then we could satisfy our physical desires without consequence, and we will all be as thin as we want to be. Until that happy day, I think only the top 1% of self disciplined people will ever diet successfully.
I know one of those successful dieters: My mother. She is a grouch, who always looks at things negatively, and she is obsessed with physical fitness and diet. As a result of those unhappy obsessions, I grew to absolutely loathe those two things!
If you can deprive yourself of the enjoyment of life instead of chewing it in big gulps, you will live a long life. But I'm not convinced it's a happy life, just a deprived life. My mother will probably outlive me, and be as grumbly and grouchy as ever.
Thing is, I'm neither of those things. I'd rather have my life than hers, even if she outlives me. A long life isn't everything; I'd rather have a life that was actually worth living.
And in the end, most people make similar judgements, even if unconsciously, and that's why diets fail. And, for that matter, why it is almost impossible to quit smoking, too.
D
Your attitude towards dieting seems a little like willful ignorance. There is a comprehensive understanding of what causes weight gain and obesity and it is simply this: if you consume more calories than you expend daily your body will store these Calories as fat and you will gain weight over time. The abundance of cheap calories and the increasingly sedentary lifestyle of Americans' is causing obesity.
There are many possible reasons for why people wind up fatter after they diet. One is that during dieting they starve themselves of essential nutrition so their muscles diminish and when they return to their former eating habits, their bodies no longer consume as many Calories as they once did.
In addition to things Megan mentioned above, I am concerned about how willing government is to jump to conclusions well before any good science has been done, let alone settled. Just look at the carbon bill.
Something like 95% of diets fail miserably. Just two years later the poor dieters are fatter than before they tried to diet. That's pretty conclusive evidence to me that we don't actually know what is causing the current obesity crisis (or we're right on the cause but wrong on the cure). I wouldn't put it past government to leap to an incorrect conclusion, legislate some massive 'cure' for everyone based on some popular diet or another, and make us all worse.
This is just another spin on why innovation is important. I'm waiting for the weight-loss theory that works every time, for every person.
Sorry for the double post. Feel free to delete.
As far as the percentage of fat people thing - I can tell you I've heard a sea change in the way almost all my friends think about the issue, from almost all "it's other people's personal problems" to "it's our national problem".
My peers seem to have changed their opinion of personal liberty and responsibility into being much more friendly to the paternalistic nanny nudge state. I've even heard the argument that there should be something like a freedom "income" or "license" in other words, the public earns its choices by proving it can handle them responsibly.
For the obese - you set a "budget" or some kind of cap on the level of obesity - say 20%. If the societal average goes over the line, then the government is "warranted" to intrude with whatever narrowly-tailored interventions are effective and necessary to push the number back below the target because, after all, "People can't handle that freedom, so what good is it? And it's everyone else who works hard to stay healthy has to pay for the enormous cost of their self-abuse!"
It's a good point. It's not unreasonable - but it's not liberty. I think you'll be hearing a lot more of this kind of argument in the next few years.
Clearly, Megan, you do not work for yourself and are not at all responsible for paying for your health insurance. Your company is paying for it - and the startling rise in health care costs each year will soon make most businesses unable to provide insurance to their employees. That's a simple fact of math. May not bug you now, but the free market solution of jacking up health care costs astronomically each year is unsustainable.
(My insurance went up 25 percent this year - a recession year - with no change at all in the health of my family - no chronic conditions to fuss with - nothing like that. The well child visit for my five year old twins was $508 per child - so for about a half hour with medical practitioners, my insurance was billed more than $1K. And let me be clear - my children are healthy - no asthma - no allergies - nothing. That was for vaccines, and the visit and the vaccine admin fees and the developmental checkup. Sorry, but that pricing is ridiculous.)
If you were a freelancer, as I am, your asthma and autoimmune disease would render you uninsurable. All the treatments you need for your chronic conditions would be paid out of pocket. And without the net of a big group to support you, as provided by your current employer, you'd be paying the very highest prices around for your treatment. That's just a stupid business model. We're not talking Hanes undies - but treatment that can save your life. Privately insured people (like me) get ripped off totally by the free market health care system we have today.
Should you find an insurance company willing to take on your risk, you would pay an astronomical premium for the privilege of health insurance.
Right now, insurance companies "rate" people who are seriously overweight or who smoke. So in today's free market system, the people playing fast and loose with their health pay a higher premium for their behavior. Not sure how the public option is worse.
The private insurance companies make enormous profits today only because they ration health care. The CEO of UHC made more than $100 million in 2005. Just the CEO.
Because doctors are paid using this "pay-for-service" model, things like talking with a patient on the phone are low priority - because they don't get to bill for that. Managing health care is not as much of a money maker as ordering tests the patient may or may not need.
And why do tests costs so much? Look at an EOB lately? Math gets all mystical when plugged into the insurance billing system.
Focusing on "obesity" or "end of life" issues is a smokescreen. Paying for the health care needed to keep us healthy is ridiculously expensive for the healthy - and something needs to be done to change that.
The private market for health care is grossly inefficient, inexplicably expensive and does nothing really to enhance health care, when compare to outcomes in other nations that don't rely on private, for-profit health care.
Whether or not you want a "public option" is not as relevant as the fact that something must be done to control costs. Ignore that fact at your peril.
Everyone thinks health care is too expensive for them to pay for. But somehow, by the magic of the government program, something that none of us can afford will be turned into something that all of us get.
This whole debate should be about health care costs. Obamacare hasn't done anything more than wave their hands on this subject. If care were cheaper, we'd be able to provide it to the uninsured without breaking the bank. We wouldn't have the dismal future projected for Medicare spending.
And if the Feds knew how to run a medical system, Medicare wouldn't be in the situation it's in. I don't see that there's a good answer to the argument that Obama should fix Medicare first.
These astronomical costs are somebody's income, including janitors at the hospital, HMO executives, doctors, and pharmaceutical company shareholders. Who gets cut out of the deal?
$508 for vaccines and checkup doesn't sound that horrible, when I think about it. I paid about $300 in vaccines and similar treatment for my dog. Now I like dogs better than those nasty brutish and short beasts called "children" but most don't. 60% higher costs for actual humans seems rather reasonable.
Contrary to many poorly reasoned and incoherent responses ("you can get rid her now" or "wow, you're wrong, I hope somebody else responds...") your reasons for distrusting a public option are well thought out. No, innovation will not immediately cease, but it will likely be dramatically hampered and slowed considerably. Let's be honest, how much "innovation" have we seen in any government run program? Postal service? Public Schooling? Come on.
And anyway, the bottom line for the government is cost effectiveness (Hah!). The question will become: which procedures are too expensive for a person worth too little to the country? In this debate the focus has been on the uninsured and the disenfranchised. I'd honestly like to know if any of us really think that the government will provide expensive cancer treatment to an unemployed, 70 year-old, urban poor person who's not benefiting the government in any statistically measurable way. These people will become a drag on the system and we'll either wind up in another social security-like crisis or the government will refuse to give them adequate coverage. Many of those who are currently uninsured will likely remain uninsured, for all intents and purposes, under a new system because they simply aren't worth the government's money.
The argument that "this is just one option and that people can still pay for health care if they want" is absurd. The US postal service is just an option, people can always drive their letter halfway across the country themselves if they want. Public school is just an option; however, only the privileged really have an option. Anyone who can't afford Private schooling likely lives in an area with sub-par public schools (again, think inner-city). And, who's going to pay for what they can get as a government handout? However well intentioned, this is just an excuse for the government to monopolize another industry and then poorly manage it for years to come.
I'd argue that the entitlement mentality plaguing America is the source of this mess. Health care is not a right, it's a privilege. If you want to provide an uninsured person with healthcare, buy them an insurance policy. Or, donate to a charity that does. But don't pretend it's some sort of right. And don't pretend that it's the government's job to foot the bill and run the whole program. The government's not a charity, and taxes aren't donations.
As a side note, I love the partisan politics our "changed" government is still using. Oh sure, maybe there's a Republican on some committee somewhere, but overall the rhetoric being poured out is given in an either/or. We can either go with the "Democrat's" solution (and that's in quotes because the Democrats can't even agree on a bill) or we can do nothing, as if it were the only option. I also love how politics of urgency plays into this. Our options, as presented, are either "do something now (and do our "something")" or "die." Hmm... well, when you put it that way....
The alternative to the USPS is NOT driving across the country to deliver your mail personally. If you don't like the USPS, you have UPS, DHL, FedEx as other options. If you notice the existence of the USPS doesn't magically make the private options go bankrupt.
Not really, no private company is allowed to directly compete with the USPS for first class mail. They never have or will compete against the USPS.
See Wikipedia
http://en.wikipedia.org/wiki/United_States_Postal_Service
"Article I, section 8, Clause 7 of the United States Constitution grants U.S. Congress the power to establish post offices and post roads. The Federal Government has interpreted this clause as granting a de facto Congressional monopoly over the delivery of mail. According to the government, no other system for delivering mail - public or private - can be established absent Congress's consent. Congress has delegated to the Postal Service the power to decide whether others may compete with it, and the Postal Service has carved out an exception to its monopoly for extremely urgent letters."
Theoretically, yes, I could have UPS or DHL drive to my house, pick up a letter, and drive it to a friend. Practically, however, I really don't have an option other than USPS; they come to my house every day anyway. It's akin to saying that Microsoft wasn't a monopoly because other people still made competing products while, practically speaking, there was no viable competition. But, regardless, it's an unfair comparison since I still have to pay to have USPS deliver my mail. If USPS was completely government subsidized, private options would, in fact, go bankrupt.
It will be the same with the new healthcare system. Theoretically, yes, I could pay through the teeth for private healthcare or I could let Uncle Sam cover it. I know we're big into this whole personal-sacrifice-for-the-greater-good notion right now but I doubt very highly that the vast majority of Americans who work hard to keep their families insured will keep paying for it when it's free. This will be especially true when the talking heads quit pretending like the bill can pass without tax increases. Any "robust" private market will very likely cease to exist.
You seem to be echoing a common libertarian argument that private markets can always do a better job than the government. But this is often an apples/oranges comparison. Many things the government provides are not subject to normal market forces, as they are a common good. Roads for instance. Or the military. Or libraries. or schools. Or tornado warning systems.
If any of these were left solely to the private market, they wouldn't be the same thing at all. There would be examples of excellence, but they would scale according to price. And many things simply wouldn't happen. You would have pockets of access, but many people would simply be denied service. It's an absurd notion, really. Yet this is the logic of that line of reasoning. Private markets simply cannot guarantee a minimum level of public education, libraries, parks, roads, etc.
The argument for government involvement in healthcare is simply adding it to the services defined as a "common good". Just as one can go to private schools, drive on private roads, or country club parks, one can always go to private insurance.
By "common good," I suppose that you mean "public good." Roads, libraries, parks and schools do not qualify as public goods (or common goods for that matter.) Use reduces their availability and user can effectively be charged for their use or barred from using them.
