US health care – divided by a common language

Nothing apart from guns for all makes the US seem quite so foreign as the Great Health Insurance debate. The holy grail of universal health cover is far from a done deal. Having narrowly passed the House, it starts all over again the Senate. The Murdoch-owned Wall St Journal’s (still free) coverage gives us the true fruit of the right wing vine. First, on costs it sounds a lament for the rich the reader is expected to sympathise with.

“The House bill would impose a tax of 5.4% on individuals with annual modified adjusted gross income exceeding $500,000 or for couples with $1 million a year, effective from January 2011. The surcharge is projected to raise about $461 billion in revenue, almost half of the cost of the measure passed by the House Saturday. The bill would spend slightly more than $1 trillion over a decade to provide health insurance to an additional 36 million Americans by 2013.”
Mind blowing figures. But rather than draw the obvious conclusion that the US should look seriously at value for money for the first time, they prefer to raise moralising fears – horrors – that abortion just might be covered. (BTW, “roil” means, disturb, muddy the waters – I had to look it up.)

Finally another topsy-turvy argument, that anything approaching universal entitlement means not better health care for the poor but rationing under government diktat for the rich. Abortion is exposed as an entry point to the right wing argument.
“However, as subsidized costs soar, government will have no choice but to ration medical care, starting with the aged and grievously ill… The real importance of the abortion uproar is as preview of the politics that will dominate every medical coverage issue if ObamaCare becomes law. Every decision of what to insure or not—when an MRI can be used, or whether a stage-four breast cancer patient can get Avastin or some future expensive drug—will become subject to political intervention over moral disputes or budget constraints. Heretofore, these decisions have largely been made between a doctor and patient. This is the real “right to life” issue.”
Rationing is of course a universal fear, but we would agree that it should not be governed by ability to pay, wouldn’t we?

  • NCM

    Here’s what we have now in the US.

    Laws providing universal emergency care, requiring hospitals to treat anyone who walks through their doors complaining of symptoms requiring emergency treatment, yet minimal public funding for this, meaning that the funds are largely recouped from paying customers through higher payments and premiums. The folks who really get screwed are the ones without health insurance but that aren’t completely “judgment proof,” meaning in practice losing one’s life-savings to pay a $40,000 hospital bill that would have cost much less had universal emergency coverage been properly funded.

    We also have unaccountable monopolistic insurance companies who arbitrarily ration care so as to minimize their payouts and thus maximize their profits. “You’d like a lifesaving treatment for cancer? Well, sorry, you see that treatment isn’t supposedly covered, and by the time you get it all sorted out, you’re f***ed anyway, and we’ve saved ourselves from having to pay for your treatments.”

    Non-universal non-emergency care, meaning people needing treatment for everyday conditions must go to the emergency room where what should have been a routine doctor’s visit has to be fit into the square peg of emergency care. Now emergency room waits are legendary, and people with real emergencies all too often die while people who never should have had to have gone to an ER for medical care went first.

    An overly expensive tort system for dealing with medical malpractice. The problem isn’t frivilous litigation as the right-wing claims but the sheer complexity of presenting these cases, the costliness of the tort system in general, plus defense insurance that won’t pay what’s fair unless you practically put them over a barrel, requiring all sorts of pointless litigation just to get a fair settlement.

    Really dedicated doctors who are increasingly screwed by the insurance companies, the government, and a broken system.

    As I see it the Democrats’ solution is to keep the broken insurance system but to superimpose a monstrous government bureaucracy that will only help to make a f***ed system *less* workable.

    The only real solution, complete socialized medicine under a single-payer system and abolition of the health insurance companies, is not even being contemplated by the so-called left.

    Good times.

  • JustPassingBy

    OMG, the health-care debate in the US is quite moronic and just plain sad. I believe that Americans are so damn selfish and gutless. All the anti-reformers are basically worried about themselves. How can one go to bed at night knowing that 30 million (that’s half of the UK’s population, and 10 times Ireland’s) aren’t covered.

    I was once uninsured and I can say that the US needs universal coverage badly.

    I was diagnosed with a debilitating disease years ago and had to stay in the hospital for two weeks. I did not have any insurance because I was kicked off my parent’s plan. The bill was eye watering. The hospital administrator told me that I could get the costs covered via “charity care”.

    To make a long story short, it was 6 months of filling out forms; filing them; filling them out agains, talking to a counsellor, filing more forms, making appointments, and at the end, they paid the bill.

