Paul Krugman: Voodoo Health Economics

John McCain's health care plan illustrates his claim that "economics is something that I've really never understood":

Voodoo Health Economics, by Paul Krugman, Commentary, NY Times: Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain’s health care plan.

It’s about time someone said that and, more generally, made the case that Mr. McCain’s approach to health care is based on voodoo economics — not the supply-side voodoo that claims that cutting taxes increases revenues (though Mr. McCain says that, too), but the equally foolish claim, refuted by all available evidence, that the magic of the marketplace can produce cheap health care for everyone. ...

The McCain campaign’s response was condescending and dismissive — a statement that Mrs. Edwards doesn’t understand the comprehensive nature of the senator’s approach, which would harness “the power of competition...,” reducing costs so that even people with pre-existing conditions could afford care.

This is nonsense... For one thing, ... the idea that it could cut costs enough to make insurance affordable for Americans with a history of cancer or other major diseases is sheer fantasy.

Beyond that, there’s no reason to believe in these alleged cost reductions. Insurance companies do try to hold down “medical losses” — the industry’s term for ... actually ... paying a client’s medical bills. But they don’t do this by promoting cost-effective medical care.

Instead, they hold down costs by only covering healthy people, screening out those who need coverage the most — which was exactly the point Mrs. Edwards was making. They also deny as many claims as possible, forcing doctors and hospitals to spend large sums fighting to get paid.

And the international evidence ... is overwhelming: the United States has the most privatized system, with the most market competition — and it also has by far the highest health care costs in the world.

Yet the McCain health plan — actually a set of bullet points on the campaign’s Web site — is entirely based on blind faith that competition ... will solve all problems.

I’d like to single out one of these bullet points...

As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. ...

Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose ... their V.A. ... provider...” That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.

Mr. McCain, then, is offering a completely wrongheaded approach to health care. But the way the campaign for the Democratic nomination has unfolded raises questions about how effective his eventual opponent will be in making that point.

The Clinton plan closely resembles the plan for universal coverage that John Edwards laid out... By contrast, Mr. Obama offers a watered-down plan that falls short of universality, and it would have higher costs per person covered.

Worse yet, Mr. Obama attacked his Democratic rivals’ health plans using conservative talking points about choice and the evil of having the government tell you what to do. That’s going to make it hard — if he is the nominee — to refute Mr. McCain when he makes similar arguments on behalf of such things as privatizing veterans’ care.

Still, health care ought to be a major issue in this campaign. I wonder if we’ll have time to discuss it after we deal with more important subjects, like bowling and basketball.

Comments

[Lafayette]

Article: ... the equally foolish claim, refuted by all available evidence, that the magic of the marketplace can produce cheap health care for everyone.

Hmmmn ... I wonder where I saw that thought before ...

[Lafayette]

It walks like a duck and quacks like a duck

Post Scriptum: It is not sure that we need "cheap" Health Care as much as "affordable" Health Care. (Neither do I feel Krugman meant to infer otherwise.)

Once again, we should refer to the World Health Organization's 2000 study that classified countries globally by the quality of Health Care (HC)services provided. A great many European countries come up in the top fifteen. America is ahead of Slovenia and Cuba somewhere around 36th. How's that?

Because the study weighted heavily not only point technology and competence in HC services, where the US comes in very high. On HC-access, however, the US failed shamefully. (One out of six Americans, at any given moment, has no HC insurance coverage -- and when they do, it isn't always the most adequate.) How did this happen?

Because a private insurance HC system has no mandate to assure affordable medical attention to all a nation's citizens. Like, say, a criminal justice system? Only a nationally funded HC can achieve that objective -- but to do so, as it has in Europe, the professional services rendered by HC practitioners must be regulated at prices that assure a fair return to the practitioner and an affordable cost to the patient.

Oh, no! We can't have that, can we? Not in the nation of Free Enterprise! But, we can have a Civil Service system that effectively moderates earnings, by offering (but not promising) secure employment in exchange for non-excessive salary levels as regards other Public Services.

And, what do our telegenic presidential candidates tell us? They say that we should rest assured. The present (free enterprise) system WONT BE TOUCHED, but Health Care WILL BE PROVIDED.

Yeah, right ... when pigs sprout wings. Health Care is not a Business -- it's a Public Service, like firefighting, or police work, or a judicial system. If some people want private enterprise HC, they should be able have it, just like they can have private guards.

But, why must those who cannot afford HC be obliged to do without, at great detriment to their personal health? That's insane. But, not if you're a health care practitioner.

Because these people don't get paid if we don't get sick. So, they cannot be displeased that Preventive Health Care should take a distant second place to Remedial Health Care. (How would you like private firefighting companies starting fires to stimulate their business towards earning a good profit?)

This makes HC practioners seem like money-hungry beasties, yes. Of course, they are not all like that. But, if it walks like a duck and quacks like a duck ... is it not greed?

Methinks, yes.

[reason]

(How would you like private firefighting companies starting fires to stimulate their business towards earning a good profit?)

Or policemen instigating crimes? Laff that is a very good analogy for the problem. If I open a restaurant providing not just food but ambiance etc, then I don't really have to promote starvation in order to make a profit. But people in dealing in problems have mixed incentives, and consumers are not in best state to make rational choices (ignoring the externalities for a minute). Disaster capitalism? Not quite but it is another class of capitalism.

P.S. What do free marketeers make of the current food market problems. Should we let the really poor starve? Or might we have to start taxing meat (after we stop bio-fuel) to protect the poor. Depending on the science (I haven't seen a full analysis yet) it might really come down to that.

[anne]

http://krugman.blogs.nytimes.com/2008/03/31/why-edwards-hasnt-endorsed-yet/

March 31, 2008

Why Edwards Hasn't Endorsed Yet
By Paul Krugman

John Heilemann * on why John Edwards hasn't endorsed anyone yet:

"According to a Democratic strategist unaligned with any campaign but with knowledge of the situation gleaned from all three camps, the answer is simple: Obama blew it. Speaking to Edwards on the day he exited the race, Obama came across as glib and aloof. His response to Edwards's imprecations that he make poverty a central part of his agenda was shallow, perfunctory, pat. Clinton, by contrast, engaged Edwards in a lengthy policy discussion. Her affect was solicitous and respectful. When Clinton met Edwards face-to-face in North Carolina ten days later, her approach continued to impress; she even made headway with Elizabeth. Whereas in his Edwards sit-down, Obama dug himself in deeper, getting into a fight with Elizabeth about health care, insisting that his plan is universal (a position she considers a crock), high-handedly criticizing Clinton's plan (and by extension Edwards's) for its insurance mandate."

* http://nymag.com/news/politics/powergrid/45604/

[AC]

If you already have cancer, then is it a market failure that you can't get "cheap" insurance?

[anne]

"If you already have cancer, then is it a market failure that you can't get 'cheap' insurance?"

