Ellington

I recently read a comment by a reader in a local paper that set me back on my heels. The post was in response to an article on the effects of the proposed hospital tax on insured and uninsured patients. The reader wrote:

"I would prefer the poor do what my family does for health care. If we can't afford non-emergency care, we don't go to the doctor. If it is an emergency, we go into debt. Currently we need about $5000 in non-emergency care that we have delayed for over a year already. That is what people do who make too much money for Medicaid but can't afford the medical bills."

Whether this person is telling the truth or not, I don't know, but I'm inclined to believe them because I've heard too many iterations of this same belief before. And therein lies the problem with health-care reform in Mississippi—many people have come to the frustrating conclusion that there are those who "deserve" health care and there is that unfortunate group of people that don't. That unfortunate group makes up approximately 20 percent of Mississippi's population, or about 572,000 Mississippians, according to the Kaiser Family Foundation State Health Facts. Of these uninsured, 133,000 are children. It falls to this group to suffer the consequences of tragic health outcomes and, according to the reader above, rightfully so.

How did we get here? When did health care become a luxury only to be bestowed on those who can afford it? More importantly, how can we move past this troublesome premise? The answer must start by eliminating two of the more pervasive myths about the uninsured. Let's start with the one in heaviest rotation: the assertion that the uninsured are poor people who have their priorities out of order and choose not to pay for health insurance.

The uninsured poor are not poor people in the way that many people would like to characterize them. They are the working poor. According to a report issued by the Mississippi Economic Policy Center, nearly four out of 10 Mississippi families with children go to work every day and still remain low-income. More than 55.3 percent of Mississippi's uninsured children are in families that have at least one parent that works full time, year round. Their incomes, many times from two or three jobs, are simply not sufficient to provide health care for their families. With the economy deteriorating, it stands to reason that without some significant reforms to health care, this trend will only worsen.

The second assumption is that the uninsured constitute a "separate" group that has no effect on the rest of "us." Anyone who has seen a hospital bill recently knows that couldn't be further from the truth. The Mississippi Legislature has been in a contentious battle for the past three years precisely over this point. There has been an attempt to tax all hospitals to make up for a revenue shortfall in Medicaid.

However, because the hospitals are buckling under the weight of increasing uncompensated care costs, they are unable to shoulder much more financial obligation. Uncompensated care is care that the hospital provides for those who are uninsured. When these costs go up exponentially as they are now, not only do hospitals have to shift those costs to those who are insured, but it also affects the services that they can afford to provide. If hospitals cannot meet their bottom lines, many have no choice but to shut down critical services such as emergency room and obstetric care. Health-care costs are going up at an unsustainable clip and by ignoring the uninsured, in the end we all pay.

The Robert Wood Johnson Foundation has designated this week "Cover the Uninsured Week" to bring attention and awareness to this increasing problem. It has been an annual event for the past seven years. Organizations all over the country are hosting events such as health fairs, Medicaid enrollment drives and policy forums to hold leaders accountable. To make the critical step toward moving beyond this poisonous thought process, we must encourage those in our circle of influence to get involved in the push for reform. We all know at least one person who is struggling with securing health care for themselves or their loved ones.

President Obama has put forth a substantive agenda to get health care reform started this year and we can no longer afford to sit on the sidelines. Call your legislators, write letters to your paper, hold community meetings—do what you can to bring this issue to the forefront of leaders' attention. There are an estimated 46 million uninsured people in America, and they don't deserve to go without quality, affordable health care. It is unacceptable that in 2009, it is considered virtuous to suffer financial ruin or even die because of lack of money to treat an illness.

If it's acceptable, then we're sicker than I thought.

Jacquelyn Agho is the program manager for the Mississippi Health Advocacy Program. Please visit http://www.mhap.org for more information on how to get involved.

