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Perhaps if MDs still took these as payment, like they did when the questioner’s mother was young, we wouldn’t be having this disagreement
The arguments against public health care fall into one of two camps: Lies and obfuscations.
The latter is on display here:
A woman in the audience told Obama about how her 105-year-old mother had a pacemaker installed, against some of her doctors’ advice, at age 100. It had improved her life significantly. Would the president’s healthcare plan ask doctors to take into account qualities in patients like love of life, she wanted to know—qualities that helped convince her mother’s doctors to try the pacemaker despite their reservations about her age?
Obama, as most of us have heard, blew the question. But here’s the thing: It doesn’t matter that he blew the question, because it is, on several different levels and for several different reasons, a nearly meaningless question.
First of all, the woman’s mother is on Medicare. This is so nearly certain, it’s almost not worth arguing over, but on the off chance she’s not, I’ll point to the fact that if she’s relying on her or her husband’s contracted pension health care, she’s among the last generations who will be able to count on that, as corporations look for every opportunity they can find to weasel out of such agreements. So government-run health care already paid for one such operation; why should we especially fear that a new public option would be significantly more restrictive?
Second of all, you know who’s terrible - CRIMINALLY TERRIBLE - at taking into account qualities in patients like love of life? HMOs. Some jackass in New Hampshire trying to hit a bottom line, fearful of the next stock-price dip, scares me a lot more than a government worker doing the exact same job, without the capriciousness of corporate America to worry about. There are and will always be bureaucrats in health care. Many of them do, and always will, suck. I’d still rather have them working for me than for some stockholder.
Third of all, you know what’d have been a worse story than the woman’s mother dying at age 100? Eighteen thousand people dying at significantly younger ages. Per year. Because they don’t have insurance.
Eighteen thousand mothers, fathers, sisters, and brothers, dying preventable deaths because insurance was too expensive or flat-out unavailable.
Per year.
Fourth of all, why do we always have to pre-EIGHTEEN THOUSAND PEOPLE A YEAR. This post aside, from now on I’m just going to scream that at the top of my lungs at anyone who questions whether a public option is a good idea.
Fourth of all, why do we always have to pretend that under public healthcare, insurance companies would fold up shop, and that rich people wouldn’t still get their healthcare cookies? Supplemental insurance is always available in countries with socialized medicine, and anyone who’s covered by the magical healthcare policies they seem so in love with would be able to afford such a policy. (The most expensive and thorough coverage I’ve seen quoted in the UK, for a family of four, costs about one-third of what I pay per month for my family of three; it’d take an awfully large tax hike to make up the difference...)
So look, all I’m asking is that we stop listening to idiots making up bullshit about the joys of private vs. public health care. All respect due to the 105-year-old mother, the questioner was essentially posing the health care equivalent of the Jack Bauer ticking time bomb scenario. “If we can get one woman a call from Willard Scott, isn’t it worth allowing 500,000 people a year to go bankrupt and 18,000 a year to die?”
Update: I was writing this late last night and forgot to link to a source for the 18,000 figure...which is too bad, because apparently it’s gone up to 22,000, at least according to the Urban Institute (PDF). The original 18,000 came from a 2002 study by the Institute of Medicine.
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Posted by
Auguste on 06:00 AM •
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Unfortunately, unless we can convince the wingnuts that even some of those 18,000 people are white, middle class people like that woman’s mother, that number will be meaningless to them.
What many in the corporate world fear, and rightly so, is that if healthcare is not linked to jobs, the shitty jobs they offer will become much less of a commodity they can use to control employees. I know for a fact that I might work less (and willingly earn less) if I didn’t have to work full time for my benefits, and whether or not that puts me in the minority or even the tiniest minority I don’t know. All I know for certain is that I’d be living and working much more like a European, and that prospect scares a lot of employers.
Of course, many people who run small businesses would welcome the prospect of giving raises to their employees rather than have that opportunity smashed each year as healthcare premiums increase (and generally for less coverage.)
In the end, I can’t see any persistent negatives about nationalized healthcare. It will be hugely expensive, but so worth it. The biggest problem is one of transition, and it’s not a question of how we get coverage since the Medicare and Medicaid systems are already in place. The question is how the market will react when less investment money from insurance companies is available. Insurance companies take money, give some back over time in services, and invest the rest. Will the fact that this money would be put into government change things enough to disrupt the economy in a negative way? I don’t know. Instead I see a whole lot of new businesses starting up, a lot of workers doing things they love rather than doing things just because the job offers benefits, a lot of people leaving government jobs, and an overall happier populace. I so want nationalized healthcare.
