WE DO NOT CHOOSE HEALTHCARE BY COST.

Sadly, cost is a minor factor in selecting health care, Congressman.

If our insurance covers Hospital A and Doctor B, that's where we go. Then we get hit with all the ancillary charges. But we do not have an alternative.

If we go to the cheaper Hospital X, then our Doctor B can no longer care for us, and we get NO coverage at all for the procedure.

Problem is that for every medical visit, at least 1/3 of the cost is for the paperwork to file for the dozens of insurance companies, so the doctor and we can hope that the medical visit will be covered.

In Italy, when we went for medical care, we had NO Co-PAY, NO Paperwork, got the xray to take home. That is what medical care here should look like under a single payor plan.

I have a question. I've read more than once that any substantive change in our health-care system won't happen because Repubs are tied by the umbilical to big insurance and Dems are tied to the trial lawyer bunch - which is the one I don't get.

Dear Congressman:

I had the privilege of being an honorary cheesehead during my law school years back when, and that status eventually earned me a degree and, perhaps more significantly, an autograph from Paul Molitor when he was shagging flies during batting practice at Yankee Stadium a few years later.

Thanks for sharing your proposals. But, to me, what you have suggested so far is indeed a band-aid like solution. As MS mentions above, I believe it is more than fair to say that, for the most part, we do not choose healthcare based on cost (although this year I did choose to take a less costly and covered stress test instead of a non-covered MRI-type stress test that I guess is still considered to be experimental).

Look, we all know it's not an easy job, but I think most of us also agree that this issue is one of the most critical, if not the most critical domestic issue that Congress now faces.

I think you and your colleagues have to start with the premise that most Americans with healthcare are concerned about preserving choice in who they are treated by. That is their fundamental concern. And, I submit, that if these Americans know that the choice component will not disappear, then that will grease the skids for more rational options, with or without a single-payer component. But the healthcare has to be there and it has to be there for all of us.

Regards,

Bruce

"some more detail" would be nice because what you have posted is incomprehensible to me. It has a bunch of verbs but I can't tell who you are talking to: For example, when you say "form a single risk pool..." who are you talking to? Congress, insurers, and, if the latter, are you asking them to do it voluntarily or are you proposing to force them? I can't tell from your post. Also, there's this little matter of something called dollar signs, which are usually followed by something much bigger called numbers. Could you put those in "the detail" (assuming you have them) and, if you have some, would you please put the backup analysis that generated your estimates on your website so we can all understand how you came up with them.

Congressman, I apperciate your joining us and offering to share your ideas. I don't wish to judge until I've heard more, but definitely I'm thus far on the side of the commenter's who lost thus far rather than those who think you've chickened out.

The article by Page helps a bit more. It describes the idea of a pool this way, "Government and the insurance industry could pull together a generic insurance policy that would cover everyone, without exclusions, for pre-existing medical conditions." That sounds a bit like the alternative to private insurance that would be available to anyone choosing it in Edwards's plan. Is that correct, and how then is the insurance industry involved in this part? And would you require that everyone obtain coverage, which some say is the key to distributing costs enough to control them? 

John 

http://www.haberarts.com/

Will this be like the Canadian system where guaranteed access often means a chance to wait and wait and wait in line. Canadians with difficult pregnancies have been sent to US hospitals due to lack of capacity (which saves the state money). Where would you send those that need such service when our capacity is maxed out? Mexico?

The sons of the prophet are noble and bold,
and quite unaccustomed to fear.
But the bravest by far in the ranks of the Shah
was Abdul Abulbul Amir

Do you work for a big medical insurance company or do you just don't get it?

Tom

Paul Krugman pointed out that the only procedure for which wait times were shorter here was hip replacement, predominantly a Medicare payout. So our socialized medicine beats Canada's on that one procedure.

Re: How would you handle risky behavior in such an environment?

Risky behavior is its own deterent. Now it is certainly true that people indulge in foolish and risky behavior when they shouldn't, but that's just human nature and it's never going to change no matter how many would be nannies tut-tut and wring their hands. And as far as incentives go, a little common senes is called for: if people are not deterred from stupidity by the danger of great pain and even death, why in the world would they be deterred by money concerns?

Re: In the one practiced in most other industrialized countries the bulk of the care is paid by the government using monies raised from various sources (taxes, premiums, etc.).

