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Ending Private Insurers' Chokehold on Health Care
For once, I agree with Republicans on health care reform. We should scrap it all and start over. Thursday's encounter between the two parties was good talking-point theater but awfully runny with repeats of the past year's parroting of a "government takeover of health care" and other dim-witted fabrications. (Don't talk to me about a government takeover of health care when the biggest fort you're defending is Medicare.) Instead of acting like the grown-up majority they are, Democrats, led by their chief appeaser, deferred to a minority of cranks and shills, each one of them better insured than most of us, as if the Republic's future depends on them. It doesn't. Quite the contrary.
The Republican minority, by its calculated prevention of progress on any issue of importance since March -- health care, jobs, taxes, global warming -- is ensuring that America's appointment with has-been status will be moved up a few decades, to China's delight. Democrats are complicit. So go ahead. Make the Republicans' day, and scrap it all.
But scrapping the Democrats' proposal isn't enough. A few details aside, even the best of the Democrats' idea of reform is not significantly different from what's in place now, which is to say that it isn't that different from the do-nothing approach Republicans favor. It builds on an existing system dominated by private insurers whose twin goals are to cover as few of the sick as possible while making as much money as possible when covering the healthy. That's not an insurance system. It's a predatory swindle. And it's certainly not a health care system.
Care isn't defined by what you can afford, but by what you need. Anything short of that is health care's equivalent of segregation, which is what we have now. Sure, some of the best care in the world is in the United States. But aside from the elderly, who have it all, most of us are barred from it. We're either slaves to insurers' orders or priced out of the swindle altogether, as some 50 million Americans are.
I'd be all for reforming the system by building on what works. We know what does. Build on Medicare, goddess of 45 million Americans. That works. Insurance for all, universal choice of providers, no interference between govern- ment and doctors, cheapest overhead, and no permission required for any procedure from some pinhead adjuster in a call center who doesn't know care from crap. Instead, by deferring to the private insurance industry, what we've done so far is attempt to build on what kills. It hasn't been working. Why should it work any better by subsidizing it with tax dollars?
The problem isn't "socialized medicine." That doesn't even exist in France or Germany, two countries with far better health systems than the United States. The problem isn't defensive medicine either, or rich doctors, or Taj Mahal hospitals.
The problem is the for-profit insurance industry. A system designed first and last to make money is posing as a guardian and underwriter of care. The two are fundamentally incompatible in principle. A patient's needs should never depend on an adjuster's rules as opposed to a doctor's judgments. Yet they do every day. The same people who claim to fear government interfering with their care seem to have no problem with those adjusters denying them care. That's where ignorance meets ideology.
If relying on private insurers to arbitrate care is incompatible in principle, it's even more so in economic terms. Why should 20 cents of every health care dollar I spend line the pocket of a shareholder or sustain the redundant bureaucracies of hundreds of insurance companies when hundreds of billions of dollars a year could be saved by eliminating profits and redundancies? That's what government insurance does. And no, Medicare fraud, salacious stories aside, doesn't come near the cost of private-insurance frauds, swindles and the immeasurable cost in dollars and dignity of care denied. It's fraud every time a private insurer drops an individual who gets sick. It's a swindle every time a private insurer denies coverage for a procedure recommended by a doctor, since that insurer is still pocketing premiums.
Health care is more than a right. It's an entitlement. What should be mandatory isn't for every American to carry insurance, but to have every opportunity to access the best care possible without risk of bankruptcy, without making choices between care and other necessities, without submitting to an insurer's actuarial lotteries. That's how civilized nations treat their citizens. The elderly aside, it's not how America treats its own. The best care in the world means nothing when it's leashed by the worst private-insurance system in the world. That system doesn't bear reforming. It bears eliminating. Until then, mark your calendar for that appointment with the America formerly known as a great nation.
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31 Comments so far
Show AllWell, you know, I cannot really argue with some sort of single-payer. Of course, we'll have to give up our empire to do it--good riddance.
