Public Option Defeated?

[Lazar]

A good post by Ezra Klein on how the number of people reporting long elective surgery wait times in Canada and Britain is essentially the mirror image of the number of people in the US who are unable to receive health care due to cost. But we are to believe that only one of those two statistics constitutes rationing.

[Tsukiyumi]

...But we are to believe that only one of those two statistics constitutes rationing.

Well, of course, Lazar. People with college degrees and money are better than people who don't have those things. Why should they have to wait at all?

[sunnyside]

First I do appreciate his attempt to bring in some actual numbers from a study. However primarily his article consists of abusing the English language. Rationing means to control distribution outside of the usual marketplace, usually meaning giving each a fixed allowance of something that is scarce.

Having something that is too pricey is the opposite. We do not ration plasma TVs and Corvettes simply by merit of their not being free.

Essentially his post would only be reinforcing the fears of those he quotes. His message to them is that, yes, you and your family are more likely to have a long wait or die in the months it takes to get an MRI scan or the extra hours it takes to get an emergency angioplasty, but other people will be better off.

Though again I'm for some form of universal health care, just not the verisions being thrown around.

However I'm starting to feel that perhaps as a nation this is neccessary. When the baby boomers are all on life support it'd be a crushing blow given our current entitlement programs for the eldarly. As the administration's health plan is written it should go a long way towards reducing research and development of newer and better drugs, systems, procedures. However while those things could help save our lives, they're almost always more expensive than some knock off of an older drug or system. Hence over time there should be a reduction in overall cost, possibly a substantial one if companies shift from trying to find ways to make people live longer and better to finding ways to maintain the current lowest allowable standard of care at lower prices.

[Lazar]

First I do appreciate his attempt to bring in some actual numbers from a study. However primarily his article consists of abusing the English language. Rationing means to control distribution outside of the usual marketplace, usually meaning giving each a fixed allowance of something that is scarce.

It's usually used to refer to something that's government-restricted, but looking at the dictionary definition of the verb (merely, to restrict consumption), I think it could arguably be extended to this case. But casting aside semantics, the point is that insurance providers allocate care to the segment of the population that can pay for it - and they do their damnedest to minimize the amount that they provide, even to those who do have insurance. How about lifetime insurance caps for rationing? How about abusive recission practices?

Having something that is too pricey is the opposite. We do not ration plasma TVs and Corvettes simply by merit of their not being free.

No one needs a plasma TV or a Corvette. People need health care. I would sure as hell not want to rely on private firefighting insurance if my house burned down, or private law enforcement insurance if someone had broken into my home.

Essentially his post would only be reinforcing the fears of those he quotes. His message to them is that, yes, you and your family are more likely to have a long wait or die in the months it takes to get an MRI scan or the extra hours it takes to get an emergency angioplasty, but other people will be better off.

The wait times that he cited were for elective surgery. If you have statistics showing that people in other developed countries are more likely to die due to emergency wait times, could you post it for me? (I'm not being snarky, just don't want to bother slogging through the whole thread.) I know you'd be hard pressed to find any developed nation with a lower life expectancy or a higher infant mortality rate than the US. But the point is, universal health care will benefit even those who have insurance, by driving costs down and offering them more choice, and it results in a humane allocation of resources. (And remember that even those who have insurance can be financially devastated by an expensive illness, or have their lives put in jeopardy if they lose their employment.) How in good conscience can we say that people should be denied lifesaving treatment because they can't pay for it? Just for the sake of the convenience of the affluent? (And I count my family among the affluent.) His point is that these two statistics tend to be mirror images - and my point is that if we, unlike every other civilized country, choose petty convenience for those who can afford it over needed care as a human right, then this country has lost its soul.

Though again I'm for some form of universal health care, just not the verisions being thrown around.

You mean co-ops?

However I'm starting to feel that perhaps as a nation this is neccessary.

Given the rate at which health care costs are rising faster than wages, you're damn right it's necessary. The fact is that this nation pays more for health care than anyone else and we get shittier results to show for it - no nation in their right mind would want to emulate us.

[sunnyside]

But casting aside semantics

My comment wasn't semantics, like whether something is green or puce or something. He was completely ignoring what the people actually mean in order to, I don't know, try and appear clever or reasure his readers. When people talk about rationing what they mean is that as a result of government control health care will be "rationed" in the sense of decisions from on high deciding what is and is not covered and applying this to everyone, lotteries, or queues based on need or time of request.

And that sort of forced equality is more or less what nationalized health insurance is trying to achieve.