Previous Comments

ID

145211

Comment

I see that you picked up on the remarks that I had made in response to the hospital tax. I would like to respond to one of your statements: "How did we get here? When did health care become a luxury only to be bestowed on those who can afford it? " You imply that at some prior point in time, health care was not a luxury. As far as I know, health care has always been purchased in this country, when not delivered by a charity. I come from a long line of doctors. A hundred years ago, my great-grandfather accepted payment in the form of cows, hogs, and chickens from those who could pay. He accepted labor and promissory notes from those without other means. I assume that he also provided charity care, but we have no records of those as we do of the receipts for the livestock and notes. Today, most doctors don't take those methods of payment, and most patients are expected to pay at the time that services are received. I'm not really sure what the uninsured do, because my family has health insurance. It just doesn't cover very much. I pay over $500 a month for four people, with a deductible of $500 per person and a coverage rate of 80% of allowable charges. It works out to about 60% of actual charges. This means that I pay over $7500 for a calendar year before my insurance pays a cent. I also have a medical savings account that allows me to put money aside before taxes to pay for these unreimbursed costs. I put aside the maximum of $2400 a year because I know that we will use at least that much to meet our deductibles and pay for our co-pays. Even so, I have two teeth that have needed replacing for over two years because other costs have had priority. So my family purchases the health care that we can afford. Last week that cost almost $500 for one child with an emergency situation. That almost met one deductible. A few days later, we took our other child to the doctor after he had been begging to go for almost a week. We kept explaining that we just didn't have the money. That visit and the prescriptions cost almost $300, just over half of that deductible. I will be able to get that reimbursed, but it probably means that I will not be able to afford the dental care that I need. I don't consider that to be virtuous, but to be practical. Because I am a taxpayer, I also pay for health care for people who receive Medicare and Medicaid. Because they are not directly responsible for their own medical care costs, they have less incentive to keep those costs under control. Instead of suffering through a medical non-emergency, they may decide to go to the emergency room where costs are astronomical. I made my child wait for days with a broken ankle just because I thought it was sprained so that we could keep from going into debt again. It didn't work. So I do prefer that poor people do what my family does. If you want to be able to afford medical care, you need to get a job that pays enough to cover your needs or has good insurance, or both. If you choose not to work for medical care, you should turn to the churches, not to the government, which remains a capitalist democratic republic. It's not a matter of whether or not we DESERVE health care. It's a matter of whether or not we can pay for it. Health care is not guaranteed by the Constitution. It's part of the pursuit of happiness. Perhaps the sight of sick children will motivate our electorate to move to an economic system where health care is not a function of an individual's ability to pay. Just don't make me have to pay for health care for other people's children when I can't afford care for my own.

Author

L Hall

Date

2009-03-28T17:35:09-06:00

ID

145218

Comment

L Hall, you make some interesting points. One of the problems that the uninsured face in this country is the high cost of health insurance, which as you pointed out, "doesn't cover very much." Your $500 premium and $7500 out-of-pocket annual expense is far beyond what many people can afford. I'm assuming that you purchase health insurance through an employer, too, because your premium is quite low in the larger scheme of things. Price your coverage in the open market and you'll see how much more it costs for those who don't have your opportunities. While it's all well and good to say "you need to get a job that pays enough to cover your needs or has good insurance, or both," the truth is that most small businesses (which employ the majority of American workers) can no longer afford to provide insurance for their employees. Even big businesses are now generally passing all health-care costs on to their employees, where, in years past, they paid most or all of those costs as a benefit. Many Americans opt out of health insurance, (even when offered by an employer) because they can't afford it. People end up in the emergency room not because they don't want to pay for routine care, but because they can't afford it. Then, like you do, they put off care until conditions are critical, costing even more. I've talked to people who face the choice of putting food on the table or going to the doctor. Their choice doesn't even come up to whether to go into debt; it's whether or not to eat. And today, with more than 13 million unemployed, I would argue whether that's a "choice" people make. Another facet of the issue is the high cost of medical care. As you know, one trip to the emergency room can end up costing thousands. God forbid you actually have to be admitted for any length of time or have surgery or need lengthy therapies. Now the costs are astronomical. In fact, the majority of American individual bankruptcies have at their root medical bills that patients (or families of patients) can't afford to pay. And then there's the high cost of pharmaceuticals. America is only one of two countries (I believe) that allows pharmaceutical advertising. You pay for their marketing and lobbying efforts with every pill and injection, pushing the costs through the roof. Go to neighboring Canada or Mexico, for example, and you can purchase the identical meds for half the price we pay here, or less. When nearly 50 million Americans are priced out of getting insurance that, because of escalating costs "doesn't cover very much," there's something very, very wrong. America can not have a healthy, engaged citizenry when so many are on the brink of catastrophe each and every day. If you pay taxes, L Hall, you're already paying the price of health care for other people's children. Now, it's a matter of how you want those taxes spent. No parent should have to deprive their child of a doctor's care when that child is sick because of money. In my book, that's child abuse perpetrated on a national scale. It's time our leadership makes adequate health care available for everyone, not just those who can afford it.

