John Goodman
President and CEO of National Center for Policy Analysis
Provided by Kaiser Health News.
AUG 12, 2010
View all previous columns at Kaiser Health News »
On Tuesday, members of the House of Representatives interrupted their August vacation and returned to Washington to vote on a bill to send money to the states. The issue that dominated the news was saving the jobs of teachers, police officers and other public employees. But most of the money allocated will prevent the states from cutting off health benefits for millions of people. If that doesn’t strike you as strange, perhaps you weren’t paying attention to last year’s health care debate.
During the year leading up to the final passage of the new health law, the Patient Protection and Affordable Care Act, the White House set up a special Web site and invited all Americans to post their own personal stories about insurance company abuses. During the days leading up to the final vote on the bill, the president and congressional supporters used almost every television opportunity to trot out these cases — sometimes in graphic detail.
Yet, in all the episodes of abuse, do you recall even a single instance where an insurer:
- Arbitrarily dropped coverage for tens of thousands of enrollees with the stroke of a pen — just to save money.
- Dropped entire categories of care — such as dental care or home health care — because it decided these services were too costly?
- Arbitrarily reduced the fees it paid to doctors and hospitals, pushing many out of its network, and leaving its enrollees with serious access to care problems?
Probably not. For a private insurer, each of these activities would be a serious violation of contract. Yet there is one insurer that does these things routinely. It’s called Medicaid. About half of all the newly insured people under the new health law will be enrolling in it.
Private insurers whose commitments are enforced by contract law have to raise premiums when costs rise; but when state legislative bodies say “no” to Medicaid’s need for funding, Medicaid revokes its commitments to the insured instead.
Here are a few tug-at-the-heart-strings examples I hope we hear more about in future political speeches:
- A nine-year-old Denver boy died because Medicaid quit paying (in error, it turns out) for his asthma medications.
- An elderly Michigan woman died of a severe dental infection after Medicaid cut off her dental benefits.
- A 64-year-old Tennessee man lost his Medicaid coverage right in the middle of his treatment for colon cancer because of income eligibility changes.
- Maryland Medicaid refused to pay for life-saving liver transplants for two children — arguing that while the procedure was medically necessary, it was not appropriate.
Not only were these abuses not addressed in the health overhaul, states across the country are currently considering more Medicaid rescissions — eliminating insurance for tens of thousands of people by redefining eligibility, reverifying eligibility more frequently, eliminating entire categories of care, and making access to care more difficult by reducing payments to providers and delaying payments.
Further, there is a history of such “abuses”:
- In 2002, Missouri eliminated Medicaid coverage for about 36,000 low-income parents primarily by lowering the eligibility limit from 100 percent of the poverty line to 77 percent.
- In 2003, Massachusetts dropped 44,000 long-term unemployed adults. Michigan cut 52,000 Medicaid patients; Missouri 20,000 and Nebraska 22,000.
- In 2005, Missouri adopted sweeping Medicaid cutbacks, in which more than 100,000 people lost coverage.
- Also in 2005, Governor Phil Bredesen of Tennessee instituted the single largest Medicaid cut in history: Approximately 200,000 of the program’s costliest patients lost their coverage over a four-month period.
- By requiring children to reapply for Medi-Cal every six months rather than annually, California estimated that more than 260,000 children will lose coverage by the end of 2011.
Of course, some of these abuses are the result of more rigorous enforcement of the letter of the law. But during last year’s health care debate, private insurers were repeatedly chastised for cutting people off on the basis of “technicalities.”
So why have we not heard more about Medicaid rescissions and Medicaid abuses in the debate over health reform? Perhaps the reason is that the health overhaul is designed to enroll 16 million new people in Medicaid and many of them will be giving up their private insurance in the process. In fact, people who acquire health insurance on their own will be required to enroll in Medicaid and will not be allowed access to the new, state-based health insurance exchanges if their income is below 133% of the poverty level.
If Congress ever revisits the new health law–as it surely will–one of the most helpful amendments would be to give people options. Let those who qualify for Medicaid at least have the option of entering an exchange, paying the (heavily subsidized) premium out-of-pocket, and enrolling in a private health plan instead.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Does anyone think that Obamacare will be any better? It will be 100 times worse, and why should we, the American people, and physicians, have to subsidize those who can’t pay?
Get yer head out of the commie clouds and smell the coffee. America was built on individual responsibility and freedom!
The answer is simple don’t take medicaid.
I have criticized SDN in the past for never publishing anything but liberal articles, so I appreciate the balance this article brings. Government funded healthcare is terrible and doesn’t work well in other countries, but we are implementing it here–go figure.
Thanks Obama, for ignoring the majority of people in this country and forcing Obamacare down our throats.
What a laugh. Transparent in it’s self-interest. Although insurers require regulation, because otherwise this great and noble calling will start rescissions again, at least they are better than medicaid.
What a joke. Medicaid provides the poorest people in our nation with health care. They get medicaid because they can’t afford any alternative. So this moronic article directly compares the insurance the poorest in our nation get with the insurance the richest get. Next you’ll tell us that rich people drive nicer cars and live in bigger and safer houses. Get out! I never would have imagined.
Hey Neglect, you’re missing the point. Medicaid is Obama’s vision for everyone. It won’t be medical insurance for the poor much longer. It won’t be long until it’s your only option in this country. And it is bad (most hospitals and doctors I’ve been in contact with don’t want to touch it).
Further, Medicare isn’t much better either. Medicare rejects many claims (at times even more than private insurance companies), and many physicians won’t accept new medicare patients (meaning, you all are being forced to buy damaged goods). Also think about this. Everyone who works in this country is forced to pay into Medicare. If you die before the age of 65 you won’t get a dime back (which is unfortunate if you are an African American male, because about age 65 happens to be your mean survival rate). Essentially Medicare relies on enough of you to die early, otherwise it wouldn’t work so well. And Medicare is the “beacon” that Obama and the other liars use as their standard for comparison. At least you have a choice whether or not to pay into private insurance and you can reap those benefits immediately. I think about how much potential is lost in all of those people who could have lived much more satisfying lives had they not been forced to pay all that hard-earned money into Medicare taxes without getting anything in return. Same thing goes for those who are forced to buy into retirement plans (i.e. Social Security) who die before retirment age. I’d rather let people decide for themselves instead of force it upon them.
