Thursday, July 16, 2009

Rationing Health Care?

There was an interesting article in the IHT this morning. Setting aside all the bioethics issues, the author's concluding paragraph should be required reading for all involved in the current health care debate:

One final comment. It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

Living in a land of public health care, augmented by private care, I share the "confidence" of Canadians and Brits. I would add that the dozen or so Americans I know who have lived in the UK and been cared for by their system prefer the Brit system. Of course, the curtains aren't as pretty in the offices or hospital rooms, and the chairs in the waiting area aren't cushioned.

At the rate the US medical industry is moving, we will soon find it impossible for anyone other than those earning more than the median wage to afford health care.


  1. Amzingly enough it seems to work for:
    Australia, UK, France, Gemany, Japan, Canada ... the list is endless.

    In all cases their health satistics are better than the US's .. and at a fraction of the cost.

    Cuba is the embarassing one, their stats are better or virtually the same as the US, despite spending 3.7% of what the US spend per person.

    Take Oz, Our GDP per person is 78% of the US (though that is changing of course). Our health spending per person is 38% of the US. But in every major health stat we are far, far better than the US.

    Now this says something about the US's system (like it takes real telent to create inefficiency like this) . The real question is not some waffle about socialised medicine vs 'free enterprise' (might as well argue the merits of regular armies vs mercenaries) it is about outcomes and the 'best bang for a scarce buck'.

    Can you imagine the cost in the future to the US as the population ages?

  2. OldSkeptic,

    Generally well said. My only comment is that you failed to apply sufficient cynicism to the US health care system. The so-called US health care system was developed solely by those people who would profit from it. Everything becomes obvious once you consider that fact.

    As for the future costs of our health care system, that's obvious as well, but you need a calculator many more digits than are commonly available (say, there's a profit for somebody...).

    BTW,I've only done a cursory glance at the proposal in the House but so far am not impressed. The House did the same thing that the Bush administration did and pretty much avoided a rational discussion on cost with the insurance industry. They'll get the same result as Medicare Part D, which is now adding $400 billion per year to the national deficit.

    The key issue here is the allocation of scarce resources (hat tip to OldSkeptic) but Americans can't seem to bring themselves to consider the scarce part when it comes to health care and frequently apply a fire hose when a garden hose would be more appropriate. I think we've been watching too many Hospital soap operas over the years...

  3. HuffPo had an interesting piece a couple of days ago on International health care -- 500+ comments, almost all favorable re. the experience of nationalized medicine.

    It can found here:

  4. The bottom line on anything not a "free resource" (i.e., air) is that there is usually some form of "rationing". For example, not everyone in the U.S. gets a Lamborghini. They are "rationed", in this case by price. If you have enough money, you can get one. If not, you drive a Chevy Nova, a Hummer, walk or ride the bus.

    We "ration" medical treatment the same way. If you have enough money you can get whatever you want. If you don't, you skip check-ups, or wait until you're really suffering to go to the ER, or work an extra job, or, worst case, lose your savings and your house...

    Of course, if your system is designed to make a profit for the people delivering the medicine, this is a feature, not a bug.

    There really is no excuse for this system in what is supposed to be a democracy. The notion that the rich should be healthier than the poor is inherantly undemocratic. But the idea that most Americans should be wage slaves, utterly dependent on someone else for their livelihood, would have been an anathema to many of the Founders, who considered a majority class of freeholders essential for the survival of their republic.

    So IMO the "health care debate", much like the "financial stimulus debate" or the "torture and war crimes debate" says less about the practical values of the various plans, ideas and goals than it does about the degree to which:

    1. We have become a nation of subjects instead of citizens, and are rapidly losing both the capability to understand the levers of power and the ability to manipulate them, and

    2. Our rulers have themselves become the fingers on the hand of the consortia of interests that have become the power within the state, that is, both individuals and groups (banks and financial companies, large unions, other large industrial and commercial groups, organizations such as "think tanks" and interest groups ranging from the NRA to the Sierra Club) with the money and influence to buy and sell legislators and agencies.

    The notion that government "rationing" of health care is bad but insurance company "rationing" of health care is good is a moronic talking point that a healthy citizenry would have seen through in a nanosecond and a working legislature would have treated with the contempt it deserves. The fact that neither has happened...?


    Sorry, but that's as close to sophisticated analysis as I can get on this one.

  5. When I turned on my TV yesterday afternoon, it was on CBS and Katie C. was coming on in a few minutes. Since the House of Reps. health bill had come out earlier yesterday, I thought I'd stay on that channel to hear what Katie would say. A few minutes, I don't know how many exactly was spent on that story. After she announced the unveiling of the health plan, they ran a story of a small business, indoor rock climbing, whose owner complained of the tax burden, and how it would put him out of business or limit his hiring ability.

    Next was their version of Dr. Sanjay Gupta, can't remember the name, in an interview with Obama. The main point was how to pay for the initiative and doctors' pay.

    Blah blah etc.

    Not a stinkin' second devoted to backing the positive benefits of this plan or why we need it.

    Lisa, your link is more than likely one of only a few places you'll see any decent discussion of what it's like to have the health care other countries and people are privileged to have. Our national media for the most part stinks to High Heaven.

    And that God-forsaken, literally, Fox news is so much the worse.

    firedoglake does good reporting on this matter too.

    Also C&L

    And don't get me started on "socialized" medicine. "Corporatized" medicine in comparison is corrupt and dangerous to your health, AFAIC.

    Stewart's TDS last night took down the silliness of "socialized" medicine and the stinkers who publicly lie about it on our public airwaves.


  6. Well, let's look at our son, who is opposed to Socialized medicine. He has never had to buy health insurance for himself or two children on the open market. When he had his own small business 12 - 20 years ago, his wife worked for a generous Fortune 500. Then he got a job with a major defense contractor, and for 8 years, they chose the least expensive combination of insurance from the two firms. When she went to being a contractor, they still had his corporate coverage. He has no clue of what it would be like to not be able to pop into the doctor's office for more than 10 bucks.

