Healthcare

[pecunium]

I'll admit it, up front, I have a vested interest in single payer (or, failing that sudden outburst of sense, a public option) healthcare.

Why? Because I am, pretty much, uninsurable without it. I have a "pre-existing condition, and if I can get on a policy I will 1: pay more, and 2: have to hope that I don't miss some single event, which is on file somewhere else, and get kicked out of my plan the moment I have some other condition show up; when my policy provider decides to engage in some retroactive recission.

That little trick (which is widespread and has second order effects [the settlement covers, "out of pocket expenses," what it doesn't address is treatment not gotten because the out of pocket expenses were too great for the affected to pay]) is evil.

You buy a policy, and when you go to use it, they cancel it. All of a sudden you are sick, broke, unable to get treatement and you may be on the hook for treatments you got when you were covered.

That doesn't happen in Canada. What also doesn't happen in Canada is the sheer level of expense. We, in the US, pay more, and get less than the Canadians, the British, the Japanese, the French, the Germans, the Dutch, the Swedes, the Swiss, etc.

I think the estimated increase in taxes for single payer is something on the order of 10-12,000 per person, per year. Maia is paying $14,400 a year for her plan.

She doesn't get to choose her own doctor. A bureaucrat decides what treatment she can get (and when they happen). She pays something obscene for drugs (I think it's full-freight for the first $600, and then 20 per scrip thereafter). She has had to go to other doctors to get treatments her provider refuses to give her.

She has to worry that some other bureaucrat will decide that her policy isn't making them enough money, and find a way to cancel it.

So, a 12,000 bite would save her money, and her level of care would go up.

Why? Because the system in the States is defective. It's not about keeping people healthy. It's about making money. Keeping people healthy is a small part of the pie.

My condition requires that I see a rheumatologist on a regular basis. It would be best if I saw a cardiologist once, or twice a year and got an EKG, and a cardio-sonogram. I need to take some drugs, every day. I sometimes have to see a dermatologist; which almost always means more drugs. I need bloodwork. All of those things are money. All of them would be a real hassle if I wasn't able, right now, to use the VA. They aren't, "neccessary." Right now most of them are to make sure things have stayed the same.

When I was first being treated, it turned out I am deathly allergic to the best knockdown drug for when I'm having a real flare-up. Walter Reed, in the first four days of my reaction, performed a spinal tap, 3 sets of x-rays, put me on oxygen, did three punch-biopsies of my skin, put in an IV; gave me IV potassium (twice), had five sets of specialists look at me, assigned an intern to keep track of me, assigned me a private room, checked my temperature every two hours, and did so much bloodwork I started sleeping through the draws, then did a broncocopy; and two pulmonary biopsies.

All to rule out infection, in case it was something other than the drug reaction which seemed the most likely problem.

They kept me in the hospital for another week after the symptoms were abated; in case my reaction had secondary complications.

Kaiser would have sho me full of steroids, right away, and sent me home.

A friend of mine hurt his arm while he was in England. He went to see a doctor (NHS is covered in the fees one pays to enter the country, so he was covered). The doctor palpated it and said, "I don't think it's broken, but lets do a CT scan, just to be sure." My friend said, "What, isn't that expensive?".

"Well, it's no good if we don't use it, so if it's free, let's take a look.". He had a minor fracture, and it was splinted up and he was on his way.

I had a kidney stone. They sent me for a CT scan to see how large it was, where it was, and how many there were. The place was empty. When she was done, the operator took a personal call for about five minutes (at which point I really wished I'd gotten another dose of fentanyl before I went).

The bill... 1,500 bucks.

For my entire stay in the ER getting treated for the kidney stone, about $9,000. It was four hours.

Sara Robinson, at Orcinus has a post up on the subject, Another country heard from with a lot more stories, facts, figures, etc.

Will the transition be trivial? No. At the very least a lot of private bureaucrats are going to be out of work. But the benefits (better health leads to a more productive economy, people being able to find new jobs because they aren't trapped in a sort of health-care peonage, extra money floating about in the system because people aren't spending extra thousands of dollars for plans which aren't keeping them healthy).

But the ad money for private plans will persist. The price will go down. Providers will have to compete, and they won't be competing with some other plan trying to make money, but with a plan trying to make, and keep, people healthy.

