Well, to be fair, the people who write the WSJ probably haven’t ever been poor enough to suffer the effects of implicit rationing, so clearly it doesn’t exist.

Precisely. I really do wonder how you can be an American in 2009, warning people about the dire consequences of a massive health care bureaucracy. I’m well aware of those consequences—I’m an American, and that’s exactly the system we have right now.

FashionablyEvil: Not only that, but it might come to pass that someone who isn’t destitute is mildly inconvenienced. Horrors.

Wait, so a non-profit, government-run health system might make medical decisions based on cost-effectiveness of treatment?

As opposed to for-profit, corporate-run health insurance agencies denying access to qualified treatments to increase profits?

What am I supposed to be scared of?

Seriously, fuck insurance.  It needs to go.  My mom’s friend just had pre-approved knee replacement.  Insurance has paid the “little” bills: the anesthesiologist, the room, etc. 

But the big bills?  Um…the hospital didn’t submit those. 

Yes they did.  Along with the little ones.  And they’ll be resubmitting them forever, apparently.  But the insurance company will pay several people to do everything they can to keep from paying for as long as possible.

THAT?  That is preferable to a single-payer system that might limit some coverage?

It is to laugh.  They really don’t realize that they are protesting the system that’s already in place, do they? 

Get the profit motivation out of health care payments, and you’ll see bureaucracy shrivel.

They really don’t realize that they are protesting the system that’s already in place, do they?

They do, but they’ve mastered Orwellian doublethink.

When confronted with this idea, they will argue, “Yes, but you have a choice of insurers in the “free market.”

But when pinned down, they’ll admit that multiple providers does not mean the consumer has any real choice.

First, because all the insurers use the same modus operandi. Second, because no insurer will cover you for a pre-existing condition, at least not without phenomenally high premiums.

They do not openly connect the dots, and say,“What do you expect from insurance companies, they’re running a business?”

The other aspect of the dreaded government care rationing: end of life care. I point out that there is already a government health insurance system that specializes in folks whose check-out time is near, and there are no cries of rationing there. (Although there are cries that Medicare does not pay enough for services.)

The problem is that bureaucracy is somehow worse to deal with when it’s government bureaucracy rather than corporate bureaucracy.  I’m not sure why that is, but for my conservative parents the line at the DMV and the line at the Post Office are somehow orders of magnitude worse than the fights they’ve had to have with their insurance companies or credit card companies over the years.

I’ve really never been able to figure this out.  Sure the folks at, say, the DMV aren’t always the friendliest.  And the line does move slowly if you go on a weekend.  But as much of a hassle as it is, it’s nothing compared to trying to get an insurance company to acknowledge that the lab tests you had done by a doctor’s order at an in-network lab listed on their website are actually NOT lab tests done at an out-of-network lab.  And that’s just a minor battle.  I welcome a public option with surly but effective workers as good as the ones at the local DMV or Post Office - the insurance companies don’t appear to employ bureaucrats half as competent.

One other factor is that many physicians/hospitals/etc do a lot of the bureaucratic work.  I have to do little or no work wrangling my insurance company, but I still pay for it, because every physician I work with has to pay staff who do nothing but hassle with insurance companies, having to know how to work with the bureaucracies of each one.

And I’m one of the “lucky” ones, since a lot of people DO end up having to hassle with their insurance companies.  Like anybody has the extra time and money to do that.

This system is so broken.

I wonder if it’s not fear of the unknown. Presumably, most people in good health right now have working insurance and *feel* reasonably certain of getting in to see a doctor. If everything changes, well… everything changes. And you might *not* be able to get in to see a doctor.

It’s hard to realize that tomorrow you could lose your job or be dropped from insurance and you’d be in the same boat, only worse. All they see is what they do have now.

Although I will heartily testify that though I LOVE the postal SYSTEM, I HATE the postal OFFICE. Seriously, I’ve been to several, multiple times in each month, for years down here, and they have all sucked as hard as anything can. And it’s a helpless feeling to realize that there’s not really a manager to complain to, because they aren’t exactly capitalism-driven. Obviously, complaining is rarely used and never works, but havingthe OPTION is a security blanket for me, somehow.

My dad, who suffered with heart disease for years before he died and had a dozen hospitalizations, never once got a single bill. Medicare paid everything with no patient (or patient’s family) involvement. He never had to argue over procedure coding, he never had to redirect a lab submission, he never had to beg for preauthorization for a procedure or a diagnostic. Me, I’m young and healthy, with employer provided private insurance (which covers very little, because we’re a small business and even 10K per employee pays for fuck-all), and I go through this crap on a regular basis. I can’t wait to have Medicare.