I'm not sure this is true. Singel payor plans (like Canada's) are not that common. Most countries have mixed plans where the government is the payor/insurer of last resort, but a very strictly regulated insurance matrket still exists.

Phelicity,
While they might argue about how to cut up the pie, the Repubs and Dems both benefit from the present system. The Dems, as you note, are especially tied to trial lawyers but law firms as a whole are leading contributors to both parties and so are health professionals.

Looking at 2001-2006 campaign contributions, law firms are the leading industry contributors to Clinton ($4,337,576) and Obama ($2,464,360) and health professionals are #8 for both, $835,511 for Clinton and $363,713 for Obama. Clinton is the leading congressional recipient of contributions for both lawyers and health care, followed by Bob Casey (ret) and Jon Kyl respectively.

On the Repub side, law firms are #2 for Giuliani ($3,093,701) after securities and investments and #3 for McCain ($161,575) after retired and securities & investments. Again, health professionals come in #8 for both, $637,987 for Giuliani and $76,500 for McCain.

Every dollar contributed says: Keep the present system, right? Don't change a thing. Or if you make any changes, make them cosmetic and minor.

What do lawyers get out of the system?

from TrialLawyersInc.com (critical of lawyers):

While the excesses of the litigation industry alone cannot explain America’s mounting medical costs, litigation is a large, and growing, contributor to our health-care bill. . . . medical malpractice liability—the “tort tax” on doctors and hospitals, whose costs constitute the majority of health expenses—has grown much faster than health-care inflation. . . Although medical-malpractice liability provides Trial Lawyers, Inc. with its largest health-care sector revenue stream, litigation over pharmaceuticals and medical devices exacts a staggering cost on an increasingly important part of the U.S. economy. . .. Some of Trial Lawyers, Inc.’s favorite targets, nonprofit hospitals and nursing homes, are the health-care providers that minister to our nation’s most vulnerable—the poor and the elderly. And as if its effects on health costs were not bad enough, the litigation industry has focused its crosshairs on managed- care providers, who, while politically unpopular, are crucial to dispersing risk and providing for health care at affordable cost.
. . .It is also important to emphasize that the direct costs of healthcare litigation only begin to scratch the surface of the toll that these predatory lawsuits exact on our economy—and on our health itself. Med-mal lawsuits tend to inflate health-care costs by encouraging “defensive medicine”—unnecessary procedures and referrals that doctors and hospitals prescribe in order to limit their exposure to future litigation. Studies suggest that defensive medicine costs are several times higher than the direct liability costs themselves.
http://www.triallawyersinc.com/healthcare/hc01.html

I am happy to see that most posters have become experts at reading between the lines of the spin put out by most Democratic politicians.

Universal access to affordable care? Why not simply universal access to care? Make the commitment. Make it an entitlement. Every single man, woman and child is entitled to medical care. Period.

Congressman Kagen,

Hello from Green Bay! We are loving you here!

My main stink about health care right now is that it's so inefficient. I wish the Congress members would emphasize just how inefficient our system is. My latest story is a prime example: I have a lump on my neck. I went to my primary to check it out. She has recommended I see a surgeon to have it removed. However, before I can make my appointment, my insurance company has to approve that visit. But, this company, Destiny Health, does not do the actual approval. They contract out that job to another company called Active Health Management. When AHM approves the office visit, assuming they do, Destiny Health, my insurance company has to approve that approval. All the while, I'm stuck with a lump on my neck, which my pathologist hubby thinks is probably benign but cannot know for sure. How much worse could it get? I have insurance and it's still not helping me.

We need to emphasize to these universal health care phobes that the system is not only broken because of the uninsured. These companies have proven that privatizing health care is inefficient.

Thank you for working hard for the 8th Congressional District and, for all you TPMers, Congressman Kagen is going to have a heck of a battle keeping his seat next year. Donate money and time if you can to keep our part of Wisconsin from a possible Congressman Gard. Think Tom DeLay in Wisconsin; that's John Gard.

Thank you Staleync.

I appreciate your concerns.

The initiative I have proposed is UNIVERSAL COVERAGE, and it will cover every citizen, everywhere in these United States, even as it drives down everyone's costs for care.

And it is NOT SOCIALIZED MEDICINE.

Thanks again.

Steve

Thanks for your comments DrSteveA.

As a physician, you're aware that Medicare often fails to pay the overhead costs for providing medical services and health products.