Author

Ronni_Mott

Date

2009-03-30T10:39:14-06:00

ID

145334

Comment

Ronni, Thank you for your reasoned response to my post and thanks to Ms. Agho for picking up on my original post. Back when President Clinton was trying to propose universal coverage, I came up with this idea: Upgrade Medicaid and allow anyone to buy into it. I don't really mind paying for other people's health care, as long as I can have care available to me and my own family. The problem is that the United States is a capitalist country where each individual is expected to sink or swim on his own. Just this week, the European leaders are telling Obama that the economic crisis is not hitting them as hard because they have been paying into socialist safety nets for years, slowing their economies, but providing the means to keep small businesses afloat and pay sizable unemployment payments for those who lose their jobs. They do not want or need a government-backed stimulus program because they are not hurting as badly as we are. Until Americans are willing to acknowledge that socialism is not communism, we will remain a land of robber barons and their pawns. If the corporate set wants to keep capitalism, they should return to the practice of noblesse oblige and make sure that their philanthropic efforts actually mitigate the sufferings of the less fortunate. They are able to amass their fortunes because of our laws protecting private initiative. In my opinion, they should pay for the privilege, whether through private charity, or if that is insufficient, through redistribution of wealth through taxation. They will still be able to get filthy rich, but they may not have such dirty hands.

Author

L Hall

Date

2009-03-31T18:46:31-06:00

ID

146071

Comment

Update on the family's medical status. Since my last post two weeks ago, one child had an additional medical visit which cost nearly $800. We are awaiting the insurance company's decision on our co-pay. Child number two had another ankle accident on the weekend (always on the week-end). This time I erred on the side of caution and took the child to the UMC emergency room, in case it was broken, after verifying that MEA would not be able to treat a fracture. Fortunately, it was just a bad sprain (which is what the Baptist ER told us about the fracture last time--it was the orthopedist who found the break the following week). We are also awaiting the insurance company's report on that. I expect it to exceed $1000, of which I expect to pay about half out of pocket, unless BCBS denies the claim, which is a possibility. Later this year, child number one will undergo a series of medical procedures of unknown cost. So wellness care for me and my spouse are still on the back burner, as is the dental care that we all need. Due to my spouse's job loss, I am having to try to budget for all this in addition to regular household expenses and college costs on an after-tax income of about $29000. We have already cut food, transportation, and utilities down to a bare minimum, and new clothes and shoes are not even considered. I don't expect anyone to come to our aid. But I do get irritated when people who don't have similar incentives to cut costs run up the tab for non-emergency care at the emergency room. After spending four hours in the UMC waiting room, I can verify that there were plenty of people there who had minor emergencies which could have been attended to at MEA or another clinic or which could have waited until Monday. Let's free up the ERs for the car accidents, heart attacks, and broken bones.

Author

L Hall

Date

2009-04-19T11:23:21-06:00

ID

146074

Comment

I am rather cynical about too much health care reform being done in the US since people don't want to pay more for it than they already are, and they don't want to recieve less care and have less choices. Health care rationing is practised in other countries but it just isn't here-if a doctor recommends a treatment and that treatment is payed for by medicare it is given, that is pretty much the bottom line. In other countries treatments given are according to what the budget is and if say not giving heart bypasses in people over 80 will save dollars then that treatment isn't given. Presumably that is how the government would be able to keep the system intact. Other ways that save money but cause inconvenience would be implemented-you wouldn't have local doctor labs but all blood tests etc. would be sent out. The government can't control Medicare spending and growth, and I have no confidence in what the politicians would do controling the rest of the health care system.

