Peddling damaged goods

steffie-himmelstein-combo– Dr. Steffie Woolhandler and Dr. David Himmelstein are both associate professors of medicine at Harvard Medical School and primary care doctors at Cambridge Hospital. They co-founded Physicians for a National Health Program. –

Once they’re finished mandating that we all buy private health insurance, Congress can move on to requiring Americans to purchase other defective products. A Ford Pinto in every garage? Lead-painted toys for every child? Melamine-laced chow for every puppy?

Private health insurance doesn’t work. Even middle class families with supposedly good coverage are just one serious illness away from financial ruin. In a study carried out with colleagues from Harvard Law School and Ohio University we found that medical bills and illness contributed to 62 percent of all personal bankruptcies in 2007 – a 50 percent increase since 2001. Strikingly, three quarters of the medically bankrupt had insurance – at least when they first got sick.

In case after case, the insurance families bought in good faith failed them when they needed it most. Some were bankrupted by co-payments, deductibles, and loopholes that allowed their insurer to deny coverage. Others got too sick to work, leaving them unemployed and uninsured.

Now Congress seems poised to fulfill insurance executives’ prayers; make failure to buy their faulty product a federal offense. We’ve seen this brave new world in Massachusetts. Here, beating your wife, communicating a terrorist threat and being uninsured all carry $1000 fines. Our law has halved the state’s already low uninsurance rate – mostly by expanding Medicaid and similar programs at great public expense.

But reform hasn’t made care affordable for middle class families, or for the public treasury. A middle income uninsured 56 year old is now forced to lay out at least $4,800 for a policy with a $2,000 deductible before it pays for any care, and 20 percent co-payments after that. Skimpy, overpriced coverage like this left one in six Massachusetts residents unable to pay their medical bills last year.

Even among the insured, 18 percent skipped care because they couldn’t afford it. Meanwhile, as costs rise for subsidized coverage our state Senate plans to drop 28,000 people from the insurance rolls, and public hospitals and clinics have suffered draconian cuts as funds were diverted to shore up the reform.

Such shrunken coverage for the middle class and the evisceration of institutions that care for the poor prefigure the ugly reality of the president’s plan. Searching for the $150 billion extra he’d need each year just to cover the uninsured, Obama threatens to tax health benefits for those who are currently insured, effectively increasing its price. And he’d drain Medicare and Medicaid funds from safety net hospitals, anticipating a sharp drop in those unable to pay for care – a drop which has largely failed to materialize in Massachusetts.

The President’s other proposed funding streams aren’t objectionable, just illusory: unenforceable pledges from hospitals, insurers and the AMA to slow health inflation – a repeat of the empty promises made when Presidents Nixon and Carter threatened cost controls; and the assumption of windfall savings from computerization and care management, assumptions that the Congressional Budget Office has dismissed as wishful thinking.

A single payer reform could realize about $400 billion in savings annually on health care bureaucracy – enough to cover the uninsured and to provide first dollar coverage for all Americans. But the vast majority of these savings aren’t available unless we go all the way to single payer.

Adding a public insurance plan option – as the president proposes – won’t fix the flaws in Massachusetts-style reform. A public plan might cut private insurers’ profits, which is why the insurers hate it. But insurers’ roughly $10 billion in annual profits is only a sliver of the money squandered on bureaucracy.

The complexity and fragmentation of an insurance system with multiple competing payers breeds this massive waste. In addition to their profits, insurers spend vast amounts on overhead for marketing (to attract healthy, profitable members); demarketing (to avoid the sick); keeping track of their ever-shifting roster of enrollees and collecting their premiums monthly; fighting with hospitals and doctors over bills; and lobbying politicians. And doctors and hospitals spend tens of billions more keeping track of who got every band-aid and aspirin tablet, and fighting with insurers to collect payment.

A single payer plan would eliminate most insurance overhead, as well as these other paperwork expenses. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget, eliminating most billing. Physicians’ billing could be similarly simplified.

While a public plan option could save on profits, it would forego most of the other $390 billion that single payer could save. Hospitals and doctors would still have to maintain their elaborate billing systems. And overhead for even the most efficient competitive public plan would be far higher than Medicare’s, which automatically enrolls seniors when they turn 65 and disenrolls them only at death, deducts premiums directly from social security checks, and does no marketing.

Moreover, a kinder, gentler public plan would quickly fail in the health care marketplace. Insurers compete by NOT paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients; and by lobbying for unfair public subsidies (as under the Medicare HMO program). Competition in health insurance involves a race to the bottom, not the top.