Notice the language, and understand the imposible viciousness of the thinking. Health care is a basic human right, the right of every American, the right of every American to life as such. Health care is our right and we will have that right assured.

[anne]

We are a country that is shamefully, immorally spending $200 billion a year on war and occupation but a country that will not spend $7 billion to protect the health of 3 million needy children. This is a perversion of American idealism or an American heritage. We have a right to health care, a basic human right, and we will have that right without which all other civil rights are a mere mockery.

Imagine turning away from caring for health of a needy child for the sake of needless wanton destruction.

[anne]

We need to leave off the insanely immoral destruction of Iraq and Iraqis, completely ans immediately leave, and turn to our civil needs and rights, profoundly turn to meeting our health care needs. We can easily afford the vision of universal health care of John and Elizabeth Edwards, where a public insurer offers easily affordable care along with the care offered by private insurers.

We have a President madly going about bullying Poland to build wildly expensive missile systems to protect Polish infants against missile bearing Iranians who are bent on adopting Polish infants at all costs. We can and must and will have universal health care in America.

[anne]

We are in recession, the need is to turn from our immoral destructive and self-destructive policies to building America and insuring American rights.

We have a disastrous economic policy, a policy that has given us more vastly military spending, less social spending, taxes lowered especially for the wealthiest, and recession.

[ken melvin]

Hard choice, this between voodoo and stupid, senile, and corrupt.

Givem hell Anne. They deserve it.

[anne]

http://www.nytimes.com/reuters/business/politics-usa-economy-jobs.html

U.S. Economy Shed 80,000 Jobs in March
By REUTERS

U.S. employers cut payrolls for a third month in a row in the biggest monthly job decline in five years, government data showed.

[Imagine, even a gain in 100,000 jobs would not have been nearly enough but might have kept us from actual recession. The only hope to avoid recession was job creation, but we have continued job loss and continued absence of job turnover so that what is lost may stay lost for some considerable while.]

[reason]

Anne,
by the way AC is correct. He just illustrated why the "free" market cannot be trusted alone to adequately provide health insurance. The market cannot capture the value of services are provided on a needs basis rather than on an ability to pay basis.

What his intention was, I can't guess. Maybe he thinks the market is what life is all about, and people only have value as servants of the market. Maybe he wanted to illustrate that the market cannot possibly do social insurance. I don't know.

[anne]

We averaged 225,000 jobs created each month through the 96 months of the Clinton Administration, while the finest 52 months of the Bush Administration have given us only 160,000 jobs created each month. Military spending and tax cuts especially for the wealthiest, at the expense of social spending, have given us such a difference. So, I am not the least interested in arguments against what we can afford for health care; not the least interested.

[anne]

Reason:

"AC is correct. He just illustrated why the 'free' market cannot be trusted alone to adequately provide health insurance. The market cannot capture the value of services are provided on a needs basis rather than on an ability to pay basis."

Agreed completely, thank you.

[swells]

Well, I'm probably going to get flamed for this but I don't quite see health care as a service like fire fighting, as a basic human right. Fires are not inevitable for every home or business, death and usually ill health before death is inevitable for every one of us. My question is this. Would fire protection be a right if every, or nearly every, home was guaranteed to burn at some point? I don't think so. I think at some point we would have to just accept our losses and compartmentalize the damage to those affected by each individual fire because to do otherwise would simply be unaffordable.

Flames anyone?

[save_the_rustbelt]

Back to the topic for a moment...

My late father-in-law never used VA services due to a 4 hour round trip drive. He purchased Medicare supplement insurance out of his own pocket.

The VA should have a limited voucher system for vets more than XX miles from a care center. Geography should not determine care, and it is impossible to put a VA facility in every county in the country.

[Mark]

Under the Edwards or Clinton plan, what is the consequence to the individual who fails to purchase health insurance?

[reason]

swells...
I depends on what you define as health care doesn't it? Nobody said cost should be ignored, or that some rationing would be inevitable.

[reason]

And actually swells I have two very close relatives (Great Aunt and Father) who died suddenly and without ever ever having suffered ill health. And another close relative who has had (hopefully she has now recovered) cancer as a young mother. Should the estate of my father receive a compensation for the care he didn't need and my sisters children now be impoverished?

says...

STR:

"The VA should have a limited voucher system for vets more than XX miles from a care center. Geography should not determine care, and it is impossible to put a VA facility in every county in the country."

Absolutely; I believe that 1.8 million veterans, along with members of their families, had no Veterans Administration or private health care insurance in 2007.

[swells]

reason, I understand your point. The only point I'm trying to make is that policing, fire fighting, etc. relate to phenomena that are less-frequently encountered than is the need for health care. This makes them intrinsically more affordable to provide. This is reflected in reality. There are far fewer policmen and firefighters combined than there are health care professionals.

I'm just trying to get at the nub of something that I personally experienced. When my mom became ill, over 300K was spent by medicare, etc. during the last year of her life to keep her alive. During that year, her quality of life was not at all good. If I am to have any intellectual integrity, I have to ask whether that money should have been spent that way or on better health care for younger people.

I don't think I would have made the choices she did about her treatment had I been in her shoes.

[reason]

swells...
I totally agree, this is a difficult issue. As Galbraith once pointed out, medicine used not to be much of problem because there was relatively little that doctors could do. The success of medical technology has become a problem for us all. Reserving medical care for the rich, is not the solution though.

[reason]

I'll tell you something about my father. He always kept saying he couldn't understand why people were so concerned about heart attacks. He kept saying it was the best way to die, and this from someone who never smoked and never was overweight in his life. He stopped drinking alcohol at some stage (not sure when, he used to enjoy a glass of beer or wine) and he died suddenly when still fit of a heart attack. Some suspect it was (semi?) deliberate. I guess no one knows.

[anne]

Forgive my computer for forgetting, but the reply to STR was from me.

"Under the Edwards or Clinton plan, what is the consequence to the individual who fails to purchase health insurance?"

That would be for Congress to discuss; possibly a cost increase for failing to apply when eligible as with Medicare enrollment. So failing to purchase afforable insurance when eligible would increase the cost later.

[swells]

reason, I probably sound heartless and cruel on this issue. But, I personally think health care would be better addressed as an infrastructure issue, like spending money for good roads because good roads make for productivity gains, than as a basic right. Yeah, that's fairly mercenary approach I know but I think it helps put some of the rationing issues into a more comprehensible framework.

[anne]

I believe a person and a person's immediate family should discuss and have a right to determine the extent of medical treatment to receive or allow, but the social and physician's obligation is to treat patients who wish treatment. My grandparents and parents have been clear in not wishing treatment that cannot improve the quality of life.

[reason]

swells...
I don't see the difference. There are traffic jams, but freeways are free to the user.

[reason]

All these anecdotes suggest that at least some of the moral hazard panic is a myth.

