Politics Obamacare

Yeah, nice argument up there, saying that if things aren't done your way, everyone who disagrees with you is an immoral gh0ul who wants you to die and, for all I know, kicks puppies, too.

Try this on for size, Pan: for 85% of the country, the current system gives them pretty good coverage and care and most of them are satisfied. Congress and our esteemed president COULD have tried to fix things for the 15% (assuming the 15% want it fixed -- most don't), but that wasn't good enough. No, they had to start issuing orders to 100% of the market. So, what this means is that I and my family (including my autistic son with a seizure disorder and various anaphylaxes) will have our health care fucked with so that you can get what you want. SO FUCK YOU, PAN. MY HEALTH IS NOT FOR SALE TO POLITICIANS WHO WANT TO GIVE GOODIES OUT TO GET REELECTECD, AND I DON'T CARE IF IT'S YOU GETTING THE GOODIES. Understand? You want health care and can't afford it? Go on fucking Medicaid. Don't fuck with my health care so that you can have what you want.

 

what odd reasoning--and arbitrary numbers. why the rest of the industrialized world must be made up of a bunch of ineffectual panty-wastes, or perhaps they simply do not have the same degree of focused self-interest that a Righteous American might who conflates "freedom" with i have mine so fuck you and die.

the problem, really, is that the ethical arguments for a form of universal health care have not been made. had they been made, there would have been little space for this kind of fuck-you-i-got-mine approach. face is that under the present form of privatized medical barbarism, the lives and well-being of the children of the affluent are worth more than the lives and well-being of the children of the less affluent. the lives of the children of those with full-time jobs are worth more than the lives of the children of those affected by neo-liberal "flexibility"...on and on.

at the same time, i have a close friend who was forced to quit a full time job because her particular disorders were not covered under the miracle of private health insurance but they were under mass health to the point where she was losing money keeping the job. such were the rigors of the treatment and the condition is such that it will never end. so the idea that private health care is hunky dory and a universal option a Problem is anecdotal. the kind of thing that can always have another anecdote balanced against it to equal zero.

that said, i am not at all convinced that the present health care plan is adequate. it's a step in a good direction, but not only are the ethical questions not front-and-center as they should be, but also the notion that people seem to have of both what is entailed by this plan and what better alternatives might look like are lacking. if you want to look at a health care system that delivers care better than the us without any compromise of research etc., look at france. but it is still the case that anglo-chauvinism combined with insurance company infotainment obscures.

a shame because this is a fundamental debate. and it's happening, still, at a bullshit infotainment american-capitalist know nothing level.

 

RB, your premise is wrong. We don't have a private system of health care now, and havent in decades. We have a semi-socialized system. Govt at all levels accounts for something on the order of 50% of health care expenditures. Is it any wonder the system is creaky at best and heartless at worst? The incentives are all screwed up.
--- merged: Mar 29, 2012 at 11:56 AM ---
And I'm sorry for losing it up there, but getting lectured about heartlessness by people who have no clue about my life gets me really steamed.

 

loquitor--it happens to everyone sooner or later. i'm aware of the overall nature of the us health care system. in these little boxes, one makes simplifications for argument's sake---the premise of my position is does not rest on a comprehensive description of the current debacle of a system (which you do not provide either)--my position is that there are models that are far better than the series of defaults we live under here. and that the french system---which is a mixed system of universal access to basic health care and a system of private insurance (which is mandatory) atop that---but the costs for that insurance are on a sliding scale. so for folk who need it, comprehensive health care is free. there are a LOT of advantages to the french system in that respect...there are some problems, but nothing like you hear from the uk model context---the only advantage of which is that most of the information is in english. the other premise i am working from here is that the entire argument for health care change has been either badly made or made on the wrong basis....

 

well, RB, what works for the French may work because they're French and they have a different culture and history. I'm not saying we shouldn't look at what works elsewhere, but Americans tend to be an ornery lot and that argues in favor of the least intrusive system possible.

 

How would a strictly private system be better? I suspect that the cold hard efficiencies of the free market wouldn't be a boon to the health of the average person. Given the extreme amount of complication and specialization that goes into generating and providing healthcare, the only way a "private" system could function would be for the government step in to ensure a level playing field.

 

We should ban most third-party payments other than for catastrophic events. That'll solve things pretty quickly. The only people who will suffer are the legions of drones at the insurance companies and the regulators who deal with them. Sorry but that doesnt' break my heart.

