Willravel

I just saw an 'early screening' of Sicko, the new Michael Moore documentary. Wow. I've been looking into the business of medicine more lately, but I ahd no idea 1) just how bad it is in the USA and 2) how amazing it can be elsewhere. I knew that the WHO had named France as the best health care system in the world, but I really had no idea how good it was. I'm not sure how to go about discussing this without spoilers, so I'm going to add the spoiler tag to the thread name.

The American system is broken, and what's worse is that we (a collective all American 'we') have had to become accustomed to the worst health care in the western world. After watching the movie, I called a friend of mine who also has Kaiser. For every 2.4 dollars he earns, Kaiser gets 1. Why? He has a preexisting condition (some type of heart problem, dissimilar to mine, but serious). He, like me, was grandfathered off a family plan onto an individual plan. He's stuck there because he can't get health care elsewhere because of his preexisting condition, and he can't reapply to Kaiser, because they'd drop him like... well they'd drop him. I happened to be in the hospital at the same time as him when I was getting my coarctation of the aorta repaired. My surgery would have cost me around $100,000 had I not been covered. His would have cost $120,000. The funny part is that if he lives to 80, he will have paid over $370,000 ($515/mo x 12 months x 60 years = 370,800). He could have gone back and had three more surgeries for the amount he will have paid, and he's one of those who has received a lot of care from the hospital. So where does the money go? Insurance is the same in any market or business. There are billionaire CEOs that need the money (thank's, capitalism!).

That's not the worst of it by far. 45 million Americans don't have health coverage because they can't afford to pay the high costs. If you get sick and go to a hospital uninsured, you'll be lucky to be treated. One instance in the film, Kaiser in Los Angeles would put uninsured sick people in a cab, and drive them over to an area nicknamed 'skid row', Union Rescue Mission. In the instance shown in the movie, a woman was dropped off in a hospital gown, confused and disoriented, unable to even care for herself. They didn't even drop her off at the entrance. When she got inside, it was clear that the bracelet provided by the hospital had been removed, so they couldn't find out who had sent her. This is not a singular occurrence. It has happened over 50 times. USC (one of the richest private schools in the country) County had happened to have dropped off an uninsured patient the day before MM started filming at the Union Rescue Mission. This patient had unfinished stitches on her head, she had several broken ribs, a broken collar bone, and was disoriented as she was dropped off. They didn't ask where to take her. They just threw her in the cab and took her over, shoving her out of the cab.

These are American citizens who are being punished for not making enough money by not even being allowed to stay healthy. 45 million Americans are in this group. That's about 15% of out total population. 1 out of every 6.6 people.


In France, things are a bit different. I was born in 1983, long before the time of the house call by doctors. Or so I thought. Apparently, in France, doctors still make house-calls. You can go into a hospital, and not only do you not pay for the health care, but they reimburse you for transport to the hospital. This, to me, is madness. It's like politicians telling the truth or a delicious chocolate bar being free of fat, sugars or preservatives. It's a fairy tale. Well, in the US it may be, but in France it's a reality. So how does the government pay for this, you may ask? Taxes, of course. So the French must pay an unreasonable amount of taxes, right? Here's a link to a simple website, text below:
More info:
http://www.frenchentree.com/fe-legal/
http://www.doingbusiness.org/Explore...x?economyid=70

I'll admit that this is not information included in the movie, but looking at it carefully, it's no exorbitant at all. MM found a local middle class family that took in 8,000 Euros a month. They live in one of the more ritzy flats I've seen in my life. They drove two cars. They had a 4 bedroom flat, which ran about $1575 per month. They owe no money at all. Not just medical, but they had no debt outside of their home. Their biggest expense was fruits and veggies. Oh, and their vacations. They're French, after all.

One thing that surprised me about the movie, is that Americans are marrying Canadians to get their healthcare. And when you get there, there are no lines. There isn't a shortage of doctors. I'm sure my friendly TFP neighbors to the North can elaborate on this quite well.

I'll post more later. Time for dinner. Please, enjoy this movie.

Cynthetiq

Well, let's see.

I have united healthcare. My doctor is on the ground floor of the building I live in in NYC. I call up and make an appointment. I pay my $10 copay. My doctor will come upstairs if I'm not well enough to go downstairs, something you mentioned as "housecalls." I pay approximately $300/month to cover me and my spouse.

My prexisting condition is asthma. I copay about $600 for my meds.

My father told me some words of wisdom growing up:

"Things cost money, there is no such thing as a free lunch. You'll need to make your own way in life since no one will be there to pick up the slack for you."

I have a friend who's daughter is dying of cancer. She is spending about $4,000 on medical expensives every month. She's sold off her homes and used up all her retirement.

Life sucks sometimes. period.

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Willravel

That seems like a good rate, except when compared to other countries. You definitely pay a lot less than I do, and a lot of people I know, especially considering that you have a preexisting condition.
I wonder if that's the trade off. I get Albuterol (or something else now, it's less effective and it tastes like ass) and Q-var and my copay is $10.
Things do cost money, and under socialized medicine one would pay higher taxes. They pay a lot less in taxes than we pay in insurance, though, and they don't have copay and they get higher rated care.

I'm really sorry your friend's daughter is dying of cancer. My aunt died of cancer (though she smoked her lungs out), and it was very sad to watch her deteriorate and have to spend their saving on her care. My uncle was fortunate that he's talented at stocks and was able to get back on his feet a few years after she passed. Had they lived in Canada, the Uk, France, etc., her care would have been free. There wouldn't have been money woes as she was dying, which I imagine would have given my uncle more time to spend with her.

host

willravel, while I agree that US healthcare can be unfavorably compared to what is available in France, a country with little foreign debt compared to GDP, almost no trade deficit, and 20 percent less poverty per thousand households, despite nearly a 10 percent unemployment rate, I am unable to separate the "healthcare gap" from the larger problem.....the disparity of wealth distribution in the US, compared to in other ODC's.

