January 23, 2014

kirkwa:

And This Is Why You Shouldn’t Get Sick In America

Many believe that the US healthcare system is the best in the world. Not so according to the World Health Organization’s ranking of the world’s health systems. The US doesn’t even rank in the top 25. It ranks 37th and is the most expensive in the world. I would argue that even if we had the best healthcare system in the world, what good is it, if no one can afford to access it.

Most companies are buying 60/40-policys for their employees these days, but even if you are lucky enough to have good insurance with 80/20-policy coverage, that 20 percent your responsible for can drive you right into bankruptcy as easily as the 60-40 policy given the cost of healthcare.

Insurance cost have been going up dramatically in the last two decades, long before the new Affordable Healthcare Act has taken affect, in some cases as much as 35% per year.

But have you noticed the latest trick the insurance companies have roll out?

Yes, Higher Deductible… most averaging $5,000 per year, per person, but I have seen some as high as $10,000 per year. For those of you that are wondering, this tactic is specifically designed too stop you from using your insurance. It reduces the insurance companies out of pocket liability by shift costs onto consumers, especially those dealing with chronic illness such as diabetes and arthritis. Consequently, because consumers can’t afford the deductible they will avoid necessary care to save money.

Although insurance companies are a problem, the real crocks is the healthcare system it self. A corrupt and bloated system desperately in need of reform!

LTMC: Man.  Canadians have cheap healthcare, but they must be dropping like flies with all that socialized medicine.  

Wait a minute…

(via postracialcomments)

January 3, 2014
"We could have eliminated the income tax in 2010 had we adopted the Canadian, German, or French health-care systems."

David Cay Johnston

I think DCJ may have jumped the shark here.  I have to assume that he reached this conclusion by comparing annual revenue from the federal income tax with the cost savings differential between international healthcare systems in terms of GDP.  But practically speaking, the math doesn’t get us there.  According to his article, “Canada, Germany, and France each spend about 11.5 percent of their economy on health care, compared to 17.6 percent in the U.S.”  2013 U.S. GDP was  $ 15.68 trillion.  If we apply the GDP savings difference of 6.1% to the most recent GDP numbers, we get a savings of roughly $ 956 billion.  

That’s huge.  In fact, $ 956 billion is enough to wipe out the present federal budget deficit completely, and would leave us with a $ 300+ billion surplus…*if* that whole amount was going to the Government.  But it’s not.  Government spending on healthcare only accounts for roughly 4.6% of U.S. GDP as of 2013.  So of that $ 956 billion, we can reasonably assume that the federal Government would only receive it’s proportionate 4.6% share in savings, which is about $ 43.97 billion.  Not enough enough to put a dent in the 2013 deficit, much less eliminate the federal income tax.

The analysis doesn’t quite end there, however.  A little over a decade ago, a study by two Harvard Medical School professors found that if you include public employee health benefits and healthcare industry tax subsidies, tax expenditures were responsible for almost 60% of all healthcare spending in the U.S.  I’m not sure what the proportion would be now, but if those numbers hold true, that amount of spending alone is enough to finance a national healthcare insurance program.  As the study’s authors note, “we pay for national health insurance, but don’t get it.”

Furthermore, it’s also true that the cost differentials couldn’t be more stark.  Both out-of-pocket and total spending for healthcare in virtually every other country in the world is far, far lower than in America.  Healthcare administrative costs in the U.S. are almost double what they are in Canada.  Medical bills contribute to roughly half of all bankruptcy filings in the U.S., and three-fourths of those filers had health insurance at the time they filed.

So there is no doubt that if we switched to a Canadian, German, or French-style health-care system, that Americans would have more money in their pockets, and the U.S. Government would be spending less money.  But it’s pretty far-fetched to claim that we could eliminate the federal income tax by switching to a Canadian, German, or French-style health-care system.  Universal healthcare saves everybody money, but it certainly doesn’t leave us tax-free.