[swells]

reason, it also occurs to me that policing and fire protection aren't addressed as basic human rights either. If there is no policeman around when you get robbed, you don't get to sue for redress. Same with fires. You only get a best efforts kind of guarantee. If your civil rights are violated, it's different.

[anne]

http://www.washingtonpost.com/wp-dyn/content/article/2007/10/30/AR2007103001316_pf.html

October 30, 2007

Almost 2 Million U.S. Vets Lack Health Insurance
By Steven Reinberg - HealthDay

Almost 2 million veterans are without health insurance, along with 3.8 million members of their households, a new study finds.

Among the 1.8 million uninsured veterans, 12.7 percent are under 65. In addition, the number of uninsured veterans has increased by 290,000 between 2000 and 2004, according to the report in the Oct. 30 online edition of the American Journal of Public Health....

[swells]

Anne, let me pose a hypothetical. What if a treatment were available that was guaranteed to extend life but cost 1 trillion per day? Are you saying there is absolutely no limit to the demands that might be imposed on society's purse in such a case? If there is some limit, then where should it be set?

[anne]

Correction:

I believe that 1.8 million veterans, along with 3.8 million members of their families, had no Veterans Administration or private health care insurance in [2004.]

[anne]

"What if a treatment were available that was guaranteed to extend life but cost 1 trillion per day?"

When a mere $7 billion a year is needed to insure the health care of 3.8 million children, there is no reason to play at impossible hypotheticals.

[reason]

swells...
reason, it also occurs to me that policing and fire protection aren't addressed as basic human rights either.
Agreed. Basic infrastructure is a good correspondence.

[reason]

swells...
reason, it also occurs to me that policing and fire protection aren't addressed as basic human rights either.
Agreed. Basic infrastructure is a good correspondence.

[Robinia]

In a market-based health care system, the tendency to overvalue the services of life-extension-oriented medicine are endemic, and consistantly place that in priority over early-care prevention medicine. Children are demographically most likely to be poor, and the wealthy amass their self-multiplying fortunes over time, leaving lots of their elderly with a tremendous arsenal of wealth to devote to keeping a death they fear at bay (that emotion is hardwired). This is "animal instinct" overcoming "rational economic man" at its most basic. The distortion is the outsized use of resources to sustain an inevitably-scarecer-and-scarcer resource-- our own lives in advanced age-- at an inevitably-escalating price.

There must be a regulator attached to this system in the US, or it will spiral out of control into some very evil, but technologically-possible, outcomes. While we have thought and written and discussed at length the economics and morality of providing enough health care to everyone in the population, we have only barely begun to explore the economic and moral issues associated with the uber-wealthy buying too much life-extension. The expression of excessive inequality is already visible in US demographics, where the wealthy are much more likely to experience longer lives. If a market-based health care innovation system remains in place, the market will dictate that products and procedures are more and more skewed toward the desperate need of the dying to defer what makes us mere mortals.

Ecology-- the sustainable allocation of resources used by the biosphere to maintain life on earth over millenia-- does not concentrate resources in one individual and then spend them all desperately preventing that individual from expiring and being recycled. TAX the over-rich before they skew the incentives into creating something we will all regret. And re-focus medicine on quality of life over a normal human lifespan-- much less spent in the final 3 months, much more earlier in life. A field-leveling tax system and a single-payer health care system does this most effectively. The single-payer health system also solves the problem of making Vets all close enough to care that they can conveniently access what they need.

[reason]

Robinia,
a novel and very thought provoking argument. That would make a good book theme I would think.

[Noni Mausa]

Majority Of US Physicians Favor National Health Insurance
http://www.sciencedaily.com/releases/2008/03/080331172524.htm
.........
swells asked: ...death and usually ill health before death is inevitable for every one of us. My question is this. Would fire protection be a right if every, or nearly every, home was guaranteed to burn at some point? I don't think so.

I'll join you in the barbeque by mentioning that death itself is cheap. US health care and social services systems (not usually individual persons) tacitly recognise this, and depend on it to reduce costs.

Let's look at your metaphor of the home, however. A home is very much like a human body. It is built all in a rush*, and thereafter is subject to normal wear and tear and the risks of calamity, just as the human body is. No one suggests that it should go its whole lifetime without repair or upgrading.

A home is not like the "one hoss shay" of Oliver Wendell Holmes:
Have you heard of the wonderful one-hoss shay,
That was built in such a logical way
It ran a hundred years to a day,
And then of a sudden it -- ah, but stay...

We have fire departments because of three things -- fire is uncommon, fire is statistically but not individually predictable, and fire is only partially preventable. Fire departments are community services because the danger isn't limited to the home, but extends to occupants and to surrounding people and buildings.

Fire control consists of urgent action (firefighting) and preventative action (education, building codes, building supply specifications, protection against mice, termites, Huns and Visigoths, etc), as does health care.

Finally, few homes last longer than your average human lifespan, (though presumably they could, if built solidly and maintained meticulously). Some achieve methuselan ages, but eventually some disaster or cumulative degradation requires the house be demolished and another built in its place.

So actually your metaphor of body-as-house maps very closely, and I think it proves the case for universal health care.

Noni

* "Nine months?" said the alien, "Then why were they in such a hurry there at the end?"

.

[swells]

Anne, playing at impossible hypotheticals isn't what I'm after here. I'm trying to elicit whether you think there are any basic restrictions that would need to be imposed in the context of health care being a basic human right. To be honest, I think the practicalities of the matter preclude treating health care as a basic human right. I'm just trying to give your position due consideration and find out what the parameters of it are. After all, even the right to free speech isn't absolute.

[anne]

There is no reason to avoid difficult philosophical problems over the provision of health care in extreme situations, but we have not begun ti agree on provision of care in routine and simple situations long before extremity. Become humane initially, then argue over how humane to be. We are just not nearly sufficiently nationally humane now.

[swells]

Robinia, an extremely well-reasoned post. Thanks.

[swells]

Noni, I tend to agree with you about the need for universal health care. I guess all I am really trying to get at is a better mental framework for myself when thinking about the issue. I do think the human rights argument for universal health care is weaker than the infrastructure argument and that the human rights framework is less useful when dealing with issues like rationing.

says...

"Become humane initially, then argue over how humane to be."

aka

Become holy initially, then argue over how holy to be.

[anne]

Paul Krugman:

"Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain’s health care plan.

"It’s about time someone said that and, more generally, made the case that Mr. McCain’s approach to health care is based on voodoo economics — not the supply-side voodoo that claims that cutting taxes increases revenues (though Mr. McCain says that, too), but the equally foolish claim, refuted by all available evidence, that the magic of the marketplace can produce cheap health care for everyone."

Precisely; but I want much more than merely pointing to such nihilist commercial absurity, for the market assures us of no rights, what I want is an affirmation of the right to health care which has been implied by our actual national existence.

says...

