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 08:24 pm (UTC)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.
no subject
Date: 2009-07-26 11:58 pm (UTC)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.
no subject
Date: 2009-07-27 01:30 am (UTC)For comparison, I've got 80% prescription coverage, $200/yr optometry, 80% dental coverage, medical devices entirely reimbursable, physio coverage, short- and long-term disability, and a bunch of little bennies like the policy also covering emergency medical costs when out-of-country including air ambulance back if necessary. (All of this above my government basic coverage, which handles primary care and emergency care and surgery and hospital stays and in-patient expenses and etc.)
My share of the co-pay is $8/month. The company picks up the other ~$30. (It'd be more if I had dependents to cover, but not a lot more.)
Oh, by the way, the insurance company's still making money.
-- Steve does have to declare that $30/month copayment as a taxable benefit, though. Such is the crushing burden of socialism. *swoon*
no subject
Date: 2009-07-27 03:16 am (UTC)three hundred and sixty bucks? oh, okay.
no subject
Date: 2009-07-27 12:39 am (UTC)Yes, income tax rates need to rise, but the average person, and the average employer, will see the total expense they have (tax vs. payments to a private company) drop.
no subject
Date: 2009-07-27 01:16 am (UTC)The end result should be more money left in taxpayers' pockets.
-- Steve sees folks all too often assuming that the tax hike would be on top of what they're already paying... and if that were true then of course they'd be right to reject single-payer. But it's not true.
no subject
Date: 2009-07-27 11:14 pm (UTC)no subject
Date: 2009-07-28 12:39 am (UTC)Yes, taxes will go up in a single-payer system.
However, you won't have to pay an HMO premiums for coverage of basic services (like doctor's appointments) or emergency services.
The increase in taxes should be less than the premiums you were spending, especially given the efficiencies available (http://content.nejm.org/cgi/content/short/349/8/768) when you reduce the number of providers (and, thus, sets of claims forms practitioners and patients have to fill out) from 130 to 1.
-- Steve pays a lot less than Americans with equivalent coverage; some of that is from the larger "pool" of insured spreading the risk out more, some of that is from lower overhead, and some of that is from not having shareholders demanding ever-increasing dividends and executives demanding ever-increasing bonuses.
no subject
Date: 2009-07-28 01:15 am (UTC)And I really don't expect my employer to say "Hey, since we don't have to cover insurance for you anymore, we're giving everyone a raise." Which means my so called benefits go down.
After time on Active Duty, and watching the hassle my soon to be father inlaw goes though to get repayment from Medicare(he's the only practitioner in his specialty left in town that still accepts it, because he feels an obligation to do so...one of the few honorable men I know in that regard. And his rates are the lowest in his specialty in the state and still only gets 1/3rd to 1/2 reimbursement from then) I have little faith in government to do anything but thoroughly screw things up.
no subject
Date: 2009-07-28 02:36 am (UTC)Up here, every citizen qualifies.* That was the point of us going to a single-payer system... and the reason I look at proposals for a hybrid or parallel system for the US a bit askance. The idea is to have one big pool of funds covering the entire risk pool and thus diluting the average risk of each insured; splitting it up into smaller sub-pools defeats that purpose.
And I really don't expect my employer to say "Hey, since we don't have to cover insurance for you anymore, we're giving everyone a raise." Which means my so called benefits go down.
Then your employer sucks, which is a problem you can't address with any sort of health plan. My employer went all fuzzy-pinko and offered us cubicle monkeys a profit share program as a retention bonus, something they could afford in part because the premiums they pay for employee health insurance are as low as they are. I'll never get rich on profit sharing, but the extra month or so of wages that adds to my income makes it easier to build up the retirement portfolio.
Sticky fingers in the boardroom is an issue for a different batch of legislation... or a change of employers, at least when things have turned around a bit more.
I have little faith in government to do anything but thoroughly screw things up.
Then stop electing friendly faces you want to have a beer with, and start voting for candidates based on their abilities.
-- Steve thinks that Americans, who bathe in the "government of the people, by the people, and for the people" rhetoric in their interminable elections, should be careful when blaming their government for their ills.
*Some non-citizens also qualify, but I don't know precisely how that's handled.
no subject
Date: 2009-07-28 04:34 am (UTC)Because every day you are the beneficiary of things the gov't did, and does, which aren't screwed up.
You get your groceries on roads they built, and maintain. Those groceries are, generally, reliable and safe; because the gov't sets standards, and eforces them. A gallon of gas from the pump is a full gallon, because inspectors from the gov't's departments of weights and measures check them.
Your doctors are certified by government boards, you get power because the gov't arranged for it (and before it was privatised, we paid less for it).
That's just a short list of the everyday things gov't has done for you.