Government Subsidies – the Catch 22 of Health Care Reform
It is sometimes difficult to remember exactly what the health care debate was all about in the days before the GOP’s decision to use it as Obama’s ‘Waterloo’ and the Democrats’ inability to get on the same page on …well, much of anything.
Health care reform was intended to (a) find a way to make coverage available to all Americans, and (b) get control of the spiraling costs of health care which threatens not only our access to care but the economy itself.
While many see the public insurance option as the best way to accomplish these goals – or at least, the goal of making affordable care available to more people – much of what is at the heart of the various proposed bills is predicated on increasing access to care for those who are not covered through their employment by providing government subsidies to help those unable to help themselves.
It’s not a bad idea if you’re okay with the notion of government subsides. However, there is a problem. For a great many Americans, the numbers just won’t work.
The effort to subsidize those in need of financial assistance so that they may gain access to health care is a noble endeavor. So too is the President’s commitment to refuse any legislation that increases the deficit by so much as one cent. Unfortunately, these two worthwhile goals are proving to be completely incompatible.
To meet the mandate of the president, Congress is forced into a position of cutting proposed subsidies in order to bring the costs of reform down to where it becomes deficit neutral. The Baucus committee has already performed surgery on subsidy levels while the House leadership is hard at work looking for their own subsidy cuts so as to stay within Obama’s restrictions.
As the subsidies get cut, more and more people- most of whom will be obligated to purchase insurance due to mandates to be created – will be unable to afford the insurance. And that means less people with health coverage, causing us to fail in the original intent of reform – bringing health coverage to all Americans.
Thus, the Catch 22 of health care reform.
To help make the point, The Kaiser Family Foundation recently published an on-line ‘Health Reform Subsidy Calculator” to help work through what people should expect to pay for their coverage under proposed legislation.
While not a precise instrument, as we still do not yet know where the subsidy sliding scale will land, we can get a fairly good idea as to how this is going work.
A family of four earning $45,000 would be in pretty good shape (with respect to the cost of their health care insurance) as, under the Baucus committee approach, the federal government would subsidize 71% of their annual insurance premiums.
However, a family of four earning $63,000 would only receive 36% of their premium costs through government subsidies. This calculates to this family paying 11% of their total income for health insurance under the Baucus approach.
As the family earnings go up, the subsidies go down.
For those in the American middle-class, while their health care premium payments may be less than their rent or mortgage payment, it’s likely to be more than their car payments. That is going to be a problem.
According to Karen Pollitz, a Georgetown University professor who studies the insurance market for people buying their own coverage,
‘This is not the loaves and the fishes _ you can’t just throw some subsidies out there and expect that will take care of everybody’s needs.
Via AP
Pollitz goes on to say that the subsidies disappear rapidly for households with solid middle-class incomes.
It is not much of a leap to make the argument that reducing the subsidies to a level where the middle-class will find themselves obligated to purchase health insurance they cannot afford- or face a still penalty for failing to acquire coverage – is a violation of Obama’s pledge not to raise taxes on the middle class. On the other hand, if subsidies are not reduced, it will be impossible to make changes to the system that remain deficit neutral.
Thus, while many will remain focused on the push for a public option as the debate moves to the floors of the House and Senate, it is likely to be the failure of a workable subsidy program that ends up becoming the real Achilles Heel in the effort to reform the health care system.
Is there a way out of the Catch 22?
Watch for Congress to increasingly turn to the idea of an excise tax on the wealthy to pay for a larger chunk of health care reform – a concept contained in many of the House bills. With Congress and the president realizing that you can’t stay deficit neutral and produce a subsidy plan that doesn’t ultimately put more financial pressure on the middle-class, there will (a) be no other option available and (b) remain consistent with Obama’s campaign promises.
It is a classic case of not being able to have your cake and eat it too – unless the wealthy class is doing the baking.
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The case for single payer sort of makes itself once you realize that we could do it for what we’re spending now, instead of having to go through a pretty expensive route here.
Yes, that’s what strikes me as true as well. But it seems as if everyone has to work through all these shenanigans–that is, every other idea imaginable–before they will accept that conclusion. So be it. As long as we get there IMO.
In response to another comment. See in context »[...] here: Rick Ungar – The Policy Page – Government Subsidies – the Catch 22 … Comments [...]