    Now I ask myself, how much did filing all those forms, counsellors, etc. cost? This sad sordid tale partially explains why health care costs so much in America.

    Hopefully Obamacare prevails.

  • USA

    It has not got to the Senate floor year and Lieberman says he will fillibuster it when it arrives.

    Obama seems to have taken the decision that he will cobble together a bill that has some chance of being passed. This he has done for the house, but approx 35 Democratic members of congress voted against it, most I suspect because they felt it did not go far enough.

    I only hope that he is taking a stepping stone approach and hoping to bring more on board once the initial reforms have bedded in.

    The best I can say right now is that something is better than nothing and it has to be better than the joke of a system that currently exists.

  • latcheeco

    USA
    Hopefully he’ll get them in the long grass in conference. I’m not sure now public care wasn’t just ever a bargaining ploy to get the right to freak out and accept breaking up monolpolies and abandoning things like previous condition clauses as a lesser evil. They must have known all along that the 60 votes weren’t likely to be there in the Senate.
    BTW funny how the right don’t complain about government run flood insurance…maybe its because the rich all have beach homes.

  • OC

    latcheeco: Holy shit, I was just thinking along the lines that catastrophic health care should be handled like the federal flood insurance program! Perhaps make it mandatory.

    But to me, the whole debate here is a red herring to distract from the truth that if everybody has a decent job, which includes health insurance, everything would be OK.

    Well, we got sold on the idea of complementing pensions with so-called 401K and IRA worker controlled plans, which in the beginning had companies matching employee contributions.

    But sure as Gresham’s Law, pension’s are nearly extinct, and private retirement accounts savaged by Wall Street, with no further employer contributions, and being drawn down by the desperately unemployed.

    I fear the same fate with a universal health care system.

    If we had near full-term employment, the issue would be moot.

  • Greenflag

    OC ,

    ‘But to me, the whole debate here is a red herring to distract from the truth that if everybody has a decent job, which includes health insurance, everything would be OK.’

    If Ireland was located in the Indian Ocean everything would be ok . The Sun would shine and the people could live on coconuts and palm oil and tropical fruits .

    Here are the players in the American Health care debate .

    1) The Private Health Insurance industry , it’s political lobbyists and indentured servant ‘political castrates ‘ of both parties in both the Senate and Congress

    2) The For Profit Hospitals and Group Clinics which can only survive by prescribing ever more treatments for ever sicker and uncured patients because to do other would hurt their bottom line .

    3) The Drug companies . Why invent a new antibiotic (they haven’t for 20 years now ) when you can generate even more revenue from repeat dosages of pills for the rest of a revenue stream’s life ?

    4) The legal and medical fraternities who believe that they are entitled to become ‘millionaires’ as of right or at least by making senior partner status and not by having to build up a business
    fromscratch like an electrical or building contractor .

    5) Those citizens with access to private health care because they are either part of a company plan or work for the Federal or State governemnts or County administrations . These people are ‘happy’ with their insurance because they either pay nothing or a small fraction of the premium

    6) Those citizens who work for small companies (the engines of future economic growth ) and have to pay much higher premiums or do without .many do without ,

    7) The uninsured or uninsurable the 50 odd million who are a drag on the system simply because they are not content to just die when they need an operation and insist on flooding the emergency centres .

    8) Government who pick up the tab for the over 65’s ? via Medicare .

    In the real world of neo conservative economics the parties mentioned in 1, 2, 3 and 4 above can only survive and keep their shareholders or partners happy if they can continue to make a profit at the expense of the other three contenders for revenue stream or from a competitor within their own category .

    Following the past 30 years of ‘evolution ‘ the parties mentioned in 1,2, 3 and 4 have discovered that the only way they can now make more money is via the ‘bleeding ‘ dry of number 5 on the list . Number 6 and 7 have nothing worth stealing . Number 8 is there to be milked for whatever they can get away with !

    The system is rotten to the core and it needs reform from inside out . It won’t get it of course because the vested interests of corporate america have no interest in the american people as people i.e human beings only as profit centres !

  • Greenflag

    brian walker ‘

    ‘But rather than draw the obvious conclusion that the US should look seriously at value for money for the first time, they prefer to raise moralising fears ‘

    Ah yes . Reduce the debate to god the devil and the micro babies instead of shillings and pence and you’ll get the attention of the masses who still aspire to heaven even if it costs them their life savings and the financial destruction of their families after a medical operation 🙁

    NCM ,

    A very good description of the situation at least according to an in law mine who is ensconced at a strategic level in the morass.