I will stipulate to every point made above. All I want is some detail on what we ARE going to get, not what we WISH we would get. I read that Congress wants to have a bill ready by Labor Day or thereabouts. I haven’t been able to find out what might be in this bill. Much speculation, but precious little detail.

I think free market true believers figure that if there are enough insurers out there then one must be totally awesome and they just need to find that one insurer that doesn’t exist to dick people over. 

Of course that would be the government funded one the left has been trying to create for years.  Its like they don’t realize we live in a democracy and that we citizens elect our government.  Its not some shadowy cabal.

Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries.

Ideally all your ailments would be cured with an elixir made from the tears of your personal unicorn. But we’re not comparing single payer to some lofty ideal, we’re comparing it to the monumental clusterfuck that is the healthcare system. Doctors and patients don’t get to make these choices now, and acting like they do for the purpose of arguing against single payer is fundamentally dishonest.

This is what someone had to say about the Lucky duckies editorial the WS ran some time ago:

Jonathan Chait, in The New Republic, reacted to the Journal editorial by writing:

  One of the things that has fascinated me about The Wall Street Journal editorial page is its occasional capacity to rise above the routine moral callousness of hack conservative punditry and attain a level of exquisite depravity normally reserved for villains in James Bond movies.[8]

I think the time is arriving where universal health care is palatable for most people because private insurance really sucks hard.  WSJ rails against universal health care supposedly because it has the potential to arbitrarily cut off care, but this is exactly what is happening now.

My neice has acute lymphoblastic leukemia and is being treated with chemotherapy.  The chemo makes it so she doesn’t want to eat, and there was a time when her weight was dangerously low.  The doctors put her on a feed tube, but the insurance company (United Healthcare)rejected covering the liquid nutrition, saying that my sister would feed her anyway.  After that, my sister applied for a state-run program and never has yet to have to deal with this sort of b.s.

My neices illness opened my eyes to another strike against one of the more common arguments against universal healthcare. Critics of universal healthcare contend that the level of care will go down and while Universal healthcare will work well for healthy people, people with special illnesses will suffer.  But if you look at the survival figures for ALL, European countries have the same cure rate.  Besides, having a kid with cancer is stressful enough without worrying that you are going to lose your house in the process.  No one should have to go through that.  That’s just my experience, I know all you all love personal ancedotes.

The problem with our health care system is that people want something for nothing. Rich people, poor people, Congresscritters, bloggers - everybody.

You can have as much health care as you, personally, are willing and able to pay for. If you are very poor - say in the bottom ten or twenty percent - then you can hope for (and receive, in a decent society) “free” care that people at the opposite end of the spectrum kick in to pay for, through taxes or contributions or whatnot.

But Joe Average, at the 50th percentile? There’s no way for someone else to be paying for his care, unless society is terribly, and unsustainably, unjust. It’d be nice to think that Warren Buffet is going to pay for my (middle-class) health care, but he isn’t. If we try to make him, Warren Buffet will go away. If I want it, I have to pay for it.

We can get a lot MORE for our money by reforming the system. Single payer is one good way to do that, although that model has its own problems. But right now we’re all paying the administrative and bureaucratic costs that arise in an effort to clamp down on people getting medical care that they haven’t really paid for. We can blame corporate greed for those procedures if we want to, but the NHS over in England is just as bureaucratic and just as sclerotic without any private profit motive.

A major part of the distrust of single-payer here in the US is the (well-founded) fear that the people advocating it actually do think that we can get something for nothing, that somehow the top 5% of our population are going to start paying the medical bills of the middle quintiles. They aren’t. It can’t work that way. TANSTAAFL. If we want lower medical expenses, we have to use less medical resources. The end.

Socialism can only work if people understand that THEY are the government, that our taxes and our benefits have to balance out.

But right now we’re all paying the administrative and bureaucratic costs that arise in an effort to keep people from getting medical care that they’ve already paid for.

FTFY. The rest of your post is just as riddled with problems, but I don’t have time to go over it point by point - I’m too busy working to pay the premiums on my wife’s and son’s portion of my employer healthcare, which I just found out nearly doubled.

FashionablyEvil: Not only that, but it might come to pass that someone who isn’t destitute is mildly inconvenienced. Horrors.