Not really sure I should be commenting. I am not a professional, just a concerned layman.
One of the basic problems I see has little to do with cost containment. It is the inequity of wealth distribution and what I see as the withering viability of the “middle class”. It seems to me that the disparity has vastly increased over the last 2-3 decades to a point that has never been seen in this country before. (The closest I could find was just before the crash of 1929). I personally found it difficult to believe a Michael Moore interview when he stated that 1% of the population controls an amount or wealth equal to what the combined lower 95% controls. Fact check seems to corroborate his statements. The old adage is that you can’t get blood out of a turnip. If the new super rich are the only ones with the financial resources, it would appear to be the only logical option. Am I misinterpreting this data?
Wlllard – first, you don’t need to be an expert to comment here. You are always welcome to voice your opinions.
In response to another comment. See in context »Secondly, as “laymen” go, you seem like a pretty smart one. You points re well taken and, so far as I know, completely accurate. There has, most definitely, been a narrowing of the middle class over the past twenty years. And while I had been of the impression that it was the top 3% whose wealth equals everyone else’s, you pretty much are on the nose.
Obama is well aware of what you know, which is why he gets accused of wanting to redistribute wealth. The truth is that we probably need some of that redistribution, but the top 3% are unlikely to go quietly on this. It is something that, I suspect, will happen gradually to the extent that it will happen at all. It will begin by allowing the Bush tax cuts to expire. Where it goes from there will have a lot to do with whom remains in the White House and in control of Congress.
Thank you for your kind comments. I do not want to over step my bounds.
Since you mentioned the Bush tax cuts I would like to expand on that topic as well. While researching on the net I found that the estimated savings to the new “super rich” of these aforementioned cuts is estimated to be in the neighborhood of 1 trillion dollars a year. Enough to fund health care reform 10 times over. If that information is indeed correct, I find it interesting that it hasn’t made it into the current public debate. I never had much interest in politics until recently, what I am finding is very discouraging. I hope articles such as yours and intelligent debate can make a difference.
In response to another comment. See in context »When commenting on a blog, it’s pretty much impossible to overstep your bounds!
Many people thought that the Bush tax cuts would be discussed n the context of health care reform. It hasn’t only because it’s politically difficult to talk about raising taxes in the middle of the worst recession since the Great Depression. This wouldn’t be the time to try and do away with the tax cuts. It will be a discussion next year when the tax cuts expire.
Don’t be discouraged by politics. If people turn it off, then those who pervert the system only grow more successful!
In response to another comment. See in context »The real catch-22 is perhaps the myth that the health system can function as an insurance model. It is generally true that if you can afford insurance (of any kind) you don’t need it, and if you need it, you can’t afford it. “Insurance” is so-called because people would not have anything to do with it if it was called what it really is. Health “insurance” could only work and be affordable if it was extremely unlikely that anyone would fall ill. Moreover, after a “claim” it would have to be very unlikely that there would be another. We all know health (sickness) doesn’t work like that, so if you have ever made a claim in the past a new insurer is not going to want to know you because a past claim is a very strong indicator of future claims. It boils down to a simple moral precept- is society prepared to pick up the people who get sick if they don’t have the money to pay for their own cure? Everything tends to suggest that the American people as a whole are ready to carry this can, but American politcians are meretricious shits.
Sorry, wqttnot, but most of that just doesn’t make sense.
In response to another comment. See in context »How do you figure that “those who can afford it don’t need it”?
Apparently, you have never known anyone with a serious illness. Any idea what that costs? Believe me – you need it. And I am speaking from very first hand experience. You’re statement just makes no sense whatsoever.
Secondly, you are discussing the problem of pre-existing conditions when looking for new insurance. Don’t know if you’ve paid any attention to the current health care debate, but that is very much going to be a thing of the past – even if nothing else happens with healh care reform.
If you’re making a pitch for single-payer government insurance, which I think you are – I’m all for it. But your argument makes no sense,. There are some awfully good ones- you might want to do a bit of reading.
OK Rick. I’m not American, but I have been following American politics closely since you got rid of Bush. I am also familiar with public health systems,having been a general manager in one for six years before I retired.
In response to another comment. See in context »I’ve done a lot of reading. Now I must try to convince you that I understood what I read.