You might be able to separate the distribution of healthcare from the "big problem" because you don't seem to recognize that an $8000 euro per month household income (equivalent to $10750 US) is not "middle" income:


<b>IMO, to "do this" discussion in a more realistic way...where the healthcare distribution gap is but a symptom of the larger US wealth distribution problem (crisis....) you run up against the same reluctance that I experienced when I authored these two threads:</b>


My thread dealing with the background of the last true American populist politician, the assassinated Louisiana Senator and former governor, called one of the two "most dangerous men in America by Franklin Roosevelt, and, in his NY Times obituary, a "fascist", <b>Huey Long</b>, did not even garner one reply:

My thread about the re-emergence of the movie "Reds", on DVD, was immediately "modded out".... the TFP owner took it's length personally, I think......

The "Reds" thread contained this quote of Theodore Roosevelt:
<b>willravel, no one wants to talk about the REAL problem....you didn't post in the Huey Long thread....for example......so I'll reemphasize some of my previous sparsely received posts on the disparity problem and on the malignant greed and manipulation that preempts even the small government effort to insure seniors....medicare, and let it go at that.....</b>

....and, finally, if nothing else explains it, maybe this will:

When the bottom 50 percent in the US finally rise up and slit the throats of some of the folks described in the preceding quote box, the sabotuers of medicare and the "churners" who earn fees by taking helath insurers "private", after taking them "public", earning huge fees for themselves and stock options or golden parachute "triggers" for the insurance executives, maybe the knife wielding "rabble" will whisper this into their fucking ears:

Willravel

Just because I didn't post in a thread doesn't mean I didn't read it. Yes, there is an income gap in this country, and it's one of the biggest problems we face. If we had a health care system funded by taxes, health care would no longer be for the rich. We all pay taxes, and we all get coverage. I know this urks a lot of people who love free markets and capitalism and such, but those have not served us in this case. The insurance companies have done to medicine what we've seen happen to everything from war to news media: profit driven business.

I've always liked to look at it like other life dependent services like firefighters and police. I'm sure no one wants a huge private police force or a firefighter you have to pay insurance premiums for (I'm sorry, you only have the Silver fire plan which covers grease fires and electrical fires. Your house will have to burn to the ground, so we can make more money).

I'm also familiar with the Sinister 18 families, but this is about bypassing them. When a democrat wins in 2008, which will be Hillary, Obama, or Edwards, we're going to be looking at a real shot at bypassing the 18. If Ron Paul wins, the 18 will just pick up and leave. Heh.

Sicko covers a lot about Nixon, Bush and Kaiser. I think you'll enjoy it.

host

willravel, I don't mean to take out my anger on you...it's just that I wish that we could articulate our vision for the future in a way that truly sets it apart from the anti-government "reform" of the libertarians and the deliberate destruction of the reputation and fiscal stability of the government by the republicans.

I posted about the description of the bi-partisan, "money party" politicians by David Sirota, a few months ago. He's back with this description of the "sell out" by congressional "money party" democrats:
http://www.workingassetsblog.com/200..._21_dem_k.html

I see Clinton and Obama in their ranks, so I don't share your optimism. We face a rapidly deteriorating federal fiscal and foreign policy environment, and a deteriorating maket fundamentals and US currency environment, as well, as baby boomers begin to turn 62 in a wave that will last until 2023 and involve 47 million, aging folks with deteriorating personal health and wealth, if my projections for housing, stocks, bonds, and paper currency valuation are correct.

To avoid mass misery, I see an urgent need for the quick results that a demagogue populist patterned along the lines of a Huey Long, or a Bill Hayward like labor organizer (see the "Reds" thread link) could potentially achieve.

I am more radical than possibly anyone here except roachboy, but I am radicalized by the "achievments" of the money party politicians and the neocon corporatists and their business "patrons". What I see coming can be "bloodless" if a ruthless charasmatic populist emerges, and a majority is persuaded to vote it's best interests.

Small compromises like expansion of health coverage, without radical reform that includes huge tax increases on the top 5 percent and the near elimination of special interest politics, may actually hasten and exacerbate the violence that I see coming, almost inevitably.

Willravel

lol, I'm a tough kid. I can take it. Hope for the future is a funny thing because it seems so different for everyone... only it's really not. My articulation would start simple: I want my daughter to have more and better opportunities than I. Then we expand on that: those opportunities are education, health, vocational, and fiscal. Then we expand in to each of those subjects: education reform that would best benefit my daughter would be smaller classrooms that are able to focus on growth and improvement, self-directed learning, and such; health can be broken up into several, be they health care (like this thread) or environment, for example.

Often it's this method in which I find the most opportunity for growth and mutuality. That and optimism.
Oh I remember that one.
They're hardly innocent, of course, but I still see their campaigns being health care focused as the best avenue right now towards health care reform. It's not going to be as simple as one is elected and suddenly everything is okay, but the biggest and most difficult part of any change like this is getting the damn ball rolling. I think that they can spark this thing if smart and invested people can spin it right right way to the right people.
I hope that's not true, to be honest, because more appeals to fear and such are what has us in this mess. I would like to think a better strategy would be to inoculate people of their chronic fear though teaching people how to think for themselves. It's things like your ginormous posts that help people get a better grasp of the situation, and the best defense against fear-mongering is knowledge.
It still feels like fighting fire with fire, but I do feel like we're headed towards if we haven't already reached the time for last resorts. It's very possible you're right and the only thing left to do is to produce several leftist talking heads that use the same evil and despicable techniques as the Bill Orly's of the world. Like a Super-Olbermann, only with a much bigger audience and a clearer message.
The idea is that change like this comes either through a slow turn or revolution. I love revolutions as much as the next guy, but they are something that is useful only if all other routes have failed and there is no chance. If social medicine is able to squeak through, that might just be the foot in the door necessary to start the turn-around.

"Of course that's just my opinion, I could be wrong."
- Dennis Miller

dksuddeth

US healthcare would be so much better and a hell of a lot cheaper if we would stop regulating the crap out of it. The worst effect of the health insurance industry is allowing them to determine who a doctor can and cannot see as a patient.

