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Finding the Balance – Healthcare Part II

[This is not a blog post. From what I understand, when blogging, less is more. This, my good friends, is a treatise. So grab a cup pot of coffee or a bottle six pack of beer, pull up a comfy chair and be prepared to be annoyed, amused and if I am at all lucky, maybe just a teensy tiny bit educated.  Oh yeah, you might want to find something unbreakable to pound on too.  Just in case.]

Seriously, I don’t expect to change any one’s views with this post. Ain’t gonna happen. At this point, I am not entirely sure of the point of this post myself. Perhaps I will be by the time its complete.  So for now, bombs away.

I have been in the unusual situation of carrying on a healthcare conversation here on TFD while simultaneously carrying on another discussion about healthcare (which included discussion of the TFD conversation) on another online list.

A bit overwhelming but it has given me lots food for thought. And made me wonder if if everybody is simply stuck in the box?

It goes something like this………………..

“Our system may not work (but only if pushed will that be admitted) BUT there is NO WAY I am going to consider or even look at any other system because I just KNOW they all suck!”

So where does that leave you, kind of where we are with democracy, maybe ………do you think you have the best of the worst?? If so, that leaves you nowhere to go. So you’re stuck where you’re at. And if you close your doors and pull down the blinds, you won’t have to see how badly its not working for some.

Yeah. I think that the US system, if not quite broke, certainly needs at a minimum some preventative maintenance.  Actually I think it needs a lot more than that.  But I really only came to this conclusion in the last couple of days (after I wrote If Its Broke You Gotta Fix It and then looking at some statistics in preparation for writing this post).

Lies, Damm Lies and Stastics or Reality Check

I readily recognize that my arguments will only be as “good” as the statistics I found to support them. But if its any consolation, the statistics I found (not suprisingly) cut both ways – for both the American and Canadian health care systems.

That being said:

  • 16% of Americans (42 million people) have no health insurance (and hence must pay for health services in full, or receive hospital charity)
  • 14% of Americans receive some form of public health care or health insurance (70% have private health insurance)
  • Families with health insurance pay premiums that are $922 higher each year to cover the health care costs of the uninsured.
  • Taxpayers foot the bill at $21 billion a year when workers are forced to turn to government health care programs.
  • There are already 9 million uninsured children in the United States.
  • 47 million people went without health coverage at some point in 2005, with the ranks of the uninsured rising by 6.8 million since 2000.
  • It’s no longer only people who are unemployed or working at low-income jobs who are without health coverage. Seems that more than one-third of those without health insurance—17 million of the nearly 47 million—have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization.
  • More than two-thirds of the uninsured are in households with at least one full-time worker.

I don’t know how much reality there is in the following examples. But I think we can all safely assume there is at least some. And I seriously considered not putting these in because this does not appear to be the sort of group to sway by an appeal to the heart strings. But to hell with it…..

 Amy is a married mother with two children but has had no health insurance since 2000. Now, Amy’s teenage son broke his hand in three different places and needs reconstructive surgery.
We don’t qualify for the state’s health plan, because according to them, we make too much money.
We have over $8,000 in medical bills and credit cards used to cover medical bills and groceries so we could pay cash for some of the medical bills! The creditors call us numerous times daily and are threatening to garnish our bank account, wages and all other assets they can find in our names.

Laurie – I was lucky enough to receive a transplant that saved my life. Unfortunately, this means that I may always be poor due to paying bills, medications, and the many things that aren’t covered like healthy foods, vitamins, and items that are essential to take care of my new organ and my changing health. I have gone through bankruptcy once, and I have just been sent to collections again.
The first bankruptcy had items listed as far back as 12 years when I was 17 years old. This time my payments had gone to a different account which resulted in collections turnover, even though I was paying an amount every month….After too many years of this, I would never have thought to look there for such important information. So once again I’m paying more for less…and I have insurance! How do Americans keep up?

I can’t imagine living this way. Can you? Is it really “okay” for someone else?

Here’s my point…. closing your eyes, pounding your fists and repeating “I ain’t gonna pay for no welfare bums” doesn’t change reality. Although I do believe that adding a pair of ruby red shoes and turning around three times (or something like that) might just get you to Kansas. Or Kris’ bunker, if you’re extremely lucky.

Bush stating that “the US healthcare system is the envy of the world” does not make it so. Does not even put in the basket I will label “reality”.

Bush saying that in his opinion “government-run health will lead to poor-quality health, will lead to rationing, will lead to less choice” doesn’t necessarily make it so either. Doesn’t mean he’s wrong but it equally doesn’t mean he’s right.

And an assertion that “other countries that have tried to have federally controlled health care …..have poor-quality health care”? – reality check.

[Just for the record, I'm only picking on Bush for the simple reason that I have quotes from him. I am essentially an equal opportunity political basher.]

I especially appreciated the irony in this one, a comment made by Bush in 2004.

Talk about the VA: We’ve increased VA funding by $22 billion in the four years since I’ve been president. That’s twice the amount that my predecessor increased VA funding. Of course we’re meeting our obligation to our veterans, and the veterans know that. We’re expanding veterans’ health care throughout the country. We’re aligning facilities where the veterans live now. Veterans are getting very good health care under my administration, and they will continue to do so during the next four years.


The Canadian System 
There are many in the US (right on this blog, I presume) who would will point to problems with the Canadian health care system and say it shows proof positive that the dreaded “socialist medicine” doesn’t work. But I could just as easily point to the US system and argue that all that “private market crap” doesn’t work. Perhaps its all a symptom of a greater ill….

I can’t and won’t speak to any other country’s so-called “national healthcare” systems [ie. the UK], only the Canadian system. I do feel eminently qualified to speak on the Canadian system – not only I have lived all my life under this particular government controlled system but our family has had rather extensive contact with the system; growing up my father was a paraplegic; I, myself, have some a fairly serious chronic medical condition and one of my children struggles with some pretty heavy duty medical issues.

I will do my best to be brutally honest and fair in writing about the Canadian healthcare system. While I would never say its perfect, I can say that I have never experienced a huge problem with our healthcare system. Sure, there are problems – long (although I submit that’s a relative term) wait times for certain specialist procedures and in some areas it is hard to find a family doctor because many of those that are there are not taking new patients and intermittent overcrowding at hospitals. The hospital problem is really a long term care problem – not enough nursing home beds so too many of the older generation trapped in hospital taking up medical beds. The doctor problem – we need to recruit and hire more family physicians, particularly in rural areas. But as long as family doctors are so overworked, new doctors don’t want the job. Kind of a Catch 22. However, personally, I don’t recall ever having to wait an inordinate length of time for anything that either my family or I have needed when referred to a specialist or for tests.

When I say the Canadian system isn’t perfect, I mean it. Not. Perfect. Far. From. It. But I think what pulls my chain the most is that often times it seems like those who fear *socialism* or *socialist medicine* are those who want to pull government out of the equation completely. You have government “interference” in health care now. Whether you see it or choose to acknowledge it or not. So where is the logical analysis of what would happen if your wishes came true, if you completely removed government from the equation, had completely private health care and let the market run the show? I question whether some people just haven’t thought it through. And I question whether, for some other people, that’s the place where the deceit comes in.

Yes, here in Canada, we have wasted tax dollars, truckloads of them. We have fat and lazy bureaucrats too. And the biggest problem at the moment, the amount of each provincial government budget which is sucked up by health care (the single biggest line of every budget) and growing steadily every year.

And much of it, in my opinion, because of stupidity – I can’t see any excuse for the lack of long term care beds, its not like they haven’t known for decades this was coming and now its been like this for another decade. Put those people where they will get the kind of care they need. Free up hospital beds for people who actually need them. And take a huge strain off the doctors and nurses who work in the hospitals. Something tells me they are costs savings to be had somewhere in there. Just as one example.

In our system, the government pays the doctors. The medical association in each province “negotiates” a contract with that province’s Dept of Health. The majority of doctors are not on salary (some specialists are) but rather are paid by “fee for service”.

Massage, chiropractic and dental  (along with a few other things) are all private in Canada, none of it is covered under the health plan. With physiotherapy, you have a choice – you can attend a hospital physio clinic, which is free, or pay for private. Depending on the province, children are covered for dental to some set age – its 10 in Nova Scotia. Use to be age 12. And kids use to be get one free eye exam every couple years. They don’t any more. Prescription drugs, not covered except through private insurance.  Actually that’s starting to change somewhat in some provinces. For diabetics here. And a “promise” for those with “low income” – read poverty line. But a lot of Canadians have private insurance through their employment.

I think the thinking is that “medically necessary” is covered by the government. I don’t consider it two-tiered because even though there are other things I wish were covered, I basically buy into the medically necessary paradigm.

Every resident of every province gets a medical card (they go by different names in different provinces). You show that card when you go to the hospital or doctor and the “bill” is put through to the province to be paid at whatever the negotiated rate is for the doctors. For hospitals, you show the card, you get service. If you have no card (ie. you’re from out of country) you have to pay out-of-pocket. Hospitals don’t bill the province by visit or procedure but get a set amount from the government each year to operate their facilities.

Waiting times. Really vary by the procedure. Some are reasonable. Some are long. Some are too long. And some people always have and always will cross the border for faster care.

And some Americans buy their prescription drugs in Canada. So……

Illegal Immigrants – not a huge problem here. But I don’t understand exactly how the US system works here. Basically its no job, no health insurance, right? If you are simply resident in the country (legally or not) do you receive the benefit of the ‘emergency care’ law? Is there any length of time you have to be resident first?

My point is this – no, the Canadian system is not perfect. But its not the way I find many Americans seem to picture/describe it. Healthcare is about taking care of people’s medical needs. I believe in the government provision of “medically necessary” services and an equal standard of care for all.

There will always be some who will abuse any system they are in, that’s a given. Now if some yahoo shows up in the ER with something that should be taken to their family doctor, than I expect my child’s issues to be dealt with first. [Without going into detail here about what they are. But trust me, I have been dealing with them for over 12 years and I am well versed in them.] And if someone else shows up mangled from a car accident, then they should be seen before mine. Unless my child’s condition at that moment constitutes a medical emergency (and just for the record, not all “medical emergencies” equate with the word “life-threatening”), which it sometimes does. In which case, they better find a way to deal with both of them immediately.

But here’s what I like about our system, when someone here needs to go to the hospital, nobody asks what their insurance is, with the exception of when you are being admitted and your private insurance, if you have it, will get you a private or semi-private room. I think that when you’re ill enough to go to the ER, the focus should be on your medical care, not on who’s paying at that moment.

But, even without insurance, at our local hospital, the majority of the rooms are semi-private anyway. And our experience has been that our daughter has been given a private room there the majority of the time (when for years we had no insurance) because that’s what they decided her care required. At our regional children’s hospital, all the rooms are private or semi-private. So private insurance would make little to no difference from our point of view. I wanted to attempt to  address what I expect to be Max’s issues with that comment but it ain’t gonna happen tonight. [To which they all utter a sigh of relief]

The Facts – Or What Passes For Them (with liberal editorializing)

The Canadian health care system is a publicly funded system, with most services provided by private entities. Some say that it is not a true public system. The various levels of government pay for about 70% of Canadians’ health care costs (although this number has decreased in recent years), which is about average for a developed country. What is said to be unusual is that in Canada the government pays for almost 100% of hospital and physician care, but contributes very little in areas such as prescription drug costs and dental care.  Canada is unusual in that the government pays for almost 100% of hospital and physician care, but contributes very little in areas such as prescription drug costs and dental care.

This leaves about 30% of Canadians’ health care to be paid for through the private sector. This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry, massage, chiropractic and optometry. Many Canadians have private health insurance, often through their employers, that cover these expenses.

