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The mirage of U.S. healthcare

August 26, 2009

On healthcare, the White House is struggling with a political riptide that threatens to drag it into deep water.

Americans, as they contemplate change, have suffered a weakness of nerve. The main reason is that nearly two thirds of Americans are apparently happy with their healthcare coverage, for all its deficiencies. Repeated reassurances from President Obama that those who like the existing set-up will not be forced to change, have had little effect.

A change of tactics may be in order. The administration must do a better job of underlining the glaring defects of the existing system. The genius of the U.S. healthcare is in providing the illusion of value and security. For their own sake, Americans must be encouraged to set aside jingoistic claims about having the best care system in the world and look more honestly at its short-comings.

Let’s start with value. Most Americans are blissfully unaware that their healthcare system provides appallingly little value for their money. This is because when it comes to costs, they see only the tip of the iceberg. While companies typically pay about three-quarters of an employee’s family premium — on average $12,680 a year — individuals ultimately bear the burden. In a free market, companies do not hand over to their workers more than they absolutely have to. Money spent on healthcare is carved out of take-home pay or other benefits.

“We pay for healthcare in considerably lower salaries,” Uwe Reinhardt, a Princeton University economics professor, said in a telephone interview. “The system seduces people into thinking care is pretty cheap. We are kidding ourselves if we think that the shareholder pays.”

One measure of this financial sacrifice is that employer premiums are now 17 percent of median household income — up from 15 percent in 2003. From 1999 to 2008, family health insurance premiums rose by 119 percent.

With healthcare costs rising fast, it is small wonder that middle-class Americans have failed to wring real pay increases out of employers. The drag on pay will increase further, according to research by the Commonwealth Fund. The foundation estimates that without reform, the cost of premiums could double again by 2020 — gobbling up still more take home pay.

The second big healthcare mirage is security. If the current downturn has demonstrated one thing, it is the fragility of an employer-based healthcare system. Lose your job — as more than 6.5 million have in this downturn — and your insurance can disappear with it. (COBRA provides only a temporary patch and can be expensive.)

It also means that you can lose your coverage if you get very sick. “Get so sick you can’t work, you can also forfeit coverage,” Gary Caxton, an analyst with Kaiser Family Foundation, said in an interview. The very idea of insurance is to protect you during a crisis. Instead Americans are getting insurance that works only when the sun shines. “The American system is least good at the worst times,” as David Cutler, a Harvard healthcare economist, puts it.

The final illusion is that the healthcare system can be relied on in the longer term. In reality it is taking on water fast. This is most obvious in small companies. Less than half of companies with fewer than 10 employees now offer insurance, down from 57 percent in 2000, according to the Kaiser Family Foundation. For all companies, the percentage is down from 69 percent to 63 over the past 8 years. Companies are also starting to unload a growing share of costs onto employees anyway.

Deductibles for most employees have more than trebled since 2000 — a trend that looks almost certain to continue. This is all before you take into account the prodigious quantity of tax dollars soaked up by healthcare.

As the private sector has faltered, the state has been forced to step in. The result is that America is stumbling toward nationalization.

A recent Gallup poll found the share of Americans dependent on the state for healthcare — including Medicare, Medicaid and VA benefits — had climbed to 29 percent from 26.5 since the start of 2008. If you include the 17 percent of U.S. workers employed by the state, then closer to 40 percent are covered by the government.

Americans need to take a good look at their existing healthcare system, warts and all. It is the administration’s job to hold up a mirror to U.S. healthcare. If they fail to do so, the U.S. will pass up an opportunity to build a system that’s fair, sustainable and offers better value.


This commentary is dead on.

We have a lousy healthcare system today. It is designed to deny you coverage so that insurance companies can maximize their profits.

The problem with trying to fix it is that most people are healthy and aren’t really using their insurance. You can’t possibly know how bad something is if you aren’t using it.

The people that know how bad the system is are in the minority simply because only a fraction of the population is sick and seeking healthcare. Many aren’t getting the care they need. This is wrong.

Posted by Kirk | Report as abusive

Let’s recall that a good deal of the problem started when the government forced the Health Maintenance Organization (HMO) on the system. Prior to that large insurers were able to negotiate rates directly with providers thus keeping rates somewhat in check.

The HMO was the first great idea from the government.

Agree that Cobra is expensive.
1. Amend the law to add a slight premium for cobra participants. There is no reason an individual should be penalized. If laid off or terminated the employee should be retained in the company’s pool until the individual is re-employed.

Prevent the loss of coverage during illness.
1. Amend the law to have insurers provide coverage to those at no cost through the illness.

Limit frivolous lawsuits. Eliminate contingency law suits. The party that loses the lawsuit pays all legal costs.

The statement that 17 percent of the US workers are employed by the state does not mean that they are covered by government run health care. The care is provided by third party insurers.

Remember the government cannot even obtain the H1N1 swine flu vaccine in sufficient quantities in time. How can they manage a complex system?

Take several measures to correct the problem and monitor results.

If the people want nationalized medical let’s do as Obama promised during the campaign; we all should be covered by the same plan that covers congress. If the government is going to run health care lets have one plan.