However, Mr. Tristam, what you're assuming is that in single "entitlement" payer, you would pay less for your care than you'd put in via taxes. Government officials will "loot" higher taxed people so you can "mooch". Still I'm not really arguing with it. Here is the real rub: when you're not the customer (someone else is paying) you want the absolute best service, usually far and above what is reasonable or needed. Combine yourself with millions of other Americans, and the portion of your taxes for medical will go up--way up (even with substantial mooching). That's why your insurance company is a major a...hole--they're paying so they're limiting the service.
Despite all that, single payer is still reasonable. Sadly, the politicians indebted the country heavily and pledged even more recently to bankers. I don't think we'll see any real sickness reform.
So what can you do in the interim? Take out a HIGH deductible policy. Put pre-tax money into a health savings account and use that account to pay for all medical expenses up to your deductible. Since you're now the customer, you go only to doctors who take no insurance and thus won't use you to make up for all their low paying insurance customers. You'll pay $80-100 for an office visit; not the $300 a visit the insurance taking doctor will try to charge you. You'll evaluate all extra costs carefully: "Doc that particular blood test is $450, do I really need it?" "No, let's start with a cheap test first, see how it comes out and they'll I'll use my medical judgement to determine if you need the $450 test." Etc., etc. When a doc knows you're paying, you will pay less. It works. Use the money you save to buy real food and cook it yourself. Then, your health care expenses will really drop.
Government officials will "loot" higher taxed people so you can "mooch".
Those higher taxed people pay a lower percentage in taxes than the average worker due to a rigged tax system.
Also, due to a rigged economy, wealth has been "looted" from the masses to enrich the elites. So it's a great thing if we can take it back.
Miamigreek, you are in la la land. The lower half of American cannot afford to save, they have been subject to class warfare by the rich over the poor for the past 30 years. The rich are the ones who have been mooching, mooching on the vast majority of Americnas.
Doctors who don't do business with Big Insurance tend to charge less but there are not as many of them and the few that are there are hard to find for most Americans. MG does have a point on saving and cooking. It is not impossible to save but it can be harder with the current environment.
Single Payer, (akin to what our military enjoys)...or a total remake of the system... to start with re-education about nutrition, excersize and lifestyle, from the moment of conception to the last gasp and rattle. Single Payer, where the person is valued and can live in peace without the tyranny of bankrupsy or death if a health crisis arises... it is time we demand that government protect us from the corporations who view us as those to be denied for their bottom line and profit grabbing mentality. Get rid of the redundancies of paperwork, swallow the pride and look to other nations that have accomplished this humane effort for the GOOD OF THE PEOPLE! A long hard look at our food, water, and air quality might also be in order, as well as the influence of the media, hypnotizing our country into complacent stupidity...which does nothing for our long term survival as a species. But maybe that IS the plan, eh?
Personally I think Tristam got it pretty right. The private insurance of healthcare is a big scam. I had as a roommate one of those "agents" at an insurance call center; he got to deny or approve medical procedures despite having ZERO medical knowledge, just following the guidelines, which favored denial.
Let's repeat it again: 50,000,000 people without ANY health insurance at all. And a "reform" bill that ignores many of them. It is inexcusable that one in six Americans has no coverage. And what most of the rest has is increasingly unaffordable (increasing the number without coverage and thereby healthcare costs) and pretty pitiful in action.
The solution is simple -- a revised and improved and properly funded Medicare for everyone. But that wouldn't involve 2000 pages of insurance and big pharma giveaways.
Gary
"It's no longer a question of staying healthy. It's a question of finding a sickness you like."
-- Jackie Mason
I have an aunt who just calls people verifying that they have health insurance.
I love her to death but it's a job that can easily be done by a computer.
Why not send an email, a letter, or get a computer to call these people up to verify that they have health insurance?
Creating a Medicare-for-all system would solve the problem of doctors who won't take Medicare patients. They would have to because there would not be anyone else.
