Health care reform threatens to violate the individual rights of patients, doctors, and business owners on a massive scale unprecedented in our country’s history.
Protectionism has to end for trial lawyers, health care professionals, and insurance companies.
How do we address these problems?
The final health care reform bill that emerges from Congress must not include any provisions that: (1) force people to buy health insurance; (2) force employers to provide health insurance for employees; (3) force some groups (wealthy, business owners, soda-drinkers, etc.) to pay for the health insurance of other groups; (4) force future generations of tax payers to pay for the health care of the previous generations; and (5) force insurance companies to write policies that offer coverage for specific conditions.
The final bill must include: (a) tort reform to minimize frivolous malpractice lawsuits; (b) ERISSA reform so that insurance companies are no longer protected from lawsuits and can be held accountable for their fraudulent nastiness; (c) provisions that allow individuals and small businesses to purchase insurance across state boundaries; (d) tax incentives for individuals to own their own insurance policies rather than being dependent on companies; (e) incentives for individuals to buy, and insurance companies to sell, policies that permanently cover pre-existing conditions; and (f) provisions that allow health care professionals to practice in all 50 states without having to be licensed in each and every state.
Dr. Gregory Garamoni
Doctors on Strike for Freedom in Medicine? http://www.doctorsonstrike.com
P.S. Now there is talk in Washington about “co-ops.” I hope Congress doesn’t spring the details of this on us at the last minute in an effort to “Rahm” this down our throats without public debate!

Your summary is comprehensive, Scot. A problem has been identified and is considered to be a big emergency – that does not mean that any response that is really big and expensive and drastic is the appropriate response, and it does not mean that those who want to discuss our response do not care or do not understand. You have articulated my own concerns well. Thank you.

Reading your thoughts on this, this morning, Scot, is indeed sobering. Aren’t there good things in place to make some sort of move in this direction now, such as the pharmaceuticals, AMA, on board to lower costs? Why is it that you seem to be suggesting nothing should be done now? Or am I misreading this?
I will say that while in principle I think Obamacare seems an appropriate goal to me, that President Obama has not given the kind of leadership needed or else a congress that is Democrat, and a nation would surely have followed. Yet such a major change always comes with difficulties.
Your premise that we should be willing to pay more taxes so that we do the good and right thing for all, I agree with strongly. Yet I also think many in our country, including Christians, will be adamantly opposed to such a thought on the basis of higher taxes meaning government spending. More out of people’s pockets into a black hole, so to speak, they think, and with some good reason.
I have to admit I’m a European or Canadian when it comes to healthcare. Why is it that other countries look on us with such curiosity? What can we learn from them?

#1 We must not require citizens to participate in whatever plan is developed? Why? We require all working citizens to participate in Medicare and Social Security, do we not? Even if you are young and healthy, that could change at any moment from disease or accident. And when it does, it is the rest of us who pick up the cost.
And Scot, you don’t believe businesses should be required to participate? Again, why? It’s already a cost of doing business that you have to pay the employer portion of social security. You have to carry various forms of insurance. A whole list of things that are simply part of doing business as a positive, contributing member of society. Either there must be some requirement for businesses to participate or we move to a single national payer system and spread the costs across society. Even in an exchange environment, I doubt those in the lower middle class will be able to afford insurance without at least some government or employer contribution.
As far as what the problems are? Go read the WHO and the CIA (yes, our CIA) reports on the facts. We spend an order of magnitude more on health care than any other nation on earth. And we don’t even break the top 20 on just about every measurable indicator of quality and effectiveness of care.

A strange debate, indeed, to an outsider. In my own country you have to go pretty far right for the opinion that the market alone should decide the care available to the sick. Surely we’re not a nation of 20 million socialists? Seriously, it’s up to US citizens to decide, but you won’t lose anything by looking at other countries and asking what they see when they look at you. The more ‘Christian’ US struggles to look after its sick than the more ‘secular’ UK, Ireland, Canada, Australia or New Zealand. Now, what story did Jesus tell to show me who my neighbour is?

Many of the problems associated with health care would vanish if the charges for medical goods and services were reduced.
I keep wondering why there is so little challenge to the business of medicine.
Why not ask the same questions of physicians and others that we ask of oil companies. When gas prices rise we ask about oil company business practices including employee compensation. Why do we assume that medical services are properly priced?
After all isn?t the price of goods and services at least to some degree a reflection of our ability to pay? There is increasing evidence that the ability to pay has not kept up with the prices being charged.
Medicine appears to be quite heavy handed in this regard. Medical providers know that people cannot escape the need for what they sell. So when demand is constant regardless of price, upward pressures on prices should not surprise us.
What surprises me is the lack of media scrutiny of the health care business. Let?s shine some light on this unexamined place. If all is well, no one should object. If objections arise, so should our suspicions.

You’ve managed to bring out a lot of why so many don’t look with favor on this idea. And right now, until someone, somewhere, manages to address those concerns, I can’t either.
And Scott, you need to understand how hard it is to start and keep a small business running. For those of us who are in need of jobs, small businesses are more likely to be the ones to provide those jobs. But not if they can’t make a profit.
Finally, as a person who is covered under a form of government health insurance (under TRICARE, as the widow of a military retiree), I can tell you that it’s nowhere near what it’s cracked up to be. Be careful what you wish for, you just might get stuck with something like this, or even worse. Yes, it beats nothing at all. But not by all that much.

Ted,
The reason we should slow down is there isn’t sufficient support from either Capitol Hill or the public. There are still too many questions to go forward. I believe there is a crisis, esp at the level of medical expenses and the number of uninsured who are taxing our emergency rooms, so we have to do something serious, radical, and soon. But, we have to work out the issues first.
Scott,
What I was saying is that small business owners sometimes work on a margin that is negligible and paying benefits etc to the few employees they have can sink the ship. This is what I have read.

Before too many more begin to tout the Canadian system, saw on the Druge Report/Google News that this just came out yesterday:
“The incoming president of the Canadian Medical Association says this country’s health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country – who will gather in Saskatoon on Sunday for their annual meeting – recognize that changes must be made.”
http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

wow. the health care issue is so complex and confusing that I even had trouble following your post this morning Scot.
I am sympathetic with Obama’s attempt to address this issue, and I certainly believe it needs major reform. At the same time, I fear we are rushing through it too fast in the attempt to simply ‘get’er done.” There could be a solution that would bring real results … however it is unlikley to happen due to vested interests, fear and ideology.
I find I cannot even discuss this with some of my life-long friends who are getting their information from fringe news sources and believe in conspiracy theories about “death panels” … so sad. Conservative church leaders and politicians find it to convenient to whip people up into a frenzy of anger and fear for personal gain.

I think its interesting that even the conservative parties in countries with universal healthcare have no platform or intention to touch the universal program. Even the leader of the Tories wrote an op-ed supporting the NHS program– perhaps the most socialized of all healthcare programs in the West. Drudge has zero integrity on the issues, I’d take everything you read there with a grain of salt.
I do believe health insurance coverage needs to be mandatory, because like I said in your last blog on the topic, the rest of us foot the bill everytime the uninsured end up in the ER. We require all motorists to have automobile insurance, why not health insurance? If I heard right, if a small business does not provide health insurance they will be tagged with an 8% fee for the uninsured employees. I can imagine that there are a lot of small business that would rather pay that 8% then drop hundreds of dollars a month on premiums for their employees.
A benefit to expanding healthcare that is not talked about enough is that major cost savings will happen when people have access to preventative care. For instance, someone who can’t afford to drop $300 on a physical and doctor visit will put off their basic health screenings like cholesterol and blood pressure– unaware they have heart disease, they could end up requiring a triple by-pass to the tune of $300,000 dollars! If they caught their heart disease early, some cholesterol medication and a daily aspirin could prevent the whole thing: saving us hundreds of thousands of dollars on one patient! As with so many diseases, prevention and early detection payoff a thousand times over.

Some of the comments above are really surprising and are leaving out even the most basic economic principles we as humans have learned for a few hundred years. Here is my take on this:
1. If the suggestion that the government has to force doctors and hospitals to charge less for services is valid, then why not apply this to other areas of life? Why not force your car mechanic or baker to give you discounts on their services if you feel like they are ripping you off? How about grocery stores, since they provide life-saving food? How can an assertion of forced discounts be even a viable point of the conversation?
2. The suggestion is made in the post above that “insurance companies are gouging consumers with high prices in order to make a profit” – this is also pretty far fetched, plus it’s implying that making a profit is a bad thing. The reason prices are so high is because the government is forcing doctors and hospitals to provide some level of dicounted services, so in order for these doctors and hospitals to make money and stay financially alive, they have to raise prices, which means that insurance companies have to raise their rates. They are not gouging anyone, they are simply trying to stay competitive within the rules created and shoved down their throats by an overbearing government infrastructure.
3. Another poster made the comment that the market alone wouldn’t work. Okay, then why is healthcare the most regulated aspect of the U.S. economy, and why isn’t that regulation making it better? By that logic, the more regulation, the better the product becomes? Again, the logic fails by looking at the results of regulation, versus the market operating freely in other areas of the economy.
4. Christians looking to a government for answers is a great mistake in my opinion. We are sons of a Kingdom that is above and beyond the kingdom of this world, or some government operating within this time and space construct we live in. The church has a calling to step up and provide healing and help to the world – when we abdicate this calling and turn over that role to the government, we have already lost sight of the Kingdom and our roles in that Kingdom.