My son did a project on Hamilton vs. Jefferson last night and it got me thinking of the state vs. federal government sponsored health care.

The problem with state sponsored anything is the inability to run a deficit during difficult times. This restriction puts a severe limitation on the stability of any state program, i.e. California and Schwarzenegger's 10% across the board budget cuts.

Given Massachusetts came up with a health care plan, it is possible to have a state sponsered health care plan, just difficult. What we need is increased state representation in the money creation business. Why not shift The United States of America into the American Union?

Give each state the ability to run deficits with loose parameters, without the threat of bankruptcy, just as the European Union does now? Allow each state the funding source it needs to ride out difficult times, taking power from the federal government and giving it to the states.

It would make Jefferson proud. Put the power of money creation closer to the people, perhaps the size of the allowed deficit could depend on the number of people a state has. Then let states start competing for people.

[anne]

Become humane initially, then argue over how humane to be.

Become holy or initially, then argue over how holy to be.

Become sacred or initially, then argue over how sacred to be.

Our lives are sacred, beyond all religion, since we are biologically singular creatures who when we are gone can never be again.

[Lafayette]

What we cannot control

swells: My question is this. Would fire protection be a right if every, or nearly every, home was guaranteed to burn at some point? I don't think so.

You could not be more wrong.

Life, liberty and the pursuit of happiness are cultural values our country. Neither life, nor liberty and particularly not happiness is any consequence to a truly sick person.

Then, there is the riddle of the Prudent Man. Knowing that of his six children only one will get sick, why should he bother to avail himself of a generalized medical coverage. It does not make economic sense.

We don't insure ourselves for what we cannot control individually -- war, epidemics, riots, natural disasters, etc. We expect the government to assume its responsibilities.

Sickness is in this category. We do not chose to get sick. Sickness happens, even to the healthiest of us.

Health Care is just such a national responsibility. Most Americans (finally) agree. What grates is the notion that the market alone should assure the service, which is what the article above is all about.

[swells]

Anne, sometimes it's a question of is the glass half full or half empty. Personally, I believe in evolution. That leaves me thinking I won a lottery that makes the biggest powerball ever look like a dinky tip after a cheap dinner somewhere. Sometimes I think we overlook how lucky we are to even be here in the first place.

[swells]

Lafayette, maybe I'm dense or something but I found that argument to be kind of incoherent. Do I interpret you correctly when I think you say what human beings need is what defines human rights?

[anne]

What is important to remember, beyond the moral mandate for universal health care insurance is that as a recession support such provision is especially important. We need univeral health care insurance just at this time more than ever. There is a critical economic support, especially critical for a society that would consider middle clas well-being at all important.

[anne]

http://delong.typepad.com/sdj/2008/04/bad-employment.html?cid=109410378

April 4, 2008

Bad Employment News in March
By Brad DeLong

Employment Situation Summary: -80,000 in March according to the establishment survey.

I will be very interested to see how labor productivity holds up during this recession-like period. Will this see labor hoarding or labor shedding?

And, of course, the thing to stress is not that a recession has come but that the policies of the Bushies have done so much to make the previous expansion weaker and fighting this recessionary period harder than it had to be.

[anne]

I completely appreciate the moral concerns over cost but find no reason to discount the nature of what peaceful caring community can be about. We are a people who scarcely notice a $3 trillion war, so I am not about to notice the cost of a few packages of cigarettes in caring for the health of a child. So stark is the current choice. We have so far chosen cigarettes and war.

[ken melvin]

Robina, I too like the thrust of your argument. If everyone's kids went to public school, we have better public schools. If everyone depended on a universal health care system, the system would provide very good health care.

[anne]

Robina and Ken Melvin:

"If everyone depended on a universal health care system, the system would provide very good health care."

This is really a simple and clever argument.

[anne]

Having finished going over the employment report, we should be afraid, we should "be somewhat afraid" of this economy. Weakness giving way to recession, from the midst of deficit spending and with repeated tax cuts. Sensible analysts could not have imagined a worse fiscal mix; policy really matters.

[donna]

I keep thinking there is a simple solution that people keep making far too complicated. The government can provide single-payer universal healthcare covering basic services and catastrophic, and individuals can still get coverage on their own with private insurance for all the extras they might want. It would be simple and make everyone happy. Companies could then focus on both cutting their insurance costs and providing insurance as an incentive again, which was why it was even introduced in the first place.

Why we keep making this so hard, in particular the Republican party, is simply beyond me. It is to ALL of our benefit if other people are healthy, well taken care of and able to actively participate in the work force to the full extent possible. I don't want to go to work with people who are sick, I don't want the inanity of the cruise ship virus spreading and airline virus spreading to continue because people feel like they just have to keep being out in public even though they are sick.

Our society is rich, we can afford health care for all and we are already paying for it. Our insurance costs are sky high because so many are uninsured, and not to see that is just ridiculous. We already pay the costs for the uninsured. If we simply provided basic and catastrophic coverage via single payer, people wouldn't get so sick from easily covered things caught early, and when they do get cancer they could still be covered.

In whose interest is it that we are not taking the steps to fix this? Really?

[anne]

http://www.epi.org/printer.cfm?id=2943&content_type=1&nice_name=webfeatures_econindicators_jobspict_20080404

April 4, 2008

Recession Takes Hold in the Job Market
By Jared Bernstein with research assistance from James Lin

The nation's job market appears solidly in recession, as payrolls contracted for the third month in a row, and unemployment jumped up from 4.8% to 5.1%, the highest jobless rate since September 2005, according to the report released today by the Bureau of Labor Statistics. Payrolls were down by 80,000 in March, the largest loss in five years, while January and February's initially reported losses were revised downward by an additional 67,000 jobs.

Since employment peaked in December, payrolls have contracted by 232,000. Private sector payrolls were down 98,000 last month and 109,000 in February. Since hiring in the government sector is less susceptible to cyclical swings in the overall economy, private sector job patterns provide a clearer signal of the weakening labor market. Private sector jobs are down 300,000 from their peak in November.

Officials often date a recession as beginning at or near the payroll employment peak. Thus, there is a good chance that the recession will ultimately be recognized to have begun in December or January....

[anne]

So we have lost 230,000 jobs so far this year, when we should have created 450,000 with just moderate growth.

[swells]

Anne, you said, "We have so far chosen cigarettes and war."

You just hit one of the big reasons that I want coerced participation in social schemes to be as little as possible. Yes, there are some good ideas out there but, to be honest, it seems to me that my fellows don't always have the best judgement.

I still think it is important to have "opt-out" provisions for most all government functions as a kind of check and balance. I admit to a bit of paranoia on this score but I have seen my neighbors up close and personal and a lot of them scare the bejabbers out of me.

