More on the Health Care Bills
The NY Post has a very good editorial on the health care bills (HT: Q&O). Too much good stuff to excerpt, it includes even more crazy provisions in the House and Senate bills I had not seen yet (its like a scavenger hunt as people go through the 1000 pages, or maybe more like searching for landmines).
But since the bill doesn't even start taking effect until 2013 (except for the higher taxes, which come earlier, of course), we have to really really rush and make sure its approved before the August recess (and before critics are able to actually read the thing - no chance those in Congress will read it, ever). Also, its such a burning problem, it just must be solved now, as evidenced by...
The most recent ABC News/Washington Post poll (June 21) finds that 83 percent of Americans are very satisfied or somewhat satisfied with the quality of their health care, and 81 percent are similarly satisfied with their health insurance.
They have good reason to be. If you're diagnosed with cancer, you have a better chance of surviving it in the United States than anywhere else, according to the Concord Five Continent Study. And the World Health Organization ranked the United States No. 1 out of 191 countries for being responsive to patients' needs, including providing timely treatments and a choice of doctors.
I have written a number of times, the fact that we spend more on health care is not a bug, its a feature. We are the wealthiest nation on earth, and there is only so much we can spend on food, clothing, shelter, plasma TV's and other necessities. We choose to spend a lot of that extra money on our health and longevity. Why is that a bad decision?
Craig Loehle:
The claim about costs being excessive (while partly true, maybe--there is surely waste in the system) is like saying we spend more on cars per capita than Uganda, so we must have a flaw in our car-care system. In Uganda if you have AIDS you die. Here we have treatment, expensive treatment, but you live.
July 21, 2009, 9:33 amFay:
You live if you have the money to live, or if your insurance decides to cover your illness. Period. That is the flaw.
July 21, 2009, 9:53 amAnon:
Fay: That would not be a flaw, it would be an improvement over the alternative (see Craig's point about Uganda, where all die).
But it is a strawman -- not many are dying for lack of medical care in the USA. On the contrary, the standard argument is that it costs too much to treat the uninsured in emergency rooms.
July 21, 2009, 10:13 amMethinks:
You live if you have the money to live, or if your insurance decides to cover your illness. Period. That is the flaw.
How does socialized government control fix this problem? In socialized medicine you live only if the government decides to treat you. Period.
That's why they all have private insurance - something which is illegal in Canada and they're trying to make illegal here. Those who can't afford private insurance die.
July 21, 2009, 10:20 amFay:
Uganda isn't the only alternative, you know. Neither is Canada.
And if you really think no one dies from lack of care in this country, well that's a nice little bubble you live in.
In the current US "system," you only live if your insurance company decides to let you get treated, or if you have the money to pay for it yourself.
There has to be a way in between.
July 21, 2009, 11:23 amTom:
Fay,
The "reform" that is going forward in the current bill hurts far more than it helps. That would be a wrong turn in most rational people's eyes. You seem to be indulging in fantasies about what the bill will do, and the probable impact on health care. I would strongly urge you to take a long, critical look at what is actually being proposed.
Oh, and regarding the following snark, "And if you really think no one dies from lack of care in this country, well that’s a nice little bubble you live in." So you're saying that the bill will magically correct this, and no-one will die from lack of care anymore? Well, turnabout is fair play: That's a nice little bubble you live in. See socialized medicine in, well, any country that's adopted it to date.
Last, regarding this, "In the current US “system,†you only live if your insurance company decides to let you get treated, or if you have the money to pay for it yourself." I call BS. I work in a border hospital, and those that come in, regardless of citizenship or ability to pay, are seen and treated just like everyone else. The issue is who pays for that. In our case, it's usually the county and the private patients. That is unjust, no doubt about it. But reducing access for the private patients is also unjust, don't you think?
July 21, 2009, 12:06 pmMethinks:
"And if you really think no one dies from lack of care in this country, well that’s a nice little bubble you live in."
Please burst my bubble, then. How many people die in this country because they are refused care because of a lack of insurance or ability to pay. How big is this problem so that we have to enslave everyone to the state to avoid it.
There has to be a way in between.
There is. You could start a charity and ASK people (versus FORCE them) to dip into their pockets to help those who cannot pay their medical bills. Churches and other charitable organizations do this all the time. Why, you could even reach into your own pocket. If you just can't accept anything that doesn't involve the government forcing compassion, then you could ask your legislators to drop costly state insurance mandates, allow people to buy and keep insurance across state lines and if they truly are too poor to buy even then, you could give them a publicly funded voucher so that they may choose their insurance.
July 21, 2009, 12:07 pmIronman:
"We are the wealthiest nation on earth, and there is only so much we can spend on food, clothing, shelter, plasma TV’s and other necessities. We choose to spend a lot of that extra money on our health and longevity. Why is that a bad decision?"