The failure of Medicare to cover the cost for providing a service or product has caused tremendous cost-shifting, which resulted in the impossible situation we find ourselves in today.

I am working closely with Chairman John Conyers on his bill - H.R. 676 - and together we will write legislation that guarantees access to affordable care for all citizens - universally - in an openly competitive medical marketplace.

I agree with you that Big Insurance is bloated, and needs an overhaul.

What is wrong with forcing Big Insurance companies to sell the same piece of paper - a standardized health insurance policy that covers everyone from head-to-toe? A policy that has no small print? A basic policy that we can all afford - and one that prevents any discrimination due to pre-existing conditions?

When I ran for Congress, I wanted to buy a Chevy Impala, and 5 different dealers were all selling the same car. They competed for my hard earned dollars, and I succeeded in lowering the price I paid - and the dealer I purchased the car from stll made a profit, albeit a smaller one than he would have without having any comeptition.

I want each and every Big Insurance company to be forced to sell the same policy - and when they do, we will all win.

Thanks again DrSteveA.

Steve Kagen, M.D.
Member of Congress

I am working hard for you in Congress and in Wisconsin everyday...

Dear Bluebell:

We must be headed in the right direction, because the only resistance to my initiative comes from Big Insurance.

I've met with the leaders of the AARP, SEIU and even the President of the AMA - and all are in agreement with the essential elements of my initiative.

But to be successful - to overcome the forthcoming deceipt and deception campaign from Big Insurance - I will need all of your support.

Thanks for posting today and for listening.

I will do my best to return in several days to respond to those who I do not have time for this evening.

All the best,

Steve Kagen, M.D.
Member of Congress

How could anybody seriously give this post a troll rating? That's ridiculous even if one believes, as I do, that the litigation component of the medical cost debate is overstated. What an outrageous use of the ratings system.

I am in agreement with Dr. Steve A. (above) Universal health care. Single payor, like Medicare.

And please don't let anyone "carve out" mental health benefits or make people who need them pay higher copays.

I don't have to tell you what I support, particularly since my views on the healthcare debate are spelled out in at least two posts in this chain. I think that your decision to troll-rate this post is in conflict with the ratings system, and that's why I did what I did. If it makes you feel warm and fuzzy inside you can conclude that by doing so I am really Grover Norquist in disguise (even though I think I'm much better looking than he is).

What Bacon is doing, and what you just uprated:

1) Posting intellectually dishonest "data" put out by winger think tanks.

2) Posting a link to a winger think tank propaganda site, particularly a Laissez Faire think tank that supports GW Bush.

That is the the definition of "Freeping" a left blog.

So you can say you support whatever. But what you actually just supported here on TPMC is a Freeper. Let's see if you make a habit of it.

I've also noticed some other regulars like cscs makes a habit of defending Freepers, supposedly to protect free speech. But it seems to turn out that the free speech they protect is frequently Rt Wing talking points that is completely intellectually dishonest.

Thanks for your comment. I claim no expertise in the details of any plan but I believe it is essential that ALL Americans are covered. I don't care if you are 22 and healthy, you never know when the bridge you are crossing is going to collapse. As it is, they have to clear the uninsured waiting for primary care out of the ER when the bridge does collapse.

I don't think there is anything "cool" about uprating Freepers, swift boaters, or the proliferation of aggressive propagandists and useful idiots the Rt Wingers have spawned.

Only other Freepers and complete idiots (redundant) think that's "cool."

cscs:

I have no idea what your politics are (well that's probably not completely accurate but poetic license and all you know), but I did take what you wrote in your blog yesterday very seriously, and I appreciate your efforts to preserve the integrity of the discussions at TPMC.

Bruce

staleync - I think that's rather simplistic and a disservice to the discussion.

We agree in supporting Universal covering catastrophic and basic care up to a fairly high ceiling, and emphasizing cost saving and health preserving preventative care. That is the optimal solution for the greatest public health, at the lowest economic cost, and most economically pro-growth policy. In a perfect world, we'd already have it.

However, considering the political reality and the tremendous amount of momentum involved in shifting the health care of 300 million Americans, it's perfectly reasonable to discuss the merits of more incremental/transitional alternatives, in the meanwhile, and in light of political feasibility.

If you have compelling argument one way or the other, let's hear it.

How many times does to need to be said?