Anyone who thinks that insurance companies are going to take people and cover them for health care when they know at the outset that the covered person is going to cost more than they collect in premiums from them is either ignorant, or insane. Legislators can write rules till they are whatever colour you like in the face and they will NEVER defeat people who employ actuaries. Insurance as a concept only works if the premium payer can reasonably be expected (statistically) not to make a claim, ever. The mathematics for this were developed by a Frenchman by the name of Poisson, but it is not fishy mathematics at all. If a large number of covered people make claims it is no longer insurance, it is a funding mechanism, and a funding mechanism can (and can only) function very well without financially incentivised managers. Getting back to the statistics, the ability of an “insurance” model to work relies mostly on the size of the covered population. The bigger the better, which is why single payer nationalised compulsory systems work and almost nothing else does, even in countries the size of the USA. As soon as you fragment it (and YOU never had it any other way) you create a cherry picking system in which the rich (well) get their health care for next to nothing (relatively) and the poor (sick) die. Few things are better correlated in public statistics world-wide than affluence and well-being. The emerging exceptions are The USA, Australia and (I believe) the UK, where the affluence and the general meaningless of life are combining to result in lifestyle choices for the affluent that are making them very very sick.
I could tell you one way to fix your problems, but I suspect you have a lot of other things to worry about.
Best wishes, Wattnot.
Wattnot – Now I see where you are going here. Hard to follow in your first comment. For the most part, I agree. Take a look at an article I posted a few weeks ago entitled “The Inevitability of an American Single Payer System.)
In response to another comment. See in context »While the insurers are going to have to take everyone (at different premium rates based on age, smoking etc.) I do agree that this cannot work without some changes. I suspect what the insurers will do is raise deductible levels and generally lower benefits provided. Because of this, we will reach a point where what they are offering just doesn’t work for the public. This will cause the government to step and and we will end up with a single payer system. I ‘m curious- where do you live?
In 1974 my country enacted legislation that removed the individual’s right to sue in event of personal injury. The government took over all legal proceedings against individuals and organisations who caused injury. In exchange, every person received accident insurance cover 24/7. This cover applies to everyone in the country, including visitors and illegal immigrants. You get free medical care for injuries, and if you are unable to return to your job you get earnings-related compensation for as long as you are indisposed. It is the best accident insurance scheme in the world, despite subsequent vandalism by conservative governments. Its proposer at the time, a visionary high court judge, intended the scheme to apply to illness as well and it is tragic that our politicians have consistently lacked the cojones to extend it. Because no lawyers are getting paid to chase ambulances here, and because there are no slime bag ceos creaming money off the top, accident/injury costs in this country are a fraction of what they are anywhere else except Canada, where a similar scheme is in place (in a couple of states). We even got told by the IMF that we would have to dismantle the scheme because it was giving New Zealand exporters an unfair advantage over their competitors!! America could implement a scheme like this for its entire population in the twinkling of an eye, because despite the current problems you are still a very rich country. In any case, universal coverage of this kind costs much less than the ghastly mess we have today. Your biggest problem is your pathological NIH syndrome. Send some people out to look at how others do it, and adopt the best practice. Send a team to New Zealand- we have got it partly right.
In response to another comment. See in context »wattnot – interesting – what do you do for coverage on illness as the program you describe is only for injuries sustained in accidents?
In response to another comment. See in context »As for malpractice, you should understand that medical malpractice only accounts for .5% of every dollar spent in the USA on healthcare. Also, in your country, what happens to people who are severely injured and suffer added costs for live due to medical malpractice? When you say the government takes it over, does that mean the government picks up the costs of these injuries?
Medical misadventure under New Zealand law is treated as an injury (reasonable) and is managed by the accident compensation commission which is the government agency that provides the accident insurance system. i.e if your doctor stuffs up the government pays the bills to fix you (if you can be fixed) and the government goes after the incompetent doctor. The terrible cost of malpractice insurance is largely absent from the New Zealand system. ACC manages your injury regardless of what the doctor was treating you for (injury or illness or both). ACC provides lifetime financial and medical support to people who are permanently disabled by injury. Our public health system provides universal coverage for all the serious health problems. The primary care system (GPs) is subsidised so that people of limited means can access health care. There is also an extensive private system and the usual range of rip-off insurance deals for those who have the money and the stupidity to use it. In New Zealand it comes down to this- if you are really sick the state will intervene. These services are provided at no charge. If you need elective surgery or other “optional” medical care you can buy insurance to cover all or part of the cost, or you can simply pay for the care at the time you need it. I and many thousands of others choose the latter. Truth is, very few people (statistically) need elective medical care that they can’t pay for, and if you add up what you give to insurance companies for this cover, most people would be far better off just paying for their operation when the need arose. The existence of a comprehensive public health system has kept the costs of private medical procedures down. I won’t bore you with all the reasons.