[Patricia Shannon]

Swells, why should we have publicly funded fire and police services? Why not let those who can afford them pay for them, and the rest of do without? Or if they were needed, you would have to pay before you got them. Like if your house were burning, and the firemen got there, you would have to pay them before they would get to work. In what way will your argument not apply to things like unemployment or house foreclosure?
You illustrate your arguments against universal health care with elderly people who are not far from death no matter what we do. But almost all of the people I know who have had cancer were in the prime of life. My 2nd cousin was treated many years ago for breast cancer and survived, ans was able to raise her children and continue working as a school teacher, and now that she is retired continued to do various volunteer activities.
It's very easy to have an attitude like yours when you feel healthy. We can't know how we would feel in a type of situation we have never experienced. You don't know how you would feel if you found out tomorrow you would need to be on kidney dialysis to survive, and that you couldn't afford it, so you were going to die.

[Patricia Shannon]

swells says...

Anne, you said, "We have so far chosen cigarettes and war."

You just hit one of the big reasons that I want coerced participation in social schemes to be as little as possible. Yes, there are some good ideas out there but, to be honest, it seems to me that my fellows don't always have the best judgement.

I still think it is important to have "opt-out" provisions for most all government functions as a kind of check and balance. I admit to a bit of paranoia on this score but I have seen my neighbors up close and personal and a lot of them scare the bejabbers out of me.

So we should be able to opt out of paying for police, fire, and military?

[swells]

Patricia, what kind of attitude do I have? I don't argue against universal health care. I might have a slightly different idea of what it would be, but I don't argue against it. I specifically said in an earlier post on this thread that I agreed with it. My idea of universal health care is universally available health care that one can, indeed, opt out of but which cannot refuse anyone who wishes to participate. And yes, part of that would mean anyone who opted out would have to pay for their own or obtain some private insurance instead and if they can't pay and need it, then too bad for them if they rejected participation.

It's about having another layer of checks and balances for me, a layer that resides directly with the people that is more difficult to render ineffective with lobbyist money. The layers we currently have don't seem to be doing their job given the craven way congress has caved in and gone along as essential constitutional protections have been gutted over the last few years.

Checks and balances are a good thing in my opinon. I'm am quite frankly perplexed why some many people think another layer of checks and balances wouldn't be a good thing.

[daveNYC]

If you already have cancer, then is it a market failure that you can't get "cheap" insurance?

Not a very good example, that's like calling up Geiko for a policy right after you rear-ended a school bus. The key thing about insurance is that you continually pay in. So in theory the money that's paid in over time covers the benefits paid out. Which is why the whole mandate opt-in opt-out stuff is important.

[sewells]

Patricia, to be honest I haven't thought the whole opt out idea through completely but my initial take would be that yes, people should be able to opt out of financing the police. For instance, if I were a black person in some of our cities I would probably not want to fund the next pay raise of the guy who's ramming his billy club up my posterior because he feels like doing it. Now, I happen to be pro-choice because I don't think a zygote is a human being yet. But, I don't think I ought to get to decide that issue for someone who thinks abortion is murder. I think they ought to be able to make sure their productivity isn't, in their view, perverted in that way.

Look, what I am proposing is problematic I'm sure. It is an idea that may not be workable. But, I think the system of checks and balances is the best practical means of dealing with keeping a democracy viable and in tune with it's members. All I'm doing is exploring the idea that another level of checks and balances might enhance democracy.

[anne]

Dave:

"The key thing about insurance is that you continually pay in. So in theory the money that's paid in over time covers the benefits paid out. Which is why the whole mandate opt-in opt-out stuff is important."

Importantly so.

[anne]

That we are all part of the insurance program is both the means of lowering costs and protecting those who have insurance, while insuring that protection is there for any person who surprisingly finds that insurance is suddenly needed. A universal health insurance program that is not inclusive will be self-defeating, needlessly costly for those insured and especially dangerous for those not insured.

[Patricia Shannon]

Swells, the problem with people being able to opt out of medical insurance is that it is normal human thinking to believe that oneself is invulnerable. It helps keep people from giving up. It is especially prominent in people like entrepreneurs, fire fighters, etc., who perform useful functions in society. It is not rational to expect people to be rational all the time.

[anne]

http://krugman.blogs.nytimes.com/2008/03/28/runaway-health-care-costs-were-1/

March 28, 2008

Runaway Health Care Costs — We're #1!
By Paul Krugman

The latest Trustees' reports from Social Security and Medicare show, once again, that there is no such thing as Socialsecuritymedicareandmedicaid. Social Security, the subject of thousands of demands that we get "serious" and cut benefits, is doing relatively well. The real problem lies in health care costs.

I am, of course, a big proponent of health care reform. But is there any reason to think that reform would curb the growth of costs?

Well, I was browsing some of the charts at CMS, * and thought I'd share some information from Chart 2.1. This table shows health care spending as a percentage of GDP in some major countries, 35 years ago and recently:

[Chart] We're #1!

Everybody knows that the US spends much more on health care than anyone else, without getting better results. Everyone also knows that health spending has outpaced GDP growth everywhere, thanks to medical progress. What I didn't realize was just how clearly the evidence shows that the rising trend is steepest in the US. We have the biggest increase as well as the highest level. We're #1!

What this suggests is that a more integrated system wouldn't just achieve a one-time saving, but also flatten the upward trend. Among other things, this would help the long-run fiscal picture. Moral: stop bashing Social Security, start demanding health care reform.

* http://www.cms.hhs.gov/TheChartSeries/downloads/Chartbook_2007_pdf.pdf

[anne]

http://krugman.blogs.nytimes.com/2008/03/28/runaway-health-care-costs-were-1/

March 28, 2008

Runaway Health Care Costs — We're #1!
By Paul Krugman

Health Care Spending (Percentage of GDP) *

Year... 1970... 2004

US... 7.0... 15.3
Canada... 7.0... 9.9
Germany... 6.2... 10.6
UK... 4.5... 8.1

* http://www.cms.hhs.gov/TheChartSeries/downloads/Chartbook_2007_pdf.pdf

[Noni Mausa]

swells said:
Noni, I tend to agree with you about the need for universal health care. I guess all I am really trying to get at is a better mental framework for myself when thinking about the issue. I do think the human rights argument for universal health care is weaker than the infrastructure argument and that the human rights framework is less useful when dealing with issues like rationing.

I completely agree with you. Bringing in "human rights" seems unnecessary, unless "universal" health care is being distributed prejudicially. But that would be governed by other legislation, I suppose.

Noni

[swells]

Anne, I agree that the opt-out / opt in thing is important. For instance, under Obama's plan coverage wouldn't be mandatory. This probably means that someone who isn't covered to begin with because they are young and healthy should have to pay a higher rate if they try to opt in later in life when they need it. Poeple would need to weigh those issues. I agree that some young people think they are immortal and won't get it because they can't see they'll ever need it. That might put them in a bad spot later on when it's going to cost them more. But, I have a hard time believing people really deserve more than they deserve.