Under the health care system, individual citizens are provided preventative care and medical treatments from primary care physicians as well as access to hospitals, dental surgery and additional medical services. With a few exceptions, all citizens qualify for health coverage regardless of medical history, personal income, or standard of living. [I know. Sacrilege, ain't it]

Although admittedly our health care system is the subject of much political controversy and debate in the country [some question the efficiencies of the current system to deliver treatments in a timely fashion and advocate adopting a private system similar to the US (oh irony of ironies) and others worry that privatization would lead to inequalities in the health system with only the wealthy being able to afford certain treatments] Canada does boast one of the highest life expectancies and lowest infant morality rates of industrialized countries, which many attribute to Canada’s health care system. [Sorry, sometimes you just gotta blow your own horn!]

Not surprisingly, Canada’s health care has a large impact on our economy. Here are a few out-of-date facts and figures about the economy and health care:

  • Health care expenditures in Canada topped $100 billion in 2001.
  • Approximately 9.5% of Canada’s gross domestic product is spent on health care. In comparison, the United States spends close to 14% of its GDP on health care.
  • Individually, Canadians spend about $3300 per capita on health care.
  • At a provincial level, funding is between one-third and one-half of what provinces spend on social programs.

Although Canada’s hospitals are often of high quality, critics allege the wait times to get into those hospitals can span weeks or months, including for simple procedures. According to the Fraser Institute (very right wing, ahem, excuse me, conservative think tank), waiting times in Canada, across all specialties, averaged 17.7 weeks in 2005. However, the Fraser Institute’s report is greatly at odds with the 2007 (and earlier) reports of the Canadian Institute for Health Information, a government-sponsored watchdog agency. Although there are long waits for some non-emergency procedures (notably hip- and knee-replacement surgery) and long waits for specific other procedures in specific provinces, most waits appear to be normal with respect to other health care. [In this case, "critics" are essentially right, as I pointed out above]

The Institute also notes a severe lack of physicians in Canada, again focusing on the health system which hinders incentives for doctors to be trained and stay in the country. Out of a 27 country survey, Canada ranked 24, with an age adjusted doctor-to-population ratio of 2.3, ahead of the United Kingdom, Japan and Turkey, in that order. [But ahead of the US, as you will see below]

The system is not a true public system as most doctors are not on a salary. Doctors in Canada make an average of Cdn $202,000 a year, (2006-before expenses). Alberta has the highest average salary of around $230,000.00 while Quebec has the lowest average annual salary $165,000.00.

Insofar as doctors’ income is concerned, it is important to understand how doctors are paid. While in Italy doctors receive a fee per patient per year, a sort of per capita salary, in Canada most doctors receive a fee per visit. Some argue that this type of system rewards repeat visits, referrals, testing and more importantly this payment system penalizes efficient and effective treatments, prevention and good doctoring. For general doctors, this is more a “fee per visit”, and not necessarily a fee per service. Surgeons are an exception, as they are paid a fee per service. [I'm not buying it.]

The doctor shortage in Canada, is resulting in a great many patients without family doctors, and trained specialists. Some of the results include complications caused by the lack of early intervention. As an article in the Toronto Star specially isolates, it is not so much a problem of a doctor shortage but of a shortage of ‘licensed doctors.’ Its been said that while the government is planning to go “poaching” for other countries’ doctors, there are an estimated 4,000 internationally trained doctors in Ontario working at low-wage jobs. While some would argue that their medical education does not necessarily meet the standards currently required in Canada, many of these doctors come from countries where the health care systems are ranked better than that of Canada. [Shades of Lex’s comments in "Criminally Stupid" - so maybe we're not all that different]

Ironically perhaps, for the sake of this discussion, some would say that this highlights a significant problem with Canada’s half public, half private system, and that is that because it is not a true public system, and profit is a prime motivational factor, simple treatments, simple cures, simple preventative measures are not at the core of the system’s motivations. [Profit ... nasty, nasty thing]

“Let’s Talk Turkey” – no, not the country
In a comparative analysis between the health systems (Canada ranked 30th and Italy ranked in the top two), Canada has a very low 2.1 physicians per 1,000 patients, while Italy, which uses a salaried system has a very high 5.8 doctors per 1,000. One could suggest that in a salaried system the financial motivation of the system is to reduce the volume on doctors, while the ‘fee per visit’ system financially rewards volume per doctor.

The comparison of Canada’s Health Care system is often made to its [wonderful] neighbor the U.S.A. which spends the most in the world per capita, and is ranked 37th in the world, by the World Health Organization; when in fact many sources rate the Health Care Systems in France, and in Italy as the top two in the world. . Canada’s Health System was ranked 30th, using certain specific criteria. It should be noted however, that the WHO Health Care Ranking has come under fire for shoddy statistical methods, and questionable criteria for ranking nations. The WHO is currently revising its methodology and is withholding its rankings until the problems are addressed.

Canada spends no more than the G7 average on health care as a percent of its GDP. Most health statistics in Canada are about average for the G7, and vastly better than the world average. Also, in some health statistics, Canada has slightly better numbers than the United States (although there are several states in the US that have better health statistics than Canada’s). Of particular note is the extensive wait time required to be administered for a medical procedure, which is especially high.

The American System
Here’s my problem with the American system – which I have never lived under so I am prepared to be corrected if I am wrong. But my concern is for the people who don’t have insurance (as set out in those damm statistics above).

Families like one in particular I know (not anyone you know) which struggles to get care because not everyone will take their disabled child’s government insurance (here that same child would have access to the same health care, same hospitals, same services and same doctors as everyone else) or families where when one parent changes employment and the new company won’t pick up a family member because of pre-existing conditions. I know I heard rumblings of a law that was going to change that situation but I don’t know if that has happened yet. If so, that’s great BUT if so, wouldn’t some consider that a bad idea because that’s government intervention?

Sometimes I think people fail to see the big picture. As I understand it there is currently a law in the US which provides for ‘open’ emergency care to everyone and anyone. But despite that, in reality, you can’t have an emergency and just go anywhere; some hospitals can and will turn you away. In which case, you might just die before you can sue. Some would use this fact to argue that it just goes to show that government regulation doesn’t work. But with no law in place, you would still just die, right?

Do you have issues with the FDA? If so, what do you think it would it be like with no FDA oversight? I submit that there are serious issues now with some pharmaceutical reps who feed doctors samples to pass on to patients like candy. What would happen with no oversight at all – a totally profit driven industry with no oversight, run only to make the almighty dollar?

Government standards as to how many patients per nurse’s aide in private institutions – some who work in the field say 20 patients per aide is too high. What would the private standard be – 30, 40, 50?

As I noted previously, if you blame the courts for the cost of medical malpractice insurance, then maybe you should blame the juries. Not to beat a dead horse but…..well, you know, cuz I already said it. In the other one. But think carefully before you advocate removing the court process from the equation. Not unless you have a plan as to what you will you put in its place.

I submit that the key to this whole debate is BALANCE. Balancing the needs of human beings for medical care against the costs inherent in providing such care. And I freely admit that people like me (who argue from the heart) need to be balanced off with people like Max. But people like Max equally need to be balanced off against people like me.

You tell me you are all just nice people who would like to take home some of that money you work so hard for. That it pays to take care of you and your family and provide for your own health care, among other things. Fair enough. But only up to a point.

Why is the concept of “There but for the grace of God [or whatever other deity or form of fate you may choose] go I” so difficult to comprehend? Would you really sing the same song if you and your family suddenly found yourself in the position of having no health care (for whatever fluky reason) tomorrow and suddenly facing a medical emergency?

Solutions?
Surely there are different options to consider. But you won’t like them. Cuz some were proposed by the (gasp) Dems. Look, I don’t have solutions. Personally? Personally I think the “answer”, such as it may be,  may well lie in a combination of systems. And I realized in the last few days that I could live with all private insurance. IF. IF everyone had access.

Shoot me for suggesting that everyone has a right to healthcare. But I have stated the obvious over at Lex’s – with rights come responsibilities. I can’t solve your “welfare bum” problem. Not yet. Not tonight. But I am the person who will err on the side of providing health care to one who by some standards might not seem to “deserve” it rather than let someone else fall through the cracks.

Choice? I can’t speak specifically to Kris’ niece and her husband because obviously I don’t know their situation. But I will give a handshake and share a coffee with anyone who works 60 hours a week to support themselves. Not everyone has the ability to do much more than work at Walmart. And by the way, the “system”, our lovely capitalist system [which I am not really as negative about as I probably sound, I just need to vent sarcasm sometimes] NEEDS people to work at Walmart and such places, doesn’t it?

So, with all that said

  • I thought this discussion about a Patient’s Bill of Rights was interesting.

Congress debates a ‘Patient’s Bill of Rights’ which would establish rules of dealing with HMO managed care. The buzzwords in this debate are:
# External Appeal: Patients cannot currently appeal an HMO’s decision to deny coverage, even if the HMO doctor agrees with the patient. The ‘Bill of Rights’ would establish some form of expert appeal board external to the HMO.
# Medical Necessity: At issue is whether the doctor or the HMO management determines what is necessary. Determination of ‘necessity’ may become subject to expert review as well, or it may become measured against established standards of ‘generally accepted practices.’
# Legal Liability: Patients would be granted the right to sue HMOs for medical costs and damages, which is not a right under current law. Generally, liberals support the right to sue HMOs while conservatives do not. This is the primary distinction between Republican and Democrat versions of Patient Bill of Rights proposals.
# Scope of Coverage: Some states regulate HMOs in ways similar to those described here; a ‘Bill of Rights’ could apply to them, to all HMOs, or to all patients.
# Prevention: Advocating prevention implies support for removing government from health care, or opposition to more federal health care funding or national insurance.
# Consumer Choice: Advocating consumer choice or reduction in healthcare bureaucracy implies support for removing government from health care, or opposition to national insurance.

  • Y’all hate your version of Medicare so I won’t suggest expanding that. Although maybe it could eliminate or at least reduce administrative costs compared with private plans. Still you woudn’t want to update and expand Medicare benefits to fit the working population and children and negotiate prices with physicians and providers that families—and the country—could afford. Wouldn’t want employers’ responsibility for health care financing to be broadly and equitably shared, substantially reducing burdens on all businesses and reducing disadvantages currently faced in the global marketplace. 
  • I am curious – whatever happened to the idea of the proposed Family Health Credit which would  pay for 90% of a basic low-income policy up to $2,000 a year, for every family making less than $30,000?  Every family that is not already covered by government programs or an employer plan would be eligible. This Family Health Credit would help to buy a basic policy that covers visits to a doctor, discounted prescriptions, and hospitalization.
  • A plan to help low and moderate income Americans between jobs by offering them a 75% tax credit to help pay for their premiums. Ofer small businesses a tax credit that covers up to 50% of their premium contribution for low-to-moderate income employees.
  • Start providing health insurance for every child in America - the federal government pays the full costs for the 20 million children in the Medicaid program. In return, states expand coverage to children in families with higher incomes than are currently eligible, as well as low-income adults.
  • Prvide a bonus for states to get children insured.

Ever hear of the 1 and 7 figure? It’s old, back from when I use to be more of a “lefty” but my guess is the numbers have probably only went up instead of down since then. It goes something like this:

For every $1 you don’t spend on a child now, you will spend $7 later in either the health care, education, criminal justice or welfare system.

So. “The Answer”? No. But we all need to think outside the box. And by the way, in case I failed to mention it, I am not sure about “national health care”, but I am pretty confident in saying that Canada’s health care system won’t kill ya.

And as much as I like the US (always have, ever since I was a kid), thanks but no thanks. I wouldn’t want to live there. But I would be more than happy to come visit Kris’ bunker. With my passport, provincial health card and private insurance card firmly in hand.

[It's very late. I am not going to do any more proof reading. Good luck and God bless. And for heaven's sake, someone get me a drink. Quick.]