Author

GLewis

Date

2009-04-19T19:30:44-06:00

ID

146075

Comment

Health care shouldn't be rationed. The gov't would have to be some cold hearted bastards to tell a person "you could live another 10-15 years if you had a bypass, but were gonna save some money and let you die, just because your to old" What's next killing handi-capped babies cause it will save money?

Author

BubbaT

Date

2009-04-19T19:45:39-06:00

ID

146081

Comment

After spending four hours in the UMC waiting room, I can verify that there were plenty of people there who had minor emergencies which could have been attended to at MEA or another clinic or which could have waited until Monday. Let's free up the ERs for the car accidents, heart attacks, and broken bones. L Hall, I think the reason why you saw many people like that is due to a lack of cash on hand. If you go to MEA, you have to pay the balance up front. If you go to the ER, you get billed later, and you can make arrangements to pay in installments.

Author

LatashaWillis

Date

2009-04-20T13:24:04-06:00

ID

146084

Comment

BubbaT, let's not slide off the deep end about rationed health care, OK? And when you say health care shouldn't be rationed, you do realized that it's already rationed in the U.S., don't you? Health care is rationed to those who can afford it, to those who can afford private insurance, and to those who qualify for Medicare. It's rationed by budgets, as in the case of LHall, above. Insurance companies ration treatment by committee, deciding what treatments they will cover and how much treatment per patient. Health care is rationed by a persons health, in that those with pre-existing, chronic conditions can't get insurance, and so can't get treatment they need. It's rationed by geography, i.e., poor and rural areas of the country don't have the access wealthier urban areas do. With nearly 50 million Americans uninsured, we need to make some difficult decisions about health care. This Business Week story says that "Medicare spends 27% of its budget on patients in their last year -- and those funds serve only 5% of enrollees. This is far different from most European systems, where expensive treatments are routinely denied when the outcome is likely to be grim. In Belgium, for example, the final year accounts for less than 13% of the health-care budget." The story goes on to say that 80 percent of Americans say they don't want heroic life-saving treatment--or even to be kept alive artificially--if they're in a vegetative state, yet doctors routinely keep such patients alive for years and send them to critical care units when they're at risk of dying. Health care has to be rationed somehow, some way. Not every treatment can or should be covered, in my opinion, but I would welcome a shift in priorities from critical care to preventive care and day-to-day treatments like pre-natal, routine check-ups and immunizations. People shouldn't have to declare bankruptcy to pay for non-chronic emergencies like broken bones and appendectomies, and treatments for chronic conditions like high blood pressure and diabetes should be readily available. Routine surgeries like bypasses that can add 10-15 years to a person's life shouldn't be rationed. On the other hand, giving heart surgery to someone who in a vegetative state doesn't do anyone any good. The U.S. can't continue to delay making a decision in a fruitless search to find a compromise that will make everyone happy. There are hard choices to be made. I say, let's get on with it.

Author

Ronni_Mott

Date

2009-04-20T15:03:36-06:00

ID

146089

Comment

Ronni, you said what I wanted to say better than I could have. Socialized medicine is not a straightforward issue. I have relatives in England where health care rationing is not uncommon for the elderly or people with terminal conditions. There are a lot of pluses as well as minuses, and I can never really decide whether I prefer their system or ours. They do believe in palliative care, which is anathema to us. Heaven forbid that a terminal bone cancer patient be allowed to become a morphine addict in his final days just because the pain is unbearable! Suck it up--everyone has to die. Why do you think you should get to zone out or nod off legally? Three of my five uncles have had cancer there. The first died at home twenty years ago, never having been told his diagnosis, but having a nurse visiting twice a day to bathe him and provide hospice care, including morphine. The other two uncles are now elderly, and receive inconsistent care, mostly depending on the luck of the draw where the doctors are assigned. Neither has been denied care and both are well-informed. During a family visit there a few years ago, my sister was taken to a clinic and transferred to a hospital for a severe allergic reaction. She was never asked about insurance or payment and she was not given or sent a bill from either facility afterwards. She was given excellent, possibly life-saving care for free. My original comments which Ms. Agho read in the paper were a response to a previous writer who was commenting on the taxation of hospitals to fund Medicaid. There had been a spate of letters decrying socialism, right about the same time that our family was really getting hit hard by medical bills. I was also really struck by the hypocrisy of the whole financial "privatize the profits and socialize the losses" bailout. My point has been that as long as Americans want to be a capitalist country, we must necessarily provide to the poor as part of voluntary charity. This is where the churches are supposed to come in and use their tithes for charity instead of big buildings on landscaped campuses. If we want government to require that all taxpayers support charitable efforts by proxy, then let's admit that as the definition of socialist and just get over it. I don't really want to let the poor starve. It is just a rhetorical device. I'm surprised that so many people took me seriously, and disheartened to find that so many "agreed" with me.