We are behind practically every first world nation in nearly every category of health care statistics, yet we spend 15-17 dollars of every hundred of the GNP on health care as compared to 7 to 9 of those nations that led us and whose health programs cover 100% of their citizenry juxtaposed to 35-40 % of our people who have NO coverage.

Why?!!!!!!!!!!!!!!

...Becaues we allow our health care providers and the private insurers to put a high price tag on staying alive for those of us afflicted with the ravages of disease and old age. We are allowing a few folks to hold our lives hostage to their outragious profits and high living life styles.

If you want to see how it can be done fairer, cheaper and in effect better the look and almost any other first world nation. A single payer, not of profit government run health care insurance is how most of them do it.

Our government officials and elected representatives are owned by the healthcare lobbies and big insurance corporations among other huge corporate conglomerates. They are living a good life with good healthcare and plenty of legal bribes that keep them in place to sell out the bulk of the citizenry who suffer from their betrayals of their voting constituencies who have little choice but to vote for them or someone else just like them thanks to the duopoly that now exists claiming to be a two party system. Gore Vidal said it best, there is only one political party in America with two wings and it serves a minority of the already wealthy.

I don't want to hear that those other first world nations have worse medical care than we do, as the, statistics just do not support that lie!

I am ready for a revolution, I’d like it to be peaceful and political as Jefferson advised and hoped for every twenty years or so, but at this point I don’t much give a damned if it gets really rough… just so it happens. It is past time for significant change in place of the dog and pony show that now masquerades as change or a choice.

We need a uniquely American solution to our health care crisis.

Thanks much. I still have not figured out the 'preview' function.

This Congressman has ideas -- everybody has ideas. The Congressman could have also stated he would like to see every American family living in a 3-bedroom home. So what? It means nothing. I'm only listening to politicians who have a detailed plan (NOT IDEAS) with numbers to prove how they'll pay for it. Keep going, Congressman, you're only half-way there.

So, suppose you manage to force Big Insurance "to sell the same piece of paper -- a standardized health insurance policy that covers everyone"...

First, some people may still not be able to afford the standardized prices, and there they go, down that crack.

Second, how will you force the Big Insurance to not only accept the money, but to disgorge it when needed? I have a health plan and, when I go for a check-up, some of the "luxury" tests (those which screen for conditions not immediately death-threatening, like bone density), although recommended by my doctor, get disallowed routinely and I have to pay their costs in full, on top of the premiums.

Sure, you, as a doctor, may get paid more by the Big Insurance than you do by Medicare but to me, a better solution would be Medicare for all, with a standardized -- and fair -- price of *procedures*, not health plans.

Our healthcare reform should, really, go beyond the "same price for all -- who can afford it". It should be "basic healthare for all", bypassing the Big Insurance entirely, and financed by taxes (I'd rather see my taxes spent on healthcare of *everyone* than on Iraq occupation, even if the latter were managed with any semblance of competence). And if I want some "luxury procedures" (like bone density tests), then I'll pay for them -- same as I'm paying now.

Families, together with their own physicians, should make deeply personal health care decisions, not insurance executives or corporate benefit coordinators.

And Hi back at you from Appleton, Wisconsin - the state with a history of independent-minded Representatives.

Kozmik,

You're abusing the rating system. Someone posting information that you don't agree with is not a "troll."

Please back off the ratings.

Gee, and don't I wish you around before we invaded Iraq. Imagine a detailed plan with numbers to prove how they'll pay for it!

They'd also be stunned to learn about French vacations and working hours.

"shambles" isn't the right word. Let's not forget that if you've got insurance through your employer, most Americans do get good care, and the insurance company pays the bill. they wouldn't agree it is a shambles. However, they may agree we need reform. I'm simply saying the building is not on fire for a lot of Americans. This is the difficulty with change, because a majority may want change, but agreeing on what the change should be is herding cats.

I believe we could solve this problem very quickly if the government accepts the role of a reinsurance agent -- much like they do with Federal Flood Insurance. This is a far less radical change, reduces individual premiums significantly. Insurance companies will like it, because it reduces their risk, and affordable coverage means everyone can be covered.

Thanks Libra:

Great points.

First - for those who cannot afford the Standard/Basic U.S. Health Care Policy, it is the moral duty of local, state and federal governments to provide these citizens with access to the care they require. After all, what kind of nation are we?

Secondly - Today, Big Insurance wins, because they write their own policies - in their favor. They give you things in the big print, and take them away in the small print. Or, as is often said, the devil is in the details. By having us write the policy, we will win.

