Centerfield

The health-care debate in this country is so muddled with corporate interests (Insurance and Pharma) and so emotionaly tied to "socialism" that most people can't honestly evaluate what should be done.

You're right about Hillary-care. It was a very well-thought-out program that offered choice and enabled the wealthy to seek premium care. The fact that it would have eliminated HMOs (who take a rediculous amount of our monay) got the insurers very scared...so they paid millions for an ad campaign to scare american voters into thinking there would be no choice, it would cost more, they wouldn't get good coverage, etc... It worked, and it's truly sad.

Any time someone claims it would be too expensive, they have their head up their ass. Why?

1. We already pay WAY too much for healthcare as it is. We are already paying...it's just a matter of who profits and how the money flows.

2. The overhead of medical insurers is absurd (I think the average is about 13%). Compare that to govt run Social Security, which has administrative costs of less than 1%.

3. The high cost of medical insurance is a direct factor in our global competitiveness as a country. It's the number one reason why GM has been laying people off by the tens of thousands. It's good for the worker, it's good for the corporation. If you are rich, and don't have health insurance because you can afford any disaster, it's probably bad for you. Boo hoo. Im crying a frickin river over here.

Posted by: ME at September 7, 2006 06:19 PM

Arnold is wrong, but he is right in some aspects. To deny the *possiblity* of a bureaucratic nightmare is wrong. But to not try something is just as bad. That is why some of Europe's best and brightest are moving to Austrailia and Canada (who had public healthcare problems of their own) rather than the US to our own detriment: health care is the most basic of needs and a country who cannot provide that - while another can - loses.
With that in mind, I started to look up "Hillary -care" I found an essay about how the plan was/was not sold and the situation of leadership when offering such a massive plan:
http://www.upenn.edu/pnc/ptbok.html
And I don't see how insurance/HMO's would have felt threatened, as 1)HMO's were still considered new and a private alternative to a public problem and 2) HMO's and insurance companies seem to be benefiting from the plan as they would recieve public and employee support

Posted by: Rachel at September 7, 2006 07:07 PM

The answer is simple, Rachel--the poster doesn't know much about "Hillarycare." The plan would have carved up the country and assigned market share to the favored insurors, and put the government in charge of setting "allowable margins." Kind of like with regional power companies--a state monopoly with regulated profit levels. But it didn't cut through the system overhead at all, just let the government decide who got to play and who got to go out of business, and who got what shares.

Medicare's overhead is much higher than the "less than 1%" cited, and that's misleading anyway as overhead in private industry is calculated versus premiums-per-member. Medicare premiums are subsidized, and since Medicare is for the elderly, expenditures per member are much higher than regular health insurance, so Medicare overhead per member is more comparable to private than indicated. Medicare overhead is 2.2% by that most generous measure, versus private insurance overhead of 6-14%. But on an apples-to-apples per member per month basis, it rises to over 4%, closing in on "best practices" rates of 5-8% in private industry.

Medicare also has no marketing costs and some obvious economies of scale, and as payer for almost half of all health care, can act as a price-setter. And if they decide to pay X and X isn't enough to cover, the rest of the cost gets shoved off onto the non-Medicare patients.

Posted by: Tully at September 7, 2006 08:39 PM

I'm sorry, but health care is not "the most basic of needs". That would be water, food, clothing and shelter, in that order. Health care comes after those things, and sometimes far after, depending on exactly what type of "health care" you're talking about.

A huge chunk of our medical expenditures in this country is end-of-life care, a lot of money spent on people in the last few years of their life. Cutting edge cancer treatment to buy 6 more months is a nice thing, and I would sacrifice a lot of my own money to provide that for myself or a loved one, but it is, ultimately, a luxury, not a basic need of life.

Posted by: PatHMV at September 7, 2006 10:03 PM

I partially agree with PatHMV. Not only is end-of-life care a big drag, but so is neonatal care. Let's face it: a lot of premature babies who would have died in infancy only 30 years ago now survive healthily to adulthood. The cost of modern technology necessary to operate neonatal ICUs is astronomical. Then there is cancer care. It is much more expensive because it is much more sophisticated. A big reason healthcare is so expensive is that it is so much more sophisticated than in the past.

