if you believe that the problem of the uninsured is about people not having something called insurance rather than people being unable to obtain medical care

If I thought Ponnuru was making an argument in good faith, I’d see this as a standard-issue map/territory confusion.  But as you note,

This is suspiciously like a massive governmental subsidy of insurance companies, and not a healthcare plan at all!  What a curious mystery this all is!

he’s probably not arguing in good faith, which means he’s relying on his readers either being in on the con or being susceptible to the map/territory confusion.

It’s really no different from saying “well, you can go to the ER if you’re not insured, so there. Nothing to see, move on.”  The payoff, Jesse, is that it allows Republicans to pretend that there’s no problem, and that anyone who complains from then on is just an evil socialist who wants to turn the US into Canada or Britain or—horreur!—France.

which means that you’re going to have $75 a month protection against your second gallbladder exploding in a bricklaying accident.

But only after spending three weeks on the phone with the insurance company, then sending a notarized brick.

After steadfastly proving that universal health care is undesirable because of conjecture and bad logic

Sentences like this are why I read this blog :D

But only after spending three weeks on the phone with the insurance company, then sending a notarized brick.

“Our adjusters have determined this to be a ‘paver,’ not a ‘brick.’”

It makes sense if you think of health care for humans as being like insurance for your car.  If you have a car, you’re responsible for all of the maintenance (changing the oil, checking the tires, etc.) and the insurance only kicks in if there’s actual physical damage of some kind.

The problem is trying to graft that model onto human beings, who can’t be kept healthy just by changing their oil every 5,000 miles.  Not to mention that if your car is damaged beyond repair, the insurance company can declare it totaled and pay you out a sum of money.  What does Ponnoru picture happening if, say, you’re diagnosed with terminal cancer—the insurance company gives you a cash payment towards a new body since your current body is now “totaled”?

This is suspiciously like a massive governmental subsidy of insurance companies, and not a healthcare plan at all!  What a curious mystery this all is!

Are we surprised at all that when faced with the probability that something will happen to healthcare, these assholes want to find a way to make the rich richer by forcing the rest of us to give them money?

Insurance is the problem.  It needlessly sucks money out of the system, and people who have good insurance don’t understand b/c it seems to “work” for them.

It doesn’t work.  Insurance companies operate and profit from removing money from the system.  It no longer goes toward medication or services, but to red tape.  It’s now gotten so bad that it sucks so much money out of the system that people are dying in this, the best country in the world, that wouldn’t die in lesser 1st world nations.

At the same time, state mandates that require insurers to cover certain conditions, which make it expensive to offer individual policies, could be removed.

Yeah, certain conditions. Like, you know, the expensive ones.

Insurance is the problem.  It needlessly sucks money out of the system, and people who have good insurance don’t understand b/c it seems to “work” for them.

Jesus jumping fuck, yes.  >.<  I remember hearing someone on the radio the other day complaining that a ‘public option’ was going to be all unfair because for-profit insurance companies wouldn’t be able to compete with it.

Why is that a bad thing?  Where in our Constitution does it say that insurance companies are guaranteed a profit, or even a market at all?

‘course, I’m a godless commie pinko faggot-ass dyke, so what the fuck do I know about markets?

Insurance companies operate and profit from removing money from the system.  It no longer goes toward medication or services, but to red tape.

No.  Or at least, not really.  The insurance companies want you to think that the money is being sucked up by red tape, but that’s not the case at all.  Giving you the runaround on the phone and making you fill out various forms of paperwork and giving your doctor’s office the runaround on the phone to delay payment costs them very little other than the time of the customer service people involved in saying “did you submit form QZ-A97 on the blue form?  Oh, we need in the goldenrod.  Please refile it.”  That’s pretty cheap.

No.  Where the money is going is into their flawed business model that has eaten up everything and forced us to bear the costs.  Here’s how the business model works (spot the flaw):

* Take money from companies to supply health insurance to their employees
* Invest money in various places - stock market, real estate, etc.  Keep a cash reserve on hand for payouts
* Take return on investments and use some to replenish cash reserve, pay salaries, and pay dividend to shareholders
* Repeat into infinity.