John Nyman has taught us about the theory of insurance: insurance is a form of delayed income. You place your money in an insurance company's hands, and then in the future, you ask for your money back when you need it - like when you become ill, or in the case of home insurance, when your house burns down. Today, Big Insurance takes your money - and then refuses to give it back to you when you need it most. This commonplace practice of corporate deceit and deception is morally unacceptable !!!

Thirdly - People are ready for Universal Coverage, but they may not yet be prepared for a Single Payer system. Why? The Neo-Cons have been successful at convincing people 'government' can't solve problems. (i.e. Katrina, Iraq, Medicare Part D, No Child Left Behind)

Let's agree to focus on access to affordable care for every citizen, and begin by agreeing that we're all in the same risk pool and that we should all be able to pay the same price for an openly disclosed service, insurance policy or pill. After all, if Big Pharma is selling a pill in Mexico City for $1, that is the price I want my patients to pay for it in NYC or Chicago or LA and everywhere in between.

I am a strong believer that good government can make a real difference in people's lives, and am workig hard to prove it in Congress.

Thanks again Libra...

Dear Brook:

Can you please be more specific about the details and numbers you wish to see about my initiative?

Golis,

This is about whether TPMC allows Freepers to spam guest threads with totally bogus propaganda. Not about what I personally agree with or not.

The above post and link is spamming propaganda, trolling, as sure as if he had posted a Nigerian scam. Complete falsehoods, only it's by a well funded Big Business think tank.

There is no rebuttal to spam.

That is exactly how policies and candidates regularly get swift-boated as bogus "controversies" fueled by well funded political operations manage to disseminate propaganda and create an environment of confusion. Say even the most absurd things often enough, and people will believe it.

1) You're defending intellectualy dishonest propaganda derailing the thread of your guest Congressman Steve Kagen. He'd probably discuss issues meaningfully, rather than play whack a mole.

2) Did you read the post above, and go to the link above? I think you should actually look into what you're defending, before dancing on the strings of whoever is complaining to you.

3) Are you saying as a representative of TPM that it's a controversial view, or even a semi-serious view, that litigation is actually a large driver of medical cost inflation? Do you or Josh Marshall consider it even slightly intellectually honest claim?

4) You might want to check the link provided above, which is to a propaganda site that only lists it's connection to the Manhattan Institute in the small print. In case you're unfamiliar with the MI, it's a far right wing think tank notable for disseminating propaganda against HC reform, and it's been repeatedly eviscerated as a propaganda outfit. Krugman dedicated an article to them and their bogus healthcare data.

5) If that's not a troll, and that's not Freeping, then what is? For example, if someone comes here and starts cutting and pasting directly from the Bill-O show transcript, The Heritage Foundation press releases, and such, and creates multiple accounts to spam TPMC with that, does even that qualify as trolling? Do you have any standards for content whatsoever?

6) Would it be unreasonable to expect you to wipe patently rt wing spam, if you won't allow users to? Or does TPMC want to be a format for any freeper to spam winger propaganda?

kozmik,

My intention was not to bash the Congressman's proposal. You are correct that the safe political move is to move in incremental steps, and each step does equal progress.

However, the Congressman specifically stated that a band-aid fix would not solve the health-care situation, and in reality, incremental steps constitute a band-aid solution.

It seems that we are on the same page as far as what needs to be done (universal single-payer), yet you believe it should be done slowly and incrementally.

If the Congressman's plan has that as a final goal, he should say so. If not, I cannot see why my recommendation of such a plan is a "disservice to the discussion."

The Congressman has my full respect, as does his position. I can only hope that you, and the Congressman, respect my opinion that it does not go far enough.

Something that is always missing in these discussions about any form of universal health care coverage is the bottom line. People will always oppose new taxes. That is almost a cardinal rule in our country today. So, to sell any such plan we first need some good numbers that tell each of us what our bottom line will be.

That bottom line will have to include the added taxes we will pay for the system. But, those taxes will presumably be offset by not having to buy health care insurance, pay high co-pays, pay for non covered procedures, and by increased salaries where we work. The last one of those is very significant. These proposals will save American employers a bundle of money, so that money has to go to their employees in a significant amount. Lacking that, this just doesn't result in a good bottom line for most of us. How would that be accomplished?