The point of argument is whether we'll maintain or current situation with short or no wait times, lack of need for lotteries, and, for many health insurance plans, no or extrememly high caps for covereage.

Or if we'll wind up like Canada or the UK.

Now how bad the Canadian or Brit systems are or aren't is a matter of debate. But the issue reason for the rage in town hall meetings is that over here republicans are putting out a lot of statistical information (some of it probably even true) and ads with ancedotal tales of how they would have died if they'd waited on the Canadian system so they got a second mortgage and got treatment in America.

The reply is usually along the lines of either studies that figure in all the uninsured Americans into overall program quality, or just saying that people NEED health insurance.

Which leaves people feeling like they're about to get killed so a couple crack heads can live. Remember however good the Canadaian system is or isn't we likely aren't going to have things as goods as they do, seeing as we're more obese, have a host of social problems they simply do not have, and don't have a lot more oil than we need boosting our government.

Your points on caps is a bit less relevant because people know if they have them or not, and generally had a choice of whether to get a plan with a cap or not.

Recission is an interesting issue. Though it seems the courts are coming down on them hard about it. Which is how the system is supposed to work.

On that note all companies are "damnedest to minimize the amount that they provide". McDonalds would really rather have you pay the same for half the fries. However competition means that they have to provide something people will buy.

Similarly before deciding on an insurance plan most people (I hope) spend some time looking up reviews and ratings. A company that doesn't provide what it says it does in the contract will lose customers, certainly indaviduals have the option to jump ship (in most cases).

If the governemnt takes over and doesn't provide what Obama advertises we're all just screwed.

Having something that is too pricey is the opposite. We do not ration plasma TVs and Corvettes simply by merit of their not being free.

No one needs a plasma TV or a Corvette.

[/quote]

Does that mean you get the rationing comment than? Since we're talking about need again(which is fair).

People need health care. I would sure as hell not want to rely on private firefighting insurance if my house burned down, or private law enforcement insurance if someone had broken into my home.

Um. People do have private insurance for those things. I think you mean something more like where you have to indavidually pay for firefighting or law enforcement.

The wait times that he cited were for elective surgery. If you have statistics showing that people in other developed countries are more likely to die due to emergency wait times, could you post it for me? (I'm not being snarky, just don't want to bother slogging through the whole thread.)

I don't feel like slogging through it again at the moment either. But some time back I posted a study I'd found on...uh...cardiac angiograms I think that had both emergency and non-emergency wait times. While the non emergency times had the typical long delays compared to the US, the emergency times were also much longer, except "much longer" is measured in twice as many hours as opposed to weeks or months.

However it seems reasonable that this is a general trend, since fundamentally there are fewer machines per captia.

by driving costs down and offering them more choice

See, that's where you have a hard sell. The doctors aren't working for free, and medical equipment doesn't show up out of nowhere. So people are still paying for it. And the fact that the governemnt will dictate what doctors or drug companies can charge will result in less choice. Both in terms of options at the moment, but especially in terms of the products that are never created due to their being no market for them.

And that's where we come out worse. If we'd stopped medical techonolgy where it was 100s of years ago it might be relatively cheap, but even those in poverty would be worse off, as at least now they can get vastly superior emergency room treatment(which no one is denied in the US), and they can cheaply get generic pills that work what would have been considered miracles.

Same idea here, except looking into the future. And of course research won't stop, it'd just slow, but it's the same problem.

Ooop gotta run.

[Tsukiyumi]

Hey, there's the ticket! I'll just refuse to identify myself if I have to go to the hospital! It's brilliant!

Eat that, taxpayers!

[IanKennedy]

But casting aside semantics

My comment wasn't semantics, like whether something is green or puce or something. He was completely ignoring what the people actually mean in order to, I don't know, try and appear clever or reasure his readers. When people talk about rationing what they mean is that as a result of government control health care will be "rationed" in the sense of decisions from on high deciding what is and is not covered and applying this to everyone, lotteries, or queues based on need or time of request.

There are no lotteries in the UK, there is no health care rationing in the UK. Lets get this straight anyone can go get private care at any time so long as they can afford it. Even without insurance private health care, anyone can and is treated for everything that is wrong with them. No government body exists to decide who is treated for what, it's a simple matter of going to your GP (family doctor) and they refer you directly to the specialist. The government is simply no more involved than they are in your system.

And that sort of forced equality is more or less what nationalized health insurance is trying to achieve.

Nobody is forced to even use the system so where is the forced equality?

The point of argument is whether we'll maintain or current situation with short or no wait times, lack of need for lotteries, and, for many health insurance plans, no or extrememly high caps for covereage.