Update: The numbers I used for federal spending as a percentage of gdp (4.6%) don’t include Social Security.  But if you include all Social Security spending (which I’m not sure is accurate for our purposes here), you would still reach a similar result: there still isn’t enough in healthcare savings as a percentage of GDP to mop up the federal deficit (much less eliminate the federal income tax), if you assume a savings of 6.1% in healthcare spending as a percentage of GDP.

December 30, 2013
"My cousin died because he couldn’t afford his cancer treatment back in 2005. The bills over a 2-year period exceeded $500k, and the insurance company cut him off. I still remember my uncle pleading with the insurance company over the phone. They said he had reached his lifetime limit. He was 27. Not to get too political, but thank god this crap is illegal now thanks to the ACA."

Redditor “muscledhunter”

December 6, 2013
"[The biggest barrier to my medical practice is] The lack of a single-payer system. We waste enormous amounts of time and energy dealing with insurance companies, whose major goal is figuring out how not to cover patients."

Steven Nissen, M.D.

October 10, 2013
What Would A Single Payer Healthcare System In America Look Like?

Via Amy Goodman:

[S]ingle-payer is already immensely popular in the U.S., as Medicare. A 2011 Harris poll found that Medicare enjoyed 88 percent support from American adults, followed closely by Social Security. [Dr. Steffie Woolhandler] explained that with a Medicare-for-all system, “you would get a card the day you’re born, and you’d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it’s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion [per year].” Dr. Woolhandler went on, rather than “thousands of different plans, tons of different co-payments, deductibles and restrictions—one single-payer plan, which is what we need for all Americans to give the Americans really the choice they want … not the choice between insurance company A or insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.”

See also:

Physicians For A National Healthcare Plan

Expanded and Improved Medicare for All Act (H,.R. 676)

Medicare Overpayments To Private Plans

Taiwan’s Universal Healthcare System Provides Full Coverage For $21 A Month - Why Can’t We?

Taiwan’s Progress On Healthcare

Most Patients Happy With German Healthcare

Universal Healthcare Much Loved Among Canadians, Monarchy Less So

The British Are Surprisingly Satisfied With Their Controversial Socialized Healthcare System

Healthcare Abroad: France

Top 9 Healthcare Systems In The World

In OECD Countries, Universal Healthcare Gets High Marks

Study: 60.3% of Bankruptcy Filings Involving Medical Bills In America Were Brought By Petitioners Covered By Private Health Plans

Gul Banana on the Necessity of Universal Healthcare in America

How I Lost My Fear Of Universal Health Care

An Eye-Opening Adventure in Socialized Medicine

Close Encounters With Socialized Medicine

Conservatism And Insurance

August 18, 2013
The Power Of Experience

Think Progress highlights the story of Clint Murphy, a former Republican staffer who left politics in 2010, and discovered how hard it is to get insured with a pre-existing condition:

Clint Murphy, now a real estate agent from Savannah, Georgia, who’s been involved with Republican campaigns since the 1990s, was diagnosed with testicular cancer in 2000 when he was 25 years old. Four years and four rounds of chemo treatment later — all of which was covered by insurance — Murphy was in remission. Insurance wasn’t a problem in his subsequent political jobs — he worked on John McCain’s election campaign in 2008 and Karen Handel’s Georgia gubernatorial run in 2010 — but when he quit politics in 2010 and entered real estate, he realized just how difficult obtaining insurance with a pre-existing condition could be.

In an interview with the Atlanta Journal-Constitution, Murphy said he thought after 10 years since his cancer diagnosis, the insurance companies might cut him some slack — instead, they found something else to charge him for.

“I have sleep apnea. They treated sleep apnea as a pre-existing condition. I’m going right now with no insurance,” he told the AJC.

Murphy now supports Obamacare:

That’s why Murphy had this to say to his Republican friends who oppose Obamacare on Facebook last week: “When you say you’re against it, you’re saying that you don’t want people like me to have health insurance.”