And I assume you're meandering off into semantics for wonkish reasons, and not to attempt a libertarian argument! I honestly have no idea what that statement adds (or even takes away) from my point. I was talking about there being services that the private sector does not have enough incentive to provide, yet society agrees should be provided to all. I'm not sure by what sort of logic you're seriously excluding roads, libraries, parks and schools from this basic premise.
Ignoring the fact that roads, military, tornado warning systems, and other similar things need to be "public" for them to work at all (try imagining "private" interstates), your underlying premise is that the government can provide quality healthcare to everyone. I'd argue that it can't. Public schools are actually a perfect example. I live in Chicago. The quality of education in the inner city is appalling, but the quality of education in wealthy suburbs and neighborhoods is great. Why the difference? They're both government run. Does location have something to do with it? Sure, children in the inner city view education in a far more negative light than their affluent suburban counterparts. But the real issue is still money. Poor people can't generate the tax revenue, so publicly funded systems, like education, suffer.
We'll eventually see the exact same problem with healthcare. The second the government takes over health insurance, it's going to need to take over the hospitals in an effort to control quality and prices. When that happens it will be public schools all over again. The poor will still get woefully inadequate healthcare and everyone else will likely suffer to boot. And even if the government leaves hospitals private, there will be more demand for healthcare while providing no real motivation to offer better service. It'll be covered anyway.
Not to mention the fact that, while the option is on the table, no one will actually pass up free healthcare in order to pay to be offered the same treatment by the same doctors in the same facilities as they would have for free. That's really the only "absurd notion" here.
Thanks for the well thought-out response Jon. I honestly don't have the policy chops to be able to argue what a free government option might do to the marketplace. It may be that it would end up being more detrimental to the overall good than what it provides to the un/underinsured. However I think regulations on the existing market to reduce costs - and at the very minimum disallowing denial of coverage for pre-existing conditions - is a reasonable proposition.
As to my main premise being "that government can provide quality health care to everyone" (it wasn't really - I was saying that health care be considered a right), but that depends on what quality means. It may be that overall quality drops some, but millions of Americans are no longer in peril of bankruptcy, serious illness or death due, or costly burdens on hospitals. I admit this is the difficult bargain you make when balancing equal access with the market. Again though as to quality, I'm not sure other countries who have socialized medicine aren't doing as good a job for much less cost... and maybe with a bit more cost things would all balance out?
One last thing - as you brought up education. Just try and imagine for one second what it would look like if there were no public education. Tell me that is not absurd. Your point is fair regarding the non-competitiveness of government programs. But the reality is that sometimes you simply can't deny access, even if you have to settle for a lesser quality.
I'm very familiar with education research, and the fundamental difference between the suburbs and inner city is not funding - inner cities are often funded at higher rates (excepting parents as resources or fundraising - but still...). The main difference is in concentrated poverty & dysfunction. These kids are being raised in households/neighborhoods that, in addition to drug abuse, incarceration and other stresses, simply do not provide the same sort of cognitive stimulation. Children are entering Kindergarten with dramatically smaller vocabularies, as well as other indicators of linguistic and cultural knowledge.
This then only grows as they are in classrooms filled with similar students, with higher levels of behavioral issues. The curriculum then becomes interventionist, trying desperately to catch them up to grade level via rote memorization and repetition that hammers into them the concept of education as something inorganic and unenjoyable. Add to this the likelihood that, because this type of teaching is the most uninteresting and the environment the most difficult, their teacher will be from the lower-end of the labor pool, as the most qualified and experienced teachers will have sought refuge in the suburbs.
So, OK, in a sense the government isn't set up to handle the education of these kids. But who is? Seriously. Private schools are out of the question (funding). Charter schools (which are really no different than any particularly innovative public school) can do great things, but are by their nature difficult to scale. KIPP schools are based on a model of novelty, in that their status is able to attract highly talented staff who is willing to sacrifice long hours for little pay - I guarantee you that if every school was to adopt this model the system would collapse as the market for teachers simply couldn't support it.
So I don't understand what you mean when you say "it will be public schools all over again". The only realistic option for poor public schools is to provide heavy-duty enrichment to break the cycle of poverty that basically invests resources necessary to do for these kids what their parents are not. What we have now in health care is actually very similar to our public schools model, except that instead of investing in preventative care (office visits, testing, medication, etc.) we just wait until people show up at the emergency room and incur absurd and preventable expenses. It's just easier to blame the kindergarten teachers than it is the emergency rooms.
Placing this kind of power over each of us into the hands of all of us is trickier business than you might think. It is not unlike a redistribution of wealth, the questions are the same: who gets, who pays, who decides?
Jon made an observation that the decision to treat or not might eventually boil down to one of social utility. That woman ate herself into obesity, so should we reward her bad behavior and pay for her insulin? That guy drank himself into cirrhosis, so should we pony up for a liver transplant? Granny is only going to live a few months longer no matter what, so should we give her the expensive therapy? One response is that Granny is not contributing much, so she shouldn’t expect much. How do you value the contribution of Granny or the fat woman or the drunk guy? Prospectively, retrospectively?
So I have a pretty specific question. Would individuals confined to penitentiaries be included in this plan? And using the same calculus as for Granny, how do you value the contribution of a guy doing time for aggravated arson or trafficking in meth or murder for hire? In a social utility utopia, how close to death does he have to get before we throw in the towel on him? On a metaphysical level, how far from the advocates for the death penalty are the advocates for government-run or government-chosen health care?
Just asking.
That's really the scariest part of this whole thing for me personally. The government already has a pretty poor track record of taking care of people that don't contribute, but now they'd be controlling who gets treatment for illness and who dies. Why should the government pay hundreds of thousands of dollars to keep someone in a comatose state?
Like most libertarians you confuse what you'd like to believe with objectivity. How much innovation have we seen in government run programs? Well, let's see: the Apollo Program, the Manhattan Project, DARPA ... ? Can you come up with private concerns that have introduced comparable innovation without government subsidies or technological support?
Do you really contend that private insurers currently go out of their way to pay for medical care for the aged/ poor/ poor prognosis members of society? If so, you haven't been watching the scandalous efforts that private insurers make to deny coverage and/or payment to these and other segments of the population, all in the interest of increasing their bottom lines. What government bureaurocracy could possibly be worse? Before the ADA was passed, how effective was private business in providing resources for the handicapped? Answer: the private sector failed the handicapped almost totally, because they didn't constitute a financially justifiable expenditure. Enter the government and this underserved, "undeserving" population was provided with ramps and other amenities almost overnight. Once again your "argument" is based on the received wisdom of libertarian dogma, not on observable fact.
The libertarian doctrine of "rights" is nothing more than a self-serving laissez-faire fiction that produces lunatic conclusions such as "gun rights" exist, but no right to health care. Sez who? Here's a hot flash for you: rights are what we as a society determine them to be. If we agree that health care is a right, then so it is.
Government does in many cases act as a charity, because we determine that it should. Taxes are your donation - voluntary or otherwise -for living in society and taking advantage of the services and conveniences it provides, without which you'd be living under a bridge. These are truisms that mature, intelligent people understand. Libertarians and other childlike individuals want to pretend that we aren't a communal species, because it feeds their sense of importance and justifies short-sighted self indulgence. This is why, other than to provide comic relief, libertarianism contributes little of value to discussions of public policy. It's based in an egoistic fantasy world that bears no resemblance to reality.
I'm a little troubled by Megan's discussion of drug innovation.
"In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does. They are no more interchangeable than theoretical physicists and civil engineers. An academic identifies targets. A pharma researcher finds out whether those targets can be activated with a molecule."
That take on pharma might have been accurate circa 1990. But with pharma companies slashing budgets for original research, academics have been shouldering a larger and larger portion of drug discovery. Not all of it, but much of it. Case in point: Lyrica, one of Pfizer's big new stars, came out of Northwestern. It treats nerve pain, as opposed to ED.
Megan is right that pharma foots the bill for FDA testing. But that's slowly growing into its main function: identifying promising molecules discovered by academics and startups, then refining them. Well, that and those snazzy ads.
Big pharma is deeply involved in phase 3 studies because FDA's drug approval process requires it. That could change were the process restructured. They don't do this out of some sort of devotion to science and in fact big pharma's inclination to suppress negative study results is anathema to the scientific method.
As it is, drug companies do not conduct adequate post-approval surveillance for long-term or less-common side effects, despite an FDA mandate. Determining that one of their blockbusters has, say, adverse cardiovascular effects would cut into profits. So it's not done with nearly the alacrity of pre-approval studies. Moreover it is not unheard of for serious adverse effects not to be reported expeditiously. This is a conflict of interest that is not in the best interest of the public.
If the rest of the world's governments sponsored basic research to the degree this country does, big pharma would move their operations there, doubly so if they allowed direct-to-patient advertising as we, and almost no other industrialized nations, do. The drug companies know a good deal--tolerance of marketing practices that favor their bottom line over patient well-being and basic research paid for by the government--when they see it.
I'd like to note that Megan McCardle, who grew up on the Upper East Side, and went to Penn and the University of Chicago, attacks the "wealthy elite" for their bigotry. Surely McCardle understands that her membership in the "wealthy elite" is what makes her think it's a good idea for a sick person to oppose affordable health insurance.
And perhaps McCardle even understands that attacking the British health care system - without having lived there - while simultaneously defending the undefendable American health care system is an example of her own bigotry. Just because she jokes about hating the poor it doesn't mean she doesn't actually hate them.
Why is it that I never, ever hear an actual Bristish person telling me how great the British health care system is? It's always an American who is trying to convince me that it's the best system in the world. Meanwhile, I've heard and read countless people from the UK, Canada, etc, who have actually lived under those systems, talking about how horrid those national health care systems are.
I'm not an elite. I went to public high school and a state university. I have an average income that puts me solidly in the middle class. I don't have insurance through my employer and I grumble every month when I pay the premium to keep my insurance. But switching from one screwed up system to something worse doesn't sound appealing to me. Change for the sake of change is not the answer here.
Well, when I was eight I had my appendix removed in an emergency operation that saved my life. Cost to my parents? $0.
At 28 I had my knee operated on to repair damage. Cost to me? $0. In the operation they discovered a different problem with the knee, and after 6 months of rehab I had a second operation to fix the knee. Cost to me? $0.
A family member has had leukemia twice in six years. Both required chemo and the second time she spent almost two weeks in intensive care. Total cost to her? $0.
Why is this so hard to understand? In Canada we pay higher taxes than Americans, but we have access to universal health care. Is it perfect? Hell no! Does it work to give us lower per-capita health care costs (as a nation), longer life expectancy, and one less thing to obsess about as we age? Yes.
Meagan, I think you are just wrong here- in much the same way that Barry Goldwater was wrong about Civil Rights. That's not an insult-- Goldwater was an honorable and decent man. But he was wrong in assigning greater fear to government intervention than outrage as what the government was intervening to stop. Like it or not some things the government alone is big enough to fix, and the example of the rest of the planet is that the government pretty much has to do healthcare to some extent. And so you can put me down as someone who is not afraid that government healthcare will be a disaster: there are too many examples to the contrary, Nor am I some callow young thing without much concern for my health: I am 42, asthmatic, with an HIV+ partner. So I do have a dog or two in this fight.
