Healthcare
Jul. 26th, 2009 11:27 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pecuniumI'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.
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.
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no subject
Date: 2009-07-26 07:56 pm (UTC)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.
no subject
Date: 2009-07-26 08:04 pm (UTC)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.
no subject
Date: 2009-07-26 11:52 pm (UTC)who or what is taxed and how to come up with that trillion.
no subject
Date: 2009-07-27 02:24 am (UTC)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.