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Willravel

In Canada, you can choose your own doctor. And the UK. And France. I suspect that you, dksuddeth, are probably more interested in a capitalist free market system, but I'm not 100% sure. What are your thoughts on social?

jorgelito

I pay $0 for healthcare, get full benefits and $20 co-pay (or was it $10?) thanks to an employer that values my skills and college education (thank you free market system!!). I don't smoke, drink heavily, nor do drugs. I have no preexisting conditions.

If someone decides to smoke and then gets cancer as a result, well then, I am very sorry but you have to take responsibility for your own actions. I would be very pissed if I had to to subsidize someone elses irresponsible choices. I work very hard for my salary and benefits.

So then, would socialized medicine be abused as a fix it all system for irresponsible people? I stay healthy and am careful with my actions because I do not want the expense of health care (especially when before I didn't have any insurance at all. A broken hand cost me $7500 cash). Therefore, I acted responsibly. I think free health care would just open up a wealth of abuse and overburden the system. People abuse the health care system here in LA to the extent that hospitals have to close down and ER centers close too.

Having said that, I do agree that the healthcare system is in need of reform. I'm not sure which part needs fixing: doctors, insurance, hospitals, patients or lawsuits.

Will, you mentioned that you think the insurance companies are to blame. Can you expand on that a little? I used to think the same thing but I'm not so sure. Maybe Jazz can give us some insight. I do know in my case, I paid $7500 cash for surgery on my broken hand. The doctor gave me a steep discount because he knew I just graduated and therefore no longer covered by school insurance and did not have a job yet. The hospital charged the most despite my financial hardship. They told me that if I had insurance, they would have charged around $25,000. I almost had a heart attack. I actually know why they charge so much but that is for another thread.

It's the same with car repair/service too apparently. Different prices depending on whether or not you have insurance.

I am interested in hearing about the Canada and UK systems.

host

Sigggghhhhhh........I provided plenty of detail that supports the POV that "insurance companies are to blame", in the lower part of post #4, on this thread; and that info was posted separately, here:
http://www.tfproject.org/tfp/showpos...7&postcount=19

....it is all timely, from mainstream sources, and it even details the recent annual profits of major health insurers and the compensation of their executives.... but...it was posted by "host"....so I guess it should be ignored while we all wait for Jazz to "give us some insight"....

Xazy

I would not really mention Clinton taking care of health care. It is 14 years since she started talking about it, and I have yet to see any results. Her current plan she released was very similiar to the one Edwards released (before she did). And do not forget that she was on the board of directors of Walmart which is known for their employees not having health care (though last year I believe their rate went up to 46%).

I am not a Moore fan but I do agree health care is a huge issue.

ubertuber

I have to think that at least part of the problem is that, culturally, in this country we have a hard time making tough ethical decisions through law.

Can you even imagine setting the basic guidelines for what an appropriate level of care would be for specific illnesses? Of course, when it's my grandmother, nothing but the most expensive treatments taken to the farthest extreme will do. When it's yours, well, we ought to be reasonable. Add to this that you can't REALLY standardize (read: socialize) medical care without dredging up the most unpleasant parts of the illegal alien debate.

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The_Jazz

host, you obviously are a very smart guy, but you're not an insurance expert. I don't think jorgelito meant any offense towards you when he mentioned me. Then again, maybe I've missed something somewhere and you and I can discuss hammer clauses and short-term nose endorsements. I'm always looking for someone to bounce ideas off of, and someone with your smarts would definitely be a big help to me on a few things.

Just like always, everyone here likes to lump all the blame in one place. Do the health insurance companies share in that blame? Sure. Are they the only ones? Of course not. I don't think they even get the majority of the blame.

We live in a capitalistic society. That's not going to change. There are a couple big problems that I see out there with healthcare and insurance. First, costs are rising. Second, many people cannot get insurance and are forced to self-insure their risk.

Second problem first: in a capitalistic society, you have to allow companies to manage their own risks, including insurance companies. That means that you can't force companies to do things they don't want to do without some sort of trade-off. Ask Florida property owners how making that mistake has been working out for them. The biggest problem here is that individuals and smaller groups actually produce more risk for insurance companies than larger ones. It's a little counterintuitive until you realize that accuaries can predict health care costs for large groups much more accurately than small groups and not at all for individuals. Someone who works for a large company is going to get cheaper insurance than someone who is self-employed, almost regardless of any pre-existing conditions. The risk is going to be factored into the premium charged to the large company from the very outset. There are also a number of things that a company can do to lower their premiums, like taking on some of the risk themselves. It's actually much more complicated than this, so let me know if you want more details. I'm trying to paint with as broad a brush as I can.

Currently, there's no good fix, but I know of several that are being proposed right now. I have a client who is a large benefits agency (health insurance falls under the benefits umbrella). They are current lobbying their state legislature to be allowed to set up what's called a "risk purchasing group" for the self-employed. Their goal is to get several thousand individuals, along with their families, into this pool to allow them to enjoy the benefits of group buying power. This is current illegal in most states (for some very good reasons, actually), but if they can demonstrate the controls that they want to put in place, it could turn into something very interesting.

In a capitalistic system, which again isn't going to change, some people are either going to not be able to afford the coverage or choose not to take it. And that leads me back to my first point, the costs.

There are a whole bunch of reasons why the costs are rising, but I don't think you can really blame the insurance carriers for that one. First, its in their (and your, as the insured) interest to keep costs as low as possible. After all, they will make more money if the costs are lower. Thats why they negotiate the cost of procedures up front with the doctors and hospitals that they work with. You can't even blame the doctors and hospitals since they've already contractually agreed to price things the same way, consistently for all customers of the health care insurer. The variable here are new technologies, which are typically very expensive to bring on line, drugs and the uninsured.