MattK, preventative medicine costs a country more than coverage after sickness, etc. There was a good piece on this somewhere this weekend in one of the online mags I read. That is, if it is mandatory preventative. (You then have to pay for enormous prevention costs.) That’s what I’ve read anyway.
Virgil, good pushback. I didn’t want to sound like I believe insurance companies shouldn’t work at profit. Perhaps I should say excessive.

Is this the same ‘crisis’ that we’ve heard since 1994?
When you have to listen to the constant barrage on the ‘crisis’ in our health care system, I now know why so many doctors become offended by the tone of debate coming out of Washington. For a system which is far-and-away the most advanced medicine the world has ever seen, with the best coverage and care in the world, and the treatment of (yes) those who cannot afford it . . . calling it a crisis seems more political than realistic. I have never heard this president speak of the greatness of our health care system – not once. One gets the sense that he must have a problem-to-fix or else he doesn’t have anything to do.
And while I do appreciate forums and opportunities taken to speak about this issue with civility, there is a definite problem with any sort of discussion regarding healthcare – you can’t have one, not really. Perhaps you’ve noticed that the President continues to speak about ‘his plan’ to fix healthcare. He has never released his plan. We have the HOUSE plan, and the President has already admitted twice that he is unfamiliar with passages on which he has been questioned. (So, he hasn’t read it.) On the rare occasions that he faces a difficult question on the matters, he denies that they are part of ‘his plan’ (though they are in the House bill).
So, he must have his own plan which is not what we are reading in the House bill. If that is the case, then we cannot debate what the President’s plan would be – it is being kept in an obscure theory. And, in theory, WE ALL want everyone to have healthcare (Dems, Reps, Statists, Conservatives) . . . but not everyone wants the government to have this much power. I agree with the many conservatives who have rightly labelled this battle over the ‘crisis’ of healthcare to have nothing to do with medical coverage. This, again, is a power grab . . . and a door which we should not let the government open up, lest we hand over more of our liberty.

It seems to me that one of the biggest problems in health care is there are no real market forces at work. When I go to the doctor he doesn’t show me a list of prices, I can’t call his competitor and find out if he charges less and he doesn’t really have to concern himself with whether or not I can afford what he charges. He knows that an insurance company or someone will pay that charge. I don’t know of another business that has this model. If there were no middle man (no insurance, no government, etc.) between me and the doctor prices would have to be negotiated between the one receiving the services and the one providing them. Cost would come down.

I hear all the talk of people who can’t get care and it doesn’t match up with what I have seen. I am not saying it is untrue but let me give you an example. I know one lady who is a single mother. She is in poor health, lives in government housing and can’t pay her bills because her income is so incredibly low. It isn’t unusual for her to ask the church for help with a utility bill or two. In the next week or two she is scheduled to have MRI’s done on both her knees and to have knee replacement surgery. As far as I can tell, she would be exactly the kind of person you would believe under our current “broken” system would not be able to receive any kind of expensive treatment like this.
Again, I am not doubting our current system has problems but I am not sure it is as bad as people are making it out to be.

It’s important to recognize that any health care reform legislation that’s passed will be imperfect. But in my judgment it will likely be much less imperfect than the system we have now–which has none of the benefits associated with either (1) a government-funded system or (2) a free market system. Health care is the most complex policy issue we face. Uncertainty is not a reason for inaction. (And, let’s be honest, most of the people calling for the process to be delayed aren’t going to support any bill in the final analysis.)
In terms of the analogy to the stimulus bill: We should recognize that, as imperfect as that bill may have been, it looks like it worked (in conjunction with the financial/auto bailouts). A few months ago, many economic experts were talking about the possibility of a “depression”; now we’re starting to see signs we may have hit bottom.
Good piece by Fareed Zakaria on the U.S.’s seeming inability to confront a situation until it faces a specific, short-term crisis:
http://www.newsweek.com/id/212163?from=rss

I agree that we are observing a manufactured “crisis” so that government can infringe on more USAmerican freedoms. We do not have a health care crisis. We have, as has been noted, a business management of health care crisis. TORT REFORM is smack dab in the middle. Insurance companies have a minimal margin of profit. They are not the culprit. TORT REFORM. When the trial lawyers are reigned in and needless lawsuits are minimized, then doctors will not need outrageous malpractice insurance and can cease and desist from test after test to cover their butts and then insurance companies can lower premiums for the public. I dread, though, that we’ll have TORT REFORM when hades becomes very icy.

Scot,
Isn’t the statement about “excessive profit” really an issue of morality and ethics? In economics alone the idea of excessive profit is meaningless (although I expect Michael Kruse will perhaps step in to show me where I am wrong). We need to approach health care from a consideration of economics, altruism, ethics and morality. Incentive for innovation is good, price gouging is bad, everyone should have some level of access – and everyone (and institution) should be required to participate.
We have a problem of varying degrees.
It is a problem when someone changes jobs and then discovers that health insurance does not cover his wife’s pregnancy or delivery including any complications – because the pregnancy is a preexisting condition (it did cover the child after birth and any subsequent pregnancies) as happened to some friends of ours (and he changed jobs because he found that the first employer was unethical not to “get ahead”).
We have a problem when a couple wishes to establish a new campus ministry in a new region of the country and finds that the biggest single issue is finding health insurance.
I am not saying that a government run plan is the way to go – I am saying that there are real problems with the current employer based system that need to be fixed.

I think there are several very important issues that are not being addressed.
One is employment. Employers have more than doubled their costs for insurance in the last 20 years. Once pastor that I heard said his insurance in 1980 for a family of 4 was 7% of his income and now it is 35% of his income for a family of 3. He and his family are all in good health. My father is a denominational staff and while it used to be that small churches asked for pastor’s wives that would play piano or direct the choir to save money, they now ask for pastor’s wives to have jobs with good insurance because they can’t afford to pay the insurance premiums. I think that if we don’t figure out how to reign in health care costs it will be the major hinderence to expanded employment. Whether you agree with universal health care or not, countries that have universal health care will have less employment costs than the US and that puts the US at a disadvantage.
Second major issue not really addressed: Health care is not currently a free market. Many opponents to health care reform act as if the current system is a free market. It is not. To have a free market you must have identifiable prices. Right now it is virtually impossible to find out what the price for a procedure is before the procedure happens. And if you can find a price, given insurance restrictions you may not be able to take advantage of the cheaper price even if you want to. Second, the consumer in heath care in not the individual but the insurance company. So the incentive is not on the individual to save money but on the insurance company. Third, there is no good way to evaluate doctors and hospitals on quality, so a significant part of the market forces argument doesn’t work.
Third major issues not really addressed is the problem of existing conditions. I have a friend that was denied coverage for her baby’s delivery because she had a c-section on a prior birth. This happens all the time. When they chose there very good insurance they had no idea they would be responsible for $15,000 in medical costs.

@ Matt Dabbs
I suspect your acquaintance is receiving health care through Medicaid. That’s the thing here: We’re not talking about the truly poor. We’re talking about the working lower class.
Here’s how I see the situation:
1. The middle/upper classes receiving health insurance through their employers. That insurance is (1) subsidized through the federal tax code and (2) regulated by the government to ensure we can’t be denied coverage due to preexisting conditions.
2. The elderly and truly poor receiving government-funded health care through Medicare and Medicaid.
3. The working lower class (people who work for companies who don’t provide health insurance and people who’ve lost their jobs) get none of this. They’re the ones who face the closest thing to a “free market” situation: They have to pay insurance costs from their own pocket and if they have a preexisting condition they’re basically out of luck because insurance companies aren’t going to cover them unless they’re required to.
The major impact of the health care reform proposals being considered is to level the playing field for the third group above. To me, unless the critics of the reform plans can address that group specifically, I have a hard time taking them seriously.

Just as we all indirectly pay for the consequences of unemployment, and thus may in the end “spend less” (not just in cash money, but in social resources) by finding any means possible to put people to work, even in completely trivial jobs (look to Japan to see that this can and does work and radically reduces social consequences caused by unemployment such as crime, drug use &c), we all indirectly pay for the consequences of having uninsured citizens, and it may also be “cheaper” (again, not just in terms of bills paid, but cultural blight) to find a mechanism to give all residents (illegal immigrants cause consequences too, so it is purely pragmatic to include them) access to health care.
As with almost everything, the current “debate” in our country is a false dichotomy between two nonexistent options:
1) Keep the status quo, because the alternative is too expensive
2) Implement the proposed plan, because even if it sucks we have to do SOMETHING.
It is almost certainly more expensive to do nothing than to do something and it is almost certain that there is a much better, simpler plan than the one on the table which, let’s face it, even the people who wrote it, no one understands completely.
The third way is always the right way.