But that would also leave some room for the private insurance market, in that the Medigap policies would still be needed. Of course, the revenues would not be as extensive as they are not for the insurance companies, and they would have to take everyone at the same rate for the same level of service.
But that would be the easiest way to segue into a single-payer system.
"Medigap" wouldn't be needed if we went back to fully funding Medicare and giving everyone the treatment they need. If you're thinking of vanity stuff then by all means let private insurance exist for boob jobs and fancy clinics where the rich can get the same procedures done to their business schedule, with fancy cuisine during recovery and staff to take care of their every fancy. But I don't see why the USA can't cover necessary medical treatment for all it's people without those people having to resort to "medigap." They don't in other countries.
"...Medicare, goddess of 45 million Americans. That works. Insurance for all, universal choice of providers, no interference between government and doctors... no permission required for any procedure from some pinhead adjuster in a call center..."
It is obvious that this person knows nothing about Medicare - and never had to deal with the government's interference with doctors or some 'pinhead' in a call center at Medicare (that's if you can ever get through to them in the first place). Medicare may be a small start, but it is a long, long ways from decent healthcare - as those of us who must use it know all too well. Medicare denies treatments and tests on a regular basis for idiotic reasons - some 'pinhead' decides to play doctor. It's probably because Medicare is being starved by the war budget - just like Social Security and every other human entitlement to life, liberty - forget the pursuit of happiness in this country because that's a farce. This is the face of fascism - and it will only get worse.
I almost died from and infected tooth, for god's sake - but dental isn't covered. The last time I looked, my teeth were still part of my body - this is insanity. It will now cost thousands of dollars to fix my teeth because I couldn't afford to get fillings when I needed them, or even extractions. Now I can't get simple lab tests - because of the Medicare gatekeepers. I may die in the meantime - and I worked hard all my life, until a freak accident crippled me and I lost EVERYTHING. You have to be destitute to get Medicare if you're disabled - you lose your savings, your pension, and sell everything you own (even your clothes) for pennies on the dollar - so don't tell me about how great Medicare really is - it isn't. (PS - the VA is a farce, as well.)
This article makes some solid points but misses on the 'Medicare' and 'quality' talking points.
Apparently, we have to say this again and again and again - Medicare is NOT "goddess of 45 million Americans", and the elderly do NOT "have it all". Medicare offers basically NO coverage for eyes, ears, or teeth. Hello? Seniors and other humans need this basic care. Medicare may be relatively efficient, but it is not free and is actually too costly for the very poor. Just because it's better than private for-profit insurance coverage does not mean it's the ideal it's too often set up to be.
Also, "Sure, some of the best care in the world is in the United States" requires a closer look as this is another mythical meme. While a lucky few gain access to some very expensive equipment and elaborate procedures, overall the U.S. ranks 37th in the world in quality of care. You don't want to know how many people die of hospital-generated diseases and medical mistakes. We are fighting so hard for access to what are actually quite variable, not always reliable services.
The USA has one of the highest rates of secondary infections contracted while in Hospitals in the Industrial world.
The USA also has one of the highest rates of Medical Mistakes in the industrialized world .
That any can claim that this suggests the "Best Health Care system" in the world is mind boggling .It one of those dumberd down memes linked to what people think of as patriotism.
"That's not an insurance system. It's a predatory swindle"
The predatory swindle is not only in the healthcare sector, Pierre, but in the entire US economy. Everyone knows it, but only a few acknowledge it.
So I say let the party of doom, and the party of me too, together carry the nation to doomsville. I want the predatory swindle to grow large enough to finally bust all the pretenses. The pretenses, among our families, friends, coworkers, are the most oppressive element of all. They prevent change.
Of course, a rendezvous with doom ought not be the people's motivator. The people ought to be motivated by the fact that the cost of US healthcare is double the cost in other countries, and slated to reach five times in ten years.
People in other countries keep tabs on their own costs versus costs in other countries and they act accordingly to ensure that they are getting best value. It really boils down to convincing USans to finally embrace such common sense.
