One of the issues the enthusiastic and empowered Democrat Congress has promised to take on is our national healthcare "crisis," where a significant segment of our population for one reason or another doesn't have adequate health insurance coverage.
We've been over this territory a few times before. Yes, there are close to 40 million people without health insurance in America. While a small number have lost their coverage or can't qualify for insurance because of preexisting conditions and genuinely need help, most of them are uninsured by choice. These are mostly younger people who fall in an income range between the truly poor and the middle class. They earn enough money that they don't qualify for Medicaid, but feel that the cost of health insurance is higher than they're willing to pay. The vast majority of this group are relatively young, working, but on a tight budget, so they choose not to get health insurance, even if they could afford it.
If you get a quote for health insurance you'll quickly discover that there are a lot of good options available. Even those with a limited need for health insurance can afford basic coverage with a high deductible. All they need to do is decide that having insurance is a priority for them. Many don't. They choose to roll the dice because they're young, healthy, and feel invulnerable.
The problem with this is that sometimes bad things happen to the young and healthy and they end up in the hospital without insurance and it becomes a huge expense for government and society. It also puts the uninsured person in the very difficult situation of depending on the government for the healthcare they may need just to stay alive and to eventually get their life back on track. That can mean catastrophic or long term care and it's very expensive. And what the government pays ultimately comes out of all of our pockets. So when they roll the dice they are gambling with our tax money, and that really isn't fair.
You'd probably like to see everyone insured so that if they get sick or injured they get decent treatment and don't become a burden on society. But what if the cost of this were the destruction of small business, massive unemployment, disaster for working families, gigantic tax increases for everyone, and an overall decline in the quality of healthcare? That's what the Democrats are likely to bring us this Spring.
Article comments
— go to most recent comments1 - Arch Conservative
"but as things stand right now we're closer than we have ever been to being sucked into a disastrous healthcare black hole."
Aren't you overreacting just a little Dave? You forget just how powerful big pharma and insurance companies are. I doubt that the vast majority Congresss, who owe their souls to capitalist lobbies would pass a government run single payer system? Not too mention the fact that despite all of our gripes about the current state of the system, socialism is just not a very big part of the American psyche.
Rather than pushing us all into that black hole Dave, I think the new congress will continue to tinker with Medicare, Medicaid and promise more aid for state programs.
What people fail to realize is that there is no utopian healthcare outside the system the US and that there are some aspects of our system that are superior to other nations.
For example the Canadian system, which has private providers but the government as the lone payer has it's own problems. Over the past 20 years or so the Federal government in canada has been cutting back on the funding that they have been providing to the provinces which have their own healthcare systems. This has led to a decrease in resources which in turn has led to long waiting lists for procedures, shortages of hospital beds and other adverse side affects.
The British system which is owned and run by the government is funded by taxes far higher than our own and consists of outdated infrastructure. British hospitals are much older and more rudimentary than American ones. Many of the newest and most sophisticated treatments are not available in the British system.
it's fair to say that for those who can pay for it, the American healthcare system is by far the best in the world in terms of technology, being on the cutting edge of medicine, having the most resources and in expediency.
2 - Zedd
Dave
I sense that the doom and gloom is more like wishful thinking on your part.
3 - Zedd
Dave
You don't know what you are talking about regarding the insurance issue...
I am living the challanges of that nightmare. I have a pre-existing condition which is costing me a fortune. The most recent example.... 3 weeks ago, my situation was life threatning and I HAD to go the the hospital or lights out... One day, just one diagnostic procedure and a transfusion...6K out of pocket. I have to get an important procedure in a couple of weeks 15K out of pocket. I have kids who will be in college soon.....
I wont define my person status on this forum but the way the system is set up is cruel.
4 - Dave Nalle
Aren't you overreacting just a little Dave? You forget just how powerful big pharma and insurance companies are. I doubt that the vast majority Congresss, who owe their souls to capitalist lobbies would pass a government run single payer system? Not too mention the fact that despite all of our gripes about the current state of the system, socialism is just not a very big part of the American psyche.
Ordinarily I would agree with you that the risk is small and one of the alternative systems I suggest would have a better chance of passing, but with this 'hundred hours' bullshit Pelosi is promoting I see a lot of legislation getting passed with very little thought behind it. It's like the brakes are off and the socialists think they can ram through whatever they want with no accountability.