A public plan that abstained from marketing would soon be saddled with the sickest, most expensive patients, whose high costs would drive premiums to uncompetitive levels. Similarly, failure to emulate private insurers’ schemes that shift costs to patients and other payers would be a crippling competitive disadvantage. To compete effectively, a public plan would have to copy private plans’ bad behaviors.

When addressing liberal audiences, proponents of mandated private coverage with a public plan option conflate it with single payer reform, hoping to deflect criticism from their left. Meanwhile, Republicans warn that such a plan is a back door route to socialized medicine. Both are wrong.

Eight decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. A government-run clone of private insurers cannot fix these flaws. It’s bad enough that insurers are peddling damaged goods. Why make things worse by requiring Americans to buy them?

378 comments

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Time for our government to do what is right by people without worrying about insurance companies, doctors, hospitals, and others living off a poor health care system. When you start looking for solutions rather than problems you can begin to correctly solve problems. I do not hold out much hope for our stuffed shirt congressional orators and all their fancy words. They do not even take the time to listen to their own foolishness. I believe that like other foolish things, ie cars, houses, businesses, and food that is not good and does not serve a useful purpose they are eventually thrown out on the scrap heap where they belong.

Posted by f belz | Report as abusive

I simply intend to post a scathing indictment of what our nation has come to, using The Withholding of Health Care Rationality as a defining example.

The sad truth is, here in the USA, if you are anything less than Flippin’ Filthy Rich & get sick, you are destined for a slow & miserable death.

The poor allegedly have Medicaid or some other placebo fallacy. This is where inner city &/or rural poor are provided for. Actual practice sees patients die while waiting in emergency room admitting areas, & if a doctor does show up. He/she is so overworked & awake on amphetamines or caffeine that they misdiagnose, send the patient home with a bagful of drugs for the wrong problem and call that treatment.

The “Middle Class” feel smug listening to BS Blather adverts on the various Drivel-Snot “News Channels” (propaganda disseminators), and when you actually file a claim against the over-priced coverage that doesn’t really exist, the insurance company pays an internal staffer to find ANY reason to deny the claim. Lawyers sue, the settlement is sent to your heirs after they put you in the ground.

The rich have the money to pay out-of-pocket and buy Imported Transplanted Organs from India & other 3rd world harvesting fields … and IF you’re an Elected Federal Congressman or Senator: You pay nothing for The Best Health Care On The Planet …

Soylent Green is the Future & The Future is now. I now know why Jerry Garcia named his band “The GRATEFUL Dead”; at 62, I have come to see this Industrialized World as not representing Humanity at all, but rather, we have fashioned a world of greed grinding humans into fertilizer for corporate profits.

God will surely hand these Movers & Shakers over to Satan for Eternal Roasting & The Same Misery they are so willing to inflict of everyone else.

At least, that’s how I see it.

Cheers & Beers

It’s a big planet you know, and there are democratic nations on it with public health systems that not only work but work well.

Want to know the secret of how they got them?

Those who got rich under the old system had a large share of their pie taken from them by their government.
Ultimately various publics trusted their governments enough to let them rework healthcare at its core despite the active campaigning, moans and proclamations of doom from those within the medical and insurance industry who saw their pie being stolen from them.

But it will never happen in any nation that lacks public trust in government nor in any nation that allows big business too large a reach into the ears of government.

Since the US has both maladies health care reform is doomed at a societal level. No matter how it is dressed it will always be an overly expensive turkey… same with education.

Posted by John | Report as abusive

The US government has been providing Medical, dentistry, optometry, pharmaceutical, and psychological care for a very long time. They run hospitals and clinics across this nation. Why would we want a federal insurance? The government has a working model of a health care system that is free to the patent and is working very well. The DoD runs the system. It takes care of our men and women who have served and are serving our nation. We do not need insurance by which our government has admitted will be used to reduce the health car industry’s costs. I am not sure I want to be used as a cudgel to beat the health care industry into submission. We need this nations health care capitalized by our government. By doing so we eliminate the need for insurance, we force the drug companies to sell to one US buyer at prices that the people find reasonable.

I have been going to military hospitals for a long time as did my father before me. I have use private hospitals. There is good and bad in both when it comes to service but let me tell you the Military hospitals were by far the best. Granted triage can be a pain but once you get beyond that you won’t see people dieing on the floor unattended in a waiting room. That crap does not happen. These Dr’s and nurses are dedicated to healing and not the dollar. The get paid Officer pay.