    85% of the population has some form of coverage, but that number is rapidly diminishing. As bankrupt states cut social programs, more and more poor will be on their own hook for medical expenses. We will just have to wait until 40% are uninsured and watch the revolution, as the other 60% won't be able to afford the insurance.

  7. Very timely thread Al-

    What to say about health care? As to US health care, after my last experience with it, waiting in an emergency room that took people without health insurance . . . the son of my best friend . . . for hours without seeing a doctor, I figure ya'll know a lot more about it than me.

    But I can say: Germany 12 years. Always covered after the first year. Dental included. To bring our first child into the world, not the simplest of pregnancies, cost us about . . . nothing, in fact we made a 1,000 DM on the deal. And in the US they always trash "socialism". I'd think we could do with a lot more of that kind of "socialism".

    Not counting of course my regular State-Guaranteed Heath Insurance) SGHI payments during that period, since they would have been paid in any case. No increases.

    Now in Portugal I have three different health insurances (one state and two private). Family costs us about 120 Euro/month. The Portuguese State Health care which is the last resort, is a very mixed bag, top of the line expertise and service in one instance, and cruddy incompetent nightmares in another. The state is willing to pay for all sorts of expensive tests, providing you go through your "family doctor" who is someone you know, but don't necessarily trust. Usually you just tell them what your private doctor wants done and Bob's your uncle (in a positive sense).

    Dental is extra now. We have a limited dental on one of the private insurances which covers some of the check ups and a percentage on more extensive stuff.

    Both of us suffer from some chronic health problems, nothing life-threatening, but painful and frustrating . . . so for us health care is an issue.

    Not having to worry about SGHI, let alone any health insurance, is a great burden off our minds as time goes on. I don't understand why America must retain the "business-model" health system we, or rather you, are burdened with. When does democracy and American ideals come into play?

  8. An acquaintance summers here in the States, and then he and his rich wife spend the winter in New Zealand. They have a home there and live there six months out of the year so they rate medical coverage under the NZ single payer system. He raves about it and how good it is.

    The funny thing is that this guy is a died-in-the-wool Limbaugh listener. He still contends that Obama is a foreign national. He thinks Bush and Cheney are heroes. Yet he loves him some socialized medicine in NZ even though he and his bride can probably afford to pay for the best medical care in the world out of their own pocket with or without insurance. But he does not want the same system here in this country. He is convinced it works in NZ but that here in America it will not work as too many of his dark complected fellow citizens will get a free ride and suck off his nickel.

  9. To get an idea of how bizarre our view of medicine is in the US, consider these snippets from a paper by Justin C. Matus, PhD, MBA, FACHE of Xavier Univ, on "Boutique Medicine":

    Let’s first look at what is the effect on the U.S. healthcare system and a given community where a boutique practice is underway. Clearly the physicians operating the practice by all reports are well satisfied and well compensated. The patients being treated are certainly more than willing to pay a premium for their care and are also well satisfied with the quality of their care. So what effects do well paid, well satisfied doctors and well satisfied patients have on their local community’s health and healthcare system? Surely we have high income physicians paying a commensurate rate of income taxes, making those dollars available for redistribution based on the priorities set by legislators and policy makers, to include establishing avenues for obtaining healthcare by those unable to pay. Surely the patients paying the boutique premium do so because by definition they are high income persons, who also pay taxes. Moreover, the more time the high income patients spend working versus waiting in an overcrowded clinic the more income they are producing and of course, the more taxes they are paying.....

    As a result of a patient’s wealth he is able to quickly get a necessary flu shot before winter sets in. Clearly this has a direct and immediate benefit to this patient. But is there not also a community benefit? The patient does not get sick, continues to work, frees up health care resources for others, prevents the spread of the flu, etc., etc. While the patient who remains without a flu shot because of his inability to pay or get access to a flu shot remains at risk, is it not true that for every patient who does get a flu shot the overall community risk is lowered?

    WOW!! Trickle Down Heath Care.

    What he doesn't address is (1) that for every enrollee in a practice converted to "Boutique", 2 or more other human beings are left to find an new doctor, and other practices become more crowded and (2) the very wealthy he is painting as the tax paying saviors of the less fortunate have effectively fought paying the taxes than might provide some crumbs to the masses.

  10. Aviator, Poe's "The Masque of the Red Death", perfect allegory.

    This issue is certainly stirring the pot politically. I follow political blogs like firedoglake and others, as I've noted before. A tired cliche, but it's like roaches caught out in the open when a light hits them, and they scurry for cover.

    At the very least, it's an open book for the open-minded person to see what is most important to our representatives in government.

    I have something else to put here, to show you all the quality of information and commentary on issues vital to folk available in the area I live in.

    Listen to this, please.

    It makes me want to hit something.


  11. While I'm not particularly fond of the healtcare plan(s) currently before Congress, the single biggest beneificial effect has been the awakening of the American people to other plans.

    I really don't want for the current plan to pass Congress because it is too flawed and I'm afraid that we will tell ourselves that we are done when we've only just begun. But I'm now confident some form of single-payer plan will eventually come to the US, probably sooner than later. Hopefully the law of unintended consequences won't bite us too hard.

    BB, I wouldn't get TOO upset at Glenn Beck if I were you. He's a hired gun bought and paid for by the people who are running the medical system. Instead I'd look at two things:
    1) The effectiveness (or lack thereof) of his arguments with his audience
    2) The fact that he lost his temper to the degree that he did means that he's well aware of the fact that he's not getting his job done and people are not buying what he says.

    You know what happens to mercenaries on the losing side of a war? I bet Mr. Beck does. With luck he and quite a few of FDC's 26 percent club will move out of the country when healthcare passes.

    Meanwhile, just because the economic crisis has been driven from the front pages by healthcare and Paris Hilton's latest actions doesn't mean that meaningful things aren't happening.

    Here's a brief discussion that discusses the single biggest current issue in the crisis, one that in my opinion, will probably end badly for both the US and China.

  12. Publius,

    The $10B Goldman Sachs bailout happened under the Bush administration. True, the Obama administration refused GS's attempt to repay that money, but I think this was a matter of maintaining some leverage in imposing financial regulation upon Wall Street.