Rather than pushing us all into that black hole Dave, I think the new congress will continue to tinker with Medicare, Medicaid and promise more aid for state programs.
That's probable, but it sucks almost as much as what I suggest. Tinkering with fundamentally broken systems is not going to fix them.
As for the rest of your comments about problems with systems in Canada and Europe, they're pretty well documented. There's a reason why Canadians come to the US for prompt, competent care if they have the money, and an awful lot of Brits end up in Hungary or India getting care when and how they want it at a reasonable price.
Dave
5 - Dave Nalle
I sense that the doom and gloom is more like wishful thinking on your part.
Zedd, I'm entirely in favor of healthcare reform. I'm just terrified by the form it will take with the demosocialists in power.
You don't know what you are talking about regarding the insurance issue...
Well, someone doesn't.
I am living the challanges of that nightmare. I have a pre-existing condition which is costing me a fortune. The most recent example.... 3 weeks ago, my situation was life threatning and I HAD to go the the hospital or lights out... One day, just one diagnostic procedure and a transfusion...6K out of pocket. I have to get an important procedure in a couple of weeks 15K out of pocket. I have kids who will be in college soon.....
I wont define my person status on this forum but the way the system is set up is cruel.
It's not cruel, it's impersonal, though it may seem cruel from your perspective.
Your example is important, because it's the one aspect of the problem I didn't address in the article.
There are people who are being denied care because they have pre-existing conditions. They're fewer in number than those who are uninsured by choice, but they are more needy and more deserving of some sort of assistance.
If there's going to be reform, it ought to start with finding a way to extend medicare benefits to those who cannot get insurance, even if they have some means. Getting sick should not mean bankrupting yourself when you can't get insurance through no fault of your own.
Dave
6 - Clavos
Nice report, Dave.
Some observations from direct experience with today's Medicare system:
At present, Medicare is for the elderly (65+) and those on Social Security Disability Income (SSDI). It's not means tested, and it's not for the poor. That program is Medicaid.
Medicare, though administered by the government, which also pays the premiums, uses commercial insurance companies as the carriers, so the commercial insurance industry gets a substantial amount of business from the plan.
I don't think amplifying it to cover everyone in the country actually will result in widespread bankruptcies in the health insurance business; they'll just start receiving the premiums from Uncle. They do have a helluva strong lobby.
Also, as currently structured, Medicare only pays 80%, so there's a considerable market in supplemental insurance.
Because of the government's ineptitude and sloppy business practices, most physicians accepting Medicare patients are doing very well. It's ironic, because when Medicare was first proposed, the physicians (and of course, the AMA) were solidly against it.
On another thread I recently gave an example, which has to do with my wife's wheelchair of how the government is currently operating Medicare:
Medicare paid $4,500 for her wheelchair and waited eight weeks for delivery. Meanwhile, I went on the manufacturer's web site, "built" the identical (same brand) chair for $2100, and the site promised delivery within ten days.
I don't see that changing.
7 - Clavos
There are people who are being denied care because they have pre-existing conditions.
Only those who leave a group plan and don't go to another group plan. It's against the law for a carrier to use that excuse if you go from one group plan directly to another; for example, when you change employers.
8 - STM
Dave Nalle wrote: "You'd probably like to see everyone insured so that if they get sick or injured they get decent treatment and don't become a burden on society. But what if the cost of this were the destruction of small business, massive unemployment, disaster for working families, gigantic tax increases for everyone, and an overall decline in the quality of healthcare? That's what the Democrats are likely to bring us this Spring."
Just to put your mind at rest, Dave, and coming from a country that has had universal free health insurance for many, many years - none of those things has happened (apart from the usual balls-ups you expect of the hospital system).
The good thing about it is, you can top it up with private insurance so that you can stay in the private hospital system, or if in a public hospital, get the doctors of your choice and a room to yourself.
Rather than leading to unemployment, it has created plenty of jobs. The tax increases? I am in the very top tax bracket. I choose to have private insurance as well as Medicare (which all citizens have), and my Medicare levy in my tax is $1000 year - hardly noticeable, really in the great scheme of things).
That levy goes down on a sliding scale depending on what your earn. People in the lower tax brackets pay a nominal levy or no fee at all.