Food for thought when you listen to the spin Dr’s who try to get you to believe the government can’t run anything better than the “free market” can. They lie! All the free market health care system has been doing is getting very rich or of our sick and injured and that is pretty disgusting.

Posted by B.Free | Report as abusive

As far as cutting costs in heathcare maybe a good start would be if your primary care could do more for you then sending you to specialists all the time , My doctor for instance (i really don’t care for him ) but he gets mad when you come to see him with more than one problem. I look at it as killing two birds with one stone. why can’t the primarys order the tests and then if a problem is detected then send you to a specialist . I remember the good old days when you went to your primary and he pretty much took care of everything , cough, gyn, boils, etc .. now a doctor won’t take care of a boil you have to go to a surgen . You all understand what i am trying to say ?

Posted by Dana | Report as abusive

Well, written- it’s simple. We need one and only one agency- non-profit people’s agency. No marketing, no fighting for care- this will lessen the chance of corruption. No more for profit health care. Obama it’s that simple go back to basic. One complicated system cover another complicated system = harvest corruption.

Posted by yo | Report as abusive

Yes, it’s that simple. If the current congressional plans are signed into law next fall, we will all be required to purchase the defective over-priced product known as health insurance. It’s NOT like car insurance: one can opt out of buying car insurance by not owning a car. How can one opt out of a health insurance mandate? Stop breathing?

Posted by saut | Report as abusive

PROPOSAL: A Single Payer Health Plan that Works

Benefits

Similar to Medicare, medical bills would be first sent for payment to the Health Care Financing Administration (or their contractors) of the US Department of Health and Human Services. The Plan would cover payments for most medical items, including hospital stays and services, doctors’ fees, lab costs, therapies, clinics and prescriptions. Those who want additional coverage may do so through private insurers.

Premiums

The cost of the Plan would be borne via premiums paid by taxpayers with their estimated and annual tax filings. The premiums would be relatively level, as a cost per person or per family. (Exceptions would be made for those below the poverty level.) The cost to cover every man, woman and child in the U.S. (300 million people) would be about $3,750 per year. The premiums may be even less because of the other single-most important feature of the Plan – a high medical deductible.

Deductibles

Annual deductibles would be based on income level – those with higher incomes being subject to higher deductibles than those with lower incomes. The actual deductible would be based on a percentage of a taxpayer’s AGI. For example, a person with an income of $100,000 may have a deductible of $5,000, while a person with an income of $50,000 may have a deductible of $2,500. The Plan will not pay for any medical service, procedure, hospital stay or prescription until that person’s deductible is met. Preventive care would be part of meeting the deductible.

Beyond the Deductible

After a taxpayer’s annual deductible is exceeded, the Plan would pay for all reasonable costs for medical care above that amount. There would be no co-payments, no restrictions on pre-existing conditions, and no limit on hospital stays. Occupational, physical and mental therapies would be covered, as would medical equipment (e.g., wheel chairs) and supplies (e.g., catheters, needles). There would be no lifetime maximum to benefits, so that chronic conditions would be covered. A medical committee would evaluate a possible cap on certain extraordinary procedures. Certain procedures would be excluded (e.g., elective surgery).

Advantages of the Plan

· Costs of medical benefits paid would be spread among the entire tax-paying population and not borne by employers.
· Because of the high deductible, each person would be in control of where and how he would spend money for medical care. Incentives are thereby provided to stay healthy and control costs on an individual basis.
· The fear (and actuality) of bankruptcy from catastrophic medical expenses would be reduced or eliminated.
· Paper work would be drastically reduced and simplified.
· Medical providers would have access to a person’s complete medical history, including x-rays, treatments, drugs used, hospitalizations, and chronic conditions. This would allow efficient integration of services from one provider to another.
· The Plan would be self-sustaining: all costs would be paid through premiums collected. As with taxes, Congress would have the authority to change premium rates and deductibles.
· All taxpayers would have guaranteed medical insurance, and hospitals, clinics, doctors and labs would be assured of payment once deductibles are met.

Controlling Medical Costs

Spreading medical costs among the entire population would reduce the cost for any special groups, such as the elderly or chronically ill or those experiencing a devastating injury or illness.

The high deductibles provide incentives for individuals to shop wisely for medical care. Providers who can help patients quickly, thoroughly and inexpensively recover from illness or injury would be preferred.

Because people will need to pay for emergency room care themselves, expensive hospital ERs would be avoided in favor of neighborhood clinics and smaller health care facilities. These smaller practices can offer services such as bone setting, wound stitching, flu shots and relief, and treatment of common pediatric and geriatric illnesses at a cheaper rate than can hospitals. Licensing can be used to require 24-hr/7-day per week availability.