We can do this, but it's going to take work. It's going to require sticking your senators', your representatives', your president's feet into the fire, and keeping them there.

It's going to take letters to the editor, calls to the radio, e-mails to NPR, FOX, MSNBC, CBS, NBC, etc.

It's going to take blogging, and speaking out when people start spouting nonsense. It's going to take pushback. I don't have the millions of dollars Aetna, Blue Cross/Blue Shield have. No one is giving me airtime, and column inches to spout the healthcare industry talking points, the way they are giving those things to Michael Steele, and Ben Nelson, and Bachus, and all the rest of the shills for the status quo.

If we are going t beat that advantage, it has to be a drumbeat. This is the best chance we are likely to see for a while. The Republicans think it's their chance to "break" Obama, and smash the move to a more progressive public policy. Like Social Security they are terrified of really fixing heathcare, because it would show that somethings are best done by gov'ts, and that taxes /= wasted money.

We can do this. It will be hard, but we can do this. We have to do this.

Our lives depend on it.

Comments

[badger2305.livejournal.com]

I am fairly sure you will appreciate this missive at Daily Kos (http://www.dailykos.com/storyonly/2009/7/25/756972/-Dear-Mr.-President).

And you are quite correct about that drumbeat. Let's make it loud.

[jpmassar.livejournal.com]

Heh, saw that already, and it was excellent.

Here's my attempt at a DKOS diary and letter to Senator Feinstein (http://www.dailykos.com/storyonly/2009/7/26/758008/-Letter-to-Senator-Feinstein-on-Health-Care)

[kukla-red.livejournal.com]

I'm with you, all the way.

[swingland.livejournal.com]

what about those of us who can't afford health care no matter the cost?

people are quick to laugh and say, "oh geez, you can't afford 12K a year on health...hahahhaaha"

i can't. neither can most everyone else i know. i'm a student and i work on the weekends. unless the government wants me to drop out of school and work a menial job full time so i can just pay for healthcare, i don't really see ANY mandatory healthcare system being possible for me. if they give me a bill, i'll send it right back.

i'm surprised the level of support that the general public seems to be lending towards any sort of government backed healthcare system.

especially with the number of completely unemployed people in the country, how can any entity reasonably expect to levy an additional financial burden upon those without full time, well-paying jobs?

this is not about health at all. hell, most of the treatments that are practiced in standard western medicine are not even DESIGNED to cure illness, just treat symptoms.

i'm curious to what level of absolute ridiculous this will rise to? do you want the peasantry to have no other choice than armed revolution or would you like to line us all up in the poor house first? i'm starting to think the hobos have the right idea.

[pecunium.livejournal.com]

Are you aware that the "tax burden" in single payer is distributed?

So the figures are averaged out, becaue it comes out of the income taxes everyone pays.

So my income of 8,000 last year would still be taxed on a progressive rate, and Bill Gates income of umpty-bump million would cover me.

It's not as if this is a bill. The present plan (public option, everyone chooses a plan, and pays from after tax income) is going to hurt people like you, and me, a lot more than a single payer, from the general budget will.

Gov't needs to be involved because there are things Gov't does better. Libraries, schools, roads, healthcare.

If you don't belive the last, look at Medicare. Look at how it stacks up in satisfaction, and level of treatment, to private insurance. Ponder that the present system of healthcare for profit increases the costs; because of fraud.

Remove the limits (and the perverse incentives) and that cost goes away; which means the money is either saved, or goes into better healthcare.

Look at this post (Mythbusting Canadian Healthcare, pt. 2), and see how removing the profit motive from driving the system, changes (drastically) what gets researched. Contrary to Randists, and Republicans, profit isn't the be-all, and end all, of innovation.

[jpmassar.livejournal.com]

In theory, if you can't afford the premiums, the government will subsidize them (under the proposed legislation). That's where most of the cost (the famous 1 trillion dollars over ten years) comes from. And the issue is,
who or what is taxed and how to come up with that trillion.

[commodorified.livejournal.com]

As Terry says, if single-payer on the Canadian plan goes through, your overall health care spending will DROP. More of it will come off your paycheque/tax return. Less of it will go on your credit card. But overall spending will drop for nearly everybody and is unlikely to actuall increase for anybody.