Universal health insurance is a huge load off your mind. An example: I recently had three lots of kidney surgery. My out of pocket expenses for the whole shebang, including private hospital stays, and a world-renowned professor in the field, was about $250.
The reason: what Medicare doesn't pick up, your top-up health insurance does.
It's nice to know too that I can just take my kids to the doctor if they're sick and it doesn't cost me a cent, even for stuff like X-rays and blood tests. I just take my Medicare card and they run it through like a credit card.
It's all good, and would be revelation to most Americans who have laboured under this nonsense for far too long.
People might also then come to realise that the cost of most medical procedures (and many doctors' fees) and life-saving drugs are way overpriced.
It is really nice not to have live in fear of getting sick, and it's also nice to know that the paltry levy you pay looks after your countrymen and women who aren't quite as fortunate as you.
9 - Dave Nalle
There are also those people who've never been insured and get sick and decide they need insurance after they're already sick.
Dave
10 - Dave Nalle
STM, your system sounds great, but somehow the math isn't working out the same way here in the US.
You pay $1000 in taxes for your national health care? Based on the plans mentioned in this article the average American will pay $3000 for their coverage.
That's the heart of the problem. There's not much point in going to a single payer system if it's not going to be cheaper than private insurance. For $3000 a year you can get coverage equivalent to Medicare or actually a bit better right now without going through the government at all.
Dave
11 - STM
As for Arch's ill-informed comments about the US having the world's best and most advanced health system, and yes it IS good in some ways, but as for the rest: sorry, but it's bollocks, mate.
You don't know what you're talking about. My wife works in one of the world's top heart-lung transplant units. It's in a public hospital, and it doesn't cost a cent to go there if you're sick. There is no waiting list here for life-saving surgery, or surgery that will improve quality of life, and most other procedures have a short list. Unless, as I said, you choose private cover as well. Then there's no wait at all.
You can have such a system in the US if you choose, and it's not socialism. It's about community, and that's a different thing altogether.
12 - Clavos
For $3000 a year you can get coverage equivalent to Medicare or actually a bit better right now without going through the government at all.
For the record. My private insurance (just for me, because my wife has Medicare, but it also pays her 20% mentioned above) costs $9600 a year ($800 a month), and that's with a LARGE employer group (my wife's). Most of the people I know with comparable insurance are paying at least $700+/mo.
It's about comparable to my wife's Medicare, except it pays 100% on hospital stays, has office visit copays of $35-50, (she doesn't) and pays for meds, with a copay of up to $55 for a month's supply. Medicare doesn't do nearly as well with meds, and until recently didn't pay them at all.
13 - STM
"You pay $1000 in taxes for your national health care? Based on the plans mentioned in this article the average American will pay $3000 for their coverage."
It's because I chose to take out private cover as well, which gives you a tax rebate. Had I not done so, I would be paying a surcharge on top of my levy that, yes, would have taken me up to about that amount. Close to it, anyway.
I like the idea of a combination of the two. I pay $25 a week private family hospital and medical cover (covers all of us) on top of my yearly Medicare levy and it gives us the very best in a combination of private/public health care.
I suspect that is the kind of system that will be available in the US, but the fear mongers are making it sound otherwise.
My taxes are probably a bit higher than yours anyhow generally, so a fair bit of the general tax income federally goes back to the states for public health care.
Mate, honestly, it's worth thinking about and perhaps doing: no-one's a loser with this stuff ... least of all, and most importantly, the patient
14 - STM
Sorry Clav, I have just had a look at my pay packet ... my private cover went up a bit recently to a tad over $30 a week. I don't even notice it really as it seems to be indexed, comes stright out of my pay pre-tax, and I only pay attention to what's left after every bastard including the government have dipped their fingers in the pie.
15 - Dave Nalle
Clav, your insurance seems extremely expensive, but I'll need to go over our packet again. I know esurance.com is giving lower quotes for Medicare comparable packages. We're paying slightly less than you are last time I checked to insure 4 of us. Perhaps the fact that we're slightly younger makes some difference.
If you have the time go on esurance.com and see if you can match your plan. I'd be curious to see how the quotes compare.
Oh, and STM. If you're paying $1000 to the government plus $30 a week for your supplemental, then you're paying a total of over $2500 a year for insurance. Still better than what they're proposing in the bills I discuss in the article, but not as much better.