Hoppy in Sacramento

~

Now, may we get back to the subject of the thread?

it isn't necessary to "shift the health care of 300 million Americans".

I'm not getting into semantics.

The fact is we're discussing changing the healthcare insurance system for all of America, to be single payer, universal, or some variation. It's also a fact it was attempted in the 90s, and it failed, because big insurance propagandists managed to scare Americans off reform.

There is much more support to reform healthcare now but that doesn't necessarially mean America is ready for single payer. SP is the best solution, but only if Americans realize it.

I like Obama's plan also. He's also said straightforwardly that he plans to do things incrementally, leading the American people, with their support, one step at a time. Which is great. His plan is fundamentally similar to Kagen's, with the addition of allowing a governmental agency, or non-profits, or others to compete fairly. (which I think is the natural, eventual, outcome anyways.) Maggie Mahar has some good threads on the proposals.

Another issue is reactionaries. Obama's approach makes less enemies. I want single payer universal someday, but I also want lots of conservatives to sincerly like the program and for it to become a part of the American fabric. Not to be a perpetually divisive issue.

Not to be pollyannish, of course some will always hate it on the far left and right. Hardline libertarians, Grover Norquist, and insurance executives will always hate it. But other conservatives surely can enjoy the same labor advantages as Japan, the family friendly policies of France, etc.

I watched "Nader, An Unreasonable Man" the other night, and one point I'd emphasize is that Nader and the counter culture movement of the 60's in some ways helped create Reagan and the conservative values movement. They got a lot done, but they also made a lot of enemies, who then regrouped and brought us decades of deregulation.

in reality, incremental steps constitute a band-aid solution.

That's just meaningless. An empty slogan.

what needs to be done (universal single-payer), yet you believe it should be done slowly and incrementally.

I support universal as the eventual goal, personally. It's clearly the most efficient system, best for public health, economic growth, and cultural values as a result of increased health and decreased bankruptcy and economic stress.

Politically, I support the leaders who convince people and make progress without creating a lot of blowback. Divisiveness cretaes reactionaries who then dismantle progress.

It's impossible to predict what's possible in a year. In the meanwhile it's a good idea to have trial runs and get the public discussion going.

So far I like Obama's principled moderate approach the best.

my opinion that it does not go far enough

We know. But you have yet to provide any substance as to why, to add to the discussion.

Again, if you have a substantive opinion, one way or the other, feel free....

we do not choose healthcare based on cost

Nonsense. Yes "choice" is important, but choice is almost entirely dictated by cost. Cost is a product of the economic efficiency of the insurance system at delivering medical care.

Without efficiency, costs rise. When costs rise, choices diminish.

Every single insured person suffers from by reduced choices for care, as a result of cost inefficiency. Many can't afford insurance at all, so they have zero choice.

...

COST:

The decision between HMO and PPO, of going to a doctor inside or outside the network, is heavily influenced by COST.

The amount of preventative care a patient seeks is shaped by cost. People who can't afford preventative, frequently develop serious medical conditions, and then lose their HC when changing jobs, and can't afford new HC due to pre-existing conditions. Cost cost cost.

...

And frankly, this "choice" mantra sounds like the Rt Wing scare tactic that consumers will have less choice under proposed healthcare reforms.

In fact, in any HC reform emphasizing the principles of Universality, choice is maximized as there are no HMO's or "networks" or "outside" doctors.

And in Kagen's proposal, since medical costs would be standardized, and since insurance providers couldn't cherry pick patients, (and possibly not doctors either) the concept of "out of network" doctors would also end. Again, maximizing choice.

We rebut these arguments here. Not censor them.

That is the ethos of TPMCafe.

If you don't like it, maybe this place is not for you. But we don't knee-jerk troll-rate here, if even the sourced link is a right wing think tank.

"Thank God George Bush is our president." -Rudy Giuliani

...does IT need...

ARGGGG

Flood insurance probably isn't a good analogy, but basically we are talking about catastrophic coverage -- which means the fed shares the risk with the private companies.

I recently had 2 relatives go through serious illnesses that required extensive medical treatment. They both had insurance and got excellent medical care. We've got problems with our system, but it's not a broken-down 3rd world mess, folks.

The smart solution would be to keep what's working well in place and figure out how to fix those pieces that aren't working so well.

I'm not so sure. A lot of people are satisfied with the private-sector coverage they're getting and won't take kindly to paying higher taxes to obtain something they already have.