Posted by Michelle

On March 21st, 2007 under Unfiled.
Comments: 68

Comments

Comment from JAS
Time: March 21, 2007, 10:26 pm

Michelle, I’m coming late into this conversation, but, having read through all the comments on the previous post I have this observation:

A moral obligation is not the same as a political or governmental “right.”

I personally believe that I have a moral obligation to find a way to provide high quality health care on an equal basis for everyone – but I don’t believe that anyone has a ‘right’ to it, the way we have constitutional ‘rights.’ I’d like to see health care for those who can’t afford it and social programs like food pantries come from the non-governmental, non-commercial sector.

I don’t expect, however, that everyone shares my belief – and that’s ok. But I do hope that those who do will work their hardest to provide for those who can’t provide for themselves – not because those who are in need deserve it (they often don’t), but because it provides rather intangible benefits to the rest of us to be generous by taking care of those who are unable to care for themselves.

Mother Theresa used to remind her workers that those in most need are often the least grateful. Many of her patients would spit in your face as you cleaned maggots from their wounds. She chose to help them anyways because the point to was to take care of them, whether they deserved it or not or were grateful or not.

For her, it was a matter of basic human dignity: the ill deserved medical care simply because they existed, and were in need. I find that to be a position I understand. We take care of others because it’s the right thing to do, not because they deserve it now or ever will deserve it. But that’s a moral stance and perhaps a faith stance that I’m not willing to force onto others. I don’t think you can legislate compassion and generosity, nor should you.

I don’t have a plan on how to get from where we are to where we might be, but I don’t think trying to ‘fix’ the current system will give us a viable solution. It isn’t broken – it’s the wrong system, and the wrong solution.

Comment from unkawill
Time: March 21, 2007, 10:56 pm

My head hurts Michelle I will finish later. Nite all.

Comment from Max Damage
Time: March 21, 2007, 11:04 pm

Well done, Michelle. Too much to get into at the moment (the hour is late, and the Sirens call) but you notice how Canada’s mix of public and private insurance effectively performs the triage I’d mentioned in the Walter Reed discussion earlier. Your system takes care of the life-threatening and the basic problems first, with a great deal of ease for the consumer. The elective, the non-threatening, they go to the private insurer. We’ve done a similar start with the Medicare/Medicade and Title 19 programs, but we’ve never felt it politically possible to go the whole route and put everybody into it. It could be done, and you’re right it wouldn’t kill us.

In fact, and read this twice because you won’t believe I’m saying it, I kind of like the idea of the tiered system. First, it has the benefit of spreading the costs across the populace at large, and it provides for the basic care that we generally need. Second, it places the *choice* for other care and the costs associated with it on the consumer, who can elect to pay for the additional private policy. In a way it’s just like the educational system — we all pay for K-12 schooling, and when it comes to post-secondary schooling the customer foots a greater portion of the bill and can choose the level of price/quality they want. Best of all, it takes insurance back to being what it was intended for, a safety net for unexpected costs, rather than a supposed necessity.

I’m sure it would have some unintended side effects, but surely nothing that can’t be tweaked later. That is the only real fear, to me, because politicians have this unnatural desire to tweak things, and typically do not consider the long-term consequences. I submit our social security system is a prime example of how our government is typically content to prolong a crisis rather than take action or cut budgets and benefits when the cash is no longer available. Our tax code is a close second.

I think Americans have a healthy distrust of government, and prefer it to have severe limits into how far it can interject itself into our lives. A two-tiered system could keep the government at bay while still allowing many of the benefits we wish to keep in our health care system, and still allowing enough of a free market system to remain so that the wait times, the incentives to innovate and improve, and the good ol’ desire to make some money and improve one’s life still remain.

While it’s safe to say we will likely never embrace the purely socialistic policies of, say, the Scandanavian countries with regards to health care, the fact that we now accept insurance as not a safety net but a requirement, and not our responsibility but that of our employers, to me indicates that we are ready for at least a portion of our care to be administered by government at this time.

Two side points:

1) why is not having insurance a bad thing? I went for years without health insurance. Didn’t need it. I didn’t have enough wealth to care about bankruptcy, and I was young and healthy enough to not care about my health. It would be interesting to get an age breakdown on that statistic. Seems like a statistic used to manufacture, rather than measure, a need that we must then address.

2) regarding tort reform, that’s a whole ‘nother issue. With respect to health care the problem here is we’re losing doctors due to rising insurance costs. Ob/Gyn’s are probably the worst hit, and a google on the subject will show several instances of Ob/Gyn’s refusing pregnant patients specifically due to malpractice insurance rates of $30K to $80K and often over $100K/year. For delivering babies. Yeah, I know.

Interesting side note, I’ve been called to jury duty probably a dozen times. Never have served. Once they ask my occupation and I reply “engineer” that’s the end of jury selection for me. It does rather make one wonder if the insurance problem is related to tort law or if it isn’t solely with the jury of my peers being reduced to those who can be easily convinced.

- Max

Comment from Max Damage
Time: March 21, 2007, 11:15 pm

So, ummm…. Michelle? I hate to ask more of you, really, but this discussion started from the problems at Walter Reed, the VA system that is one of the few examples of government-run health care in the country. Shall we handle that separately then, since it’s obviously a specific case compared to health care in general?

– Max

Comment from Michelle
Time: March 22, 2007, 4:23 am

Unkawill
While not quite “glad”, I am okay with your head hurting. So does mine. Still. It was a very stupid thing I did. But that’s life.
Then again, from your point of view, I did warn you, didn’t I?

Max
Chances of getting more from me? Right now? Slim to none.
Chat later.

Comment from KrisinNewEngland
Time: March 22, 2007, 6:37 am

“Patients cannot currently appeal an HMO’s decision to deny coverage, even if the HMO doctor agrees with the patient. The ‘Bill of Rights’ would establish some form of expert appeal board external to the HMO.”

This isn’t exactly true. I know because I’ve appealed to my HMO several times in the past and with a reasoned appeal, they have always reversed themselves. Granted, my appeals were for more minor illnesses and problems – nothing major or life threatening – but it did mean the difference between a $25 co-pay and a $1,500 bill from an emergency room.

I must admit, along with Max, that a tiered approach wouldn’t be so bad. The analogy to schooling seems appropriate – though I’m still concerned about the cost to me – above my own healthcare. How can you spread the cost around when, according to the stats Michelle presents, 16% of Americans have no health insurance presumably because they can’t afford it. I have to presume that those of us who can afford it in the “now” would still have to pay for those who can’t in a tiered approach. Maybe I’m just not making the right “mental break” between the philosophies of the 2 different systems.

Max also says that “…I think Americans have a healthy distrust of government…” and I would 110% agree with that. With good reason unfortunately. And it’s not just that they insist on tinkering when it’s not necessary, they also tend to forget what their constituents really want, and focus on their own political career. But that’s a whole nuther subject of course.

I mentioned in the previous post that I have friends in the U.K. who have experienced first hand what those waits Michelled mentioned can be like. Forgive the lack of brevity please:

My friend Lizzie had a Uncle who had a degenerative hip problem diagnosed back in the 80s; it didn’t really bother him greatly until the latter part of 2001, So, in November 2001 he made an appointment with his family doctor to begin the process of diagnosis – that appointment took 2 months to get. The family doctor told him in January 2002 that he likely needed a hip replacement. The Uncle was told he needed to see a specialist for a formal diagnosis; that appointment took 6 months to get. In June 2002 he saw the specialist, who confirmed that he needed a hip replacement. Since surgery was considered elective, despite the debilitating nature of the problem, it was scheduled for December 2002 – 6 months after the appointment with the specialist and 13 months after the Uncle began the process. And since the hip problem was a degenerative issue, his mobility continued to decline over these 13 months. By the time he had the surgery, he was in a wheelchair, unable to walk. He was 60 at the time. The surgery was successful and as far as I know, he’s doing just fine.

13 months to get a hip replacement for a degenerative problem that put him in a wheelchair. Perhaps it’s an extreme example; I know the U.K. system is different from the one in Canada. But in the end, it’s a government-controlled system that is clearly broken…

Michelle talks about doctor shortages – which I presume is a similar situation in the U.K. and the reason my friend’s Uncle had to wait so long for treatment. Given what we are used to, how many Americans would be willing to wait 13 months for a hip replacement?

Comment from Michelle
Time: March 22, 2007, 9:02 am

I really, really can’t do this right now……….so why I am here? Cuz I’m my own worst enemy, that’s why!

But a quick note – I tried my best to be brutally honest in pointing out the faults of the Canadian system – knowing full well that if I wasn’t, someone here would! So in that vein, wait times here for something like a hip replacement…..might well be even a little bit longer than that exerpienced by your friend’s uncle. Sucks, eh? I guess it all comes back to being a trade off…..

BUT I need to get a job at the moment. Actually I have a job. Two jobs. One of which I will lose if I don’t get my rear in gear and actually work. One of the downsides of working from hom is that its much too easy to get distracted.

So please…….talk among yourselves. I will be back – but not until I make some money for the governent to tax (actually I’m poor enough that personally I don’t pay income tax, can you imagine? Only CPP and sales tax – well, let’s not go there!) to pay for health care.

Thanks for reading. You were brave souls.

Comment from KrisinNewEngland
Time: March 22, 2007, 10:41 am

Michelle said: “…might well be even a little bit longer than that exerpienced by your friend’s uncle. Sucks, eh? I guess it all comes back to being a trade off…”

Some trade off – being in chronic, debilitating pain from a degenerative condition that can be managed thru a fairly routine surgery. And this trade off would be so that those who can’t insure themselves, get the same insurance we all have?

Hmmm….

Comment from Michelle
Time: March 22, 2007, 10:50 am

Kris
You’re cheating. I can’t answer this right now. But can you see how much that bugs me?
Damm “you got mail” ping on these computers, anyway :)
Later.

Comment from KrisinNewEngland
Time: March 22, 2007, 12:33 pm

Michelle, apologies for the increased snark level in that comment. But can you see how much the idea of THAT kind of trade-off can bug some of us here???

The American system isn’t perfect and neither is the Canadian one – I think we probably all agree about that.

But to go from no lines/no waiting (or at worst minimal waiting) to a 13+ month wait for a routine surgery – can you see how that might, um, frustrate me?

Comment from Buck
Time: March 22, 2007, 12:36 pm

First: Bravo, Michelle. Extensive and well-argued.

Second: Kris writes:

I mentioned in the previous post that I have friends in the U.K. who have experienced first hand what those waits Michelled mentioned can be like.

Anyone who watches the PM’s “Question Time” on C-SPAN, even casually, will immediately notice the first ten minutes or so of each episode is consumed by Blair tap-dancing to the opposition’s “difficult” (and they are that) questions about this week’s Health Service outrage. And it seems like there’s NO lack of bad stories…

All this from an arguably “mature” Public Health Service. I’d hate to see the US health care system devolve into something like the UK has, based upon simple (yet anecdotal) evidence.

And that said, I encountered the Brit health care system once or twice while stationed in London. It didn’t seem so bad (at the time), but I never had anything worse than a bad cold or a sprain. Just by way of explanation…we USAF personnel stationed in London had the option of driving an hour or so to the USAF hospital at RAF Upper Heyford or going to a Public Health Service contract doctor in the local area. For minor problems, the choice was obvious.

Comment from Michelle
Time: March 22, 2007, 2:38 pm

Okay, a quick drop by. Sorry if I was bit snarkier than usual last night/this morning but it was a bit of a taxing although fascinating adventure.

Where to start – a few individual posts I guess.
Max, funny, I was going to say I didn’t know much about veteran’s healthcare until I recalled that I had somewhat direct (if dated) Canadian experience. My father was on a 100% disability pension from Veterans Affairs when I was born. And in and out of Veterans and local hospitals and our home for the first nine years of my life.