New technologies, especially hardware, are usually exponetially more expensive in medical applications than elsewhere because of the details, whether those be precision, cleanliness or a combination. That exactitude costs more to produce.

Personally, I think that if there's a bad guy it's the drug companies, although I have to admit even they have good reasons to do what they do. Drug companies are moving more and more towards developing long-term drugs rather than ones for short-term use. That means that there aren't nearly as many antibiotics being developed as cholesterol-lowering drugs. After all, you won't take antibiotics for the rest of your life... Another interesting thing to note - whenever you see a drug advertised, you can bet that it will be a long-term drug. You're going to want to pop a woody for the rest of your life, but clearing up that nasty cough is secondary.

The uninsured are the 1000 lb gorilla in the room. Honestly, they force everyone's prices up. In almost any other industry, they'd be ignored because they aren't anyone's customers nor are they necessarily desirable as customers (there are obvious exceptions). Everyone agrees that ignoring them is the wrong thing to do not only from a public health point of view but also from a humanitarian one. There's been talk of "forced placements" with health insurers, where the uninsured sign up with the state and are assigned an insurance company. There's a similar system in place for Workers Compensation insurance, but the fatal flaw here is that most of the uninsured can't afford the premiums for a number of reasons. First, employers typically absorb between 25% and 75% of the cost of the premium, depending on how their plan in set up. The employee contribution typically only pays a portion of the premium, especially if the employer has a large self insured retention and is gambling that there will be little erosion of it. The uninsured, who are mostly poor, can't afford the costs because their underwritten individually, and they are typically in mediocre health at best.

Its my professional opinion that a universal healthcare system will not happen in the US in the next 10 years. Beyond that, it's grows more possible the farther you get away from the present, but the system, as it exists now, is too powerful to overturn easily. It's much more probable that the uninsured will be covered by a quasi-government entity, although I have no idea how that would be funded.

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roachboy

interesting post, mister jazz...objections to it:

capitalism is not one thing: there can be and are any number of institutional arrangements that operate within that general context--there is no contradiction between capitalism and universal health care. capitalism has no "natural logic" to it--there is no normative capitalist system relative to which others can be parsed. the american system follows not from any such natural logic within capitalism: it follows from political choices made by "representatives" from within the ruling oligarchy....

the french model is far more interesting and effective than is the british.
it is a mixed system: the only reason that it is not a part of the debate concerning potential models for a system less barbaric than the present one in the states--which operates according to a logic that (i'll say this again) amounts to the assumption that the lives of the children of the wealthy are worth more than the lives of the children of the poor---seems to me a function of linguistic ignorance/chauvinism (take your pick, they're the same thing from different angles). the french system delivers better health care on a more equitably basis than does the american and than does the british/canadian model. period. it is also a curiously bureaucratic system which profiles in the way the french state does--which is based on a different legal tradition than you have in the states--so if the americans were to come to their collective senses and realise that there is something ethically Wrong about a medical system that is stratified on class lines in terms of access and were to adopt the french model, it would look quite differently than it does in france.

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it make you sick.

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The_Jazz

roachboy - I certainly agree with your universal logic arguement, and I have no experience or knowledge of the French system and will defer to those that do.

That said, the health insurance industry works within the free market. Perhaps that is a better term than the overarching "capitalism". The free market allows consumers, whether they be corporate or individual, to chose the plan that best meets their needs and budget. The obvious flaw is the group that can't (or in some cases won't) pay the premiums necessary to offset their risk. Those people end up costing the system billions of dollars and remains one of the biggest reasons that doctors and hospitals agitate for higher prices from the insurers. The insurers, on the other hand, can demonstrate that their clients/insureds do not deserve to pay the higher prices because they are in better health and cost less to treat. They also have the benefit of group negotiations.

__________________
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin
"There ought to be limits to freedom." - George W. Bush
"We have met the enemy and he is us." - Pogo

connyosis

I just saw Sicko and I was shocked by seeing how the less fortunate can be treated. I'm seriously going to stop complaining about high taxes here in Sweden. For the first time in my life I'm actually happy we have them (And how fucked up is that?).

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Willravel

Everyone pays taxes, therefore everyone would pay for a great deal of the system. It wouldn't be you funding other people, it would be the whole funding the whole. Irresponsible people... wait, by that do you mean those who purposefully hurt themselves? Or do you mean people who aren't responsible to make a lot of money?
All of it should be examined carefully, I think.
I don't have figures comparing the average cost of health insurance for an individual vs. the average amount the insurance pays out to said individual, but considering the soaring profits from the industry, I can imagine that people pay more than they get. That's how all insurance industries work. They make a profit from the amount they don't have to pay out (which is outlined in Sicko by showing health care professionals who are asked to deny coverage to people, and who even have denial quotas to reach). Between the high cost of insurance with the lower cost in taxes in places like France, the UK, and Canada, a clear picture appears. Their system is a good samaritan system. Our system is an individual supporting themselves system. I imagine, then, it boils down to philosophy. Clearly, most people in the US think that police work and firefighters and the likes shouldn't require you to pay a private corporation. We get fire coverage and police coverage for relatively cheap (if you were to compare it to health coverage, though it might be a case of apples and oranges in people's minds).
That's absolutely true, but I wonder how much less we'd be paying if those companies weren't looking for a continually larger profit.
UK
Canada
She's no where near perfect, but a lot of why she had to shut up was in the film. In the early 90s, as I'm sure most know, she fought veraciously for better health care. She brought it all the way to congressional committees, until George J. Mitchell, the Senate Majority Leader shot it down and took with it a great deal of her political clout. As a result of this defeat and the resulting loss of political power, she lost her ability to fight. Now, she's a Presidential front runner. If she wins, the bought and paid for Senate Majority leader won't be there any more to get in her way. With the Dem congress, they have a good chance of getting something done, if they're not too busy not helping the troops.
I think that's something we all can agree on.
This is an absolutely brilliant point. I imagine this would be a lot easier if we were able to translate ethics through lawmaking. I'm not really sure as to how one would address a broad problem like this. Maybe we have stronger ethics training in schools, so the next generation will have the ethical technologies necessary to make the decisions the leaders of today have trouble with?