    ‘The only real solution, complete socialized medicine under a single-payer system and abolition of the health insurance companies, is not even being contemplated by the so-called left.’

    Of course not . That might actually reduce costs and wastage and not destroy enough lives and families and who in their right minds would want that ;(?

  • OC

    Yeah, you’re right Greenflag; what was I thinking? We’ll need a national UHC to treat all the ever-increasing unemployed being thrown into institutionalised poverty, and the ensuing alcohol abuse, domestic violence, depression, despair, etc., that goes with it. Kinda like bread and circus. Soma! Soma!

  • Comrade Stalin

    Universal health care works reasonably well in the countries that have implemented it. There is no reason why it cannot work in the US.

    NCM:

    The only real solution, complete socialized medicine under a single-payer system and abolition of the health insurance companies, is not even being contemplated by the so-called left.

    This is not what happens in countries that have successful universal health care systems, eg France and Germany. Complete elimination of private insurance is not necessary. In fact, it arguably helps.

    BTW the system in the USA is already “socialized”. Hospitals do treat people with no insurance, and that’s covered by the feeds paid by those who are insured. It’s just that it doesn’t work well.

  • NCM

    BTW the system in the USA is already “socialized”. Hospitals do treat people with no insurance, and that’s covered by the feeds paid by those who are insured. It’s just that it doesn’t work well. — Comrade Stalin

    ————-

    Sort of. Emergency care is universal but largely not publically funded (though there is Medicaid for the very poor and Medicare for those over 65), but it’s not only people with insurance who end up paying for those without. People without insurance end up paying too — and the costs they pay are higher than they otherwise would be because they are also paying for everyone else without insurance. The folks without insurance who get screwed aren’t the rich or the very poor [who have no assets or income to go after] but those who were making ends meet before they went to the hospital but who are bankrupted when they get a bill for $60,000 upon being discharged.

    And add to it the brilliant plan to tie health insurance to employment and guess what happens during a period of high unemployment? You guessed it: lots of people without insurance who get screwed when they get a hefty bill for necessary medical care and lose everything they’ve worked for and saved for in life as a result.

    You are right of course that this doesn’t work well.

    ———

    This is not what happens in countries that have successful universal health care systems, eg France and Germany. Complete elimination of private insurance is not necessary. — Comrade Stalin

    —–

    Perhaps it isn’t strictly necessary but it would sure as hell make things better — getting the insurers out of the loop re: treatment decisions would be well worth it. The insurers have transformed from simply paying the bill to deciding what doctors can and can’t do for patients under their care — this should be criminal yet it is standard practice.

  • NCM

    Of course not . That might actually reduce costs and wastage and not destroy enough lives and families and who in their right minds would want that ;(? — Greenflag

    ——–

    So, so true.

  • Greenflag

    NCM & Comrade Stalin & OC

    And then there is the fact that the non insured have a 40% greater chance of dying prematurely than those with insurance despite having access to care if they are ‘penniless’ . Post operative ‘bankrupts’ can be assured of future medical care at no personal cost. In the insane world of American Health Care the system does provide ‘free ‘ healthcare by making ever more middle and working class americans bankrupt ?

    And then there are the military veterans of whom one in five are homeless and hundreds of thousands of whom have no health insurance. They can get care if their injuries are directly ‘war ‘ related. As many as one in five end up homeless and in the USA that’s a ‘bummer’ in a way that their ‘european’ equivalents would not experience .

    I agree with comrade stalin that a complete removal of private health insurance is’nt strictly necessary but the present toxic level of for profit insurance companies in the system is not just killing americans before their time but is on the verge of killing the entire economy !

  • OC

    And many of the bankrupt will never recover their previous financial health because there are now no jobs worth having.

  • Greenflag

    OC

    ‘ because there are now no jobs worth having. ‘

    This is all so deja vu 😉 I await the arrival of the next Tory Government and Mr Tebbit’s direct successor with baited breath. Can the new ‘boy’ on the block come up with a more original admonishment to the British unemployed millions than the bould Norman did in the 1980’s ?.

    Will the new Conservative Minister for Unemployment be quoted at a press conference in London telling the fifty thousand newly unemployed in the financial services sector to stop complaining and to get up on their bikes and cycle to Sunderland or Middlesborough and find work if they can’t find it in London town;)

    And so it goes as Mr Vonnegut would say if he were here 🙁