In response to another comment. See in context »In New Zealand all prescription drugs are purchased by a single government agency. The drug companies are wetting themselves at the prospect of this model spreading like a contagion around the world.
Many New Zealanders are of the view that governments are actually much better at doing many things than the private sector is- especially where those things involve natural monopolies or severe power asymmetry. Americans, despite abundant evidence, seem to have swallowed some enormous crock of bile to the contrary.
Rick,
A little more math to consider….
Currently, the Baucus plan has a “pre-existing condition waiver”. Meaning that the insurance carrier cannot decline you no matter what condition you may be in.
It also has a $950 fine (individual) $1,900 (family).
I am 44, my current premiums for me an my wife are $300 a month for a $3,500 deductible.
Since, the pre-existing’s are waived, there would be no use for any Underwriting. In fact, you should be able to purchase health insurance instantly over the internet.
Now, to the math.
If we forgo health insurance and simply pay the fine we will save $1,700 each year. Premiums as you age go up every year. However, holding this number constant until we’re 65 we would save over $35,000.
Plus, knowing that the insurance carrier must take me no matter my condition, I could purchase health insurance in the ambulance with my i-phone on the way to the hospital and be covered.
And…how long do you think it will be until everyone is on a National Health Care plan because the insurance carriers are bankrupt?
I don’t see how competition can thrive in this scenario to lower the cost of health care.
Blake – I’ll try to take your points one by one -
“Currently, the Baucus plan has a “pre-existing condition waiver”. Meaning that the insurance carrier cannot decline you no matter what condition you may be in.”
Completely true – just as it is for the other bills under consideration, but not really relevant to the point of my piece.And I’m very aware of the fines for violating the mandate, but, again, not relevant to the point of this piece.
“Since, the pre-existing’s are waived, there would be no use for any Underwriting. In fact, you should be able to purchase health insurance instantly over the internet.”
Again, true – it is the entirely the point of the health insurance exchange that will be created. But, again, not really on point with the piece.
“If we forgo health insurance and simply pay the fine we will save $1,700 each year. Premiums as you age go up every year. However, holding this number constant until we’re 65 we would save over $35,000″
And…how long do you think it will be until everyone is on a National Health Care plan because the insurance carriers are bankrupt?”
True and true but you’re preaching to the converted. Please see my piece of two weeks ago entitled, “The Inevitability of an American Single Payer System” which makes the same point, with a fair amount of data to back it up.
“Plus, knowing that the insurance carrier must take me no matter my condition, I could purchase health insurance in the ambulance with my i-phone on the way to the hospital and be covered.”
this one is not true. Read the Baucus bill a bit more carefully. This situation is excluded and would not be permitted.
In response to another comment. See in context »Rick,
Just one question here. Is this a universal subsidy, or is it just for those under a public option? Does everyone who is qualified to get something going to get something, or are there other requirements?
Thanks!
skid – the subsidies are based on income levels. It doesn’t have anything to do with the public option. The notion behind it is that if the government is going to require everyone to have health insurance, they are going to have to subsidize a percentage of the population so that they can pay for it. Otherwise, they would be penalizing those who can’t buy it for being poor.
In response to another comment. See in context »Terrific.
Thanks Rick. I really appreciate all the explaining you do. Makes things a bit more understandable.
All this talk about the cost of health care is tedious. Health care is expensive, period. It is a matter of how expensive, our current system is twice what it is in government programs elsewhere. When we get sick we pay, either through our insurance or the government picks up the tab and we all pay. Everyone will need care before we die, most of that tab is picked up the government and the last year of a life is the most expensive. Somehow we are trying to devise a system that will pay for itself. This idea is peculiarly an American one, that does not apply to other social or defensive services. Currently we subsidize the transportation industry, the roads and bridges and airports do not run at a profit or even break even. We subsidize our food, hospitals and education. The government supplies flood insurance and student loans. Police and fire departments and emergency disaster relief do not break even, ever. Our defense department not only doesn’t make any money it is a corrupt money pit. This is all about a social contract, the government steps in when their is a need for universal betterment.