Jazz, so you're saying doctors (who are making less than in the 80s and 90s), new technology (something that has always been present in medicine), and drug companies (I COMPLETELY AGREE ON THIS ONE). I have trouble believing that the skyrocketing costs can really be attributed to doctors or technology in any big way. When I was getting my heart surgery in the late 80s, the Catscan machines and EKG machines were very expensive. As I understand it, as a layman who's simply spent a lot of time talking to doctors, a great deal of the money is going into administration, insurance, and prescriptions. I would call those the big three reasons, based on my understanding.

May I ask what you would do to help those 45m who are uninsured in the capitalist system you were describing?

Thank you very much for pointing this out. Canada is no less capitalist for having universal health care just as we are no less capitalist for having socialized fire protection.
I agree. Too often we ironically thumb our noses at France. Yes, yes: cheese, frogs, surrender, coffee. It's all fun and games until you realize just how much easier it is to live under a lot of their social programs, especially their health care which did deserve it's rating of #1 from the WHO. If, by some mericle, we did ever switch to the system the French use, I suspect a lot of people would complain about taxes...until they needed the system. Then, suddenly, they would shut up like Bush not remembering the name of a head of state. "Old Francy!"

It has a lot to do with collective vs. individual, and that's a much more difficult call in a free market. I do have to wonder, though, if a free market is always right, or just usually right. I think we can see that an 'unfree' health care system can flourish when we look at the rest of the Western World. Does that mean it will work here? Not necessarily, but considering how much better they have it there, I keep coming back to the thought, "Well, it can't really get much worse." Also, I'm a bit of a socialist, so my take on this is bound to be different than other people here who are less socialist.
Hahaha...yeah sometimes it's hard to see what you're paying for when it's all you know. Things could be a lot worse in Sweden (the swedest country of them all).

powerclown

I'm curious to know why Moore took some Americans to Cuba for a doctor's appointment yet Castro had to bring in Spanish doctors for his illness.

Spain > Cuba > US ?

Willravel

Spain is in the top 10. I'm trying to find my old link to the WHO study.

flstf

The_Jazz,
I snipped a couple of paragraphs from your post although I did read it all and I have a couple of questions.

In the first paragraph you say:
What could be a larger group than the whole country? Isn't this a good argument for putting everyone in one group and providing universal healthcare and wouldn't it therefore be less expensive?

In the second paragraph you say:
What are some of the very good reasons for not allowing individuals to pool together to reduce their healthcre costs?

The_Jazz

Fire coverage and police coverage only deal with the immediate problem - the fire itself or the actual crime. Insurance, whether it be fire, liability or health, reimburses (theoretically) the insured for their loss from whatever peril they suffered from. Firefighters will not restore your home. Policemen will not fix your car if a thief drives it into a lake. This just isn't apples and oranges - this is apples and the number i. Health coverage pays for your healthcare costs. Homeowners insurance pays for your possessions if they are damaged or stolen. Fire and police departments have nothing to do with this arguement.

Doctors are making less, but the reason for that has to do more with rising malpractice premiums, competition in the medical field and the application of simple economics to the equation (i.e., there's no need for a doctor to pull your ingrown toenail when a physicians assistant can do it for much cheaper) than a nefarious plot by the insurance industry. Whereas I twice had doctors work on my inflamed toe due to a nasty ingrown nail in the 90's, when it happened again 2 years ago, the nurse practioner took care of it and did a great job. My doctor spent 5 minutes checking her work and then went off to do something else. He didn't have a nurse practioner/physicians assistant 10 years ago.

New technologies cost more than I think you realize. The cutting edge machines can run into the millions of dollars now, but I'll conceed the point for the moment since it's not a huge part of my equation. Administration is another large cost, but no more so than in the past, even with HIPPA.

Malpractice insurance varies greatly from doctor to doctor. Some (usually general practicioners) buy it individually. Most buy it through a group or hospital. Malpractice coverage skyrocketed a few years ago for a few reasons, one of the chief ones being that some new models came out showing that claims were beginning to skyrocket. Illinois's largest malpratice carrier is a mutual (meaning it's owned by its insureds), and they had to charge a significant increase in order to stay solvent. The reason for the model changes came from the number of new malpractice claims out there as well as the higher verdict amounts. Many lawyers found some easy targets in the medical community, particularly among doctors with addiction problems. Whether the doctor did anything wrong or not started to become less relevant since a cocaine problem basically demonized the defendant from the start.

will, I'm a liability broker. You're lucky that I know all the big words that I do. I can't fix anything because it's not something I have any hands-on knowledge about; ask me about fixing the 3rd party liability system and I can offer opinions until I'm blue in the face.

That qualifier firmly in place, I will venture to say that some of the uninsured are just dumb. I can't be any nicer than that because if you have the ability to buy health coverage and chose not to, I find that to be a completely selfish and frankly moronic decision. You may be young and healthy today, but that doesn't mean that a Flying Elvis isn't going to come hurtling out of the sky and break your pelvis or that you won't develop drug resistant TB because jackoff thought it was ok to fly internationally on your flight to Buenos Aires.

That's not the position of the majority of uninsureds, however. For those who can't afford the coverage for whatever reason, I think that there needs to be an amalgom of forced placement and public subsidies. I imagine it working where the state pays the majority of the premium with the individual contributing what they can, possibly on a sliding scale. That doesn't work for the truly desititute, and I don't have a quick and easy solution for those.

__________________
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin
"There ought to be limits to freedom." - George W. Bush
"We have met the enemy and he is us." - Pogo

host

powerclown's "question" is influenced by a campaign on the anti Michael More blogs on the "internets"....such a closed little circular world they dwell in:

.....and blah, blah, fucking blah....and on it goes, for 2000+ entries....bad rich Michael Moore......sheesh !!!