This might be a bridge too far.  There are many problems with the Affordable Care Act, and people are opposed to it for different reasons.  Many folks on the Right tend to oppose it because they feel it adds more costly government regulation of the private sector, raises taxes, and some of its provisions are hopelessly complex and impossible to implement.  Some folks on the Left oppose it because they feel that it’s an incomplete solution, doesn’t actually insure everyone, and constitutes a handout to private insurance companies, who are now guaranteed customers by the government.  Reasonable people can come to the conclusion that the Affordable Care Act is not the best solution to covering people with pre-existing conditions.

But what Murphy’s story really demonstrates is the power of personal experience to change a person’s mind.  Clint Murphy was convinced that the health insurance system worked.  He had faith that the insurance companies would “cut him some slack” once he had to re-enter the private sector and purchase his own health insurance.  But once he had a pre-existing condition, he learned the hard way how America’s health insurance system deals with the people who need it the most.

Personal experience is a potent source of knowledge.  It is the reason, for example, why people with gay family members and friends are more likely to support marriage equality.  It’s the reason why Black Americans are more likely to have a poor opinion of law enforcement than White Americans.  It’s the reason why Hispanic Americans overwhelmingly support a more humane immigration policy.  When you or someone you know is directly affected by a problem, that experience tends to change your worldview in ways that might differ from what you might believe in the absence of those circumstances.

But it’s important to remember that this is also a conversation about empathy.  When I was younger, I spent a large portion of my youth growing up in a mostly White suburb.  Despite this, I felt like I was racially conscious.  But as I grew older, I realized that my “racial consciousness” was basically a fraud.  A large part of this growth happened in law school, where I studied the criminal justice system, and realized that it is tainted by racial injustice at every level.  Suddenly, the anti-police narratives in hip-hop made sense.  Malcolm X seemed less like a violent rabble rouser and more like a legitimate voice for the frustration of the Black community.  The realization that my history books really had been “White washed” to some extent was frustrating, but also liberating, because it allowed me to see a deeper truth that had evaded me for so long.

This is relevant to politics, because most of us inform our political positions based on personal experience.  So when a small business owner tells me that he opposes Obamacare because he genuinely can’t afford to offer insurance to his employees, I don’t just shrug my shoulders—even though a part of me is glad that people with pre-existing conditions can get coverage under the law.  If I was a small business owner in his position, I might feel more strongly about the mandatory employer coverage provisions of the law.  In the political realm, being able to understand why others might feel differently is an important part of understanding how to change peoples’ minds.

In Clint Murphy’s case, all it took to change his mind was to be placed in a vulnerable position.  All of a sudden, the complaints of people with pre-existing conditions didn’t seem quite as trivial.  Of course, Clint spent years of his life believing the opposite.  If only there was a way that the wisdom he gained from his personal experiences could have reached him sooner.

If there was a way to achieve a critical mass of empathy in this country, one which allows us to more keenly learn from the personal experiences of others, we might see a public policy revolution.  Perhaps the Executive branch would stop dropping as many drone missiles in the Middle East, weary of the blowback caused by civilian deaths.  Prosecutors might be less anxious to rack up convictions, knowing the devastation that mass incarceration and criminal records have on poor communities.  We might actually see a humane immigration policy, knowing that 11-year old girls wouldn’t be torn from their fathers.  Drug use might be treated as a public health matter rather than a criminal one, knowing that incarceration has not only failed to prevent people from using drugs, but done immeasurable damage the lives of those affected.

Will it happen?  Who knows.  It’s probably wishful thinking.  But one can always hope for the change.  With same-sex marriage and marijuana legalization on the upswing, there’s plenty of possibilities on the horizon.  We’ll just have to wait and see.

March 31, 2012
Cancer v. the Constitution « Dr. Jen Gunter

The patient in the emergency department smelled of advanced cancer. It is the smell of rotting flesh, but even more pungent. You only ever have to smell it once.

[…]

She hadn’t gone to the doctor because she had no health insurance. The only kind of work she could get in a struggling rural community was without benefits. Her coat and shoes beside the gurney were worn and her purse from another decade. She could never afford to buy it on her own. She didn’t qualify for Medicaid, the local doctor only took insurance, and there was no Planned Parenthood or County Clinic nearby.