    As for the healthcare crisis, I don't see how this can possibly be solved without tackling some really, really, really, hard problems with respect to rationing. These days, about 50% of a person's lifetime healthcare cost occurs in the last six months of life.

    Who is going to agree to a plan that cuts off medical care to 90-year-old Aunt Nellie who is clearly dying? What politician will face this issue.

    And Aunt Nellie cannot easily go into that good night voluntarily, because most states don't allow assisted suicide, and even "Do Not Rescusitate" instructions are often ignored by eager doctors. (Though terminal ancer patients, through hospice organizations, can often get all the pain-killers they ask for, up to and including a lethal dose.)

    Aside from the old-age issue, I don't see how we can avoid the need to create a list of medical conditions ordered by priority, e.g., cost-benefit, or ease of cure, or some other criteria. Agreeing on where to draw the line between covered and not covered medical conditions is going to be excruciating, if it is possible at all.

    I'm very curious about how countries with nationalized healthcare handle these issues.



  13. Pluto, I'll match your fellow with Krugman writing about Goldman Sachs' recent "success":

    The bottom line is that Goldman’s blowout quarter is good news for Goldman and the people who work there. It’s good news for financial superstars in general, whose paychecks are rapidly climbing back to precrisis levels. But it’s bad news for almost everyone else.

    We've blown through our home equity funds, infamously, and according to Duncan Black at Atrios, commercial real estate is on its way into trouble.

    He hasn't been proven wrong yet.

    Mr. Markham's article may be valid, I don't know. I think that what's holding global economics together, so far, is faith among world global powers that we all can work through this.

    If not, well then, what can you do?

    I go back to my "connections" article. As long as the nation's people have faith that our leaders are working in their best interests, I believe we'll be fine.

    However, if that belief starts to waver and the people's trust evaporates, then I do fear for our future.


    Goldman Sachs and its huge bonuses, do the rich recover first and get richer and the rest of us get poorer and continue to suffer?

    A connection within our society is severed, as people see who really prospers.

    GM goes into bankruptcy and is trying to put its corporate world together, but their retired workers' health care is gone.

    Workers and retirees have suspected for years that companies often use bankruptcy as an excuse to cheat retirees out of their promised benefits. Now, three unions say that's exactly what the U.S. Treasury Department is doing to tens of thousands of General Motors (GM) retirees.


    {End of Part One}

  14. {Part Two}

    Jane Hamsher, activist and co-founder of firedoglake, is refused access to see her senator Diane Feinstein about the health bill.

    This is all about NO PRYING EYES, it's not about Jane Hamsher vs. Dianne Feinstein--that's bullshit, it's about transparency. It's about Ms. Feinstein's untenable position on the public option, which 76% of the American people support and she doesn't; it's about her indefensible position on the most important legislation of our life. And most egregious, it's about the culture of Washington D.C., it's not just your garden variety bubble, it's a closed society, and they don't want No Prying Eyes.

    In this closed world, there's an illusion of transparency--but it's basically a mirage. Legislation gets posted, for example, but the deals get made behind doors made of steel and cement. I don't have to tell you that the traditional media rarely if ever ask the relevant questions, rarely if ever put the politicians feet to the fire, because to do so, means loss of access.

    I wish everyone could come up to the Hill for one day and see what it's like right now. The place is crawling with lobbyists, and the entire process is devoted to responding to their immediate pressure. Hundreds of them sitting in the markup meetings, on their cell phones, taking notes, following the Reps out in the hallway, chatting with staffers, with a microfocus on every action of every committee member at every moment. You really don't get any idea what it's like from watching the hearings on CSPAN.


    Back to Beck. If you want to turn on your AM radio in my area for entertainment, news and information, you'll get Limbaugh, O'Reilly and Beck in the afternoon, local yokels selling stuff via a community market and other local programs and discussion.

    No real education in the major issues of the day.

    That's why I have 3 dipshits for Congressional representation, Brownback, Roberts, and Moran.

    Moran's a decent fellow, even met him briefly at a parade, and passed on my 2 cents, for what it's worth.

    My 84-year old mom, when I saw her at our re-union last month, when I brought up health care issues, commented "Isn't that socialism they're wanting?"

    What could I say? No, and I left it at that.

    This is why I'd like to beat Beck and his ilk to mushy pulp. That's my Irish speaking. :)

    What gives me hope is that there are still good people banging away for what I believe, "faith" again, is the common good.


  15. JP-

    Non-governmental insurance providers already say what is covered and what isn't. There are "tiers" for prescription medicines that limit, and even deny coverage. What about "pre-existing conditions"? Lose your job and the new employer's health plan (if he has one) may very well not cover an illness or injury that began before you started the new job.

    Rationing already takes place, but it is driven by the financial well being of the individual, not medical necessity. Those with money and/or "good" insurance get medical care, those without don't.

    As to extending someone's life, the 50 year old with private medical insurance will have his life extended by the premiums of the other healthy people who are also subscribers to that insurance. When the cost of extending 50 year olds' lives by six to nine months begins to eat into the insurer's profits, the insurer finds ways to deny the care that extends those lives. It happens every day. Then you hire a lawyer to fight the claim denial. There is a huge and profitable legal industry suing insurance carriers to collect denied claims.

    If we were simply remove all marketing expense from US medical provider's budgets, per capita medical expenditures would go down some 20%.

    Does all this make sense?

    People on our island live well into their late 80's. None seem to be obsessed with an extra six months. They live that long because there is universal access to health care, and a responsive health care delivery system. Greek national health care does not deny me access for conditions that existed before I moved here. They simply treat me if I am ill, or provide me with my annual physical as part of the social contract.

    Unfortunately, real national health care would eliminate many profit making opportunities. Better we should have no health care than less profit.


  16. Wow, Basilbeast, you've said a lot! And it was all worth hearing!

    You and I are in basic agreement on all issues. I've got some good friends who are Limbaugh fans, I use the word 'fan' because they used to be fanatics and now they are getting disillusioned with him but they still want to believe. Although I haven't seen any numbers on the topic, I suspect the same is true for all of the right-winger radio hosts.