@Obamanation
America is built on individual responsibility and freedom?…. You really need to look at history. This nation was built on one helping one another. In the 1800s the people would pay high taxes so that all kids go to school. In return the next generation would pay back the previous generation when they came to retirement. Does social security ring a bell… This is one of the many things that pulled our country from being 3rd world to 1st world. Policy change takes time and you have to wait at least 5 years before one sees results. I know Obama care is not that great and but you have to realize that he could not get a better plan out their because of the Republicans and other 3rd parties. I don’t know about you but I welcome Obamacare over our current insurance any day.
@Jay
You really like our care now. I don’t believe you have had an life threatening illness or injury or had a close family member with one if you are saying that. Or maybe you want a system like India’s or other 3rd world countries that have a fee-for-service system. Yeah those countries are doing far better than a government implemented system… There is a reason why the majority of government insured countries are in the top 20 WHO best health care countries. Of course they do not come close to US in terms of “immediate care” and technology because they can’t fork over the money to do so.
What people don’t relize is that the insurance companies will make the premium cost so high that no one can afford coverage. I lost my insurance five years ago, and I have had individual policies and now I can’t afford anything. The large compaines are going to raise premiums and the social programs will cut benefits. How can we win ?
Hey John Goodman, you wanna know who dropped large blocks of people? Re: “Arbitrarily dropped coverage for tens of thousands of enrollees with the stroke of a pen — just to save money.”
http://www.huffingtonpost.com/2009/12/04/aetna-forcing-600000-plus_n_380130.html
Yeah, Aetna, and more than once.
PS: I loved you on Roseanne.
Ro: Are you serious? Do you honestly think this country was built on high taxes and principles of communalism? LOL What are they teaching kids in schools these days!? Have you even read the Constitution? It lists what go’vt can do..it’s CANT do anymore than what is listed, at least, not legitimately!
I bet you think the founding fathers were racist too, huh? ROFL
@Ro
You obviously need to look at the history books again. This time read the non-revisionist versions and read them without wearing the kool-aid goggles.
You cite the 1800′s??? Now, you’re not suggesting we go back to slavery are you??? Yeah, sure I guess you can call that people helping each other out (the civil war kinda makes it complicated of course) Lol!!!! Now don’t you feel dumb???
You think social security is what made us a super power??? Try winning WWII and being the first to go nuclear. Not to mention we are the most competitive (which is why, in spite of this being such an aweful economy right now our GDP is still around $14trillion and China is the next closest, but not anywhere near the US, with something close to $3trillion GDP).
You think it takes 5 years for policy effects to be seen??? Oh, so that’s why Obama keeps blaming Bush for everything that goes wrong under his watch, while taking credit for the very few things that go right. Yeah, I get it.
Republican’s and third parties were to blame for Obamacare??? Try, the democrats had enough of a majority to do whatever they want. Especially when they changed the rules so they only needed a simple majority. So how are the Republicans and Independents responsible for any of this???
Ro, I could go on and on but I have a feeling that you and I could look at the same smokin’ hot picture of Megan Fox and you’d say you see an ugly man.
I trust that SDN will also post the rebuttal to Goodman’s article … http://www.kaiserhealthnews.org/Columns/2010/August/081510Cohn.aspx.
@ Dave. Do you have an ounce of data for your assertions? Also, does your point have anything to do with this CEO’s self serving article?
@ neglect
Absolutely: (since you’re too lazy, I’ll do some leg work for you)
Mean life expectancy for African American Males is 69.7 years: http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_21.pdf
The data on claims denied/rejected comparing Medicare to major private insurers as recent as 2008:
http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf
The same data from 2009 (notice all rates of denials dropped dramatically, but Medicare is still at or near the top):
http://www.ama-assn.org/ama1/pub/upload/mm/368/2009-nhirc-long.pdf
And I’ll preempt your potential assertion that “well, medicare’s denied claims may have likely been fraudulent, eventually covered, and/or justified, etc.” by pointing out that private insurance claims denied are also accounted for in many cases by fraudulent claims, claims by people who were no longer eligible (because they lost coverage/lost their jobs and still tried to push it through, were covered by a different insurance entity at the time the claim was filed, may eventually have been covered after appeal process or justification, the service/product was never intended to be covered by contract in the first place, etc. The point is the facts are the facts and you can’t be one-sided in trying to wiggle out of them.
Doctors limiting the number of new medicare patients they will accept is at an all time high (and is expected to keep rising)and is particularly higher in primary care:
http://www.usatoday.com/news/washington/2010-06-20-medicare_N.htm
http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-survey-results.pdf
Everybody knows Medicare for most people (exempting disabled and certain other criteria that makeup the slim minority) is an entity that you pay into your whole working life and only receive benefits after age 65, I’ll just wikipedia it for you:
http://en.wikipedia.org/wiki/Medicare_(United_States)
Obama’s plans to expand eligibility for Medicaid (a taste of more to come):
http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf
If you don’t think Obama and the democrats plan to push us into public option/single payer, then you didn’t listen to what they’ve been saying all along (and don’t doubt that there’s enough language hidden in that 2000+ page bill to make it happen under cover of darkness). How do you think private plans will compete with “non-profits” run by beaurocrats with ties to Washingon, and are subsidized with taxpayer funds? They can’t and won’t (and thus will shut down, eventually leaving only one option).
My point has everything to do with how naive you are. If he’s self-serving it’s because he should be (otherwise I would hope his shareholders fire him). If he’s lying, maybe you should call him on it. And my point about Medicare being Obama’s plan for all is that you state how this guy is comparing “rich” private insurance to “poor” dirt plans, well look out because you might find not too far beyond the horizon that these “poor” dirt plans are the only option we all have left.