See the flaw?  There’s an assumption that step 2 (or as we like to call it in the business “Collect Underpants”) will inevitably lead to a positive income stream that can be used to pay the actual cost of doing business and leave a tidy profit afterwards.

But three things lead to this being EPIC FAIL for insurance companies.  The first is the fact that CEO and upper level executive salaries have been growing out of control for the last couple of decades.  Because of that, insurance companies have to use ever growing portions of their investment returns to pay over-priced executives (the idea of paying them less of course never comes up - how could you hope to compete if your competitor is always snatching your best talent away?  See every argument for salary caps in sports ever made and wonder why no shareholders seriously discuss salary caps for high level executives in this country with the same passion that they want to slap them onto baseball players.)

The second is that shareholders have been demanding larger and larger returns on investment for the last 30+ years and companies that don’t put out those returns don’t get investment dollars.  This not only leads to downsizing the company into a shell of its former self (cutting people makes it look like you’re increasing profits) but also requires more and more of that investment return be given out to shareholders.

This is all fine and dandy until we get to the third major flaw - investments are not guaranteed to always be positive.  Very often, markets will contract and you will lose money.  And of course most insurance companies invest heavily in “safe” investments like real estate which never decreases in value - or so I’m told. 

So having a market where not only has the stock market crashed, and various foreign currencies that companies were dabbling in have crashed, but even their “safe” real estate investments have crashed combined with the short term pillaging of the investment returns by high-level execs and shareholders have pretty much destroyed the ability of most insurance companies to actually, you know, provide a good service. 

So of course they raise rates and premiums and lower payouts to doctors and blame it on things like malpractice insurance and demand tort reform, but that’s all smokescreen.  It’s all about the fact that in down markets, insurance companies are bloody awful.  And when markets turn good, they pillage themselves and remain bloody awful.  The insurance model for health care is completely broken because our capitalist model can’t handle it - it would require less juvenile executives and shareholders to make it work, and IME that’s just not going to happen.

What does Ponnoru picture happening if, say, you’re diagnosed with terminal cancer—the insurance company gives you a cash payment towards a new body since your current body is now “totaled”?

That’s what life insurance is for, and perhaps your surviving family won’t be so reckless or genetically indisposed next time.

And I’ll bet good money that Ramesh is signed up to a group plan at National Review, and has never had to price out an individual policy, let alone buy one.

Awesome graphic.

See every argument for salary caps in sports ever made and wonder why no shareholders seriously discuss salary caps for high level executives in this country with the same passion that they want to slap them onto baseball players.

Surely it couldn’t be because many professional athletes are brown people (and in baseball specifically, many are Spanish-speaking brown people) who have the temerity to trade their health for a shot at lots of money and TV time?

Nah, couldn’t be.

Jesus this is a whole bag of stupid.  And looks very much like the ridiculous proposal made by John McCain last fall during the campaign.

Here’s what pisses me off.  The progressives in selling universal healthcare realized that an ancillary benefit would be that it would help reduce overhead for employers by removing their costs for insuring their employees.

Idiots like this guy said… “hey, that sounds great!  Let’s get those healthcare costs off the back of employers!”

And so this is what they come up with.  For folks fortunate enough to have decent employer paid healthcare coverage, you know that anything you try to get in the private sector isn’t gonna stack up favorably, and is gonna cost you a whole bunch more.

So this douche says… easy solution - lets make that catastrophic private insurance even more worthless than it already is, and only require them to cover only the most absurdly catastrophic events which are likely never going to happen to 99% of the people with the policy.  And it will be cheaper!!!  Yay!!!!

Wow.  Conjecture and bad logic indeed.  There are so many assumptions and precious few details on how this new and improved system would work…but then, this isn’t supposed to be an actual solution, it’s just supposed to sound like one.

I love how he thinks that Obama becoming the Democratic nominee was a referendum on Clinton’s healthcare proposals.  Because really, there was NO DIFFERENCE between them otherwise. Putz.