And one thing in your argument I will respond to specifically:
"why don't you tell some person who has a terminal condition that sorry, we can't afford to find a cure for their disease? "
I have no trouble saying this at all. We already do say this (metaphorically that is). We do not have an infinite a amount of money at hand to spend on medical research and inevitably we must limit what we spend. Maybe if we threw a half trillion at ALS we could cure it. But we don't have that kind of money, so we do say to ALS patients: "We'll make you as comfortable as we can as your body slowly petrifies, but we can't afford any more research into what ails you." So really, Plus ça change, plus la meme chose there.
Finally, why do you think that the "robust private market" is going to go away? I really don't see that happening here at all. There's nothing on the table that leads to that result. When anti-reformers say things like this I feel like I am debating someone in an alternate reality. Are you sure you are not reading a lot more into this reform than is there? We aren't "gutting" the current system: we're doing a built-out on it.
(And "robust" is not a word I would use for current market at all: "dysfuctional" is more like it)
It should be like computer technology. If you want the absolute best, you pay a lot. If you want last years absolute best, you pay less. And if you want the absolute best of five years ago, you pay rock bottom prices.
If we had a combination of (stingy) public plan and lightly regulated private providers and insurance (not what we have now), advanced medical care would be expensive, but the price would drop as the private marketplace operated to reduce costs. The public plan would trail along behind picking up treatments as they got cheap.
And if you doubt it could ever work that way, look at the price inflation of medical care. We could offer the 1990 standard of care for half what care costs now, even correcting for inflation. 1990 was not some stone age version of medicine.
I assume Megan that this post is solely in regards to a national healthcare plan and not health insurance reform in a general sense. The fact is, employer based healthcare is unsustainable. With major manufacturers such as GM and others going under, many people are going to lose the health insurance they have. And one of the major reasons they went under is the healthcare they had to pay for their retirees. Do recently laid off people have the $800 it'll cost per month to cover their family through COBRA? There as to be a full scale overhaul in how health insurance is delivered to people. Non-employer based so that everyone can buy into it. Will the health insurance industry go along? That remains to be seen. Some people won't be able to get coverage due to existing conditions. Should they be able to get some sort of coverage? Perhaps government tax credits could cover some parts of this. But something has to be done, regardless of whether its a federal healthcare system or new options brought about through government legislation.
What a find a little funny is how the libertarian health care system advocates fail to see how pro business, pro entrepreneur and pro capitalist a national health care system, yes socialized medicine, can be.
Some of the basic long term micro-economic advantages.
Lower barriers to labor mobility.
Lower barriers of entry for new entrepreneurs.
Lower fixed costs for entrepreneurs as well as other self employed persons.
Lower fixed costs for all businesses with the greatest benefit going to large employers so NHC is pro job creation relative to the current system.
The macro economic advantages are lower overall expenditures on health care, which are dead losses for the national economy, so any saving here frees up monies for other areas be it personal savings, government savings (ie surplus), private or public investment or consumption.
The real limiting factor for how economically efficient national health care can be is the tax system of the country. Here the US is not doing so great. There should be a move to consumption taxes away from payroll and corporate taxes. Income taxes will probably have to rise a bit in America independently of the health care issue as America's debts from wars and recession fighting must be serviced and slowly repaid, so I am removing them from the health care funding formula. A national sales tax is the best option.
While a universal/government health care system may have to develop some incentives to promote innovation in medical treatment, that is not the only economic issue which affects the health care system. I'd suggest Ms. McArdle spend some time with Maggie Mahar's Money Driven-Medicine. The opening chapters do an excellent job of showing how our medical system takes factors which serve to improve services and reduce prices in most areas of economic life but have the perverse effect of increasing health care costs. As far as I can see, without some kind of systematic change, these costs will only continue to increase, driving more and more people out of the necessary protection provided by health care insurance. I realize the transition from our current system will be a difficult one, but to oppose the development of a reasonable universal care system primarily because it might inhibit the creation of new drugs (and unproven assertion) seems to show limited knowledge of the odd system of health care that has developed in this country.
I think the Energy bill will fail but the medical reform bill will eventually pass, producing a watershed moment in the history of the progressive movement. From 1900 to 1930, the progressive movement resulted in some very good things, like wage and hour laws and social security, but its romantic idealism, dogmatism, righteous conviction of its superior virtue and intelligence, and warped view of what is good science also brought us horrors which should give us pause. Just a few examples:
(1) Tuskegee syphilis study initiated by progressive do-gooders and executed by the federal government (including the CDC) for the “good of black men”: see http://www.cdc.gov/tuskegee/timeline.htm
(2) Jim Crow laws. See David W. Southern, The Progressive Era and Race: Reform and Reaction, 1900–1917. Woodrow Wilson, a very noisy racist and the most powerful progressive of all time, was a vigorous supporter for these “progressive” laws, whose goal was, among other things, to protect the racial purity of whites (see Eugenics below). He re-segregated the federal goverment after earlier Republican presidents had integrated it.
(3) Eugenics: Margaret Sanger. "The Eugenic Value of Birth Control Propaganda." Birth Control Review, October 1921, page 5.
"Eugenics is … the most adequate and thorough avenue to the solution of racial, political and social problems.”
Prominent, very vocal progressive advocates included: H. G. Wells, Woodrow Wilson, George Bernard Shaw, John Maynard Keynes, and, of course, Alois Schicklgruber.
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I think we can safely conclude that this wave will produce its own horrors, both intended and unintended. The new, highly intrusive and controlling medical system will be ideal for this purpose, as can already be seen in many of the House bills sections. We conservatives agree with the Bible that all men (and women) are imperfect and prone to sin and error. Even the most high-minded, intelligent, and religious are excepted (e.g., Mark Sanford is a sad but not surprising example to us all). How tedious. I could almost envy progressives their delusions of virtue and infallibility. It gives them a certain romantic zest and makes them immune to the tiresome demands of reality.
Dear Seg,
That kind of authoritarian scientific approach to social issues, which was popular in the 20s and 30s on both the right and the left, died with the Nazis and Stalinist Russia. In that the Third Reich and the USSR gave free reign to many of the invasive aggressive medical practices and in the aftermath of Allied victory they were seen (in the West) for what they were; immoral doctors playing god to prove their theories and advance their careers. Some of this carried on in the 50s in America too, the psychiatric branch of medicine being the most prone to abuse; lobotomies and electro-convulsive therapy being the big examples. Ironically to your point, it was the expansion in the scope of individual rights championed by liberals and leftists against the notion of institutional authority in America that ended these questionable medical practices.
So really to point to the the 3 things you do as a reason to fear or invalidate universal health care is a non argument. It is ahistorical to link these things with the modern american left. The left doesn't live there anymore. These practices have long been discredited and in fact discredited by liberals and leftists as well as conservatives. Your argument is fear by false association.
PS Seg,
The quip about delusions of virtue and infallibility. This really shows how beauty is in the eye of the beholder. How you can utter that statement and not think of the American Right is fantastic.
Whether we have a national plan or not the general public is going to have to learn how to control its own healthcare costs. High deductible plans make this a necessity. We as consumers need to learn how the system works, what we should be charged, and make sure that we don't over pay for what we need which in many cases we are doing right now. Check out wwww.healthcarebluebook.com, a free consumer pricing guide that tells you by zip code what health plans pay their providers for services. This gives you some idea what you should pay. Then you can shop around. Consumer education is one alternative to a national plan.
ya diet is so not the only reason people are fat. but you know moderately overweight people like to talk about the obese people to make themselves feel better.
They've done multiple studies on metabolism. A hell of a lot of it is genetics. And once you've gained weight, dieting isn't going to take the weight off.
You starve yourself, and your metabolism slows, exacerbating the problem. You have to make sure you are getting a proper diet and exercise to be healthy, and you won't necessarily lose weight.
I can't find the source right now but I read a study on metabolism of obese people who were on a strict diet for weight loss in a clinic. Their metabolism slowed to the point of someone who is starving and malnourished.
To study the flip side, they got male prisoners to eat a huge number of calories a day. Their metabolisms alternatively sped up.
Granted, over time, overeating would make one gain weight, usually as the metabolism slows as the person got older. (IE before I turned 30, I didn't gain weight, and had a hard time keeping weight on, now I'm actually above the 'ideal' weight for once, and I no longer have doctors telling me it wouldn't hurt to gain a few pounds because their convinced I'm anorexic - and yes, it was in my file, a nurse took one look at me recently and removed it)
The obesity epidemic is a distraction. Just like the rest of her article. Many countries with government health care systems also have a private track. Those with money or insurance can choose to go to the private track. Sometimes it's better, and sometimes it's not.
A friend of mine, who has been going to school in England, and has severe asthma and depression, is having trouble, now that she's back in the States, locating a medicine similar to the one available in Britain that kept her asthma under control. She was lucky enough to find an equivalent for her antidepressant. So while we may have a few treatments here that are better than theirs, for some people, they also have a few that are better than ours.
The only valid argument regarding public health care is the cost. When you consider we are already subsidizing the uninsured, but spending more because it's on emergency, rather than preventative, care, it's a moot point.
"Americans are getting fat because they're eating fattening foods, and not exercising."
Before you start commenting on obesity and how people get there, I suggest you do more thorough research. Gina Kolata's "Rethinking Thin" is a good start, and highlights a wide array of scientific studies that show that this old "calories in/calories out" binary regarding weight loss, is far more complicated than what you are alluding to with that phrase. Gina is not from a "fringe" group but a science colunnist from the New York Times. For example:
ttp://www.nytimes.com/2007/05/08/health/08iht-snfat.5614611.html
And this also Megan:
"You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back," said Traci Mann, UCLA associate professor of psychology and lead author of the study. "We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people."
http://newsroom.ucla.edu/portal/ucla/Dieting-Does-Not-Work-UCLA-Researchers-7832.aspx
And this:
"Poor nutrition and a sedentary lifestyle do cause health problems, in people of all sizes. This is why it’s so fucking crucial to separate the concept of “obesity” from “eating crap and not exercising.” The two are simply not synonymous — not even close — and it’s not only incredibly offensive but dangerous for thin people to keep pretending that they are. There are thin people who eat crap and don’t exercise — and are thus putting their health at risk — and there are fat people who treat their bodies very well but remain fat. Really truly."
http://kateharding.net/but-dont-you-realize-fat-is-unhealthy/
What exactly should we do then? I'm serious. There are millions of people uninsured, people dying because they can't get their meds, etc. Look up the numbers. O.K. fine you aren't for socialized medicine. Are you suggesting we leave people to die? Or that there is a way to reform what we have without having socialized medicine? This question seems hyperbolic, but really it isn't, that's what is being debated here: people's ability to live or die based on whether or not they are insured, or can afford their meds.