Some may choose to meet their medical deductibles through wellness checkups and other forms of preventive care. Evidence shows these actions would reduce a person’s total medical costs, and make it unlikely he will need medical insurance.

Naturally, there are medical emergencies, illnesses and conditions that go beyond the norm. Hospitals, especially teaching hospitals, will still need advanced medical equipment and highly trained personnel. Patients that enter at their own expense have the incentive to be discharged quickly. Those that enter under insurance do not have such a financial incentive (There is of course the natural desire to recover and get out of a hospital). Hospitals and other medical providers would be evaluated and compensated under this Plan based on their ability to efficiently treat patients.

Posted by Dr. Peter Astor | Report as abusive

Who say’s that we MUST provide health care to all American’s anyway? Natural Selection…

Posted by Gentoo | Report as abusive

Do we need health care reform , yes!!! How do you define the word reform? How you define reform will enable you to define the problem, too much care, too many uninsured,lawyers suing doctors, too much money on research, too many good choices for care etc. Everyone has a point of view but not all points of view equals reform and taxing the rich to pay for the poor just will lead to less rich people and less health care……So the solution is to fund those who can’t afford or won’t get insurance, and a good number of fair referees, and leave the market place to create the reforms….It will with incentives and fairness; not any other way, the rest of the reform ideas will create more inequality and we all will be standing in line for poor care.

Again I’m reading an article that points out all the downsides of the health care reform, yet the article doesn’t give any alternative ideas. It seems everyone is a critic, but they never have an alternative idea for the problem once they tear apart the current idea. Unless you have alternative ideas to your critiques, keep your thoughts to yourselves. Its easy to sit back and bitch…its hard to actually take action. So if you have nothing to contribute let the brave at least try to make a difference.

Posted by john bonham | Report as abusive

Although Dr. Astor has some good points, the premiums and deductibles suggested would keep many people from seeking medical care until it became an emergency. High deductibles are not the answer. We need plans that encourage wellness with low or no cost preventive care and medications. Keeping a diabetic’s sugar at a normal level and early diagnosis and detection of cancer are much more effective use of health care dollars than treating complications at a later stage.

I totally agree with a single payer system as the way to go.

The point that most commenters on this article failed to take into account is the American psyche, which is very much influenced and directed by our public officials. Americans truly believe that health care and health insurance are the same thing. They are not, the Democrats are simply marketing their argument in this method in order to invoke an unreasonable and uncalculated public support for this idea. The fact is, health care is a right that is bestowed on any American, for a cost. If you are maimed or wounded, stricken or taken poorly, a hospital or doctor in your area will treat you and send you a bill, which often times, does not get paid. That is the only right you have in this debate. In fact, public hospitals rely almost entirely on government support already to maintain their insolvent business model of treating those with no means or no intent to ever pay their bill. This is your right as an American. Yet insurance is defined as paying monthly or annual premiums against the risk of catastrophic events taking place in the future. The liberals in Washington and proponents of the Welfare State will have you believe that there is a method in which all Americans can pay the same premiums to insure them against the same care which may become necessary. But, is it really fair that I pay the same premium as an 80 year with heart disease? No it isn’t. The 80 year with heart disease is the person who milks insurance funds dry. These are the persons who drive up employer group plan premiums, year after year. Also, those with terminal or chronic illnesses do the same. So, based upon the President’s declarations and falsities, the government will introduce such a plan to compete with private insurance companies, who are equal in size and stature to the banks and financial entities that were, very recently, deemed too large to fail. The government will never compete with these corporations, it is not in their direct interest. If it were, there would be no argument or political push towards a government-run plan, but rather the push would be towards rewriting our insurance laws and regulations, recosting our medical testing and treatment methods nationwide while also auditing public clinics and hospitals nationwide for solvency and fraud. We already possess two government-run plans which our insolvent, Medicare and Medicaid. Thus, rather than the government actually meaningfully challenging the insurance industry, they will simply introduce their own product to compete with them. If that does not make one wonder about the validity of their arguments and the true reasoning for their massive push towards this end, I do not know what possibly could. This is the American psyche at work. We listen to our politicians babble all of this utopian nonsense towards us which is not economically viable or even functionally feasible, global warming bills, health reform bills and even more spending. They then cut the middle class tax rate to make you feel like they’re working for you. Yet, how long has it been since nearly all homeowners nationwide got a notice that their property taxes will be reassessed soon? It’s funny, the federal government cuts your taxes by a negligible amount and suddenly your state and local governments are levying new indirect taxes against you to make up the shortfall. Pandering at its finest, and we as weak-minded Americans, buy this nonsense with great vigor and truly believe it is all possible and even our right as Americans. In the end, they are simply telling you what you want to hear to accomplish another task on their list towards political consolidation of power. My final point is this, if the government is truly working for you on the matter of health reform, why do they carefully speak about health insurance as health care, and why do they seek to create a new plan where the government will gain profit motive, rather than simply addressing the ails and chief cost factors which plague the industry? The answer is simple, they have a different motive for their momentum which is not available for public consumption. I can only speculate what that motive is, but like most other bold legislations of the past, it will prove a failure in the future and Americans will fail to realize, once again, that they were simply duped.