Posted by Healthy For Now | Report as abusive

What the article fails to mention is that employer-provided health coverage a GOVERNMENT subsidy, because what employers pay for is tax free. The government pays 60% of the US health bill. That’s what is driving the prices up up up……

We haven’t had a free-market health care system in a looooong time.

Posted by wxbrwer | Report as abusive

Is socailism the only way to reform health care?
Maybe we should look at the socialism that already exists in our country first. Like the VA. Like the Post Office. AmTrak. Face it, there is not very many things hat the government does well and socilized health care has been tried in other countries. IT SUCKS!!!!


Real reform can only be had with a great simplification. My healthcare bills are lower when they come to me and I file the claim. I pay and receive the reimbursement. I get the same service and show a high level of concern for the turnaround…I’m on the hook. Sometimes as much as 2/3 lower. Huh! Fees are so varied for similar services from state to state you wouldn’t beleive it. I once took my son to a Florida ER while on vacation. They billed my insurance 3 times what a resident would have paid. My Maine insurance paid twice what the Florida resident would have paid and I was billed the difference: all of what a Florida resident would have paid. A few phone calls and a couple well crafted letters and I never heard another word (or got another bill.) So in addition to insurance co shenanigans we all know about, the multi tiered billing of hospitals needs a whack…The price shopuld be the price, I don’t feel well or have had a crash and I’m supposed to negotiate fees? NOT EVEN CLOSE TO FAIR!
Doctor Canuck, You said technology is slow to catch on in the Canadian system. How about this: I needed a hip in Maine. One group wanted to do minimally invasive surgery followed with 12 weeks recovery then (and they didn’t exactly come out and say this) 12 weeks of physical therapy. I’m young and asked for a 2nd opinion. Referral produced a Doc that does th 24 hour hip. I took it, paid less, had no restrictions, minimal scarring and returned to work without any assistance at all in 13days. The other Docs don’t even want to consider this because they have something that works and makes them a ton of moola. Problem is if you do their standard hip replacement on an elderly person the 12 week recovery makes their recovery less than ideal. REWEARD OUTCOMES!

Posted by DanO | Report as abusive

Why are the only people complaining about Canadian/British health care American?

Posted by Matt K | Report as abusive

I have no problem with reform – this is what government needs to help us with – tort reform, more control over the insurance companies to reduce cost and limit them from giving someone the boot for pre-conditions, etc, etc. How about big gov lowering our taxes so that people could afford better health care? Force in the availability of HSAs to save for health care.
The point is that there are many things that the gov can do to help us change health care with forcing extensive bill down our throats. I have herd some of the good and the bad about the bill and can only conclude that it will get expensive and worse case set our health care system back. Why do I conclude this? Simple, the government is too involved. Gov Health Care, No thanks.

Posted by MJ | Report as abusive

A recent visit to the US confirmed my suspicion that the US, for all it has good, has no safety net for the disadvantaged. Not everyone is poor or unemployed due to personal failings.
Branding health care for all as “socialism” is a weak riposte. Firstly, ideal socialism is about sharing benefits rather than the rich grabbing the lot. It’s not red-rag communism, but I can see how it grates on the more rabid capitalists who seem to think it’s possible for everyone to grab all the money they want.
All I have to say, really, is there are a lot of ways to make health care more equitable. Just one comparison would be the Aussie set up, and I am certain there are others as good or better.
I am covered both by the government Medicare, and optional additional private insurance. Because I have some private cover – which of course I have tailored to my own needs and income – I pay a 1.5% levy at tax time towards Medicare. My additional private cover (if it matters I am 59 and just about to retire) costs me $24 a week, about .05% of my wage, and slightly more of superannuation. Even that is subsidised between 30% and 40% depending on age.
That’s a darn sight better than the 33% of pension mentioned by another comment on this thread, and the coverage is quite good.

Posted by John from Oz | Report as abusive

And I can keep going:
My brother was laid off, COBRA healthcare cost him $1700 a month. Thats more than I make in my day job. How is this helpful
Again I say simplify.
My Older brother died of cancer last year @59. He had had little health coverage as an independent plumbing contractor, and luckily he had just a little prior to diagnosis gotten on his girlfriend’s policy. He did not suffer utter financial ruin, but barely dodged that bullet. As he became disabled he applied for SSI in April. He died the following January having received one check from SSI. I think his widow was asked to return it.

If the Govt is going to pay we are going to pay too much for too little. If the government will hand down minimum and best standards and practices to this gawdawful mess of an industry we could all feel comfortable dealing with the bills and expect our reimbursement. Hospitals can’t keep a straight face overcharging you as easily as they do your carrier.
Still there will be times when many of us are on the outside of the system. Medicare/Medicaid should be extended to all who are out of a job and a subsidised benefit should be made available to all who are working at slave labor/wages. Taxes are an important part of the mix. Witha few well placed simple tax changes we can cover the gap. 1. Tax all market trades @.01%. This will move the markets toward more secure positions and reduce day trading and program trading. 2. Treat all compensation (salary bonus stock and options) as wages. Raise the top tax bracket to 90% at $1 million. eliminate the tax cap for social security.
The derivative market being worth $450 trillion turning over 3 time in the next year could produce $135 million.
Think of the volume ot the markets on a daily basis. If securitization has this much capital tied up, our money supply is about 4 times too small. We can and should print the difference and inject it at the bottom of the economy. It will multiply about 8fold on the way to the top and I dare say barely inflate prices. A great deal of foreign debt could be retired on the way from the bottom to the top.
I could keep going but someone might call me a Nazi and I’d have to send out the flying monkeys.