Scot, there is a necessary corollary to your point #8 which reads “Self-aggrandizing insurance companies and businesses who are lobbying in order to scare the public into not supporting Obamacare.” That corollary is that a self-aggrandizing political party which holds the white house and both houses is itself lobbying in order to press through a bill that will dramatically change the nature and availability of health care in the nation, but which is still not fully formed and full of murky unanswered questions, the only available response to which is “just trust us”. So the issue is a powerful and aggressive play for influence on both sides of the debate, not just on one side, as your #8 seems to suggest.

As far as the support of the American people for reforming health care… it’s already there.
We had an election. The person who won, Pres. Obama, promised a major health care reform. Now he’s doing what he said he’d do. If you don’t agree, you shouldn’t have voted for him. But you can’t complain because the Pres. is doing what he promised he’d do!
I hear a small, yet vocal minority who are upset. Most did not vote for Obama. Some are being mislead by fear and misinformation about a plan that is still being put together.
The vast majority of Americans I know want a major change in our health care system… including some public option. That’s part of the reason the Pres. got elected!

One question that must be considered is what kind of structure best allows advances in medical care to be produced. Getting better medical care starts with medical advances becoming reality. In time these advances become available to more and more people. Many of the poor today have better health care that the very rich did 50 years ago. And so short term goals of broader coverage must be understood in relationship to longer term goals. It seems that historical studies may be of some benefit here.

ISTM that as Christians we have a responsibility to care for the poor, the widows and the orphans, i.e. taking care of their basic needs such as health, food, shelter. That being said, what is hard to know or understand for me is the best way to do that. I haven’t spent a lot of time looking at the issues, but I face several challenges when doing so:
1) I have yet to find somewhere that provides a simplified version of what the proposed healthcare reform will actually do.
2) Even in simplified form, this is an incredibly complex system that we are talking about involving at least four different “players” – the government, the taxpayers, the care providers and the insurance companies. In such a complex system, the solutions and implications are much more intricate. Which goes to Scot’s point that we best not rush into it. Yet, we don’t want to wait too long either. But how long is too long?
3) Much of what I read is not based on data but on anecdotal evidence – a friend of mine in Ontario told me how great their system was vs. my cousin from British Columbia said he wishes he were a US citizen.
4) Is this at core an issue of free market vs. regulated?
Other questions I have include:
- What do we do to improve the health of our nation? In other words, does this plan or is there any way to encourage exercise and better eating? What correlation is there between our rising healthcare costs and our expanding waistlines?
- Is there any correspondence between this discussion and the issue of public education? From my reading of the statistics, we have not done very well at educating our children through mandatory education compared to the rest of the world. What can we learn from that?
I apologize if I have not added much to the conversation but appreciate the opportunity to have some civil discussion.
I am certainly praying for wisdom for our leaders in these troubling times.

Actually I think much of the “lack of clarity” is purposeful from folks who DON’T want reform to occur.
See: http://www.politifact.com/truth-o-meter/article/2009/aug/13/health-care-reform-simple-explanation/
I think the President is accurate saying there is broad consensus on 80 percent of what reform needs to be.
All the sturm and drang we are seeing now is over truly ancillary parts of the bill: for instance the public option, which I think is neither the panacea that some on the left think it to be, nor the creeping socialist threat that folks on the right are being told to fear. There is no good reason other than conservative ideology to NOT have the public option, but it isn’t the heart of the reform bill either…
As to cost: the President has said it MUST be deficit Nuetral over ten years. Yes they are hashing that out, but in the end he final bill will be.
To me Christians should be talking about this much as you started this post Scot: this is a larger question of “How do we best care for the sick amongst us?”
It’s amazing that THAT central question has inspired a vocal minority of us — many of whom name the name of Christ — to such vitriol and anger and slander.
This leads me to see other fears and other motives behind it. Fear of change, fear of race issues, and just plain fear… For instance: if the central question REALLY was “how do we best care for the sick amongst us?” then why should that incite foks to bring loaded guns to town hall meetings to talk about THAT?
Timmy C

As an American living in Canada, married to an Australian and traveling throughout the world, I have learned one constant about health care: nothing really works. Don’t get me wrong, I am glad that I live under the health care that Canada offers, but neither should it be idealized. First, it is deeply flawed and needs changes in and of itself. Second, we don’t live in a vacuum- Canada’s health care system is somewhat symbiotic to the American system, especially in our dependence of research & development. All this to say, the questions are not easy for anyone.
MLK Jr. is known for saying that, while we can legislate the desegregation of the system, we cannot force the integration of the hearts of mankind. The gov’t will never be able to offer any work health care system while we live in such obscenely indulgent and self-abusive ways. This includes people in EVERY socio-economic bracket. If any reform is going to work, individuals & communities will need to work to see change on a social fabric level. I believe the church should be a leader in this. Preventative health care is critical, but like you said, Scot, enforced gov’t prevention will only get costlier and mired in the complexities of ethics, etc.
Is it fair for the haves to support the have nots? From a purely civil perspective, it probably isn’t fair. And yet, as Christians, we are called to service and sacrifice at our own expense time and again. So let’s not expect more from our government than we are willing to do ourselves.
Great post, Scot. Very thought provoking.
Peace,
Jamie

Scot,
If you really want to have a rational discussion about this, you should do a better job of framing the discussion neutrally.
“Who has the most to gain if things stay the same? Who has the most to lose? I suggest answers to those questions will leads us to wisdom.”
How about a more complete question set? How about the inverse: Who has the most to gain if our current administration enacts massive healthcare reform? Who has the most to lose? Suddenly new villains come into view, right?
“Nearly 15 million of that number are recent graduates of high school, young adults who aren’t covered by their parents, and recent college graduates.”
Right good start, but what about the rest of the debunking of that 47 million uninsured number so often tossed around? I agree with you that we should not be dismissive of providing care to illegals… let’s at least have the conversation, but let’s have an HONEST discussion, and not used trumped up numbers to support our leanings.
Here’s a great editorial cartoon assisting with that: http://ibdeditorials.com/CartoonPopUp.aspx?id=333232530356809
“Insurance companies who gouge the insured with high prices in order to make a profit”
“Businesses having premiums raised because of insurance companies gouging the insured”
“Will they destroy the profitability of insurance companies because of their lack of ability to compete with the non-profit government health care option?”
Profit is evil? They’re GOOUUUUUGING? How do you come to that conclusion? You’re inserting polemic into the discussion to dismiss a priori the arguments you disagree with. A profit motive is a great way to force a fallen world and faceless companies to act “altruistically” in order to keep their customers who can take their money and go elsewhere.
Can anyone who thinks a government run option is just one more player in the field, explain to me how adding (1) to (30,000) is going to make a difference UNLESS that playing field isn’t actually even?
“Self-aggrandizing insurance companies and businesses who are lobbying in order to scare the public into not supporting Obamacare.”
Need I really address the bias present here?
“Citizens who don’t act with civility when Obamacare discussions are held in Town Hall meetings.”
What about the politicians? Are you getting your information from sources on different sides of the discussion on this? Because I can assure you, picture framing and sound bites being run over and over sure to paint an angry picture… I wonder if it’s accurate…
“Citizens and others who have now turned to exaggerated, apocalyptic rhetoric in order fan the flame of political debate”
What about politicians? We could start with the POTUS on that. Good thing he’s against people fear mongering for political reasons.
There’s a lot of room for a lot of good discussion on this, but if you really want it here on this blog, then you might start discussion without the polemic and rhetoric inserted at the outset.

“Let’s discuss …President Obama’s very serious proposals”
Pres. Obama has no proposals. Much like the “stimulus,” all of this has been farmed out to Congress, and many of the bills that have been offered have been seen before in some form or another — some going back decades. That is probably part of the problems — this thing has inherited the stink of the “stimulus” pork grab because it is being handled in much the same way by the Obama administration.
“40+ million who do not have health insurance and, therefore, lack ready access to health care.”
Most of whom could get either insurance or Medicaid if they wanted. We really need to separate the voluntarily uninsured from the involuntary, but the proponents like the larger number. (Here’s an interesting idea on what to do with the voluntarily uninsured.)
“Insurance companies who gouge the insured with high prices”
Scot, I must object to “gouge.” That’s a judgment call assuming that you know what is an appropriate profit. It also glosses over government regs that raise the cost of doing business for insurers.
“And drug companies are charging too much”
For whatever reason, the drug companies let other countries get away with telling them how much they can charge for their product. Thus the American people end up paying for the R&D that keeps the whole world alive. If Canada and Britain paid fair prices for drugs, our prices would be lower. If we cap prices the way they have, drug research will be less profitable, and will likely greatly decrease — as has already happened with vaccines.
“a knee replacement unit can cost a patient $5000 but that an older, but completely workable unit, can actually be purchased for $200″
I don’t know about knee replacements, but I know that in cancer therapy you can still get treated with 1993 technology if you want to. You don’t want to. I’m loathe to criticize a doctor for recommending the best.
“Citizens and others who have now turned to exaggerated, apocalyptic rhetoric in order fan the flame of political debate”
Does this include Obamacare supporters who act like this must be done by August, er, Thanksgiving or the world will end?
What the Obamacare squad neglects to consider is that a big part of the problem with our health care system is due to government. Congress caused the whole employer-based system in the first place. They essentially invented HMOs. Government mandates for insurance to cover every conceivable procedure make it impossibly expensive, and government caps on what Medicare can pay cause cost-shifting to private patients.