It cannot reasonably be otherwise. If Canadians were spending 12 000 per capita *more than the US is already spending* on health care, we'd be feeling it in terms of standard of living.

We are not. We spend less per capita and get better outcomes, and that is with MUCH less in the way of economies of scale, given that the population of Canada = the population of California.

Meanwhile, - Terry and I were just discussing this on the phone, actually.

In real terms, between Canada, the US, and the UK, standard of living at any given time for a working person in any given situation (student, retail clerk, professional, whatever. Assume any person who moves between countries without changing occupation. This is a much better measurement than trying to figure wages against prices/taxes/user fees etc) is very nearly level. He thinks Canada and the UK have a slightly higher standard of living than the US, I think the US has a slight edge. We both agree that whichever one of us is right, the overall difference is too slight to actually pin down, and he reasonably points out that, given that the highest single cause of bankruptcy in the US right now is medical bills, there is infinitely more STABILITY in stanadard of living in Canada and the UK - BEFORE you take into account unemployment benefits/social assistance/other forms of government support to keep people from sliding down the scale.

So, no. It's not going to cost you more. It cannot reasonably cost you more. As a US resident you are already paying the highest health care costs in the Western World for your health care.

[soldiergrrrl.livejournal.com]

After seeing the absolute extremes of military healthcare, I'm not sure I really do want everyone to have to suffer through government healthcare.

That being said, I don't know what the right answer is.

[anton-p-nym.livejournal.com]

Not government health care. You don't want that, in all likelihood.

Government health insurance, amortising the risk over all 300+ million citizens and thus lowering each individual's premiums, is another matter. Think of it as a really, really big group insurance policy; insurance is one of those systems wherein "bigger is better" is roughly accurate.

That is the system we have up here in the Great White North, and though it's not perfect it's a lot less burdensome than what the HMO system has turned out to be in the States.

Come to think of it, the "nightmare scenario" raised by the anti-single-payer crowd (rationing of service, arbitrary denial of coverage, doctor and therapudic regimen selection by faceless bureaucrat) is terribly close to what you already have down there... whereas I get coverage whether I visit a doctor or a walk-in clinic.

-- Steve thinks the Canadian system stumbles the most on prescriptions, and coverage is biased to preventative and emergency care over chronic care (the latter is a bit of a mess here), but still wouldn't swap systems with any other nation in the Western hemisphere. (And most of the Eastern, come to think of it.)

[cjmr.livejournal.com]

I think the estimated increase in taxes for single payer is something on the order of 10-12,000 per person, per year.

Hang on a minute. Is that $10-12K per wage-earning/taxpaying entity per year, or per capita per year? Because there sure as hell is no way we could absorb $50-60K more per year in taxes for our five member/single wage-earner family.

[cpolk.livejournal.com]

The idea is that your *state* is the only insurer in town, and they cover everything, and pay for it out of state taxes, which might jack your state bill up 7%.

Yeah. that is a big chunk. How much more is it than a typical family of four's health scam insurance premium, anyway?

so with the state as the primary insurer, private insurers can go fuck their hats, or provide private coverage plans for *extended* health care, the way insurance companies in Canada do.

so you could, for example, have extended insurance to pay 50-100 percent of your prescription drugs, one to five hundred dollars worth of massage therapy a year, a budget for physical therapy and chiropractic appointments beyond the 13 already covered by your government health insurance, reimbursable expenses for the crutches you had to buy when you broke your ankle, 300 dollars in prescription eyewear every year to two years, that sort of thing --

and what I just described was a kinda mediocre work related health insurance plan in canada, or the kind of coverage I can get for fifty bucks a month on my own.

[benet.livejournal.com]

What seems most surreal to me about this debate is the wilful pretense, on part of defenders of the status quo, that one of the following false propositions holds:

a) Universal coverage through a two-tier system like Britain's, with government-administered, free health providers existing in parallel with private, for-profit health providers, has never been tried and is thus a Perilous Venture Into The Unknown.
b) Universal coverage through a single-payer system, like Canada's, where health providers are mostly private and operate on a for-profit basis, and the government acts as the insurer, has never been tried and is thus, too, a Perilous Venture Into The Unknown.
c) Where either path towards universal coverage has been taken, it has brought in its train either the utter penury of the nation in question, or an authoritarian Communist takeover eradicating all personal economic freedoms and civil liberties.