Not saying we HAVE to do socialized medicine, but this is a serious quesiton: should we do nothing? What is the conservative and/or libertarian alternative here to our current health system problems? or do you think we don't have a problem?
In large part I agree with you completely. I would point out, though, that I spend roughly $1400 per month on medicines for HIV treatment and even though it's tax deductible it is still a burden. The alternative is to declare myself a pauper and stop working. Perhaps this is an argument for less government involvement but I don't really think so. The point is, if you don't have insurance in the U.S., you're fucked. The government doesn't have to steal market incentives, just make the results of competitive research reliably in reach.
This article ignored the two elephants in the room:
1) The American economy cannot sustain the current levels of health care spending, let alone the accelerating costs. All the talk about freedom and innovation will mean very little if you can't pay for your medical system, and you can't pay for it now, and have even less prospect of paying for it in the future.
2) You don't have a free market in health care. No country has a free market in health care. Virtually all countries, and certainly all Western countries, have the last survival of the medieval craft guilds, self-governing professions with legislated monopolies running health care. Maybe that model really offers the best option for delivering health care, but let us not pretend that the United States has a free market in health care, or intends to get one.
I don't understand why the government hasn't come up with the primary reasons healthcare costs are skyrocketing, and then address those reasons to bring the costs back down. What is driving costs up so fast? Is it lawsuits and malpractice premiums causing defensive medicine to be practiced? Are the pharmaceutical companies ripping us off? Are we just sicker? What's going on that prices are going up so fast???
Karen, one factor driving up health costs is third-party payments. The lion's share of medical costs aren't borne directly by patients but instead by insurance companies or governments, and they get reimbursed indirectly (either from insurance premiums or taxes).
Patients have no idea how much treatments cost, unless they have a hefty co-payment or their medical premiums get so high they become hard to afford. Providers have little incentive to offer cost-effective care because they're going to bill an insurance company or the government for payment.
Obama's analogy about tonsillectomies was incorrect and wildly inaccurate -- for one thing, pediatricians don't perform surgery -- but the general point about the disconnection between who's getting the service and who's paying for it is correct. Each individual patient may never notice that he's being billed for services that may not be necessary but when those individual costs are multiplied by millions of patients, then the societal costs rise more than they should.
That's part of the rationale for reducing the tax advantages of employer-provided health insurance and encouraging high-deductible policies -- and in making the costs of treatment more visible to patients. If consumers had to pay more out of pocket for routine medical care, they tend to become better shoppers.
Another factor driving up health care costs is that we're a wealthy society and have more money to pay for expensive treatments that improve the quality of life, including "nonessentials" like cosmetic surgery and joint replacements. I appreciate living in a society that allows such freedoms.
I would also say that the House health-care bill could accelerate costs, at least initially, because it would move away from high-deductible policies, community rate insurance (so that people likely to have high medical costs don't pay more than people who are generally healthy), and scrap Health Savings Accounts, mechanisms that give patients more control over their out-of-pocket costs.
The House bill would entrench third-party payment. That's the wrong direction to take.
Up front I'll admit that I'm no expert in anything pertaining to this discussion. All I have is a basic understanding of policy and business and my own experiences. So, if any of this comes off as know-it-all, I'll defuse that right away.
I honestly don't understand a lot of the criticism of any government intervention in health care. "They'll tell you what kind of care you can get. They'll tell you what providers you can use. You won't have access to the best." These are some of them. My question is: How is that remarkably different from what a lot of us who work and are far from indigent live with already?
It's been four years since I had health insurance. At the time I worked for a company and had one of the prized jobs there. That didn't necessarily translate into a fat income, but it was decent and I was working in my chosen field and enjoyed the work. We had what seemed to be a decent health plan. (Recently, when my glasses broke, I really mourned the loss of the optical plan we had.) Even so, my choice of provider was limited, the co-pay was high enough that it discouraged any regular visits to a doctor, and I feared what would happen if something serious happened to me. And that's on a shiny private plan (actually three plans since the company switched every couple of years with diminishing results).
You'll forgive me if I can't see how this is much different from the horror scenarios painted about a possible government-aided plan. You might even say that if the plan was so bad I should have paid for a better one or should have traded up to a better job with a better company. That would have been great. But I really couldn't afford anything more and I guess I wasn't good enough to get a job with a bigger and better company. So, I suppose I had the health coverage my talents and ability warranted. If I'd asked for more I guess someone would say, "You're not good enough or important enough to get better than what you've got."
If you can tell me how it's worse to hear that from the government than from a private company, I'd love to hear it.
I don't claim to know any solutions. My company laid off almost its entire workforce and is not limping along with a skeleton crew. I'm freelancing and am lucky to have a fiancee who doesn't belittle me for making far less than she does. And I'm fortunate to have good genes and no chronic or debilitating health issues. I'm working hard to make a success of myself in my field and to be able to afford good care and more. Whatever form that takes when I get to it, I'll be glad to see it.
One point about telling people they should just make the budget adjustments to get the care they need. That's a lot easier said than done. And our capitalist engine wouldn't run well if people were relegated to spending money only on food, shelter, and health care. If I had chosen to take that on myself then or now, that would be a pretty unexciting and dull life. Most of us strive to cover the basic needs and eek out what's left for adding a little joy where we can get it.
And lastly (I promise), we can make a lot of hay over this obesity issue. It's not really an issue, it's personal respect and responsibility. Do you want to live in a body that functions fully for the way its built or not? I haven't always lived that way. I'm working to do better. It's not a matter of looking for a quick fix. It's a regular commitment and one worth making. Being healthy is not a choice of total denial over happiness. It's making regular choices for the good and allowing for those moments of joy and indulgence. We're at our worst (physically and mentally) when we choose the indulgence on a far too regular basis. The basic functions of calories in/calories out is just that: basic. You can live a fulfilling lifestyle and adhere to healthy eating plans. (I'm not being preachy. I'm predisposed to weight gain and it's work to maintain a healthy balance.) And getting your body into motion on a regular basis is an absolute good. Your body responds well to doing things and that ultimately improves your mental well-being. It doesn't necessarily satisfy the immediate-gratification impulse we all have. But at the end of that work are more benefits and rewards than is easy to see before you start. But like anything- a good career, a happy home life, a community you're proud to call home- it's incredibly worth the effort.
If nothing else, a single-payer system could be the catalyst for a serious discussion of which sorts of individuals are beneficial to society and which are not. I mean, if you are a sub-90 IQ fifteen year-old with a pot habit does our society really want you to carry that pregnancy to term, or aren't we all better off if you are prompted to eliminate the problem via abortion?
The state giveth and the state taketh away. Blessed be the name of the state.
Anyone who thinks the govt will do a good job of running a nationalized health system needs to go tour a V.A. hospital. Those are a national disgrace. Filthy facilities. Outdated equipment. Poor patient care. And rationed treatments at its worst.
Or how about asking liberal members of the Canadian parliament why they sneak to the US for surgeries if their socialized health system is so great?
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Thank you Megan for putting this intuitive argument into precise language. I make the same argument against the US going socialist. If you have the choice of being the economic engine, or to go along for the ride, all is well until the last car, the US, decides it doesn't want to be an engine either, and the train starts rolling backwards downhill.
Europe and Canada have both drifted right in recent years.
Another benefit of socialized medicine is that the US government could become the sole distributor of pharmaceuticals, which would still be produced by for-profit companies, which they would charge out the nose to Canada and Europe. Canada and Europe would be subsidizing the US, for once, instead of the other way around.
See the problem with you people is that you close-mindedly think "left" when you hear the term "socialism".
It's time to give right-wing socialism another shot.
The case against universal health care is that it does not work and never has anywhere including the State of MA..
The debate that we are having is very misleading.
To be sure, if we were to redesign our healthcare system from scratch, we would do it differently.
The question, however, is this: WILL THE CURRENT PROPOSED LITIGATION AS PROPOSED BY THE HOUSE AND UNDER CONSIDERATION BY SENATE FINANCE MAKE OUR CURRENT PROBLEMS BETTER OR WORSE?
It is one thing to talk about how wonderful Canada or Singapore is. That, however, is NOT what is under consideration.
Here are two stubborn facts. 80-85% of Americans have health insurance. We are going to make these 80-85% unhappy in some form or fashion to subsidize the 15-20% who don't choose to buy health insurance, are eligible for Medicaid but are too lazy to sign up, or truly cannot afford it.
The second stubborn fact is that you can't expand access to the system (i.e., increase demand) AND cut costs at the same time.
The frustrating thing is that govt could pass a series of tax and insurance reforms that would lower costs, expand access and wouldn't cost a dime.
Finally, Megan is right that the govt screws up everything they get involved with. Why wouldn't healthcare be different? Both TN and MA have tried "universal" insurance - TN abandoned their efforts (costs) and the MA plan looks like a stinker.
I want to see a liberal commenter or blogger actually go through the 1,000 page House Bill (I have) and defend it. That is more relevant than talking about Singapore.
JohnBoy: My partners and I have read the bill. The answer to your question is it will it make worse and more costly. We have did a great deal of research and your post is on the mark. The MA plan is a stinker which was originally projected 6% annual cost increase. It's experience has been 10% annual increase resulting big tax increases and cuts in benefits. One of the cuts is MA will no longer cover LEGAL immigrants. Additionally we have been lied to. What were are being told is not what HR 3200 as currently written says. We were told if you like the plan that you have you can keep it. Read pages 14-19 and you will find that it is not true. There is no reform in this bill, with cost factors such a taut and fraud reforms not even mentioned. The VA, Medicare, and Medicaid have been run by the government for decades all are in trouble and in red ink. This plan will only benefits those who are political insiders who will make money, and those who are looking for a fee ride all at taxpayer expense. If this plan was any good Congress and the Executive Branch would not have exempted themselves from it.
To add to Johnboy's spot on comments, this is not about improving healthcare, or providing increased access to healthcare for Americans. It is about the leftists in control of the DNC's ever expanding their control over another facet of the US economy. The naive posters who proclaim that it won't destroy the US health insurance industry refuse to investigate any of the facts behind what they profess to have any knowledge of. When a subsidized governmental entity is provided as an alternative to private healthcare plans, it won't have to compete on a level playing field, ever, period. It won't happen immediately, but it WILL happen, very quickly.... the competition that the subterfuge spewing socialists in the Obama administration state is important is exactly what won't happen. The "Public Option" (which is what the leftists in the Franking commission are now insisting fact speaking republican legislators state, instead of referring to Obamacare as "government healthcare".) will wipe out the ability of Americans to choose their own choice of healthcare. Everyone will eventually be stuck with a rationed, crappy governmental bureaucracy for their only healthcare choice, except the elected politicians who enacted this nightmare for Americans.