Anytime someone talks about “price gouging” it tells me they do not understand basic economics. Real price gouging can only occur in the case of a monopoly, which only occurs if the government runs something, if there is geographic isolation (e.g. in a hurricane nobody get can go anywhere elese) or if companies are violating anti-trust laws. Otherwise, if any company charges too far above the real cost, another company will simply charge lower and take take their market share.
So why are insurance prices high? Because costs are high. Why are costs high? Two reasons: 1) runaway litigation with no caps on awards, so companies have to bank on $100 million+ awards, even if those never happen, and 2) mandates from the federal government, pushed by consumers who have rising expectations. Insurance companies are told they must cover certain exotic operations and procedures, so consumers do not have a choice to get insurance with less coverage for less money (like they do for car insurance). It is like a law saying that you can only sell Cadillacs.

Also in terms of just understanding what is being proposed, this is a helpful visual:
http://4.bp.blogspot.com/_BTt4cJQj7GI/Solw65XNBXI/AAAAAAAAACg/z5uZtUZImyk/s1600-h/hayes_flowchart.PNG
From this blogger: http://www.donkeylicious.com/2009/08/flowchart.html

@James
I have a hard time taking the IBD editorial page (which seems to be the go-to editorial page for health care reform critics) seriously at this point:
http://www.nytimes.com/2009/08/17/opinion/17krugman.html
As for the categories of uninsured displayed in the cartoon:
Does getting diagnosed with cancer while you’re “temporarily” uninsured somehow make it better?
Do people who choose not to purchase health insurance sit in a corner and die when they get diagnosed with a major illness? Or do they get treatment at the ER? Who pays for that? Is this something like a tax?
Criticism/cynicism is easy. Real solutions are hard.

D Snoke #31,
But that IS part of the problem that must be addressed. If you are for a free market system, we don’t have that in health care. Heath care/insurance companies, state by state DO have a virtual monopoly. There are really only one or two options in my state… how is that competition?
AND the cost is partially high because it can be… what are people going to do, not go to the doctor when they’re sick? not by the medicine they need? That’s where the gouging happens… for example, medications that are manufactured in the US, yet are cheaper in Canada and elsewhere.
There needs to be accountability, and other options… I don’t believe private health care is really working in the ‘free market’ way that most assume. Taking some of the profit motive out would be a good thing.

These are a lot of things to consider at once. I respectfully suggest asking one or two questions/day that can be discussed and debated respectfully.

Addendum: The IBD cartoon also fails to account for the millions of families purchasing expensive/inadequate insurance on the open market right now because the system’s stacked against them. (See post 21 above.)

I agree that there needs to be something done about providing people access to affordable health care.
I think the biggest issue is that the government has a poor track record of running social programs. I am tired of the government spending money it does not have and showing very little reward for that money.
A public option also makes me responsible for the health of everyone else, as my taxes are supporting their health. If they live healthy lives then then there will be less cost to the whole of the U.S. Being partially responsible means that I should stop people from smoking, excessive drinking, eating fatty foods, force people to wear bike helmets, exercise, etc. Maybe as a Christian this should be my responsibility, but I am not sure that any of us want to be the “keeper” of all our neighbors.
I think the co-op model may have legs, because it supposedly removes the government from controlling the health care system. Co-ops provide voices to the constituents, (we have a energy co-op in AK). This allows the people who are part of the plan to have some voice in how it operates. Since they are also non-profit it should reign in much cost. The only problem would be how well the elected board runs the co-op, though you can always vote them out and put new people in place.

To the folks going on about “Tort Reform”, I mentioned this in Scot’s last blog, but the rise in insurance premiums over the last ten years has far and away outpaced any rise in malpractice suits. I am for Tort Reform, but you’re dreaming if you think it’ll solve the crisis.
@Scot. I saw that headline too about the costs of preventative care, but I have to wonder if that’s more about excessive and less than necessary testing? I just can’t believe that getting a diabetic started on insulin is more expensive than dialysis, or that prescription meds are more expensive than open heart surgery. Getting poor, sick people better coverage will mean savings.
On insurance companies, the ten largest providers in the US saw profits rise almost 500% over the last ten years. They’re making money while the rest of the country goes bankrupt due to healthcare costs.
I’m usually sympathetic to the idea that the free market can be more efficient than government, but healthcare seems to be the exception. Two years ago my daughter spent 21 days in the ICU and had two open heart surgeries before she died. It took over eight months to work through the mountains of insurance paperwork before the bill was settled (literally, we’d get some 200 pages a week mailed to us for months). You folks who are worried about government bureaucracy? The private insurance sector certainly takes the cake. Unfortunately I don’t have the citation, but at one point I read that the average administrative overhead for private insurers is in the neighborhood of 20% while Medicare manages to keep its overhead at around 5%.
Unfortunately, both the Dems and Repubs are in the pockets of the insurance lobby, so it appears the “public option” is dead in the water. But it remains true that the GOP is playing politics big time with this, while the country continues to head towards bankruptcy.

@Kyle,
No, it doesn’t “fail to account” for them; it’s not talking about them. No one denies that the under-insured are a problem, but the left is using this “40 million” as a bludgeon without ever acknowledging that millions of them could be insured if they were so inclined. It’s dishonest and bypasses important questions as to why these people choose to be uninsured.
(And, for the record, I think IBD leaves a few people out.)

In your opening “conclusion statement”, you speak of the Christian thing to do.
Why then do some of the major Christian denominations stop spending so much money promoting a political stance??? They (the loud mouth denominations) ought to use the same funds to start their own “insurance companies” (eg. Thrivent), then use these as “outreach” mechanisms to serve those who have no insurance.
History shows that most hospitals in this country were started by churches … why not again?

This study: http://pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf is also something worth throwing into the mix, particularly in re: to MattK last comment.
To highlight,
“62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three
quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.”
If *something* isn’t done it truly will bankrupt us all.

@john #37, You’re already paying for the healthcare of poor people. Everytime an uninsured person ends up in the ER, we the insured foot the bill. The proposed healthcare plan gets uninsured people on plans they can afford so they can see their own doctor rather than wait until they’re deathly ill and end up in the ER. This is what insurance is: we all pay into a pool to distribute the costs of healthcare. Some folks will run up a million dollars in costs, others won’t ever come close to that. We’re dispersing the risk over a large group of people. Getting everyone insurance coverage means the risk pool grows even larger and costs can be kept down.

About the large number of young people (recent high school or college grads) who are no longer covered by their parents’ insurance and do not have their own coverage:
These young men and women are not “choosing” to be uninsured. My recent-University of Michigan grad daughter says, “My friends have JDGS insurance…Just Don’t Get Sick.”
This population doesn’t “choose” not to be insured. They “choose” to buy food, pay rent and college loans. There simply isn’t enough left over to pay for insurance.
In New York City, where she and her friends live, insurance coverage for low income people is available. To be eligible one must make less than $24,000 a year AND pay a monthly fee of “just” $200. This amounts to 10% of pre-tax income for an eligible individual. Where, one wonders, would someone living in New York City on less than $24,000 a year come up with $200 a month for insurance?

Here is a fact check on the insurance company profits from the St. Petersburg Times: One health insurance company turned a profit, but not a record. Looking at S&P’s industry analysis, return on equity for these corps has been in decline since 2007.
As some have noted above, sustained high profits will draw new competition into the market and that will drive the profit down. However, heavy regulation can distort things to the point that potential new entrants will not enter because the regulatory learning curve is too long and risky. Too much regulation, or the wrong kind, can actually protect existing firms against competition. It is possible to have both too much and too little regulation.
In this issue, I’m not persuaded that insurance companies are at the center of the problem but I’m open to learning more.

@ChrisB
I agree that oversimplifying the issue down to a single number is misleading. Both sides in any political debate are going to resort to oversimplification. My personal experience is that the right is oversimplifying a lot more than the left is in the current debate.
Regardless, the question remains: Why shouldn’t uninsured working-class families (why don’t we stick to just the 9 million IBD says are temporarily uninsured for now) enjoy the same kind of government subsidies/protections the rest of us do under the current system?

@Kyle,
I don’t know. Ask Congress why it’s been illegal for decades.