Believe it or not, even with that great wealth, there are diminishing returns to consuming additional medical care, which ensures that there is indeed a natural cap on the level of health care spending in the U.S.!
July 21, 2009, 12:19 pmNot Sure:
"In the current US “system,†you only live if your insurance company decides to let you get treated, or if you have the money to pay for it yourself.
There has to be a way in between." -Fay
If you know of people dying for lack of health care, nothing is stopping you from paying for them yourself, you know. You can even solicit donations from others if you'd like.
But that's not what's being considered.
The "way in between" is to force other people to pay, as though you know better than they do what their money should be used for. You'd have to be pretty smart (not to mention arrogant) in order to insist that you be free to do that, I'd guess.
And pretty dumb to think that congress and the president actually can do it.
July 21, 2009, 12:23 pmilovebenefits:
In car insurance we pay an uninsured motorist tax. In health care we pay as part of our premiums about $1800 per year to cover the uninsured. People get care if they go to a hospital. One of the issues is getting the uninsured preventive care and chronic care. However, if you take the $1 trillion dollars and ask the hard core uninsured whether that money would be better used to get them food and housing or health care what do you think their answer would be? Follow the healthcare debate at http://www.ilovebenefits.wordpress.com
July 21, 2009, 2:31 pmDr. T:
"We choose to spend a lot of that extra money on our health and longevity. Why is that a bad decision?"
Because you're not spending your own money on a less well-off stranger who wants to get good health care on your dime.
This massive bill will not improve health care or make it more cost effective. Its two purposes are to increase government power and to transfer wealth from the well-off to the middle class. Obama craves the first purpose and is buying off the voters with the second.
July 21, 2009, 5:44 pmDr. T:
Fay said: "And if you really think no one dies from lack of care in this country, well that’s a nice little bubble you live in."
I've been a physician for 20 years in urban areas. Please show me all these people dying from lack of care. ERs, by law, must treat every significant illness or injury regardless of whether the patient can pay. Most cities and many rural areas have free medical clinics. Some even have free mobile clinics that drive to underserved neighborhoods. Poor people get Medicaid and can seek care from nearly all clinicians.
The only lack of care deaths I've seen were non-institutionalized mentally ill people who would not go to a doctor, a clinic, or an ER. I have not seen or heard of deaths among persons who were denied care because they were poor, though I did hear of one case where a hospital ER told an ambulance to go to another hospital and the patient died en route. But, that was a logistics problem rather than a financial problem.
People like Fay take a few exceptional news stories and turn them into common patterns. Then they use those 'patterns' as justifications for federalizing health care. They engage in magical thinking and believe that NannyState will kiss the boo-boo and make it feel better. In reality, NannyState is an impersonal, control-freak. You don't want to make her bigger.
July 21, 2009, 6:03 pmrxc:
What Dr. T said.
ALso, note the comment in the NY Post that a lot of the funding is directed to setting up community organizations and review boards, etc. This is the establishment of a low-level nanny-state monitoring infrastructure that can be expanded to cover all sorts of behavior besides health care. It can be expanded to include the sort of "anti-social" behavior that the Brits have been trying to stamp out for about 10 years. It is control over your life, if you do not live the way the nanny-state wants you to "live".
More and more, I am coming around to the Jimmy Buffet philosophy: "I want to die while I'm living, not live while I'm dead". I think I may try to post this somewhere on the NY Times, and see what reaction it triggers.
July 22, 2009, 12:11 amBob Smith:
But since the bill doesn’t even start taking effect until 2013
If I were a conspiracy theorist, I'd be claiming that this is suspiciously timed so as to not affect Obama's 2012 reelection campaign.
July 22, 2009, 12:38 amFay:
Please note that nowhere have I asserted that the current administration's plan would be any sort of cure-all. I am only saying that it's crazy to pretend that the cost/affordability of health care in this country is not a problem, which is what the original post asserts.
And as for people dying for lack of treatment: I am not talking about walking into an emergency room. I'm talking about longer-term illnesses that first bleed the patient dry (often even WITH insurance), then ultimately kill him/her when all the money and benefits run out. I can think of four examples of this off the top of my head, just in my own daily (comfortable, middle-class) life. Yes, it's anecdotal. How many anecdotes do there have to be? Do you really think people are just making this stuff up?
Dr. T, have you never encountered anyone who first got sick, then could not work, then lost their job, then lost their insurance, then lost all their assets, and then died from the combination of the illness and the stress of it all? No? Well like I said... nice world you live in.
July 22, 2009, 7:00 amMethinks:
I’m talking about longer-term illnesses that first bleed the patient dry (often even WITH insurance), then ultimately kill him/her when all the money and benefits run out.
Fay....