Why is it that everything the Obama administratio proposes needs to be enacted IMMEDIATELY, or life will cease to exist? It is simply because they don't want anyone to actually prudently examine the details of their socialist attack on corporate America. All of the signs where there before the election that Obama believed that socialism/marxism is the way to go. 52% of the naive American public did not want to believe that the evidence about Obama was the truth and voted for this post turtle anyway. The US did not become the leader of the free world by following socialist/marxist political philosophies. This whole frantic push to pass Obamacare is nothing but another power grab by the extreme leftists controlling the DNC.
There are many ways to curb inflationary trends to healthcare in America that the house and senate could pass in a heartbeat without destroying private healthcare in the US. ALL of the inflationary trends in medicare and medicaid far exceed the inflationary trends in the private healthcare industry. So, what makes any of you naive liberals think that any type of governmental healthcare option will be more affordable? Is it how fantastic any governmental program is managed? Name a well run efficient governmental agency.
Did any of you idiot liberals that insist that Obamacare won't eliminate private healthcare happen to notice (of course you didn't because none of you bothered to read any of the bill) that one portion of the proposed bill prohibits the renewal or beginning of any private health insurance coverage? Why isn't the post turtle of the United States talking about any of these details. Well, one, he has no idea of any of it. Other leftists in his administration have crafted this socialist agenda. He didn't. He just pushes what he thinks will expand a socialist agenda upon this once great country.
How would you like the government to be telling you how much you can make if you went a quarter million dollars into debt to put yourself through med school? Countries like Canada and the UK are experiencing massive doctor shortages because no one wants to go through the grueling experience of med school, only to be a pawn in a terribly managed govermental bureaucracy. Expect the same for American medical care physicians with Obamacare.
How do Canadian healthcare officials meet their annual budget funding constraints? They ratchet down the availability of care to the public. This rationing wasn't present immediately, but became the norm eventually as year by year, they adjusted procedure availability to Canadian citizens in order to stay within budget limitations. How long are you willing to wait for chemo, or an MRI? Wanna wait a year for a hip or knee replacement? The nationalized healthcare plan was initially an option, but eventually became mandatory. This this won't happen here with socialists in charge?
We have the greatest healthcare in the world. Nothing is perfect and there need to be some corrections to US healthcare, but these corrections can be legislated without destroying private healthcare on a gradual basis. This does not have to shoved down legislator's throats by leftist thugs in a bully administration hell bent on achieving their agenda at the expense of the American healthcare industry.
None of the proposed changes are going to save any money on any facet of healthcare. Again, it is not about cost savings or improvement, it's about an ever hungry socialist power grab.
I guess this is what happens when you get posted on RealClearPolitics, Megan: all the apparatchiks come out of the woodwork to attack whatever they disagree with using whatever personal, illogical, or fallacious means they can muster. Very mature. I happen to think this is one of your best posts. All the rest can just go back to reading Ezra Klein and his latest brilliant, just BRILLIANT, post on healthcare, confirming everything they already knew.
Oh ..... BTW.... that wonderfully run governmental institution, the postal service, just announced that it's billions in the hole again. Let's put the government in charge of our healthcare.
O.K., like JohnBoy, I, too, have actually read this beastly so-called "health care" reform bill, the House version and the Kennedy Senate version (got'em both saved to my desktop as PDFs). All I can say is "Yikes!" As JohnBoy and Megan noted, but perhaps did not quantify, is that many of the supporters on this thread of a Singapore or NIH-type system, are operating on suppositions of what they imagine it will be like. First, I'd like to make a clarifying point, and then I'll offer two examples, one from the U.S. and another from the NIH.
For starters, when everyone shouts to the rafters that "the cost of health care is going up! And I can't afford the premiums" they are conflating health insurance with health care. They are not the same. Allow me to specify.
When I was in graduate school in Indiana - one of the least regulated states in the Union for health insurance, by the way! - I had a policy through USAA, out San Antonio, Texas. It was great, too! Like a buffet, I could mix and match; I could drop this coverage; I could add that one; I could lower my co-pay and increase my premium, or do the opposite. Now USAA caters specifically to United States military officers, regardless of service (truth point here: they still insure my home and autos)and provided great flexibility to my family. For example, when my wife and I were planning our family, we added pre-natal. When the children were born, we dropped pre-natal and added pediatrician coverage. That's how the policy worked!
Fast forward to 1999. I move back to Massachusetts, my home state where I was born. About thirty days later, I get a form letter from USAA explaining to me that they could no longer offer me a health care policy. I call them up and ask why. They say that because of regulations and the State Insurance Commission mandates in Massachusetts that they can't afford to offer me a health policy unless I want to pay $4000/month for it (in Indiana, it cost me $200/month). In essence, it was against the law for USAA to sell me the policy that I wanted for my family. Gee! Who wrote that law, I wonder.
Well, what were my options now? Remember! This was 1999. We looked at policies approved by my state legislature via its Insurance Commission and all of the policies were $10,000 a year or more! No way! My wife and I made the decision that we would pay cash for everything. Even when my youngest son had two emergency hospital stays in 2003, it cost us, out of pocket, $3,500, bringing us out ahead for that year some $6,500. When people buy insurance in Mass, many things that you don't need are mandated in the coverage, jacking up the costs. For example, all family plans have pre-natal care, which, I suppose, is all fine and good, but not to gross people out (use your imagination), I can't father another child even if I wanted to; we planned our family at three, and three is what we have. But in Mass I have to have pre-natal. It's the same with chiropractors, who, by the way, have a huge lobying arm here on Beacon Hill, to make sure that they get mandated in Mass resident's/people's insurance coverage, further jacking the price of health policies through the roof.
My wife and I were part of that "uninsured" pool of 44 million (a dubious figure, by the way). We were neither lazy or willing to avail ourselves of Medicaid; rather, we made an economic, rational choice. So, when I would tell my dentist that I would pay cash for my cap, by cutting out the "middle man" bureaucracy, what had been a $2,600 job now cost $900 bucks. This way of doing business increased my take home pay at work, too. Instead of taking my employer's Blue Cross/Blue Shield coverage, which would have siphoned off $500/month from my take home salary (and, folks, I don't make a lot; I'm a high school Latin teacher), with my employer matching the other 50%, costing about $1000/month for ten months, I asked for the $500 buck a month that they were going to use to buy insurance as extra cash in my wallet, increasing my gross take home pay by $5000/year (I teach in private schools; you can't do this with the public school unionized step salaries). It worked out pretty well doing business this way for my family until...
MANDATORY STUPID MASS HEALTH INSURANCE!! - Which sucks, by the way. Well, our legislature kept adding the mandates upon mandates throughout the 90s and the people of the Commonwealth, specifically, the upper middle class nuclear family types, like us, said to ourselves, "Pay cash!" And it followed that fewer and fewer people were buying health care policies in our state. Gee! I wonder why!? You don't, perhaps, think that the reason why health care, like education, is so damned expensive in the United States is because it's overregulated by the state and Federal governments, do you?
Anyway, now we have to buy it - Thanks, Mitt. So, through my wife's employer we get it at about $15,000/year. But after reading the Federal Governement's House version of the bill, and realizing and justly fearing that it just might pass, guess what I did? After 25 years in the U.S. Army (I'm a Major in Ordnance), I retired last year, effective August 2008. But, since my Federal Government is going to take away my private health insurance by regulating it to death like Massachusetts did to my USAA policy, I went back into the Army Reserve so I could meet both the Federal and State laws' requirements and get some money saved for my familty at the same time. I'm now eligible for the Federal Government's, via the DOD, Family Tri-Care health insurance; it costs $280/month, which I'll pick up on 1 AUG 09, for those who like to compute dates in a military/bahnhoff train schedule manner.
Now, before people on this thread go "Oh, what a great bargain!" consider this. In the last 10 years, I was only home for five of them. "Why?" you ask. Because I was deployed overseas, most recently to the Balkans - Yeah! We still have troops there, too!
So consider this: I was only retired for a year or so, and I am now back in the Army because I have to buy health insurance for my family. I lost two freedoms here: my economic freedom, paying for something I don't friggin even want, and my temporal freedom, i.e. time, which we ALL have an equal amount of every day, because now I have to give up that one weekend a month, the two weeks in the summer, and it is very, very likely that I am now at risk of deploying to Iraq. And think about this, you folks hate the Iraq war and are shills for mandatory health insuranc for all, I am doing this all for the stupid health insurance policy via the Army Reserve. What a bargain this whole health insurance thing is! I get to be a slave, losing my precious time from this mortal life while simultaneously getting an insurance policy instead of actual health care, which previosly, I had pleny of.
Now my second and last point. Someone above mentioned VA. And boy is he right. The VA hospitals suck like there's no tomorrow. Army medicine, its bastard stepson, isn't much better, either. On our last deployment, one of our soldiers had an intravenous in her right arm. She complained of pain, but to no avail! When they finally noted that, after about five days of her being in agony, well, maybe there might be something to her complaints afterall, they decided she was serious. So, they finally checked the intravenous in her right arm. It turns out it wasn't sterile and she had gangrene. Don't worry though, folks! They managed to save her right arm by removing an inch deep, V-shaped wedge of flesh where her right arm arterial artery had been, from just above the wrist all the way up, just past the right elbow. It looks like she has a miniature Marina Trench on her right arm. A pretty sight, indeed!
In my new Army Reserve unit, that I just recently joined (see above), one of the LTCs had been stationed in England. His wife at the time was eight months pregnant and had broken her hip. When he took her to the NIH for care, at meal time, when the food came, they wheeled it in on a cart. It was self-serve! You had to get out of your bed and get the food yourself! SHE HAD A BROKEN HIP AND WAS EIGHT MONTHS PREGNANT! Naturally, the good Lieutenant Colonel took his wife out of there ASAP and brought her to a private clinic in Britain, which cost big bucks. A private clinic in Britain! But I thought that the NIH was so great. You mean they have two-tier system over there, one for the suckers and one for those where it's cash only!? Who'd a thunk it!
And in conclusion, I just want to ask rhetorically the posters on this board who are so enamored of single payer insurance and are shills for single payer a couple of questions. Since when is it your damned business if I have health insurance or not? Mind your own business! Moreover, do I have to live in Japan to buy a Toyota? Of course not! Then why can't a I buy a USAA health insurance policy from San Antonia, Texas for my family when I live in Massachusetts (who's Legislature made buying health insurance from out of state a legal prohibition)? I don't need to go to Detroit to buy a Ford and I don't need to go to Hollywood to see Transformers II or buy a DVD? So how come we can't buy insurance anywhere we want in the world, matched to our own particular needs, but have to have a one-size-fits-all insurance run by the Federal Government? Can you say "control freak"? I know you can. I know if I could have a choice in my own insurance, my family's policy wouldn't have hair plugs, cf. Connecticut's insurance laws, let alone abortion providers, cf. the House bill referenced by JohnBoy above/below!