And someone who isn’t destitute can pay out of pocket or go to Costa Rica or something for a denied procedure.  It’s an imperfect solution, because of course poor people will still get the shaft to some degree, but it will be a better system for everyone, especially the poor.  Getting the stressful, invasive colonoscopy is better than getting none at all.

First, because all the insurers use the same modus operandi. Second, because no insurer will cover you for a pre-existing condition, at least not without phenomenally high premiums.

And third very few employers offer a choice in health insurance providers.  Most people feel lucky if they get benefits at all.  They’re in no position to complain if the insurance provider sucks.

while Universal healthcare will work well for healthy people, people with special illnesses will suffer

Special illnesses?  Is that like unusual illnesses?  Even if that were true, so what?  With the system we have now, you can get excellent treatment for an unusual illness if you have the money or if you’re willing to go into extreme debt.  So, right now, your choices are going without treatment, paying much of your net worth for treatment, or ruining your finances for treatment.  Let’s say that under a universal system you can’t get the same Cadillac care for an unusual illness.  At that point your choices are accepting inferior treatment, paying much of your net worth for excellent treatment, or ruining your finances for excellent treatment.  How is that worse?

Hell, my wife’s insurance company came out and flat told he last year that they would stop covering one of her necessary arthritis medicines because it was too expensive.  No beating around the bush, just plain old “you are costing us too much.”

right now she’s trying to get them to pay a claim they already approved months ago for a medical test at a local hospital.  the hospital keeps complaining to us that the insurance company never paid and all the insurance company will say is that they approved it…

and this insurance company is one of the bes tones we’ve had, and if we switched my wife could be denied coverage for her arthritis because it’s a pre-existing condition…

Our health system is broken and the rightwing in the country is too f****** stupid to let it be fixed!

Keshmeshi - maybe I didn’t make myself clear

I was saying that one of the arguments the right trots out is that universal healthcare may work only for people that are usually healthy.  However, if you look at the cure rate for something like ALL,  which is rather rare in children,there is no difference between the us and european countries, so this right wing talking point is bull.  Furthermore, if you look into the cure rates of ALL in the united states, african american children often fare worse than white children and some researchers speculate that this is because of the healthcare divide.

So, I guess my larger point is that all of the right wing talking points are pretty easily disproven if you use the great gazoogle to your advantage.

I totally FAIL at communicating, sorry.

I totally FAIL at communicating, sorry.

It’s ok.  I think I get what you meant.  I was just making the point that even IF the right-wing talking points were true, in the worst case scenario things wouldn’t be any worse than they are now.  But of course the wingers are full of it.

I work in health care at an oncology clinic. Recently I met someone from Canada who was telling me that her aunt was dying of lung cancer, and was told by an oncology clinic in Canada that there was nothing they could do for her, so they denied her treatment.  At my clinic they would’ve treated her, charged her insurance, taken her valuable remaining time, and subjected her to side effects, and she would die of her disease just the same in approximately the same amount of time.  Sometimes refusing treatment is the right thing to do.

<quote>But Joe Average, at the 50th percentile? There’s no way for someone else to be paying for his care, unless society is terribly, and unsustainably, unjust. It’d be nice to think that Warren Buffet is going to pay for my (middle-class) health care, but he isn’t. If we try to make him, Warren Buffet will go away. If I want it, I have to pay for it.</quote>

What a national health service gives is _security_. Yes, I pay for it through taxes (as do companies), and the healthy person may ultimately put in more than she takes out, but I know that if tomorrow I am hit by a bus or develop cancer I am not going to have to face the choice of my life or a roof over my head. Or my hypothetical child’s life or a roof over her brother’s head. Or merely get trapped in a job because if I leave I won’t be able to afford inhalers. The benefits of this are incalculable to the individual, but very real. They are probably calculable to society.

Yes, there’s bureaucracy in the NHS and other European systems, but patients see relatively little of it. Today I got my final isotretinoin prescription. This involved the incredibly bureaucratic procedure of seeing the consultant who gave me a new prescription, paying £7.20 at the pharmacy, and going back to work with a couple of hundred pounds of drugs in a carrier bag. Oh, and unlike in the USA, I didn’t have to submit my personal medical details (including sexual history and details of any STDs) to an insecure government agency and be forced to take unnecessary treatment just because I’m female (the iPledge programme) in order to get it.