Wait…
18,000?
That’s like...FIVE 9/11s. FIVE OF THEM.
And we’re not worried about that and taking off our shoes over this because?O
Oh yeah. Because the 23 men who are the CEOs of the top 23 insurance corps made $14.9 Billion in salary between 200-2005.
Billion with a B.
Anything that profitable has to be good, because capitalism is the root of our country and the font of rainbows and ponies.
Polls show that most Americans get it. We may be “satisfied” with our current coverage, but we’re not HAPPY, and we’d all be interested in more choices.
Actually, we’d be happy with medical care. No one wants or needs insurance. We need access to doctors and treatment, and the crazy quilt financing ponzi scheme of medicine-only-affordable-with-insurance-and insurance-only-available-through-employers has led us to ruin.
I’d be interested to know how, exactly, the woman asking the question proposes one’s ‘love of life’ be taken into account when deciding whether to cover treatment. Would a questionnaire answer be sufficient, or would one be required to offer some kind of demonstration or proof?
“Because the 23 men who are the CEOs of the top 23 insurance corps made $14.9 Billion in salary between 200-2005.”
At least the 9/11 hijackers had the decency to die in the process of killing their 3,000 victims. And they only did it once.
The health insurance CEOs (and the congress people, and the Senators who help keep them in business) kill their 18,000 Americans every year and still walk around like they’re god’s gift to Capitalism.
America: Live and let die…
This woman is apparently unaware of reality. Why worry about the possibility that a government might deny a pacemaker for a 100 year old woman, when insurance companies already try to do that? At least when the government is in charge, we have a way to protest their “rationing”, which is done by voting. With insurance companies, we have no power to stop their rationing, which is already far worse than any government rationing would ever be. I wish I could ask this lady why rationing is all rainbows and puppies when insurance companies do it, but it’s a horrible evil when the government might do the exact same thing, only less so. I’m certainly not naive enough to believe that the public owns the government or controls it, but we certainly have more power to influence the government than a private insurance company. Also, 18,000 people are dying per year! But that doesn’t matter to this woman because she doesn’t personally know those 18,000 and so everyone who isn’t her or her family can basically just fuck off and die for all she cares.
In the end, I can’t see any persistent negatives about nationalized healthcare. It will be hugely expensive, but so worth it.
I’m not so sure I agree that it will be hugely expensive. All other countries that have universal health care pay less than we do, but get more. Of course we’ll pay for it one way or another, either through taxes or through deductions from our paycheck, but I predict that we will stay pay less in the long run because more of our money will go directly to providing services instead of making a profit for CEOs.
I just tweeted a trivia quiz, because nobody can resist a trivia quiz:
OrangeXW Trivia quiz: How many Americans die each yr because they lack health ins.? Auguste has the answer at Pandagon: http://tr.im/qiGK
Because holy crap! 18,000 is a lot!
My in-laws have private supplemental insurance on top of Medicare. They’re Republicans, but they were grousing that the private insurer keeps jacking up their premiums but providing no additional benefit. Mm-hmm, that is one thing that private insurance excels at. It’s surprising that more rank-and-file Republicans haven’t been up in arms over this same thing and haven’t pointed out to their elected officials that dealing with insurance bureaucracy is so often a nightmare.
Of course we’ll pay for it one way or another, either through taxes or through deductions from our paycheck, but I predict that we will stay pay less in the long run because more of our money will go directly to providing services instead of making a profit for CEOs.
Check out the comments on Dana’s blog for a look at wingnut “thought” on this. To quote “It is better for everyone to have to pay the same, regardless of income” - meaning that, in at least one wingnut’s opinion, it’s better that everyone pays similar amounts for private healthcare rather than using progressive taxation to pay for health care based *solely* on the ideology, regardless on the effects.
What it comes down to with their arguments against socialising payment for health-care is that they want their ideology to prevail even at the cost of people’s lives, as long as it’s only the poor that die. Really. Better Dead Than Red as long as it’s the plebes dying (and you know they can’t conceive themselves being in that category)
Because holy crap! 18,000 is a lot!
Yeah. Auguste, can you substantiate that? How robust is that figure?
“It is better for everyone to have to pay the same, regardless of income”
So basically, this particular commenter would rather pay more and get less, simply as a matter of principal. S/he would rather risk going without necessary care than actually allow someone else to benefit from being a member of society. This shows the typical conservative mindset, which is basically to cut off your nose to spite your face. It’s better for everyone to suffer as long as the people who really “deserve” to suffer are getting enough suffering.