So nothing was done about the bleeding until she passed out at work and someone called an ambulance. She required a couple of units of blood at the local hospital before they sent her by ambulance to our emergency department.

[…]

She needed a biopsy to confirm the type of cancer and a CT scan to see if the tumor had spread beyond the cervix. If she were lucky, she would have a some combination of a hysterectomy, chemotherapy, and radiation with a 50-65% chance of survival. If the cancer had spread, she would have radiation and chemotherapy with about a 25% chance of surviving.

But the cancer surgeons were not allowed to offer an uninsured woman a hysterectomy. Every now and then they snuck someone in, claiming to the administrators that the patient was more emergent than they really were. But one surgery doesn’t cure stage 2 or 3 cervical cancer, or even stave it off for long. It takes multiple admissions and week after week of expensive chemotherapy and/or radiation.

The radiation doctors were also not allowed to see uninsured patients. They could not even give a dying women a few weeks of radiation to ease her tumor’s stench while it caused her to bleed to death or killed her another way. They could give her one dose today. A very temporary measure for the bleeding, but only if her blood count was low enough. It wasn’t because she’s had the blood transfusion to get her here.

There was a charity program that paid providers and hospitals pennies on the dollar for cancer care. One hospital had signed up, resigned to the fact that they were seeing those patients anyway so better to get something for the cost of the care than nothing. Our hospital administrators had declined to participate. Better to get no money and keep seeing these uninsured patients over and over in the emergency room, each time providing the same stop-gap care that has no hope of cure or even palliation like a purgatory version of Groundhog Day, than to be inadequately reimbursed for the right care.

I had never encountered this clinical scenario during my training in Canada. I had never seen a woman suffer because she couldn’t afford something as simple as a Pap smear, never mind deal with the indignities of shopping around her sorrow and hard luck to try to patch together what would inevitably be inadequate medical therapy. It is this reality of medical care in America for which I was wholly unprepared. Many times I found the residents comforting me.

I gathered my thoughts before explaining the situation. To get her care through the charity program there was a catch. A set of hoops to jump through and we could jeopardize her eligibility with specific tests. I explained the ins and outs of accessing care through the program, where she needed to go, and what specifically she must say. The Intern printed out the sheet of community resources and advocacy groups that might also be able to help her patch together some kind of treatment.

It’s not health care, not by any stretch. But as long as the Supreme Court finds it constitutional I guess they’ll sleep better than I do.

LTMC: Oh look; another person who avoids seeking healthcare due to short-term cash flow incentives until her condition has deteriorated to the point where she can no longer feasibly avoid seeking treatment, at which point, her financial position runs into the conflict-of-interest generated by a for-profit insurance model.

Nobody could’ve seen this one coming.

(Source: sarahlee310)

March 27, 2012
The Case For A Single Payer Healthcare System

In a 2009 interview, Jon Cohn sat down with Dr. Michael Chen, Vice President and CFO of Taiwan’s National Health Insurance Bureau, the government office in charge of managing Taiwan’s government-run health insurance program.  Some excerpts from the transcript, via PNHP:

Jonathan Cohn (JC): You have what most people refer to as single payer health insurance - the government is the main insurer for everybody.

Dr. Michael Chen (MC): Yes.

***

JC: How did you decide on that model - the single payer? Why did you go in that direction?

MC: Well, we sent our people around the world to learn their programs, including the United States. Actually, the program is modeled after Medicare. And there are so many similarities - other than that our program covers all of the population, and Medicare covers only the elderly. It seems the way to go to have social insurance…

JC: Now, one issue that comes up in the United States when people talk about a single payer system, or even any kind of a system where the government is defining the benefits, there’s a big concern that there’s not enough choice. People in America… we want to know that you can choose the kind of insurance you want - how much coverage, what services. Is that an issue you dealt with in Taiwan? Was that a concern?

MC: Not at all, because in Taiwan the benefit package is rather comprehensive… We maintain a very long list for prescription drugs - more than twenty thousand items. And the benefit package includes inpatient, outpatient, and dental service which is usually not covered in this country.