    They're still spout the same old bile but it isn't as effective as it used to be and will become even less effective over time.

    The one thing that really scares me about the current economic crisis is the connections. Markman's article makes clear that the Chinese have found themselves in a Ponzi scheme or their own devising and are trying to find a way out. There is NO way out that doesn't involve major pain.

    Markman believes that the Chinese have no choice but to divest themselves of US Treasuries over time, suffering losses slowly over a long period rather than risking completely collapsing the system and taking huge losses all at once. That is a reasonable theory but there is a chance that it will be wrong.

    This economic mess is going to be around a while, it's probably not going to start getting better until July of next year. The R's are going to be gunning to get back into power in Washington (which you have so accurately described as government of, by, and for, the lobbyist). They are already hunting for issues and IMO, their best bet is to start revealing some of the poorly kept little economic secrets about how the Obama administration handled the economy.

    None of these secrets are giant smoking guns, they are exclusively small pinpricks, but they give the impression that:
    a) the Obamaites didn't know what they were doing (probably true, but the R's were worse)
    b) made lots of obvious and simple mistakes (so did the R's, crises cause mistakes, the trick is to survive, not be perfect)

    Taken in aggregate all of these stories give the R's enough birdshot-type political ammunition to really shoot the snot out of the D's but only by making the government look like total fools and panicking people, especially the 26 percent club that is their core.

    If the government fails to respond with considerable evidence showing that they did substantially the right thing it could easily cause a crisis of confidence and further erode the critical connections you've mentioned.

    On the topic of pension benefits:
    Of course the companies have shorted the employees and are now using the US government as a stick to make the retirees put up with it. Far too much of the last 20 years of financial wheeling and dealing was aimed at concentrating wealth in the hands of a very few people. Do you think those rapacious robber-barons would leave the giant pension funds intact when they were looting everything else?

    Faith in government and major institutions is beginning to fail in a wide range of areas more quickly than I would have ever expected.

    I've heard lots of comments and rumors that suggest local police departments are beginning to discover that they can get away with robbing the people they were supposed to protect.

    Public education in this country is falling apart so fast it's appalling. I will be pleasantly surprised if the current system survives another 10 years and wouldn't be surprised if it starts suffering catastrophic failure in 5 years.

    In the last few months I've had to seriously revise upward the likelihood of a complete collapse of government in this country at all levels. The odds are still unlikely but conditions are beginning to get ugly for the bottom 75% of the working population and they aren't happy about it. Unrest that widespread suggests something much more likely to happen.

  17. Pluto: The Markman column was well worth linking. Seemed to me like a good analysis of the mutual cleft stick impaling both the PRC and us.

    The thing I think he elides is that this wasn't an accident on the U.S.'s part, either. Just as the Chinese thought they were building the perfect growth engine, we thought (i.e. the Clinton-Bush people who were controlling the Fed and the regulatory agencies) we were building the perfect growth engine, too. Nobody bothered to inquire - or if they did, they were derided as a kook - whether an economy that broke down as 70% consumer spending, ~15% manufacturing and ~15% financial services was a good idea in the short run or sustainable in the long run.

    Bob Reich - who I've disagreed with in the past - has a pretty good post about this here: His money graf is: "This economy can't get back on track because the track we were on for years -- featuring flat or declining median wages, mounting consumer debt, and widening insecurity, not to mention increasing carbon in the atmosphere -- simply cannot be sustained.

    The X marks a brand new track -- a new economy. What will it look like? Nobody knows. All we know is the current economy can't "recover" because it can't go back to where it was before the crash. So instead of asking when the recovery will start, we should be asking when and how the new economy will begin."

    One of the huge cash sucks that is draining our present economy is the grossly inefficient heath care biz. Think about it - what does an insurance company "make"? At the very least, medical treatment makes you healthy and able to work and make stuff. But where does the "profit" for the insurance company go towards "making" anything useful or productive?

    The re-emergence of Goldman Sachs and JP Morgan Chase as unfettered high-rolling risk takers - the Goldman CFO was quoted as saying that "their financial model hasn't changed" - tells me that nobody in power has any intent of reversing the Reaganite plan for a return to a pre-Depression-style, boom-and-panic 19th Century economy.

    So if you liked the Gilded Age, hang around. You'll LOVE the 21st Century.

  18. "In the last few months I've had to seriously revise upward the likelihood of a complete collapse of government in this country at all levels."

    I know I'm a broken record on this subject, but the traditional beginning of the death-spiral for decrepit republics is when the elites stop working for the general good and begin looking out for themselves.

    Republics, as much as any system but, thankfully, less so than most, depend on the rich, the well-born and the able for their governing class. But the critical factor is that these elites need to have some sort of connection to the proles, whether out of self-interest, noblesse oblige, tradition, religion or philosophy. When the nobles start to govern for their own interests...look out!

    I don't know if I agree with you, Pluto, about total breakdown. People will tend to hang onto something that works long after it starts to perform suboptimally. Rather, I suspect that, like the Roman, our republic will slide - is sliding - slowly into oligarchy. Only if our elites are as clueless as the Bourbon or Romanov ones will we get the full meal deal - breakdown, revolution and reconstruction.

    What happens then? I have no idea. The possibilities are just too far outside the box to envision. But the breakdown of the globe's hegemon could be either a great opportunity or a great disaster.

  19. I'm in agreement with you Chief, I'm also a broken record on the topic so you sound pretty good to me.

    Your reasoning that people hang on to what they know, even if it doesn't work, is sound and has a solid history to it. I'd be in agreement with you except that I keep seeing and hearing things that are rather jarring.

    Here's an example that has some media documentation, during the Republican National Convention last year, the St. Paul police department arrested several hundred (bare minimum of 300 perhaps as many as 500) people without charging them with anything, kept them for a week and then let them go after taking a whole bunch of valuables that they never returned (or even admitted to taking).

    Lest you appeal to a higher power, the local police were trained to do this by the FBI.

    There was no outrage over the trampling of individual rights, just sullen anger because people are all too aware that supporting the arrested people will bring unwelcome attention (and thieving hands) to them. All you heard was the sound of thousands of Basilbeast's connections being snapped.