Check out the comments on Dana’s blog
I have no desire to visit Dana’s blog. Thank you for summarizing the worst of it for me.
I agree with you, catgirl, that it will pay for itself in very little time. It will be less expensive, but compared to what? Our healthcare is ridiculously expensive, we (as a nation) have ridiculously expensive demands, we have very expensive technology, highly-trained physicians and nurses, the best researchers, we may have more facilities than we need in many places, we need more facilities in others, and it all costs one hell of a lot. I agree that it would cost less if we took private insurance corporations out of the mix to a good degree, but we’ll still be left with a lot of other corporations calling a lot of shots on a lot of things government still wouldn’t do (and that’s largely a good thing, if you ask me.)
I’m all for governmental socialized medicine, but I think the cost benefits are being exaggerated. It will certainly look hugely expensive, because it will be hugely expensive. Worth it, but expensive.
Where does that 18k figure come from. A shout-out is all very nice, but a shout-out with verification is better.
D
Sorry about that, I’ve added the sourcing (and realized that I may have been understating the case.)
I think we’ll always pay more for comparable (at best, broadly speaking) healthcare than the rest of the developed world, because we accept that providers should be very highly compensated, and in the case of most physicians, among the wealthiest people in their communities. Better hours and respect don’t seem to cut it here.
And of course conservatives will risk lower standards of care for themselves in order to burden those they consider beneath them even more; if there’s one consistent character trait I’ve observed among the breed for my whole life, it’s that they’ve gotta have someone lower on the ladder to kick if they feel like it, and then blame the injury on the victims’ lack of character. Works for neocons, theocons, moneycons, and libertarians.
This story was in the New York Times last year, and you are absolutely correct—the 105 year old woman is on Medicare. So the question was total crap.
When people whine about the demise of private health care insurance I want to ask them what else do they miss. When you’re perusing the aisles of Target do you ever think, “I wish I was at Montgomery Ward?” When you run into CVS or Duane Reade do you think, “I sure miss Woolworth’s?” This is what happens in the free market that conservatives are always touting. Competition shows up and sometimes it is so much more appealing to consumers that the old companies can’t keep up and they go away. Boo hoo. Cry me a river. I might feel sorry for the folks who work at insurance companies but something tells me they will be the first ones to get jobs under the government plan since they already know how to fill out paperwork.
I might feel sorry for the folks who work at insurance companies but something tells me they will be the first ones to get jobs under the government plan since they already know how to fill out paperwork.
This is no doubt true. However, there will in all likelihood be far less of them as each stage will not need its own batch a paper filers (doctor, doctors’ group, insurance company, doctors’ group insurance company; repeat around multiple times).
My aunt made a similar argument against national healthcare, on the basis that my mother might not be able to get a transplant (my mom received a kidney transplant almost 17 years ago) on a public plan. What she didn’t realize (but now does) is that the government paid for my mom’s transplant, because everyone with end-stage renal disease is eligible for Medicare. My mom now has constant fights with her insurancy agency to get them to cover her multiple medications, and if something happens with my stepfather’s job or health-care pension they’re going to be in deep trouble financially, because her medications are incredibly expensive. We all really want a public plan (my aunt’s all for it too) because we trust the government way more than the insurance agencies who make money every day they refuse to pay for medication.
So government-run health care already paid for one such operation; why should we especially fear that a new public option would be significantly more restrictive?
The conservative modus operandi seems to be to repeat a lot of garbage and hope that some of it sinks in. The idea that universal health care would somehow eliminate healthcare for the one age group who can count on it today is bizarre, but right wingers adhere to it as if health care for oldsters would, in future, involve an ocean and an ice floe.
The one thing that conservatives have omitted from their nacreous (opposite of rosy, I hope) is the unsurprising fact that insurance companies drop coverage on people who cost them money. Just as they do people who crash up their cars, or who have the temerity to make a claim on their homeowners’ policy. You would think they would welcome—or at least not mind—the government becoming the health care insurer of last resort, so that they could continue to skim profits from the relatively healthy.
I think we’ll always pay more for comparable (at best, broadly speaking) healthcare than the rest of the developed world, because we accept that providers should be very highly compensated, and in the case of most physicians, among the wealthiest people in their communities. Better hours and respect don’t seem to cut it here.