“A major part of the distrust of single-payer here in the US is the (well-founded) fear that the people advocating it actually do think that we can get something for nothing, that somehow the top 5% of our population are going to start paying the medical bills of the middle quintiles. They aren’t. It can’t work that way. TANSTAAFL. If we want lower medical expenses, we have to use less medical resources. The end.”

Do you think all this Insurance Co. bullshit is free?  Do you think massive profits the Insurance Co.s “make” come raining down from heaven?  That money comes directly out of the pockets of those who pay for insurance.  And since they don’t pay to keep Emergency Rooms open for the medically indigent, guess who pays for that?  We do.

So on the one hand we have a ridiculously complex and bureaucratic Medical-Insurance-Complex, and on the other we spend loads to give some care to those without insurance, delivered through the most costly and least efficient mechanism.

Between those two realities, there is no reason why we can’t cut out the Insurance Co.s and deliver a great standard of care to all Americans.  We can probably reduce medical costs for everyone.

But the key is to get rid of the Insurance Co. leeches.  They need to be put on the street just like the Wall Street boys.  I don’t mind if they get to use American Healthcare like anyone else, but I’ll be damned if I’m going smile while those thieves rob us all blind…

“It can’t work that way. TANSTAAFL.”

Oh, so there’s no such thing as a free lunch?  Okay, I’ll go along with that.  But there is such a thing as paying for a steak dinner but getting a McDonald’s burger instead…

It’s a sign of how many hundreds of millions the insurance companies have poured into propaganda that we’re even having this discussion.  The WSJ editorial board and columnists are a bunch of reality-free wackaloons, to the point where if they make a coherent assertion about something in the world you can pretty much assume the opposite.

I don’t know about the interior editorial staff (although I expect they’re pretty darn well compensated, including fringes) but the columnists have the best possible health insurance of any employee: that paid for by someone else (usually their primary employer).

But Joe Average, at the 50th percentile? There’s no way for someone else to be paying for his care, unless society is terribly, and unsustainably, unjust. It’d be nice to think that Warren Buffet is going to pay for my (middle-class) health care, but he isn’t. If we try to make him, Warren Buffet will go away. If I want it, I have to pay for it.

Aside from MikeEss’s point about the overhead which comes with commercial insurance…

The point is not that Warren Buffett should be paying for my care, the point is that of the people in my income bracket, maybe 5% will have bankruptcy-level health expenses, 20% will have high health expenses, and 75% will have low health expenses. So the 75% are paying more than they’re getting back, the 20% are getting a bit more back than they’re paying, and the 5% are getting a lot more back.

So why would the people in the healthy 75% agree to subsidize the care of people they don’t even know? Because you don’t know whether you’re in the 75% or not.

Also, pepito, because subsidizing that care means the rest of their dollars can be better spent. The offices they work at aren’t shorthanded because someone is always sick and untreated, the stores they go to don’t go belly up because the proprietor couldn’t afford to keep up a prescription, the restaurants they go to aren’t full of cooks and waitstaff who feel really sick but came in anyway because they don’t have insurance and need the paycheck.

The US has been really lucky with herd immunity and what public-health care we have. Rich people used to die from breathing the same air as poor people. (Who also died, but they already didn’t give campaign contributions, so no one cared.)

Worrying about whether Health Insurance companies survive makes me wonder how the public responded to the death of the blacksmith industry. Was there a lobby of farriers demanding to be grandfathered in to the auto industry?

There’s a life cycle to business, is my point, and I, for one, think it’s time to euthanize Big HealthIns.

When I am hit by a car and fall down and my femur breaks at the hip because of a condition called avascular necrosis (about what it sounds like) pretty much everybody is going to help pay for it.  And if I’m diagnosed with a nasty and expensive form of cancer, pretty much everybody is going to help pay for that too.  Insurance is a way of organizing things to spread the cost and make things less unpleasant all around, but in the end, everyone is going to have to pay for everyone’s health care, or if not, for the lack thereof.  And single payer health care is a way of organizing things so that everyone’s care gets paid for and none of the money goes to people who make a huge profit by betting on who will get enough care and who won’t.

One time I had to go to a hospital to get ultrasound to look at my heart.  Two weeks later, I found out that the insurance had paid for the procedure but not for a doctor to look at the data because it wasn’t specified in the referral from my PCP.  My PCP ended up writing a new referral and back-dating it, and it was eventually paid by the insurance company.  I wonder how much money they wasted in going through all that nonsense.  The process of denying claims probably costs almost as much as just covering procedures without all the hassle.