But I have no real knowledge around the Walter Reed situation – you know who would. Or at least some. My suggestion there would be FbL. Anyway, I did answer what you posted about Vetreans care on the Walter Reed thread and I think I’ve kept up my part of the bargain here on TFD since throwing down the gauntlet, so to speak, so……..if you want to post something, I would be happy to be a commenter. Other than that, my days of serious blogging are over for a while I’m afraid.

Comment from Michelle
Time: March 22, 2007, 2:58 pm

JAS
Glad to see you back. And thanks for joining the thread.

Sigh…..that’s where I differ from my fellow crew here on TFD. I would stretch constitutional interpretation -our Charter of Rights and Freedoms has a constitutionally gauranteed right to “life, liberty and security of the person” and the right to not be deprived thereof except in accordance with the principles of fundamental justice. Yeah, I know. Lawyer-speak.

People have tried to strech that to cover many, many things but the courts have been pretty conservative in interpreting it. Although I believe that clause or something similar was recently used in a Quebec case to find that Quebec’s prohibition against private health insurance for medically necessary services was unconstitutional. Something about “Access to a waiting list is not access to health care.” [ouch! Talk to you later Kirs] That being a SCC decision I didn’t really want to bring into this discussion – yep, my own worst enemy!

Anyway, back to reality. So you think you have the wrong system? If you were the artist and the US your canvas, what would yours look like? How’s that for a loaded question? :)

Comment from Michelle
Time: March 22, 2007, 3:12 pm

Kris
A quick comment on wait times (a lick and a promise?). You pegged hip replacements and I know joint replacements in general are a real issue in the Canadian system. So I was somewhat talking off the top of my head.

Decided to take a quick trip across Canada (always helps to have friends that are pilots) and see what I could find. Each province is suppose to have data up on waiting times. Key words “suppose to”. The only ones I could access quickly were in Nova Scotia.

Knee replacements- the range is from 30 days – 720 days. 57% of the people in the province had the procedure done within 270 days.

Hip replacements: same range from 30 days – 720 days.
50% of the people in the province had the procedure done within 180 days.

Bone density tests: This gets weird. In Cape Breton Island (traditionally considered a “poor” area) the wait time is 11 days. Where I live, become there is no place that does it in my area, I have a choice between heading to the South Shore (59 days) or Halifax – 410 days??!! That’s ridiculous! And I think, inaccurate. My daughter had yearly bone scans for a few years. We always went to Halifax. And never waited over a year. Of course we only needed yearly appointments.

MRI – Cape Breton is once again the best – 32 days. Halifax 94 days. IWK (Reg Children’s Hosp) in Hfx but for the entire Maritime region (NS, NB, PEI) 80 days.

Some of these seem off to me though. My daughter has used up a LOT of services in her life. MRIs, CTs, ultrasound, bone densities………never a waiting time that made me so much as blink. And with the IWK, those that are felt to really need MRIs, the waiting time is one week. Actually, many many years ago, when she was in IWK, one was scheduled within 48 hrs.

Okay, off again.

Comment from Michelle
Time: March 22, 2007, 3:36 pm

As I said before, I am basically having this same discussion simultaneously in two different groups – TFD version being much more detailed, of course. Anyway, I made this comment to a friend in the other group earlier today:

“I am saying that some ‘socialist’ leanings ain’t all a bad thing. That in my opnion some socialist leanings could actually be a good thing. Remember how communism use to be THE ENEMY? So whazzup now, do we still need an ideological enemy? Still need an us and them? Don’t we already have that with the terrorists?
No system is pure. Capitalist. Socialist. Whatever. We know that. I happen to think that’s a very good thing. But here’s a thought – pull a few concepts from each ideology. Put them together and wrap them in a pretty bow. Call it your own. I wonder………….I think maybe I am finally getting it. Took me long enough. People so motivated by a fear of……the dreaded big government, regulation, socialism … some other ism? [pick your poison(s)] that you simply CAN’T change anything……

Comments?

Comment from unkawill
Time: March 22, 2007, 5:32 pm

Unkawill
While not quite “glad”, I am okay with your head hurting. So does mine. Still. It was a very stupid thing I did. But that’s life.
Then again, from your point of view, I did warn you, didn’t I?

Please let me clarify Michelle,

My head was hurting from a combination of Beer and Bad air from one of my employees painting a car in my warehouse.

I have to agree with buck, Max and Kris and yes, even YOU!

Extensive and Well Argued, Compassionate yet Pragmatic Reasonable and Civil.

I don’t think, no I won’t allow you to don the wings of a “MOONBAT”.

They DON’T Fit. To paraphrase Johnnie Cochran… If they don’t fit-you must acquit!!!

Bet you thought I was going to lay into you?

Comment from Michelle | Edit comment
Time: March 20, 2007, 7:44 pm

unkawill
I give! I surrender! But only to you – and only on certain points. Just two minutes ago read your response to my moonbat comment at Lex’s. Didn’t know whether to laugh or repeatedly bang my head into the monitor in frustration – so I did both!

You already Surrendered, and I don’t wan’t you to have to utilize your health care system on my account!

ICSFTH

Can’t wait to meet you at Kris’s bunker dedication.

lastly, I am off to darts. On the morrow, fair lady

Comment from Michelle
Time: March 22, 2007, 5:59 pm

Yeah, yeah, yeah….
I was kind of hanging around TFD, all quiet like, figuring you would show up soon….. I was going to apologize to you for my snarkiness earlier. But, on second thought ….. nah, can’t see it.

So you will have to settle for…..thanks for the compliments. I deserve them! (that was a funny BTW)

Poor Kris, you think she really wants all us moonbats eccentrics around? Hanging out in the bunker, howling at that New England moon, maybe even a few trying to see if they can get flight ops going off the roof?

Me thinks its her we should apologize to. In advance!

Comment from KrisinNewEngland
Time: March 22, 2007, 6:06 pm

Heck, bring it on baby! The more the merrier – remember New England is more Blue than Red, despite the best efforts of a certain New Englander who is planning a bunker.

Flight ops from the roof of the bunker? Nah, but the roof of the neighbor’s house – no problemo.

All are welcomed – the “eccentrics” may not have access to the best beer or food, but we’ll take care of ya.

Comment from Michelle
Time: March 22, 2007, 6:39 pm

I’ll be there …. “with my passport, provincial health card and private insurance card firmly in hand.”
Cuz I know the stakes. LOL

Comment from JAS
Time: March 22, 2007, 10:06 pm

Michelle, I’m honestly not sure what I’d lay out – mostly because I’m too burned out right now to give it the thought effort it deserves. :-)

It’s been a hot topic in our household for years as both my husband and I worked for Fortune 200 insurers, and we have rather strong opinions about how badly implemented and poorly designed the private insurance coverage has become, from an inside perspective. I don’t think that private insurance as it is currently enacted holds the answer, nor does government insurance per se – but I don’t have a solution. Yours I find intriguing, and well thought out, btw!

As someone who got dumped into the Medicare system when my company found a loophole that literally forced all employees on disability to receive Medicare instead of the primary benefit of employer-sponsored health insurance we’d been “guaranteed,” I have a close-up and personal opinion about *that* program (and I’m not even going to go into how crooked I think it is that an employer is allowed to dump their responsibility for providing a health insurance plan in such situations onto the federal government – it’s supposed to be a cost of doing business to actually fulfill the promises you contractually made to employees when you hired them in terms of benefit payouts… but I digress!).

I pay more for the Medicare policy than I did for my employer-sponsored plan, but I am also getting better access to practitioners and treatments in many areas (not all). Administratively, Medicare has been far superior in handling claims compared to any private insurer I have ever worked with. In the past 5 years, Medicare has made less than five processing errors in handling claims. My secondary insurance, on the other hand, has made literally hundreds of claims errors during that same period of time, requiring hundreds of hours of my time and the time of my practitioners’ office staffs to straighten out – and the same errors occur again and again, in addition to a never-ending stream of new errors.

On the negative side, if Medicare says I don’t “need” a treatment – then I can’t get it, even if I pay cash, without going through some fairly hellacious contortions within the ‘system.’ Doctor’s who provide treatment to a Medicare patient in those situations without a special dispensation (which requires the aforementioned contortions to obtain) are fined hefty fines, too. So – I have some bureaucrat who knows squat about my medical history or condition – or about medicine – deciding what I need for health care, which I find decidedly infuriating and dangerous for my continued survival to boot.

Medical Assistance and Medicaid are frequently confused with Medicare, but they’re not the same at all, and are a whole ‘nother story. That system is, frankly, a nightmare – the worst combination of federal and state co-mingling administration of an insurance program. From what I know about them second hand, through acquaintances who have children or adult dependents, that system simply doesn’t work.

Comment from Michelle
Time: March 23, 2007, 4:47 am

JAS, interesting….
I must be off to work (darn capialist system!) but the Medicare/control of treatment issue – how does that work? I mean presumably you have an actual doctor saying your require “x” and Medicare says no?

Reminds me of my recent private insurance battle – my child’s doctor (who has been her ped neuro) for 12 years says she can stay at home with nursing care (LPN care) during times when she would usually be hospitalized. First, my insurer says their doctors have decided “No, she can’t stay home, its not safe.” Second letter from ped neuro saying she could stay home was ignored. Threaten litigation. Get a phone call telling me they would give me 8 hrs of nursing care per day so I could work. Mighty generous of them, but what I wondered how she went from her own health and safety reqiring hospital care to it being okay for me (no medical training) to look after her 16 hours per day? And all this time they have no medical information on her other than letters from her specialist. Sorry, sidetrack, just one of many experiences with insurers.

Anyway, that sounds just wrong – the Medicare situation. Can you appeal that decision or something?

Any chance of a quick primer on – okay, Medicare is for those without private insurance, right? Can you (or someone) give me a two-liner each on Medicaid and Medical Assistance? Thanks.

And yeah, seems just wrong to me that an employer can get away with what yours did. Fine print in the contract?

Comment from JAS
Time: March 23, 2007, 10:48 am

You can appeal the Medicare situation – but the first round of appeals that are rejected something are something like 95-98% outright. That’s with your doctor (or panel of doctors) signing the appeal saying that the treatment is medically necessary! You are entitled to a second round of appeals but those must be in a federal administrative court and believe me, the process is incredibly difficult. Plus, your expert witness – the doctor(s) have to take off time from all their other patients and their practice and do the paperwork and the court appearances free as – remember – this is Medicare and the patient may not pay them for services unless Medicare approves! So very few doctors are willing or able to even do the second round of appeals.

Ok, Medicare Primer: Medicare has two different sets of ‘clients’: disabled citizens and retired citizens. The programs are different, and I can only address the one for disabled citizens.

Medicare part A (major medical) and part B (everything but hospitalization) is not for people who don’t have private insurance per se. It is only available to individuals who have a) been legally declared disabled by the federal government and b) do not have a primary private insurance policy and c) are receiving “Social Security Disability Income” (which is in itself considered the most difficult benefit program to enter). To be determined as “disabled” you must be proven unable to do any type of work at any type of job – period.

So: you must be disabled and qualified for Social Security Disability Income and not have a health insurance policy available to you. Under these conditions, the govt provides the option to buy the Medicare insurance policy to those folks – not their spouse or dependents – just the disabled individual.

Now, here’s how people like myself – who have insurance when they become disabled – end up with Medicare as their primary insurance, and the rest of the working folks in the USA are forced to pay through their taxes for my Medicare when they shouldn’t be shelling out a dime.

It wasn’t fine print in the contract – it’s a loophole. Here’s how it works.

My employer refuses to declare me (or any other employee) “permanently” disabled – even though the federal government has declared me totally disabled, and did so more than a decade ago. The employer is not required to find any employee permanently disabled. By refusing to declare me disabled, the employer can pay me, through a third-party insurer, ‘third party sick pay.’