Tell medical students that their loans will be forgiven if they go into family practice or internal medicine and I think you’ll be astounded at how many of them are willing to make “only” $100,000 a year. One of the biggest reasons we have a glut of specialists and not enough generalists is that medical students are looking at the loan burden they have to take on and coming to the very sensible conclusion that they’d better get into a high-paying specialty if they want to be able to pay those loans off within 20 years of graduation.
I think we’ll always pay more for comparable (at best, broadly speaking) healthcare than the rest of the developed world, because we accept that providers should be very highly compensated, and in the case of most physicians, among the wealthiest people in their communities.
I have a friend, who is an obstetrician, Harvard-trained (and Canadian), who is now working in Toronto with her husband, in the same specialty. In this last fiscal year she and her husband each paid more to Revenue Canada for their income tax (and our tax brackets are very comparable to American ones, so it isn’t like they were paying that much a greater percentage than I am) than my total gross income for the same period. And I’m not underpaid.
Both of them, of course, work in the socialized hell of the People’s Republic of Canukistan.
From what various specialists say, salaries in Canada are entirely comparable to those of the US, and in some cases better, significantly so. The main difference is at the very upper end of the scale: a few specialists in the US could expect to be pulling down over a million a year while that’s pretty much impossible in Canada.
One of the biggest reasons we have a glut of specialists and not enough generalists is that medical students are looking at the loan burden they have to take on and coming to the very sensible conclusion that they’d better get into a high-paying specialty if they want to be able to pay those loans off within 20 years of graduation.
Not to mention that the invisible hand of the market conservatives love so much says that the cost of Med School should go down as doctors’ salaries go down, due to the decreased demand. And knowing what I know about what the kind of doctors who get into medicine “for the money”, I’m not going to cry that we lose that particular subset of any given medical school class.
This is no doubt true. However, there will in all likelihood be far less of them as each stage will not need its own batch a paper filers (doctor, doctors’ group, insurance company, doctors’ group insurance company; repeat around multiple times).
Luckily, the vast majority of these paper filers stay at their paper filing jobs because they can’t afford to lose their employer-provided health care.
..and would gladly do some other job they’d enjoy, one that isn’t a soul-crushing nightmare engine of hatred and pain and violence.
18,000?
That’s like...FIVE 9/11s. FIVE OF THEM.
needs to be part of ads/discourse for public health option.
Yeah, the shortage of primary care docs is straight money, and it can be solved that way. It’ll get a little expensive at first, since the current batch of primary care docs are overworked due to the shortage, then it’ll calm down as working conditions also improve.
Docs are people.
A woman in the audience told Obama about how her 105-year-old mother had a pacemaker installed, against some of her doctors’ advice, at age 100.
What really gets me is that is not an example of rationing. The doctors could very well have been understandably concerned that a 100-year-old woman might not survive the surgery. What a stupid woman—the daughter, not the mother (as far as I know).
My aunt made a similar argument against national healthcare, on the basis that my mother might not be able to get a transplant
It seems like availability of organs is by far the main concern for transplants. I doubt the government would even have to impose rationing (even considering the high cost of surgery and anti-rejection meds) simply because the number of implants performed every year is determined by how many organs are available—not many.
Check out the comments on Dana’s blog for a look at wingnut “thought” on this. To quote “It is better for everyone to have to pay the same, regardless of income” - meaning that, in at least one wingnut’s opinion, it’s better that everyone pays similar amounts for private healthcare rather than using progressive taxation to pay for health care based *solely* on the ideology, regardless on the effects.
The system we currently have is regressive. I pay the same dollar amount as the salespeople at my company; they make six-figure incomes. Even a flat tax would be more fair.
One thing that shocked me about the medical clinic I currently go to is the number of nurses they have performing administrative tasks and the like. As far as I can tell, the only people working there who don’t have some sort of medical degree are the receptionists. You need a specialized degree to draw blood, but you don’t need it to fill out lab paperwork or prepare the sample for the lab. You need a specialized degree to correctly interpret lab results, but you don’t need it to take lab results out of a chart, make copies, and hand the copies over to a patient. You definitely don’t need a specialized degree to take a message from a patient, stick it to the patient’s chart, and hand it to the doctor. At my doctor’s office, all of these things are handled by people making probably $40k a year. I did many of these things (often more competently than the trained nurses I’ve had to deal with at my doc’s office) at a small medical clinic while making about $20k a year. Our system is deliberately wasteful.
keshmeshi,
One reason I could see to have nurses do that sort of thing is that they can also do the nurse-stuff, so if you are short staffed on the nursing side, the nurse who is doing admin stuff can do nurse stuff.