[cpolk.livejournal.com]

wrong spot. grr.

[cpolk.livejournal.com]

I simply do not understand how the most powerful industrialized nation in the world thinks it is okay to treat people as badly as they demonstrably *do.*

honestly. Every time I read one of these, I'm utterly boggled by the sheer stupidity and malicious uncaringness of the united states of america, and say aloud, "Thank you, all the gods that were ever imagined, thank you for making sure I was born a Canadian, because if i'd been born any further south I probably would have died long ago."

Canadian Health Care

[commodorified.livejournal.com]

So, as you know, Bob, iclysdale had his right kidney removed in 2004. He'd been having troubles since about 2001, of a hard-to-pin-down sort.

We'd been to a neurologist, a rheumatologist, and had countless GP visits (fully covered) when he went into his GP with suspected food poisoning (when the abdominal pain finally made itself known).

They took a look at him, suspected appendicitis, and shipped him off to the hospital by cabs (not covered) for [note: I was not in town for the next bit, the order of the incidents may be off but all of it happened] an MRI (done within an hour), looked at the results, said 'oh dear', drew some blood, and sent him up for a CT scan (within 45 minutes). Whereupon they noticed that his left kidney appeared to be more like an eggcup than like a kidney, scheduled an ultrasound for the next day, looked at his blood results and general condition, and slapped him into ICU with a load of fluids and Cipro and painkiller running into his arm.

After the ultrasound, they realised they couldn't give him an internal stent [boring details skipped over] so they fitted him with an external nephrostomy setup, got him stable and on a pain control regimen, and - after some discussion - sent him home to wait for surgery.

He could have had surgery immediately if we'd wanted to do it the old-fashioned way and crack his abdomen, but as this is far more major an traumatic surgery than a laproscopic removal entails, we [Ian, me, the doctors, all together] decided to wait it out.

This was February, and at this point we have spent no actual money. The province covered all proceedures, all nephrotomy supplies, and all meds given in hospital, Ian's work plan covered all other meds.

Ian was off work from the beginning of February to the end of August. 66 percent of his wages after the first two weeks were paid by the Canadian Government via Employment Insurance; it was made up to 80 percent by his workplace's Long Term Disability coverage, who also paid out Employment Insurance's aforementioned 66 percent to us direct and recovered it from the government rather than leaving us to deal with the two-week delay and the weekly paperwork.

We had a longer wait than planned: yes, there was a 'waiting list'. Everyone ahead of us had active cancer. Had Ian's condition begun to deteriorate, they would have moved him up if possible or else we would have gone ahead with the conventional abdominal surgery.

While waiting we had five rounds of IV antibiotics, numerous nephrotomy equipment replace/repair visits, a weekly visiting nurse, and six or eight rounds of oral Cipro.

So, eight months of fairly constant medical attention with a hospital admission at the front end and another one - plus surgery - at the end.

Oh, and a year and a bit later he developed an incisional hernia, which required an emergency room visit (covered) and more surgery (covered). No Long Term Disability this time, but the lost wages were about two weeks in total.

So because we had good workplace insurance, we were out of pocket 20 percent of his salary and some cabfares.

Had we had NO insurance we would have been out of pocket 44 percent of his salary plus meds plus some cabfares.

We ran into debt, but were out again by November. With no workplace insurance, we still would have been out of debt within a year at worst.

Without Provincial and Federal coverage, we'd have been bankrupt, at best. At worst, I'd be a bankrupt widow, because we wouldn't have been able to find the money to do the tests to find the problem in time.

We also learned a valuable lesson about "waiting times in Emergency Rooms". You can walk into any emergency room in Canada and go straight to the front of the queue, under certain circumstances. Having lived said circumstances, I can testify to this: You never, ever ever want to be that person. You'd FAR rather have time to read a medium-size novel.

Re: Canadian Health Care

[starcat-jewel.livejournal.com]

May I quote this, in toto, on my journal? I can remove names if you prefer.