One would think that in a democracy or a federation the people would have a say in how this contract is executed. We are going to pay for health care by cutting health care (medicare) is stupid. Stupid.
I used to make a living making budgets work and the idea that if something in the budget is imperative, one does not try to find savings on that line item. You only hurt the important, create a situation that will create problems of execution. To find the savings you search elsewhere on something that is less imperative. The health of everyone vs. a jet fighter we do not need? That is the debate we should be having, that is a moral debate. In the station fire here in California the federal government decided it needed to cut the forest service fire services. The result was the largest fire in our history. Currently we are throwing numbers around like darts and no one is hitting the target. In fact we forget what the target is: The health and welfare of all of us, we the community, we the ones that are being ignored. This debate is about everything but that and I for one am sick to death of it.
sorry for the rant.
I don’t disagree with most of you comment – but its not true that we are going to cut Medicare. What we are going to cut is the Medicare Advantage program which, in some cases, provides additional benefits to Medicare aged people but at a greatly increased cost to the government.
In response to another comment. See in context »Rick,
I do know we are not actually going to cut medicare, as in the medicare we all know, but medicare advantage reads as medicare, plus the democrats are pulling out the old chestnut of waste and fraud, but now at least not blaming the welfare queen. What is stupid is to even talk about waste, medicare advantage or any of it. Here’s the problem, numbers, stats can be manipulated to be read anyway one likes. Read this posts…the result is confusion. We need a clear choice, a moral choice. This “why should the guy who can’t pay screw up my insurance is morally suspect, defies the idea that America pulls together when the chips are down, etc. The point I was making with the station fire is that making cuts with something important bites you in the ass every time. The cuts were ordered, did they affect the fire. Maybe maybe not, but why consider the cuts in the first place? To make a budget look good. No matter what it is going to expensive, public option, single payer or whatever. Is it worth it? That should be the question. If we can’t find a trillion dollars over ten years in our budget someone isn’t trying.
Health and insurance are separate businesses, insurance industry used to be a betting business. The numbers drive me nuts and I know every budget trick in the book. I used to present budgets that said 6 million dollars but were actually 6.5 and the numbers were all there right in front of you and you wouldn’t see it. We will never get anywhere throwing numbers around. To me it is a guns and plowshares issue. America can understand that and if we choose guns we know who we are.
In response to another comment. See in context »Libtree,
I too live in California – and I would beg to differ (or at least say it is a stretch) to link the Station Fire with cuts in the forest service. I also lived near Oakland when the “Firestorm” occurred, I would not blame a lack of Forest service there – simply put, opportunistic pyromaniacs take advantage of weather conditions to wreak havoc.
But, let’s stick to the point of your discussion – If 90% of Americans have some form of health insurance and (depending on your poll source) around 50% are content with their current coverage – is it morally correct to upset them to cover the 10% who do not?
In addition, of the 10% who do not have coverage, it is estimated that 4-5% of them simply do not want coverage and 3-4% would purchase it if they could afford it. Therefore, the true number of those who do not have but need coverage is between 1 and 3%. We are spinning around in a frenzy trying to cover this minority by throwing the entire system into chaos.
There are solutions to this problem without extreme government intervention – but, it seems to be an all or nothing deal with the President and therefore with Congress.
Some problems with this analysis-
1. We don’t really know how many Americans are satisfied with their health coverage as the overwhelming majority have not had to call upon it for a major illness. those are the people to ask if you want to know how well the insurance system works. I’m happy with my home insurance – I think – because I’ve never needed to ask them for anything as my home has not been injured. I might feel differently if I did.
2. While it may be all well and good to say that we shouldn’t worry about those who don’t want health insurance, there is a problem. When they get sick, it falls to all of us to take care of them. Does that work for you?
3. Your numbers are way off. The number of uninsured who would like coverage is much more in the 15% area – not 1 to 3% This is a very signficant number, particularly when you consider what it costs us all when they fall ill or get injured.
In response to another comment. See in context »Just to add to the dialogue.
Fox news (sorry) just completed a poll that states that a little over 80% of people with health insurance are happy with their provider.