What really gets me is that is not an example of rationing. The doctors could very well have been understandably concerned that a 100-year-old woman might not survive the surgery. What a stupid woman—the daughter, not the mother (as far as I know).
I didn’t realize from the quote/post that that’s what it was supposed to be a concern about. I was thinking “What a stupid question.” It’s still stupid, but I get it now.
I didn’t realize from the quote/post that that’s what it was supposed to be a concern about.
I’m not 100 percent sure that’s what’s going on, but I do know that doctors LOVE overusing Medicare. I just can’t see concerns over it costing too much and not being worth it because the patient is too old factoring into this. Age is sometimes taken into consideration if the procedure could kill the patient or impinge on his/her quality of life, which is why doctors often won’t push aggressive chemo for elderly cancer patients.
Probably everyone here already knows this, but here’s what it seems to me that so many people are missing about health insurance: the WHOLE ENTIRE FRAKKING POINT is that they take in more money than they pay out. The only way it works is if most people pay in (or have paid on their behalf) more than they receive in health care. Only those who experience serious illness or injury come out ahead financially. This is fair, because we all know that any of us could be affected by serious injury or illness at any time.
With a private insurance company, enough money has to be taken in to A) pay for the health care that people under the plan get, B) administer the plan, and C) provide a profit for the company and its shareholders.
With a government-run plan, enough money has to be taken in to A) pay for the health care that people under the plan get, and B) administer the plan.
The government plan can’t *help* but be cheaper. And since the goal will be to come out even, not to make a profit, there would be *less* motive for the people administering the plan to deny coverage. I can’t figure out why anyone thinks the private-sector version is better--unless they are either very stupid or actively evil.
In addition to medical-school costs, we’ll probably have to reform a lot of medical-school and residency methods to get more docs in family practice and get costs down. Or just go with a lot more RNs and PAs. Because in addition to the crushing debt load, there’s also a huge frat-initiation-style torture gauntlet that doctors-in-training go through (and yeah, I’ve heard the continuity-of-care, gotta-learn-to-function-impaired arguments for it, and I don’t buy them). This abuse makes a lot of otherwise normal people think they have the right to abuse others, including the others who pay for their services.
Oh, and on the nurses-filling-out-forms thing: until someone computerizes all that stuff completely, it’s going to require medically-trained personnel to fill it out so the right boxes get checked and a doctor’s slip of pen or voice doesn’t get somebody killed. (A friend who works in a local hospital just spent two years in night school upgrading his DRG-coding skills, which is essentially translating medical conditions into the right categories for medicaid/medicare/insurance billing; lab work is somewhat simpler, but not necessarily that much.)
Thanks, Paul. Lt me add that the abusive scheduling of interns is a large part of what makes physicians more likely than average to have some form of alcohol or drug abuse problem. And directly increases the chances of mistakes from sheer exhaustion. I also wouldn’t be surprised if it discourages otherwise interested students.
Something few are talking about is how wonderfully this dovetails with “the other issue” on the pro-life plank: euthanasia. Folks like Bobby Schindler, Terri Schiavo’s brother who is a regular speaker at anti-assisted suicide events, and Wesley J. Smith, a vocal blogger, are more than happy to hear the GOP talk rationing (a talking point devised by regular spinmeister Luntz). Now three states have assisted suicide laws and the Obama Administration’s review of the conscience clause is making anti-choice-in-death folks nervous. Currently Washington and Oregon laws have a built in conscience clause but the Montana law does not (it was court decided, not voter decided). The pro-life machine is poised to work more than just the abortion issue. This perceived desire of the administration to cut short the lives of the elderly plays well to the right’s worries about our escalating “culture of death.”
You definitely don’t need a specialized degree to take a message from a patient, stick it to the patient’s chart, and hand it to the doctor.
You need someone who knows enough to know the significance, or if it actually is significant.
Compare pharmacy: back when pharmacists mixed their own compounds and rolled their own pills, pharmacists had a bachelor’s degree or perhaps no degree at all. Now that all they do is count pills, the entry level degree is a PhD.
But they need more than how to count pills—they need to know drug interactions, drug-food interactions, a host of things about today’s new drugs.
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Unfortunately, unless we can convince the wingnuts that even some of those 18,000 people are white, middle class people like that woman’s mother, that number will be meaningless to them.