Better yet, we could just round up all of the uninsured and keep them in huge feedlots until we need to harvest their organs to benefit those with insurance.  Pretty soon, not only will everyone have insurance, but we’ll also take care of the shortage of organ donations!  It’s a win-win.

Ramesh Ponnoru has proposed a solution to the problem of the uninsured

Darn near a final solution to the problem of the uninsured . . .

That’s what life insurance is for, and perhaps your surviving family won’t be so reckless or genetically indisposed next time.

ROFL.  That’s exactly right!  And if the Repubs were arguing in good faith, it would even be an appropriate point (though they wouldn’t understand why).

Republicans who keep saying “the free market will keep health care costs down due to competition” don’t realize that that won’t work because good health care is a scarce commodity, if you treat it as a commodity.  Also, they don’t think about the consequences along the way to establishing that equilibrium, i.e. people who need healthcare having to do without because it is too expensive.  The free market will work with apples because you’re not going to die without apples and you can postpone your decision until the price comes down.  You will die without healthcare and you can’t wait for the price to come down if you’re having a heart attack, so in fact critical care costs will go UP in a free market because the demand is absolute and they can charge more.

This is the part that people like Ramesh just don’t understand.  When they say things like:

state mandates that require insurers to cover certain conditions, which make it expensive to offer individual policies, could be removed.

they don’t understand that those “certain conditions” are exactly what insurance is FOR.  Why the hell would I need insurance if I knew I wasn’t going to get one of those “certain conditions?”  Insurance is for more than just reducing the cost of an office visit to a $35 co-pay when you go once a year for a checkup, which I’d bet is all Ramesh ever has to do.  It’s also for those once in a decade catastrophes that spring on you unbidden, and for those chronic conditions for which treatment is available but expensive.  They then say “well just get catastrophic event insurance then” but that kind of insurance is way expensive; paying a gazillion dollars in premiums for a policy that you probably won’t ever need just to cover the one in a million chance that you might in fact need it is an incredibly inefficient allocation of resources.

They need to get over this idea that health care is a privilege and not a human right.  A civilized society takes care of its citizens’ needs.  Rugged individualism had its day; we’re beyond that now.  Now it’s the time of all for one and one for all.  Socialism?  You bet!  And it’s a GOOD thing, not a bad thing.

Salary caps in professional sports are on TEAMS, not players.  Important distinction.

Instead, this is a system which would ensure that virtually everyone except the super-wealthy found themselves covered by high-deductible catastrophic insurance which would be useless in the 95% of cases in which one would normally use insurance, meaning that healthcare would get drastically more expensive.

True, but his clueless & disingenuous proposal sounds more palatable than just saying that poor people are losers whom God disfavors so much he had them born into the wrong class.

This is suspiciously like a massive governmental subsidy of insurance companies, and not a healthcare plan at all!  What a curious mystery this all is!

Think of the <strike>shareholders</strike> Children!

“Darn near a final solution to the problem of the uninsured . . .”

...as long as the Overclass squeezes everything they can get out of you first, who cares if your now empty and soulless body lives a while longer or not.  Well, I guess your friends and relatives do, but who are they?  And aren’t they up to (and over) their necks being squeezed too?...

Quite simply, if the average person actually paid for their own damn health care instead of buying cost insulation, then average health care costs would go down, not up. The current system is so bad that it would be difficult to make it worse if you tried! Heck, things would probably improve if you simply banned private health insurance and did nothing to replace it.

I agree with you, although I think the system is too phenomenally borked for the idea to work.  But, as my mom says, “Insurance has screwed up everything.”

I look at what we’ve paid for veterinary bills.  (At this point insurance hasn’t fully infiltrated veterinary medicine, but they are trying hard to get their share of the pie in that field.)  About five years ago, on a bad year, we paid about $2500 in vet bills.  That included an overnight stay for the dog, and a week long hospitalization for my horse.  It included surgery and meds for the dog. It included various tests (ultrasound) and IV for the horse, who was dying.  (He recovered and his neighing for his dinner right now.)

The thing is, that $2500 is still less than the average family pays for medical insurance premiums per year.  $2500 which covered hospitalization and expensive procedures.