Posted by DanO | Report as abusive

You hit the nail on the head.
As to people who are concerned about tort reform and medical malpractice exposure, they should consider that if there was a single payer universal plan, the traditional standard for adjusters and personal injury lawyers calculating damages in settlements- medical expenses times a multiplier- disappears. Medical malpractice creates additional medical costs. Inadequate health care coverage creates additional tort damages. So in addition to helping business a national plan with a single payer model helps business again by reducing tort claim exposure. The only busines that would be hurt by reform is the health insurance business, and it only makes money by not providing all the needed coverage.

Posted by Bradford C. Riendeau | Report as abusive

I believe that we owe the citizens of the United States a workable and affordable healthcare system. We can build it but one of the controls over the system would have to be an separate citizens group that controls it. I think we need to limit tests and Doctor and Hospital liability. People can only do so much and people make mistakes. We will also have doctor testing and continuing education, plus we need to develope cures rather than drugs that keep patients coming back. Enough of the designer drug and drug advertizing. Might also start allowing pharmacists sell people cures without prescriptions like they do in other civilized countries. Just give me a system that works.

Posted by f belz | Report as abusive

I have a medical insurance from a German insurance company that provides a worldwide coverage, with only one exception….. no coverage in the USA. Why would that be?

Posted by Leonardus | Report as abusive

Yes, in my opinion, Kaiser Permanente the model of a not-for-profit HMO who provides affordable health insurance and quality, efficient health care to it’s members.

Kaiser has already implemented Electronic Medical Records (EMR) as well as an extensive integrated health care delivery management system, HealthConnect.

Members are empowered to set appointments, refill prescriptions, email their physician, and even view some lab results via a secure internet portal.

Not only do they provide free flu shots to all Members (no cost, no co-pay) but some Kaiser locations even offered “drive through” flu shot clinics last fall.

Posted by Thrive! | Report as abusive

“Because the government has had so much success in running any business, I guess we should let them run healthcare as well. King Obama said it best, “Fedex and UPS aren’t in trouble. It’s always the USPS”. Anybody that agrees that the gov. should be in healthcare is a moron.”

You must be thrilled by the performance of private industry lately, especially the banking, automotive, housing, and real estate sectors that brought such prosperity to this nation and have left us in such a strong position. Is it still “Morning in America” you rube?

Posted by Randolph Matamoros | Report as abusive

“Americans, as they contemplate change, have suffered a weakness of nerve.”

Idiot. Whoever wrote this is either a graduate of the Frankfurt School or a moron. Perhaps both.

Kaiser is crap everywhere but California. There is no such thing as “free” flu shots. Somebody paid for it. Another mentally challenged demi-nut.

Posted by Denver | Report as abusive

“Americans have the dubious distinction (among many others) of living in the only industrialised nation without a healthcare system. The natural question for any rational person to ask (”why is that??”) does not seem to occur to Americans. They seem to be content with, even proud of, their ignorance.”

1) because we’re different doesn’t mean we’re worse (or better). We need the system that works best for us and that may not be the same as any other system in the world.
2) because we’re different doesn’t mean that we haven’t asked the question of “Why?” That question has been asked (and answered) many times. We know (or have a general sense at least) of why we have been different up to this point.
3) because we’re different doesn’t mean that we are ignorant. Most Americans are aware of our differences and in many cases proud of them. Most importantly we know that we must do what is best for us, whether it is what the rest of the world is doing or not. Too often what “the world” thinks we should do is not in our best interest.

Posted by Mark | Report as abusive

I really don’t like the idea of trusting the proposed healthcare while at the same time denying cola’s for retirees and at the same time INCREASING the medicare insurance payments.

Posted by ken | Report as abusive

“Less value – For $13000 a year, an average American gets health-care that is inferior to all industrial nations.”

Quality of care is highly variable, just like any other service, since it is dependent on the person giving the care. There is no doubt the best quality of care in the world can be found here in the US. There is also no doubt that some of the worst quality of care can be found in the US. The “rankings” of health care are of little use in determining who has the best health care because the rankings are biased by their preconception of what constitutes “the best” healthcare. For some it is the availability of “universal” healthcare, while others have their own bias. However, absence of “universal” healthcare doesn’t mean that we don’t have available the best quality of healthcare in the world.

Posted by Mark | Report as abusive

“denying cola’s for retirees”

ken, the cost of living has declined in the past year. Denying a cola is doing retirees a favor because the cola this year would be a reduction!