If the system is set up correctly, then poor people will have no incentive to opt out because their coverage won't cost them much.

[jean]

The health blogs often address the money making aspect of health care. I like http://heartscanblog.blogspot.com/ This guy probably makes a pretty good living but nothing like the interventional radiologists,(read cardiac caths, stents etc). Since the bypass operations have been majorly discredited as moneymakers, cardiac caths are the new frontier.

[Jay]

"The key thing about insurance is that you continually pay in. So in theory the money that's paid in over time covers the benefits paid out. Which is why the whole mandate opt-in opt-out stuff is important."

The whole mandate opt-in opt-out stuff is only important if the payment structure is such that instead of paying based on your actuarial expected costs, the system is a huge scheme to redistribute wealth. If each individual's DCF of payments was equivalent to the DCF of their expected benefits you wouldn't need to force people to purchase it. Of course what is not advertised is that some people are going to end up with extremely negative DCF's as a result of HillaryCare. These people need to be coerced into purchasing such a financial derivative.

[anne]

Yes: I understand that slander and deceit are always important, and I am so amused, but please do explain what Hillary Clinton's health care proposal is because I would like to know beyond the slander and deceit.

[Jay]

I guess I should have spelled that out. DCF = Discounted Cash Flow.

I shouldn't assume everyone knows finance that well.

[billyblog]

Have grazed the comments and have a few thoughts.

1. On Basic Human Rights

There is a practical convergence in a democracy between the concept of basic human rights and what is acceptable (economically and otherwise) to the democracy. It's called the social contract. And there are myriad institutions which support that contract, the ultimate – though, by far, not the only -- one of which is universal suffrage. Well, you do have to be 18.

If we look for a working definition – given our American traditions – of what constitutes basic human rights, we can invoke the Declaration of Independence option and speak of life, liberty, and the pursuit of happiness. Particularly that last one is the hole big enough for the electorate, in its role as the ongoing ratifier of what constitutes the social contract, to drive through whatever proverbial Mack truck it ends up agreeing to do.

That being the case, we should try to avoid getting caught up in false aporia of the form:

PRE-EMPTIVE DIALECTICIAN (with possible oligarchic tendencies): Well, we can't do that because we can't afford it.

DEMOCRAT (small "d" formally, but pretty close to big "D" in practice): Who's "we," Kemosabe? It's called, ahem, priorities.

PD: But what if it cost a $1 trillion a day?

DEMOCRAT: Yeah, and what if there were WMD? Come back to me when you want to have a serious discussion about healthcare policy and not a ghosts and goblins ridden one.

2. Veterans Administration

The fact that 1.8 million vets and 3.8 members of their families had no VA or private health care coverage in 2007 doesn't come close to being a principled argument for diluting the VA system in the manner proposed by John McCain's healthcare "plan" (more like, as Krugman points out using the deserved "bullet points" put down, a farrago of strands of spaghetti tossed up against the wall in the hope that something might stick).

What this shameful statistic means is that we should appropriately strengthen the already excellent – but admittedly short of utopian perfection – VA healthcare system. If we have to do something at the margins to accommodate very real geographic proximity (and other) issues, we can do that. But we're clever enough to do that without unraveling the whole system for ideologically driven reasons.

3. On Rationing and Our Ethnocentric Fears of Morbidity

We see emotionally and anecdotally driven arguments even in this thread -- where one would have assumed one was having a conversation with economists who should be aggressively statistically driven – that we should all (especially the older folks who frequent this blog, if only because they have the time!) fear our impending Soylent Green future if we let our tender-minded talk about healthcare as a basic human right get out ahead of our ability to pay for prolongation of life.

See no. 1 above for the basic answer to this irrational fear mongering.

But also reflect on the fact that the rest of the developed world with its (heavily) publicly financed universal healthcare systems has not yet been reporting an unusual number of geriatric disappearances. This despite the fact that other healthcare systems also have cost pressures because of the availability of technology to prolong life. Nor are their, um, better performances than the U.S. on life expectancy rates – not to mention the majority of positive qualitative, not just quantitative, measures of the effectiveness of their healthcare systems -- been going down relative to our own hodgepodge and increasingly dysfunctional "system."

Moral of this particular story. Before you logically convince yourself that something simply can't be done, take the "Hmm, do bees really fly?" test and look around and watch them merrily (well, not really, that is the pathetic fallacy, but you get the point) flying and making honey.

[anne]

Me, I think having the sort of health care insurance that a United States Senator has, which is what some of us fortunately have as well, and which is what Hillary Clinton and John and Elizabeth Edwards would have available for all, is just splendid. Me, I think having the sort of health care insurance a Senator has would be perfect for all of us. That is what Hillary Clinton is working for.

[Alec]

" If everyone depended on a universal health care system, the system would provide very good health care.

I'm not to sure of that. Soviet Union did basic stuff well enough, but high level stuff was beyond their skillset due to lack of training and facilities.

ROW are basically free riders off our system.

The problems that needs to be solved for Universal Health care are multifold, yet not impossible.

Some of them:

1)How do you structure?

Do you put out multiple bids to tender annually for 10 year periods? Do you do it off low bid or by services offered off of number X + pop. growth?

)What kind of pool size do you need to gain economies of scale and introduce randomness?

)How to promote competition to increase efficency without a reduction in service.

)How to compensate doctors and nurses for opportunity costs, keep the good ones in the biz, yet root out the crappy ones

)level of baseline coverage that finds an equilibium betwee the customer, the administratiors and the staff.

That's just off the top of my head, but I've been thinking for a while about this.

[swells]

billyblog, really impressive vocabulary. I like words. Thanks for introducing me to aporia. Now, where the social contract is concerned, it is my understanding that the theoretical underpinning of the social contract is the idea that free human beings delegate some of their rights to the state in order to receive the benefits of social society.

In this scheme, exactly where do the rights that no idividual possessed in the first place come from prior to their exercise by the state. You know, like the right to dispose of another human beings property against their will? Or the right to amass weapons of mass destruction for defensive purposes despite the fact that there is no valid theory of self-defense that gives one a right to respond to aggression with weapons whose effects inherently cannot be limited to an aggressor?

Are you really sure that sociall contract is the frameword you want use in making your argument?

[dissent]

Americans are worker-serfs. How many millions are stuck in jobs because they have health insurance? How many businesses don't get started because the founder can't risk no health insurance?

Rant On: Americans are best in the industrialized west at one thing: kissing rich and corporate butt. You may end up on the street in your fifties with no pension or health insurance, but comfort yourselves with this: you've got a mouthful of rich ass. Leave in your will for your kids before you jump off that bridge. Rant Off.

[swells]

The social contract theory only takes one so far in grappling with the issues that face modern democratic societies. The matter of its modification ALWAYS deals with practicalities and limitations.