@ChrisB
Why what’s been illegal?
To repeat: The health insurance my employer provides to me is (1) subsidized by the federal tax code and (2) regulated by the federal government to ensure I can’t be denied coverage due to a preexisting condition.
My questions:
1. Do you believe those same policies should be applied to the working-class uninsured?
2. Do you believe the policies should be repealed as they apply to me?
This is at the heart of what the current proposals would accomplish. Unless the answers to both questions is NO, then the status quo is unacceptable.

i live in Canada and it is hard for me to imagine not having universal health care. We pay our own insurance premiums. For a family of 4, our health insurance costs were approximately $1500 per year. If our income were below say, $50,000 we would pay less than that, and if we earned only $25,000 we would pay nothing. You are not forced to pay health insurance premiums but you would be crazy not to. However if you are that crazy the system is forgiving. If you arrive in hospital without coverage they work it out later – that usually involved retroactively signing you up. We have lived in the US and Canada and I continue to be very grateful for Canadian health care. When I say prayers of gratitude it is often something I include. That is not to say that the Canadian system does not have its problems. As in the US emergency rooms are often overcrowded – with the indigent, the mentally ill, addicts, the people the police have brought in. Because emergency rooms are often the point of entry to the health care system (especially on weekends, when doctors offices are typically closed and especially in inner city or rapidly growing urban areas) it can be a bit of a nightmare waiting to be seen in some urban areas. (I recently spent 5 hours sitting in emergency with my elderly mother-in-law on a weekend trying to get them to look at an infection on her leg. ) There ARE often waits for elective surgery and sometimes people DO die while waiting for treatment. Some of those people are very ill and would have died anyway, of course, but that is not what grieving families are prepared to hear. Sometimes when you are sick or in pain it is very difficult to wait, because someone sicker than you gets in ahead. On the other hand, if you were the sicker person you would be grateful. People also die in the US waiting for treatment. They also have health care rationed, especially if they are working poor. In the US you can always pay your wait out of a waiting list. In Canada, you can also pay your way out of a waiting list – by going to the US, or India. Of course, we also get uninsured or underinsured Americans crossing the border and paying out-of-pocket for health care here because, even without insurance, it is a lot less expensive. So free-riding is taking place from both countries. On the other hand, with rare exceptions I have nothing but praise for any medical treatment we have received in Canada. My daughter sees some of Canada’s best specialists and the fact that she is still alive is a bit of a miracle. The probability is that in the US she would be alive, perhaps, but we would be bankrupt. We pay our own insurance premiums. My mother, an elderly woman living only on an old age pension and a veteran widows allowance, has had spectacular care which has given her 15 years she might not have seen, even though she had to wait a couple of months for her heart surgery and we had our fingers crossed that she wouldn’t die before getting in. Her doctor still makes house calls. My husband, likewise, had amazing care when he had cancer and the subsequent grafts and microsurgery required from one of Canada’s top micro-surgeons. He had to wait – for several weeks – but he had access to the same treatment which would have been reserved for the wealthy in the US. The man on the bed beside him had had the same surgery from the same specialist and was living on welfare in an inner city roach hotel.
Like most Canadians I have been born and raised with universal health care. Like many Canadians, the health care situation in the US is one of the reasons we have chosen to live in Canada, even though my husband has been offered jobs at twice his salary in the US, we would pay much less tax there and we would no doubt have excellent health care in the US and health insurance provided through an employer. Now the Americans are shaking their heads! Of course, there is always, like the fear of death, the fear of ending up at the wrong end of the health care system in the US. A bit of bad fortune and there you are – unable to pay either your insurance premiums or for adequate health care (this bad fortune has happened to us in a way – my adult daughter is unemployed and has serious, chronic health problems – and we give thanks everyday for the Canadian health care system). Canadians are more risk averse than Americans – it is part of our psyche. It may be the primary difference between us and you. But there is also the sense that it is just fairer. Sure, WE are all right Jack. But what about our children, our parents, our friends who aren’t as lucky as us. Yes, it costs us in our taxes – my husband sometimes sardonically states that he supports at least 5 people on government income, but at the end of the day we sleep easier,and that, in itself promotes better health.
I think there is a lot of exaggeration and political rhetoric on both sides. In Canada, and in Europe, we hear lots of horror stories about health care in the US. Travel insurance providers in particular love to run ads about the astronomical costs of health care in the US. And plenty of Americans visiting or living here feed our fears with their stories of their high insurance premiums, of being refused emergency treatment, of having to drive miles and miles to find a hospital or clinic approved by their health insurance company, about doctors afraid of being sued. Those things are all true. But the reality is that the majority of Americans have access to excellent quality health care and they have health insurance provided by their employer. Americans hear horror stories about Canadian waiting lists for surgery and crowded waiting rooms and good doctors leaving Canada because they can make more money elsewhere and those things are also true, but the reality is that all Canadians, not just most, have access to good health care, even spectacular health care, Some doctors leave Canada for higher salaries and that is a problem. But many come back because they are more committed to equality in health care than they thought they were and they are sick of the fear of lawsuits and the bureaucracy involved with HMOs (apparently even worse than Canadian government bureaucracy).
On balance I prefer our system to yours but I don’t think you would be able to create the Canadian system in the US even if you wanted to. You wouldn’t be starting from scratch as we did. It is always easier to build from the ground up than renovate. Right now you have a enormous jerry-rigged structure already in place. It will be extremely costly to renovate and it will be extremely costly not to. You could tear it all down and start from the bottom but I think it would require more trust in government than you would be prepared to give, more fights with special interest groups than you can win, and a fundamental change in mindset.

I don’t understand all of Obama’s suggestions and proposals. What I do know is that I find the system right now very prolematic. I have had a number of my new college graduate friends go without insurance while looking for a job or working an hourly low-wage job. When money is tight, sometimes they simply cannot afford insurance.
Same goes for the refugees I work with. I was also surprised to find that despite their meager income, they did not qualify for medicaid after their first six months in the US.
My own experience also embitters me. My husband and I were on a great Aetna insurance plan in downtown Chicago through my job. We had a kitchen fire and my husband received a deep second degree burn that required surgery. Post-surgery the burn wasn’t healing, and our surgeon tried to refer us to a burn doctor, only to find that Aetna insurance didn’t cover ANY burn specialists in the entire city of Chicago. None.
That… is unacceptable, and yet because of the lack of competition, there was absolutely nothing we could do about.

I don’t understand all of Obama’s suggestions and proposals. What I do know is that I find the system right now very prolematic. I have had a number of my new college graduate friends go without insurance while looking for a job or working an hourly low-wage job. When money is tight, sometimes they simply cannot afford insurance.
Same goes for the refugees I work with. I was also surprised to find that despite their meager income, they did not qualify for medicaid after their first six months in the US.
My own experience also embitters me. My husband and I were on a great Aetna insurance plan in downtown Chicago through my job. We had a kitchen fire and my husband received a deep second degree burn that required surgery. Post-surgery the burn wasn’t healing, and our surgeon tried to refer us to a burn doctor, only to find that Aetna insurance didn’t cover ANY burn specialists in the entire city of Chicago. None.
That… is unacceptable, and yet because of the lack of competition, there was absolutely nothing we could do about.

How is it that we are supposed to get the BENEFIT of healthare with no COST? It is clear from the discussion that many still believe that healthcare will still be ‘free’ and that the financial obligation will be the only piece the the government will control. Simply untrue, even by current legislation.
And the countries which do have socialized medicine are going bankrupt from it, have no breakthroughs in medicine, and substandard care. Yes, some individuals love their socialized system and some individuals have had horrendous times in our system. But we cannot allow exceptions to make the rule.
Nor can we simply say that those who do not want government interference here do not want any health care for the poor. That is (at best) a straw man argument and (at worst) demonizing the opposition.
The next question for ‘free’ healthcare should be this:
How will individuals (and their care) be regarded when the money starts running out? Will they retain their level of dignity or become a budget line-item that needs to be manipulated?
The President himself has already admitted (twice!) that the private sector can run businesses better than the government – he cited (twice!) that UPS and FEDEX do a better job than the USPS. He’s right on that one, and he erroneously thinks it helps his case . . .