Here's the deal. You guys who love Singapore, the Canadian and the NIH systems can go on the Federal Government' health insurance plan. Leave me an my family the hell out of it. And when you realize how much the government hoses up everything it touches - and, folks, speaking of procurement, I've been an Army logistics guy for long, long, long time! - trust me when I tell you that the government is so friggin' big, the proverbial left hand doesn't have a clue what the right is doing! - your government run health care is going to suck so, so bad, you'll come to regret it, particularly when you are 55 years of age and have to start attending the mandatory "end-of-life" sessions in the Obama Death Care coverage because as noted above, and which happens in Europe with more and more frequency, the elderly require a lot of care, and it's a hell of lot cheaper to care for the elderly by euthanizing them.
But relax. You can still pay cash in Guatemala. Check it out.
Thanks for reading this post. Live long and prosper. Sed cavetis ut mortem laudetis.
Sincerely,
Major O
Um, sorry but who is actually proposing nationalized health care? As I understand none of the bills under discussion come even close to what you're arguing against here. Why are you talking about the NIH instead of Germany or Holland or France where there's a public/private mix that's at least a little closer to what we could theoretically end up with here? Why not engage with the actual conversation underway instead of setting up false villains?
@Guy Misterioso - exactly!
Megan, why are you even discussing the British health care system since that is not what is being proposed?
sheesh.
I have no problem with folks having issues with a public option, but a least make your arguments reality based.
Try looking to Canada's program or France or Sweden. Have you takent he time to look into them?
I guess if I had breast cancer I'd prefer a system where I can actually get treatment, any treatment, then one where I can lose my coverage or never have it at all. I think I'd rather not fight with a cancer company whilst fighting cancer. I think I'd rather not worry about money while ill.
But maybe that is just me.
Just got a call from my Dr., had a blood test yesterday and seems I have elevated levels of calcium and probably have Parathyroid disease.
Who knew?
I'm lucky, I have decent insurance that has just got done paying most of my husband's radiation treatments for prostate cancer and we have probably hit our out of pocket limit for the year so my testing and treatment might cost us nothing but our monthly premiums.
But we can never leave our jobs for better ones now that we have these conditions and I know that if we were like so many of the un-insured working and middle class I would have not gotten the blood test done and would have ignored my escalating ill health because I just could not afford the easy-peasy treatment.
Does some of the VA suck? sure, but not all of them do
Does the Post Office suck sometimes? Sure, but I've been mailing out packages for 3 years on a weekly basis that get where they need to go within a week and have had 3 lost in all that time.
Does the DMV suck. Not in my town. Here they are efficient and friendly.
Medicare? I have not heard any complaints from my parents or my in-laws. They seem to be happy to no longer have to deal with an insurance company.
Listen even Bill Kristol admitted the other night on The Daily Show that the Gov't does a fab job providing and administering health care to our troops...he just does not seem to think the rest of us deserve it.
Go figure.
I bet he has great health care too.
This is a fairly appalling piece of analysis from someone who is supposed to be a serious economic journalist. The ultimate conclusion is Palinesque in it's insights and originality:
"The real issue is the effect on future lives, and future freedom. And in my opinion, they way in overwhelmingly on the side of stopping further government encroachments into health care provision."
Basically this characteristic is what signals the difference between liberals and conservatives: Change. In order to fight this change, conservatives will say anything and do anything within their power to retard change. They point out every maleficient of the proposed change the could that can possibly occur. This spread of fears appeals to all of our conservative sides.
The liberal, on the other hand, casts these fears aside in the hope of change yielding a more beneficial outcome for those suffering under the yoke of injustice. Most of us fall somewhere between these two extremes.
I am a liberal. I believe in a public option as a part of the proposed health care reform. I believe the American economic system will make allowance for private and public plans--like the Swiss system. I do not believe that a public plan signal the death of medical research or quality health care. The great thing about the U.S. is that we don't have to copy anyone's system, and can avoid their draw-backs. We can synthesize our system from the best of all, if desired
Every time I read the sources for Republican statements--like the Lewin Study--I see how they've twisted the facts. A new book, "The Best Care Anywhere", by Phillip Longman, posits the Veteran's Administration, as an excellent model. Although I'm sure some are not satisfied with it, his view is that most are--which agrees with my own experience. And that's a government program.
Now there are many influential politicians who have publicly denigrated V.A. health care, like Republican Senator John Barrasso of Wyoming; but you just have to consider the source. Besides, they--like most neo-cons--have never been a veteran. Although they may recount their medical experience with the V.A., it's generally based on archaic information, and has nothing to do with the new V.A.
Nice opinion piece, MM, but I think you overrate medical innovation in the current state of affairs.
Oh, all will talk about what a cutting-edge profession they're in, but what they remember viscerally is that, for instance, Tagamet came along and gastric recessions (a third of some surgeons' practices) disappeared. Flexible endoscopes and same thing with colon surgery.
Disintermediation alone (if you have to go thru B to get from A to C and you can get rid of B without compromising standards, that's disintermediation) could make our physician shortage go away and dramatically drive down health costs, often with public health improvement, but the rules of medicine are stacked against getting rid of the gatekeeper roles.
Simple example: I helped an ENT with a device that allows a nurse to provide a manipulative cure for positional vertigo. An $80 walk-in procedure could then provide instant relief for what is now a $2000 treatment after referral to a specialist. Only he was in dread his peers would find out and think him a rank commercializer looking to take $15,000 a month from each of their practices.
Even NIH grants can be argued to stymie innovation by promoting incrementalism, careerism and grantsmanship (why didn't I bookmark that great study?) Private investment comes with milestones, scrutiny and expectations of ROI.
Market forces, and only market forces, have the power to work this level of beneficial system change. Government oversight will lead precisely the opposite direction, as it already invariably has.
Questions:
1) What are the top five factors in driving up health care costs?
2) What are the free market solutions to driving those costs down?
3) The laws of insurance coverage dictate that profitability is driven by minimizing losses. How can the free market cover demographics that are, by their very nature, prone to losses (the already sick, poor, elderly, et. al)?
4) How would a public health insurance option hurt public/private investment in private medical research?
I'd be interested to hear the answers to the above, which seem a lot more pertinent to the debate than esoteric arguments about "the freedom of markets".
jules wrote: "Listen even Bill Kristol admitted the other night on The Daily Show that the Gov't does a fab job providing and administering health care to our troops...he just does not seem to think the rest of us deserve it."
The troops get health care as part of their compensation. They get paid and they get healthcare (by the government) because they perform a service for the government. They don’t get free health care by virtue of their status as humans and citizens, they get healthcare as a consequence of a specific service they provide to the country. They pay for what they get. Others not performing the same service and giving the same sacrifice, do not “deserve” the same compensation.
Soldiers get housing and food also. Would jules upbraid Kristol for suggesting that not all of us “deserve” these benefits but should have to earn and / or pay for them? Or does she think we should all get 3 hot meals and a bunk and a pay check (along with the bofo care given at Walter Reed) just like the troops do?
Brilliant! Honest! Pertinent! Accurate!
What are you doing writing for this pompously self-important know-it-all liberal rag?
The problem I have with health insurance reform without some public plan is that the insurance companies will still try to wiggle out of insuring people who might get sick. When you read about insurance companies collecting premiums, and then looking for technicalities on applications only after collecting years of premia, once a significant claim is filed, you realize that these guys are but a small step above the Mafia.
If you're worried about innovation being squelched by a cheap public plan, then what's wrong with a public plan providing basic insurance, and additional insurance plans from the private sector providing insurance for experimental therapies that the public plan may not cover? Over time, of course, the public will demand that the experimental therapies that work get added to the public plan's covered procedures.
While we can (and will have to) regulate the insurance industry to ensure that pre-existing conditions no longer prevent people from getting affordable health insurance, it will be hard for regulation to keep up with what I expect to be a never-ending series of attempts to game the system by the insurers. A public option will help keep these guys honest much more effectively, by providing a plan run without the private sector executives' greed driving the entire company.
The real problem with Megan's post is that she's not actually attacking anything that's on the table in the health care debate.
As far as I can gather, she's just against "national health care" which appears to be similar to Britain's system. It's true that there are many problems with the National Health Service in England. In fact, one of the first signs you're getting used to living there is reflexively making NHS jokes. It does a few good things too. But that's all beside the point.
No such system is on the table in the United States. Even advocates of a single-payer system aren't talking about national health care. They're talking about a single payer of the insurance bill - the government. This is the system Canada has, for example. There are lots of other systems out there. Mixed models like Australia, highly regulated private markets like Denmark.
The point is, regardless of the merits of Megan's attacks on "national health care", it's just completely irrelevant to the current health care debate in the United States. Her arguments about prevention have more relevance. Bizarre, sure, but at least relevant.
The rest? Not so much.
Meghan,
Your objections are based entirely on some high level political philosophies backed by completely false assumptions of the state of the current health care market. I just don't understand how you could spend so much time writing this post while at the same time spending so little time researching the issue.
I agree with you completely that monopolies do not innovate. They also don't attempt to keep costs low for their customers or provide better service.
Well, guess what we currently have in health insurance?: Regional monopolies that continually increase prices, reduce services and don't innovate. Here is a link to the source report from the AMA.
"So in the absence of a robust private US market..." So now you're setting up a strawman, that the intent of the reform is to create a government monopoly on health insurance even though NOT ONE CONGRESSMAN HAS SUGGESTED THIS, and knocking it down. How about you criticize the actual measures being proposed rather than some theoretical measure that you seem to believe these more modest proposals will inevitably lead to? No one is proposing eliminating private insurance.
If you had some plan to break up the regional monopolies, add more price discovery to the system by breaking the link to employment, all while increasing coverage to the entire population so as to dramatically reduce needless and expensive emergency room visits, I'd be happy to listen.
If you had some plan to break up the regional monopolies, add more price discovery to the system by breaking the link to employment, all while increasing coverage to the entire population so as to dramatically reduce needless and expensive emergency room visits, I'd be happy to listen.
There is such a proposal. It is the Healthy American Act, sponsored by Senators Bennett and Wyden. In addition to these concerns, it does have bipartison support.
"in the absence of a robust private US market" as others have noted you given no proof that a public health component would deter a robust market.
"Of course, the obese aren't the only troublesome bunch. The elderly are also wasting a lot of our hard earned money with their stupid "last six months" end-of-life care. Eliminating this waste is almost entirely the concern of men under 45 or 50, and women under 25. On the other hand, that describes a lot of the healthcare bureaucracy, especially in public health.
Once the government gets into the business of providing our health care, the government gets into the business of deciding whose life matters, and how much."
I don't feel qualified to comment on medical innovation (nor healthcare policy in general), but the straw man that the government will decide who gets "their stupid 'last six months' end-of-life care" is really absurd. Nearly everyone already has national insurance by the time they face end-of-life care, and I haven't heard anyone claiming Medicare is euthanizing seniors. If they were, I kind of doubt it'd have highest satisfaction of any kind of insurance coverage.
while it's true that no one is deciding which seniors die now, there is a possibility that the proposed MedPac committee would have the power to not cover certain kinds of treatment. Is this euthanasia? well, no, probably not but I could spin out scenarios where a decision not to cover a certain procedure would save Medicaire millions of dollars a year and also cause people to die sooner. Maybe only a few people or maybe they wouldn't die sooner but would not have as good a quality of life. The point is, there could be a slippery slope here. If i am not sick, then I say let's save teh millions. If I am the one who sick on the other hand, I might have very different feelings.