[Alex Tolley]

I'd like to ask if anyone has debated H/C with supporters of the status quo. I find in my discussions that republican/wealthier friends tend to argue that Universal H/C are:
1. Socialized medicine - "and we don't want that here".
2. US examples such as the VA show how bad government run programs are.
3. Universal H/C will stop them seeing the doctor of their choice (The Harry & Louise gambit) [although why they don't criticize Kaiser the same way is beyond me]
4. It will raise premiums because it will have to cover the currently uninsured.
5. Why should I care about coverage issues as long as I am working and my company provides coverage. (Screw the unemployed - and maybe the self employed].

Has anyone been successful at persuading the likely McCain voters about this issue?

[Detlef]

swells,

My idea of universal health care is universally available health care that one can, indeed, opt out of but which cannot refuse anyone who wishes to participate. And yes, part of that would mean anyone who opted out would have to pay for their own or obtain some private insurance instead and if they can't pay and need it, then too bad for them if they rejected participation.

That doesn´t make sense.
Say, you opted out, couldn´t then pay for your private insurance (lost your job) and contracted an infectious disease. Wouldn´t it make sense for society to pay for your health care?
Which is one of the reasons Republicans don´t make sense.
If they´re really that worried about terrorist attacks with (biological) weapons they should insist on universal health care coverage.

And what about your kids? Should they too pay the penalty for your opting out?

Anyway, western societies (at least in Western Europe) have decided that some things shouldn´t happen to members of their own society. Starvation for example or dying from entirely preventable illnesses.
Your "opt-out and then can not pay example" once again.
I would be shocked to hear that a German citizen died because - stupid example warning - he/she couldn´t pay for setting a broken leg. And then contracting an infection and dying. Which could be the end result of your "too bad for them" attitude.

It´s not called a human right here in Germany. It´s called basic human dignity by our Supreme Court. Not being homeless, not die of starvation, not die of preventable illnesses.

It's about having another layer of checks and balances for me, a layer that resides directly with the people that is more difficult to render ineffective with lobbyist money.

That layer will only work if you ensure that private health insurance companies can´t lure people out of the universal health care system with teaser "offers" initially. And f*cking those people once they opted out and are no longer eligible to get back in. You´ll need quite some regulation to avoid that. :)

I´d say you have two options.
1) Single payer plan for all of the basics. With an option to buy additional private insurance for "more and better" things.

2) a) Or something like the German reality now.
(A result of the Bismarck plans in the 1870s or 1880s.)
Publicly owned, non-profit health care funds competing with each other. Heavily regulated to cover at least all of the essentials. Which means that each fund is interested in preventive medicine since all of them have to cover the essentials.
(Monthly payments are a percentage of your wage. Half paid by you, half paid by your employer. Your kids are insured through you. Your spouse - if not working - too. In case of unemployment, unemployment insurance will pay for your health insurance. If you´re destitute, the state will pay for it.)

Plus additional health care insurance is available from private health care insurance companies for things not covered by the funds.

2) b) You can opt out of the public health funds if you´re self employed or earning more than xxx Euros. Don´t know the current limit right now. Only 8-9% of Germans are insured by private companies. They are required by law to put at least 10% of your monthly payments into a lock box. To pay for your higher health care costs once you get older. And probably more sickly.

Oh, and in both cases, none of the German health care insurance companies - publicly owned or privately owned - can terminate your insurance plan.

Quite simply put, I just don´t understand the US system.
How can you spent more per capita than anyone else while still not insuring 16% (?) of your population?

[anne]

Detlef:

"Quite simply put, I just don´t understand the US system.
How can you spent more per capita than anyone else while still not insuring 16% (?) of your population?"

Interesting construction, but I am comforted knowing we are #1.

[swells]

detlef, 1, 2a and 2b all sound pretty reasonable to me. I think my preference would be 2b. One quibble. There's no way the employer pays half. Believe me, it comes out of your pocket one way or the other. If the company didn't have to pay that half, they could pay you more, etc. Not that there's anything wrong with paying for what you get.

In the scenario you laid out with infectious disease, it would be possible for the state to take a lien against assets, like the IRS does now if you don't pay them. The IRS is pretty effective at getting paid.

I agree that the situation here in the US is fairly senseless. One concern that I have is the way politics and money intertwines here in the states. It is usually the case that business interests are able to get pretty much whatever favorable treatment they want by throwing money at politicians.

[anne]

"Has anyone been successful at persuading the likely McCain voters about this issue?"

With the exception of a single person who has increasing health care needs, and agrees with Edwards, but will vote for McCain in any event for worries of being otherwise overrun by terrorists who threaten to force us to learn to speak French, there is a remarkable absence of concern.

[Jay]

"Quite simply put, I just don´t understand the US system.
How can you spent more per capita than anyone else while still not insuring 16% (?) of your population?"

I just don't understand why everyone looks at such a large aggregate number and believes they can draw conclusions about a small subsector.

"How can you spent more per capita than anyone else while still not insuring 16%"

One word example, Botox. Two word category, Elective Treatment.

[Patricia Shannon]

Swells, I missed your comment agreeing with the need for universal health care. I do agree that there might need to be limits at the extremes. Like, chemotherapy for someone in a vegetative state.

[Francois]

To all those who oppose universal health care,

Why is it that we have public education available to all?

An educated workforce is essential for the economic progress of a country.

Oh! And a healthy workforce is not??

I can't hear you!!

During any debate on health care I've listen to, no one came claiming that public education should be abolished "because private solutions would be better, LIKE IN HEALTH CARE.

I STILL can't hear you!!

I rest my case.

[anne]

"One word example, Botox. Two word category, Elective Treatment."

Rubbish, but do keep trying.

[Patricia Shannon]

When the SARS scare was active, there was talk about quarantining people with it. I guarantee you that the result would be the working poor hiding the fact that they were sick, because missing a single day of work is a big hardship on their finances. When people can only afford to pay for part of their antibiotic treatment, the proliferation of antibiotic bacteria is facilitated, which is dangerous for all of us.
How much of our attitudes come from the fact that the people who immigrate to the U.S., at least before airplanes, had to be fairly healthy, and were mostly young. Also, they often had to be willing to leave family behind. (I read a study that found that people with schizophrenia are more than other people to immigrate to another country.) So maybe people in the U.S. are genetically selected to be less able to form normal human connections.

[ilsm]

"Competition" is a red herring.

There is "competition" in the war machine, they divide up the spoils in feigned competition for unneeded expensive stuff and lawless occupation. Excuse to keep more companies at the trough.

The US opened competition for the air refueler to the EU so that it could show Boeing it needed to hire retired generals like the 22 Northrop consultants supporting the airbus debacle, and not a civil servant for the big bucks.

The term "insurance" is also a red herring. If you call health care funding insurance you make it a hazard, probability of harm from the hazard, consequences of the harm relationship, which means that it is not health care funding but betting that you will get sick.