RJS #19, Carl #26
The challenge is how do we translate Golden Rule ethics from face-to-face communities to mass society? In face-to-face communities we know each other?s character, abilities, needs and foibles. We have a history with each other that informs future decisions. This information is essential if I?m going to ?do unto another? and love them. Social science tells that upwards of 150 people is the maximum number of people we can be with in a sustainable face-to-face community. No individual or entity can have the intimate knowledge of millions of others to ?love? them. While the ethics of face-to-face communities is about responses customized to individuals, the ethics of mass society institutions is about impartial application of rules and protocols. Both are essential but when we begin to apply the ethics of one context in the other we do great violence to society. Following the lines of subsidiarity, the question is how can mass society institutions aid our face-to-face communities without simply trying to substitute for them?
It is critical for society that individuals internalize responsibility for themselves. Economists speak of ?externalities,? impacts of a transaction a person experiences who was not a party to the transaction. (i.e., I open a chicken farm in backyard to sell fresh eggs to neighbors subjecting you, my next door neighbor, to the noise and smell.) If we are to offer blanket coverage, then that means everybody who falls on hard luck is going to be covered by the plan. Their misfortune is externalized to the rest of us. We can justify this externalization as something that creates a more just society.
However, this also means the consequences of people who incur health care costs due to irresponsible behavior are also externalized to everyone else. The absence of financial consequences for irresponsible behavior serves as an incentive to engage in more of it, creating further externalities. In a market situation, there would be financial incentives for behaving wisely and disincentives for behaving foolishly. Unfortunately, many of those who end up in need of care are there through no fault of their own, so they also get penalized. But absent a market mechanism, how will government avoid creating massive negative externalities and thwarting the internalization of responsibility? What is the information government will draw on to determine how to allocate care, because if it doesn?t use something we will be encumbered with these externalities? That is what generates fear of government intrusion into private decisions.
The fact is, we are already are experiencing these negative externalities because health care providers are required to give care to those who need it. I think the challenge is to figure out how to get care to those who simply can?t afford it without thwarting the need for internalized responsibility.

Michael @ 52,
What are you suggesting, that people will start deliberately injuring themselves if healthcare is free at the point of need?

@Michael #52
“What is the information government will draw on to determine how to allocate care . . . ?”
Can you point me to where exactly in any of the Congressional plans the government will be “allocating care”? (Beyond what it already does through Medicare/Medicaid–which, again, people seem pretty happy with.)
The distinction between government-subsidized/regulated health care (which we already have to a large extent) and government-provided/controlled health care (which no one in power is proposing) has been completely lost in the national debate on this issue.
http://www.nytimes.com/2009/08/17/opinion/17krugman.html

#53 Travis
“What are you suggesting, that people will start deliberately injuring themselves if healthcare is free at the point of need?”
No. I’m suggesting I might.
Seriously, one of the health care issues is the explosion in obesity. If people had to directly cover their own health care and knew how much it costs versus having it covered through an intermediary I think you would see some changes in lifestyle behavior.
Understand that I’m not that I’m laying out paradox above, not making a case for a particular solution. Care will be rationed. Period! The question is by what mechanism (market? insurance corps? government?) and based on what criteria?

#54 Kyle
“Can you point me to where exactly in any of the Congressional plans the government will be “allocating care”?”
I meant #55 to go to you as well. See above.

Scot, perhaps we should ask that anyone who wants to comment on the current legislation actually reads the proposed bill (1000+ pages) before trying to say what is or is not in it . . . (and, that would place those in this discussion ahead of the majority of Congress who have not read it either).
Kyle @ 54
“Can you point me to where exactly in any of the Congressional plans the government will be “allocating care”?”
*********
This is what the bill says, pages 284-288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE
HOSPITAL READMISSIONS:
?(ii) EXCLUSION OF CERTAIN READMISSIONS.?For purposes of clause (i), with respect to a
hospital, excess readmissions shall not include readmissions for an applicable condition for which
there are fewer than a minimum number (as determined by the Secretary) of discharges for such
applicable condition for the applicable period and such hospital.
and, under ?Definitions?:
??(A) APPLICABLE CONDITION.?The term ?applicable condition? means, subject to subparagraph (B),
a condition or procedure selected by the Secretary . . .
and:
??(E) READMISSION.?The term ?readmission? means, in the case of an individual who is discharged
from an applicable hospital, the admission of the individual to the same or another applicable hospital
within a time period specified by the Secretary from the date of such discharge.
and:
??(6) LIMITATIONS ON REVIEW.?There shall be no administrative or judicial review under section
1869, section 1878, or otherwise of? . . .
??(C) the measures of readmissions . . .
EVALUATION OF THE PASSAGES:
1. This section amends the Social Security Act
2. The government has the power to determine what constitutes an ?applicable [medical] condition.?
3. The government has the power to determine who is allowed readmission into a hospital.
4. This determination will be made by statistics: when enough people have been discharged for the
same condition, an individual may be readmitted.
5. This is government rationing, pure, simple, and straight up.
6. There can be no judicial review of decisions made here. The Secretary is above the courts.
7. The plan also allows the government to prohibit hospitals from expanding without federal
permission: page 317-318.
**********
PS – People are generally NOT ‘pretty happy’ with Medicare/Medicaid . . . we just went through a process with my Grandmother and it was one of Dante’s first levels (with many people we met along the way who felt likewise).

BIG APOLOGIES . . . my quote above did not have a proper attribution
This evaluation (and quoting of the bill) comes from John David Lewis (Duke University prof).

#54 Kyle
“Can you point me to where exactly in any of the Congressional plans the government will be “allocating care”? (Beyond what it already does through Medicare/Medicaid–which, again, people seem pretty happy with.)”
Like :Mic, I’ve heard complaints about the Medicare program as well. One of the ways non-profit and governmental entities ration goods and services is through accessibility. The good or service isn’t technically denied, but the greater the demand relative to amount of goods and services available, the more cumbersome and time consuming becomes the process for accessing the service. It weeds out those who don’t have the perseverance (and sometimes a necessary advocate) to pursue the good or service. Time is money. This is a way to raise the price to meet market demand.
Also, even assuming everyone loves Medicare, it is going bankrupt in ten years. It is unsustainable. So we need to spend a whole lot more or find a way to bring prices down. Restricting care, either through outright refusal or through bureaucratic encumbrance, are the primary ways to bring prices down, unless we are going to introduce some form of competition.

Rationing Steak
I’ve seen in various comments here and all across the web that we already ration health care, it’s only a question of who does the rationing.
Let’s consider how that’s done using restaurants as an example: A man walks into Outback and orders a filet.
1) The waiter tells him (bear with me) that a filet costs $15, and he only has $10, so he can have the chicken fried steak or the grilled chicken but not the filet. (This is market “rationing.”)
2) A government bureaucrat tells him that there are only seven filets allotted to this restaurant, and they have already been given out, but he can have the chicken. (This is akin to the “postcode lottery” in the British system.)
3) A government bureaucrat tells him that, given his dentures and aging taste buds, he wouldn’t be able to properly enjoy a filet, so he may have the chicken instead. (This is akin to Britain’s NICE, which judges the acceptability of treatments based on a ratio of price to “quality adjusted years,” similar to that which appears in the House bill.)
4) A government bureaucrat tells him that, based on his weight and cholesterol, he may have a salad or baked potato. (This is just me, but given how many liberals already want to tell us how to live, I don’t think it’s implausible.)
Only #1 is based on the American “meritocracy” — if you can afford it, or you’ve managed to get a good job with good insurance, you can have it. #2 & #3 are based on the notion that some government official knows best what you should have.
I think societies with Lords and Dukes, not to mention Queens, can stomach that more than societies like ours that try to be level.
#4 is based on the notion that our liberals are bolder, and perhaps crazier, than anyone else’s.

On Preventative Care, the source is the Congressional Budget Office director Doug Elmendorf:
Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.
…
But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. Even when the unit cost of a particular preventive service is low, costs can accumulate quickly when a large number of patients are treated preventively. Judging the overall effect on medical spending requires analysts to calculate not just the savings from the relatively few individuals who would avoid more expensive treatment later, but also the costs for the many who would make greater use of preventive care. As a result, preventive care can have the largest benefits relative to costs when it is targeted at people who are most likely to suffer from a particular medical problem; however, such targeting can be difficult because preventive services are generally provided to patients who have the potential to contract a given disease but have not yet shown symptoms of having it.
…
Of course, just because a preventive service adds to total spending does not mean that it is a bad investment.
Source: http://keithhennessey.com/2009/08/12/portsmouth-5/

@Michael
I misinterpreted your original comments, so I apologize. I understand the point you’re making. Ultimately, people do need to have more direct economic stake in their lifestyle/health care choices (recognizing that, to some extent, the insurance mechanism is always going to blunt that relationship). But that would require much bigger changes in how our health care system operates than what’s being proposed right now.
(I also apologize for double-posting that Krugman link.)
@mic
I’ll confess to not having read the full legislation–although I’ve tried to read as much as I can _about_ the legislation. A scanning of the legislation on the GPO website indicates that the language relates to the calculation of payments made to hospitals for Medicare–not direct rationing of care. The language would allow, not require, adjustments to payments based on “excess readmissions”–and only beginning in 2014. I don’t pretend to fully understand the technical details, but it looks a lot less scary than it is when pulled out of context (as is being done in a lot of blog comments sections according to a Google search for the language). Link to read the text in context:
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3200IH/xml/BILLS-111hr3200IH.xml

What I hear from some quarters is that it’s all about freedom, and keeping our rights I suppose being a part of that. And we do want that (I think particularly our freedom of religion here, where the state can’t interfere). But they don’t realize that the ship they’re on is surely sinking, and needs fixed. Or else the fix will be a lot worse down the road. Though maybe then we’ll have to start more from scratch.
What I want to hear is that one way or another, everyone is going to receive health care, and that all who can pay towards it, will. And probably both a mix of government and free market involved. Even Europe is looking at ways to improve their health care with some free market, though they get much more than we do for their money over there, now.