Dave
16 - STM
Dave wrote: "Oh, and STM. If you're paying $1000 to the government plus $30 a week for your supplemental, then you're paying a total of over $2500 a year for insurance. Still better than what they're proposing in the bills I discuss in the article, but not as much better,"
All true Dave, and I don't have a problem with it - but as I keep pointing out, it's nice to know that my money contributes to a system that ensures anyone who gets sick also gets first-class help, and without being sent to the wall.
Like I say, it's not socialism, it's about community - and a fair go for everyone, which is one of the things I love about Australia.
17 - STM
And it very similar to the system you yourself are proposing ...
As an aside, the Health Insurance funds here have not gone out of business. The opposite: they have expanded their products into such areas as holistic and alternative health care (chiropracters, gym memberships, etc).
Americans are the people with the can-do attitude: You CAN do it, somehow, and without all the dramas you are foreseeing.
18 - STM
This a pretty good breakdown of our Medicare system and explains how it all works, and addesses some of the political issues as well.
I realise we are different countries, but we are also very similar countries (apart from size) and we have been through the mill with this after it was introduced in the early '70s and have just about got it to the point where it is right.
There is no reason why the US shouldn't have a system like this one, or similar, and would benefit from not having to go through all the mistakes we have made.
Nothing is ever perfect, BTW, but I reckon this system is as good as it gets.
This has become like your "third-rail" of tax breaks on mortgage payments - any government here that now tries to dismantle this popular scheme would be committing political suicide.
19 - Zedd
No Dave, it is cruel. Again you don't live it. “Impersonal” doesn’t qualify as a definition for how this system affects real Americans.
My father contracted Diabetes and a heart problem and fell into the pre-existing condition slot. He was in his late 50’s. For the next 10 years my parents struggled, spending all of their retirement on medical costs, where an aspirin in the hospital could cost you $7. He had 3 heart attacks, a couple strokes and continued to suffer from the complications of diabetes. He died ten years later leaving my mom penniless with a stack of bills. These were two people who never received public assistance; hard working patriotic Americans. My Dad had a bronze eagle in his office, an American flag with a plaque with the words “these colors don’t bleed” below it. He died without a dime. My mom is in her 70s and is still having to work….. she is tired.
Dave this is not a tit-for-tat tennis match where whomever has the best come back wins. You are talking about peoples lives. Real Americans, by the millions who are affected tremendously by this issue. Since it hasn’t touched you severely enough, you see it as mere impersonal. I don’t think that many people care about how personal a system we have, we need an affective one that serves the people of this “greatest country in the whole world”.
Also your partisan obsession does seem to direct you towards a wish for a catastrophic outcome. Since the Republican Revolution when the paranoia that you will deny your infected with, was supplanted in the minds of many like yourself, there has not be a Democratic calamity. The Dems have not overhauled anything and let the country down a disastrous path.
However as you know, the Republicans have been the spenders, giving us an unimaginable deficit while not providing any tangible benefits to the public (not improving the quality of life for most Americans). What we have noticed however are record high salaries and parachute packages for CEOs.
Yes Dave it seems that you would relish a major fiasco even though you profess to love this nation.
The examples that I gave constitute what I am contending with, just within one month, they are certainly not the entire story. I wont go into that……..
20 - Dave Nalle
All true Dave, and I don't have a problem with it - but as I keep pointing out, it's nice to know that my money contributes to a system that ensures anyone who gets sick also gets first-class help, and without being sent to the wall.
All true, but my concern is that you're getting it at such a low price. Why is it that our lawmakers can't seem to figure out a way to do it at a similarly low price? They're coming in at triple what you pay and that's without even counting the supplemental insurance which this system will need just like yours does.
And it's that supplemental insurance which is the key to keeping the economic problems at bay and getting it passed over the objections of the insurance companies, and given their behavior I can see them raising prices on supplemental insurance to cover their losses and the whole thing ballooning out of control.
Like I say, it's not socialism, it's about community - and a fair go for everyone, which is one of the things I love about Australia.
Whatever you call it, it's still socialism. Some socialism isn't so bad when it genuinely does originate in the community. We ought to be developing more healthcare coops. That's grassroots socialism where people provide for their own healthcare and bypass the government alltogether. I'm all for that.