Costs

[commodorified.livejournal.com]

British Columbia covers their health care via a 4 percent sales tax on everything except children's clothing and absolute base necessities. Once you have been in the province - and therefore paying the tax - for three months, you have coverage. Period. If you moved from another province, your three months was covered by your old province.

Until I was roughly 21, Ontario charged premiums: I want to say my mother way paying 150/yr for the two of us. There were provisions for low-income.

I don't know when it changed exactly, but I know I never got a bill as an adult. Premiums were reintroduced in the last few years, and are handled as part of payroll deductions, with various provisions for low income. If you're not working, you do not pay. I think we're still paying about 150/year to cover two people.

[izzydesan.livejournal.com]

My father and I were discussing this issue via email. He had a great idea for a Congressional poll and corresponding action. I quote:

"I would like to do the following -- require each congressperson and senator to mark and sign a ballot. There would only be two choices:
1 -- I believe that each American has a right to health care throughtout there [sic] life.
2 -- I believe that health care is a privilege for those Americans who can afford it.

Post the answers on a Website. If #1 receives the majority of votes, tell them to quit futzing around and just do it. If #2 receives the majority of votes, tell the poor people that they are going to remain in poor health and die early."

[commodorified.livejournal.com]

brown_betty has a has a post up in which she offers to Explain Canadian Health Care to all comers (http://brown-betty.livejournal.com/486534.html).

I've been trying to drop by and add answers to stuff when I get time, as have a few others.

[cpolk.livejournal.com]

Oh I better go there too and help out. thanks!

[dichroic.livejournal.com]

Re "we pay more and get less": After direct experience with three healthcare systems, I do not think the Dutch get more than Americans do (and from hearsay, I'm pretty well convinced this is true of the British as well). what they do have is *better distributed* healthcare. I have no complaints about my healthcare in the US, because I've always been lucky enough to have good insurance first through my Mom's job and then through my own. Where I have complaints is about the number of my friends who have either no coverage or completely inadequate coverage.

I have to say that I *do* feel like I get more care in Taiwan; partly because so many doctors' offices are within a hospital system here, when you go to get checked out for say flu, it's very easy (and cheap!) for them to take you right over for a lung x-ray and a test of lung power.

It's also true that even when you're not covered in other countries, the costs are far lower. (Direct experience again, in New Zealand, and in boththe Netherlands and Taiwan before my health insurance kicked in.) In Taiwan even if I choose a clinic that caters to expats (speaks good English, works on an appointment rather than walk-in system, is quiet, luxurious and uncrowded but *doesn't* take the national insurance) prices are low; I recently paid about $90 for an exam, Pap smear and 12 months of oral birth control. In the US, with insurance, the copays for the pills alone would be more like $120.

[pecunium.livejournal.com]

Depends on what you mean by, "get,". If I hadn't been in the Army, on active duty, and came down with Reiter's Syndrome... I'd be either crippled, or dead.

Because some 40 million people have no healtcare they don't pay (an inflated) full-price for. Some unknown number of millions don't have adequate healthcare (such as seniors who are trying to "fill the donut hole" in the Bush fils, "Plan B").

So at least 15 percent of the US is getting nothing. I'd wager at least another 15 percent aren't really getting enough (what with insurers cutting them, or raising their rates to levels they can't afford).

So, as a whole, all those people are getting more, because they are getting basic coverage, irrespective of anything else.

[pdlloyd.livejournal.com]

Very well put. I agree with you that we need a better healthcare system. I'd prefer a single payor system (possibly similar to the system in Taiwan, which is iirc based on our Medicare or Medicaid system), because I believe that would provide the best care for everyone at the lowest price. Still, at this point, every tiny baby step closer is closer and I'll take it.

[dichroic.livejournal.com]

Not sure that would work, except perhaps as one tier of a tiered system. When you go to the doctor in Taiwan, it's crowded and chaotic - more so than even an American urgent care facility, though possibly less than an emergency room. People often stay all day and sometimes sleep in the hospital room with their relatives and generally bring in food for them. I think it would be extremely difficult to get Americans to accept all that, expecially given that our attitudes to being in crowds are very different.