Also, don't underestimate the "better the devil you know" factor.

A lot of people are satisfied with the private-sector coverage they're getting and won't take kindly to paying higher taxes...

But surely those people aren't happy with the fact that 45 million Americans go without healthcare? Surely they can't be happy with the overall state of health care in this country?

How many of those people who are happy with their coverage have really needed it yet? What happens when they get, as we saw in SiCKO, a brain tumor, and the insurance company comes back and says, "Denied"?

I think one of the fundamental questions that has to be discussed in this debate, before any policy or specifics are even brought in, is -- whether we're a selfish nation, or an altruistic one? (And, by altruistic, I mean "socialist." heh heh.)

If the former, then maybe your argument about the people who are now happy matters. If the latter, than we need to reassess what it means to be "satisfied" with our health care, if it means, in the long run, that millions and millions have to go uninsured.

We need to decide whether health care is a "benefit," or a "right." 

"Thank God George Bush is our president." -Rudy Giuliani

I think the number of people who are satisfied with the employment depending care they are getting and the premiums it requires is declining rapidly every day.

Tom

What I meant was that most of us do not have choices in terms of the coverage we are offerred, if we have insurance options, but in any event your point is well-taken and obviously cost is a major factor in the American healthcare system.

Bruce, your point here is not quite accurate. Individuals always have choices in terms of what they are willing to pay for their healthcare. They may not have the economic means to afford the healthcare they would like, but we all have choices. For the most part it is about prioritizing our health and willingness to incur those costs. Whether you are being provided with insurance options is not as important as how you choose to incur any costs that are in the interest of your best health.

Would you envision risk premiums being part of any such system - for example, a 100% excise tax on motorcycles, more taxes on alcohol, etc.?

So we are back to being judgmental about who is deserving, eh? Surely, you are aware that the vast majority of Americans are obese. Obesity is a risk factor for heart disease, hypertension, diabetes, cancer, gallstones, kidneystones, stroke etc.  Which means that eating is a risky behavior.  Are you going to impose regulations for the adverse risky behavior of eating a calorie dense diet?  How about sex? Sex is now an adverse risk behavior given that we have fatal STD's and the maintenance of those diseases, just like cardiac, cancer, and diabetes cost upwards of a trillion dollars.

Who is going to determine what the premium is for risk behaviors?  Will there be a tiered cost for premiums based on sex and eating along with tobacco and alcohol? How much will folks have to pay who desire IVF and refuse 'zygote reduction' when there are 6 in the womb vs. one?  Will society pay for the diminished developmental potential of each of those brought to term for the rest of their lifetimes having been grown in a less than optimum womb environment.  You know like a root-bound plant fails to grow optimally?

Where does your risk behavior begin..do we impose driver premiums on folks for using cell phones and speeding as well as those who get stopped for DUI? Given that driver distraction and speeding cause more accidents than all DUI's annually?

I am curious about your thoughts on this.

And no one seems to mind that we've socialized our police departments, or fire departments...

"Thank God George Bush is our president." -Rudy Giuliani

Whiterose:

Point taken. People certainly do have choices, even when insured, to try and scrape together funds to go out of network, etc. when they have to.

I think you might know that I'm a union attorney and I spend quite a bit of time at the bargaining table. Healthcare is almost always the A number 1 issue at the table, and it is becoming harder and harder to preserve existing benefits for actives and retirees. The example of a guy with 25 years of hard labor with the ability to retire at 55 with full medical is becoming increasingly rare. I see the crisis first-hand, believe me. When individual employers or industry groups say across the table that they can no longer afford to pay for decent benefits, many of them are no longer just posturing. And that's why I stand by what I said to Brook somewhere else in this chain, and that is that our system is in shambles (even with respect to those with private insurance).

In any event, always a pleasure Whiterose, even though I think I read a post from you in which you said that the name Bruce still gives you the willies! Now that's a discussion for another day. In the meantime call me bslev if it makes it more palatable to you!

Bruce (I mean bslev)

People will always oppose new taxes. That is almost a cardinal rule in our country today.

National stories about a bridge collasping go a long way towards helping people understand the old adage 'you get what you pay for'.

An even bigger truth is that a politician who campaigns for more taxes will likely be trounced by a rival saying 'no new taxes'. Whereas, the politician who campaigns to prevent bridges collasping, after years of no new taxes, will win time and again....unfortanately as yiou noted, preventative care and maintenance with our taxes just doesn't go over well.  Only catastrophes win in elections.