Posted by Mark | Report as abusive

I do not disagree that the healthcare system is not perfect. I believe it has many flaws that must be addressed. I simply disagree very strongly in Government making decisions concerning my healthcare. I do not believe politicians of any persuasion when they deny any intentions of forcing me into making decisions I am uncomfortable with concerning me or my family’s healthcare. The politicians track record permits me to not trust them even more than the facts written in what I have read in the healthcare proposal(s) thus far. I am not a right wing nut job nor am I a left wing weirdo. I simply believe the government should not be involved in my decision making, but protect my right to make informed decisions. The politicians approach here will not lower costs, but it will get them what they want, further control over our choices in order to force upon us their ideologies whether from the right or the left. Give me liberty or give me death.

Posted by Scott | Report as abusive

I, like most Americans, understand how expensive health care is, and that we need some rational reform. But, like most Americans, I don’t want to throw the baby out with the bathwater, as the Obama-Pelosi-Reid legislation would do.

I, and most Americans, as near as I can tell, have no clue as to HOW the Obama-Pelosi-Reid Health Care legislation will actually operate.

But I, and most Americans, know what we DON’T want: a single payer Federal system.

No one has yet articulated rational answers to the many questions being asked.

How will we provide 40 or so million additional people with quality health care without adding substantial cost and rationing to the system? Will illegal aliens be covered, and if so, WHY, in heavens’ name? Why should anyone think the government can run such a complex new system effectively, when they have failed miserably with much simpler systems like Social Security and Medicare? Why does Congress choose to exempt THEMSELVES from the system? Who works for whom?

Unless and until Obama-Pelosi-Reid effectively and unequivocally answer the legitimate questions Americans are asking, I can guarantee that Americans will respond extremely negatively in the next elections to any politician who tries to ram an unwanted Health Care system down our throats.

Posted by Mike | Report as abusive

Where is tort reform?
Where is insurance reform?
Where are the pledges from our duly elected representatives that we will have access to the same quality of care that they have?

If our health care is soooo awful – why do people we personally know come here from France, Canada, Saudi Arabia, China and Germany?

Posted by PFMinTN | Report as abusive

Kudos! There are other massive defects:

Insurance (any kind) defies normal economic supply/demand curves. The principle of “Adverse Selection” says that the risk spreading mechanism itself is damaged by low-risk people who opt out. In essence, young healthy people say, “I’m young and healthy… I’d rather just NOT participate and keep my money, but thanks anyway.” And the market is left full of high risk participants.

Now pose the question: Should anyone be able to opt out of paying for roadways? (Highly socialized…except in Orlando and a few other places where there is a toll booth every 50 feet. Last time I traversed the city I wanted to shoot myself. Thanks so much, Mickey Mouse).

Should anyone be able to opt out of paying for police, fire departments, or military? (Much like health insurance, all risk spreading mechanisms. All incredibly socialized).

Meanwhile, people with families should not have to work for large companies (groups) to attain low cost coverage. That effectively dampens job liquidity and thus hinders broader economic markets. In effect health insurance actually dramatically dampens competition in the economy. What happens when GM closes down a plant and 800 workers find themselves constrained to working for another big company in order to find health care comparable to what they had before for their family? (Ever notice how manufacturing plants are often planted in small towns where there aren’t a lot of other big companies?) Stated another way: Big companies don’t have to compete nearly as hard for good talent as little companies because they get the only deals in town on health coverage. (They don’t have to compete with small companies to provide a better working environment, product, or culture…all the elements they should be forced to compete on). Health insurance under the current paradigm is just bad for capitalism at large.

Market job liquidity demands that job decisions be completely separable from the major health coverage decisions. So the current system patently discourages broader free markets and discourages massively liquid value flows rather than encourages them.

There has not been enough head-on discussion of “Adverse Selection” and the underlying group economics involved.

Posted by Kyle S | Report as abusive

our healthcare system cant be that great.1st you only see a doctor when your sick or get cancer,then they are so tightly regulated as to what there allowed to study or comment on (regulated by big money,can you say “drug corporate interests”).so were forced to pay for pro-active health screenings & tests out of pocket after taxes ,ouch! can i really aford that with a mortage & kids&car payments& oh yeah insurance premiums?there are fantastic legitimate roads to better health,though its hard to tell which anti-aging clinics arent just out to break you ,because they have to pay the sales teams salary ,who probably get there testing & supplements for free,thats why you can see how effective pro-active healthcare is by just looking at how healthy these people are on the leading edge of health&fitness.maybe if we break the old school idea of i only should worry about health after im sick &break down high costs for everyone we just might all fair much better than allowing huge corporate giants from holding healthcare like a carrot on a stick in front of us /as if were not paying for it through lower salaries & wages.reform could open the door to a cornucopia of new-age healing & experience new & better health alternatives through naturo pathics & chiropractics,which insurance pays for regularly,maybe because its pro active ie acting on the body before it gets sick? is truly the better way to look at heathcare &reform.or go back to the dark ages of oh, im ok,i dont have cancer yet,so lets keep things the way they are for fear of real progress,& health for future generations!!!!