I will say, though, that if the waiting rooms can be pretty awful, the standard of actual medical care in Taiwan seems to me to be very high.

[therinth.livejournal.com]

This is how i've started to phrase it, to get it through to people:

http://therinth.livejournal.com/312113.html

If you aren't for nationalized health care, you want people to die.

[zeeth_kyrah]

Combine this with bradfitz's recent request to increase the supply of doctors (many qualified students are refused on artificial grounds in order to keep the supply low and therefore keep prices inflated), and we could return to the Golden Days where doctors were only an inconvenience to the prideful, and almost everyone had a family doctor whom they knew personally.

[qp4.livejournal.com]

Once I finished up with what I felt was my obligation to the Nation in fighting in a war I had to carefully evaluate my decision on whether to stay in Service. Obligation complete and all. One of the big ones, especially since I got married, is the health care thing. And I'd be pretty pissed to find out that I'm going to have to start paying for someone else's.

[dampscribbler.livejournal.com]

What pisses me off is insurance companies' executives getting six- and seven-digit incomes (or more) each year while Americans go bankrupt or die (http://abcnews.go.com/GMA/OnCall/story?id=3120743) because of the way the current system is structured.

Thank you for your service. I mean that sincerely.

[don-fitch.livejournal.com]

I think of it as a matter of "civilization". The concept of Rugged Individuality may have worked well back in the days of Conquering the Wilderness (or may have been unrealistic even then), but co-operation seems to be much more effective when the population density is as high as it is in most of the modern world. We -- as individuals -- are not nearly as much isolated islands as we used to be, and it makes sense to pool our resources. I think it is not -- selfishly-speaking -- to our advantage to have our neighbors (much less ourselves) impoverished or bankrupted (or dead unnecessarily) because of the high cost of health-care.

My own feeling/sense in this matter is that Single-Payer (aka "socialized medicine") health care is the best solution in terms of coverage (which does need to be universal) and quality, and I don't think we can afford to settle for less than (2nd-best) a Public Option system that includes tax-provided support for all those who can't afford to pay for it. Unfortunately, the private, for-profit Insurance businesses can easily afford to pay most of our Legislators enough to cause them to dismiss both these concepts.

[ceelee.livejournal.com]

Thank you, folks from Canada for letting us know how your system works..and other countries, too. It really helps to hear first hand experiences.

[mmegaera.livejournal.com]

You don't know me. I'm here via jaylake. But would you mind if I linked to this?

[pecunium.livejournal.com]

I would not mind in the least. I write to be read. If I make a public post, it's public. I prefer a link, so people can get context (not that I assume, ipso facto bad faith on the part of those who quote me, but I've screwed the pooch of context mangling, so I know it can happen by accident; contrary to intent), but you may link to me, freely; and without reservation, and quote me to illustrate.

[lyorn.livejournal.com]

Just to throw some numbers into the room -- I am in Germany, where health insurance is mostly mandatory (unless you are high-income or self-employed, in which case you can get private insurance instead), but handled by insurers and paid seperately from taxes. (It's a mess, btw.) Insurance premiums are a fixed percentage of your income, with an upper and lower limit on the absolute sum. Mandatory insurance covers the insurance holder, a stay-at-home spouse, and any number of kids or stepkids. Private might, or might not.

Upper limit is around 7200 Euro a year, of which, if you are employed, half is paid by your employer. (If you are unemployed, uppper limit will not be on your radar. If you are self-employed you have to pay full.)

Lower is (IIRC) around 1500 -- it assumes that you earn 800 Euro a month. If earn less, and/or if you work less than 21 hours a week for one employer, that will bite you: With less than 21 hours your employer won't have to pay half, and you'll still have to pay those 1500.

There are some co-pays, especially for drugs, which are limited to 2 per cent of pre-tax income (1 per cent if you are chronically sick). After that, the insurance has to pay.

Glasses/contacts and dental reconstruction are not covered. (You get the root canal for free, but replacement will cost you. I have a private policy for dental work that costs about 300 Euro a year, but I don't yet know if they will actually pay if something comes up.)

So, maximum per family (excepting glasses and teeth) is about those expected 10-12K USD, with a strong Euro. I guess, though, that creating a system from scratch and having to placate special interest groups might add to the price tag.