In the UK system, which has worked since the 1942, there are no caps on coverage. You are still able to pay your own way.
[snip]

[sunnyside]

There are no lotteries in the UK, there is no health care rationing in the UK

I wasn't sure if the lottery thing was supposed to be the UK or Canada. However a brief google search indicates that perhaps that was a bit of misinformation as I can't find something on it.

However that leaves the question of how you allocate the best doctors and equipment. Unless the info I had read when we were talking about it a few pages back was old, you have exactly one proton therapy unit in the entire country. Who gets to use it? Are there elaborate algorithms based on age of patient, prognosis, etc that determine some kind of queue?

On a note more related to Rochey's questions, when searching for info on that I found:
http://gammaknifemarketing.com/news/LGK ... n_0505.pdf

Which is a historical example of a surgical procedure you could get in the US but not Canada. Presumably there are such things currently, I'm just not up on medical technology enough to know about the latest advances.

In any case when people are talking about rationing they're generally including queues if the government controls how they operate, as that's a rationing system.

To be fair however "rationing" isn't always worse. Usually when governments have rationed things there has been a good reason. For example not having the population starve during a war.

It may well be that overall there is more net, I don't know, happiness from the UK/Canada systems where everyone is on equal footing for the wait for an MRI as opposed to the American system where ~85% of the population can get one right away while ~15% are basically screwed.

No government body exists to decide who is treated for what

While not the "death panels" spouted about from some, I do believe you have some government agencies that determine things like what can be charged for a drug, charged for a procedure, and general rules for who can get what. Or can a 98 year old with terminal cancer have their hips and knees replaced and a bit of cosmetic surgery on the government dime?

I'm not so sure that terminal cancer patient could get all that done in the US either, I'm just saying I think instead of having a bunch of different competing companies you have a government body that answered questions like that.



In answer to Lazars other comment. Co-ops have and I think still do exist in the health insurance arena. I believe what was proposed in congress was just a re-naming of the public option (from an article where the congressman in question said as much).

What I meant was that I would rathing see universal health care acheived by raising taxes instead of cutting R&D and availibility of equipment (plus some heaping national debt). And I'd like to see some strings attached. Something along the lines of workfare in some cases, and possibly something more like a requirment to send children off to a nearby boarding school/military school in others where the uninsured is a dysfunctional household. That'd actually be more expensive at first, but could possibly help turn around some of America's deep underlying problems.

[Aaron]

There are no lotteries in the UK, there is no health care rationing in the UK

I wasn't sure if the lottery thing was supposed to be the UK or Canada. However a brief google search indicates that perhaps that was a bit of misinformation as I can't find something on it.

The lottery thing was a town in Newfoundland that had managed to attract a doctor and they held a raffle to see who he could take on as new patients because he would not be able to see everyone, it was a way to ensure it was fair and a novel approach. The right wing idiot brigade in the US latched onto it and trumpeted it as an example of how health care is managed everywhere here.

[Tsukiyumi]

I'd rather have a raffle than no care at all. At least that way, I'd have a chance.

Like you said though, he was a private doctor. I'm assuming he'd be separate from the national system.

[Lazar]

My comment wasn't semantics, like whether something is green or puce or something. He was completely ignoring what the people actually mean in order to, I don't know, try and appear clever or reasure his readers. When people talk about rationing what they mean is that as a result of government control health care will be "rationed" in the sense of decisions from on high deciding what is and is not covered and applying this to everyone, lotteries, or queues based on need or time of request.

As if health insurance companies don't deny claims! I don't see senior citizens clamoring to abolish Medicare.

And that sort of forced equality is more or less what nationalized health insurance is trying to achieve.

Nationalized health insurance (which Obama isn't even proposing) is trying to get everyone covered and stop people being financially devastated by illness. And as Ian points out, there's no rationing in the sense of maximum allowed treatment.

Now how bad the Canadian or Brit systems are or aren't is a matter of debate. But the issue reason for the rage in town hall meetings is that over here republicans are putting out a lot of statistical information (some of it probably even true) and ads with ancedotal tales of how they would have died if they'd waited on the Canadian system so they got a second mortgage and got treatment in America.

Well I've seen a ton of anecdotal stories of people not being able to get the care they need, people having treatment delayed (sometimes with fatal results) because of the claims appeal process, and even some Americans who moved to Canada and are now "health care refugees" because of pre-existing conditions that would ruin them if they ever moved back to the States.