    Now multiply this by a factor of 10,000 across the country for every traffic stop where the cop is looking for a bribe instead of to enforce the law, or a low-level bureaucrat who uses or abuses his power for personal gain and you've got an almighty tower of rage building with frightening speed.

    Hopefully it will blow away as before it blows up, that would be my prediction if we didn't factor in the rapid decline of the public education system.

    As for your theory that we'll slide int oligarchy, I'd say we hit that stage without recognizing it in 2000. You'll notice that oligarchs who are secure in their power (as ours are) don't govern particularly well.

  20. I still find it astonishing that so many people are still drinking the Rush Kool-aid... Day after day I listen to people regurgitating "talking points" about "socialized medicine" "Obama is a socialst" blah blah blah on and on. The really sad part for me is that most of these people are working class types who seem to have enlisted as drones to defend the greed of the ultra-wealthy who wouldn't let them into the yard unless they were there to do the gardening. I admit that I wonder how they can be such blind, illogical morons. They still like Palin as well. They seem to have been subject to some sort of Pavlovian brainwashing that causes them to respond to keywords in ways that are against their own self interest.

    Anyway... the greedy plutocrats (sorry Pluto - no offense intended) have succeeded beyond their wildest dreams. I haven't noticed the enthusiasm of the dittoheads flagging, but I hope I am wrong.

    In response to a comment above... I have been a hospital RN for a decade and have yet to see an MD ignore a DNR/DNI order. It just isn't done. At least not anywhere I have worked. Trouble is that there are numerous things that can be done within the confines of DNR/DNI to keep some poor wretch alive in a hospital bed at massive expense for a very long time, and this is what usually happens. Plus... just about every day I come encounter patients in their 80's and 90's who are full code with families who haven't really accepted the fact that life does come to an end eventually no matter what we do. Madness.

  21. This is a wonderfully substantive thread; my kudos (and thanks) to Al for the initial post, and to all of the commenters. I've learned a lot and I must say, I continue to be amazed and gratified at the intellectual horsepower available in our small community. Just trying to keep up with you folks always ensures I get a daily dose of (needed) humilty. Thanks.

    I must admit I'm not as well versed on the nuts-and-blots of the whole health care kerfuffle as I should be. Yes, I'm in favor of a national health care plan, specifically because I believe such a plan is the hallmark of a advanced civilized society. That we don't have such a plan and leave millions of folks out in cold tells me we're not nearly so advanced or civilized as most Americans think. And I have to tell you I think Obama and the Democratic Party (Franken won't, BTW) are going to screw this up; I think we might see something, but I also think it'll be unsatisfactory.

    One of the reasons I've been erratic in posting or commenting is some health issues of my own. About three months ago, I passed out while approaching the 6th green on a local golf course. My playing partners were terrific: 911 call (cell phones are nice), and so were the emergency responders; they arrived on the course within 10 minutes. By then, I felt fine, but of course we had to do the ambulance ride and go to the emergency room. All tests—ECG, blood, you name it—were fine. I was back home within three hours, knowing I hadn't had a heart attack, but wondering what was up.

    Long story short, I went through a bunch of tests and failed a critical one. That's when I had my first encounter with a cardiologist. He moved quickly, and within two days, I was on a table in a hospital in Charleston, undergoing a cardiac catheterization procedure, knowing that if any blockages were found, I'd be getting a stent. Sure enough, I got one stent. Everything was great: heart was undamaged and all other arteries were clear.

    I'm a lucky dude, and, oh, BTW, no one can say with any certainty that my fainting was in fact a manifestation of the blockage. And the reason for my erratic posting pattern isn't the cardiac procedure itself—I feel fine—it's the three days a week rehab involving some pretty serious work outs. I've lost eight pounds, am changing certain dietary patterns—thankfully, beer is still OK—and have gained upper body strength to the point where I'm hitting the golf ball 20-30 yards further.

    I'm telling this story because I want to share the financials with you. Once the cash register finally stops its ka-ching, ka-ching, we're probably at around $25K. My share? Looks like around $500. I am in a single-payer system—courtesy of the taxpayers—known as Tricare, the military's health care system. Tricare handled the billing rapidly and efficiently, and my supplemental insurance carrier from the Military Officers Association did so as well. This is a scenario repeated daily with millions of military folk (and veterans) as well as with folks on Medicare. Granted, there are a lot of problems with these government systems. For one thing, in some parts of the country, medical providers are refusing to participate in the programs because of the ludicrous cost caps emplaced by politicians, but that's not a factor where I am because of the large retiree and military population. Anybody who's ever wondered why I retired from the great California climate to the stinking hot and humid South Carolina climate now knows one reason why.

  22. Well, I ran into the space limitations. So here is the rest of my post:

    Socialism. Ah, socialism. I guess I'm a socialist. As are all other military personnel, active and retired, as well as Medicare recipients, civil service people, teachers, firemen, cops, you name it. Basil, next time you see your Mom, tell her my story and ask her for me if she thinks I ‘m undeserving of medical care. After all, I don’t pay for it. I suspect you won’t do it, but you might also ask her how she feels about being in a “socialized” medical system herself—Medicare, which is a single-payer health care system—bought and paid for by taxpayers. I don’t mean to be hard on your Mom, but I wish she wouldn't listen so much to those clowns your state has sent to Congress. I have the same problem here. And it’s exactly why the insurance companies and their bought-and-paid-for politicians can make any traction whatsoever with their horseshit. And it’s also exactly why Obama, even if he actually has the right instincts and isn’t just another craven politician, is going to end up cutting deals and producing a crappy health care plan.

    I agree with Pluto about the dismal state of the nation and how we've already slipped into oligarchy. But I don't see a sudden collapse. Rather, as FDChief notes, I, too, see a long, steady decline. This nation will always be here—it's a large land mass with lots of people and still bountiful resources—but I'm glad I won't be here in 50 years. I suspect the nation then will bear little resemblance to the one in which I grew up and went through middle age, the nation for which I willingly fought. I doubt I'd fight for it again. Frankly, the only way I see of reversing the trend would be if the American people suddenly saw the wisdom in my cousin Mr. Jefferson's prescription for refreshing the tree of liberty.