Author

L Hall

Date

2009-04-20T16:10:06-06:00

ID

146090

Comment

It's kinda hard to debate this issue when no one is really sure what the alternative plan is. I say that not because Obama has not published his plan, but because it's not really a plan. It's just platitudes and nebulous promises to require insurance companies to cover everyone. It sounds good I gotta give him that. If there are 50 million uninsured it also sounds really expensive. Someone has to pay the premiums to the insurance companies and if the people who are uninsured could afford insurance premiums, well most wouldn't be uninsured. Good thing we have plenty of money... Oh wait, we are already running massive Federal budget deficits. Most of the details in the President's plan are about saving money over the current system. I hate to break this to the President but the Federal Government really really (I could go on with reallys for a while) sucks at saving money. (see above reference to massive federal budget deficits) So while again that sounds nice I don't expect that to happen. Usually when the Federal Government gets involved with price controls and restrictions on free enterprise prices have a tendency to skyrocket. So I wouldn't be looking for a cost savings anytime soon. The most conspicuous absence from the Obama-Biden health care plan is the cause of the problem they are trying to address. How can you solve a problem if you don't know what the cause is? The Obama-Biden plan starts like this: Health care costs are skyrocketing. Health insurance premiums have doubled in the last 8 years, rising 3.7 times faster than wages in the past 8 years, and increasing co-pays and deductibles threaten access to care. I agree with that, health care is too expensive for a lot of people to afford and is getting worse. So why has it gotten so expensive? I would assert it's because the end consumer of health care is rarely the one who pays for that service. What does this plan do to address that? Nothing at all. As a matter of fact it would only make that problem worse by adding millions of consumers who in turn do not pay directly for their care and therefore have no incentive to control costs. There was a time in this country when people did pay for their own health care. (I'm not sure where the author of the original story of this thread got her facts to the contrary but I promise you it's true.) If doctors and hospitals had to charge a rate people could afford because there was no one else to pay I believe there would be a different price for the same services. Actually I already know there is a different price if you pay cash than if you let your insurance pick up the tab. It's simple as supply and demand. There is no law saying a Doctor who does cosmetic surgery couldn't charge a million dollars a breast for enhancements but they don't. Why? Because no one would pay it. They would starve and their student loans would default. So they charge a reasonable rate as set by the market place where they compete for their business. As demand has risen for that procedure and the competition (supply) has increased to meet the demand the price has steadily declined even as the costs of non elective health care skyrockets. The only difference between the two is one is predominately paid for by insurance companies and the government and one is mainly paid for by the consumer. All of that said, I like Obama and that his administration is actually talking about the issue seriously. There is one thing no one can deny and that is that something has to be done. It can not continue the way that it has been going. I think he is going at the problem all wrong but sometimes failure leads the way to success.

Author

WMartin

Date

2009-04-20T16:25:16-06:00

ID

146093

Comment

First, I really like this column and the conversation it's generated. Second, it's a canard that procedures like heart bypass surgery are rationed in a country like Canada. Give me a citation. The rationing is for non-essential services. Now, I've read that National Health in the UK won't pay for exorbitant chemotherapy that extends survival for only a week, but that's quite different from bypass surgery. Moreover, it parallels the rationing insurance companies perform here. The difference is that insurance companies answer only to their stockholders, whereas National Health answers to the voters. Finally, Obama does have a plan, and it's one that I pray Congress has the courage to enact. In essence, he wants to allow ordinary Americans to switch from their private insurance to medicaid, diverting contributions from employers to that program. Despite talk about the government not being able to control costs, medicaid delivers quality health care for substantially lower cost than insurance companies, partly because medicaid does not operate for profit. Of course, the insurance companies are screaming bloody murder, and they'll do everything they can to derail this reform. The reason why is that there will be a stampede from private insurance to government insurance because the premiums will be much lower. The free market has failed abysmally in controlling costs. The United States spends about 15 percent of its health care dollars on administration, which is more than twice what "socialist" systems spend. So much for private enterprise cutting through red tape. Don't believe the propaganda. The free market does some things well--like run department stores. It does others poorly--like provide electricity. Health care is more like the latter than the former. What we need is pragmatism, not more of the same free market fundamentalism that has caused so much of the mess we now face.