 

What do you mean by third party payments?

 

Third party payment = bill gets paid by someone other than the patient.

 

The result would be significant cost increases for tens of millions of Americans. In my own case, as I explained above, approximately a $20,000 annual increase in out of pocket costs to me and I am not alone in these circumstances.

Catastrophic does not cover chronic conditions or cancer treatments (cancer is not considered catastrophic) or maternity costs (average of $9,000 with no complications). I could go on.

 

The result would be HUGE cost decreases. Remember, if you take insurance out of the equation, you're not paying for insurance for regular care and you get to keep that money. You then control what you're willing to spend and what you're willing to spend on. People are always more careful with their own money than with other people's money. Do you have any idea how expensive insurance is relative to the normal person's health care spending needs?

Chronic conditions are pretty much the only thing that this wouldnt' solve, and even those you'd probably force prices down if people had to pay at least the first X dollars. There could be prepaid plans and other such things ,but the important thing is that the patient has to pay his own money for medical care rather than someone else. Depending how you define catastrophic (you can do it by frequency of incidence or by size of expenditure - either meausre can be used), pregnancy might be covered, but I would guess even if you define it by frequency, which would exclude pregnancy, price will in any event come down by quite a bit, and many normal pregnancies may well end up being done by doulas and midwives, which in most cases is all that's really needed, with docs on standby. If you let the private market work you'll see a lot of changes in how people think about their medical care and what services need to be in hospitals (and special health care savings accounts). Of course, if someone else is paying, why should you care? You'll always want top of the line because someone else is paying the bill. And that's the problem.

 

Not just chronic conditions. The families of every person undergoing cancer treatment goes bankrupt while watching a loved one die.

Your numbers are way off base. A private market has a profit motive and is highly risk averse.

 

Cancer is catastrophic, isn't it? That's exactly the kind of condition that insurance should be for -- a thing that strikes out of the blue with big impact. I'm not proposing anyone be 100% on the hook for cancer treatment.

 

Most catastrophic coverage that I have seen excludes cancer (or stroke or...) They are "unforeseen accident" and relatively short-term "hospitalization" policies (and no after-care).

I suspect a catastrophic policy with cancer coverage would have obscenely high premiums and deductibles.

 

again, this is framed in a bizarre-o way, and because it's framed in a bizarre-o way the speculative incentives/outcomes seem arbitrary, when you compare them to actually existing systems in the actually existing world. for example, universal access to basic health care in france creates a system imperative to streamline usage--which results, in part, in a far more proactive system in terms of, say, nutrition and/or making available a range of remedies for routine problems via pharmacies--and everyone seemingly understands that this is an aspect of an approach to health care that makes for better basic care for everyone. the main differences lay in how doctors are educated (a totally different approach to university education, one which **really** should be looked at by the fading american educational system, gutted in significant measure by the same neo-liberal nonsense that's fucked up so much else about the united states) and compensated (they're functionaries)...with no significant compromise of levels of training or levels of care---both of which routinely outperform the american system. my sense is that it is the changes in the social position of doctors and medical schools as much as it is the threat rational health care delivery poses to the obscenity that is a for-profit insurance industry that explains why people "can't get their heads around" a more rational health-care system. lots of money is going into preventing just that. and in american capitalism, all you need to be a "legitimate" information source is the capital to buy air time and other forms of infotainment product placement.

 

If you get rid of this crazy regulation we have now, policies that cover cancer above $X per year would certainly be available (there is no reason a market niche won't be served if it's out there and isn't pressed on by the govt). Just because something is a certain way today doesn't mean it will always be that way forevermore. Markets are dynamic. I live in NY where those policies are not available - policies have to cover everything because the politicians got lobbied to require all health insurance coverage to cover every conceivable service that the service providers could lobby for: chiropractic, hypnosis, acupuncture, you name it. I have no ability to choose which coverages I want and am willing to pay for.

 

If you privatize Medicare, as the Republicans propose, what "market niche" would willingly take on the highest risk and highest utilizing consumers at affordable rates?

There is no profit for the private sector in serving the elderly.

 

Sounds like you'd be essentially putting everyone on an infinite-deductible plan where insurance only kicked in when a person suffered some condition that met some arbitrary definition of "catastrophic".