Posted by Brian Krapohl | Report as abusive

Any honest assessment of the health care reform should start from the reality which is that in order to provide care to all, care will have to be rationed. There is simply not enough money to do otherwise.

There is simply not enough money to provide all the available high tech care to everyone. To attempt to do so will bankrupt and destroy the economy.

Not unlike a national disaster where triage of the patients would occur so that resources would be provided to those most likely to benefit, a national health plan would need to do the same. Some patients might be denied transplants, some might be denied high-tech ICU care, premature infants might not be kept alive on respirators because all those things come at a very high cost.

Malpractice reform should be a cornerstone. In the same way that military and veterans are not able to sue for care they are provided, neither should participants in a government funded health plan.

For too long, the expectation has been that everyone should be able to get everything, but in the end someone has to pay. There are too many particpants who do not contribute anything to the system in way of taxes to be able to provide endless care to all.

There will be rationed healthcare, so get ready. It is the only means to provide “insurance” to all.

If you ask anyone who already works in the public healthcare sector they would tell you the above is true.

Posted by sstambolic | Report as abusive

The savings you refer to repeatedly were also shown to be a fantasy as reported recently by the CBO.

A better plan would have all people enrolled in some private plan. Those who do not choose a plan would be enrolled in a plan through a random drawing. Individuals could switch between plans on a yearly basis. The base coverage for all would be written at the state level and each private insurer would handle all paperwork. The US government would mandate that each state be responsible for determining how to fund this base system. This would allow states to be creative and would allow the country to see what works and what does not work.

Beyond the base plan, individuals could choose to pay for additional coverage. This would avoid the inevitable healthcare rationing of a single system.

No government plan would be allowed. This would also set the stage for tort reform.

Posted by Guy Thompto | Report as abusive

Americans are eating, smoking and drinking themselves to death. Obesity and smoking-related illnesses cost all Americans billions in health care costs each year.

Our lack of personal responsibility for our own health is a social issue. We smoke and eat ourselves to death then complain that insurance costs are too high.

I wonder what would happen to health care costs and the system if millions more of us simply weren’t so sick, ie. took personal responsibility for being healthy?

Posted by Rebecca B. | Report as abusive

How can we, mere citizens and taxpayers, fight the 45,000 lobbyists in D.C.? PhRMA, the mega lobby of the pharma industry, is lead by Bill Tauzin, former Representative from Louisiana. His masterwork is the 2003 Medicare Modernization Act, a huge bonanza for drug and insurance companies – remember, Medicare can’t negotiate drug prices thanks to his leadership!

Posted by Margaret Walsh | Report as abusive

I agree that single-payer is by far the best (although FAR from perfect) answer, but the general public has been frightened away from that option by clever advertising. Since there is such conflict regarding single-payer vs. traditional independent health insurance, has anyone considered using the federal government’s power to offer catastrophic coverage, simply to help families avoid financial ruin from injuries or illnesses? A means-tested program could set limits on the definition of “catastrophic” (eg, a family below the poverty level might have a federal disaster limit of $10,000 in medical costs while a wealthy family might have a federal disaster limit of $500,000 or more–the government has the statistics to set these numbers). Private insurance (this would have to be mandatory for everyone, just like car insurance in many states!) funded much the same way as present insurance coverage could then continue to exist to cover the costs below what the federal government deems “catastrophic”. It is completely unconscionable that the federal government allows individuals and families to be ruined by severe illnesses and injuries. Using a plan such as the one I have outlined, wouldn’t it be possible to bridge the gap between our present system and one which is not nearly so cruel? Mandatory traditional insurance for everyone in the financial zone below the federal “disaster” limit (covered by employers or individuals) with the federal government kicking-in coverage for all costs above (means-tested) that limit. This would ensure that no one is bankrupted by health costs while the system stays somewhat similar to the current one that is so very broken
As a further cost-reducing measure, why doesn’t the federal government step in and pay for the training of doctors. If it did so, it could demand a 2-4 year stint in disadvantaged areas (rural or inner city) as a payback (as in what the military often does already). While this might chafe against the authors’ private-sector bias (Harvard Medical School and the $200-300,000 it costs simply for the first 4 years of medical school there and elsewhere, not to mention undergraduate and specialty training), this measure would further reduce costs by not forcing so many young doctors so deeply into debt, allowing their fees to moderate. It would also have the advantageous effect of producing a more demographically diverse group of young doctors. We currently have a system that produces a higher and higher percentage of doctors from wealthy backgrounds, not necessarily the best qualification for producing a cadre of caring, concerned physicians.