Americans are the people with the can-do attitude: You CAN do it, somehow, and without all the dramas you are foreseeing.
I think we can do something about the problem too, but drama is inevitable.
Dave
21 - S.T.M
Dave wrote: "All true, but my concern is that you're getting it at such a low price."
Federal tax money from general tax revenue (GST mostly) is returned to the states for health care funding.
It can't be run purely on the levies and surchages we pay, and as I explained I get a tax break even on my original levy.
Read the link I have included in one of the above posts and you'll see how it works as a combination of private/public care.
22 - Dave Nalle
No Dave, it is cruel. Again you don't live it. "Impersonal" doesn't qualify as a definition for how this system affects real Americans.
I don't live it, but color me skeptical. For it to be cruel there would have to be intent to do you harm. Are you saying that the insurance industry designed their system specifically to hurt people rather than just to make money? I'll agree it's heartless, but that's a far cry from deliberate cruelty.
Dave this is not a tit-for-tat tennis match where whomever has the best come back wins. You are talking about peoples lives. Real Americans, by the millions who are affected tremendously by this issue.
I agree, and I've seen the problem first hand. There are clearly flaws in our current system that need to be addressed. I acknowledge that in the article. The question is whether this approach is the answer.
Since it hasn't touched you severely enough, you see it as mere impersonal. I don't think that many people care about how personal a system we have, we need an affective one that serves the people of this "greatest country in the whole world".
The problem is that the system isn't designed to 'serve the people', it's designed to make money and provide a paid service. It's not inherently altruistic. Like I said, it's impersonal and uncaring.
Also your partisan obsession does seem to direct you towards a wish for a catastrophic outcome.
No, it's a FEAR of a catastrophic outcome. Big difference. And there's nothing partisan about it. The numbers just don't add up.
Since the Republican Revolution when the paranoia that you will deny your infected with, was supplanted in the minds of many like yourself, there has not be a Democratic calamity. The Dems have not overhauled anything and let the country down a disastrous path.
They haven't been in power until now, and it only has to happen once for it to be catastrophic.
However as you know, the Republicans have been the spenders, giving us an unimaginable deficit while not providing any tangible benefits to the public (not improving the quality of life for most Americans). What we have noticed however are record high salaries and parachute packages for CEOs.
This is a false analogy. Nothing the Republicans have done is a justification for disastrous mismanagement from the other side. This is like saying that because the Republicans shot you in the arm it's okay for the democrats to shoot you in the leg.
Yes Dave it seems that you would relish a major fiasco even though you profess to love this nation.
Again, I'm not cheering for disaster, I'm concerned about it. The difference should be obvious.
Dave
23 - Nancy
Dave, love the hat, and generally enjoy your writings - except when you start nattering on the state of health care & economics for the bulk of us working stiffs, in which case you clearly exist in some kind of odd zone having no connection to reality. Perhaps it's a touch of the BushCo Unreality Zone contaminating you from Crawford. In any case, you clearlyhave no conbception of how life is lived by The Rest Of Us, most of whom can not AFFORD (as opposed to 'choose not to buy') medical coverage - not when the alternative is the rent, car, & food. We aren't talking making a choice between health insurance & giving up Outback Steak House once a week here, Dave, we're talking stiff health care payments PLUS considerable & outrageous out-of-pocket payments up front, OR do we pay the mortgage & stay off the streets or out of the shelters sort of choices. You keep denying this is the situation, that YOU pay only a few dollars for some kind of utopian coverage, & if you can do it, so can everybody else. As I've said before, you live in some kind of fairyland. I can guarantee you, your options (and truly, I'm thrilled for you, I really am, that you're that fortunate) are NOT available to most of The Rest Of Us, if they exist at all. When someone is bringing home a paycheck of $300 a week, there is NO ROOM for extras such as health insurance - NOT in most areas in the US where the basic cost of living is so high.
You've provided figures from your own budget & living expense costs for your area before, Dave, and frankly, you live in some sort of Bermuda Triangle. You sure as hell don't live under conditions common to anyone else I know or have ever met, online or off.
Stick to writing about politics or bumper stickers, Dave; when it comes to money, you've got all the credibility of W. recalling his aircraft piloting days.
24 - Nancy
Excuse all the typos; my carpal tunnel is bad today.
25 - Maurice
You've got it backwards, Nancy.