"The pretenses, among our families, friends, coworkers, are the most oppressive element of all. They prevent change."
I think you hit the nail on the head here--ignorance and pretense both.
Great comment!
A nation's health care system must reflect the values of the society and that is why the American system is based on greed and misery.
...and fear of death on the other side. What a racket! I shall withhold my vote for either political 'party' until we have a National Public Health System.
Why not just vote Green Party or Socialist Party USA?
Democrats and Republicans are counting on you not to vote so all the other fools who vote for them will keep them in power.
There's a fundamental contradiction between for profit health care and one of the principal precepts of medical ethics, namely "First, do no harm". This contradiction is apparent in the insurance company's everyday practices of enying or rescinding coverage, copays, deductibles and limiting patient access to specialists and expensive medicines/treatments. all of which by putting profits first endanger patients. No surprise then that there's also a contradiction between the for profit health care system and the raison d'etre of health care itself, namely, delivering the best possible health care to everyone. That's because these privatized systems skim off upwards of 30 percent of the premium dollar for profit and administrative costs, an amount large enough to provide health care for the 45 million uninsured Americans whose annual death rate (just from their uninsured status) is 0.1%,
I thought the vital point of making it possible for Americans to AFFORD coverage was a national plan. The subliminal term "socialist program" is appalling considering not ONE opponent has mentioned that we have MANY SOCIALIST programs that cater to the RICH.
I have a huge problem with the mandate being enacted without a public option. I have done my homework and read and watched to see if there was any REAL changes that actually benefit the middle class who now finds themselves with a -20 balance weekly and shuffling bills to meet that deficit! It scares me to think how a FORCED additional bill of even 100.00 a month would bankrupt even more families. Subsidies are a laugh~ if the argument that "we want government out of health care" is a threat wait till the mandate decides how much you can afford and over-rides what you have included in your budget. I honestly now question IF the public option was even a vision to begin with.
National Flood insurance is a huge "socialist" program that works pretty much in the same "flow" as health insurance. If we "accept" and permit it we should have 1000x more "incentive" to insure the health of all in this country. On top of the flood insurance I know MY state has "citizens insurance" which is funded by ALL taxpayers although most of the benefits and payments go to "oceanfront" properties. I'm thinking if you want to build on the ocean u would EXPECT to either lose your investment or PAY YOUR WAY to rebuild your home every 5-6 years~
http://www.ntu.org/news-and-issues/government-reform/ntu-testifies-on-the-national-flood-insurance.html
But the architect was right. If the ocean took my house, Uncle Sam would pay to replace it under the National Flood Insurance Program. Since private insurers weren't dumb enough to sell cheap insurance to people who built on the edges of oceans or rivers, Congress decided the government should step in and do it. So if the ocean are what I built, I could rebuild and rebuild again and again--there was no limit to the number of claims on the same property in the same location--up to a maximum of $250,000 per house per flood. And you taxpayers would pay for it.
Thanks.
I did have to pay insurance premiums, but they were dirt cheap--mine never exceeded a few hundred dollars a year.
Why does Uncle Sam offer me cheap insurance? "It saves federal dollars," replied James Lee Witt, head of the Federal Emergency Management Agency (FEMA), when I did a 20/20 report on this boondoggle. "If this insurance wasn't here," he said, "then people would be building in those areas anyway. Then it would cost the American taxpayers more [in relief funds] if a disaster hit."
That's government logic: Since we always mindlessly use taxpayer money to bail out every idiot who takes an expensive risk, let's get some money up front by selling them insurance first.
The insurance, of course, has encouraged more people to build on the edges of rivers and oceans. The National Flood Insurance Program is currently the biggest property insurance writer in the United States, putting taxpayers on the hook for more than $640 billion in property. Subsidized insurance goes to movie stars in Malibu, to rich people in Kennebunkport (where the Bush family has its vacation compound), to rich people in Hyannis (where the Kennedy family has its), and to all sorts of people like me who ought to be paying our own way.