    Greed, ignorance and stupidity have doomed this nation.

  23. Good comment, Publius, particularly because it will compare and contrast nicely with my next story.

    Two years ago my wife came down with kidney stones, not a surprise given her family history be extremely painful. We were in the process of transitioning between insurance plans at the time and the doctor scheduled the outpatient hospital visit on the last day the old insurance policy would be in effect.

    I asked him if we could shift in one day so the procedure could on the new insurance policy. He looked at me blankly and said, "Go ahead and do so if you want but you'll have to find a different doctor and reschedule all the tests. I will not tolerate patient meddling in my schedule."

    I allowed myself to be shoved around on this occasion because the pain medication my wife was on hardly had any effect on the pain.

    The procedure itself was a tribute to modern medicine, in and out in six hours. Non-intrusive surgery using sound waves didn't leave a mark if you don't count some interesting patterns of bruises. She was in much better shape within a day or so and completely recovered in less than a week.

    Then the bill arrived. Since I'm not on Tri-care or Medicare, my share of the 26k bill was $5,200, due in 15 days. Fortunately I'd been able to establish an emergency fund for just such emergencies and paid in full immediately.

    But I started receiving collection phone calls a week before the bill was due. I was shocked, collection calls a little over two weeks after the surgery? Apparently this is now routine at this hospital if the patient doesn't have government-backed health insurance. I told them that the check was in the mail and received polite laughter.

    They asked if I'd sent the check via certified mail. I hadn't, I wasn't aware that it was necessary. They responded that they'd call back if they didn't receive the check the next day.

    They called back to tell me that the check hadn't arrived yet and asked many of the same questions they'd asked the previous day in a slightly more suspicious tone and promised to call back the next day.

    Fortunately I have online banking and was able to see when the check was cashed on the third day. The collections agents didn't call back again.

    What would I have done if I hadn't had the money? I suppose that I could have charged it but that would have added hundreds, perhaps thousands of dollars in interest if I wasn't able to pay the debt off quickly.

    When I calmed down I started seeing this from the hospital's perspective. My share of the insurance cost was roughly 1/10 of the average family's pretax income.

    That's an incredible bite from a family's finances and if the hospital doesn't start working to collect immediately it may well get nothing because the family will declare bankruptcy first.

    How many bankrupt families at one time does it take to bankrupt the hospital? I know from working for two different hospitals (including the one where the surgery was performed) that it doesn't take much to bring the hospital to its knees. And if that happens, where do all of the people who need serious medical services go? Its a fairly long distance to the next hospital and it's on the verge of financial collapse because many of its customers have below average income.

    This mess of a medical system highlights the many of the problems our country faces.

  24. (darned 4,096 character limitation!)

    Rick98c mentions people parroting the "socialist" accusation against Obama. The sad thing is that perhaps half of the country doesn't understand what a socialist (or a fascist or a communist) really is. All they know is that they feel like their lives are vaguely out of control and they feel better if they use certain slogans at the right moment.

    This gets back to my comments about the rapidly failing public education system. Our educational system has been failing our country's needs for the last 35+ years, favoring flashy education trends (from both the right and the left) in preference to teaching rigorous thought. Who are the major perpetrators (and victims)?

    Powerful teachers unions that are more concerned with tenure and benefits than the quality of their product (education). Absurd dictates from school board members who are more interested in playing political games than in ensuring that the next generation can spell. Entrenched (and ever growing) school bureaucracies that turn every little request into mountains of forms and requirements. Taxpayers who are feeling the pinch from every direction and vote down tax levies without considering the cause or effect.
    And finally, the greatest criminals/victims of all, the parents, who do their best but frequently make the situation worse.

    The net effect is that high school graduation last year was down to 52% of those kids who entered the school four years before. What can you do without a high school diploma in this country? Pretty much nothing.

    What kind of a salary can you command with just a high school diploma? Sigh, the odds just are not in your favor with the standard American education.

  25. BTW, I'm not sure I agree Mr. Jefferson's prescription for watering the Tree of Liberty.

    I've never had the misfortune to clean up after a civil war but everything I've read suggests its a difficult and thankless task.

  26. Interestingly, our 47 yr old son said that the people he works with at the mega defense contractor in TX call Obama's plans "Europizing" our country. When I asked what Europizing meant, he said, "Like socializing medicine". I bit my tongue, as he is a beneficiary of tax dollars to pay his medical insurance, as the firm's revenues are 95% government contracts.

    The irony of it all was that he arrived on the Island suffering from significant upper respiratory distress, headaches and could hardly get out of bed. He was worried about Swine Flu from the airplane trip to Greece. So we took him to the "socialized medicine" health center here at 7:00 PM. Was taken into the exam room at 7:30, given a thorough exam, to include blood work. At 7:50, when the blood results were returned to the Dr, he was told it appeared to be allergies (he has several) exacerbated by a cold and jet lag. Swine flu was specifically ruled out. Was given a prescription for a nasal spray and sent on his way. Total cost - just 7 Euro at the nearby pharmacy for the spray.

    He sheepishly had to admit that for the symptoms he was presenting, he would have needed an appointment to see his Dr in TX, and that would have taken a couple of days. Further, his copay for just the DR would have been $20, plus his share of the blood work cost, which would probably taken a week for results. And, of course, the Dr would have raked in about $100 for 10 mins work, and the lab another $150.

    He never mentioned "Europizing" in my presence again.


  27. Well sir, at other places I read, folk say you're lying.

    I do not think I should be associating with the likes of you, Al.

    ( End of Sarcasm )

    So your boy, not a legal resident of Greece, I assume, gets better medical treatment, or at least faster and less costly, than at home?

    I don't know if you read all the moaning and groaning and crying "socialism" here, but it is overwhelmingly pitiful and contrary to common sense and the reality of what the foreigners have.

    Thanx for the kind words, Pluto. I'll say again, ya otta gitcher stool here. ;)

    I don't know what to say about your police story, other than I might want to get hold of a lawyer mean and hungry for some class action suits.