Its in bad taste to have an insurance company write an article like this for SDN. The article would hold much more weight if it was written by someone who didn’t have a finanical interest in seeing medicaid look bad.
When you have to cite the Enquirer for your data, it might be time to hang it up.
@skeptic
Umm, Kaiser Foundation is not affiliated with Kaiser Permanente. Why didn’t you also mention that it was poor taste to have a former emperor of Germany write the article? That’s equally as stupid as what you wrote.
@RO
You obviously haven’t been to India recently. They have two health systems in that country. The government based one and the private one. Private care in India is far superior. Being admitted to a government hospital most likely means you will contract somethign rather than actually get a cure. I’m sure if anyone on SDN visited india they would far prefer being admitted to a paid private hospital over a government hospital (which is essentially free). That entire nation has realized the wisdom of making different industries private (same as the US did).
You use India as an example? What about all the European countries with either completely government run health care or highly government regulated and standardized systems that are significantly more efficient (as in less costly) and better than ours?
Why are you people OK with insurance companies in the US making billions in profits while many go with out insurance and our country becomes buried in health care debt?
A biased source. This guy works for the National Center for Policy Analysis a right-wing organization that receives funding from many conservative organizations and also from corporations-
http://en.wikipedia.org/wiki/National_Center_for_Policy_Analysis
I’m not certain that efficiency is the best goal to strive for. It is more effecient for me to continue working at Sonic which is down the street and I can walk. However, I prefer to work hard, buy a car, drive to school and become a doctor.
It is more efficient that we simply allow breast cancer patients to have some pain pills and die, but I would prefer we use our resources to find new treatments to keep my grandma around. Efficiency only allows for so much and it usually kills progress. That is not to say that we shouldn’t find a balance, but I don’t believe we should strive for the most efficient system so much as the best service with the least waste while still improving technologies.
@whatk
Tell me, which countries are you referring to that have absolutely no private component to healthcare, with healthcare systems that are superior to that of the United States? How superior are they to the United States that would warrent us eliminating our private component? Can the metrics that demonstrate their superiority to that of the United States be attributed to things extrinsic to the structure and quality of the healthcare system? What metrics show them to be inferior in ways to the healthcare system of the United States?
Also, what’s your problem with private companies making a profit? You talk a good game about health insurance companies making billions in profit, but you fail to mention that the profit margins (as in % of total revenue) of the biggest and most profitable health insurance companies on the Fortune 500 are anywhere from 1.5% (Cigna) to 4.5% (Aetna). This essentially normalizes the profits based on the size of the company and the amount of business they do (which is both big and a lot respectively). In fact, in this regard the medical insurance companies run a very slim margin compared to many of the Fortune 500 companies. Such companies include Microsoft (29.3%), Ebay (20.8%), Google (19.4%), McDonalds (18.3%), Coca-Cola (18.2%), Apple (14.9%), Walt Disney (11.7%), Nike (10.1%), and many many more above, below and in-between. Believe me, it is not difficult to find lots of other companies on the Fortune 500 list that run a higher profit margin than major medical insurance companies (and if you don’t believe me, then just look for yourself: http://money.cnn.com/magazines/fortune/fortune500/2009/performers/companies/profits/ ).
So then tell me, should the government not takeover all these other companies and industries that run so much higher profit margins than medical insurance companies??? Remember, your doing business with medical insurance companies is just as much voluntary as it is with any of these other companies (although I should revise that statment and say IT WAS VOLUNTARY UNTIL OBAMACARE CAME ALONG!!!).
@wrongness
Every source is biased. Attack the message, not the messenger. If you’re saying he’s a liar or what he’s saying is wrong, why don’t you just call him on it? You say he’s biased because he is affiliated with an organization that receives contributions from corportations. By that same argument most scientists are biased because they receive contributions from the government. Should we ignore the scientific literature because of this perceived bias? Along the same lines, maybe we shouldn’t listen to physicians because they are biased, having received contributions from both the government and corporations (medicare, medicaid, private insurance)?
Hey Dave, I DID call him on it! He either outright lied or is ignorant of blatant and well-known happenings in his industry. I would think a so-called expert to know of such things, so I’m leaning towards liar. Is that better than incompetent?
Hey xanthines, I hate to do this to you, but I did read the entire article you cited from (non-other-than) “The Huffington Post”, and I gotta tell you this was a big-time hatchet piece if I’ve ever seen one.
The author of the article you cited actually provided the source of his information. While this is admirable, unfortunately I read the entire transcript of his source and compared it to the assertion of his article and the two didn’t square with each other AT ALL. In fact if you read the full text of the source first AND THEN read the full text of the article, you fully recognize this as a huge hatchet piece because the quoted words are pieced together from completely different paragraphs (and at times even different sentences) of the original text to mean something the speakers never intended to say. In other words, lies were peddled and words were taken out of context by the author at the Huffington Post. You see, I actually predicted this because I am quite familiar with The Huffington Post well enough to know that they rely on their readers being too lazy to look at the actual data rather than simply accept what the authors say as gospel. Further, the original source that the author used was a publicly published online conference call produced by Aetna (you can read it yourself if you look at the text of the article you cited and click on the hyperlink that is linked to the words: “officials at Aetna announced” and visibly distinct as being colored differently from the rest of the text, in blue). You have to look at both the “Presentation” and the “Q&A” section (they are tabbed at the top of the text so you can view them both), because it gives you the full context. They start the conference call by stating “Today’s conference is being recorded”, which gave me first indication that nothing sinister would be lurking in their conversations (for obvious negative publicity). Here are the only two mentions of the “650,000 members” piece that is the central assertion of the Huffington Post author’s argument:
The first is in the text of the “Presentation”, about halfway down (for those of you who don’t want to do what I did and read the entire text, you can also “ctrl-F” search the website for “650,000″ and your browser should take you right to it):
“I will now provide additional comments on our 2009 guidance and some preliminary thoughts regarding 2010. Starting first, with 2009, we project year-end medical membership of approximately 18.8 million members, reflecting total economy related in-group attrition of approximately 625,000 to 650,000 members.”