Author

Brian C Johnson

Date

2009-04-20T17:18:18-06:00

ID

146095

Comment

The Obama-Biden "plan" calls for expanding eligibility for medicaid but I can't find anywhere in the text where it offers it to all Americans as you describe. This is what it says about medicaid: EXPANSION OF MEDICAID AND SCHIP. Barack Obama and Joe Biden will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function. They even call it a safety net so I would imagine it will still be means tested. It does mention the private plan alternative Medicare advantage. Here is what it says about that: Medicare's private plan alternative, called Medicare Advantage, was established to increase competition and reduce costs. But independent reports show that on average the government pays 12 percent more than it costs to treat comparable beneficiaries through traditional Medicare. These excessive subsidies cost the government billions of dollars every year and create an incentive structure that has led to fraudulent abuses of seniors. Barack Obama and Joe Biden believe we need to eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare. I love the solution they propose to the problem, we just won't pay them. Cool, we need more solutions like this. Federal Debt too high? Screw 'em we aren't paying. LOL I do agree that if the government is picking up all or most of the bill I'm dropping my private coverage along with everyone else. I don't really blame the Insurance companies for screaming though, I don't know what you do but if the government was about to put me out of business I might scream a bit. But the good news is they will be able to get health care from the government like everyone else who is unemployed. Propaganda would be to call the current system the free market because it's not and I don't really have any illusions that we will try it before we socialize the whole thing. It's laughable you talk about private enterprise cutting through red tape as we discuss a huge federal bureaucracy about to be born. They have their own special extra sticky red tape. Is it pragmatic to assume that the government somehow will be able to pull off something of this size and be efficient too? I'll pray you are right and I'm not religious at all.

Author

WMartin

Date

2009-04-20T18:16:27-06:00

ID

146101

Comment

Here is a story that should make people think: http://www.nytimes.com/2009/04/21/us/21uninsured.html?pagewanted=1&hpw

Author

L Hall

Date

2009-04-20T20:05:27-06:00

ID

146103

Comment

WMartin, the Medicare Advantage program you mentioned is a great example of how private enterprise has failed to provide affordable health care. The Bush administration and the insurance industry pushed hard for MA as a way to control costs, but it hasn't worked out that way. Part of the problem is that these programs run for a profit, and that profit adds substantial costs on top of Medicare, which does not run for a profit. These programs really do nothing but siphon money away from Medicare, enriching shareholders at the expense of taxpayers. So I too love President Obama's solution. It's not walking away from obligations; it's eliminating waste. One of the major problems in our system today is that Republicans have tied the government's hands behind its back in reducing costs. Look at Medicare Part D, the pharmaceuticals for seniors program. The Republicans forbid Medicare from negotiating on drug prices, essentially letting the pharmaceutical companies set whatever prices they want. No corporation that purchased on such a scale would pay retail prices, and the VA, which does negotiate, has much lower costs. But thanks to the "free market" Republicans, Part D is exorbitantly expensive, and the pharmaceutical companies have posted record profits. Finally, you say you're not religious, but you have a blind faith in the efficiency of markets versus government programs. Some government programs are extraordinarily efficient. Social Security has administrative costs around 1 percent. Of course, you conservatives wanted to hand that program over to the "free market" as well. If I may express a religious sentiment myself, thank God the Democrats stopped you.

Author

Brian C Johnson

Date

2009-04-21T06:33:30-06:00

ID

146104

Comment

Here is one of many news stories on Obama's private-public competition plan.