Because I am therefore not disabled according to my company’s administrative policy,I am still an “active” employee and legally they can therefore change my benefits at any time (regarding health insurance – there they can change any time they declare an open enrollment) – except for the actual disability insurance payment they must provide under the policy that was in effect at the time I became disabled. Since I am a “non-permanently-disabled” (NPD) employee by their fiat, and that is a clear ‘class’ of employees, they are allowed, under federal law, to create a ‘special’ group of just NPD employees for benefit purposes, and put all their disabled employees in that group.

After one year of having separated NPD employees into their own group within the company, the company can legally provide us with different benefits than they offer to all their other employees! So, for example, they were able to eliminate my participation in any 401K retirement plan (except for what I had already put in) and eliminate my my health insurance for all practical purposes. They wiped out my insurance in fact, but not in name, by writing a “health insurance plan” that declares itself a secondary insurer which only pays out as a limited Medicare supplemental insurance (without calling it that) for employees they have declared as NPD who have at the same time are considered completely disabled by the government.

In doing this they are not regulated in what they must offer as a Medicare supplemental insurance, because legally they aren’t providing a Medicare supplement… which translates as they can do as they damn well please in what they offer as coverage.

Is this legal? Absolutely, because of the ‘special group’ loophole that was found and abused in this fashion. Likely to change? Only when we convince our legislators to rewrite insurance law to eliminate these loopholes.

Quick summary of Medicaid: It’s a program sponsored by the federal government and administered by states that is intended to provide health care and health-related services to low-income individuals.

Quick summary of Medical Assistance: It’s the customized Medicaid program as offered by each individual State. Medicaid is the backbone and Medical Assistance is the implementation. The implementation varies depending on what each state choses to fund and offer.

Comment from Michelle
Time: March 23, 2007, 1:50 pm

Okay. Gotchya.

Hey guys, listen to this – somebody is working the system here and it sure doesn’t sound like its JAS. Wonder why so much of your tax dollars are going into Medicare and those other terribly wasteful government programs??

You gotta stand up and SHOUT….

Sorry, its 5:30 on a Friday and I got a few more hours work to do….. Needed a “Lex break”. Who needs a Kit Kat when you got TFD?

Seriously though. Putting aside the question of the (possibly prohibitive) costs in doing so, theoretically would it be possible for employee(s) in your situation to, at some point (maybe when first placed into a NPD group or more likely, after the year is up when all hell breaks loose and the employer can essentially do whatever it wants), make a court application for declaratory relief – in other words, an application brought against the employer asking the court to issue an order stating that the employee(s) is (are), in fact, “disabled”. Thinking being that the employer would be bound by the court’s finding and would then be compelled to provide whatever benefits the health insurance policy stipulates for disabled employees.

Or, maybe the “answer” would be an action for breach of contract – by refusing, in bad faith, to find the employee to be “disabled”, the employer has breached the terms of the employment contract? I know I am talking mainly at legal theory and not necessarily practical possibility level here BUT, assuming your employer is not the only one pulling such shenanigans (and really, even if they are), it would seem to me that some union or other group should be willing to take such a case forward and set a precedent to help employees who are, effectively, being shafted.

And/or, as you suggested, legislation should be brought forward setting up some sort of process an employee in your position could set into motion in which an independent third party would look at the bona fides or not of the employer’s decision.

It’s funny, years ago (in my “leftier” days), I use to ask myself why everyone thought it was not only permissible but even laudable to stretch the income tax system as far as possible [read get as close to "cheating" as possible if not outright doing so] and yet screamed bloody murder if the welfare bum mom got enough extra money for another quart of milk…..

You ever think that sometimes maybe we’re blaming some of the wrong people?

Comment from Max Damage
Time: March 23, 2007, 10:50 pm

Michelle, we’re certainly blaming the wrong people in this instance, but I submit the problem isn’t with the people, or the lawyers, it’s with the laws that allow through exception the abuses we’re seeing.

Sadly, I do not see a cure to that probem that doesn’t involve a re-write of the tax code such that government is relieved of their ability to write laws to transfer wealth.

And I think we all know that battle will be well-fought.

– Max

Pingback from Neptunus Lex » Off the grid
Time: March 24, 2007, 6:39 am

[...] talk amongst yourselves if the mood strikes, or join in over at the Flight Deck in one of the longest running conversations ever sponsored by a naval aviator on the subject of healthcare – socialized, free market or hybrid? [...]

Comment from Michelle
Time: March 24, 2007, 9:44 am

Whoa!
Major computer prolblems at the moment but if I tread very carefully I can navigate through here. Can’t get to email at all so doorkeeper, maybe you could please pass that on in the Cafe. Hope to get it looked at on Monday. Seemed to blow a fuse while I was responding to email last night. Actually had a quick thought that maybe writing this healthcare post blew my computer’s brain as much as it did mine!

Okay, back to work. Max, you do lose me occasionally. “Rewrite of the tax code such that government is relieved of theri ability to transfer wealth”…. has me saying WTF? You trying to sneak one of those awful anti-socialism concepts into my healtcare debate? :)

Seriously, can’t compute your comment. But what I was saying was that I saw two possible legal routes to take to lay down some law to close this “loophole”; other option being goverment stepping in to change the insurance law to close the loop.

And I know you caught one of my bigger points – not all of the terrible waste and mismangement of resources in government sponsered healthcare is being caused by the actions of government. Perhaps arguably by government inacton in this case….. although remember, I think it was you (not going to navigate around too much to check) that frowned on government “tweaking” things too much. Well, sometimes a tweak or two is obviously what is called for.

Comment from Michelle
Time: March 24, 2007, 9:58 am

Words of warning – don’t talk about “tiered” healtcare in Canada. Or, if you do, prepare to duck.

“We” say we don’t have a two-tiered system. Idea being that the orginal intent of our medicare system was to NOT allow those who could “afford it” to “purchase” care outside the system. As things have progressed, some would argue that either we now have two tiers or are certainly heading in that direction.

Personally, in theory, I think I would be okay with the concept of more “private operators” providing service which they directly bill the government for. Except to make it worthwhile for a private operator (and boy, are private operators ever trying to get a foot in the door here) wouldn’t they have to charge more than what government is willing to pay? If so, then not only do we run the risk of those with money getting quicker access to care (to which you all respond “Yes!”) but there are only so many “professionals” in the system and the doctor, nurse and lab tech working for a private company (and presumably being paid better) won’t be available to work in the hospital.

Comment from Michelle
Time: March 24, 2007, 10:28 am

Max, despite Canada’s problems with the idea of a “tiered” system, it might just be an idea for the US to consider. I think that “going the whole route”, as you put it, and covering everybody for basic and life-saving care would be a good first step.

You asked “Why is not having insurance a bad thing?”. First let me say that I agree on the concept of manufacturing statistics; as doorkeeper pointed out to me in another conversation, the Amish (?) choose not to have insurance and structure their “society” in a way that works for them.

As far as being young and wild and free and feeling that you didn’t need insurance…. I remember those days (almost fondly). I’ve only had private insurance (not the same as your situation obviously because of our government healthcare) for about ten years of my life. But I think part of what you refer to involves the perceived invincibility of youth. Problem is even that if you failed to realize it then (or now?) anyone from an infant to a senior can be struck by ligthening or a motor vehicle, be diagnosed with cancer or have any number of bad things happen to their body. And, if something like that had occurred to you back then, what would have happened? The only saving grace is that presumably you would have been only responsible for yourself as opposed to family. So even though we may think we need it less when we’re younger, I would say you’re really just playing russian roulette. That being said, if you’re willing to gamble and take your chances (and good luck convincing the young that anything bad could ever happen to them!), who am I to stop you?

Jury duty – the irony there is that I would be loved to serve on a jury. But I won’t ever be allowed to unfortunately (or maybe, depending on your point of view….) I would put you on my jury, Max. Well, maybe, depending on what the case was. Well, maybe, if I could get some one-on-one time with you. Then I would at least have some hope of making you “see the light of reaon”.

Engineers. Interesting sub-type :)

Comment from Pixelkiller
Time: March 24, 2007, 2:56 pm

My God in Heaven, my eyes glazed over before I got much into the comments. (My eyes haven’t glazed over like this since,….. Gee, since I can’t remember when). Sorry.
I think the point is missed. We are all blind-sided, by the drum beat of “The Health Care Crisis”, which is Bullsh!t from those with an agenda.
A little history of me and mine so you’ll know how much the world has changed: My Dad was born in 1899 and was the youngest son of Italian immigrants. He wanted to “Make something of himself”, so like all those who wanted to better themselves, he set out to get an education. He worked his way through Stanford Medical School. (are any of you old enough to remember working your way through college? Er, that means graduating with no debts?) [Cost-of-education-inflation began, I believe with the G.I.Bill, but that's a discussion for another day]. After his internship he opened an office in the heart of North Beach in SFO. (He was to remain there for 40 years).
As a little kid I would go with him, sitting in the front seat of the DeSoto, (before seat belts), on Saturdays as he made “calls” at people’s homes. Those too old or too sick to come to him. (He knew who they were. Sometimes he would arrive at their houses unannounced as he hadn’t seen or heard from them for awhile. He’d sit at their kitchen table, talking about nothing and everything, take their blood pressure, check out their refrigerators to see if they’re eating right, see who’s there with them, renew a prescription, what-ever, but really checking them out really closely a-la Sherlock Homes).
During the week, his normal routine was the hospital in the morning, or house calls, and then to the office before noon. He had lunch with “The Guys”, (a bunch of other professional men from the area). All afternoon he was in his office. He was home at 5pm for supper. At 6pm he was heading back to the office as he had many patients who worked during the day and could only see him in the evening. (These were, plumbers, cops, garbage men, auto mechanics, secretaries, steam fitters, electricians, street car conductors, well, you should be getting the idea; they were almost all “working men and women”. I only saw him at Supper and on the weekends.
Nobody had health insurance. What passed for health insurance was the bigger companies footing the bill for any injuries or sickness of their employees. Anyway, everybody got taken care of one way or the other. The differences in care were three: A private room, a ward with 25 other people or finally, the county hospital which was underwritten by the county. Your own doctor could and would treat you there. Perfect? No. Did it work? Yes. Was it cheap? Yes.
European socialists and American “liberals” kept bringing up “Free government Health care” and kept at it until Medicare came in in 1964. As some of you might be aware, it’s been downhill ever since unless you are so young you never knew what “good medicine” or “good health care” was.
I had never really thought about it, but always sort of figured I’d go to Stanford, become a G.P. like my Dad, and someday take over his practice and do medicine like him. Isn’t that what lots of sons did? Walk in the footsteps of their fathers?
Not to be….. One day as I was still in highschool, my Dad took me aside and said if I wanted to follow him into medicine, fine. He would pay for Stanford and help in any way he could. However, he cautioned me that medicine, in his opinion, was not going to be a “good business” in the near future as the Lawyers, the Politicians and the Insurance Companies were going to take over and I would not be allowed to take care of my patients properly; the way he always had. He advised I find something else to do to make a living.
So, I went to NYC, became an Industrial Designer, got drafted, got out in 2 years, and got a job making industrial films, documentarys and commercials. What-the-hell. It took me around the world twice, I made some money and I got to see places where you can’t go anymore.
The point is this: “The Medical Care System” we have now will never work properly but will none-the-less cost more and more until it falls apart of its own weight, when it costs everything and provides nothing. (In 2005 I had a triple bypass. Ten days in the hospital cost $112,000! It was an A-La-Carte experience. Everything else was extra on top of that bill!). Discussing the various “schemes” to make it better is a giant waste of time. You are playing the “Spin Meisters” game. Take it all apart and keep the government, the lawyers and the insurance companies out of it. Go back to the old “Free Enterprise System”. (Oh, the breaking of rice-bowls!)
The last advice my Dad gave to me before he passed away in 1973 was, “Mike, don’t get sick!”
Sorry if I bored any of you. I have no regrets as to how I lived my life. I am Pissed that the Bull Sh!t artists ruined a perfectly wonderful and honorable profession and most people alive today will have no memory of how good it was. More’s the pity.