Posted by john d. mayo | Report as abusive

In 2004, my wife had a cancer operation on her colon. The initial exams and subsequent surgery and treatments by a team of doctors proved to be quite successful. She did require a return to the hospital a short time later for a stomach levage due to the complication of a colon block brought on by the heavy use of pain medicines. Through another complication of a rare infection she was remitted to the hospital three weeks later for care and treatment that was more serious than the cancer procedures she had undergone.
Eight months after that, we were involved in an auto accident in another state in which I was at fault in very inclement weather with my wife and two grandchildren. We all required treatment of some form for various injuries of which my wife sustained the worst.
The insurance companies (health and auto), in effect, came to our rescue and upheld their contracts 100 %, even for coverage of our grandchildren, to the point of reimbursing our grandchildren’s parents for expenses and lost time at work required of them for travel out of state to check on the condition of all of us. Within the course of those infirmities and those months we had incurred expenses amounting to roughly $30,000. Our portion in the form of out-of-pocket co-pays and deductibles amounted to $1,200.
The insurance companies handled all the administrative details and simply asked us to comply with their procedures and processes, which we did. They paid all our expenses without a sound or whimper, much to our peace of mind.
Our insurance plan was a simple plan provided by our employer and was not in any way special or “cadillac.”
Before retirement, I was a retired pharmacist who, during his career, filled 90 % of his prescriptions billed to third party insurance companies. Each day hundreds of thousands of prescriptions are transacted through pharmacies nationwide for payment through insurance companies – without slow down or hassle – with insurance companies fulfilling their part of the contract.
Has anyone researched the hundreds of thousands of medical insurance transactions and payments that are made quietly and successfully on behalf of patients every single day in our country?
Our current discussions on health care are filled with banality and apparent ignorance of the current high state of medical care in this country. You focus on a tree stump and cannot see the forest.

Posted by Old Sage | Report as abusive

If this covers illegals, I am against!!!!!

Posted by JJ | Report as abusive

there are no such illegals, that you let them die

Posted by Manuel Klarmann | Report as abusive

The Health Care Bill has nothing to do with Health Care!By definition it’s the prevention, treatment, and management of illness and the preservation of mental and physical well-being. The bill does not help one root cause of poor health namely a bad diet. Why is a burger a buck yet broccoli $1.50 or so? Why is high fructose corn syrup the #1 source of calories (sugar per capita 150#/person)followed by white flour. Why are billions spent on subsidizing corn and other crops? Why are cattle fed corn and M&M’s rather than crewing their ccud as their supposed to? Why is 30% of our farm land used to grow unhealthy (aflatoxin, one of the most allergenic)corn with 90% Monsanto’s GMO seed? Why is there no prevention? Why no tort reform? Why should an D in NJ have to pay over a $1 MM lawsuit for treating a patient for $35 without any problem…except didn’t speak English. Why the increase in paperwork…53 some odd codes for getting hit by a ball! Why no reduction in regs preventing so much waste (once a box is open, all the individually wrapped items are discarded).
This bill penalizes those (of the same age) who have a healthy diet, don’t smoke, don’t do drugs and exercise by subsidizing those who abuse drugs and their health.Why is autism (a brain inflammation)1 in 150 and in the UK in boys 1 in 35? Why is the flu vaccine with 25 ug of mercury going to be pushed to pregnant women.One answer Money.Look who’s being rewarded for getting who elected? Why is Janet in charge? Support and loyalty. Where’s the integrity in Congress or the White House.

Posted by Russ | Report as abusive

Russ has it about right in his post, we’re not focused on health care, we’re focused on treating illnesses. Treating illnesses makes money for the big players; healthy people don’t.

The whole “health care” debate is a conundrum. Most people have figured out that we have a big problem with health care costs. But we’ve also figured out that we don’t trust Washington with our money. So any kind of reform is going to have to happen without a big infusion of government influence.

Good luck to that happening in the current Dem congress!

Posted by Lin Atkinson | Report as abusive

“This bill penalizes those (of the same age) who have a healthy diet, don’t smoke, don’t do drugs and exercise by subsidizing those who abuse drugs and their health.”(Russ)Are we contemplating having white bread police here? Or are we simply asking for better and more varied alternative and preventative coverage? Will sports and exercise that lead to medical problems also be considered high risk?

“Good luck to that happening in the current Dem congress!”
- Posted by Lin Atkinson . So when was the last time ANY health reform was offered by a non-Democratic leader? Don’t cut off your nose to spite your face or you may end up in medical bankruptcy.

I, and most Americans, would like to not be included in other peoples smack downs! Own up to your smack-down on your own or cite references!

Posted by Linda | Report as abusive

Just pass a law that requires they carry basic catastrophic like we have a law that requires basic liability insurance for cars.

If people submit bills and proof they can’t afford that, then let they should be on Medicaid.

There is a nation wide shortage of doctors the media loves to completely and totally ignore that is one of the root problems, so expand the slots for student in medical schools and give block grants for medical educations with the requirements that in return they work for ten or twenty years where the state needs them or that fifty percent of their patients be Medicare or Medicaid patients free of charge.