Author

Brian C Johnson

Date

2009-04-21T06:38:09-06:00

ID

146105

Comment

Here's the problem conservatives face on this issue. You can complain all you want about how our system isn't really free market, just as you complain that the banks failed because of too little regulation. I hope you keep making that argument because it's a natural born loser. But what would you do? McCain's meager voucher plan? We have to make substantial reforms now. We simply must control costs, and the current system has failed miserably. According to CBO projections, if current cost inflation continues, we'll be spending 1 of every 2 dollars on health care by 2050. That simply cannot be sustained. So what would you do to control costs?

Author

Brian C Johnson

Date

2009-04-21T06:43:20-06:00

ID

146109

Comment

We need both sick and preventive care. In fact, I think preventive care is more needed because if you catch something early, the better the treatment options are, thus, the cost of care won't be so high. I don't think insurance really covers preventive care, or at least not in a way they should.

Author

golden eagle

Date

2009-04-21T07:50:44-06:00

ID

146111

Comment

You can call me a fiscal conservative all you want, but please don't use the "R" word, at least not about me. I haven't called you any dirty names ;-P. It's propaganda when they talk about the free market too because they use the government to interfere in the private sector as much or more than Democrats. I saw the house minority whip liken the credit markets to a public utility not too long ago. So I would have to believe in miracles to think that a free market solution would magically appear all of the sudden from either major party. I agree with you that costs are out of control but again I say you can't solve that problem if you don't understand the cause. But you allude to it. You cite governmental interference with the market in causing high prices, "The Republicans forbid Medicare from negotiating on drug prices, essentially letting the pharmaceutical companies set whatever prices they want." and then use a private sector example to show how cost savings are achieved, "No corporation that purchased on such a scale would pay retail prices..." and then cite the example of the VA negotiating (using competition) for lower prices. So I think we agree somewhere in there at least in theory. I don't have to have faith in free markets. I have seen evidence they work. This is an article about why medical costs are so high from a free market perspective. http://www.mises.org/story/2285

Author

WMartin

Date

2009-04-21T08:40:03-06:00

ID

146113

Comment

Fair enough, WMartin. I didn't mean to play dirty pool by associating your views with the Republicans. But I restate my claim that politically, conservatives are going to have a hard time convincing the public that too much regulation of health care is the problem rather than too little. Politics aside, the article you offered on medical costs essentially argues that government programs are to blame for rising health care costs. I would offer a comment and a counterargument. First, the article is conspicuously devoid of proposals to control costs. By implication, the solution is to disband Medicare and Medicaid, but that's a nonstarter, as you've indicated yourself. Second, how is it that the country with the largest government health care system--namely France--has both far better outcomes for health and far lower costs as a percentage of GDP? If the French give you gas, consider the British or the Canadians. Both countries have better health outcomes and spend only about 10 percent of their GDP on health care. Meanwhile, in the United States, we cover only about 80 percent of our population, but we spend 16 percent of our GDP on health care. And our outcomes put us somewhere between Costa Rica and Slovenia in health care success. And Medicare is to blame?

Author

Brian C Johnson

Date

2009-04-21T09:00:51-06:00

ID

146115

Comment

I agree that to disband Medicare and Medicaid is a non starter politically, and that is why the article I posted doesn't call for it. It does make the point, however, that political considerations will drive the industry and not real world needs. So I think that is what we have to be mindful of as we do go forward with the plans that will be proposed that actually have a chance of becoming reality. That being said, a governmental system in place of a free market system must be as efficient as possible because we are already strapped for cash. A single payer system is much more efficient than some sort of hybrid between public and private providers. Something like that is only going to drag out the inevitable and cause more pain than need be. The most important thing now is to fix the system before more people go bankrupt or die because of the mess we created with half measures and hand wringing. I believe the only fiscally responsible thing, that's actually politically possible, would be a single payer nationalized system such as Canada or Australia. France has got a good one but it is a two tiered system that relies on private supplemental insurance to cover what the government insurance doesn't and imposes significant cost sharing on consumers to discourage over-utilization and control costs. Plus their private insurance industry is less regulated than in the U.S. in a lot of ways.

Author

WMartin

Date

2009-04-21T10:12:23-06:00