I should add though: many many good comments and links here today.

The primary problem is one of cost. If we can lower the cost of health care (via insurance or otherwise) then the uninsured problem becomes much more manageable as price is a primary reason why people are uninsured. A few things we can address:
1. MattR#34 is right, Hospitals are virtual monopolies, but they don’t have to be. They also don’t have to be huge – there is no reason why there can’t be many, many smaller clinics around various cities which allow for more competition. I think we over-estimate how much of medicine is immediate in nature. Mostly, we’ve been conditioned to just accept what our doctor says so we feel like we have no choice, but medicine is a big, huge grey area.
2. The American Medical Association is also basically a cartel that decides how many ‘slots’ there are for various specialties each year for new docturs. They limit the slots for specialists which makes the salaries higher, thus higher cost to use and more doctors who want to be specialists. Then we have a shortage of general practitioners and geriatrics.
3. Nowhere are you the customer. The Hospital’s customer is the insurance company. The insurance company’s customer is your employer. Your employer’s customer is…also your customer. So it is no wonder that you don’t have much say in quality or cost of care.
4. Doctors, nurses, etc. have no idea what things cost. Ask them and they’ll look at you strangely. Atul Gawande had a great story in the New Yorker about McAllen, TX which was had the most expensive healthcare in the country and they had no idea it was so when he told them.
5. Doctors and nurses are paid by the procedure or at least a commission for every procedure they bill. How do you think your house would look if you paid the electrician by electrical outlet or carpenter by number of rooms?

@Jesse,
“How do you think your house would look if you paid the electrician by electrical outlet or carpenter by number of rooms?”
You do.
If everyone paid the same regardless of the amount of work, everyone would have a 4000 sq ft house with 10 outlets per room.
What if everyone paid the same amount when they went to a restaurant. Oh, you may do this with friends sometimes, but what if it always happened. How long would you be happy eating a $10 turkey sandwich knowing you were subsidizing someone’s $10 lobster?

ChrisB, et al,
I don’t believe these metaphors are getting us anywhere in this discussion–perhaps it’s time to look for a new vaulting pole! Medical care is a morally and technically complex issue; it trivializes the problem to compare it to building a house or going out to eat. Sickness afflicts some of us catastrophically, while others are blessed with good health.
I think we can all unite around our love for the homeless, the hungry, AND the sick. Could this important discussion reflect that passion rather than underscoring political divisions?

I will be 69 next month. My wife just had her 66th birthday. We are extremely happy with medicare, and all our friends on medicare are happy with it. It is a single payer system. The overhead costs are very low compared to the insurance companies, around 5% compared to 30%, I’ve read. My wife and I lived in Colorado and tried to retire out of state 6 years ago, but were turned town by the only two insurance companies which were willing to interview us. She was teaching school, and Cobra benefits expire after 12 months if you move out of state. We were turned down because we both had pre-existing conditions. I had elevated cholesterol, around 240. She had elevated serum prolactim. Both of us had these conditions for over 30 years. Both of us were in excellent health. She walked 2-3 miles a day and did longer hikes. I was still running 10 K races (and had run 48 marathons) and climbing 14,000′ mountains “14ers.” We were unable to get insurance and therefore unable to retire and move back east nearer family.
Medicare will be running out of money, not because it’s poorly run or inefficient, but because the aging population is becoming a larger and larger per centage of the population. The same thing is happening throughout the developed world. Medicare will run out of money sooner if we find no way to cut medical costs. It will run out of money much sooner if we stay with the present inefficient system with costs rising much faster than inflation or salaries. If you want MUCH higher taxes do nothing now.
My wife is from the Canadian border, and I have talked with many Canadians who all like their provencial single payer systems much better than the system of their southern neighbor. No one goes bankrupt due to medical emergencies or conditions. Everyone has coverage. Medical costs are considerably lower than in the United States, so much lower that, if we adopted their proven system, the cost savings would afford coverage for our 47 million uninsured without greater expenditures than we are now paying.
I agree that we need to somehow give incentives to everyone to maintain healthy weights, not smoke, and exercise- without limiting their freedoms. I do not know how to solve that problem, but if it’s not done, we will all be paying MUCH higher taxes to pay for mostly avoidable disease and hospitalization.
I’m very upset that some talk show hosts are spreading lies and fueling hysteria as part of their effort to increase ratings, and that some of my usually thoughtful Republican/conservative friends (and sadly, some of their political leaders) are buying into it.
Doug

I should have said above, MUCH higher taxes and/or premiums. Also, when my wife read the post, she reminded me that Cobra health insurance (a continuation of your health insurance when you retire before age 65) expires in 6 months if you move out of state, which is why, with insurance companies denying us coverage, we had to wait another 5 years to retire. She also said I spelled prolactin wrong, before kissing me and saying I hope they “get it” before it’s too late and too expensive.
Doug

I’m pretty sure Jesus didn’t say “let the Romans take care of your illness. That’s why we pay taxes.” To assume we are doing the Christian thing by letting the government care for the ill is pretty presumptious and I think unChristian.
There is a class struggle perspective in the Libertarian movement that says there are essentially two classes: those who benefit from stealing from the labor of others (politicians, judges, bureaucrats, those on entitlement programs) and those who are victimized by it (workers, the middle class, tax payers). It’s funny but often those who support socialized medicine seem to be the ones who benefit from it. And hence some of these replies.

@ Kyle #62
Simple question:
If you feel that the language is a bit vague (that some read it worse than others), how can you be certain that the government will interpret its power in the most positive way for individuals?
Or, are you certain that they see it as patient-giving as you do?

For those who are convinced that market forces will lead people to make better choices, we should keep in mind some of the unspoken corrallaries of “Teaching a man to fish”:
We can teach all we want, but if poor people do not have real and meaninful ACCESS to the water, if the water is POLLUTED, or if fish are absent for any other reason, or if people don’t have the right EQUIPMENT it does not help to give fishing lessons.
Peace,
Randy Gabrielse

Here’s plan to fix it for my family: Move to Canada.
God comes before country, and any country that places corporate profit before health care for all citizens is not acting in a Godly manner.
In this so-called Christian nation, we tie everything from health care to justice to education to political representation to a person’s wealth. That happens everywhere, true, but only here are we PROUD of it and defend it as God’s perfect plan for His favored nation.
I’m taking suggestions on the best places to live in Canada. Right now, somewhere outside Montreal is the top contender.

MikeM @70,
What part of your statement comports with civility? You may not agree that socialized medicine would be a good thing for the country, and from your comments I’d guess you don’t believe in socialized anything (police? education?) or a progressive tax structure of any kind.
But you’re right, I do tend to support socialized medicine because I think I’d benefit from it. By having better healthcare. Along with everyone else.
I may be totally and completely wrong about that, but don’t impugn my motives or the motives of people like me as if we’re part of some nefarious communist plot.

@AlanR
“Medical care is a morally and technically complex issue; it trivializes the problem to compare it to building a house or going out to eat.”
Or you could say because the issues are so complex you have to simplify to even have a conversation.
“I think we can all unite around our love for the homeless, the hungry, AND the sick. Could this important discussion reflect that passion rather than underscoring political divisions?”
No. We can all sit around and talk about how much we love the homeless, but as soon as we start talking about solutions, divisions will occur. That’s life, even for the Church.

Doug Allen has had great experience with Medicare. Wonderful. He’s not the only one.
Here’s the problem: “hospitals received only 94.1 cents for every dollar they spent treating Medicare patients in 2007. MedPAC projects that number to decline to 93.1 cents per dollar spent in 2009, for an operating shortfall of 7%. Medicare works because hospitals subsidize the care they provide with revenue received from patients who have commercial insurance. Without that revenue, hospitals could not afford to care for those covered by Medicare. In effect, everyone with insurance is subsidizing the Medicare shortfall…”
This isn’t talking about reducing profits. This says hospitals, like the one where I work, lose money on every Medicare patient. That is not a model we can immitate for the general population, because at some point hospitals won’t be able to pay the light bill.

A problem is that no matter what the system is, somebody will be left out. There is no magic money machine that spits out all the money everyone needs for all their health care.
Something that bugs me is when people point to those who are currently unable to have insurance as proof of the need for a new system, as if the new system would leave nobody out. A fair discussion would include on what basis people are currently left out and on what basis they would be left out under the new system, as well as what recourse they currently have and what recourse they would have under a new system in question. Jumping from frying pan to fire is change but not for the better.