Comment from Michelle
Time: March 24, 2007, 3:39 pm

I don’t have any problem with what you’re saying Pixelkiller. I particularly agree with this comment.

“The Medical Care System” we have now will never work properly but will none-the-less cost more and more until it falls apart of its own weight, when it costs everything and provides nothing.”

I know you don’t want to talk about it anymore anyway. But what I am missing is how that would work, what that old “free enterprise” system as you describe it would look like today. All I want to know is how, when my daughter ends up in the hospital for a week, am I ever suppose to pay for it? Today? Now?

Comment from Pixelkiller
Time: March 24, 2007, 5:54 pm

Michelle;
That’s the point of it all! You can’t pay for it. Nobody can. You will be impoverished, made a slave of the system. A serf. A subject. Pretty soon, if not already, you wont be able to afford the premiums on your insurance policy. (Watcha gonna do then? Borrow to pay your premiums? Think GM or Ford)
I have a friend who sells medical liability insurance to doctors here in New Jersey, Connecticut and NYC and already they can’t afford them. (…And the people delivering babys? What their premiums are?) The older doctors are leaving the “business” altogether. The younger ones are working for wages in a hospital or clinics. (Think about a 60% premium increase in your renewal letter). My friend has to continually increase his area as his customer base keep shrinking. I remember that old fraud C. Everit Coop, the surgeon general some years ago, when he noted in passing that doctors for the first time ever were advising their sons and daughters not to go into medicine. (I refer to him as a fraud because he saw that as plain as the beard on his “kindly” face, but put his weight behind anti-smoking instead. He passed on what was truely important, mind boggleing, earth shaking, and went with the popular and politically correct. Please God, may I live long enought to pee on his grave).
When the end comes, as it surely will, the question should be, will the train wreck be a “controlled train wreck” or will it be a complete surprise? (That’s with everybody pointing the fingers at everybody else as the dust settles and they try to keep even their shadows out of gun-shot range). I would hope there would be someone who could get elected who could go about setting up a controlled wreck. And, would the voters ever elect that person? (We both know that answer to that one. Not! …And almost forgot, all those rice bowls!). Otherwise it’s gonna be just awful. “I can see the train a-coming, coming round the bend. I hear that whistle blowing since I can’t remember when…..”
My advice, Michelle, to you and your daughter and anyone else reading this, is what my Dad told me, Don’t get sick. It sucks, I know, but this whole “Regulated” and “government sanctioned” health care idea was an insidious scheme from the beginning! The anti-Christ could not have thought up anything worse! Such misery!
The point is: prepare for it. What will it be like? What it’s always like when you begin again from scratch. Hard. Really hard! But, maybe this time it will be all of us together picking ourselves up by our own boot-straps and we’ll see if we are as good, as kind, as generous, as hard working, as civilized and as honest as we like to think we are. (Oh, and smarter too this time. Naw. who am I kidding. I forgot all those rice bowls again).
Color me cynical.

Comment from Michelle
Time: March 24, 2007, 6:50 pm

Actually, if you don’t mind, I think I’ll colour you pretty smart. In some warped way, I actually like the way you think. Funny, I use to think maybe people were good, kind, generous, civillized and honest but now……..

Comment from Pixelkiller
Time: March 24, 2007, 7:44 pm

Michelle;
Not so fast. Let us not confuse real people with lawyers, politicians or insurance agents. In some parts of this country, people are what we would hope. In one very small part, way up in north western Montana, two years ago, there was an accident. Me and my best friend were on motorcycles. He was killed and I almost was. It took two seconds. Total strangers took me into their home, fed me, dressed and undressed me, got my prescriptions for pain killers filled, let me use their phone for calls all over from Dirty Jersey to California, saw to it someone was always there, and on and on. I was there a week before I could arrange my return along with two broken bikes and all my friend’s stuff. (The bloody helmet bothered me). The State Cop who took my statement in the emergency room and later drove me to their house in the middle of the night is a credit to his state and cops everywhere. They should all try and be as compassionate as he. The people at the local hospital were exactly as we would hope/dream. (Well, not exactly all,,,, the little SOB taking my blood couldn’t find the vein and left me with a hemotoma the size of a flapjack). The young lady doctor had a gentle touch tho. Total strangers took it upon themselves to save me. They wanted nothing but to see me well again.
So, Michelle, fear not as anything is possible because in some places people are still even better than we think we are. I’ll be passing by there in July and hope to see them again. (And yeah, by motorcycle).

Comment from Max Damage
Time: March 24, 2007, 11:13 pm

Pixel, nothing frees the soul like a motorcycle ride across the country. I’ve just over 230K miles on a ’93 Sportster and I wouldn’t trade a one of them for time in a car. It’s the fact that I get to stop in those small towns, grab a bite with the folks playing checkers in the city park, and chat with the gas station attendant and the hippies in the campground when I call it a night. On the scooter I get to meet the face of the country, and it’s a good country indeed. Some, like me, merely have faces for radio.

Michelle? Yes, I was playing Russian roulette. The odds were in my favor, I had no wealth and no person to protect, bankruptcy was a perfectly viable option if it came to that.

I know I make some leaps of logic that are hard to follow, but you’re capable of following them, I merely need to explain them better. Eliminate the power of Congress to transfer money from one person to another? Pure and simple, it goes back to our tax code argument. Tax codes are used to raise money, and also to reward and punish behaviors. Employers can deduct health care costs on their taxes. There is a reason I cannot as an individual. I submit that reason is because it would reduce the power of government, and also because as individuals we’ve little power, but as blocks of agregated power (such as a business and the lobbying groups they fund) suddenly we’re worth noticing and patronizing.

Yes, we engineers are a breed apart. I still feel naked if I don’t have at least two pens and a slip-stick in a pocket, and I’m sorry I don’t seem to have heart-strings that can be plucked, but I can tell you that if I’m on your jury you need never fear that emotion will outweigh evidence and I refuse to claim I’m sorry about that.

– Max

Comment from Pixelkiller
Time: March 25, 2007, 7:16 am

Max;
Way to go! The sense of freedom and independance is overpowering. I have 107,000 on a ’93 Heritage, and 70,000 on a ’99 Classic. I’m getting on and my knees don’t carry me like they did, but my behind is still Okay. I am hoping I have at least one more “ride” in me.
You can thank LBJ for the loss of your “medical deductibility”. That was key to the passage of Medicare. But, what-the-hell, it was only gonna cost 10 billion a year… Remember? That’s just a “snick-snack” to congress.
Bankruptcy will work, sorta. The doctors will wait, work out a deal or just write it off, but hospitals will chase you and take everything so be thoughtful and hide the assets you love.
Regarding a change in the tax code? Don’t hold your breath. They need our money to stay elected or get elected. You must admit it’s a cool system. They use our money to bribe us into re-electing them. What did Pogo say? “I met the enemy and it is us!”
203 k on a Sportster? My God but you must have a cast iron Ass! I’ll bet you’re still “vibrating” for an hour after you shut her down. I’ve come to “appreciate” the larger seat, better suspension and the fairing of the Classic. (I Only keep the radio for the built-in clock. Too distracting).
Stay well and beware of agressive, asexual young women on cell-phones and 4-wheelers in general.

Comment from Michelle
Time: March 25, 2007, 7:52 am

Perhaps I’m not as capable as you think?
But before I go there – you can’t deduct medical expenses at all? That is wierd. We can, only a portion though, you can only start claming for the portion that’s higher than, I think its 3% of your income. And then its a tax credit, so it ends up that you get an actual value of something like 17% of what you paid. But there’s no upper limit and besides the cost of any private service you pay for, you can claim your premiums for health insurance and travel and meals if you travel beyond a certain distance from home for medical care. Now you can even claim more things; for example, if you have been diagnosed with celiacs disease, you can claim the cost of buying gluten-free food.

But I still don’t get your tax argument at all. How does not letting you claim medical expenses increase the power of government? All I see is it gives them more money. Unless you’re equating that money (the taxes you pay) with power? I do agree with your point about lobby groups.

But “Eliminate the power of Congress to transfer money from one person to another?”" So, what, you don’t want them to collect taxes or you just want to limit what they can do with the money they collect? As in eliminate…. social assistance…….medicare……..what?? I am not being intentionally obtuse, I just don’t get it.

One more thing. Your comment that if you were on a jury, emotion would not outweigh evidence. My take? 99% of the time emotion shouldn’t outweigh evidence. But that doesn’t mean that emotion has no place in the equation. It’s what make us human, its what gives us our humanity, and without that, really, what are we?

Guess I am back to where I started, my comments about balance. Never relegate emotion to the garbage heap, there is a reason why its part of what and who we are. We need to recognize it, accept it and then make sure we put in its proper place, not running the show but …. kind of like a program on the computer, running silently and, for the most part, unobtrusively in the bacground. But wathcing and monitoring all the same. And then, when it recognizes a situtation where it is called for, to step forward and asset that it has a role to play. Similar to a conscience maybe? At that point, we have the hard job, finding the best way to justly balance the two together.

And now, its a beautiful Sunday morning, and I need to get a life.

Comment from KrisinNewEngland
Time: March 25, 2007, 8:03 am

As with retirement funding, I believe that here in the U.S. it is now up to the individual to make their own plans for health care in their “old age”. My generation – tail end of the baby boom – can’t count on anything except that which we plan for ourselves.

Which might explain some of the unapologetic selfishness you’ve been hearing. We know it’s up to us as individuals to make our own plans – nothing will be there for us the way it has in the past for our parents (at least speaking from the B.B. generation).

Comment from KrisinNewEngland
Time: March 25, 2007, 8:19 am

Michelle – we can’t deduct medical expenses, per se. We have something called a Flexible Spending Account, where you have money deducted, pre-tax, for use to reimburse yourself for things like co-pays for doctor visits and prescriptions, and for deductibles for larger medical expenses. The FSA will reduce your taxable income, but if you overestimate how much you need in a given year (you have to state your year’s needs the prior year) you loose the money at the end of the year.

Comment from Michelle
Time: March 25, 2007, 8:33 am

Because your health insurance (which is through your employer) ends when you retire? Never thought about that. So then what’s suppose to happen? If I read JAS correctly……but I thought there was a program for seniors? Am I right and you’re saying you just can’t trust that the program will be there when you need it or that there isn’t one at all?

Nah, either which way, you need to do something different. Before it crashes like Pixelkiller says. But if I was that worried about my own future situation, then why wouldn’t I ban together with some people and demand something be done? And help others at the same time that I’m helping youself?

Look, quick example. My daughter is mentally challenged so the school sytem is always an interesting challenge, to put it mildly. I use my legal background and training to advocate for children in special ed. Just an an upaid advocate in adittion to what I might do pro bono at work. Some parents will not take half a step to help out another’s child. They take the view that if they come forward and, for example, say that they have been provided with such and such, then the school or the Department of Education might get angry and take it away from thei child. Their only focus is on taking care of their own.

I cannot and will not buy that reasoning. Everything I do for another child, I view as something I am doing to help my own at the same time. Equally, every time I adivocate for my child, I am hoping and planning how it might help some unknown other child out there. It doesn’t have to be and shouldn’t be a case of “either/or”, of either taking care of myself and my family or taking care of someone else. I see that a cop-out. That’s why we have a “we”, so we can take care of one another.

No, not emotion without reason (not “I will save them all while not even noticing what’s happening to my own family”) but the powerful product of melding emotion and reason together and figuring out how to help yours and theirs.