When my crew was working on the 20/20 story on this indefensible insurance subsidy, producer David Sloan was shooting on the elegant Outer Banks of North Carolina. A man who saw our camera invited Sloan to videotape inside a luxurious beach mansion he was renting. Sloan accepted and was surprised to see, taped to the refrigerator, a picture of presidential hopeful (then House majority whip) Richard Gephardt.
"Why is his picture here?" Sloan asked.
"He's an owner of the house" answered the renter.
Aha, a surprise twist to our story: A Missouri congressman owns expensive beachfront property insured by taxpayers. We called Rep. Gephardt's office and asked to interview him about flood insurance. I was excited. He and I had something in common: We were both welfare queens. I thought he might say something like: "Yes, it's disgraceful--we shouldn't get special protection because we are rich enough to build on beaches. I'm trying to end this boondoggle." But when I interviewed him, he just smiled blandly and kept saying Congress would "look into the program"
Why subsidize affluent people like Gephardt and me? Why not let us sink or swim on our own? If my house erodes away, it should be my tough luck. FEMA chief Witt at least attempted an answer: "The American people are pretty compassionate toward their neighbors."
I don't know about you, but I'm moving to Thailand where top-quality health insurance costs $500 per year -- not per month, as it is in my country (USA). For real.
My good friend had a heart attack in the USA, and by day three, a Kaiser Permanente representative was in his hospital room, shouting at nurses and demanding that he be released from care immediately. Take the tubes out of his arms! Too expensive!
Actually, he had to wait for hours for the Kaiser doc to come on the scene, because other doctors were not covered by Kaiser. And, this is supposed to be one of the BEST insurers! Thrive indeed!
I think the health care "system" in the US is beyond repair. In Thailand, I can get some of the best health care in the world for a small fraction of US costs. If you are in need of medical care, but can't afford it in the US, I urge you to check out:
http://www.bumrungrad.com/
You can get cost estimates on procedures. Most of the docs are trained in the best schools in US:
http://www.bumrungrad.com/realcost/procedures.aspx
....
A recently-spotted bumper sticker:
"USA ... Where If You Stumble, You Die...."
Good bumper sticker. Hey, I would love to get to Canada for some dental work, but I can't afford the trip. I certainly couldn't afford to go to Thailand. I've never been able to afford a simple plane ticket to anywhere -- and I'll bet my fellow millions of other Americans who are uninsured have the same problem. Our country's got us by the balls. I often feel more like a hostage in these United States than a citizen. Anyway, I totally espouse the bumper sticker:(
I'm with you on Thailand and I was there to witness their caring for the patients at one point during the trip. In fact, just about any Far East nation has good universal health care, even India and China, while the US is a lost soul to provide for one.
I've noticed in internet/telecom how the USA's bizarre industrial policies increasingly degrade the value of infrastructure/services.
For example, I just had an opportunity to select mirror sites for download of software packages. Normally we select a mirror site as close as possible to minimize network loads. But here in the "good ol USA" all of the mirror sites failed. I had to select a mirror in Switzerland.
As another example, I've noticed over the past few years, the audio quality of the telephone exchanges has significantly to severely degraded. I often have to call people back to try to get a noise-free line.
It used to be a lot better. I think ma bell was a public monopoly wasn't it?
And that is just the landlines. I don't often communicate with people who are on cell phones, but when I do, it can be really bad. A friend likes to use a bluetooth with cellphone - it is the absolute worst. Creating a massive load of garbage noise sounding like the person is taking a handsaw to the walls and fixtures. I wasn't the least bit surprised.
Today was the first call I made using internet telephony. I could have predicted it: Garbled echoed voice I could barely understand. This from the network of the "most spectacular corporation in the galaxy - Google". I was connected via Ekiga, an open source program.
None of these are technical issues. Rather they are political issues. The "invisible hand" of the free market, and the affect of the bizarre political messages, from the extreme right gutter, on the attitudes/behavior of the builders/maintainers of the telecom infrastructure.