Nothing about Jeb Bush and his european Cuban south florida political base, and their influence on keeping up the financial and trade embargo on CUba and it's effect on Cuba's healthcare system.....

Instead of wondering why third world Cuba, hobbled by extreme economic conditions and by the US embargo, still manages a lower infant mortality rate, per the CIA Factbook data, compared to the rate in the US, powerclown tows his "party line"....let's cut apart Michael Moore !!!!!!!!!

It's old, powerclown....sheeeesh !!!!!!!!!

powerclown

The_Jazz

Actually it is, assuming that the state is going to pay everyone's cost. It would allow for relatively accurate budgeting (most likely to within a few million dollars out of around several hundred billion). Over the long term - meaning several decades - I have no doubt it would end up being less expensive.

That said, it's not going to happen. For one thing, lots of folks don't want it to, particularly Congressmen who have large healthcare insurers employing people in their jurisdiction. All those folks would either immediately be out of work or become federal employees. Most likely, the group would become a combination of the two. Assuming I live as long as the actuaries say I'm going to (about another 50 years), it's possible that we'll make some great strides in that direction within my lifetime. It won't happen overnight, and it won't happen without the current uninsured being taken care of first. It's the necessary progression, especially given the current legislative climate. I don't see that happening until at least 2010, and as I mentioned in my first post, I have no idea where they're going to raise the money. Maybe they'll take Rod Blagoevich's worst idea ever and put a gross receipts tax on every business in the country.
First, they don't have what's referred to as "insurable interest". Typically that means some sort of relationship linking them all together, whether it be through family, employer or some other commonality. What's being proposed here would just link the self-employed, with that being the sole link, which is technically illegal. Those laws are in place to prevent consumer fraud, and I can't say that they're necessarily misguided in this case.

Then there's the problem of who ISN'T going to be included in the group. There's the very real problem of discrimination based on real or perceived disadvantages to allowing someone to participate. The issue of pre-existing conditions, etc. would only increase it.

The big question is exactly how it would be set up, whether or not there would be an amount retained by the pool somehow to offset the risk and if people wanted multiple options. I can give you more details if you'd like, but I can't really do it without using some techical terms.

There's also the issue of fraud against the consumer, where the administrator of the purchasing group would take the money and run. My own company was the victim of that about 8 or 9 years of that. Given who's doing this, there's not much chance, but it exists.

Basically, my point was that both sides need to make sure that the other one has all the right legal controls in place

__________________
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin
"There ought to be limits to freedom." - George W. Bush
"We have met the enemy and he is us." - Pogo

Willravel

...dealing with the immediate problem, like emergency medical care? Let's say that I get shot in the leg and I have no insurance. The cop gets the bad guy, and I do what? I try to get it out myself and get an infection? I go to a free clinic and compete in line with the 45 million other uninsured people?

What if just emergency care were covered in a social program like fire and police? It's dealing with the immediate problem, which seems more than comparable to fire crime (firemen prevent the fire from getting worse, doctors prevent the wound from getting worse; firemen put out the fire, doctors clean and stitch the wound).

I'm wondering if you could sit down with a man that works two jobs and still can't afford health coverage and tell him, "You're SOL."
Oh comon. Let's leave the 'nefarious' language where it belongs: in threads about Bush.

Do you have statistical information available to you on this? I think it'd be really helpful. I know most doctors are against socialized medicine (and a lot of that has to do with the fact that they believe they'll be making a lot less and seeing a lot more patients, which is a big fat myth).
I'm aware that the cost of these technologies is astronomical, but it was astronomical in the 80s and 90s, too. Expensive technology is hardly something new, and I have no information that tells me that technology now has become more expensive relative to inflation. A million dollar machine in the 80s may have a counterpart ( better replacement replacement) now, but it's basically the same when you adjust for inflation, according to my cardiologist.
I wonder if the better thing might be ceilings on malpractice suits imposed by the government. No one needs $15b because a doctor did his best but still couldn't save someone. I know a lot of doctors make mistakes, and it's important that the victims be taken care of, but what can a million dollars do for someone who's finger was put back on wrong?

I imagine this might be something we agree on. I'll have to check and see how malpractice is handled in France.
I understand what you're saying, but I still can't bring myself to think that 45 million Americans don't buy insurance because they just don't feel like it. As a matter of fact, I'd guess that most of them can't afford it or have been denied. I feel deeply for them because, had it not been for positive circumstance, I would have been one who was not insured because my preexisting condition. If I hadn't been able to get a few scholarships, I'd be dirt poor. It's that small twist of fate that separates me from these 45 million. If you can't think of their situation, think of yours. Imagine if somehow you weren't able to afford medical care and something, god forbid, were to happen to you or your family. I would want a system in place that can deal with anything you can throw at it whether you're Bill Gates or a bum.
Single payer, sorta.

MM was right in Bowling, and that could have prevented the Virginia Tech shootings. MM was right about the Iraq War.

MM is right about this, there is a problem.

host

NO,,,,,,,,I take no meds, but I've had it with all of the bullshit spin that is intended by CNP/Salem, Bozell, Charles Taylor LGF, Horowitz, Flopping Aces, Clarice, Necons/AIPAC Powerline Blog, ET AL to obscure what actually needs to happen in the US...... a seachange in awareness that influences the 150 million of us that "own" just 2-1/2 percent of US assets...to act and vote in their own interests....no more votes for pols who bring us "bankruptcy reform: or a "fair tax" that replaces a progressive income tax.....no more greedy insurance lobbies defrauding medicare and then telling us that government can't do anything right, and no more "catapulting the propaganda" to attempt a "privatization" of social security from a POTUS who transformed a total US treasury annual deficit increase of just $18 billion from 10/01/99 to 9/30/00, into a $3 trillion increase since 2001.......

No more bullshit, powerclown. Moore has found a way to get people's attention, to make them think and to discuss our real problems, He's only a messenger.....WTF is your purpose......your agenda?????