Haven't read the thread, just my immediate reaction to McCardle's post:
1) Megan has gotten lost in a cloud of abstraction and "theory" that has nothing to do with how governments, businesses, doctors, and patients actually work and live.
2) Megan goes on and on about the problems of the British NHS. I lived in Britain for 3 years and visited a doctor for minor ailments twice, so I don't fell qualified to comment on its success or lack thereof when it comes to major surgeries and the like. Both times I went to the doctor's office, though, service was quick, good and very polite.
3) Why is Megan talking about the NHS in the first place? No one is proposing a national health service like Britain's. It's far closer to the systems in France, the Netherlands, Germany, and Israel, where there's a mix of public and private and insurance and most health care services are indeed bought even though there's a baseline free public option.
Does Megan not know what's going on or is she being willfully dishonest?
It's really this simple:
1. government run health care in the USA is unAmerican, undemocratic and unContitutional.
2. In a country with a fully armed citizenry, you tell us you're not going to treat our parents, children, spouses and you are going to have a replay of the movie John Q. a thousand times a day.
i don't understand which argument you are making. is it one of these?
1. people will take the law into their own hands because the government run healthcare system is telling them no to treatment.
2. people will take the law into their own hands when the insurance company or private healthcare provider is telling them no to treatment.
either way it works.
What a silly article.
First of all, opposing "National Health Care" is irrelevant to the current legislation, and current debate, because it is not being proposed by any legislator. One government-sponsored health insurer to compete with several private ones is not even "national health insurance." If you are going to oppose the current legislation, that's fine, but you have an obligation to do so on honest terms.
Second, if you do oppose government provided health insurance, then I assume you also oppose Medicare, the VA, the health insurance made available to policemen and other government employees? If you do, come out and say it and defend your position. If you don't, then you *don't* actually oppose "government provided health insurance," you just oppose it for *some people.*
Finally, the claims in this article range from the flimsy to the ridiculous. Innovation in drug companies has very little to do with where the health insurance money is coming from. You're just talking about who writes the checks. If a government plan is really so awful that it doesn't sponsor innovation, then I'm quite certain a private insurer will emerge and take hold of that lucrative business opportunity to provide better care for the customers who demand it. Private firms ALL compete to provide services and goods to government run entities like the military, the post office, the police and fire services, etc. Innovation hasn't stopped in those industries, and it won't in pharmaceuticals...there's still a global market out there.
Finally, this fear mongering nonsense has got to stop. In a time when publications like The Atlantic are under financial pressure from blogs and other forms of media, the one advantage old media has is QUALITY, REASON, and THOUGHTFULNESS in coverage. The oh-so-hip glib tone of the first paragraph does not mask a clear lack of quality in reasoning here. One government entity that provides money to private health care providers is going to result in the slaughter of the elderly and government-enforced menus. Puh-leeze. There are legitimate ways to argue the merits of the current legislation without resorting to this kind of nonsense. The spelling error in the last sentence ("they way in overwhelmingly on the side of") is symptomatic of the intellectual laziness of this entire article. If the author won't take responsibility for that, the magazine should.
yes, but isn't the whole "Public Option" idea really a Trojan Horse that seeks to get rid of private insurance? Many conservatives say this and I never hear anyone refute this claim. What I do often hear is something like, "Well, so what if it is? a single payer system would be better anyway." and so it goes.
I personally think that a public option could be made to work very well, but should be designed by people who actually believe in it.
My spouse has had four (count 'em) four aortic grafts. After the first one or two in Washington, D.C., the complications exceeded the capabilities of any doctor we could find in Our Nation's Capital, and we were directed to the Debakey Center in Houston for further repairs. Why? Because a guy there named Dr. Joseph Coselli had invented a clever graft to use when it's necessary to swap out the particularly delicate parts of the aorta, and having done that, set up a practice where they do lots and lots and lots of aortic grafts. Any health insurance reform that fails to give tomorrow's Coselli the financial motivation to invent new devices or medicines will be flawed.
I understand the U.S. spends a lot more per capita on health care than anywhere else, but the part of that excess cost that goes to innovative new treatments might be worth preserving.
A Federal health insurance monopoly has the opposite incentive of the Coselli incentive. A monopoly gives the monoplist the incentive to find "good enough" treatments at less cost, not breakthroughs that cost more. It's what Megan calls "health theater."
Our family knew my spouse (and now my daughter, as well) has a genetic weakness that leads to things like expensive aortic graft surgeries. We'd pay good money for a plan that would cover extraordinary costs for a surgery that costs a lot of money but keeps either one of them alive and healthy. Most people don't need that kind of medical backstop....just a place to go to get a prescription or a flu shot from time to time.
I hope the Congressional plans allow everyone three basic choices: (1.) Public option, dirt cheap, you get to see a doctor when you need to; (2.) Private insurance, more expensive, better care; and (3.) Gold-plated plan, if you have a rational reason to want it, you probably would be financially wise to pay for it.
So long as #2 an #3 maintain the Coselli incentive, putting most people on #1 would have a wonderful impact on business and the economy. I do telephone polls, and I learned years ago that the kind of people willing to take $10-an-hour phone bank jobs in North America are very different in Canada than in the U.S. Why? Because in Canada, with universal health care, a $10/hour job is pretty good. In the U.S., not so much.
Most people belong on a very inexpensive, even subsidized (if necessary) health insurance plan like Canada's. Cherry-picking all those healthy younger people our of the private insurance (#2) pool will drive the cost of that middle option up somewhat, but in the olden days, that was the advantage of employer-paid health insurance--employers competed for good workers by finding the best health insurance plan that workers found attractive but the bookkeeper said would not break the bank.
I don't think it really is simple, devan. I think it's complicated, but with the political will, it could be done.
There seems to be a fairly prevalent assumption among left leaning contributors to this thread that health insurance is some sort of sovereign right of citizenship.
In-fact, it is not.
Hope this helps.
The purpose of gov run hellcare is decided who lives and you dies, to make people slavishly dependendt, and to erode the quality of care so much to make people weak and fearful and to ctontrol people through fear, intimiodation, and terror and as you can see therought he fascist speak of the pigs on this comment section a few, not a low, but a few worship evil and want to murder as many grnadmothers, austic children, and any other unwantables as desired. Healthcare is not a right it is a service and the free-market provides the only service, and it provides it damn well and as good as can be expected. But as usual facts do not matter for the fools. No truth can penetrate their dark stupid little minds. Reason #177,102,406 to load up on ammo and guns, fascist pigs like the hellcare terrorists running around spweing their filth.
Everyone should call up their congressman and senators and urge them to cosponsor the Healthy Americans Act. It's the only plan with a chance of
1. Passing
2. Helping people get health insurance
3. Bending the cost curve.
4. Maintaining the best parts of our system and fixing the broken parts.
Maybe we should look at other examples beside England which seems to be a bad one. A bit dishonest to only compare our systems to England's. I know it is difficult b/c of the language barrier, but try examining Spain's Healthcare program. It is excellent.
Those who criticized this column have typically done so because they have long ago been convinced that a single payor, public system, would be an improvement. So, their summary rejection of market based solutions and embrace of a government solution is suspect, which is only to say they are curiously critical of markets but have an a wholly unwarranted confidence in a government run system.
Having worked on both the payer side and physician side for nearly three decades I can tell you that if you like the system our veterans must use---TriCare---you'll find nationalized health care just fine.
But, first, talk with veterans because most of them find that system deplorable due to inhibited access times, poor quality, horrible coordination of care, and a labyrinth of vastly complicated paperwork.
Anytime the government presumes to enter a market, whether it's the auto industry, pharma, or health care, you can be assured it will result in complicated delivery, reduced quality, and higher costs. The fraud rate for Medicare has stayed steady at about 11 percent per year, for many years. If a private insurer had a rate that high it would be out of business by sunset.
Then, there's the issue of freedom of choice. Consumers demand and enjoy it in everything from breakfast cereal to cars to houses, so why, pray tell, would we sacrifice it for one of the most crucial services we're likely to need---health care?
Moreover, since fully 83 percent of Americans are happy with their current insurance regimen, can anyone tell the rest of us why there is such an urgency for 'reform'? It can't be the 45 million uninsured, since, as reported by Factcheck.org, the non-partisan research arm of the Annenberg Public Policy Center of the University of Pennsylvania, 26% of the uninsured are currently eligible for some form of public coverage but do not make use of it; 20% of the uninsured have family incomes in excess of $75,000 and either decline to spend money for employer-sponsored insurance or are otherwise not able to obtain it; 40% of the uninsured are young, and although insurance coverage isn’t offered to some of them, many turn down their employer-sponsored insurance. Some unknown percent--estimates are about 10%--are illegal aliens.
So, although it’s a complicated issue, the number of uninsured reported in the media is misleading and is being used to create a sense of urgency to garner political momentum for reform.
By all means, let's find a sensible, cost-neutral, and effective way to expand access to those without it. Why not try a refundable tax credit which would allow consumers to choose the plan that works best for them? And, then rescind the law that prohibits insurance companies from selling across state lines.
The reason those options aren't being considered is they don't provide politicians and special interest groups with the power over our lives they so desperately crave.
Freedom is truly scarey for many these days because it demands accountability, which is rapidly being written out of our civic script.
Best,
Phil Mella
http://clearcommentary.townhall.com
Apparently the Blue Dogs just capitulated:
http://www.rollcall.com/news/37333-1.html
Twice in the last decade my wife’s grandfather was left for dead in the Canadian health care system. He was elderly (late eighties) the first time when he caught CDIF in a filthy Montreal clinic and even older (early nineties) when he developed a monster stone in his urinary tract. In both cases they would not treat him with anything other than hospice because of his low likelihood of productive survival. The CDIF was suposidly too entrnched in his digestive system to be treatable and they could not operate to remove the stone because he was to feeble to survive the operation and his heart medication made his blood too thin. They did however offer him a morphine drip he could take home with him so he could use it to either elevate the pain or remove the devices’ governor and end it all in a blissful overdose.
Luckily for gramps he was a citizen of the US. Born in Canada, thus still eligible for their free health care, but naturalized in the good ‘ol USA. He summered up north and wintered south of the border. Against the advice of Canadian healthcare pros who continued to push the morphine option, his sons drove 7 hours up and (with Dad) 7 hours back with the weak old man in back seat. Indeed they almost lost him during the stressful trip.
But low-and-behold Aetna went all in for the old guy, even to the point of a medivac helicopter from his home to the hospital. (Even I thought that was a bit wasteful) They saved his life in both cases and once, many years earlier, by paying for bi-pass surgery when he was in his late seventies. He lived for 3.5 more years after the gall stone and played cards with one of his sons just hours before he passed.
Left for dead in Canada by the benevolent Habs. Rescued by the ones who loved him and the evil private insurance company who paid tens of thousands so he might enjoy 36 more months and some cribbage with his family.