As you can see, this is simply stating they project by the end of the year 2009 they will have lost up to 650,000 members to attrition. This alone flies in the face of The Huffington Post article who’s author’s assertion from the get-go in the very first sentence is:
“Health insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations.”
As you can see, this is a flat out lie because this article was written on 12-19-2009 and the original source said absolutely nothing about planning to lose up to 650,000 members in 2010. They were simply stating that they project to have lost 650,000 members total in 2009. Big factual error by the Huffington Post author (or a big fat lie).
The second mention of the “650,000 members” comes in the Q&A section:
“Okay. So just so I understand, those pricing actions will result in what I think Mark said, was 600,000 to 650,000 of net membership decreases excluding Medicare, Medicaid, etcetera but you are expecting a significant improvement in pricing beginning in 2010. To me that sounds like a better year than 2009.”
Again, this is talking about the reality of 2009 and that they projected to have lost up to 650,000 members that year (not in 2010). Furthermore, look at the use of the word “but” in the middle of that paragraph. It suggests that losing those 650,000 members is actually a bad thing for the company, and they are worried about it (so why would they be trying to make it happen on purpose???).
There is a huge difference between raising premium prices on everyone that leads to people halting further purchase of Aetna coverage (or employers covering their employees via a different insurance company), and doing what medicaid does (and Mr. Goodman talks about in his piece), which is to simply say that “we are no longer going to cover all of these services and we are also no longer going to cover these demographics” to save money.
I’m sorry xanthines, but the author of your article is not at all supported by the facts of his source. I know you wished you had the “smoking gun”, but you uncovered a huge lie being peddled at the Huffington Post (quite frankly, I wasn’t at all surprised) NOT by John Goodman. Maybe you owe Mr. Goodman a public apology, since you called him a liar and/or ignorant. Seems like the only ignorant people in the room right now are you and the author at The Huffington Post.
So please, feed me, what are these other “blatant” and “well-known” happenings in his industry that you speak of??? Maybe we can settle a few of your other myths while we’re at it. Lol!!!
Having done my MPH, I grow increasingly weary of all the political rhetoric that attempts to paints a dystopia of any form of healthcare reform. Stop chest-thumping about “our great nation”. We never got anywhere without adapting and implementing best practices in the interests of the country. Blind faith never got us anywhere.
Just goes to show you get what aren’t paying for. Entitlement will screw this country. Not having it and letting people make money is what got us here.
Hey Dave, first I want to say that I think it’s great that you care so much about this issue. I mean, honestly, I wish everyone did.
To me the issue is pretty simple. First, nobody can deny that our health care system is well… screwed up. Costs are rising, relentlessly, and we have huge numbers of uninsured. Second, several countries in Europe (Germany, Netherlands, France, and the Scandinavian countries are the best), to varying degrees, have been shown by simple economic data to spend significantly less than us on health care while at the same time providing at least equal quality of care (besides anecdotal evidence, infant mortality and average life span are one form of “hard” evidence that suggests this). Also, everyone is insured in these countries because they have some form of universal health care. A few do have private insurance components (netherlands), but they are more highly regulated than ours, there are government options, and insurance is mandatory. In these countries health care is a right, not a privilege.
So, why not learn from these countries (not that they’re perfect), when our system is so clearly broken? I don’t know if the new health plan will work, but at least it’s something. What’s the Republican strategy anyway? Not that I want to get into politics…
And the data:
http://www.infoplease.com/world/statistics/infant-mortality-life-expectancy.html#axzz0y4NoFULo
http://seekingalpha.com/article/146992-comparing-u-s-healthcare-spending-with-other-oecd-countries
and a nice infographic
http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/
@whatk
To me the issue is not so simple. The fact that you find these issues to be so “simple” tells me you don’t know what you’re talking about.
You didn’t answer my question of: “Can the metrics that demonstrate their superiority to that of the United States be attributed to things extrinsic to the structure and quality of the healthcare system?”
It is already settled science that it is the US’s much higher percentage of preterm births that primarily accounts for the disparities in infant mortality rate (which has more to do with cultural/behavioral practices than the quality of our healthcare system). If the US simply had Sweden’s gestational age distribution our infant mortality rate would be 3.9 per 1,000 live births (which would then rank us the 9th lowest infant mortality rate in the world).:
http://www.cdc.gov/nchs/data/databriefs/db23.htm
http://www.nytimes.com/2009/11/04/health/04infant.html
http://www.realclearpolitics.com/articles/2009/08/23/health_care_and_infant_mortality_the_real_story_97998.html
You see the same problem of confounding variables with the life expectancy rankings as well (particularly with obesity rates in the US being far higher than any other country in the world {>30% compared to the next closest country UK being >23%, also note that UK’s life expectancy is only marginally higher than that of the US [79.4 years versus 78.2 years]}:
http://www.hsph.harvard.edu/news/press-releases/2010-releases/four-preventable-risk-factors-reduce-life-expectancy-in-us.html
http://www.nationmaster.com/graph/hea_obe-health-obesity
http://reason.com/archives/2008/06/17/accidents-murders-preemies-fat
http://www.realclearpolitics.com/articles/2007/08/why_the_us_ranks_low_on_whos_h.html
I could go on and on and give you my take on issues of cost, spending and how that relates to the drift away from consumers controlling how their healthcare dollars are actually spent. I could also demonstrate how great this healthcare system is at actual performance measures that are directly attributable to the quality of the healhcare system (like rates of survival after diagnosis of cancer, though I’m sure people could argue lead-time bias there as well).
So how do you begin to learn from these other countries when you cannot easily quantify the differences between us and them, and all the variables that can easily confound your conclusions? People make whatever conclusions they want to make, and push nifty little stats (like infant mortality rates and life expectancy rates) that they think proves their point. I look at reasons behind the numbers and I don’t accept them as so simple.