Which leaves people feeling like they're about to get killed so a couple crack heads can live. Remember however good the Canadaian system is or isn't we likely aren't going to have things as goods as they do, seeing as we're more obese, have a host of social problems they simply do not have, and don't have a lot more oil than we need boosting our government.

But we do spend a shitload more than they do on health care, in both absolute and relative terms.

On that note all companies are "damnedest to minimize the amount that they provide". McDonalds would really rather have you pay the same for half the fries.

And it's a reasonable proposition for nearly any other industry that the seller is acting in their own self-interest - they've got a profit motive and they're trying to get as much money out of you as they can, and that's fine, because that's how capitalism works. But medical providers have a unique responsibility to serve their patients' best interests, and health insurers hold the unique power of life or death over their customers.

However competition means that they have to provide something people will buy... Similarly before deciding on an insurance plan most people (I hope) spend some time looking up reviews and ratings. A company that doesn't provide what it says it does in the contract will lose customers, certainly indaviduals have the option to jump ship (in most cases).

But in most areas health insurers don't exist in a good state of competition, as you can read here or here - and whaddya know, premiums have been rising much faster than wages. The nature of a large risk pool favors monopolies to begin with, and insurance companies have been exempted from federal anti-trust laws. Add to that the notion of the preexisting condition, and tons of people are forced to cling to whatever insurance they have even if they're being fleeced.

If the governemnt takes over and doesn't provide what Obama advertises we're all just screwed.

Obama isn't advertising a government takeover - that would be single-payer.

Um. People do have private insurance for those things. I think you mean something more like where you have to indavidually pay for firefighting or law enforcement.

No, I meant if you had to buy an insurance policy to pay the firefighters or police for responding to you. (If ambulance costs are anything to go buy, I assume that private firefighting costs would be through the roof.) And if you didn't have insurance coverage and couldn't afford the cost, they would let your house burn down, or they wouldn't investigate the burglary. Not a perfect analogy, because of EMTALA, but denying someone a lifesaving surgery or treatment because they can't pay for it is morally equivalent to letting their house burn down because they can't pay for it. (And that was the reality in the early history of this country, before the abuses of private fire brigades led people to establish public ones.)

I don't feel like slogging through it again at the moment either. But some time back I posted a study I'd found on...uh...cardiac angiograms I think that had both emergency and non-emergency wait times. While the non emergency times had the typical long delays compared to the US, the emergency times were also much longer, except "much longer" is measured in twice as many hours as opposed to weeks or months.

There does seem to be a paucity of data available for emergency wait times - but one thing that seems clear is that in all countries, the wait times can vary greatly based on what region or community you're in.

See, that's where you have a hard sell. The doctors aren't working for free, and medical equipment doesn't show up out of nowhere. So people are still paying for it. And the fact that the governemnt will dictate what doctors or drug companies can charge will result in less choice. Both in terms of options at the moment, but especially in terms of the products that are never created due to their being no market for them.

We have to drive costs down somehow - the current system just isn't sustainable. As for drugs, why shouldn't Medicare (and the public option, if it's enacted) be able to negotiate drug prices like everybody else?

[Aaron]

I'd rather have a raffle than no care at all. At least that way, I'd have a chance.

Like you said though, he was a private doctor. I'm assuming he'd be separate from the national system.

No he wasn't. What most American's don't get is all our doctors are private contractors paid directly by the Provincial ministry responsible for health care, so yes there was a raffle for people to have a GP. That doesn't mean they don't have access to health care though. I'm 45 mins away from my GP but I can walk into the local emerg and see one at any time.

So yeah, our health care ain't perfect but I won't go bankrupt if something happens to me. That's worth the "wait times" and any of the other fear mongering examples morons come up with.

Sorry if I come off as bitter, long day.

[Lazar]

So yeah, our health care ain't perfect but I won't go bankrupt if something happens to me. That's worth the "wait times" and any of the other fear mongering examples morons come up with.

That's the view that I've seen from pretty much everyone who lives in a developed country outside of the United States - they may bitch about their national health care systems, but there's no way in hell that they would trade them in for the American system.

[Tsukiyumi]

Sorry if I come off as bitter, long day.

No prob, bro. I'm in a similar boat.

I'm not entirely clear on how health care works up there, so forgive my confusion.

[Aaron]

That's the view that I've seen from pretty much everyone who lives in a developed country outside of the United States - they may bitch about their national health care systems, but there's no way in hell that they would trade them in for the American system.

I've noticed that folks from countries that are more socialist then the US tend to accept these things a little more readily, bear a bit more responsibility for others care.