Yeah...lets go with the public option.
Megan,
I think you must admit to a logical mistake. You say: "Living a fit, active life is correlated with being healthier." That's true, but what is both true and far more important is that living a fit active life CAUSES you to be healthier. As you know, most people commonly screw up by seeing a correlation in a regression and mistakenly assuming a causation. You are making the mirror-image error, seeing causation and claiming only a correlation. This matters.
We do not know that marriage, religion or living in small town causes a person's health to improve, we merely know that it is correlated with better health. (And, I'm willing to bet, much more loosely correlated than diet and exercise.) If the government is going to pay for your health care, it is logical for it then to concern itself with behavior that is proven to cause large increases in health care costs. It may not be desirable, but it is logical.
There are other differences, but that's the one you obviously skate over.
That quibble aside, you run a great blog.
I'd just like to put in a word for our health service here in the UK. Megan says she'd not like to fall seriously ill here. Well, who would. But there are certain truths about falling seriously ill in the UK. You'll never find you don't have insurance. You'll never find your insurance company withdrawing your cover due to some prior issue. You'll never get bankrupted by your illness. You'll never find yourself worrying about what policy to buy or how much it costs. We don't think about these issues in the UK - we get on with our lives. Do we have pre-natal or peditrician cover? Of course, we get it automatically. And is our health service rubbish? No it absolutely isn't. We have on many counts better service than you have in the US. And, you can also buy private cover if you want it. No, we have socialised medicine and it works justs great for everyone. That's everyone.
I'd just like to put in a word for our health service here in the UK. Megan says she'd not like to fall seriously ill here. Well, who would. But there are certain truths about falling seriously ill in the UK. You'll never find you don't have insurance. You'll never find your insurance company withdrawing your cover due to some prior issue. You'll never get bankrupted by your illness. You'll never find yourself worrying about what policy to buy or how much it costs. We don't think about these issues in the UK - we get on with our lives. Do we have pre-natal or peditrician cover? Of course, we get it automatically. And is our health service rubbish? No it absolutely isn't. We have on many counts better service than you have in the US. And, you can also buy private cover if you want it. No, we have socialised medicine and it works justs great for everyone. That's everyone.
"Making information, or fresh vegetables, available, hasn't worked--every intervention you can imagine on the voluntary front, and several involuntary ones, has already been tried either in supermarkets or public schools."
HAHAHAHA. This is just completely absurd. Public schools have been a dumping ground for overprocessed unhealthy food for as long as the system has been around. The #1 food the school lunch program dispensed last year was mozzarella cheese. We're only just beginning to see widespread growth of community gardens, CSAs, public gardens, and more emphasis on nutrition in general. Agriculture policy is dramatically skewed to favor unhealthy and processed foods. I mean really, "every intervention has you can imagine has been tried." That doesn't even sound remotely credible, and of course it isn't. The way the author just sort of matter of factly says that as if she knows what she's talking about really makes me question everything else. I think the very first comment summed up this piece quite well.
Well said. Innovation in healthcare and drugs is a huge job creator too. A family member has a small R&D company that researches and develops delivery systems for fragile drugs like some cancer drugs. They also are developing a system for the delivery of AIDS fighting drugs for countries that have unreliable clean water and little or no refrigeration. They employ 20 or so well paid engineers to bring these off. All paid for by the pharmaseutical companies.
When the government starts demonizing one segement or another for their impact on health costs, we have to ask...where does it stop? Will we stop providing care for the reckless kids who make a choice to ski outside of bounds, crash and require care for teh rest of their LONG lives? Will we instead say that their "end-of-life issues will take too long? Will we refuse to provide care for people who bicycle to work thus placing themselves in jeapordy for a car accident? AND who decides? What government "Solomon" Tzar will pontificate on these matters and deliver the verdict...live or die? Insure or not insure? Cover this but not that?
Obama lies when he declares that there will be no rationing. Every country with a single payer system rations care. Why do you think Canada has SO FEW MRI MACHINES??? IF IT IS NOT DIAGNOSED, IN CAN'T BE TREATED. HELLO!!!
Megan's take is sensible and certainly more substative than 95% of the "cases against national health care" that are spewed out there. My major beef with it is it's pithy assumption that we cannot influence people towards healthy behavior. Fat people will stay fat. Smokers will keep on smoking. And any attempt to change this would just be an infringement upon freedom by the "wealthy elites." Listen, elites sometimes get it wrong and sometimes get it right. They have not cornered the market on wisdom at the expense of the huddled, low-income masses, but that does not mean that some of their causes are worthwhile.
A healthier society is a worthwhile goal on many fronts and rules in place to make that so are no less tyranical than McDonalds chokehold on low cost cuisine. Sometimes the free market is only as honest as you allow it to be. In the case of preventive health, I think there is a strong case to make that it can be coerced into more productive and efficient behavior than it is currently exhibiting.
http://chaosoutoforder.wordpress.com/
It is possible to design a universal coverage health care system with incentives to provide quality care and control costs. Please see
http://www.3dsafety.com/thoughts-on-healthcare.htm
for details.
Let's talk about all those innovations, new drugs and advances in medical care that you say are not going to take place with universal health-care. If we keep the system we have got, there might be more advances in those areas, but fewer and fewer people are going to be able to take advantage of those new discoveries, because fewer and fewer people are going to be able to afford insurance or medical care. In other words, those great advances are only going to benefit the wealthier or the more lucky among us, and millions of other people will not be able to afford them. There will be advanced and expensive care for a small number of wealthy people, and the majority of people will have not even basic care. I suggest we start with basic care for everyone. That is more equitable and humane, because it will save the greatest number of lives and prevent the most amount of suffering. What is the point of extraordinary advances in research, when people cannot even afford to see a primary care doctor or get basic diagnostic tests?
For those who for some reason don't think health care is a right: Yes, it IS a right, along with clean water, clean air, adequate and safe food, safe housing, good education, good roads and an adequate defense against external threats.
I guess this article puts context in Glenn Greenwald's tweet:
"I just react to McArdle as "economics expert" same as Jonah Goldberg as political historian"
While normally I respect Megan's basic skills, this post wanders all over the place, occasionally knocks over a straw man and then kind of sputters to an end.
I really love the parts about how pharmaceutical firms will not innovate. WTF?
Look it really is very simple of all the stakeholders and providers in the healthcare (patients, doctors, nurses, hospitals, pharma, research, Government, taxpayers) there is one player in the American system that contributes nothing, balloons costs and has responded to their inexplicable position as the rulers of health care with massive administrative costs and a core objective of denying health care to patients:
Insurance Companies
The inevitable drift of all societies will be to a single payer system with an option for private services for those able to pay. The alternative being ruin. How this balance is managed will be telling. The English example has been to make the NHS shitty enough that a private option is necessary. Canada has made the public system good enough that it creates public sentiment against perfectly reasonable private options. Check out Finland for how this likely plays out.
In what universe does getting ranked 37th translate into "the best health care in the world"?
Yes, that's right folks, the U.S. health care system is ranked 37th in the world by The World Health Organization - Behind every single "socialist" country all the deniers love to rail against.
37th isn't anything to be proud of. In fact, some might say that 37th constitutes an utter failure ... considering we are, of course, "the most advanced country in the world". B.S.
What non sense this essay is. Right now its an open playing field for the private industry insurance market. They have done a terrible job! I would welcome any alternative to the horrible job and outrageous prices being forced on us by private insurance. If we don't fix this more and more people will be priced out. That is a fact. Those who oppose health reform are waging war against the middle class to protect their own, and only their own, narrow interests.
As I Canadian, like many others, I watch with dismay as people in the US debate the healthcare issue. I live about 50 miles north of the border and it is by that alone that my own son is alive and well, working, productive and happy. We watched a Frontline program recently about the healthcare situation in the US and it gave us chills. A young woman with exactly the same situation as my son - Lupus, could not get health insurance because of her illness. She could not afford the medication necessary to keep it under control, so she died. My son has undergone expensive surgery twice - hip replacement - necessitated because the steroids to control the lupus destroyed his hip joints. When he has a flare up, he needs drugs that cost thousands of dollars every month. He has had the best of care here, the latest in surgical techniques and he is alive. If we lived in the US, he would be dead.
There are no "perfect" healthcare systems, but we cannot comprehend a country that would put people's health and their lives at the mercy of the free market. We know all about the woman being used in ads in the US about how she was on a waiting list here in Canada. Well, in the US, she wouldn't even have gotten onto a list in the first place. And, our government will be covering the costs of her surgery in the US. As an average Canadian, I have never had to wait for anything. We have always received excellent medical care and services. The maximum that we pay individually (in addition to general taxation) is $900 a year for an entire family in Ontario. For a single person, the payment is $600 a year. We do not fear that we will lose our homes, our savings and our lives through lack of access to medical treatment. I am also a recruiter (international). One of my candidates is a high-level, senior architect in New York City who lost his position in the financial meltdown. He receives just over $300 a week in unemployment benefits, which run out on August 1st. He also has to pay about $475 a month for health care insurance. He is now living in his truck!
We are not perfect, our system is not perfect, but you would never get a majority of Canadians willing to support private-for-profit healthcare. The only people here in support of 2-tier or private insurance based healthcare are those who are either patsies of the large insurance companies or those that stand to benefit financially.
There is still profit to be made in our healthcare system though. Prescription drugs are not covered under our healthcare system. So we have private insurers for that and many working people have that covered by their employers. Poor people and the elderly are also covered. The only ones who have to pay out of their own pockets are self-employed people like me. I can live with that, because its the really big situations like heart attacks or necessary surgeries that we never have to worry about. If you are sick here there is no discrimination. You will be taken care of just as well as anyone else.
And by the way, our government does not "run" the healthcare system - they fund it.
"Living a fit, active life is correlated with being healthier. But then, as an economist recently pointed out to me, so is being religious, being married, and living in a small town; how come we don't have any programs to promote these 'healthy lifestyles'?"
Very simple - causality.
There is a correlation between being religious / married / a small town dweller and being healthy, but, to our knowledge, there is no causal relationship connecting them.
In the case of obesity, we don't just know that there is a statistical correlation between obesity and ill-health, we know both about medical complications which are directly caused by obesity, and about medical complications which share a common cause with obesity (such as a poor diet or a sedentary lifestyle). Advising people to tackle obesity (through diet, exercise etc.) will impact on their morbidity both directly and by tackling the common causes (poor diet, sedentary lifestyle.)
Regarding direct causality, we know that increases in body fat alter the body's response to insulin, potentially leading to insulin resistance and diabetes. We also know that increased fat creates a proinflammatory state, increasing the risk of thrombosis.
Being a small town dweller might mean you are more likely to eat healthily, exercise more, and lead a less stressful lifestyle but it would be stupid to advise everyone to move to small towns when we could instead simply advise them to make other changes to their lifestyle (eg. diet, stress, exercise) which we understand to have a causal relationship with their health.