I found that to be disingenuous at best. I would be willing to bet that well over 80% of people with insurance have never had to make a serious claim. (the old adage about statistics?)
The insurance industry has no problem dealing with broken arms, stitches, minor surgeries. As long as the money coming in exceeds the money they have to pay out you are a “good” customer. Most people buy insurance to cover themselves in the event of a catastrophic illness or injury. In our current system, just when you need the coverage the most, is when the insurance company looks for an out.
I find it fascinating when so many people defend the insurance industry so eagerly. Insurance is the only business model I can think of where your most satisfied customers are the ones that have never needed to use the services you provide.
Personally I find it a little distasteful that so many high paying fields are based on the miseries of the weak and infirm. Doctors, lawyers, hospitals, pharmaceuticals, medical devices, diagnostics, and insurance. All for profit. All making much better than average income for their practitioners, and all with one source of income, the sick and injured. Of the group I personally find the insurance industry the least ethical. Most can at least say that they have the patient’s best interest at heart. Insurance companies interest are diametrically opposed. The less care they can provide, the more money they make. Just my personal take on the situation. Thanks for the opportunity to vent.
In response to another comment. See in context »Willard- You’ve got it exactly right. The polls are useless in that most people included in that 80%, thankfully, have not had to test their insurance during a serious and expensive illness. The ones that should be asked are those who have had to put their insurers to the test.
In response to another comment. See in context »Willard,
As an insurance agent, I could not agree with you more. I find it distasteful that all involved, including myself, receive benefits from preying on fear.
In response to another comment. See in context »Quite honestly, I earn 10% of everything I sell…the problem is that I don’t try to sell anything, people buy it no matter how much I try to talk them out of it.
There is not a day that goes by that I do not find myself fighting the insurance carrier for one of my clients…most of the time, thankfully I win because I know what questions to ask. Should I receive payment for my services…yes. Currently, I live near poverty for my family of 6 – I’m not fond of the money, but I enjoy helping people receive what they thought to be impossible.
Part of the problem as I see it, is the private negotiated rates between the insurance carrier and the provider that we the patients are not privy to.
If, a patient could know how much something cost BEFORE they saw a provider (aka transparency), much like everything else in life, prices would drop.
Now, if you were having a heart attack would you care how much one hospital cost over the other? Of course not, but…your competing carrier sure would like to know so that they can lower their costs. And, the media would love to get their hands on this information;
which in the end leads to more competition and lower overall costs.
This is undoubtedly the best discussion I have seen on the topic. I would like to thank Mr. Unger for providing the venue.
Blakepannell. Thank you for your disclosure that you are in the field. You mentioned the topic of competition and that is another one of my personal issues with the current system, and for that matter the reforms currently being proposed.
Whatever possessed the United States people and or government to tie health insurance to employment is beyond me. We now have 15 million newly unemployed and the numbers will get worse. That would indicate that there will now be nearly 15 million added to the ranks of the uninsured.
I believe competition is generally beneficial, but I also believe it is not the total solution, nor is it likely to be under the current system.
My observations are that despite their protestations, big business does not tolerate competition well and one of their primary goals is to grow into either the sole source or have a “working arrangement” with their so called competitors. If big business were truly competitive there would be no executive compensation issues. Corporations would look for the best, brightest, and CHEAPEST executives they could find. This does not happen.
I believe that no one has more incentive to spend my money wisely then me. Having someone in between the user and the provider (whether that is the insurance company, or an employer) is inefficient and wasteful. If I am an employee I want the best treatment available regardless of cost, because I don’t directly pay for it. If I am the employer, I want the cheapest insurance I can get, because I don’t directly benefit from a better policy. If health insurance were left entirely to the individual it would be better than what we have now. The individual would at least have an incentive to look for the best benefit for the cost, rather than at the extremes of the spectrum.
I too have an issue with the double standards in fees. I site one example. Woman in Miami Florida has an appendectomy. She was uninsured. She paid $22,000 for the procedure.
Insurance company negotiated price at same hospital was $5,800. Medicare allowance was $4,500. In each case the services provided were the same. Name one other business that can have that great a discrepancy in price structure.
Again, thank you Rick Unger for the opportunity. Will
In response to another comment. See in context »Rick,
First let me disclose that I am a health insurance agent in California.