MathewS,
Fair enough. NO ONE is left out of the Canadian system that I prefer or most of the other single payer systems that almost every developed country has except us. We have had posts here from the UK, from New Zealand, from Canada and from elsewhere saying that. The medical outcomes, life expectancy, morbidity, childhood death rates, etc. are better in those systems, and the the costs per medical visit and per medical procedure are much lower. No one goes bankrupt or even looses sleep worrying about medical bills.
ChrisB, EVERYONE I knew in Colorado and every one I know here in SC is very satisfied with medicare. The people I’ve spoken to in Canada and in Europe are very satisfied with their country’s single payer system. BTW, I also own “medigap” insurance which pays hospitals and doctors in addition to my medicare. I agree hospitals and doctors need to pay the light bills, etc. which is why we need a more efficient system as so many of us have pointed out.
:mic, the idea that a libertarian system of healthcare is compatible with Jesus’ teachings is really a cruel stretch. Just let people die or faint on the side of the road and pass them by.
Doug

I am all for the church getting involved in helping people, but is anyone here serious about “the church, not the government” being responsible to care for the poor and needy in a country? Are you afraid the government would be inefficient, unfair, poorly run, etc.? Do you really think the church would be an improvement? Anyone been to church lately? How many churches would remain open without being tax-exempt? Most churches are trying to pay the bills, including building large buildings. Do you really think they would have the time, money, personnel, or interest to make a serious dent in caring for the people in their community in a systematic and organized way having expertise in medicine, finance, counseling, transportation, etc.? Get real.

I don’t think everyone’s anecdotes about how lousy medicare is or about poor Canadian healthcare is helpful. Look at the statistics. Medicare has cheaper overhead costs than private insurers, and patients in dozens of other countries with universal healthcare have higher rates of satisfaction than the U.S.
I’m tired of stories about “a friend of a friend” who had to wait 2 months for a knee replacement. We could go around in circles all day telling stories. The numbers say that in nearly every category the privatized system of US healthcare is underpreforming and driving american society towards bankruptcy.

Matt K *and Mariam* as always, a compelling story…
I’m a nurse who once worked in clinical research for the pharmaceutical industry. As global program manager (whatever that means), I was very apprehensive about traveling to the UK to begin some clinical studies in kidney failure and transplantation, sure to find that I would be traumatized by all the untreated patients there, left to die outside hospital, perhaps left in rows in the car park *ok, I’m talking “UK” now*. Imagine my surprise to find that not only did they get good care, but far better, imho and in their humble opinion, than kidney failure patients here. And my further surprise to find that most docs in western Europe look at the pitiful treatment of kidney failure patients here and view us as providing far inferior treatment.
Bottom line… I had fallen for that tired old litany of the far right… we have the best health care in the world… blah blah blah. NOT. Not by a long shot. We are so accustomed to looking to the US as THE standard and presuming that others line up somewhere below us, that it becomes almost impossible for us as a nation to see the truth. Virtually every other first world industrialized nation gives better healthcare than we do – cheaper, and people there, overall, are far happier with their healthcare than we are, overall, here in the good old USA.

Why is it that all the “Problems” are listed with the healthcare plan and never the title “Advantages” to the Obama Healthcare plan. The entire plan can’t be all problems…..it’s ashame that someone is trying to do something and all anyone seems to find are problems. I’m surprised such one sidedness is posted on a Christain site. Wouldn’t God want us to be fair and list both advantages and disadvantages!

Has anyone actually read the complete proposals)? The need for reform is a reality and definitely needed. However, and unfortunately, it IS about politics at this time, including Obama’s recent town hall appearances. Health reform will likely cost of all us and there still will be some that will not receive the care and services they may require. Bottom line, those can afford the best services will continue to receive them and those that cannot will not.

This is a HUGE change that is going to go through no matter what. What worries me is that every member of our legislative bodies that I have heard speak, when asked if they have read the bill have said ‘No, it’s too complex,’ or some variation of that response. The Cash for Clunkers is a comparatively straightforward program, yet dealers are dropping out because they have been reimbursed for 1% or 2% of the Clunkers they have taken in and neither they nor their customers can get through to get an answer. How in the world can a health care program that is too big and too complex for our Representatives and Senators to read, let alone understand. The idea behind the program is good; its implementation scares the daylights out of me.

Well I have to agree with 75% of what you said. Those are alot of the questions. Many also don’t believe they should have to pay for someone else’s care. I don’t like the way you put that most probably don’t choose to have healthcare. The reality is that their choices are food or rent etc. They don’t even have a chance to put getting their own health insurance which is normally at a higher cost then if they could get it through a group plan into the picture. If my kid looks up at me and is hungry how can I look back at that child and say sorry I can’t feed you because I had to pay the insurance premium so if we get sick I can take care of us. Just my humble opinion.

I am not sure that this isn’t already happening and it probably would amount to less than a drop in the bucket towards health-care reform…but, as part of a larger plan couldn’t the Govt. underwrite to some or all of the cost of medical school in exchange for the new doctor donating a set number of days, hours/etc. to treating patients for reduced costs/ free etc. In other words, kind of like where the military educates you in exchange for military service there could be a national service to society that you give time to and the costs of education are partially or fully underwritten. Also, in addition to tort reform, perhaps for so many ongoing hours/days/partial cost of malpractice insurance could be underwritten by Fed/state agencys??
It would seem at least in this way, if the Govt. is going to ‘throw’ money at the problem, there would at least be tangible results.

As an unemployed person with no insurance, I wish there was something in this country that would provide healthcare. I have also worked in places that have kept my hours just under 40 a week so they would not have to provide health insurance and these were big companies, too. I do believe something should be done to help out small businesses. We have enough super Walmarts that have driven out the small business person, who, by the way, offers way better customer care than Walmart ever will. So the small businesses should be able to provide for their employees too. Basically, I think a lot in this country needs a HUGE overhaul. If that has not been abundantly and glaringly clear by the events that have driven this country in a downward spiral, I don’t know what has.

A friend of mine just buried his friend a couple of months back. Died because medication was denied him.
His blood is on the hands of the HMO’s and the health care system.
It is time to stop the lies and protect the health of the poor.

I agree with Mr. Mooz. Something has to be done and done right now. There isn’t just millions without health care in this country, there are thousands that die because they can’t afford proper health care. This country is still, one nation, under God, with liberty, and justice for all. Let’s all come together, try to understand the pros and cons of health care and together with the president, come up with a workable plan for all Americans. We are our brothers keepers!!

I have listened to many reports but no one is talking about the gov’t access to our bank accounts on pages 58 – 59. Gov’t is trying to control everything and not let the people make any decisions for themselves. They will not only tell the people where to go for a doctor but will also tell the doctors what type of medicine that they will practice and where they will practice. I believe that they need to toss HB 3200 in the trash and start over. I am wondering when the Senate’s version will be coming out?

Item 1 – I disagree with the choosing health insurance comment. When I hire someone this is the number one item they ask about. For most, it is a matter of cost because low wage employers offer health insurance with minimal subsidies.
Item 3 – uninsured emergency room patients are a very small portion of health care costs. Some hospitals are impacted disproportionately, but over all a small impact. The insurance game does drive up the cost. Doctors do in two visits what could be done in one to maximize claims to the insurance company. Insurers delay payments and weed out high cost clients.
Item 5 – another “bloody shirt” issue that amounts to a very small part of medical expenses even when defensive medicine is calculated in.
I do agree real question is a HEALTH CARE and not just a health insurance issue. Our health care is both innovative and antiquated at the same time. Health care costs are rooted in inefficient bureaucracies unwilling or unable to learn from others.
Free market is not always the best way to deliver public service. Fire departments originally were a private enterprise operation. This proved an inefficient and ineffective method of delivering fire protection to the community. Health care may not be a right, but caring for the sick is the Christian thing to do.

I think that congress and the president needs to do much better at solving this problem. 1. better price on health insurance, it’s sad when you start a job and can’t afford the insurance when you have a family to think about. 2. these town hall meeting has gotten out of hand people are bring guns to them. What’s next? 3. I hope they look at the health care issue a little better let the people of this nation get a better and clear understanding, it’s not about one person view but about we as the people view. let’s not lose focus or sight on this matter. Lord help us all!!

Travis: “But you’re right, I do tend to support socialized medicine because I think I’d benefit from it. By having better healthcare. Along with everyone else.”
I’m a vet. If you think socialized medicine is “having better healthcare” then talk with someone who has had to deal with VA emedicine. Until you eat of the vine, don’t ever tell me it’s a sweet, sweet fruit. Or if this is out of your league, imagine what it would be like if the government ran medicine like it runs the post office: do you like mail on Saturday or can it wait until Monday?

Travis @74: “But you’re right, I do tend to support socialized medicine because I think I’d benefit from it. By having better healthcare. Along with everyone else.”
I’m a Vietnam era vet. If you think socialized medicine is “having better healthcare” then talk with someone who has had to deal with VA medicine. Until you eat of the vine, don’t ever tell me it’s a sweet, sweet fruit. Or if this metaphor is out of your league, imagine what it would be like if the government ran medicine like it runs the post office: do you like mail on Saturday or can it wait until Monday?