  28. BB-

    I have posted previously that my cousin came here for a visit and broke her hip. Surgery and 11 days recoup, rehab in hospital. Bill was 1,200 Euro for "room and board and supplies" (walker, crutches, etc, which she kept). Her orthopedic guy in the states billed her insurance $5,000 for the exam (X-rays, and comments on how good a job the Greek Dr did) he conducted to pick up her rehab care there.

    Yes, non-residents have access to our national health care facilities. The center is loaded with sick and injured tourists all summer long. EU residents are fortunate in that their insurance from home will cover "supplies" or a private Doctor, if they prefer. Very few US insurance providers will pay for medical care (to include emergencies) outside the US. The former head of our health center is a friend. He said it isn't worth trying to collect from any US insurance carrier unless it is specifically "traveler insurance". The health center ( or any other National Health Care facility) doesn't have a department dedicated to processing insurance as is so common in the US. Ah - we just discovered one terrible feature of NHC - no jobs for platoons of insurance clerks!


  29. BB - "I don't know what to say about your police story, other than I might want to get hold of a lawyer mean and hungry for some class action suits."

    That's the clever thing about what's happening with the police. They are only attacking the disenfranchised and people who can't afford lawyers and who don't talk to each other or the press. If this happened to you and I we'd make sure that the police officer was miserable.

    But previously convicted felons, political activists who have views that they fear might not be viewed well by the judge, and poor individuals who don't trust the courts are fair game for these attacks.

  30. Back on the subject of healthcare, I saw a brilliant analysis by a Norwegian healthcare analyst on US healthcare in the newspaper today.

    He argued that the major issue of US healthcare today is extremely low rates of productivity. First we need to define productivity, he defines a healthcare system as productive if the patient needs few or no visits per year and is still healthy. This is what the Norwegian healthcare system provides and does a pretty good job at a lower cost than the US system.

    As you can see, the US healthcare system is broken by that definition of productivity. We only reward healthcare providers for treating sick people. If people are healthy and don't need to see the doctor the system collapses.

    This leads to an interesting potential decision that the doctor faces. Say he's got two treatments he can apply to a situation, the first is 10 minutes and he's done. The second gets the same results for the same amount of patient pain and discomfort but requires multiple visits. Which does he choose? It depends on the doctor's schedule and current financial situation, not the patient's best outcome.

    This guy also pointed out that the current healthcare reform plan before Congress doesn't address this problem. To quote him, "if you take a broken system operating at maximum capacity and add 50 million more patients you are going to make a considerably worse and more expensive system."

  31. Pluto

    Most doctors are piece workers. To increase their income, they must either handle more pieces of medicine per day or increase what they charge for a piece of medicine.

    Now, the really clever doctors have found that they can increase their income by simply charging an "enrollment fee", while reducing the number of patients they are willing to accept. It's called "concierge medicine", and it costs anywhere from $1,500/year upwards. In return, the doctor drops 3/4 of his patients and you get a very thorough annual physical. Everything else is still billed to your insurance carrier. You will be promised much easier access to your doctor. $1,500 or more for a physical and more access. What a brilliant stroke of raising the price of one piece of medicine.

    Of course, the 3/4 of the former patients will have to scout up a new primary care provider. But hell, if they aren't willing to shell out the $1,500/yr or more, that's their problem.

    What a wonderful system. No wonder the right wing fears "rationing". It would eliminate all sorts of obscene profiteering.

    Oh, yes, and Concierge Practitioners typically retain legal counsel to keep them from making any billing errors or legal mistakes, as they are really treading thin ice with this approach. But hell, with suckers paying $1,500/year or more, there's plenty available for legal counsel. The typical Concierge physician handles 300 patients, so his minimum revenue for about six physicals per week is nearly one half million dollars! Supplement that with income from colds and fevers, and he's going to be just fine.


  32. God, reading the posts you have brought home to me just how bad the US system really is. The overall statistics are one thing but the day to day reality is so much worse.

    I mean who wins out of this? Is the US such a country of lobbyist, special (rich and corporate) interest group dominated country that even someting as simple (and it is simple) as reasonable healthcare at a reasonable price can't be sorted out?

    I mean this is not rocket science. There are so many models to choose from (Canada, UK, France, Australia, etc, etc) to choose from. Pick one, any one, and apply.

    There must be some amibitous politician somewhere who can (obviously) see that they can have a run at a more senior position on this issue.

    So we must go back to US citizens. Why wont they, logically, elect a politican who says (for example) we will introduce the Australian system of heath in the US and these are all the benefits. Now from a sheer self interest point of view 80% of US citizens would be better off and, logically again, vote for such a policy.

    So why dont they? I'm really curious. Are they mind bogglingly stupid or poltically indoctrinated to a level that many current and past totalitarian societies would envy?

    I mean the term 'socialsed medicine' gets bandied around (not here in other blogs, etc) like it is some bad thing. It just is simply the best bang for a buck. The old maximalisation of the greatest good for the greatest number.

    From a strickly, cold, monetary point of view 15%+ GDP spent on such poor outcomes is incredible inefficiency, on a par with things like the F-22, etc.

  33. Excellent question, OldSkeptic.

    1. We're a center-right country recovering from a 30 year experiment that lead us deeply into the right wing. In some places it seemed like we were politically identical to the original Spanish colonies with the peasants waiting for Zorro to show up.

    2. We're scarred right now. There's a very strong distrust of major institutions. The so-called Conservatives would run on a platform of smaller government and then would vote for just about any budget increase that came along (without a corresponding tax increase or budget cut). Obama is currently discovering the limits of the public's trust in government and I think he's a little shocked at how low it is.

    But it goes further than just government; faith in large corporations, churches, even large charity organizations is also way down. This is a country that is beginning to realize that the version of the American Dream that we'd been living for the last 30 years was just a pack of lies. That realization (and the resulting cynicism and skepticism) has really hampered efforts to get anything going nationally.