That said, it is, in my opinion, a "right" to which people should have access. I don't know enough to know what is the best solution. But the current system is broken in many ways, and getting worse.

Posted by: Elrod at September 8, 2006 12:49 AM

A "right" that depends on funding provided by the work of other people is not a right at all, but a privilege and a luxury.

Posted by: PatHMV at September 8, 2006 08:44 AM

Bureaucracy can and does work; we only notice the bloated ones that don't. I submit that a Hillary-like national health care system would probably be the most scutinized in our history, to be tweaked, or scrapped, as the case may be.

Posted by: Elliot Essman at September 8, 2006 12:48 PM

I worked on a medical app once. The hardest part was dealing with Medicare's required findings codings, which were completely idiosyncratic, and required a great deal of code to make work. It was probably a great opportunity for the company, but a horror for doctors. I don't see how a human could hope to get it right, and see why many unautomated doctors' offices didn't take Medicare. The cost to the medical industry has to be absolutely huge; and this is just one aspect of dealing with Medicare.

In my city, no small doctors' offices remain; it's
all behemoths and a handful of three-doctor places that are great to deal with but always seem struggling. How much of that is because of Medicare?

Dealing with Medicare is like taxes at their worst. There's a growing industry of professionals that deal with Medicare for you, or at least help you through the steps to take to deal with it. MediGap insurance is a booming business.

With regular insurance (esp non-Blue-Cross), things are a ton easier. I sign up in 1-2 months, walk in the door of a doctor I like, and get treated with far fewer worries about what'll be treated. No long wait to start, fewer employees in bad moods who just say no.

I favor something like what Massachussetts is trying, although it's going to take alot of debugging (see Brian's grumbles about its likely fiscal troubles).

Posted by: Jon Kay at September 8, 2006 01:29 PM

The sad truth is that complex issues like national health care are far too complex for the average voter to understand. If Hillary were to package it right and sell it during the campaign, it would sound very attractive to those frustrated with the current health care ills. Depending on who gets the GOP nod, the Dems could score a lot of points on health care. As I noted elsewhere, if Hillary is running against a conservative popping off on non-issues like gay marriage, she could win over a large number of moderates.

Posted by: WeekendPundit at September 8, 2006 02:16 PM

I'm sorry, but health care is not "the most basic of needs".

Funny, I only hear that from people who have health care and are in no danger of losing it anytime soon.

I get the point Pat, but it is a need, even if it is not a basic one. Those who live in fear day to day of getting sick, or injured, and not knowing how to pay for it, go through hell. I think this issue is about what kind of country we want to be.

Posted by: Mathew at September 8, 2006 02:54 PM

Bureaucracy can and does work; we only notice the bloated ones that don't.

On it's face I agree with Elliot's premise. Having worked in government I have concluded that it isn't the bureaucracy that fails but the political appointments and Congress who make the rules. Is government too big? In some areas it is, absolutely. However, that does not mean we should dismiss and idea because it is a government solution.

Posted by: Mathew at September 8, 2006 02:57 PM

Perhaps we could achieve more progress on Health Care if we took smaller bites out of the solution than proposing a single health care system. Perhaps expanding Veterans Health Care and Medicare to certain people. Perhaps standardizing the paperwork. Perhaps standardizing the coverage and removing barriers to competition.

I believe that many improvements could be made if we backed off of extreme proposals that freak out the industry and the voters. More modest incremental improvements may better slide under the radar.

Paul
Austin Centrist

Posted by: Paul at September 8, 2006 04:26 PM

I agree with Paul, even though I may differ with him on some specifics. I don't see why anybody would object to a number of reforms which could be made quickly and easily. First off, I think we should make health care payable with pre-tax dollars whether your employer provides it or whether you pay for it yourself. That would open up the market for individual health care policies, improving access to health insurance for self-employed individuals and employees of very small companies. And purchasers of such policies wouldn't be tied to their existing job like many people who depend on health insurance are today.