I only win on my monthly bet if I get direly ill. That is sick.

That is one hell of a way to provide "health" outcomes.

So, the term insurnace is a red herring in the argument as well.

The debate should not be about red herrings like "insuring" against risks or "competing" that red herring.

It should be: if a woman who owns a home gets ill should she be bankrupted?

It don't happen in any country who spends a quarter of what the US spends on insuring that the generals can send 1000 vehicles and 6000 troops into central Asia with all the support delivered by airbus.

[Francois]

"I'd like to ask if anyone has debated H/C with supporters of the status quo. I find in my discussions that republican/wealthier friends tend to argue that Universal H/C are:
1. Socialized medicine - "and we don't want that here".
2. US examples such as the VA show how bad government run programs are.
3. Universal H/C will stop them seeing the doctor of their choice (The Harry & Louise gambit) [although why they don't criticize Kaiser the same way is beyond me]
4. It will raise premiums because it will have to cover the currently uninsured.
5. Why should I care about coverage issues as long as I am working and my company provides coverage. (Screw the unemployed - and maybe the self employed].

Has anyone been successful at persuading the likely McCain voters about this issue?"

This is absurdly easy:

"1. Socialized medicine - "and we don't want that here"."

Sorry pals, but the US go-vermin already pays for 47% of ALL the health care services in this country. In less than 5 years, whether one likes it or not, this proportion will be higher than 50%. Which means that the majority of health care dollars will come from the big baaaad go-vermin a.k.a. "socialism" (BOOO! said Casper the Ghost)

"2. US examples such as the VA show how bad government run programs are."

Puhleeeeeze! Do not mix headlines for the NYT and WP with the whole situation. The facts is that the VA has shortcomings, some of its institutions suck, but overall, please see BusinessWeek (hard to confound with the Pravda in terms of political inclination) take on the VA. (http://www.businessweek.com/magazine/content/06_29/b3993061.htm) You might be surprised, very surprised.

"3. Universal H/C will stop them seeing the doctor of their choice (The Harry & Louise gambit)"

Says who? Good luck if you want to go "out-of-network" in the US if you have private insurance. Any of these clowns ever been abroad? (meaning outside their village) I've lived in Canada and Europe for extended periods of time and the laws out there specifically states that coverage must be accepted everywhere. I personally NEVER had a problem seeing the doctor of my choice.

Did I heard "waiting list"? Been to the doctor recently here? How about 6 months for a mamography? 3 weeks for a checkup? "Sorry we don't take new patients." Are there waiting lists abroad? Duh! The same as there are here.

"4. It will raise premiums because it will have to cover the currently uninsured."

ROFL! You ALREADY pay higher premiums because of the uninsured. Ever heard of EMTALA? No? And you describe yourself an informed consumer?
EMTALA is this law that say to the hospitals "Do not refuse to treat/stabilize ANY patient that crosses your doors for financial reasons...or else!" Trust me if I tell you the "else" can be quite painful for the offenders. How do you think hospitals recoup these costs in free care? Hmmmm? You guess right! Higher premiums via inflated billings to the insurance companies.

"5. Why should I care about coverage issues as long as I am working and my company provides coverage."

Tell me oh Grasshopper...what if you're forced out of work for disease, accident, outsourcing, bankruptcy etc. You know, all those little imponderables called life in general? What then? A true insurance should cover you for these situations, correct? Strangely enough, in the US of A, it is precisely at that very moment you'll find yourself out of luck to get coverage you can afford.

Any questions?

[Detlef]

Swells says:

detlef, 1, 2a and 2b all sound pretty reasonable to me. I think my preference would be 2b.

Agreed as long as you accept competition from publicly owned non-profit funds. I fear that competition just between privately owned health care insurance companies would lead to a race just comparing profits at Wall Street.

There's no way the employer pays half. Believe me, it comes out of your pocket one way or the other. If the company didn't have to pay that half, they could pay you more, etc. Not that there's anything wrong with paying for what you get.

Well, of course not. In a sense...
How is your US health insurance system right now working?
You´ve got lots of employer based health insurance benefits?
You think employers right now aren´t thinking about these numbers?
And adjusting your wages down because of these benefits?

Just to mention it, your Social Security and disability insurance rates are a percentage of your wages as far as I know.
You want to abolish them too?

And just forget that "If the company didn't have to pay that half, they could pay you more, etc."

Ever heard of outsourcing?
Why in the world would any company in the US or Europe pay us any more without any regulations when they can threaten us with outsourcing our job to Mexico, Romania, India or China?
If it wasn´t a regulation here (Western Europe and the USA), multinational companies would gleefully tell us to just shut up. We´d be threatening their profits.

[Holly W.]

Swells: When my mom became ill, over 300K was spent by medicare, etc. during the last year of her life to keep her alive. During that year, her quality of life was not at all good.

I think this sort of thing might be helped by implementing "Best Practices" medical protocols, as I understand are being put into place in other countries. In cases like your mother's, when a person is not likely to benefit much from spending a huge amount of money, they might be more likely to be encouraged to go to a hospice and focus on pain relief rather than expensive life-extending measures.

At some point, we Americans are going to have to have an honest discussion about the allocation of healthcare resources -- but I think it's been easy to avoid it when health insurance companies get to make the calls and play the bad cops.

[BAWDYSCOT]

1. Is it possible when you control what a healthcare provider will get as recompense for his/her services you will ultimately have less of those providers performing these services?

2. Is it possible mandating healthcare insurance to all citizens will actually hurt the chances of a citizen getting healthcare because of the possible chance of question 1 happening i.e. does healthcare insurance = healthcare?

[anne]

It is possible to be absurd, so sure enough count on absurity to come along as Republicans without conscience pretend to to be other than they are.

It is possible, really possible to be possible. Make me a Republican in another life, if it is possible.

[anne]

"Is it possible mandating healthcare insurance to all citizens will actually hurt the chances of a citizen getting healthcare...."

Only for Republicans.

[Alex Tolley]

Francois: Unfortunately my republican/wealthier friends are either immune to, or just don't buy, your answers. I've tried. They are very intelligent people. So either I am very poor at arguing this case, or, more likely, the mindsets I have described go to the emotions, rather than logic and evidence.

(c.f. cognitive styles of conservatives and liberals)

I really think that we need to look beyond arguing the evidence, which appears indisputable, and think about how to reframe the debate (ala Lakoff) or pitch at the emotional level. That was why I asked about actual experience winning arguments with republicans on this issue - data not theory.

[anne]

There was an interview of 2 sanitation workers from Memphis by the BBC this evening, both were part of the 1968 strike that Martin Luther King joined. That was 40 years ago, of course, and the workers interviewed were still working as sanitation workers for Memphis. The older has worked for Memphis for more than 50 years, both had and have no pension. Such is Memphis, such is America.

Now let us preach about the problems with universal health care and the like..