JC: Now the flip side is that if you are offering such a generous package, that’s very expensive, is it not? I mean, how do you pay for it?

MC: Not the case.

JC: Not the case. What percentage ofGDP?

MC: Six percent of GDP,so that’s very affordable. The premium on average that the family pays is about two percent of the household income because the premium is shared by your employer.

JC: … In this country we spend far more than that, and even looking at Europe - Switzerland, France - they spend a lot more than that also. Are there waiting times for services in Taiwan? Is there something that people are going without? I mean that’s a lot of services for such a little amount of money. I’m trying to figure out what it is that you’re not getting.

MC: No waiting lines.

JC: No waiting lines? I can see a doctor any day I want…

MC: If you are not too particular.. you can visit even a specialist in a matter of minutes…

***

JC: … If I were to be sitting here with a doctor in private practice in Taiwan - I know in this country doctors worry a lot that Medicare doesn’t pay enough money and that it’s very bureaucratic - what kind of complaints would I hear from them?

MC: Of course, doctors would complain in public, but appreciate it in private - because, you know, especially in this economic downturn, how can you find an industry with assured growth rate annually? Right now they enjoy somewhere between four percent to five percent increased rate, and this is a sure thing.

Much like any institution or business, a single-payer system can be poorly run or competently run.  When they are competently run, most of the systemic horrors that people like to attach to “socialized” healthcare delivery systems become apocryphal phantasms.  That doesn’t mean people are never going to have trouble, or that tragedies won’t happen.  No system will ever be perfect.  But the question is which system is “least worst” among those that are available.  Taiwan’s system is both viable and effective without sacrificing outcomes or access.

Ezra Klein notes that if the Individual Mandate in Obamacare is ruled unconstitutional, then Progressives will be left with no way to achieve universal health insurance coverage without pressing for a single payer program.  Interestingly enough, I’m sure conservatives would very much prefer Obamacare (or perhaps Romneycare) over a single payer system.  But in the absence of these programs, all we are left with, it seems, is a giant tax credit, which does nothing to solve the problem of pre-existing conditions.  Private insurers will continue to deny coverage to people with pre-existing conditions who are not profitable unless they have a mandate that forces everybody to pay in to the risk pool, which allows them to use the premiums of healthy (i.e. profitable) people to pay for the care of sick (i.e. unprofitable) people.

If the rest of the civilized world is any indication, market-driven delivery systems for health insurance are a beast of antiquity.  That’s because no amount of deregulation or tax credits can resolve the anti-patient incentives that health insurance companies must reconcile.  It remains the only industry in America where, the more you need their product, the less they want to give it to you.  That’s an impossible dichotomy to reconcile without regularly screwing people over.  As one J.C. might put it, you cannot serve two masters.

We know that other approaches work.  We know that ours doesn’t.  Taiwan’s system has an 80% approval rating.  In America, it’s closer to 50% on a good day.    So if the mandate is found unconstitutional, Conservatives may find themselves in a difficult position, because the only route to universal healthcare at that point is through a single-payer system.  Indeed, if the mandate is struck down, that may be the political capital that progressives need to get single-payer on the national agenda.  Winning the battle, for Conservatives in this case, may mean losing the war.

March 19, 2012
Some Daylight On The Right With Healthcare Reform

Matt Sheffield, founder of the Right-leaning website Newsbusters, has written a relatively sane piece about healthcare reform in which he approvingly quotes Avik S.A. Roy, who discusses Switzerland and Singapore’s universal healthcare system:

One of the most frequently-made arguments in favor of socialized medicine is that it saves money, relative to the American system. And it is true that Europeans et al. spend less per-capita, and as a percentage of GDP, than we do. But the pro-socialism argument has a glaring weakness: it ignores the two most significant examples of market-oriented universal coverage in the developed world, Switzerland and Singapore, where state health spending is far lower than it is in other industrialized nations. Neither Switzerland nor Singapore could be described as libertarian utopias—both systems contain aspects that conservatives wouldn’t like—but they provide powerful examples of how market-oriented health care systems are more cost-efficient than socialized ones.