Posted by Bill Reinthal | Report as abusive

Those who claim the private health insurance companies are getting rich off of sick people are completely missing how the so-called ‘free-market’ has failed us. Those companies get rich by dumping ‘low performing accounts’ by pricing the contracts out of reach of the buyers, rescinding insurance for even trivial errors on an application, seeking the healthy and dumping the sick off the subscriber list, and pushing ever more costs on to the insured and euphemistcally calling it ‘personal responsibility. The bottom line is these private companies make money insuring the healthy and dumping the sick. That is how they make $10 billion in profits each year.

Posted by J | Report as abusive

So far only 2 working large scale systems are known.
One is the 3rd party payer system. It’s the one most Americans know and use, and it works (OK, mostly, with a few exceptions) for the ones included (aka insured). Too bad it doesn’t work for the uninsured…
Another one is single payer (aka public, or socialized) system, implemented in EU, Canada, and many other countries big and small, rich and poor. It has its own advantages and deficiencies. As of advantages, there’s only one – it’s egalitarian. Does it outweigh the disadvantages of which there’s a multitude?
Firstly, it’s not up to the patients to decide who would treat them, it’s whoever the local health bureaucrat assigns.
Next, it’s waiting. Patients have to stay on waiting list for treatments of which there are shortages. Some don’t live long enough to be treated.
Then it’s rationing. The bureaucrats, not the doctors get to decide who receives what treatment, and oftentimes it means they decide who lives, who dies, and who lives the life that is more miserable than death itself.
The list can go on and on, but even the aforementioned disadvantages should be more than enough to think.
There are also self-pay option and government provided option in the US, but both are of much smaller scale than 3rd party payer system. Too few can afford to pay out of pocket for everything. And the government can just barely afford to pay for treatment of Armed Force members/vets, poor, and elderly. Medicaid expanded to cover everyone will bankrupt even American economy – even though Medicaid already rations treatment and pays doctors a pittance comparing to private insurers.
What system is better? So far there were no stories (or did I miss the news?) of Americans seeking treatment in European, Canadian, or whatever else socialized system. Just the contrary – foreigners who can afford to pay come to America for treatment. Yes, American also go to some cheaper locales to get treatment for a fraction of American cost – but it’s mostly for assembly line ops like hip/knee replacement done by Western (mostly American) trained docs using Western (mostly American) equipment in places like India. Or it’s for illicit transplants, or other treatments not approved in America for scientific, ethical, legal, or whatever else reasons. You can save a buck or 2 or a few thousand. But if something goes wrong you get no recourse, legal or otherwise.
Here we come to malpractice lawsuits that drive the cost of treatment way up. You can condemn the greedy lawyers and insurers all you want, but only until you or your loved one becomes a victim of malpractice that needs money to reverse the damage (if possible at all), or live with it (and it costs!), or get compensated for loss of income, or all of the above and then some. Disclaimer: neither I nor my immediate family members ever filed malpractice lawsuit in any jurisdiction.
Now, BHO wants to introduce the public insurance option. Not exactly universal public coverage. Not exactly market-driven private insurance. Sort of middle of the road option. But middle of the road is the place where you most likely will find not success, but rather a dead skunk. You don’t want to be there, unless you don’t mind to be flattened by an 18-wheeler of reality. Need a reason why BHO “middle of the road” plan cannot and will not work? Read carefully the original post by Dr. Steffie Woolhandler and Dr. David Himmelstein.

Posted by Anonymous | Report as abusive

According to the bureau of labor statistics , administration is the fastest growing job in health care. Up 2500% since 1970. Insurance company = administration. The elimination of national health care from Congress’s consideration is an American travesty of domestic policy.

Posted by Douglas Dewitz | Report as abusive

Health is life. And Good health is a full life.