I also do not accept your premise that the healthcare system in this country is broken. Every single time I needed care I received it promptly (and great care!). Same thing goes for every single one of my friends and family. I say more appropriately that the priorities of people in this country are broken. How do you fix the problem of people living beyond their means? People having children they can’t afford to adequately care for? Drug use? Violence? Overweight/obesity? Why are people so freaking impatient and drive their cars in ways that put themselves (and others) in greater danger (which I see every day on my commute)? Why do so many people fail to invest in their own education? Why does our public education system fail us?
We have real problems in this country and it doesn’t so neatly boil down to faults of the healthcare system.
Ah yes, clearly sir, you are a true scientist. Although you failed to leave out any solution to the problem of escalating costs of health care and the tens of millions of uninsured (who are NOT all simply unemployed leeches of the system), that’s fine because there are many in our country who are simply not worth it,right? – the sooner they die off, the sooner costs will be controlled?
I especially have to give credit to your very scientific bit of reasoning here: “Every single time I needed care I received it promptly (and great care!). Same thing goes for every single one of my friends and family.” because you, as the most intelligent of human beings, are able to generalize a population of 300 million based on your personal acquaintances. I therefore must defer the argument to you.
I mean, the state of the nation’s health care was doing so well under Bush- who didn’t do much except try to increase privatization of medicare. Oh wait, I thought health care costs rose, as did the number of uninsured but I’m probably wrong because nobody understands the issue like you.
P.S. your nytimes article contradicts you – the reason we have more premature births is largely attributable to lack of health care coverage, as included in said article: “Dr. Alan R. Fleischman, medical director for the March of Dimes, said the new report was “an indictment of the U.S. health care system” and the poor job it had done in taking care of women and children.” oh, but I’m sure this doctor’s just an idiot. And regardless of the question of “who’s best”, the fact remains that our system, despite costing much more, leaves less people satisfied (I’m sure it’s just the lazy people though).
http://www.gallup.com/poll/117205/americans-not-feeling-health-benefits-high-spending.aspx
Another thing you need to ask yourself is why is it assumed that the best and/or only way to achieve more affordable and fair medical care for more people is to have more government control? There are disasterous consequences to doing what our government and those of the EU are doing with their interventions in healthcare. It is a terrible idea for Obamacare to create a stronger link between employment and medical insurance provisions because it will cause employers to hire even fewer people and pay people less, and more people will be without a job and without medical insurance. At least if you have a job you might be able to feed yourself and your family. Making them a bundled deal will make the problem worse (because more people will have neither). You should also be startled by some of the statistics you provided, in the sense that the amount of healthcare spending as a % of GDP is anywhere near that of the US (16%) in such places like France(11%), Germany (10.4%), Canada (10.1%), considering the way that these countries ration their healthcare and severly restrict the freedom for all to choose. It shouldn’t even be close, and the fact that it is tells you that maybe they aren’t doing quite as well over there as you might think.
What is the republican strategy? Heck with them! This isn’t a partisan issue. At least they could prevent funding for Obamacare and possibly repeal it once we boot him and his friends out of office so that there can be better economic confidence for employers to hire by putting a stop to all the damage he and his friends have been doing. That’s the role and utility of supporting the republicans. Beyond that, it’s up to us to build ideas to solve this problem. I propose that we move away from universal coverage in favor of less government control. Universal coverage would be more costly to more people because there are lots of services that people would not want to pay for if they themselves were paying the bill. A great start would be to create a system within private insurers that arranges the premium cost structure much like those of auto insurance companies. This would make it in everyone’s best interest to think about and implement a living will which would be readily accessable to healthcare providers instantly and electronically through the insurance company. This would enable people to pay much less in premium costs if they promise that they would never want to have $1million spent to prolong their lives for a week while they undergo chemotheraphy for such terminal illnesses as lung cancer, or prolonged life support in persistent veg. states (as two examples). For those people who want everything done for them, fine, but you gotta pay more for it! Choice is such a powerful thing and we need more of it in this healthcare system so that we are not forced to buy into these bundled deals that make it so much harder for people to afford the most basic services. Health insurance companies do this to a very small degree through grouping people based on some of their behaviors (smoking, drinking, etc.) and age groups, as well as pay structures through variable copays, variable coinsurance, variable deductibles. There needs to be more choice than that and we need to find ways to work with the health insurance companies to make it happen. That way we can move much closer to never having anyone say “well, I wanted everything done but nobody would do it for me, even if I paid for all of it out of pocket!”. In my system you could have nothing done, or everything done and it would be entirely your choice to pay for it through more costly incremental premiums over time or at service out of your own pocket. We could go even further to make the most basic services more affordable by giving people the choice to whittle down what they decide are the most basic services to them (which could make the major medical insurances even more affordable by better specifying what constitutes a major medical service). If the people decide that they want government to make it happen sooner if the insurance companies won’t give the people what they want, fine. Why not have the government create a non-profit that isn’t taxpayer funded, with the qualities that I described. They would force the private insurers to compete against the market (not compete against taxpayer subsidized government programs that are unfair to all of us since we are essentially paying the government through our taxes to put our choices for health insurance out of business!).
I could go on, but I gotta go to work and make a living. Just wanted to provide examples of how we can solve this problem going in the opposite direction of more government control over our lives, giving the individual people more choice and control.
@whatk
You are trying to put lost of words in my mouth that I would never say. You now bring an unintelligent argument to the debate based on no facts. You clearly make this a partisan issue, and you show me your true colors along the way. Rather than make educated arguments you make emotional ones. Just like that doctor who was quoted in the New York Times article I cited. If you look at my other sources, they come to the conclusion that if we had a Canadian-style healthcare system and gave more care to these women, that would actually worsen the infant mortality rate. That doesn’t jive with what the Doctor in the New York Times piece states (notice his statements weren’t backed-up with evidence, and also notice it was the New York Times).