Posted by: PatHMV at September 8, 2006 05:33 PM

I want to see a new paradigm that addresses affordability, shared responsibility and the promotion of healthy living. Single payer, government-run health care does none of this

In this instance Arnold is sadly mistaken. Several examples of government run health care systems that are cost-effective and good at promoting health. The political jargon in this statement: 1) "shared responsibility". I wish this meant that we must all pay for some of our health care. That's what its supposed to do. No one wants to acknowledge that high deductable systems don't work well for middle class and below. In addition, the Republicans don't want to address catastrophic or significant chronic disease that impoverishes.

Lets be honest, all health systems are facing serious cost and budgetary problems. However, the Europeans were "fortunate" enough to get their comprehensive systems in place before the huge cost crunch. So like our Social Security system in the US, they can't "back out of it now".

Here's my quick, exceedingly over-generalized summary of the contrast: In Europe the social contract is that we all agree to pay for a comprehensive system but we all have to put up with that system. WE lose choice in exchange for universality.

In the US we all agree to get someone else to foot the bill until we hit 65 (when were supposed to get sick) and then we all get the Universal system.

The latter would work great if only none of us got seriously ill till 65 AND if we all died off (quickly) by age 70.

Posted by: c3 at September 9, 2006 10:21 AM

Having lived half my life in the UK & half my life in the USA, I feel I have the experience to comment on the two systems.

I find the following quote from the governer to be baffling:

"I want to see a new paradigm that addresses affordability, shared responsibility and the promotion of healthy living. Single payer, government-run health care does none of this"

Affordability
The numbers quoted in the thread concerning bureacratic overhead miss a huge part of it - namely the costs born by the doctor's offices. In the UK, a practice of three doctors will have one or two adminstrative assistants. My local three doctor practice in the USA has at least ten administrative assistants, including full time coding and billing specialists!

Furthermore, the costs that American's pay for drugs are well documented. A single payer system that buys drugs rationally and negotiates with big Pharma would save a ton of money. Of course, the reduction in price would force Pharma to stop spending billions advertising directly to the consumer.

Shared Responsibility
It seems to me that a single payer system based on taxation is the ultimate in shared responsibility.

Promotion of Healthy Living
Why does a single payer system preclude the promotion of healthy living?

Help me out here folks. What am I missing?

Posted by: N Jones at September 10, 2006 09:24 AM

First off, I think we should make health care payable with pre-tax dollars whether your employer provides it or whether you pay for it yourself.

Woo hoo! I'll go that one more step. Make ALL health care spending tax-deductible. Dentist. Doctor. All of it. OK, I'd go along with elective cosmetic surgery not being included, but little else.

N. Jones, the problem with totally shared responsibility is the same as with our current system of partially shared responsibility. When your payments are unaffected by your usage, you will use more. See "tragedy of the commons." If the amount we can get is unaffected by what we pay, we will all want as much as we can possibly get.

This leads directly to the rationing choice. Like all goods, there is not an infinite supply of health care, but there IS an infinite demand. So it must be rationed. The big question becomes how to ration it. Pure market, pure government dictate, or somewhere in between. I vote for somewhere in between. :-)

A single payer system does NOT preclude the promotion of healthy living. Indeed, a greater focus on preventative medicine would go a long way to improving the US system, but the experience in this country with our current system is that it actively works against preventative care. The multitudinous insurance companies know that their patient pool "turns over" enough that they are unlikely to be stuck for the care of an acute condition that could have been caught by preventative care. They simply aren't likely to have the patients in the pool long enough for the investment in PrevCare to pay off for them. So they shuffle those costs down the road--and end up paying for the lack of PrevCare on new patients coming out of some other insurer's pool.

A single-payer system on the other hand would have incentive to promote PrevCare. And in turn that would provide more incentive for new doctors to go into primary care, the lowest-paying end of the doctor pool. To a doctor coming out of med school with a couple o' hundred thousand or more in student loans hanging over their heads (I'm not exaggerating) specializing in almost anything BUT primary care looks real good.