It's similar issue in all sectors, in the "Good ol USA".
Quality of Internet telephony is totally dependent on your upload speed.
Typically, you need 1mbps for good clarity. Try Skype.
It's the bandwidth, not the software. And get a good headset.
What nobody in the US health insurance debate seems to understand is that Medicare for all, starting tomorrow, will cost far less than the national wealth created by healthy citizens who are not driven into poverty by illness or paying the health insurance chief executives 4 - 12 thousand dollars per hour. I have no problem with success, but, really, $12,000/hr ? What does that mean ?
I'm skipping earlier comments to write this while I still can...
A truly brilliant article but one detects a peculiar prejudice against the elderly, to wit:
"(Don't talk to me about a government takeover of health care when the biggest fort you're defending is Medicare.)"
Also:
"I'd be all for reforming the system by building on what works. We know what does. Build on Medicare, goddess of 45 million Americans. That works."
Frankly, in my experience Medicare does not work all that well, and I don't hear so many people defending it as it exists, but instead keep referring to it as a model for a solution to what ails, WHICH, IN THEORY, IT IS.
Try living on a small Social Security payment, from which a Medicare premium is deducted monthly. Medicare does not cover dental, which becomes increasingly a problem as one ages. Then there is the deductible for doctor visits (which I have yet to experience). Then there are the complexities of Part Duh, in which I refuse to participate and the existence of which proves that AARP sold out its original constitutency. Why am I receiving JUNK MAIL from AARP and Humana and Capital One urging me to sign up for their plans when the only prescription drugs I have taken in the past several decades are for antibiotics for dental infections they do not cover? How'd they get my address, anyway?
Under Medicare if I end up with a nasty tooth, I may need a pair of pliers to extract it while staring at the bathroom mirror with a 5th of brandy handy.
Medicare started out as one of the Great Society programs from LBJ in the tradition of FDR, while it has been whittled down and its Trust Fund raided over the decades.
If Tristam thinks Medicare is some program that enables the currently elderly to access health care that the elderly now seek to deny to any later generations, he is wrong.
We are terrified for our children and grandchildren.
Otherwise, truly an incisive article on the so-called "health care debate" inside the Beltway. Tristam needs to get out on the streets and interview his neighbors and do some "anecdotal journalism."
Medicare is no panacea. It is the outline of the best possible plan. Beware of the Frist's of the world (Part Duh). Behind all the Media gibberish there really is a sense of terror in this country and it is NOT from the so-called "terrorists." It is from the inchoate sense of having no secure expectation as to what is going to slap us upside the head next.
That is a failure of government in its most essential form. Who seeks this failure? Who wants it? I don't.
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As one who actually has pulled his own teeth ( twice) I sympathize with your experience, but must add a proviso.
Medicare is certainly not abuse free, nor is it optimized. But that is the fault of the Insurance Industry which controls legislation on health care. With a Congress free of the influence of profit seeking executives with large checkbooks Medicare can be optimized easily and made available to all.
Medicare could be more properly funded and expanded on a fraction of the money poured into private insurance grifting.
Then there's the cost of all those bases and bombs, but that will be another fight.
It is estimated that up to 8 million uneeded surgeries a year are performed in the USA. These include Coronary bypass surgery, Caesarean sections and hysteroctomies. (Source Gary Null in death by Medicine)
A case in the USA had one doctor bill medicare for some 47 million in uneeded surgeries.
While getting Insurance companies out of the "Business" of health care is a start what MUST happen is that "Business" has to be taken out of Health Care as well.
The for profit motive in a Single payer system will NOT stop unless Profit taken out of the Industry itself.
Single Payer and No Profit health care go hand in glove.
Hear hear. Scrap the bill. Scrap the companies: those who are healthy, scrap your policies and starve the lobby.
Scrap it and start over.
I've read the threads.
It would appear that there is general agreement. Less on what has happened and more on what must be done.
S I N G L E P A Y E R !
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