You attack the Republicans like this is a partisan issue, well then what is the Democrat plan for controlling healthcare cost? More of the same bundled garbage for all and paid for all? Look at my previous post for a plan to save cost and improve satisfaction. Choice is the way, not mandates, not rationing, not one-size-fits-all.
Funny, your Gallup Poll source seems to contradict what you said. 83% of our population is satisfied with their healthcare. Read your Gallup Poll again! So if 83% of the country is satisfied with their healthcare (they, along with me, my family, and all my friends, as I stated), then why are people like you so hot-to-trot to change our healthcare system so drastically? If it works so well for 83% of the country, why should we turn the system upside down for the other 17% (a slim minority)?
Oh, they ended up permitting my post. Yeah, I agree my post was a little rude but that’s because you initiated it by stating, with no proof or knowledge whatsoever, that I don’t understand the issue- along with your other somewhat rude comments to other posters. But, I really just wanted to express my point of view, not have an argument. I agree with many of the things you say about the state of the nation – it’s pretty bad right now and, sure, people should be better educated- it would probably solve a lot of problems. But don’t start claiming that I’m making this partisan, talk about putting words in someone’s mouth- I hate politics and have little faith in democrats or republicans. I agree that our health care system can provide great care – I also have had a good experience, more or less. However, what’s 17% of 300 million? – 51 million, which is interestingly near the number of uninsured. I mean, come on, there has to be something to this statistic. Clearly, those people in other countries with this horrible “rationed” care, as some put it, are pretty happy with their care. Even Fox News posted an article from WebMD stating the same thing- see next comment.
The problem with an unregulated system of for-profit private insurance companies is just that- it’s unregulated and for profit. Now, how would a health insurance company make a profit. Hmm, maybe they would just insure healthy young people. That way they don’t have to pay for sick people’s care. Sure, there’s the occasional claim, but as a whole they make a lot of money. And why wouldn’t they do it that way? If they have the choice, they’ll choose the money – they aren’t going to be “nice”. If it wasn’t for medicare, as problematic as it is, we would have even higher numbers, because why would private insurance companies choose to insure old people with all their health problems? Your ideas are interesting and I think that if everyone was more intelligent and educated, they might work. In my opinion though, we have a ways to go. I mean, I’m not saying we should avoid the issue of education, I think it’s one of the most overlooked areas but I also don’t think we should just wait to make major changes to a health care system that I, and many others, think could use it.
Hey, but you’re right, it works for me, why should I care? I actually met someone today that makes me care- a 60 something individual came into our clinic triage, he stated that he hadn’t been to a doctor for 10 years due to lack of insurance but now he has medicare, so he will start seeing a doctor. I took his BP and it read at 225/132- he had few other symptoms and it was unknown how long it had been so high. Needless to say, he was sent to the hospital. Who knows how long he had this condition though, and what permanent damage may have been caused – damage that may have been avoidable. I know, just one case, and maybe it’s his fault for not having insurance or for not going to the doctor or being ignorant, I don’t know. But I have to believe that of that 50 million or so uninsured, there must be some honest people.
I have no idea whether the new health bill will work, I’m unsure of Obama’s, or the rest of the democrats, ability to get anything right. But, to me, it appears to have some aspects that might work, might save money in the long run, and most importantly, will at least provide insurance for many who didn’t have it. To ask the question in another way – why not give it a chance? Like I said, the rest of our great lawmakers don’t have much of an alternative proposal.
http://www.foxnews.com/story/0,2933,136990,00.html
If you don’t like being called partisan, then don’t start talking about “what do the republicans offer anyway?” I could argue: They aren’t in power, they aren’t being listened to, and the media is largely not on their side so they don’t have voices to be listened to. Obama tells his mouthpiece/echo chamber (the mainsream media) that republicans bring nothing to the table to offer, and these statements go unchallenged (regardless of the fact that republicans have been offering ammendments, counter-bills, etc. that get no media attention). There you go. What do you expect? Does that explain why you say “what do the republicans offer anyway?”
I don’t know if people in these other countries are necessarily happy with their healthcare. That’s the problem with these objective standardized polls. It’s just like when I evaluate my teachers and clinical preceptors in medical school, at the end of a month I’m asked: “How good is the level of this person’s teaching?” and on average I’d have to say it’s pretty good to be fair to them. You don’t hear about the real problems that need to be fixed, and nobody has the time or motivation to complete the more subjective “comments” section to express the real problems because everyone has long since known that nothing gets done to fix them and it isn’t worth your time and energy (and you’re already done with your rotation so it won’t help you personally anyway). I bet a “man on the street” version of polling could raise some eyebrows in these countries. Have someone confront a lot of people and ask them: “what is wrong with healthcare here that you see?”, “what problems have you had with your interaction with the healthcare system?”, “what works really well in the healthcare system that you see?” ask these questions in our country too of course (we already see that and politicians drag them out as props all the time). One-size-fits-all standardized questions don’t attack the real problems. I’d want to know why people are more supposedly satisfied in other countries, and why the unsatisfied are unsatisfied. What role does the media/politicians play in their perceptions?
Our system is anything but “unregulated”. Period.
We also don’t have a pure “for-profit” system. It’s a mixed and intertwined system. Thus, you can’t take all the faults of the system and pin them on the for-profit elements in calling for more government intervention (that’s what politicians do).
Actually medicare and other government elements don’t necessarily improve the way private insurance operates by taking the older and sicker people out of the system because many of the medicare and veterans affairs patients have their own private insurance (have you ever heard of “medigap”?) that they utilize because they know medicare doesn’t pay for standard checkups among many other things that they like, and many veterans know that VA doctors generally don’t provide very good care. So essentially it adds duplicate costs to the system. I saw this all the time when I spent a month at a major VA center and when I saw medicare patients at the family doctor for checkups (that their private insurance covered) in my month of family medicine. Were these rare outliers that I just happened to see? Not likely.