This is the absolute truth of the whole health issue. You must ask yourself as a citizen what this is worth to you. And also you must ask yourself whether our leaders’ actions will result in genuine, practical, beneficial results.

Educate yourselves fully and don’t rely on soundbites from talking heads. Our whole philosophy on this issue stems from an improper assumption. It is the assumption that money must some how be a limiting factor in providing health care.

There are other ways in which “costs” can be covered. And If we are creative we can find solutions.

In imperial China some doctors would open clinics that offered general care to the community which supported it. Doctors would provide service to the community as needed. If while following doctors orders, one were to become ill, then the ill patient was freed of the obligation to pay the doctor until the doctor made things right.

This arrangement encouraged the doctor to provide sound medical advice and preventative care, and gave the community a sense of control over the quality of care. The clinic was regarded as a community asset, and the community was the life of the clinic.

Perhaps hospitals, clinics, and other such providers should be required to garner support in this fashion.

Just an idea. It would be good to explore other ideas where money is not the central focus.

If you want to cut down the cost of medical care why not also go after these drug companies that want to charge hundred of dollars for a pill that costs pennies to make? Once the research cost is covered from profits all that is required is the pennies to make it, so there’s no justification of these high prices. Cutting out the bureaucrats is a common sense idea, as such I expect we’ll never see it acted upon.

Posted by Orgizmo | Report as abusive

Although I agree we definetly need health care reform but forcing people to buy insurance will actually going to excarbate the problem We need to get rid of insurance period. Untill then our pocket holes are going to get larger and larger till we will be left with nothing.Then the tides will turn.

Posted by Nancy | Report as abusive

I like a personal healthcare account where I am in control. The government doesn’t care about my health they just want to control me. Thanks but no thanks. Look at our economy and now they want to ruin health,just great.

I’m not surprised two doctors want the government to ensure everybody purchases cadillac health care. Problems in the health care industry exist because government has intervened in the free market. These doctors fail to see that government actions have driven up the cost of health care and contributed to the personal bankruptcies. For example:

Government creates a big demand (via Medicare, Medicaid, CHIP) but no supply
Government forces hospitals to treat those who do not pay including illegals if they show up at the emergency room
Government allows lawyers to sue doctors for possible but adverse outcomes regardless of negligence and prevents patients from contracting with doctors with a promise not to sue
The FDA increases costs of medications (via various means I won’t get into here)
State governments specify what insurance must cover so males pay for pregnancy, non-smokers pay for smoker’s illnesses, viagara is covered, etc
The federal government prohibits employers/individuals from purchasing insurance across state lines

The solution is not more governmental meddling in the free market. Medical care used to be so inexpensive that doctors actually made house calls. Not any more.

Posted by ForFreedom | Report as abusive

I fully agree with Rebecca B. America is the sickest nation on the earth .. the richest, and yet the sickest. I have written repeatedly to the Obama administration to suggest that they tackle the problem from a different angle. Firstly, stop chemical farming, which is not only ruining American health, but it’s also ruining American land, rivers and streams, and our air and seas. If we could get away from the pesticides, chemical fertilisers, GMO’s, and the massive quantity of useless chemical additives in our food we would be in much better health as a nation. Secondly, we should disallow the continuing supply of ‘junk’ food by requiring healthy standards from those who purvey food to the public. Once that has been sorted out, and we go back to organic farming, just as it has been done for millenia, we can replant the Garden of Eden right here on American soil, we can replant the billions and quadrillions of trees we have cut down, and we can grow herbal medicines and aromatics which cannot be patented by the greedy pharmaceutical companies. We can become an example to the world. Only then can we get away from the pernicious pharmaceutical industry that is intent on poisoning us with their expensive drugs once we have eaten the miserable non-nutritious food that is killing us and causing so much obesity and disease. We can’t “keep eating and drinking and smoking” ourselves into oblivion and expect anyone or any system of insurance to restore us. We, each individual, must decide to take our health into our own hands and make sure that our life style rewards us accordingly. Then there will be plenty left for those who are not fortunate to have good health because of genetics or other circumstances, and for those who sustain accidents. I know this doesn’t answer the health care dilemma, but as Hippocrates, the father of medicine, said, “Let food be your medicine”.

Posted by Samarkand | Report as abusive

Contrary to the claims of this article, private health insurance DOES work for the vast majority of the insured, as most polls show. It’s worked just fine for me for 31 years, and for every member of my family, protecting us all from financial ruin through major illnesses and accidents, just as insurance should (no thanks to the politicians who have been trying to destroy private health care for more than a decade).