I think you need to face a cold hard reality - eventually, you're going to die and it might be disease that kills you. If these people died of their disease despite draining their entire life savings, that means that no amount of modern medicine could have saved them. So, what you're proposing is that these people not only drain their bank accounts but yours as well so that they can continue to get ineffective treatment until their final gasp. Does that not strike you as stupid? No, you want them to drain MY bank account, not yours, since you obviously don't want to reach into your own pocket to help these people out. Your feelings are only strong if it's someone else who is forced to pay for it. Very compassionate.
No medical system can offer limitless medicine to hopeless cases. So, these people will still be cut off and die at some point - probably at an earlier point. That's if they can get in to see their physician to get a timely diagnosis. Otherwise, they die much sooner. In exchange for this, you rob everyone of their liberty.
The reality is that most of "the rich" in this country are not employees, but rather employers and the first thing to go when taxes are raised on them are jobs. It just gets better.
How many anecdotes do there have to be?
Enough to be significant. Where are these scary stats, Fay?
July 22, 2009, 7:20 amMethinks:
One more thing for you to consider, Fay....
You are relying on people like me to pay for this plan with a surcharge. I laugh. I've had a long and successful career and I can comfortably never ever work again. I simply won't accept the 10 percentage point hike in my taxes and I won't produce the income you're looking to tax. My employees will be out of a job, so they won't be producing much either (we're losing, not creating jobs in my field). If taxes or inflation continue to increase here, I'll simply buy citizenship elsewhere and my money will be out of reach of the IRS. Meanwhile, I'll happily pay cash to avoid Dr.'s wait lists and I'll still get much better care than you will. You do, of course, realize that these are not just my incentives but the incentives of everyone in my position - the very people you're relying on to provide you all this "free health care"?
The young folks not yet earning above $350K will have very little incentive to get above that mark since they can afford out of pocket healthcare at that income level and they won't be hit up for a health care tax surcharge either. So, they won't work as hard, won't produce as much income for you to tax and won't take the risk of starting their own business (a high tax rate reduces the reward, but not the risk), thus won't create new jobs. So, eventually, that tax surcharge is going to increase and creep down two the middle class. It'll have to increase because 5.4% of $1MM is $54k and 5.4% of $100K is only $5,400. You'll pay the surcharge (which, I bet is more than you pay now for healthcare) and you'll wait on long wait lists to actually receive rationed care (which in some cases is like not getting care at all).
Good luck. You're going to need it.
July 22, 2009, 7:42 amWill H.:
Fay said:
Dr. T, have you never encountered anyone who first got sick, then could not work, then lost their job, then lost their insurance, then lost all their assets, and then died from the combination of the illness and the stress of it all? No? Well like I said… nice world you live in.
While I'm not Dr. T but I do know people that got sick and then could not work, they went on disability. A Co-worker developed a problem that stopped him from working, he first was on short term disability then long term kicked in and also with that SSI kicked in. He is surviving and didn't loose everything, just his health. That's what disability insurance is for.
My sister became disable and unable to work. She went on SSI and has medical coverage through it. She is somewhat poor now, but she lives with my mother in a house I own.
Fay, we already have programs in place, both private and public, to cover the problem you addressed. Plus the health care plan in congress would make this worse, not better. They want to reduce the money spent on people not more.
July 22, 2009, 9:05 amK:
It appears that very few of any political persuasion think higher government revenue has a high moral value. Otherwise many more would give the government generous gifts.
The health care reformation is to depend upon both savings and on higher taxes for upper income earners. That makes me wonder why the higher taxes are needed. Why don't those with a lot of money just give it to the government?
The federal government and at least some states accept gifts. My state solicits right on the income tax forms. You can just fill in the extra amount you want to donate to the state.
Year after year only trivial amounts are received.
That is very puzzling considering the great wealth possessed by millions in the US.
I cannot explain why the government gets so few gifts. We know there are millions upon millions of prosperous liberals who insist taxes should be higher. In fact they insist that higher taxes are absolutely required for better government and for health care reform. Higher taxes are morally desirable.
Well, let me qualify that. Some higher taxes are morally desirable. Other higher taxes are not. Liberals understand the difference and know who should be taxed more.
There also are millions of prosperous conservatives who consider any taxes at least somewhat bad. Perhaps necessary but still bad.
But what has this to do with the negligible voluntary donations? Are gifts to government somehow morally repugnant to both wealthy liberals and conservatives? Why do groups that differ about almost everything agree about gifts to government?
Not too hard to figure out. Taxes are forced upon the payer. Gifts are not. A tax, especially one earmarked tax such as a surtax, forces the social wants of some to be paid for by others.
This can be seen clearly when we look at the high taxes on tobacco. They certainly weren't imposed by smokers. Most revenues are earmarked for specific causes. Those may be health care, anti-smoking advertising, etc.
Politically, people who disliked smoking outnumbered the smokers and made them to pay up.
At least tobacco taxes are avoidable. You quit smoking. That is really social mobility; you resign from a class heavily taxed and enroll in one more lightly burdened.
July 22, 2009, 1:59 pm