1) I’ll agree that satisfaction is in the mind of the beholder and until a claim is made satisfaction is up for determination. I myself am on a $3,500 deductible plan – I’m not happy with it, but it’s inexpensive and utilized only in the event of a catastrophe. Still, you bring up a fair debate and it’s one a person cannot win or lose depending on their point of view – it’s unmeasurable.
2) I have spent a considerable amount of time in what is considered a 3rd world country. When the “uninsured” get sick, the doctors and hospitals take care of the patients pro bono. Grant it, it’s limited care and not what one would consider to be adequate by US standards, but it’s care none the less and the people understand that because it’s charity they do not expect more than they are receiving. Philanthropic orthopedic surgeons are few and far between in the US; as are hospitals. Yes, we must take the ill, but the provider expects payment in some form. We have an “entitlement” problem that permiates everything we touch, smell, taste, hear and see that starts at individual and goes all the way up to the providers (and their buildings). I personally would have people purchase their own insurance at birth and keep it for their lifetime. That is being responsible – however, we have factors in the US that prevent a person from keeping their insurance for a lifetime i.e. State lines.
3) I beg to differ – Your numbers are way off. 15% is the total amount of estimated uninsured, not the total who want insurance. There are 304 million people in the US, it is estimated that 47 million of them do not have health insurance (not because they want it). Of those it is estimated that nearly all illegal aliens do not have health insurance and there are roughly 15 million of them. making the total population without health insurance 10%. Of those, nearly half are the “young invincibles” that do not believe they need health insurance. Which leaves 5% that actually are legal citizens that want health insurance. It is also estimated that of the total population, 3-4% of them cannot afford it, but do not have a medical condition that necessitates insurance. Therefore, we are down to a population of 1-2% that actually need insurance but cannot get it due to pre-existing conditions.
In response to another comment. See in context »1. Not sure I agree with health care fitting into the “entitlement problem.” I think that every American should be entitled to health care.
2. That fifteen million as illegal aliens is, at best, a guess and has a big impact on your numbers.
In response to another comment. See in context »The number of illegals does vary and estimates are between 10 and 20 million – I chose the middle.
In addition, the Obama administration has been sighting the 47 million uninsured for quite some time – and yet, it was Obama himself during his health care speech that stated the number of uninsured was 30 million and then he went on to say that illegals would not be part of the equation (with the now famous “You lie” statement from Mr. Wilson).
Leaving one to believe that his administration considers the number to be 17 million. So, my number is not a guess…unless the administration’s number is also a guess.
In response to another comment. See in context »wattnot-
Thanks for the info on how New Zealand handles medical malpractice. Sounds like a darn good idea. I can only imagine how the lobbyist would react to it if proposed in the USA. Might be worth looking into, however. As for government vs. private in health care, don’t be fooled. Keep in mind that 30% of Americans are already a part of a government provided health care system (Medicare and Medicaid). 65% of Americans would like to see a public insurance option added. A large number of Americans would like to see a single-payerk government health system.
So, it isn’t necessarily the US people against it – it is the strong lobbying effort of the private health insurance companies controlling our politicians.
also – to be fair- there are some very big differences between New Zealand (one of my favorite places, by the way) and the US when it comes to population, etc. Thus, what works where you are may not entirely work in the US. Given the size of your population, I would imagine that you don’t have a big problem with waiting periods, etc. for health care, correct?
Rick, Thanks for the kind words about NZ. I may have been unclear. I certainly recognise the difference between the aspirations of the American people and the priorities of its corporations and vested interests. Reagan, probably, and possibly Bush may have genuinely believed that prosperity would seep by osmosis from the rich and powerful to the weak and poor, who would then be able to “negotiate” for a fair deal in the private health market. But if they did believe that crock of crap, it is the same sort of belief that has people thinking that the God who allows millions to die in floods is benevolent–ie deranged. Our current NZ government since late last year is completely at home with Reaganism and are likely, for example, to start distributing vouchers so that the poor, who are really on the bread line, can go out and get education from the “market” for their kids.