The hospitals all have to be run as non-profit organizations and the spending sprees by their administrators have to come to an abrupt end. These are the ones setting the horrendous prices and where government really needs to get tough. Might as well go after the university administrators and their binge spending at the same time. Right now this pack is all just waiting for their big bail outs so they can buy new jets too.

Posted by Jasmine | Report as abusive

Just pass a law requiring basic catastrophic health insurance like we have a law that requires basic liability for cars.

If they cannot afford that then they are supposed to be on Medicaid. Do some public service ads to let those people know what Medicaid is and where to go to get it. There are people all over the net who have never heard of it and do not even know it exists.

Pass a law to end people with pre-existing conditions being barred from coverage.

END THE NATIONWIDE DOCTOR SHORTAGE – Which is one of the roots of the problem with prices. Expand the slots for students to fill at medical schools. Give block grants for free medical education, with the condition that 25% to 30% of their patients be Medicaid or Medicare patients that they see for free for as long as they practice medicine.

And just as importantly – CRACK DOWN ON HOSPITAL SPENDING AND CHARGES – Their administrators have been spending like drunken sailors come into port for decades and their prices reflect that. Right now that pack is waiting for their bail outs so they can get new jets too.

Posted by Jasmine | Report as abusive

Liberals think they can improve the problem of a partial monopoly by turning it into a total monopoly. That’s what single-payer health care is: “Single payer” means “single provider.”

It’s the famous liberal two-step: First screw something up, then claim that it’s screwed up because there’s not enough government oversight (it’s the free market run wild!), and then step in and really screw it up in the name of “reform.” (hat tip Ann C)

Posted by ThomasS | Report as abusive

I love all the commenters attacking “government run healthcare” when the current reform being proposed is not anything close to government run healthcare. Yes, there is a public option and that will be government run insurance, but which part of “option” don’t you understand?

If you don’t think the government is any good at running things then don’t choose the public option. How hard is that? It’s your choice, but don’t take away my choice. I want the public option.

Healthcare reform opponents are all about taking away choice from Americans.

Posted by Kirk | Report as abusive

This is similar to the military-industrial complex. Very expensive, lots of cheating, lots of redundancy, lots of unnecessary stuff etc…Lots of $ for few companies and individuals.
Same scare technique used: if u do not have it you are at a major risk! And who pays for it? We the people with tax and we the people have no say. Just the lobbies have the say.
Will Obama have the chutzpa to rise to the occasion!

Posted by Steven L | Report as abusive

This is just another news service hailing the praises of Obama, who has no clue about anything, having never held a job, or done anything worthwhile with his life, prior to buying the presidency. Keep the government out of our lives, and let’s continue to live the American dream, and not destroy it with socialist nonsense.

Posted by Tom | Report as abusive

Dear friend,
I like all your writings.
This subject of commenting is taking for number of days and for months.
Yes.Many American middle class employees will not get much home take salaries,if they join to this new health care schemes.
I know very well that,America is not following Socialist pattern in economics and in regard to social welfare.
One thing,we have to understand that,her ratio of income for the same jobs from other developed and from developing countries are very high.
Being moderate income generating countries have started to provide some,immediate health care insurance by deducting very negligible percentage from their monthly salaries with equal deducted amount sharing by concerned governments for better health care to her own people.
Here,many Americans are objecting of Mr.Obama!s new health care insurance scheme.
Please assume that,you are in government head,what will you do for your own people with poor economic and social back grounds.
After getting public opinion polls from her citizens,if necessary with some genuine modifications for this new health care scheme for implementation.
Some dramatic scenes are in air.
To sum up,real,modified,genuine benefit oriented new health care insurance will be accepted by majority Americans.


Moe Badderman is, I think onto something, when he (she?) commented on: “content with, even proud of, their ignorance. Why is that?”

I think the answer is kind of simple, sadly. One part of it is about the dumbing-down in America over the last 20+ years. I’m an American who would say that applies to: entertainment media (e.g., The Simpsons, relity TV, American Idiot) so-called “news” media (Faux Noise,) public education system (No Child Left Behind,) political ideologies (cartoon-level of Libertarianism,) politicians (Palin,) pseudo-religions (Falwell, Dobson, etc.); just to start the list!

What you end up with is a nation of ignorant people, who end up being EXTREMELY foolish, to put it mildly! Mind you, “ignorant” in the sense of lacking knowledge.

That folly is best typified by them becoming what has been termed: Sheeple — people who behave like scared sheep, who believe what ever they are told, ESPECIALLY by those they regard as “authorities.”

Couple that with the real national religion: worship of wealth, and the attended encouragement of individual greed without bound. One of the fundamental tenets of that being: do what you are told, even if it conflicts without your own self-interest, the self-interest of your kids & grand-kids, etc.

Put it all together, and you end up w/ the poor, confused, foolish woman who had the outright stupidity to ask a nonsense question (about Obama and Nazi’s) of Barney Frank, and expect him to not take her head off?!!?

Barney is right — how do you have a conversation with a dogmatic, ignorant (as in unknowing — could she get a passing grade on a 10th or 12th grade quiz about Nazi Germany??), stupid (as in exceptionally dull, or in this case, gullible) person? Likely not!