Comment from doorkeeper
Time: March 25, 2007, 12:00 pm

I’m baaaaack………. and way behind. So catching things as I can:

KRIS: you say: “16% of Americans have no health insurance presumably because they can’t afford it.”

I’d like to see this figure adjusted (no idea if anyone’s ever even tried) for those who do not have health insurance BECAUSE THEY DON’T BELIEVE IN IT. I live in an area with religious communities who do not believe in health insurance, namely, Mennonite and Amish. They take care of their own, quite well, without insurance. It’s astounding to watch. It really is. Then there are groups like the Scientologists, and others I am not sure of (being ignorant) who refuse medical treatment–therefore, they don’t have health insurance.

So I wonder if the figure would be even 1% smaller?

doorkeeper

Comment from doorkeeper
Time: March 25, 2007, 12:04 pm

Don’t wanta seem to be picking on Kris…
but you say, “Some trade off – being in chronic, debilitating pain from a degenerative condition that can be managed thru a fairly routine surgery. And this trade off would be so that those who can’t insure themselves, get the same insurance we all have?”

would you not forgo the hip surgery for yourself if it meant a child would live?

I’m sorry, but until recently, people lived without hip replacements and many other expensive but non-life-threatening conditions. Sometimes people just had to suffer. We’re talking about saving people’s lives. Aren’t we?

Comment from doorkeeper
Time: March 25, 2007, 12:13 pm

M, possibly consider this (I know I said it elsewhere, slightly differently, but perhaps to say it again and here will–help?)

You said:
“I am saying that some ’socialist’ leanings ain’t all a bad thing. That in my opnion some socialist leanings could actually be a good thing. Remember how communism use to be THE ENEMY? So whazzup now, do we still need an ideological enemy? Still need an us and them? Don’t we already have that with the terrorists?”

What if…just thinking, here…the great evil, the ENEMY you percieve capitalism to be, is an exaggeration in your mind? I know you equate capitalism with GREED unfettered, but to us, capitalism = competition, and chances for each-man to work out his own destiny.

ponder that, eh? d

Comment from doorkeeper
Time: March 25, 2007, 12:16 pm

gonna pick on Max briefly
You say: “why is not having insurance a bad thing? I went for years without health insurance. Didn’t need it. I didn’t have enough wealth to care about bankruptcy, and I was young and healthy enough to not care about my health. It would be interesting to get an age breakdown on that statistic. Seems like a statistic used to manufacture, rather than measure, a need that we must then address.”

I had two wildly divergent thoughts, first, a knee-jerk reaction, what IF you had needed it?? What if, God forbid, you’d been in a severe accident and had medical bills that an Army of oompa-loompas couldn’t have paid off in several lifetimes? Or would you have refused care because you couldn’t pay?

Second reaction (no, I’m not schizoid ) was, He’s RIGHT!! Because I live where a LOT of people have no health insurance, namely, the Amish and Mennonite communities.
They do fine w/o insurance.

so……..my eyes are crossing, and I need a beer and a nap!
d

Comment from Michelle
Time: March 25, 2007, 1:04 pm

doorkeeper, you definitely are back!

I don’t consider capitalism to be the enemy, per se. Yes I do tend to equate it to a certain extent with the idea of each man for himself and whomever owns the most when they die wins. But capitalism is a system, an ideology, and I’ve said it before and I will say it again – any concept that a man can could put together, its guaranted that another group of man will find a way to pervert and abuse. And I believe we see that happen a lot with capitalism.

Way back at the start of Part I, unkawill proclaimed “socialism rears its ugly head”. And I responded with “no, unbridled capitalism rears its ugly head”. And now, having come from there to here, I would say that any unbridled system will eventually run amok. And when it does, it won’t be pretty. In my opinion, capitalism, like any other system, needs to have some checks and balances applied. My natural inclination would be to give that role of checks and balaces to government. Which, I have come to realize, will make you all shudder and give you horrible nightmares for at least a week. So if someone has an idea of anyone else who can do the job…??

Although I must admit that every time I type this stuff now, my thoughts come back to pixlekiller’s comments….

Comment from Michelle
Time: March 25, 2007, 1:09 pm

doorkeeper, your comment to Kris on waiting for a joint replacement to save the life of a child (or anyone else in my opinion), thank you for that. Although I don’t think that a person should have to wait 17 months for a joint replacement, either, I would prefer to be saving someone’s life while working on the wait time issue.

Comment from unkawill
Time: March 25, 2007, 8:23 pm

Michelle, Capitalism is the rising tide that lifts all boats, without guy’s like me who create Capital and therefore Jobs, there wouldn’t be anything to redistribute to the poor,needy,disabled or lazy.

You said; My natural inclination would be to give that role of checks and balances to government. Which, I have come to realize, will make you all shudder and give you horrible nightmares for at least a week. So if someone has an idea of anyone else who can do the job…??

No nightmares here, that is exactly what we are subject to.

And before you jump on me for the lazy admonition, I have a sister who has gamed the system for all it’s worth her entire adult life.

I don’t know why she is lazy, she certainly doesn’t get it from my family who are all either business owners or professionals and whom all have offered employment.

I mean why should she work, when she can live off of the fat of the land?

Comment from Max Damage
Time: March 25, 2007, 10:07 pm

Doorkeeper asked, “I had two wildly divergent thoughts, first, a knee-jerk reaction, what IF you had needed it?? What if, God forbid, you’d been in a severe accident and had medical bills that an Army of oompa-loompas couldn’t have paid off in several lifetimes? Or would you have refused care because you couldn’t pay?”

If I’d been in a severe accident chances are homeowners, renters, or automobile insurance would have covered it. Very few people have strokes at age 24, or heart attacks at age 18. Very few single men riding motorcycles live through many accidents. The odds were all in my favor — I was going to live fairly well and the high-cost diseases weren’t for another 20 years, or I was going to wind up a dark stain on the highway and insurance wouldn’t matter.

So yes, until I proposed I went without health insurance from the end of my college days until my future wife and I decided we should be married. Insurance wasn’t useful to me in the interim, it was a cost without significant benefit. Healthy people age 24 do not shop for insurance unless they’re sick already. Given that is the transition age between being covered by a policy from the parents or the college, and one is earning the minimum they will in their career, the odds say give up the insurance because anything that will kill or maim me will happen under another policy like my automotive or renter policy.

Funny, my life insurance premiums have risen since then, and I’ve not really changed at all. Perhaps the other side of this coin are playing those same odds?

– Max

Comment from KrisinNewEngland
Time: March 26, 2007, 6:02 am

Doorkeeper: I was quoting Michelle’s original post when I said this: “KRIS: you say: “16% of Americans have no health insurance presumably because they can’t afford it.” I don’t know where she got those figures, we’d have to ask her for her source..

Doorkeeper said: “I’m sorry, but until recently, people lived without hip replacements and many other expensive but non-life-threatening conditions. Sometimes people just had to suffer. We’re talking about saving people’s lives. Aren’t we?”

I thought this discussion was about healthcare and accessibility? I understand the relationship between the 2 – accessbility to healthcare CAN mean the difference between life and death. And I don’t mean to say that a child should die so someone can get a hip replacement (which does seem like an apples to oranges comparison to me). My larger point was that I highly doubt Americans will be willing to wait 17 months to 2+ years for such a routine surgery, just so that some sort of national health care system can be implemented. And frankly, they shouldn’t.

But then again, no child should die due to a lack of healthcare – which I don’t believe happens in the States. For REFUSING healthcare, yes, but that’s their (or rather their parent’s) choice.

Comment from KrisinNewEngland
Time: March 26, 2007, 6:03 am

Michelle said: “but I thought there was a program for seniors?” And there is, but even now it’s not enough to provide basic coverage to just about anyone. My in-laws and my mom are all retired – and they have to purchase supplemental healthcare to cover what Medicare doesn’t cover, and that includes prescriptions. So I figure, much like Social Security, these programs won’t be stable enough for my retirement, so I need to plan accordingly.

Let’s revisit this topic in another 30 years, and see how that statistic about uninsured Americans over 65 looks…

Comment from doorkeeper
Time: March 27, 2007, 12:18 pm

I don’t believe there will be healthcare as we know it in 30 years. Forgive me for cynicism, but dealing as I do with the disabled population, with the exploding incidence of autism–a disability for which the kind of care that we expect in the current climate is overwhelmingly expensive–with the increasing population of elderly, I believe we’ll come to a crisis long before I am eligible. I can’t see any other way.

As for children dying for lack of healthcare, I can’t point to specific cases, nor can I point to areas to search for this information. But living at the top of the incredibly impoverished Appalachians, seeing rural poverty at its worst, sometimes, I have no doubt that children don’t receive care until they are far sicker than is usual for those in urban areas.

I do know that the elderly are dying for lack of healthcare, for I see it happening. Sometimes it is lack of CARE, for the system is desperately overburdened already. Sometimes it is actual lack of coverage, and sometimes it is the inability of elderly people with no one to represent their needs, simply being unable to deal with the incredible paperwork and redtape which surrounds getting what they need.

I do believe that the programs for which our taxes are extracted by force, should be made to work, and work effectively and efficiently. But having dealt closely with “the System” I doubt if it can be done without sweeping reforms.

Comment from Michelle
Time: March 27, 2007, 3:52 pm

This one is for you, Kris.

“A Prescription for Wait Times – Fundings aims to speed up access to rediation therapy, other services”
Its a bit of a long article, but if you’re still interested…

Comment from Michelle
Time: March 27, 2007, 3:54 pm

So, Max, what do you think?
Do you want to take on vetrans’ health care of shall we give this subject a decent burial?

Comment from KrisinNewEngland
Time: March 27, 2007, 4:11 pm

Michelle – interesting article, thank you. But it does seem incomprehensible that people can receive a cancer diagnosis and then have to wait up to 8 weeks to begin treatment. In that time, some cancers will grow PAST the point where treatment can help.

I applaud Canada for trying to make changes – including the last sentence in the article about hip/knee replacement surgeries – but still, 8 weeks can be a VERY long time to a cancer patient – sometimes the difference between a chance to push back the cancer, and death.

Comment from Michelle
Time: March 27, 2007, 4:57 pm

Kris, all you can do is try.
This one is from December 2005, so a little dated – “First ever common benchmarks will allow Canadians to measure progress in reducing wait times” – might show you where we are attempting to go.

Don’t feel obligated to read though. Could just be that I just *think* that I have too much time on my hands this evening.

Comment from Michelle
Time: March 27, 2007, 6:03 pm

unkawill, I know this is old but some talk in another thread reminded me of this post I hadn’t respond to. I believe we will always have the poor, the needy and the disabled among us. Unfortunately, we will also always have the lazy among us to. Because, to an extent at least, that’s human nature.

Those who have work available to them and choose not to take it without good reason shouldn’t receive benefits. But the flip side is that we must be careful never to punish those who don’t fit into that category just because there are those that do.

Comment from unkawill
Time: March 27, 2007, 6:10 pm

Michelle On this, we agree. Damn I hope you aren’t turning me into a” MOONBAT”

Comment from Michelle
Time: March 27, 2007, 6:25 pm

~Aaah… I see my evil plan is working well.
Excuse, I must report back to my moonbat superiors now. They will be very pleased.

Comment from unkawill
Time: March 27, 2007, 6:53 pm

Tis Time, fair Michelle, That we put this thread and my @ss to bed.

O’ Dark Thirty comes mighty early, round these here part’s

I’ve five customers to make deliriously happy tomorrow with my services.