I guess it depends on what one considers a "choice".

My choices:

1. Pay $200/month through my employer.

2. Pay $400/month outside my employer.

3. Not have health insurance.

Oh, wait... I'm a contract employee, so I don't qualify for #1.

I'm not going to divulge my salary; however, I can honestly say I can't afford #2.

Looks like I get to "choose" option #3. That's been my choice, incidentally, for the past three years.

~~~~~~~~~~~
Quidquid latine dictum sit, altum videtur.

Come visit PROJECT: Lucidity.

Cutting and pasting from a winger think tank, all of the details of which I posted, and even linking to them, is so obviously not in good faith.

It's about as "good faith" propaganda as the global warming deniers funded by Exxon. And how long were they enabled?

This is exactly why Dem candidates and issues get swift-boated every election.

The fact is your post claimed "we do not choose healthcare based on cost" and that "choice" was the important issue, which is nonsense and typical Big Business spin.

"Choice" is entirely a function of cost. Waste = less choice.

HC COST is absorbing 15% of the GNP!

Strangling the economy, reducing many choices in life. Like attending college, consuming goods and services, taking a vacation, or investing to name several.

the millions of Americas who don't necessarily think like garden-variety visitors to liberal blogs

Those millions know damn well that COST is a huge factor in their healthcare, and that saying otherwise is nonsense.

If you don't want me to point out how nonsensical your posts are...

I agree, whiterosebuddy. I'm not talking about affordable insurance for those who can afford it and government-sponsored healthcare for those who can't. We have that system now, and whenever there is a budget shortfall, guess who has to eat that cost? People on state-sponsored health care. The states end up closing mental hospitals and cutting staff. And at the same time, you have tons of people who fall in the middle - they make too much to qualify for state care but not enough to pay for health unsurance.

I'd have liked to see the Congressman address my points, rather than regurgitate his own. I could write a program that could do pretty much the same job.

I, for one, wouldn't mind turning my health insurance premiums over to the state in the form of taxes if everyone was covered.

when you were in Toronto, did you actually talk people about the health care system there?

No. It was a few days on a short vacation. I was just checking the local paper and the CBC out of general curiosity, not looking for any topic in particular. The prominance of these stories was suprising as we keep hearing in the US how great the Canadian system is.

Here is a link. See the first paragraph.

Link

The sons of the prophet are noble and bold,
and quite unaccustomed to fear.
But the bravest by far in the ranks of the Shah
was Abdul Abulbul Amir

Sorry that I'm so naive to think that ithe nsurance company financed "Harry and Louise" campaign killed Clinton's health care plan. I'm telling you people would rather pay more taxes than keep these ever increasing premiums they have now (if they have coverage at all). I think Krugman recently quoted a poll that said as much. I think there are plenty of Americans who buy into Michael Moore's "We not me" idea.

Tom

PS What an honor it is to be lectured by someone who is in the self-appointed "un-naive" elite.

I hope you're right about people thinking "we," not "me," but I have my doubts.

One thing I haven't seen brought up in this debate is the fate of the 1988 Medicare "catastrophic coverage" expansion. The bill would have not only capped Medicare expenses, but also provided a prescription drug benefit more than a decade before Medicare Part D.

The bill was passed with great fanfare, only to be almost completely repealed within a year because of a firestorm of protest from relatively well-off seniors who already had comparable private coverage and resented paying higher taxes for a benefit that was perceived as at best duplicative and at worst clearly inferior to what they already had. This 1993 Washington Monthly article provides a good overview of the debacle.

Money quote:

As important as remaining wary of the well-connected will be remaining mindful of the least organized, who are also most in need; namely, the 37 million Americans without health insurance. When the catastrophic care act was repealed, the soft voice of the elderly poor was, not surprisingly, drowned out by their wealthier counterparts. Only strong political leadership could have prevented this.

Simply stated, the people most likely to benefit from the act, the elderly poor and the spouses of the elderly ill, lacked the financial wherewithal to effectively voice their concerns. This, combined with the fact that they do not vote as dependably as their more affluent contemporaries, made them a lower priority in the eyes of many lawmakers.

Have things changed so much since 1988?

I disagree. The profligate companies are the main problem. The government is only a problem now because of the way the Bushies do things.

Tom