    3. Politics in this country for the last 20 years has mostly been composed of bait and switch. The politician offers one thing and then delivers something completely opposite. He admits to his angry constituents that he failed in his efforts to persuade the rest of Congress to go along with the original plan but promises to fight for the original cause if we'll just re-elect him again and again...

    The worst part of the situation is that all politicians from both parties play the game because its so easy and so profitable. That eroding trust issue keeps coming up but ever increasing advertising combined with smear campaigns run against third party candidates currently keeps things in line.

    This is really hampering everybody's willingness to try yet another government program that will go wildly wrong.

    4. Although the Conservatives are currently in retreat, they have a great deal of money and infuence and aren't afraid to use it. At the same time the Liberal and Moderate wings of the Democratic party don't trust each other very much.

    Congress was designed to make it vastly easier to prevent legislation from being passed than it would be to pass get it passed. The founding fathers assumed that politicians would put aside their differences for matters that were obviously in the nations best interests. They were wrong this time.

    5. As part of the process of waking up from our long national slumber, we're discovering that we are A LOT poorer than we thought we were. Yes, I know that our relative wealth level still looks pretty impressive in much of the world but its nothing compared to what we thought it was and our expenses are way out of control.

    You don't want to take on a major initiative like this when you are afraid you won't be able to afford food and rent in 10 years.

    I'm finally going to give in to BasilBeast and sign up as a poster with the Chief and then I'll go into personality-based politics (vs. the old policy-based politics) and you'll see why ambitious young political candidates stay FAR away from healthcare issues.

  34. Yep, Pluto, that is about the sum total of it all.

  35. I was going to run this as it's own thread, but I want Lisa's thread to hold court for a me sentimental, call me a gentleman, but don't call me late for dinner!

    Anyway, I think it's appropriate to this thread...

    And the details are what again?

    With all the brouhaha about “socialization” of health care in the United States, little, if anything is coming out of the government about what exactly is being discussed in regards to the various ideas about what to implement in regards to any form of Health Care reform.
    For one, I was having a devil of a time trying to find non-wiki information about the subject because I have no idea what “single payer” entails. I found a couple of sites, but still…for a responsible system of debate for all parties, which would include us, the electorate, the details of the subject should be opened and accessible to the public. We should know what is being discussed, but still, I’m coming up with…at best…sketchy information.
    So, what I’ve found so far…
    Single Payer, seems to be the one that gets the Republicans all up in a huff

    which for the life of me…I can see why…I’m not a big fan of socialism…I’m old school like that…I know, lame, but still, I’m being honest with my thoughts. So with that said, I’ve got to say that the more I read about the details of Single Payer, and what wiki has to say about it…I’m kind of liking it.

    Perhaps socialism isn’t so dam scary after all.

    I guess my problem with the thing is that the subject has become very…um…heated, and the voices howling for reform are becoming quite stentorian.

    So, I’m hoping that information about the subject is more forthcoming so that we, the people who will be footing the bill, know what it is that is being debated.
    Because really…I do not like being kept in the dark.

    And to me, throwing money at a problem that has yet to be resolved is the same as giving alcohol to a drunk to keep the shakes down…it’s doing something for something’s sake without taking the pains to figure out how to fix the problem forever. I believe that treating the symptoms does not a cure make.

  36. BTW, a little something for those of you wondering "what is the hold up?"

    "money talks!"

    H/T to TPM

  37. sheer-

    Thanks for the references. The lunacy of the opponents of a single payer system is reflected in the wiki piece:

    "An opinion piece in The Wall Street Journal by two conservative Republicans argues that government sponsored health care will legitimatize support for government services generally, and make an activist government acceptable. "Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care -- an argument that would resonate with middle-class families entirely dependent on the government for access to doctors and hospitals."

    So, we are better off with a health care industry that will bankrupt the nation, currently leaves 15% of the population without insurance and delivers mediocre care with astounding administrative cost than to risk people developing an "attachment to government"?

    Spare me!


  38. Al,
    I think the Republican's arguments about "attachment to government" set sail on the same ship called, "Warrantless Wiretapping."
    In effect, the Republicans turned the US into a Socialist (borderline tyranny but that's just my opinion) state by trying to concentrate executive power, and marginalize the Constitution and the Bill of Rights.
    So...whats wrong with the next step then?
    At least with socialized medicine the average schmoe gets something in this increasingly sad state we call our nation.

  39. Sheerah:

    Socialism (purest form) is where the state owns the means of production.

    In AmmuriKa, the means of production own the state.

    Even with the third Reich (Nationalist Socialist party), private entities like Krups, Deutsche Bank, and Siemens (where mutti worked before being called to the colors - funny story), were not taken over by the Fuhrer, but were instead told what to produce for the war effort. Geez didn't that commie FDR do the same during the Big One? FDR, BTW was Ronnie RayGun's favorite preznit.

    The Repubs are hoping that enough of the Redneck Goobers that defected to the MagiK Negro can be wooed back with the socialist Oooga Boooga scare.

    A silver lining in a black cloud is that, should a one payer system (with back up secondary insurance like tricare prime), not be instituted, the Goobers will die off faster than the smarter population. This will be due of course due to no coverage, no health maintenance, ignoring of symptoms until criticality kicks em' in the solar plexus, and checking in (people's Hillbilly Hospitals - the few that will still be operating), so late, as to be unable to walk out (you can check in but you can never leave).

    Is there not a law of physics associated with this? Or a law of nature?

  40. BB - "I don't know what to say about your police story, other than I might want to get hold of a lawyer mean and hungry for some class action suits."

    Pluto said: "That's the clever thing about what's happening with the police. They are only attacking the disenfranchised and people who can't afford lawyers and who don't talk to each other or the press. If this happened to you and I we'd make sure that the police officer was miserable."

    The real genius was that the motherf*ckers in Minn took out liability insurance for this period of time. That means that, even if they were successfully sued, the officials and police involved would not lose money.

    Of course, they'd still be open to criminal prosecution - unless, of course, the prosecutor's office was in on it, which I'd be money that that they were.

    Now, if I were the insurance company, I'd charge a pretty penny for this, since there's a high probability of lawsuits and large settlements. Which suggests to me that the policies were bought with official funds.