In response to another comment. See in context »The differences in scale between the US and NZ make some things easier and some things harder. For example, if we were both operating on a single payer, universal access basis (fat chance!), you could probably justify twenty centres of excellence (of real world class) for cardiac disease alone, we would be struggling to justify one- yet in fact we have at least four, none of which therefore can really call itself a centre of excellence- same for renal, onccology, neonatal etc. We do have waiting times, and everybody bitches and moans about them if they are stirred up by the polis and the media, but the real truth is that we prioritise the serious stuff and it gets done, and a lot of the waiting times are actually needed to prepare the patient for the procedure in order to get a decent outcome at the end. People have ridiculous expectations. Having been diagnosed with occluded coronary arteries and made aware that the only hope for restoration of more or less normal cardio-vascular function is a five-way bypass graft, they then say that it is totally unacceptable to have to travel out of town for it! If the world was rational, all liver transplanting would probably be done in Tokyo (or somewhere), and the cost of getting patients there and back would be petty cash in the scheme of things. But if the world was rational blogging would not have evolved.
Cheers.
So, has the government told you that you have to wait for your bypass surgery or did they just say you had to have it where you live??? When I had mine, it was immediate. Of course, living in Los Angeles, I had no trouble getting to the right hospital for the surgery.
In response to another comment. See in context »Rick,
So far, I have not personally needed any major (life or death) surgery- I was speaking in parables based on my time as a health administrator. However, to answer your question- if you have a bit of angina in this country you are probably going to have to wait for free surgery. If you have a myocardial infarct you will get it immediately. If you have private health insurance, or enough money, you can have anything you want whenever you want (“need”) it- eg caesarian section rate among privately insured women 48%, non-insured 16%. Ob-Gyns who treat rich women like to go skiing in their weekends.
However, as I am sure you know, there is a black-and-white economic argument in favour of fence at the top of the cliff versus ambulance at the bottom. Making someone wait for a hip replacement until there is irretrievable spinal damage and complete loss of employability is dopey economics, quite apart from the questionable ethics. So, yes, health care (disease treatment) access in this country is rationed, but pretty much on the basis of clinical need and not ability to pay. Governments move the lines back and forth based on their ideologies, and this is oemthing that probably scares the crap out of a lot of honest Americans contemplating a bigger role for government in health care.
There is evidence to support the view that the private sector does a large amount of unnecssary surgery- eg varicose vein removal, some of which results in fatal complications- medical misadventure cover-ups are as common here as they are where you live.
In response to another comment. See in context »I would never want to hold up New Zealand’s approach as THE way to go for anyone else, but everyone could learn from nearly everyone else if we could get past our prejudices. I certainly do not see why your lawmakers in the USA should have a taxpayer funded health care service that is better than what ordinary citizens have- that’s how things are done in jursidictions that Americans (and many others)hold in extreme contempt. The only interpretation I can come to is that American politicians, with noted exceptions, hold the community they represent in even greater contempt.
And final point before I bore you to death, there is an even better black-and-white economic case for a safety fence inside the safety fence- ie for a disease prevention strategy that positively incentivises disease-avoiding behaviour. How to live healthily is no longer something that is known only to people in kaftans- there is now good science to corroborate what the kaftan people always knew, and practised. Question is, are we willing to dismantle our present absurd society in order to have one that can survive?
this definitely does not bore me.
In response to another comment. See in context »Is the NZ system similar to Australia’s where everyone is entitled to public health care but are incentivized to switch to private insurance?
Rick,
There are similarities between NZ and Australia, and close co-operation between the medical professionals, much of it good, and some of it anti-competitive and patch-protective. Your keen observation of the way the system works in Australia is well-put. Under conservative governments the pressure is always on to shift the entire system off the public books and onto the private ones. In Australia that is easier to get away with because the population is a lot wealthier per capita, and while I will get vilified for saying it, Australia doesn’t give a flying reproductive encounter about its indigent communities, indigenous or otherwise. We (NZ) have just (last Nov)come off nine years of a socialist government and they made enormous improvements to the public health system in New Zealand, all but eliminating wait times and reducing cost of access to primary care to next to nothing for almost everyone, but especially the young, old, and poor, in return for which they got thrown out on their arse. A year before that Australia turfed out their right wing putsch and are engaged in a cautious love affair with a kind of Tony Blair-flavoured Labor. My assessment is that New Zealand and Australia will diverge over time (not just in health care ideology), until New Zealand is flown into the tarmac by the Reaganites now in charge and we become, perforce (You’d call it Chapter 11), another Australian State- check back on this prediction around 2016.