I expect the quality, convenience, timeliness and freedom of my health care to decline under a government-run plan, and its costs to increase. That is because there is only one thing that government brings to the table on any issue that private systems cannot, and that is a monopoly on the legal use of force to compel submission to its wishes. How could that possibly be a desirable attribute of any health care system?

Government-run health care will eventually -

Be operated entirely by unionized employees. Union contracts protect the worst employees and drive off the best. When unions negotiate with politicians for their contracts, the tax-payers and the public who depend on public services become nothing but deep pockets and hapless victims, often not even having a place at the bargaining table if the politicians were put in place with union money, as they often are. The unions have destroyed our car industry, our schools and are bankrupting some of our biggest and (formerly) richest states. Unions and high quality affordable customer service are simply incompatible with each other in the long run.

Make all but the rich and the political elites subject to the whims, fads, prejudices, and corruption of a political bureaucracy. Already, insurance plans are rendered far more expensive than necessary because politicians mandate coverage at the behest of lobbies and anti-science health cultists, and against the wishes of the plans’ customers. Politicians have forced my plan to include coverage for acupuncturists, naturopaths, chiropractors, mental health counselors, and others, not because members of the plan wanted that, but because lobbyists for those groupsd donated heavily to the Democrats who run my state. Naturally, I’m forced to pay for worthless (to me) coverage.

Give the government a financial incentive to terminate the lives of more “expensive” citizens and to limit the health care available to unpopular minorities (or majorities) like the obese, smokers, carnivores, the political out-party, and anyone who doesn’t graciously submit to its demands. What is to stop the government from limiting your health care if you refuse to sign a “living will” authorizing the withholding of treatment? What is to stop the government from requiring that you undergo “counseling” if you want to aggressively fight an illness that the government would rather you give in to, until you agree to what it wants? Right now, if my doctor doesn’t support my choices, I can find a different one. A government-run system simply cannot allow that, any promises it may make now to the contrary.

Not to mention that nothing in the U.S. Constitution grants the government the authority to take over such an intimate area of its citizens’ lives.

A government-run health care system will eventually end up being as dysfunctional as the D.C. public school system, except that you will not be allowed to drop out and you will never graduate from it. There will be no escape. And the costs will end up, as with all major government entitlement programs, vastly exceeding current projections.

Posted by Ann | Report as abusive

As an example of the kind of thinking that could easily end up running our health care system, see Samarkand’s post below.

Posted by Ann | Report as abusive

In what ways can a single payer plan provide incentives to avoid high risk behavior? For example, are people who are obese due to dietary choices still charged more to offset the higher cost of their care? Does a race car driver still pay more to offset their higher chance of injury? Let’s reward people for avoiding risk like the Safeway employee plan has done effectively to stabilize costs.

70% of all health-care costs are the direct result of behavior. 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

Are there good examples of countries who have a single payer plan which provides rewards based on behavior? Choosing to receive a reward should require that the recipient agrees to non-invasive monitoring by friends and family. If I catch you smoking, I get your reward and you get penalized.

Scott Harrington writes…

Safeway’s program offering employee premium discounts related to tobacco use, weight control, blood pressure and cholesterol levels is a good example.

Financial incentives for healthy behavior have the potential to significantly reduce costs without reducing quality. A failure of health-care reform to permit or incorporate such incentives would make coercive government measures to control costs more likely. These controls might include limits on provider reimbursement, comparative-effectiveness or cost-benefit criteria that must be met for care to be reimbursed, or budget caps. The results would be less health–more obesity, diabetes, heart disease, and cancer–and eventually less health care.

An aversion to having health-insurance rates and coverage linked to individual behavior may be on the verge of becoming national policy. If that happens, the unintended consequences could be very costly.

Posted by Loren H | Report as abusive

First let me be clear that I am insured. I am 56 & own a small struggling retail store. My health insurance policy costs me $6000 a year. In order to have such a “low” premium, I have a deductible of $2500. I have almost no extra money after paying my basic bills. I can’t afford to go to the doctor although I have some real health issues. I fell last year and tore muscles in my leg. I need physical therapy but I can’t afford it. It is difficult for me to walk and it keeps getting worse. My quality of life has greatly deteriorated. I can see myself in a wheelchair in a few years. Blood was found in my urine 3 years ago. I took the tests I could afford but the cause wasn’t found. I can’t afford further tests. Maybe I will end up on kidney dialysis because I have an untreated condition. All I can do is to hope that I don’t. People in my situation who are under-insured are really in a bind. We are not poor enough for Medicaid or rich enough to have good insurance with a low deductible

Posted by circe5 | Report as abusive

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