Posted by: Tully at September 10, 2006 06:17 PM

Regardless of Arnold's comments (first we put an underachieving corporate idiot in charge of the country and then an actor of Austrian birth into a governor position...where to begin), socialized medicine can work and it will go down that path. Time magazine had wrote about how the best medicine and state of the art technology was found in many of the VA clinics. The VA system is America's socialized medicine.
Increasing taxes to $ 20 a pay check is still significantly less than paying private insurances. I used to pay $700 every other month for my medical insurance with a $3000 deductible. Now all I have is catastrophic insurance. All my private doctor visits are paid out-of-pocket. Would I rather just pay a tax increase instead? Sure would. Would socialized medicine hurt America? No, but it would slow down certain progress like pharmaceutical research (look how great it did for Vioxx/Celebrex, etc.).
Doctors (I bet most of them would agree) would rather receive a steady pay, have retirment options, pay no malpractice insurance, and work normal hours and not deal with insurance paperwork, denial of charges, etc (just like the VA hospitals).
It's not as if we don't have point-of-references. Study the Canadian model, improve upon it and turn it into a successful American socialized system that offers healthcare for all. It is possible.
As for all the morons we keep puting into office, I can't wait for the majority of informed and intelligent Americans to start voting for real politicians, not wanna-be's that stall progress.

Posted by: Dr. Sean at September 10, 2006 10:06 PM

On a historical note Blue Cross and Blue shield used to be non-profit entities. That all worked fine back then I thought. Every Dr. office I visited used to have a nurse and an occasional assistant in to do some book-keeping. Sometimes the nurse did both.
Then a couple of decades ago BC and BS got the laws changed and became for profit.
As noted above you go to Dr.s offices and they are loaded with staff. My dentist has 2 admin people. My Dr. part of a groupf of 6, has at least 10 people working at his office who have nothing to do with health except billing , etc. Recently the C -level execs of Blue Cross got hundreds of millions in a buyout, ostensibly not charged to the customers - yeah and I can turn Slurpees into gasoline.
To sum up, we pay C-level salaries and bonuses, investors and bureaucracy. I say take out the first 2 and we might do better than having 46 million people uninsured.

Posted by: Marcus at September 11, 2006 03:23 AM

oh and Pharma - my dentist complains that he hears from at least 3 salesmen per company.
There's a 1999 Boston U study that showed that Pharma spent 31% of its revenue on sales and 11% on R&D.

I've edited lots of the feel good sales party videos shot in expensive vacation destinations(I never get to go), you know, where everyone is drinking and saying "Hi" and then we list the sales figures for the big winners who get big bonuses.

The upshot - high medical care costs that put American industry as a whole at a competitive disadvantage to foreign competitors.

Posted by: Marcus at September 11, 2006 03:38 AM

Recently the C -level execs of Blue Cross got hundreds of millions in a buyout, ostensibly not charged to the customers - yeah and I can turn Slurpees into gasoline.

Slupees into gas??? Marcus for President!!!! ;)

Posted by: Rachel at September 11, 2006 02:37 PM

On a historical note Blue Cross and Blue shield used to be non-profit entities.

Many of them are. Many of them are not. Many have converted and "gone public" in the last two decades. It differs by region/state. BCBS insurers are independent franchisees, not one big company. But all, both for-profit and non-profit, are required to pay federal corporate income taxes under the Tax Reform Act of 1986. Congress did this because commercial insurers were complaining that BCBS's tax-exempt status made them TOO competitive...the non-profits do, however, get a lower corporate tax rate.

Thanks, Congress. Removing the exemption is what spurred the conversion of many of the plans to for-profit status. States began allowing the conversions back in the early '90s.

Posted by: Tully at September 11, 2006 06:34 PM

Dr. Sean;

first we put an underachieving corporate idiot in charge of the country and then an actor of Austrian birth into a governor position...where to begin

This openning phrase immediatly shuts down my listening capacity. If you are a doc then this phrase would preclude you from assuming what "most doctors" would want. Not that they're all Republicans but I'm sure many would find fault with the above intro.

Posted by: c3 at September 11, 2006 10:30 PM

Much as "Dr Sean" has a lot of ideas I agree with but such cute little phrases make him sound childish and turns me off, too.

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