As I noted above, the insurance industry is trying to get their mitts on veterinary medicine, with adverts in pet magazines and even at vets’ offices.  But at this point, pet insurance is primarily for catastrophic care and regular stuff, even surgery, is manageable for a middle class family.

But not-so medical insurance, and certainly not medical care.

“Quite simply, if the average person actually paid for their own damn health care instead of buying cost insulation, then average health care costs would go down, not up.”

In an overall sense, eliminating the Insurance Co’s and all the complex billing and negotiation and bureaucracy they require would definitely reduce medical costs.

The problem is individuals get sick, not the group.  And when individuals get sick, the cost to “repair” them could be anything from $50 to $50,000+.  If you were always required to cover the full cost of your own medical care, very few Americans would be able to handle the costs of anything more than getting an antibiotic or setting a broken arm.

I’m sure from a Randian/Objectivist/Libertarian POV, that’s perfectly okay.  I’m not sure anyone else would concur.

I’ve worked in and around IT in the medical field for 20-years.  I’m pretty confident that we already spend way more than enough to cover every American and give them the best care in the world.  Our problem is what we spend now gets thrown away on the most ridiculous things (like going to the ER because you have no other way to get treated, and of course the Insurance leeches).  With the Insurance Co’s gone and a system in place to ensure the care is available to all, without bankrupting the hospitals or the doctors, but also without bankrupting the individual, healthcare could become much less of an overriding concern than it is now.

“The current system is so bad that it would be difficult to make it worse if you tried!”

The only thing that would be worse than the current system is having no system at all…

“Heck, things would probably improve if you simply banned private health insurance and did nothing to replace it.”

Again, without something like a Canada-style or French-style universal healthcare system in place, eliminating what little we have would be a disaster.

I’m not defending the Insurance Co’s by any means, but I want to make sure we get a replacement system up and running before we shut them all down…

High deductible plans tend to make people living close to the margins (i.e., most of us) think twice before going to the doctor for routine “sick” (as opposed to preventative) care.  I’m sure this makes economists who worry about “moral hazard” extremely happy.  Unfortunately, especially with kids, routine illnesses can turn into serious health problems if left untreated.  Generally speaking, people should be erring on the side of caution when it comes to seeing a doctor, something they won’t do if they have to pay full costs out of pocket.  No one should have to decide between paying the rent and taking their kid to see a doctor for that lingering cough that may or may not be pneumonia.

Of course health care costs less if you just effing let people die. RAND did the studies. People who have to pay more directly for their care end up avoiding or postponing necessary care and not filling prescriptions for lifesaving medicines.

Among other reasons, because that’s the only cost-containment mechanism most of them have available. When you get sick, the choice isn’t “OK, let me do some research in this perfectly transparent field and find the optimal combination of doctor/hospital with open appointments/beds and expertise in what I think I might have, crossreferenced versus distance, average patient outcome and fee structure, and then make a call”. It’s go to the doctor or the hospital (the one you already know or the one the EMTs take you) and consent to the care they tell you you need. Or grit your teeth and stay home.

To run the analogy with veterinary care, we could indeed keep costs for humans lower if every sick person were accompanied by a decisionmaker who was not in debilitating pain or fear, and who was perfectly willing to let the patient suffer or die if the expenses seemed too far out of line.

At any rate, it’s not like the CBA-mandated minimum salary is going to leave anyone scraping the top of the poverty line, so there’s really no way to rustle up much sympathy for the poor, exploited professional athlete based purely on raw dollar amounts, regardless of race or national origin.

Good point… the lowest paid player in Major League Baseball still takes home a paycheck of $400,000 per year, making him richer than more than 99% of the rest of the country.  And those are the players that most people have never even heard of except the most diehard fans of their particular teams.

That said, I do think race could be a factor for otherwise staunch free-market types who don’t want anyone messing with anyone’s paycheck other than pro athletes.  I fully support capping pay in the pro sports leagues.  And the banking leagues.  And the manufacturing leagues.  And the insurance leagues.  The racism occurs among those who staunchly support it in the pro sports industry but not any other industry.