Nite sweetie ;-)

Comment from Pixelkiller
Time: March 28, 2007, 5:08 pm

Ladies and Gentlemen;
For one last time; I’ve read all the posts and I’m left with this: You are still missing the point. You are very busy and well-meaning, but you’re all running around trying to tie up Gulliver. ….A thread over a pinky here, a string over a wrist there…..
On the 7th day, the book says, God rested. (A job well done and all that doncha know). Well, what the book doesn’t say is God had left something undone. (The sound of a hand striking the forehead), No law! So, God thought and thought. It had to be something simple and elegant. A law all the other laws, (think universe here), could come from and hang onto. “Eureka! I got it”, said God. And so it came to pass in the fullness of the 7th day, the first law, “There shall be no free lunch”.
It seems to me, and I have a lot of milage on this old body, that all the misery in this here world, (and I’ve seen more than my share), starting way back from day “8″, comes from ignoring/finessing/ that law. This whole “longest running conversation” is a study on what happens when you/us, or those before you/us, bought into the scheme/scam of a free lunch. (Insert here: affordable, universal, government sponsored health care).
I advise you/us all again, prepare for it to collapse, because when it does, it’s gonna really suck.

I sorry if I brought you down, but I am reminded of something that might perhaps lift you up a little. (eh, maybe not)….. A long time ago in Hong Kong when it was still festooned with Suzy Wong Bars, I was walking down a small street when from up ahead and across, three British sailers exploded out of a restaurant door. They fell into the street and were immediately followed by a large Chinese cook dressed in white and brandishing a huge cleaver. As the sailers were picking themselves up looking to continue escaping, the Chinese cook stops at the curb and yells loud enough for everybody on the street to hear, “You, , you, , , you, suck hairy moose-cock!” All the people within earshot had stopped and were watching, but at his curse, we all broke into laughter. The cook looked around, slowly lowered his cleaver and walked back into the restaurent. The sailers, now all upright, staggerd off in search of another adventure as did I. So, I guess the point of this story is, as bad as it will appear, it too shall pass.
Good luck y-all. I’m gonna pour myself 2 fingers of Jack Daniels and see if anybody came up with any news on any of the TV news shows. (I’m kidding, I’m kidding).

Comment from unkawill
Time: March 28, 2007, 7:48 pm

Pixel killer, Is your Nom-de-Blog related in any way to my favorite childhood/ early teen author Robert A. Heinlein?

In the body of your comments you state: “Eureka! I got it”, said God. And so it came to pass in the fullness of the 7th day, the first law, “There shall be no free lunch”.”

IIRC he coined the phrase, or should I say acronym “TANSTAAFL”– There ain’t no such thing as a free lunch.

I agree with you overall, It’s not going to be pretty when it all comes crashing down.

It’s going to be chaos for all long time till it all shakes out.

As far as the name Pixel, Heinlein had a cat by that name as a minor character in several of his books.

Comment from Pixelkiller
Time: March 29, 2007, 9:06 am

Unkawill;
I grew up with Heinline also, but no, “Pixelkiller” did not come from there. (That’s a story for some other time). As a Heinlein fan, you remember his series of stories on “Future History”. You also remember, no doubt, Issac Azimov? He came into my life a little later with his Robot stories. Mostly I came to appreciate Azimov when he wrote Science Fact articles in a pulp called Analog Magazine. A fellow named Cambell was editor back then. Cambell’s editorials every month opened my eyes to how people really are and the way things work. Cambell gave lots of SiFi writers their start. Sorry, I have digressed.
What I failed to say, or just left unsaid, was that after the crash, there will be chaos and misery first and then rebuilding. I’m on the lookout for someone, anyone, who can manage a “managed crash”. (The foundation Trilogy?) We will rebuild properly if we remember the “Law”. If we persist in wishfull thinking, we won’t.
Good luck to us all…..

Comment from Michelle
Time: March 29, 2007, 9:16 am

Ah, Isaac Asimov’s Science Fiction magazine…….. I was a subscriber for a long time :)

As for healthcare….bah, I’m done with this subject (she says hopefully).
“Managed crash”, huh? Good luck with that BTW

Comment from Pixelkiller
Time: March 29, 2007, 12:53 pm

Michelle;
Either you manage it or it manages you, (and it doesn’t even know your there).
I think you’re probably correct, unfortunately. Our fearless leaders will continue to muddle through until there ain’t a muddle left in sight. If they wont lead and can’t follow, they should at least get the hell out of the way! so many don’t realize or refuse to even look, but we are all in the same leaky boat so we all better bail.
That 2 inches of jack Danials was wonderful last night. Maybe I’ll begin a tad earlier today. The bike’s in the garage, my shoes are already off, what can happen?

Comment from unkawill
Time: March 29, 2007, 4:28 pm

I own everything RAH ever published, Just got done with “Time enough for Love” two weeks ago for the fourth time. I have an extensive library of Sci-Fi, Biographies, History,all Sherlock Holmes, Clancy, DuBois, Griffin, and I hope one day to add our host to my collection.

Right now I am trying to slog through Madison’s Bio. It’s as good as a twelve pack before bed as far going to sleep.

Five minutes top’s and I’m out!

Comment from Babs
Time: April 5, 2007, 10:50 am

Nancy is a 21 year old unmarried cocktail waitress who also goes to school part time at Red Rocks Community College in Golden Colorado. Her birth control pills are causing uncontrolled bleeding due to a homonal imbalance… She went to a public health center, the same place that prescribed the pills for $10/yr, as she didn’t have private health insurance, and was seen by a gynocologist on a sliding scale. The fee she was asked to pay for her health care was affordable to her and, was also subsidized by the gov’t…
Just one step short of having some kind of surgery to stop the bleeding, Nancy stopped bleeding. The Dr.s at the health clinic re-regulated her on the pills and, she hasn’t had a bleeding episode since.
Nancy paid several hundred dollars for this although it would have cost thousands of dollars through private health care.
She has gone on to live a healthy life and bear two live born children… She has also contributed tens of thousands of dollars to the federal tax coffers.
Nancy has been very grateful for this federal safety net and thinks this is probably the best way to deal with health care in the United States. She understands that the health care she recieved in the 70′s, with the sliding scale and the opportunity of public clinics, is now antiquated.
9 years later, Nancy bore her first born son in a public hospital as an indigent as she and her husband were full time college students. It cost her and her husband less than $500 to have this baby (never mind that Nancy was kicked out of the hospital less than 24 hours after giving birth). But, Nancy and her husband did pay what was asked of them.
Nancy wonders why some people think they should get health care “for free”.
Nancy read an article in the LA Times in about 1995 in which the reporter interviewed people that owned condos in the Huntington Beach area and also had full time jobs that did not have health insurance. Nancy marveled at the statements of these people. Basically they said, we are healthy, we don’t need health insurance and don’t want to pay for it. We would rather pay for condos and cars…
Nancy wonders why the same type of health care that helped her so much has fallen out of favor.

Comment from Babs
Time: April 5, 2007, 11:10 am

Fast forward. Nancy is now50 years old and having a lot of trouble sleeping. She makes an appointment to see a sleep Dr. It is a 6 month wait. She is told she needs to go into a sleep clinic, another 4 month wait. She finally makes it into the sleep clinic. The people there are very nice and hook her up to recieve beams from Mars. She tries to sleep. Getting out of the sleep clinic she is told it will be a three week wait for the results.
After three weeks, she calls the clinic. She is told that it will be another month or two before her results are available. Meanwhile, her insurance company is charged $15,000 dollars for her stay in the sleep clinic! She calls the insurance company and tells them not to pay the bill as no diagnosis has been forthcoming…
They tell her that is not possible…
She calls the sleep clinic back and demands results. She is told her notes are in “transcription” and she has to wait.
After a whole bunch of huffing and puffing, Nancy finally gets a diagnosis. Severe sleep apnea. She is then told that the insurance approved company needs to be contacted and, they need to approve the recommended course of treatment.
Does anyone here get my point? We are so tied up in red tape that people are suffering at a terrible rate. Why is that? Do you really think that public health clinics would be any worse than this? I don’t.
The funny thing is the panacea that people see with single payer health care. Why do you think public health care would be better than private? Private health care sucks…. just in case you didn’t know.

Comment from Babs
Time: April 5, 2007, 11:34 am

Back it up 15 years. Nancy’s son is sick… He is terribly sick. He has a head cold that won’t quit. Nancy tries all the over the counter remedies. Finally, she calls her Dr. The Dr. is unavailable for 3 days… She takes the kid into the clinic, twice… They tell her it is pink eye. She tries to hang on for a couple of days. Finally, the kid’s right eardrum bursts. She calls into the clinic. The Dr. is finally available. She tells the Dr. that her son needs to see an ear/nose/throat guy, the situation is serious. The Dr. points out to Nancy that she is an HMO patient and she can’t authorize going out of the service…
Nancy gets a lead on a local ENT guy. She calls the office and tells them she will pay cash to have her son seen…
Her son is seen. He has a raging virus in his head. The ENT guy sends the kid next door to a pediatric opthamologist as his eye is involved. Nancy tells the staff again she will pay cash…
Long story short, after the bills settle, the primary pediatician calls up pissed… Why did you do this, Nancy?
Why did I do this? Ah, because I love my son and, BTW, you are fired…

Anyone that has the financial means to override socialist health care will. Anyone that pushes socialist health care is either a fool or, they know they can buy their way out of it.

Comment from Michelle
Time: April 5, 2007, 12:35 pm

I don’t know about anyone else but Nancy has me totally confused. Too bad she wasn’t here to speak for herself. Because all I hear are what sound to me like contradictory situations, impressions and statements.

Let me take the liberty of moving Nancy and her family to Canada. Let’s also assume that the cold winters don’t kill her. Without private insurance, Nancy will be footing the bill for those birth control bills. However, she won’t be paying anything (that she can clearly see) for the medical care she requires.

When she has her son, she will likely be able to stay in the hospital 48 hrs, assuming neither she nor the baby have any medical complications.

Sleep problems? Well, she will wait to get in that clinic but I will give you 3-4 months maximum to see the sleep dr, maybe 4 months to get in the clinic (totally guessing here). I will tell you one thing that won’t happen. Nobody will be paying a $15,000 bill. What does a family dr bill your insurance company for a regular visit? A few hundred dollars, as I understand it. Here that same dr would get around $45. Specialist dr for an office visit – around $75.

Hmmmm…..wonder where all your money is being sucked up? And no, before you go there, I don’t think our physicians are hurting too much financially – see the figures quoted in my post above. Those numbers are gross, of course, before the payment of overhead and such. They are also somewhat dated.

I’m sorry but I am legitimately confused here. In one post I think I hear you praising public health care; in the next, I think I hear you slamming it.

Anyway, let’s continue with Nancy’s son. No issue with HMOs and going “out of service”. No paying cash up front. If she can’t get into see her family doctor quick enough, she can go to a clinic (as she did in your scenario). And unfortunately the kid is just as likely to get misdiagnosed here too. But she will make it to the specialist without pissing off her pediatrician.

I had a long discussion with a friend today about all these labels – social democrat, socialist, communist, facist, conservative, moderate conservative …. After I pegged down definitions, I decided that I am likely a social democrat (which at least some here are probably well aware of) – in my opinion, health, education and social welfare require government assistance and intervention. But I think private insurance has its place too. As as adjunct which needs to be kept in check.

I think I probably come off as more anti-capitalism than I really am. But I think that much as I wrote in my “A Little to the Right Please” post, I push back against anything I perceive as being too extreme in one direction or another. The discerning readers here on TFD and at Lex’s being, for the most part, more conservative than I likely bring out what some perceive as my “socialist” leanings.

Oh yeah, after pinning down those elusive (to me) labels, I hereby declare that they should all be chucked. Out. Because too often I find they are used as an unfair and ultimately unhelpful shield, something to hide behind. “That’s socialist. Can’t have anything to do what that”. “Damm facist!” Frankly, I think they are cop-outs. Just another form of ad hominem. In my opinion.

Thanks for joining the discussion, Babs. But I really am somewhat confused. In other words, no, I really can’t see what you are trying to say. Could you clarify?

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