I don’t know if the same people who are unsatisfied with their health are necessarily the uninsured. I’m actually surprised you didn’t catch my typos stating that 83% of US people surveyed in that gallup poll are satisfied with their “healthcare” (it’s actually their “health” that they are satisfied with, not their “healthcare”). I would expect satisfaction with healthcare to be less because I would expect that type of satisfaction to be heavily influenced by the news and political dialogue. There is a constant drum beat in the news in this country about how bad our healthcare system is, and other countries like Canada, UK, France, etc., are much more proud of their healthcare systems and are touted as great and fair (and I would think their media coverage probably reflects that and could have a trickle-down effect on peoples’ perceptions of the healthcare system). Just look at the correlation between the constant drum beat of media opposition to the Iraq war when Bush was still president and the steady decline in public support for the war effort if you doubt the profound effect of media coverage (the longer the media harped on it, the lower the approval numbers fell…also notice that the war in Iraq doesn’t seem to get nearly as much media attention now that Obama is president even though we are still over there risking American lives and spending lots of money…hmmm, interesting…). In the gallup poll 83% of the people could be satisfied with their health even if they don’t interact with the healthcare system. 17% of the US people surveyed could be unsatisfied with their health simply because they are unhealthy regardless of how our healthcare system works. Mind you (as I cited previously in linking US life expectancy rates to obesity) we have an obesity rate of over 30%, higher than any other country in the world, and I would expect that people understand the link between obesity and health. I’m more inclinded to believe that a good number of that 17% who are unsatisfied with their health simply perceive themselves to be unhealthy (whether they are sick, or simply obese, etc.). There are many factors that could lead someone to be unsatisfied with their health and I don’t think this gallup poll really delves into that (they probably didn’t even ask the questions, I bet they didn’t ask respondants to state their BMI). What I have been trying to demonstrate to you is that unless you relentlessly ask “why?” you cannot make the conclusions you make with much certainty, because there are people, like myself, who will find ways to blow-up your argument by citing significant confounding variables (which is very effective, as you can see). Until we met on this discussion you had written-off this US healthcare system as inadequate based on cost, infant mortality, and life expectancy data comparing us to other industrialized nations with some form of nationalized healthcare plan. I agree cost is an issue, but I do not think we are moving in the right direction by asking for more universal, one-size-fits-all, and everyone pays for it, top-down government mandated healthcare. Look at how much US healthcare costs have exploded since the packaged deals via health insurance and government interventions via medicare/medicaid took effect. Believe it or not, consumers used to pay directly for their healthcare at the point of utilization and costs were a lot lower (because otherwise nobody would be able to pay the bills and fewer services would be utilized, hence capitalism works). You cannot now adequately distinguish between failures of private versus public healthcare in this country accounting for the problems we have because there is too much cross-influence (a perfect example is the way that medicare reimbursement sets the bar for private insurance reimbursement; providers participating in Medicare are mandated to provide certain services that they probably otherwise would not want to invest so much money in, such as on-site foreign-language interpreters; etc.). With regards to infant mortality rates and life expectancy, I demonstrated to you that there are many confounding variables that can easily cause these differences irrespective of the structure and quality of the healthcare system. You dispute my assertion that infant mortality rate is largely high in the US because of the much higher rates of preterm birth, because you (and the doctor cited by the NY Times) state that preterm birth is a result of inadequate care and poor access to care. I have read studies that analyze this data and it seems more linked to racial and cultural differences as well as the state of poverty and lack of education itself, rather than inadequate/poor access to healthcare causing the higher rates of preterm births. I even found an interesting article that seems to demonstrate a link between obese mothers and higher rates of preterm birth (there you go again, another confounding variable, 30% obesity rates in this country, higher than any other country). I’ll try to cite these articles in a separate post since SDN takes a long time to permit posts anytime you imbed a web address. I notice you don’t dispute the link I demonstrated between obesity and life expectancy as confounding your implied link between our healthcare system and life expectancy. The problem with using such outcomes as mortality rates and life expectancy rates is that they are largely dependent on the individual and their freedom to do whatever they want with their lives (which I pray never gets taken from them). What do things like gang violence and accidents due to drunk driving have to do with the healthcare system? I hope in your clinical encounters you understand this better by trying to help people manage their diabetes and other chronic health problems. Primary care is trying to evaluate practicioners based on their ability to adequately control patient blood glucose, HbA1C, and blood pressure. The problem with this is that there are so many factors that are out of the control of the practictioner (such as, does the patient distrust healthcare/medications? does the patient comply with treatment? does the patient care about their own health? does the patient want to pay for all these things that need to be done? Is the patient educated enough to do it right? etc.). It is unfair to judge clinicians based on this final overall metric because you could conclude that clinicians in very affluent areas are much better doctors than those in poorer areas (which would be an unfair statment because of the confounding variables I cited). Concierge medicine would be the best in the world. I really hope that they don’t go through with these plans to set physician reimbursements based on doctors/hospitals’ ability to get good outcomes with fewer contacts/hospital days because it will be a disaster based on the patient variables (and disease variables) that don’t rest on the shoulders of the doctors/hospitals/healthcare system. I bet it would exacerbate the problem of many hospitals not wanting to accept sicker patients and poorer patients if they think that they won’t get paid for predictably poor outcomes as a result of them simply being sicker and poorer. It would probably lead to more manipulation of the system (many doctors in hospitals currently don’t document ventilator associated pneumonias because they know they won’t get reimbursed for it, same with foley-associated UTI’s, etc.). Maybe more patients will get booted out of the hospital sooner than they are ready for, because outcomes would be judged partly based on length of hospital stay (not good). When the patient comes right back to the same hospital, maybe that hospital will defer them to another hospital because they know they won’t get paid for the relapse of the same disease. What a disaster this could be!