The_Jazz

That's a fine and dandy suggestion. I think it has merit. I also think that it would never happen for the simple reason that you'd have to raise taxes to do so and figure out when coverage gets cut off. I think some emergency ambulances provided by governments are free to the patient, and I agree that's the way it should be. But you can't make emergency rooms into public entities. If you get shot (again), you go to the hospital and worry about how to pay for it later. In the current system, charity would take care of a portion of the bill if you are uninsured.

Again, this isn't what I do. I don't have this kind of information at my fingertips. I'll check my back issues of Business Insurance when I get home to see what I can find with a minimal amount of searching.

I don't think I've been clear. The $1M machine 10 years ago has a new version that costs $2M. The rate of inflation should make it about $1.1-$1.2M. The technology costs more today.

I Actually, we don't even get close to agreeing on this. Malpractice caps have worked very well at keeping insurance costs down for California doctors, but there's a doctor that I know of in N. CA that delivered a number of babies while high on cocaine. He moved from Illinois specifically because of the caps. Many times the doctor didn't make any mistakes and life happened. Some times the doctor plain old fucked up. Those are the times where the cap is a huge disservice to the claimant.

You missed the next paragraph where I conceeded that this isn't the majority of uninsured. The majority are most certainly those who can't afford the coverage. I just went off on a rant against those that can but choose not to.

As far as single payer - no. Not at all. Single payer means that someone pays all of their own bills outside the health insurance system. They are the "single payer". My proposal would have the individual apply through the state, be assigned a health insurer who's already writing business in the state and assigned into a plan with the payment burden being shouldered by the state for the most part.

__________________
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin
"There ought to be limits to freedom." - George W. Bush
"We have met the enemy and he is us." - Pogo

Willravel

Charity is hardly reliable. I see your statement "But you can't make emergency rooms into public entities", but you don't give a reason why.
1.1-1.2M today isn't 1m 10 years ago. Based on the general market, it's more like 700-800k = 1.1-1.2m today. I was obviously just throwing out examples not actually based on real prices. Again, according to a source I cannot cite, unfortunately, my Cardiologist said that the cost is basically the same. I can't back that up, but you can always ask someone if you don't have the information.
Then the doctor goes to prison. I somehow doubt that's the norm in malpractice cases.
I respond in order. As I'm typing now, I've not read your last paragraph.

Those who can afford health insurance, have no preexisting conditions and don't get it are dumbfucks. On that we agree.
So you're talking about something not dissimilar to prisons. Government pays, privately run. That hasn't gone too well.

joshbaumgartner

I am admittedly an extremist when it comes to the issue of health care. I believe that allowing citizens to be destroyed by illness is as bad as allowing their homes to be bombed by a foreign country. Lack of access to health care is a weapon of mass destruction that has killed far more Americans than terrorists could dream of. Denying adequate health care on the basis of finances is in my mind akin to levying the death penalty for poverty. But like I said, I'm a wee bit of an extremist on this issue.

I support all efforts that result in more people having better access to comprehensive health care, but the only ultimate goal of my tack is to achieve universal, comprehensive, guaranteed health care for every single citizen regardless of any factor beyond their need for care.

It's not a question of whether we can afford it or not. We can't afford not to.

It's not about addressing the needs of poor people or working people or rich people. It is for all people regardless.

It's not about getting companies to shoulder the burden. Companies should be able to focus on their business, not covering their employees' medical costs.

It's about the fact that American citizens are dying because our health care system is not comprehensive, nor universal. Working parents are unable to cover their children. Elderly have to gamble on which card will cover what they need to stay healthy. Young people around the country are routinely weighing the cost of medical insurance against getting a college education or making other important investments in their future. More bankrupties are due to medical costs than all other factors combined.

Yeah, I'm an extremist; I admit it. I believe that this issue is one of great moral and social importance and if we don't improve matters, our children will have every right to be ashamed of our actions, and look sadly back on us when they read their history books.

powerclown

Did you know that Moore is as popular in Syria as he is in Beverly Hills? I have to draw the line when Michael Moore and fanatic hezbollah terrorist maniac Hassan Nasrallah espouse the same opinions of America. This is not to say there is nothing in a conversation on the state of the American health system of course, just that Moore is a most unfortunate medium by which to raise peoples awareness on an important issue.

Willravel

The same can be said of the Pirates of the Caribbean sequel, but it's meaningless either way.

Ch'i

Who cares? The idea is to direct attention towards a problem that many Americans are completely unaware of, not to boost his popularity.

Willravel

I couldn't agree more. 18,000 people a year die because they don't have health coverage. How many die each year from terrorism?

According to this page, about 20% of the average French gross salary goes into the incredible system they have, which is the most expensive of all social medical programs in the world. Germany is about 13%, according to this site. This lists the average annual rates for people of different ages under the UK's NHS. Note that even at NHS's most expensive, it's only $220 per month, which is probably a lot less than the national average in the US.

The_Jazz

will, I'm not talking about anything like prisons in the slightest. Let me elaborate my point and perhaps make it clearer:

An individual, for whatever reason, finds himself without insurance. He applies to the state fund. The state takes the next insurance carrier in the queue (as a part of the benefit of writing health insurance for anyone in the state all carriers join the pool) and assigns that carrier to the individual who then underwrites the individual and assigns them a premium. The state then pays a significant portion of that premium with the individual paying the rest. The individual thereby has healthcare coverage.

There are some big pitfalls that even someone like myself who only knows enough to be dangerous about health insurance can see. Namely, is the individual treated as such or is there a greater plan in place that is accessible? Is there a deductible or retention in place for the state? How do you pay for it? Is there a cap on the coverage? There are others beyond this, but these 3 seem good enough to start. The carrier has to administer everything, make the payments and negotiate the terms with the providers. The state takes the financial burden. The individual has the coverage and, at least theoretically, contributes.

I don't know where your prison analogy came from, will. Honestly, that question disturbs me because I thought up to now that I'd done a decent job describing what I had in mind, but apparently I wasn't even close.