It is true that I am not well-versed in the arcana of salary caps in American professional sports leagues.  On the other hand, it is also true that I have heard many people complain about how much top-level professional athletes make in explicitly racialized terms.  Different subject, perhaps, but it seemed related.

Why is it legal to sell a kidney for zero dollars, but not for fifty thousand dollars?

Because I don’t have an incentive to mug you and sell your kidney for $50,000…

Doug, correct me if I’m wrong, but the study you cite seems to prove that if you give two groups of people access to the same healthcare, but one has copays and one doesn’t, the results will be largely the same because they’re receiving the same care.

The point of the study is whether or not reducing the cost to the insured results in better health outcomes (and the cost to the insured is the only variable), which has virtually nothing to do with whether or not extending comprehensive health care to all Americans will result in better health outcomes.  Your conclusion about catastrophic health insurance is irrelevant, because the study had nothing to do with it.

“Why is it legal to sell a kidney for zero dollars, but not for fifty thousand dollars?”

Yeah!  I feel the same way about arms, legs, eyes, and children.  If you have a spare one or two, why shouldn’t you be able to sell them for a nice profit?  Some of these rules society forces on us are just so arbitrary…

Why is it legal to sell a kidney for zero dollars, but not for fifty thousand dollars?

For the same reason that it’s legal to have sex with you for zero dollars but not for fifty thousand dollars.

When you treat intimate exchanges (sex and kidneys) as items with a cash value, you inherently create a situation where the rich can prey on the poor for those intimate items and the poor have, collectively, no say in being disenfranchised because, realistically, you’re going to take the money to be violated against your desire rather than, you know, starve to death.

The system rewards the rich for keeping the poor underfoot. Because if Richie Rich gives to charity, that’s fewer people for him to organ harvest when the time comes.

If all hospitals, doctors, and charities stopped helping the uninsured, the problem would fix itself pretty fast.  Of course, it would be a little harder for rich people to find someone to mow their lawn and serve their food if they’re all dead.  So, we need to provide enough care to stop them from dying during their workable years, but not enough to let them be healthy and have a good quality of life.

Incidentally, I think it’s absolutely outrageous that people aren’t allowed to sell their kidneys. Many people who have an extra kidney are in desperate need of money, and many people with money are in desperate need of a new kidney.

This is a complex issue.  First of all, it allows the people who can afford kidneys a better chance at getting one than the poorer people.  If people can sell their kidneys, they may be less likely to donate them, making it even harder for the poor to get one.  However, there would likely be more available kidneys overall.  I don’t know if it’s a good reason to ban kidney selling because it might make it less fair for the people who need them, even it might mean more lives saved overall.  And of course, both the situations of fewer kidneys for the poor and more kidneys overall are only possibilities, so it could work out that there are no extra kidneys, but still an unfair advantage for the rich (worst case scenario).  Or it could work out that there are more kidneys overall, but still the same amount donated and available to poorer people, and more available to the rich people who buy them (best case scenario).

The other issue is that selling of organs can encourage people to risk their health for money.  One reason that it is illegal to pay for donated blood is because some homeless people used to donate too often and it would negatively affect their health.  Similarly, kidney donation is relatively safe, but has risks like any surgery.  People who are not healthy enough to go through that but are desperate for money might be tempted to lie about health conditions.

On the other hand, people can already sell eggs and sperm for money, although that has much less of a health risk than giving a kidney or even blood in most cases.  Also, I’m pretty sure that women who act as surrogate mothers are paid for it, and pregnancy is more risky than kidney donation, but usually the woman still has use of her uterus after the birth, so it’s more like organ-renting, rather than organ-selling.

It’s a complex issue and I don’t even know which side I’m on.

Why should a poor person be allowed to sell their organs when we can work out a system to take them without their consent?  I’m sure the prices would be better, and the market wouldn’t be limited to things we have two of…

MikeEss, my solution to the organ donation situation is to make organ donation the “default” and let people opt out by filling out those little “organ donor” cards you get at the DMV. (Of course, it would be NON-organ donor cards, in that case.)