Once upon a time, in the U.S. being a conservative meant you had a brain, and used it. I’m old enough to remember Wm F. Buckley.

Now, it seemingly means the exact opposite! Namely, if you do have a brain, you stubbornly refuse to use it! Instead, you repeat what Rush told you!!

You also allow yourself to be bamboozled by utter bull-shit! But one example: a lot of the gas-bags, and their parrots, talk about Free Markets. None of them apparently studied economics. If they had, they would have learned that there is a HUGE difference between a free market in which no seller/producer has dominance over any other, and hence over the market, from the polar opposite case of a monopoly!

I a true free market, the profit of each supplier / producer is held in check by the market. The closer you get to a monopoly, the less that check exists, or is effective.

So, in their confusion, they play into the hands of the wealthy, and becoming more so by the day, insurance and health companies — who like so many industries in America have become more consolidated over the years. The wanna-be monopolies are not confused; they know that the more concentrated they are, the more profits they make!

They just get the confused, uneducated followers to clamor for exactly the opposite of the direction we are really going, in order for us to go there faster! The fools cry for “free markets” and “keep the government out of it,” while the consolidation proceeds, to the increased enrichment of the few remaining.

They are profoundly confused in that they *fear* Big Government. They were told to be afraid, and they are!

What I fear is Big Corporations cum Government — the day, that has likely already arrived long ago, wherein the few, major corporate interests control the US government utterly and completely.

What was it Obama just spent 5 hours golfing with a UBS big-wig this week?!!?

The ignorant masses are herded along, excited when necessary, and distracted when not.

How utterly pathetic!!!

What will be profoundly sad is to see those same folks give up their lives, and the lives of their kids, grand kids, and every other living thing on this planet, because they are told by “authorities” that they foolishly trust that is what they are supposed to do!

We’ll obliterate life on this planet in order to maximize the wealth of a very few, in the short term.

Hopefully Europe, China and the rest of the world will put a stop to that seemingly uniquely American madness!!

After all, we may be jingoistic about our national superiority, but in the end, our ignorance and stupidity will prove stronger, and we will slowly crumble into a third world status that already typifies so much of America; especially the South. In the end, we will be stupid, and the rest of the world will rightly knock us from our perch! And right so!!

And for those who would respond to this about patriotism, I’d recommend they go read Mark Twain’s comments on that subject, and educate themselves before they open their stupid mouths!

Posted by MadAsHell | Report as abusive

Mr. Swan,
I enjoed your article. Especially how you point out the obvious, costs are rising. However, to fix somehting even a huge system like US healthcare you must first understand what is causing the costs to rise. In your role as a reporter you have done a good job of regurgitating what the experts you contacted said you forgot to give any reasons why the problem is occuring. I would suggest you do a follow up article and look into what is driving the prices up. Is it the crookedness of healthcare companies (as the President has implied on several occasions), is it the demand for healthcare is ever increasing, or is it the legal/government pressures that have been placed on healthcare (lawsuits, medicare requirements, etc). Do yourself and your readers a favor and educate yourself on the real issues not on what the politicians are saying. Thanks

Posted by Healthcare Worker | Report as abusive

True, the commercial side of health insurance has warts. What isn’t said in the article, however, is how bad the alternative is. We know, for example that Medicare, the shining example held up by all in favor of “health care reform”, provides the average beneficiary with from $100,000-$450,000 more in benefits than they actually pay in over the patient’s lifetime. The system is heavily subsidized by people that pay in, but don’t, at this time derive a benefit. An aging demographic and a horrible economy are ensuring that less money is “making it into” the medicare system. Medicare is set for catastrophic failure and adding millions more onto the rolls will only hasten its demise. No the better answers to our problems are a healthier lifestyle, modified health savings accounts, cross border health insurance purchases, risk pooling and tort refrom on the private side. On the public side, strigent criteria for aid for new enrollees, adjusted age of eligibility for Medicare and increased premiums must be inacted.

Posted by Brad | Report as abusive

American friends, please note: Canadian medicare is not what is portrayed in U.S. Republican ads.

Visit 2009/08/best-net/universal-health-care-m essage-americans-canadian-doctors-hea

Posted by Thomas Bergbusch | Report as abusive

To Mad As Hell:

Hear! Hear!

Thank you for your statement regarding the path America has taken in the last few decades. I fear it is too late for those trends to be reversed within the remainder of my lifetime. It will be sad to see my country just a shell of itself when I go.

Hopefully, the next generation will get it right and not suffer much from the ill effects of idiocy.

Posted by Steve in CA | Report as abusive

I really appreciated this article. I work for a large, not for profit health insurance company, and I am a strong supporter of health care reform.

I agree with your assessment that our employer-based insurance approach is failing many Americans – and leaves most of us without a safety net in the event that we lose our jobs.

A random musing on the health care debate: I’m surprised that the moral / religious / values-based aspect of this hasn’t become more of a “selling point” for advocates of reform. I think the human dimension of the health care problem – the fact that millions of people go without proper care because they can’t afford it – is actually one of the most compelling reasons for change.