Sheffield then refreshingly admits that the Right has never put forth an honest, coherent alternative to Obamacare:

The reason we have Obamacare is that the Right, once it stopped supporting the individual mandate, has not aggressively put forward a market-based solution to the problems that plagued the American health care system.

Ideas have been thrown out there in the past, but simply throwing them out there isn’t enough, especially now that Obamacarehas been put into law. Policy abhors a vacuum. We had a healthcare policy before Obamacare, and we will have one after Obamacare. Conservatives owe it to America to propose free-market policies to replace Obamacare.

It’s nice to see some introspection on this topic from the same folks who were for a mandate before they were against it.  But putting that aside for a moment, I find this entry from Roy intriguing:

The Swiss and Singaporean models wouldn’t be perfect models for America; we would want to replace the Swiss individual mandate, for example, with a more market-oriented approach like allowing people to opt out of buying health insurance if they also agree to forego subsidized care. But both Switzerland and Singapore embody the most important principle of all: shifting control of health dollars from governments to individuals.

This is where advocates of a market-oriented approach to healthcare reform continually fall down.  The only reason that this opt-out would be necessary is if the person opting out wanted to stay uninsured voluntarily.  In which case, they’ll certainly opt out of subsidized care…up until the time they have a catastrophic injury or illness that requires medical intervention.  Which once again, takes us to the crux of the healthcare debate: when someone shows up at a hospital looking for medical care that they can’t pay for, you have two choices: 1) give them the care they need, and make someone else pay for it, or 2) deny them care.  Option #1 is the definition of subsidizing the individual’s care. Option #2 is morally untenable for the vast majority of people.  And the notion that private charity would pick up the slack is counterfactual, to say the least.

Removing the mandate also makes it impossible for insurance companies to cover people with pre-existing illnesses whose coverage would result in a net loss for the company.  You can’t get universal coverage with a market-based approach without a mandate.  You need everyone paying into the risk pool so the unused premiums of healthy people subsidize the care of people with chronic and/or serious health issues.  

In other words, Roy and Sheffield want to imitate everything about Switzerland and Singapore’s healthcare systems that make it successful, except the parts of the system that make it successful.

As Fareed Zakaria noted this evening, just 5% of Americans account for 50% of America’s healthcare spending.  That’s an enormous disparity.  And given the fact that we all consume more healthcare as we get older, it’s a safe bet that most of us will end up in that 5% at some point in our lives.  So this isn’t an issue of subsidizing irresponsible people.  It’s about subsidizing the care of people who the private sector won’t cover because it’s not profitable.  Either that, or we start letting hospitals shut down Grandma’s/Uncle Joe’s/Little Timmy’s respirator once their family’s estate is bled dry.  Or, alternatively, to stop treating you or a loved one’s cancer in the same event.  Call that scaremongering if you wish, but this sort of thing already happens to people on a regular basis.  So this isn’t hyperbolic bluster.  It’s the status quo.

I’d be happy to hear a policy proposal from Sheffield et al. where this doesn’t happen.  I want to hear the market-oriented solution to healthcare where people with pre-existing conditions can get access to affordable health insurance without a mandate or a gov’t-subsidized program of some sort.  Sheffield himself admits that this solution has yet to be forthcoming.  I suspect they haven’t found it yet because it doesn’t actually exist, which explains why Right-leaning thinkers supported mandates in years past as the market-oriented solution to healthcare reform.  We are now at a point where that solution is apparently no longer tenable.  And all we are left with is tax credits.  An example of Epistemic closure at its finest.

March 16, 2012
"

Twenty years ago, Switzerland had a system very similar to America’s - private insurers, private providers - with very similar problems. People didn’t buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance. So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly.

The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high.

"

Fareed Zakaria

Like I said, universal health care has worked in many countries for decades. The evidence is overwhelming.  

(via prettayprettaygood)

LTMC: whatever do you mean?  Socialism has ravaged Scandinavian welfare countries.  Just look at this hellhole:

what a wretched monument to tyranny.

(Source: prettayprettaygood)

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