A LOT of people I know are totally ok with organ donating, but they can’t be ‘bothered’ to go fill out a card. It’s annoying. If organ donation was the norm, not the exception, they certainly wouldn’t ‘bother’ to go fill out an exemption card, as they’d be totally ok with it AND they didn’t have to, you know, DO anything.

I’m pretty sure that the “I am cool to donate but I don’t want to think about it beforehand” crowd could easily make up for many of the shortages we see.

The other issue is that selling of organs can encourage people to risk their health for money.  One reason that it is illegal to pay for donated blood is because some homeless people used to donate too often and it would negatively affect their health.  Similarly, kidney donation is relatively safe, but has risks like any surgery.  People who are not healthy enough to go through that but are desperate for money might be tempted to lie about health conditions.

Or, you know, you could have a bunch of kids and “encourage” them to sell their organs. That wouldn’t be a problem at all…...I’m sure no parent would do that without considering the child’s best interest.

Or, also, if Aunt Edna is getting to be up there in years and we can’t afford the mortgage this month, we could encourage her to start selling stuff. I mean, she’s going to die soon anyway and it’s not like we haven’t taken care of her faithfully all these years, and she really doesn’t NEED that kidney…....

“MikeEss, my solution to the organ donation situation is to make organ donation the “default” and let people opt out by filling out those little “organ donor” cards you get at the DMV.”

That sounds like a good solution. 

I carried an organ donor card for years, and then found out from people who work in ERs (I worked in a hospital for many years and have many friends and relatives in the field) that they don’t even look for them, so having one when you are incapacitated and terminal doesn’t help.  They still have to bring your family,etc., in to make these decisions on your behalf.

This was about 10-15 years ago, so maybe things have gotten better…

A LOT of people I know are totally ok with organ donating, but they can’t be ‘bothered’ to go fill out a card.

I am an organ donor, but I never had to fill out anything.  When I got my driver’s licenses, the clerk asked if I wanted to be an organ donor, I said yes, and he put a little symbol on my license.  I wasn’t even aware that some states make people fill out a card.  I have no idea about the statistics, but I wonder if verbally asking people when they renew their license encourages more people to become organ donors.

They need to get over this idea that health care is a privilege and not a human right.  A civilized society takes care of its citizens’ needs.

liberalrob

I assume you mean everyone has a right to received adequate health without regard to economic circumstances, even for non-emergent conditions.  (One would need to beware of that word “adequate”, but I’ll leave that aside for now.)  Outside of unstable emergency patients or laboring mothers-to-be presenting to a hospital (who must be treated until stabilized under EMTALA as I understand) it’s safe to say we are not at that status.

How does a society go from a privilege to a right on an issue such as adequate health care?  Legislative majority?  Constitutional Amendment?  Court decision?

This thread’s probably dead by now, but in answer to MiddleageLiberal:

I’ve wondered for a while if something really drastic is needed to break the legislative logjam that prevents anything more than the most milquetoasty legislation from being passed, universal healthcare being an important example of what has little chance under current conditions.

When it was obvious the first constitution of the United States, the Articles of Confederation, had serious problems, the states set up a Constitutional Convention whose purpose was to fix certain problems in the Articles of Confederation.  But that’s not what happened.

Wikipedia quote: “At what came to be known as the Annapolis Convention, the few state delegates in attendance endorsed a motion that called for all states to meet in Philadelphia in May, 1787 to discuss ways to improve the Articles of Confederation in a “Grand Convention.” Although the states’ representatives to the Constitutional Convention in Philadelphia were only authorized to amend the Articles, the representatives held secret, closed-door sessions and wrote a new constitution.”

Many Americans don’t know, or are only vaguely aware that America’s first constitution was a failure, because it gave almost all power to the states (which many libertarian and federalist types still clamor for today), which was a disaster.

It was only because the Founders drastically exceeded their mandate and trashed the existing constitution that we got what we needed as a nation.  I wonder if something similar is needed now.

Of course, the first problem is how you would prevent a process like that from eliminating the Bill of Rights and imposing a military or corporate dictatorship, or something equally evil…