It is just the RIGHT thing for a wealthy, developed nation to ensure that all of its residents have access to healthcare! Presumably, many of the opponents of health care reform are also “good Christians” – how would they propose to take care of “the least of these” Americans who can’t afford to pay for appropriate care themselves?

I also believe that universal coverage will create value in terms of public health and economic productivity. A healthy population is a more productive population.

Posted by Heather | Report as abusive

Mr. Swann: Your article is terribly written and suggests the only real alternative is to have the U.S. government step in to save us, PLEASE. The same government whose Medicare and Medicaid is frought with fraud and waste and rapidly running out of money? Instead of looking for the government to bail us out how about instead we look to eliminate goverment regulation??? Allow Insurance Company’s to compete on a national basis instead of regulating them and requireing they only operate on state and regional levels. If cash for clunkers is any indication on how the government will run healthcare I for one am very happy to keep it just the way it is. If the government truely wants to revamp healthcare then privatize Medicare and Medicaid, provide Tort reform and get out of our way.

Posted by Doug | Report as abusive

Whoa, eliminate regulation?? The collapse of the banking system and the subsequent world economic crisis didn’t teach us anything? We are indeed doomed.

Posted by Laz | Report as abusive

@Doug “If the government truely wants to revamp healthcare then privatize Medicare and Medicaid, provide Tort reform and get out of our way.”

Are you aware of some examples of other industrialized nations that have taken a similar approach, which is working well?

I agree with you that Tort reform is much needed – American physicians drive up costs because of the need to practice “defensive medicine” in case of being sued. Malpractice suits should be limited to cases of actual negligence, and awards should be limited as well.

Also, how would your suggested approach address the issue of the uninsured?


Posted by Heather | Report as abusive

As an outside observer, I just don’t get Americans. I mean, I could see your concerns if people in America actually lived longer than other developed nations, which they don’t, or if your health care system was more efficient, which it isn’t. Why on earth you want the keep the system you have is beyond me.

Do you really WANT to have to suck up to your boss, so you can keep your job, so you can keep your insurance, so your sick kid’s medical bills won’t destroy you? I can walk away from my job and that won’t happen. I have a choice, do you? I live in one of those dreaded “socialist” countries (Canada) and I can go to any doctor I want, any clinic I want; I can choose to pay for stuff that’s not covered (and I have), can you? My father, a financial failure by any measure, got sick and went to the hospital. I worried about him, but not about his care, not about any medical bills. Not one of his medical decisions had anything to do with cost, only care. What would happen if your parents went into hospital and they had no coverage, no ability to pay anything? Would you just walk away, or pay for their care? Some choice. You’ve got to love that American Freedom.

Why you all aren’t demanding something better is beyond me. I guess you have to be American to understand.

Posted by Fixerdave | Report as abusive

Only the most stupid and uneducated people bring the word “liberal” into this debate.
This entire debate is about helping the very people who oppose a public option.
Those are not smart enough
to understand the basics of how they would benefit.
Big Business has herded them around like little children and filled them with fear.
Time to grow up and actually use your brains…….

So decide…is America a country where laws and policy are based on lies, and controlled by big business, or is America a country where law and policy is based on truth and
and dictated by an educated majority.
I’m not sure those screaming “liberal” have any intention of finding the truth, but I hope the rest of Americans will.

Posted by K Schluter | Report as abusive

We pay for car insurance in most places in america**.
I think we should pay for our own health insurance. WHO we pay is up for debate, whether the federal system or a private system or both. To address the article’s issues about the mindset of the common man in america, having a monthly, payment like my cell phone bill or car payment, should help people realize just where the money comes from that pays for thier formal health care. Just like children think money comes from the bank, people need to realize the money comes from us. **in pennsylvania if i want to drive an automobile, i must buy and pay for insurance.

Posted by dr jiminsurance | Report as abusive

My wife and I are very “saddened” by the behavior of a number of Americans in trying to use vitriol to try to derail a serious discussion on health care and the apparent agreement by others that this “anger” must mean something so let’s not change anything. I think it’s true that many currently working American believe they’re ok with health insurance and add to these those on Medicare, well just let the others get a job or get old.

The problem is those that don’t have coverage, tend to leave their health issues until they’re a crises and then go to emergency rooms, which have to address at least the immediate problems and pass these higher cost services onto those with insurance. So this issue of 50M+ Americans without insurance coverage doesn’t go away.

I also am a Naturalized US citizen from Canada and have experienced both health insurance systems and the Canadian system BY FAR exceeds that in the US. I was assaulted about 2 years ago and experienced the health insurance maze in trying to get insurance coverage for the health damages resulting from the assault. The health insurance file on just this case is more than 3 inches thick with rejections, appeals, partial payments, appeals…. I’m sure many others would have very similar stories as the insurance companies are very good at maximizing profits and minimizing payments.

I do fervently hope that the vast majority of thinking, considerate Americans will work past the hyperbole and self-interest and truly establish a health insurance system we can be proud to show the world. Right now as a nation we do not have a health insurance system that protects our citizens from financial disaster.

Posted by jgt | Report as abusive

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