I hope that at least I was able to convince you that it isn’t as simple as you stated it to be, and I really hope you become much more skeptical of any news organization or politician who cites a statistic and uses that as justification to mandate drastic changes in the way we do things. If we are to make life-altering changes for so many people based on statistics, we better be darn sure we have adequately scrutinized those statistics and asked “why?”. Unfortunately it becomes nearly impossible to make direct comparisons between countries that are so different. There is no country exactly like the US geographically, politically, demographically, etc. Many of those countries that are cited as having better healthcare systems than the US are smaller than the size of some of the average/small US states (and I also point out based on studies I have read, that healthcare within the US is better in some states than in others). We are a melting pot of immigration. In the US we have a significant population of slave-descendants whom we have left behind in many ways with regards to education and certain practices (including health practices) and maybe distrust plays a large role in this. Maybe racism does play a large role. Poverty and lack of adequate education plays a huge role in accounting for health disparities (and you should note that infant mortality rates are much higher in African-American and Hispanic-American populations, compared to Caucasian and especially Asian-American populations {Asian-Americans actually have some of the lowest infant mortality rates in this country}). Note that the public education system of the US has long been scrutinized as lagging far behind many of those of the other industrialized nations. Many have even looked at the effects of “perceived racism” as accounting for certain conditions, including higher rates of hypertension in the African-American population. I am not trying to prove anything other than to state that we have not adequately looked at all the data to be able to come to the conclusion that this all rests on the quality and structure of our healthcare system.
To counter the patient you cited, I could cite numerous patients I have seen who are in a big time mess with their personal health and it has nothing to do with the structure and quality of our healthcare system. Many have great insurance, or are even independently wealthy, and get great medical care/attention. Unfortunately, in spite of our effots, many of them don’t take good care of themselves (obesity, smoking, drinking, unsafe sexual practices, poor compliance with medical management, etc.). To add insult to injury, many of these are people that those of us who are more responsible in these regards need to pay more for through insurance or public plans. Again, packaged-garbage, one-size-fits-all, lack of choice makes everyone suffer more. I feel justified in demanding that smokers and drinkers join a different level of premium pay than those of us who abstain because I don’t want to pay for their addictions that we all know lead to more unfavorable health outcomes. Motorcycle drivers, shoot they can ride as a pack together under a separate healthcare plan with higher trauma/orthopedic-driven premiums. I also feel jusftified in demanding that those who would demand that everything be done for them if they are in a persistent veg. state, or terminal states where millions could be spent on treatment to gain them only a few days of suffering should join a different level of premium pay than those of us who simply don’t believe this is right.
So you ask, what’s the harm in giving Obamacare a chance? That’s the scary part, we don’t know what the harm will be! Currently the harm is that many potential employers in this country are scared to hire people because they don’t know what Obama’s going to do to them (via Obamacare, via new taxes on the horizon, etc.). What happended to the “summer of recovery”? Nobody knows what 2000+ pages of legislation will do to them and most people are rightly scared. Why don’t we ask the people what they want and try to give it to them? People were not happy with the way this bill was jammed down their throats and they still aren’t happy with it. So now you have idealogues in Washington who just want to change things the way they see fit regardless of what the people want. I believe there could have been a lot more room for compromise in both directions to garner more support for this bill. They could have had a public option that would gain more support from liberals, and meanwhile conservatives would have likely come aboard with it if payment into the public option were only contingent on your voluntary enrollment in it. They could have pushed litigation reform, which would have gained more conservative support (and more physician support). If this gained widespread support and the people wanted it, great! Then justice has been done. Sadly, this was not the case. Further, I don’t agree with you that people aren’t intelligent enough to make health insurance choices in the same way that they currently do with auto insurance. This could be something that primary care physicians would be empowered to work with the patients on (which they should do anyway with implementation of power of attorney, living will, etc.). Don’t use lack of education as an end-point, use it as a beginning and then we can work together to educate them. I actually agree with Obama on non-profits, but I disagree with the idea of making the taxpayers supplement the non-profits to help put for-profit insurance companies out of business. Make the for-profit insurance companies compete with non-profits fairly, and use the non-profits to make for-profit insurance companies offer more for less. Make them do more to offer more choices. Make some non-profits structure their plans like the auto insurance plans (like I proposed) so there can be more choice and greater ability to offer cheaper plans that don’t need to offer services people don’t want. As I said in previous posts, the health insurance companies don’t make huge profit margins (most run no higher than 3%-4.5% profit margins, which is tiny in comparison to the vast majority if major corporations), they just have huge numbers of customers which makes the total sum of profits very large because the size of the company is often large. It’s a game of proportions, that is hijacked by politicians effectively because people get mad when they hear “little Billy didn’t get his chemo, while Aetna made XX billion dollars in profit”. This means they don’t take all our money and keep all of it. Not even close! Profit isn’t evil. Companies aren’t evil. The American way isn’t evil. It’s a system of mutual cooperation and most often the more choice and freedom we have, the more we can get for our efforts (which is probably why we have such obesity problems in this country…that’s for another debate).
Alright, I think it’s about time for this thread to die but I just wanted to quickly address two points. First, I never thought that the problem or solution was simple- don’t automatically assume that I’m ignorant- I meant that the fundamental issue could be explained with relatively few words. Second, I actually lived in Europe for a few months and heard no real complaints about the health care system, only astonishment that not everyone in our country was insured (not that I talked to everyone, of course). I’ve heard similar accounts from other travelers and from health care professionals in Europe. I think you have some really good points though- let’s both hope that all of our lawmakers will also be honest and thoughtful about this issue and not have alternative, less honorable motives.
Sure. Hey, I just want to say thank you. When you debate someone you can really benefit from putting your ideas up for scrutiny because it forces you to look at what you know and believe from a different perspective. It strengthens your ideas and your ability to debate them. I learned a lot here and I bet you did too. Too many people avoid real debate in favor of a type of “intellectual football” that rewards those who can devise a “crafty jingle” or a quicky comeback. You didn’t do that and it made the discussion worthwhile. You’ll be better able to debate others on this subject in the future, I know I will. Thanks again. I also hope for the best outcome for our country no matter what, though I remain skeptical about what’s actually going to happen.