__________________
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin
"There ought to be limits to freedom." - George W. Bush
"We have met the enemy and he is us." - Pogo

powerclown

Thats my point. Many people see Moore and want to run away as fast as they can. If I wanted to learn more about the American healthcare system (or avoid the risk of spreading disinformation), I'd choose to get my information from the documentation of serious doctors, administrators, nurses, and journalists in the industry than from an obnoxious blowhard like Moore. Actually, the more I think about it and amidst the poisonous political climate pervading the country, the fact that Michael Moore is commentating on healthcare awareness in America has the effect of trivializing the whole issue in my opinion.

Willravel

I understand. Uninsured is covered mostly by state, but is treated by private hospital. The state pays for public care to be run privately. Like a prison. That was my comparison. It wasn't intended to be very direct, so far as comparisons go. I'll speak to why I mention it in a second.
Danger is my middle name. The deductible might have to be voluntary or to be put on an extended payment plan, considering the financial problems that an uninsured person may have. I'd even be worried about the payment plan, as they could easily put people into debt. I don't think we need more credit in medicine. Cap on coverage? I don't see why. The idea here is to treat people who need help, despite the fact that they can't afford coverage. My only concern would be proving you are unable to get insurance (to avoid people simply not having insurance because you can get it for free). All of this involves a lot more bureaucracy in addition to that which we already have in medicine, and I'm not sure how much I like that. It will only add on more costs to the whole thing.
Look at the private prison system. They are privately run, but they get funding from the state. This is similar, though not the same, as what you're talking about. I guess my first thought ran to "how will the hospitals try to make a profit off this..." and then I figured they are treating people who aren't able to sue or anything like that. This could lead to cutting corners in order to squeeze profits out of the government funding. This is similar to the prison system in that the prisons cut corners all the time to make a bigger profit. It's a concern.

Ch'i

Understandable. I was definately skeptical when I heard that Micheal Moore was making another film. Yet, after watching it, I have to admit that his argument was pursuasive, informative and well defined. Even his usual bias was subdued.

It certainly doesn't lack in poignancy either.

joshbaumgartner

Well I can tell you that my current premium for a PPO plan for me and my family is a lot more than that. In fact my portion is about $250/mo and my employer covers 100% of my coverage and 50% of the family, so you can figure the total plan cost is probably $600 or so. This is a must-pay cost and I don't exactly have the ability to do a lot of shopping around. This means that I view this expense no differently than if it were taken by the government.

According to the WHO's international health statistics, here are some intersting points:

Per capita total expenditure on health (% of GDP in parenthesis) and the percentage that is paid through government expenditure:
Australia: $3,123 (9.6%) - 67.5% government
Canada: $3,038 (9.8%) - 69.8% government
France: $3,464 (10.5%) - 78.4% government
Germany: $3,521 (10.6%) - 76.9% government
India: $31 (5.0%) - 17.3% government
Italy: $2,580 (8.7%) - 75.1% government
Japan: $2,823 (7.8%) - 81.3% government
New Zealand: $2,040 (8.4%) - 77.4% government
Norway: $5,405 (9.7%) - 83.5% government
Russia: $245 (6.0%) - 61.3% government
Sweden: $3,532 (9.1%) - 84.9% government
United Kingdom: $2,900 (8.1%) - 86.3% government
United States: $6,096 (15.4%) - 44.7% government

Why are we Americans, supposed masters of getting the best deal, so willing to pay so much for so little? 15.4% of our GDP! That's 50% more than most any other developed nation, and even then a huge swathe of people are left with inadequate care. Only one nation in the world (Tuvalu, at 16.6%) spends more. I have no problem spending the money that needs to be spent, but please can we get some better value for our money? One thing I don't know about this statistic is whether it includes only money actually spent on health care, or all the money spent on the organizations that pay for the health care (i.e. does it only count money paid to doctors, or all the cost of premiums)? If the former (which I suspect) then we really pay a lot more on top of our 15.4% to support the insurance industry.

When I hear that we can't afford it, I cringe. France has a fine system of health care, and does it for 2/3 the cost of our system and covers everyone in the country to boot. I know there is not a system in the world that is without issues, but many of these countries routinely are rated as providing better health care across the board than the average care in the United States, and here many people can't even get that.

roachboy

i cant imagine caring what conservatives think of michael moore.
it seems par for the course that when confronted with problematic information in the context of a film he made, the response is "moore is a blowhard" or some other such. not able to mount a coherent critique of the positions outlined, or anything remotely like a solution to the problems he raises--unwilling to even acknowledge there is a problem (except to say that moore "trivializes" it by being the person who made sicko)--all that remains is ad hominem.

well, moore is not my favorite documentary film-maker--he is not even on the list of the top 10 or 15 i just drew up in my head as i sit here---but he is pretty good at presenting complex problems in a well-researched way to a popular audience across a medium that folk generally view as entertainment. like any documentary film-maker, this presentation comes in the form of arguments, and the arguments are clear--whether you agree with them or not, they ARE clear. there are often problems or holes with the arguments, and personally i sometimes wish that someone else would make these films--but the fact is that moore does what he does and it is good that he does it BECAUSE like the films or not, from whatever political perspective, they generate debates and they also provide a coherent starting point for those debate. this is very different from conservative opinion management tactics, which substitute superficial and crude sloganeering for analysis, which when analysis does happen uses indefensable categories in crude ways to generate conclusions that are of a piece with the political starting point of a piece and which are NOT about fostering the messy process of debate across all positions, but only debate with those who are Other.
and even that's not debate.
it is slogan rehearsal.
you know, shit like "michael moore is a blowhard"...

so powerclown: if you dont like moore, make different, better films.
go for it.
i am sure its easy--if you think michael moore is such a fool, then you must also think that what he does is easy, and so prove how easy it is and do some films yourself.
do it and show the results.
then we'll see what is actually up, yes?

it's like walking around a contemporary art gallery with someone who looks around and says: "well that's stupid: i could have done that"
to which the only response is "why didnt you?"

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite