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Six Myths As Barriers to Health Care Reform

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cross-posted from DailyKos. These regular Diaries by Dr SteveB on health reform are a great resource for all

Six Myths As Barriers to Health Care Reform

Single Payer Health Care part 3, by DrSteveB, Dec 07, 2006

This diary continues the series, detailing six myths that have been promulgated by self interested corporate stakeholders (notably Insurance, Pharma, Corporatized for-profit hospitals & HMOs, AMA) as deliberate barriers to health care reform… and we are going to do some myth busting (who you gonna call…)!

  * There’s more…plus 259 comments

National resources on health sytem reform in addition to Dr SteveB’s weekly Daily Kos blog (I just found out it comes out on Thursdays, so I’ve some catching up to do with cross-postings) include Physicians for a National Health Program based in Chicago, and the grassroots organizing effort called HealthCare-Now.org that’s based in NYC.

On the local MA scene resources for fundamental system reform include MassCare.org and the citizens Health Care Amendment Campaign.

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  1. There’s only one barrier.  Don’t overanalyze.  It’s not Pharma, HMO, Homos, For profits, not-for-profits, PPO, AMA, etc….)

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    The people who have insurance (old, poor, state and muni workers, most employed individuals) out number and aren’t willing to pay for the people (working poor) who don’t.

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    Who says you can’t vote for a civil right.  Majority voted.  We got what the majority wants.

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    End of analysis.

    • because, actually, those with insurance repeatedly state that they are willing to pay more if it would cover everyone.

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      so it’s the wrong analysis for that reason, as well as for the reason that we’re all getting ripped off under the current health care “system” in the state and on the national level.  we certainly should not pay more into it until there’s evidence that we’re getting a better deal out of it.

      • If you ask the population “Should everyone have insurance,” the majority says yes.

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        If you ask the population “would you give up your insurance for a new government run single payer insurance,” the majority says no.  Depends on how you ask the question.

        • with the data supporting your hypothesis?

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          i do recall that there is data out there supporting the exact opposite findings.  no time now to search for it – somebody help me out here, and if not, i’ll look for it to post the links later.

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          and i’ll be looking for your data links, gary đŸ™‚

          • Might be the ignominious defeat of the Hillarycare proposal in 1994.

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            The attack on the proposal was:  Reduced choice:  i.e., hey, insured person who pays for your own insurance!  Have we got a deal for you: pay the same (or more), get less choice and coverage, so that people who have none get some.

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            The splat produced by the failure of that proposal seems to me to be a significant datum that, if whatever AnnEM’s initiative proposal is (I haven’t read it enough to understand the specifics), it will die running the same gauntlet.

            • I never even understood what Hillary Clinton’s panel proposed. It was a very complicated. In attempting to make it politically palatable, they produced complicated policy that ended up being not terribly palatable to liberals — never mind the majority of Americans.

              • to the immensely powerful insurance-medical-insdustrial complex and their influence over members of congress. (Press Release link below has revealing political contributions info).  Instead of putting the U.S. squarely on track to join the rest of the industrialized world by proposing a national health insurance program (using a social insurance model that provides for both universal coverage and HUGE COST SAVINGS), the clinton plan rested on the creation of Mega-HMO’s called Health Insurance Purchasing Cooperatives (HIPC’s) that represented a cave-in the the industry and its strangle-hold on congress.

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                Political insiders at the time stated that the Clintons were single payer univ. coverage reform fans, but they just could not amass the political support to overcome the industry’s power.  What a sorry state for our country.  Then and now.

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                Press Release, 8/06: Democrats and Republicans Downplay Health Care Crisis

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                Back to the clinton plan fiasco, a New England Journal of Medicine article from 1994 discusses 5 books on nat’l health reform written after the failed effort http://content.nejm….] but I couldn’t get the entire article.  One of the 5, “The National Health Program Book”, is authored by two local docs and i was able to get a blurb from the Annal of Internal Medicine journal about it

                The National Health Program Book: A Source Guide for Advocates
                space

                David V. Himmelstein and Steffie Woolhandler. 288 pages. Monroe, Maine: Common Courage Press; 1994. $11.95.

                The authors, both physicians at Harvard, readily admit their bias for a single-payer system modeled after Canada’s. To support their preference, they begin their book presenting 10 myths about Canadian health care. In five sections, such as “The Economic Context of the Health Care Crisis: Rising Costs, Declining Coverages and Incomes,” the authors concisely discuss their convictions in easy-to-read prose. In a chapter titled “More Money Insures Fewer People,” one of the many interesting charts indicates that most U.S. doctors would accept a 10% cut in pay for a substantial decrease in paperwork and utilization review and for tort reform. Part IX, “Making Insurance Companies the Feudal Lords of American Medicine,” refers to the Clinton plan as “a Grimm fairytale.”…

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                Two lessons to be learned from the clinton fiasco (and the Medicare D debacle) that we have an individual and a societal obligation to apply assidously to any and all reform efforts are these:

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                1.  Follow the money trail
                and
                2. Who wins and who loses under a proposed (or existing) reform? And in the overall balance/final measure, who’s the biggest winner and who’s the biggest loser?

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                An intersting exercise is to practice these by applying them to our New MA health care law law…

          • Turns out that in the 2003 poll, 62 percent in the October 2003 WP/ABC poll said they wanted a universal health care system run by the government rather than the current system.  This was verified by Pew and another poll, I forget and don’t have a link.  Regardless, it’s clear, in 2003, Americans support Single payer! Go single payer, the Blue Holy Grail!

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            But then California then Oregon rejected Universal state coverage in referendum.

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            Hmm … if Americans overwhelmingly support Universal why would 2 states in referendum reject it?  It makes no sense. Are Calif and Oregon closeted red?

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            So, the pollster ask, what if your choice of doctor were limited or there were longer waits? Can you guarantee no rationing Ann?  After all, there will be more riff-raff in the clinic with Universal coverage.

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            Support for universal dropped to 35 percent.  The link (page down).  Will you Ann, give up your current coverage so that the riff-raff can share a waiting room seat with you?  More chairs, more people, that smelly guy who talks to Jesus…

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            Then the pollster started talking money.  And when talking taxes, the pollster ask, would you be willing to pay more in taxes or premiums? Well, turns out that 51% would NOT.

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            Next the pollster ask of the entire population how much would you pay.

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            The answer was that 40% didn’t have a clue and 16 percent said less than 100 bucks a year.

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            Polls:  devil’s in details.

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            You play Craps Ann?  If so, you know what betting on the pass line means. Best bet at the table. That’s Universal Health; it might win.  Trust me, throw the dice, place your bet and you might win.  You also may not.  And, if you’re happy with the money in your pocket why would you bet it on the money on the table.  That’s Universal Health.

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            “But, but, but…Canada, France, UK.”  Yeah, they’re happy.  Happy so long as it’s not MI long term survival, hip-replacement surgery or dialysis, then not so much.

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            And so long as I’m on a rant, I’ll tell you that of course I don’t support Universal Coverage.  This notion of “healthcare as a right” is simplfied nonsense. (oh crap, I’m probably dead for saying that.)  BUT! That’s not my point. You can attack me for that statement later. 

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            My point is, if you want to win the Single Payer debate, my Energizer Bunny, you must convince the Majority to give up what they have so that the Riff-Raff will benefit. 

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            So far, Single Payer advocates haven’t done it.

              1. for covering craps analogy.  with poker covered as well, we now have to hit roulette and blackjack before new year’s to cover all basees. 

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              2. smelly guy who talks to jesus…a) honestly, my wife just treated this guy, shrunk his tumor from grapefruit plus down to cherry tomato in last 4 weeks, PLUS got him reunited with well-housed sister, feel good story of the year, but more importantly b) – isn’t he already covered under mass health?  i’m just looking for clarification – seems like “riff raff” IS covered, no? 

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              it’s what you might call “riff raff plus” – those who work enough NOT to be eligible for medicaid – that i thought were uncovered. 

              • But it doesn’t matter.  The riff-raff don’t vote.  Riff-raff plus doesn’t vote either so they’ve always ‘relied on the kindness of strangers’.

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                The Blue-hair crowd votes, but they get better and better medicare every year so why would they vote Universal Health.  They already got it.

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                Pretty dull craps table.  Only person rolling is AnnEm et. al.

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        • Here’s the link to polling: “Now thinking about health care in the country as a whole: Overall, how would you rate [see below] — as excellent, good, only fair, or poor?” 53%-46% say excellent or good. A majority, but certainly not overwhelming.

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          “Health care coverage in this country”: 25% good or excellent, 74% fair or poor. Hrrrm…..

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          “Which of these statements do you think best describes the U.S. health care system today?  It is in a state of crisis.  It has major problems.  It has minor problems.  OR, It does not have any problems.” 71% crisis or major problems, 28% minor or no problems.

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          “”Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance?” Replace 39%, Maintain 51%.

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          I don’t know, Gary. You may be right as far as it goes, but that last number doesn’t sound like intractable to me. That’s why Ann’s making the case. People do change their minds.

          • So, rephrase the question to:

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            Will you give up your current coverage and choose instead a yet to be tried Government run health system? 

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            Would you?

            • the devil is in the details on a particular plan.

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              If you told me that the government run system wouldn’t limit my choice of doctors, would costs as much or margnially more, then I think you’d see a lot of people changing their minds.  Obviously, when you dial down the choice and dial up the cost, it becomes less appealing.  And surely, no matter how perfect the government program, it will be Swift-boated to death (“You’ll have no choice, it’ll be expensive, the people next to you will smell…”).  (By the way, Gary, I love it that one of your main boogeymen is the smelly Jesus talking guy.)

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              Could a government program actually be more efficient and less expensive than an HMO?  Maybe.  But sooner or later we will have to deal with the choice issue on some level and confront how we feel as a state, or as a nation, about the appropriate level of care and treatment toward the end of life, and start asking the tough questions:  Does the 85 year old smoker REALLY need the experimental cancer drug that, although unbelievably expensive, could pro-long his or her life another 3, 5, 9 years?

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              this is why it’s really hard to talk about healthcare in the abstract.  Every issue you try and deal with brings up five more really tough ones.

              • Reminds me.  I used to ride the bus in Pittsburgh every day.  One guy, nearly everyday used to chant “Eddie, Eddie, Eddie, I knew Edie, he was a rod lathe rod worker, Eddie, Eddie….”  It went on for almost 4 years.  Then he disappeared.  I’ve wondered about him for years.  Anywazz….we all have the boogeyman, me, probably more than most. 

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                But, bottom line, the feel-good question that says “would you like Universal Health” is like asking if you like puppies.  The real question, and I’d love to hear from Ann, is will you give up what you have so Eddie-guy can have insurance. 

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                My contention is that most people will spend other people’s money to pay for Eddie, but they won’t give up their own health insurance to get there. 

            • that’s England’s Nat’l Health Service which is both publicly financed and publicly run, where the health professionals work directly for the gov’t.  That IS NOT what a single payer universal coverage American-style system is envisioned to be (or what the Canadian-style system is for that matter).

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              What HR 676, Rep. Conyers National Health Insurance bill proposes (see this entry in Library of Congress THOMAS bill directory is to over 10 years a publicly financed national HC system where the gov’t collects and administers the funds to pay for PRIVATELY delivered care.  health professionals would not work for the government under this plan.  this type of publicly administered financing mechanisms would allow for use of regional and global budgeting, and for businesses to have more reliable (and affordable) health care costs.

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              This reform approach also provides for the use of rational health care planning and spending that is based on/driven by patients’ and communities’ needs, not on expanding market share and the other wasteful market-based competition (that does not help a single person’s health!) that sucks up a huge amount of our health care dollar (insert sound here of a pig slurping at the trough). Under this approach the admin., marketing, advertising and other NON HC expenditures would be greatly reduced allowing us to afford covering everyone without having to spend more.  single payer financing allows us to save enormous sums of our money by streamlining the payment bureaucracies and non-HC expenditures that currently exist.

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              Private health care provider networks would contract with the sinlge payer (yes, the gov’t) to participate in the system to deliver private services.  this includes clinician practices, hospitals, clinics, etc…  The payor could establish quality indicators that would be a requirement for participating in the system.

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              As a step in building the national movement toward this end, on the state level the MassCare bill “An Act to Establish a Health Care Trust” will be re-filed in Jan to move us toward establishing a state-based system of single payer universal coverage affordable health care for all.  The nat’l group HealthCare-Now.org is doing fantastic national organizing work for the HR 676 Conyers bill (that 6 of our 8 MA congressmen have signed onto already!).

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              Give us grassroots advocates a level playing field and we would win this type of reform hands down, I’d bet you my last dime.  re the other states’ expereinces you referenced, did you happen to do the OCPF research on the Calif. and the Oregon ballot question campaigns to factor spending into the results?  sadly, with health reform initiatives as in most others, it comes down to who buys the bigger microphone and slick P.R. firm to make use of it.

              • But Ann, I understand that single-payer has a chance of success.  It also has a chance of enormous failure.

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                Put you on the spot:  Will you (not hypothical “them” but “YOU” and your family) give up the coverage you have at the cost you pay, to opt for a government run program with some probability of i) increase wait times ii) some probability of reduced access to your physician of choice?

                • because my husband and I would be delighted to be among the first to sign on, and to bring our 2 kids along with us.

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                  btw i just had an appt today that i had to wait ages and ages for (so boogeyman wait times exist now in case you hadn’t noticed), and for most of my adult life i’ve chosen to have a nurse practitioner as my primary care provider and i’ve been quite satisfied. 

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                  “it’s the hmo’s dummy”, they’re the ones that have created “restricted access to choice of clinician”.  and this problem would certainly improve with a streamlined payer univ. coverage system.

                • Yes, Virginia, we already have that.

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                  My friends in Canada, on the other hand, would NOT move to the US’s system for all the tea in China.

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                  From what I remember, ALL other industrialized countries with universal health care (which is all of them) have lower cost-per-person. Most of them have lower infant mortality rates, birth mother deaths, etc, key measures of quality of life in your health care, than the US does.

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                  I dunno…better results with less money per person? Sign me up too!

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                  The problem is what to do with these companies currently making money off of insuring (and kicking people off of insurance). They will fight like mad for their revenue streams, so it winds up costing us more (bills with universal health care end up with using private companies as providers, and those companies need to make money, so the overhead cost to the taxpayer is enormous compared to direct government-run health care).

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                  It’s an inherant conflict of interest to make money off of health care insurance. The companies are always looking to shunt off their risk by denying care and trying NOT to cover the most risky (elderly, pre-existing conditions, etc). Now with genetic testing…it’s a slippery slope to saying “sorry, we can’t give you a good price on your coverage because your genes say you have a 75% chance of having cancer and a 50% chance for heart disease.”

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                  Time to make the moral choice of cutting the profit out of health care insurance forever.

                • No, they wouldn’t trade, at least until they really need something, now, like major heart surgery.  Then they beeline to Michigan and pay cash.

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                  My parents have a pretty high end doctor at one of the major NYC facilities, at it is not at all unusual for us to see Brits and Germans in the waiting room, here for cancer care, and presumably paying cash.  Why would they do that?

                • For insurance companies?

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                  For rich folk who can cross an ocean for health care? 

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                  I’m not sure this is a problem, C.M.D.

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                  The problem I’d prefer to worry about is people not getting their cancers recognized and treated early enough rather than the well off being free to opt out. It’s utilitarian approach of which Jeremy Bentham would be proud.

                • But my question wasn’t whwther we should design a program for those travellers.  It was, why do you suppose they travel?  In addition to the expense, which isn’t small, even if you are well off, it is difficult and painful to travel a long way when you are profoundly unwell.  Why go through the trouble, unless you perceive some very serious shortcoming in the treatment of the very ill at home.

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                  Most of these broad “quality of healthcare” statistics on this thread seem to me to be based on what is sometimes called “wellness care.”  It makes perfect sense that better preventive care decreases the incidence of people beoming truly ill (and thus overall costs), and that the univeral care advocated here would better promote preventive care.

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                  But it is only prevention, not elimination, and it sure seems like those who become very ill under these nationalized programs are rather screwed; the resources have been allocate elsewhere.  Hence their willingness to engage in difficult travel, and exhaust their savings to come here, where unwell care seems better.

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                  I think it comes down to a difference in philosophy.  Here, when people advocate single payer or what-have-you, they really are after universal health care; the insurance model is only a means to an end.  Many Americans don’t think of insurance in this way.  Rather, they want protection when the really, really need it.  They don’t want insurance to pay for routine maintenance on the house, or to replace the brakes on the car, they want it if the house burns down, or if the car is in a wreck.

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                  If the tradeoff must be pay the same or more, get better well-care, but less un-well care, then I susepct that many people will read that as “pay the same, or more, and get less.”

                • I had a doctor for many years whose practice at Beth Isreal grew to the point were I wasn’t usually seen until several hours after my appointment time.

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                  I have fixed this problem by research in which I found another good doctor who better manages his schedule.  Now I do not wait.

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                  Problem solved.

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                  But what if I only get to choose a new doctor in the same way I get to choose a public school for my kids: “umm, sir, you may attend school you wish, so long as it is the one that we tell you to go to.”

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                  No, thanks.

                • I doubt that the Commissar of Health will grant it to you. In fact, you will not be allowed to bring unapproved magazines into the waiting room. “The New Republic, Sir? That will have to wait outside.”

            • as others have said. But I will tell you this: If it was permanent health care “that can never be taken away”, as Bill Clinton once said, you’d have a hell of a lot of people saying yes — the botch of Hillarycare notwithstanding.

      • I  think this is winnable. It will be hard. It will cover many election cycles. We could win it.

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        The point of course is not to look at today’s polls and say “Hooray! We’ve won!” or “Boo hoo! We’re lost.” There are no doubt many ways to ask polling questions that make the Estate Tax look like a fine idea, but the scoundrels got it repealed.

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        There’s a political problem with the “free choice” in the current system. It’s pure illusion but an appealing illusion.

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        Similarly, when rationing is done by the invisible hand of the market, no one notices it’s being done, but, when our government does it, it becomes very noticeable.

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        Our tendency is to think in absolutes — we’ll pay whatever Tiny Tim needs — even if that means we shortchange hundreds of other Crachits thereby diminishing their lives. (Aside: This is one of the shortcomings of Christian morality: it gives one no clue as to how to divide resources in a terribly finite world.) I wonder whether stating explicit rules about rationing would make the system fairer. Imagine a rule like “the system will not pay out more than $1,000,000 for treatments with less than a 5% chance of success.”

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        I wonder too whether the approach to universal health care has been too dour. The current system is full of negatives. Communicating optimism and moral purpose tend to win more in the political arena. Whatever the tack is taken, we should, like the lonely conservatives Republicans of 1964, think to what is needed to move the polling so that eventually opposition to universal health care becomes a fringe position.

    • It wouldn’t cost more to insure everyone. We already pay far more, per capita, than any other nation on this world to insure our population. And we insure a far smaller percentage of our population. And the healthcare we get is only so-so (life expectancy in America isn’t all that great compared to other industrialized countries).

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      So maybe people will think it will cost more, but it shouldn’t have to. With a little planning, early care, etc. – it could cost a whole lot less.

  2. Could you guys possibly love polls any more than you do?

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    Polls polls polls!  Healthcare is a Right because of Polls!  Our logic makes sense because of polls!  And when we tire of polls, we’ve always got statistics!  (see:  govt. is more efficient at healthcare, thanks for continually propagating that myth folks).

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    Sorry if that was sarcastic.  My point is that polls and statistics are easily misleading and that there is such a massive reliance on both in these healthcare threads that I have to wonder how hard you are really thinking about it.

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    Kudos to Gary, even at the lowest level of discussion you rock on this topic.

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    D

    • “… especially when I’ve got such great talking points!”

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      I actually agree with you on polls: if 99% of people believe something that’s false, it’s still false. Still, polls are relevant in political issues, aren’t they? And in fact, it was Gary that continually speaks for what he imagines is the majority: “Most people would want this/that”. Maybe he’s right, but I want proof of his contentions when he claims to speak for a majority.

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      “I have to wonder how hard you are really thinking about it.” Because if we thought really hard, we’d ignore what data is available to us? Now there’s an approach.

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      This is a reality-based blog. We like contentions to be backed up by reliable sources. Get used to it.

    • “(see:  govt. is more efficient at healthcare, thanks for continually propagating that myth folks).”

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      By the way, care to bring anything to the conversation on that? Or are you going to fall back on your groundless talking points?

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      Come on, Demolisher, bring it, and back it up.

        • Not even for folks who can afford everything:

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          Americans 55 and over are much sicker than their British counterparts even though the United States spends more than twice as much per person on health care as Britain, researchers said Tuesday.

            …The researchers wrote that “health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic-status tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts.”

            …the study found that “differences in socioeconomic groups between the two countries were so great that those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in England.” [my emphasis]

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          Isn’t that amazing? Now of course, this is a public health issue as much as a health insurance issue, but it’s still relevant.

      • Al Franken has made a cottage industry our of pointing out how conservatives pundits routinely elevate their own conventional wisdom into fact.

        • Perhaps we should just wait until your complete works are issued in hard cover.

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          We’re patient.

          • There are two reform schools here: 

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            Free marketers (that’s me, you know, the Heartless Bastard) and Universal (that’s you, AnnEm and the Blue Fuzzies). 

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            A) Free marketers argument is that 90% of all medical payments are made by someone other than the consumer and therefore the consumer isn’t educated or careful about how much he pays.  We should encourage policy that encourages the consumer to bear the cost of his heatlh choice.  Competition driven by the consumer will curtail medical inflation.  Society and its taxes will cover the old and the poor.  Some people will not buy insurance.  Poor them.

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            B) Universal argument is that we need a single payer. Raise taxes to pay for the coverage, drive the profit to a more reasonable level, utilize the economies of scale to force efficiencies and drive down the cost while covering everyone.

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            Between A and B, perhaps our common ground is this:  neither of us knows for sure, if either A or B will succeed, because we’ve not tried either.  Either could fail. 

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            Unless you’re clairvoyant, it would seem you’d have to agree. Agree?

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            I don’t care if you favor A or B.  That’s not my point. 

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            My point is that too many people/factions (old, poor, employer covered, Pharma, Insurance, Medical Pros) are pleased with the current system and their own individual insurance to risk choosing B.  They won’t give up what they have.

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            Upthread AnnEM says “I’ll sign on the dotted line”.  To what? 

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            Lynn says “I dunno…better results with less money per person? Sign me up too!”

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            Well, hold on.  Better results and less money?  You sure that’ll happen?  I heard a rumor a few years back that we’d be in and out of Iraq with a year or so. Guess there’s no guarantees on futures.

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            [apologies to non-blackjack players]

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            Blackjack analogy time:  You’re holding an ace and a 7 (your current insurance) and the dealer shows a 6.  With your soft 18, and the dealer’s weak hand, you’re probably gonna win.  Do you go for the ‘better results’ by doubling down and give your extra winnings to the poor, betting the dealer will bust? Or, do you hold, still expecting the dealer to bust but with half the bet on the table? 

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            My hypothesis is that most of Americans will hold because they win.  i.e. they keep the coverage they got, rather than supporting a Universal program which has some chance of failure.

            • You get a 6.

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              The thing with A. is that nobody knows much about how to improve quality, yet. I mean, why do we go to see doctors? Because of their supposed expertise. And yet they often don’t really know much about the relative effectiveness of various kinds of treatment, or drugs, or whatever. And the insurance companies don’t know either. So, instead of making Joe Sixpack read up on his Organic Chemistry so that he’ll know that Prilosec and Nexium are practically the same @$%@%^ thing, let’s have some knowledge and information among those folks who are supposed to have, like, knowledge and information.

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              It’s a serious problem, but it seems to me that we shouldn’t push the problem off on Mr. Sixpack and say “whoop! You’re on your own, buddy.” Here’s what Consumers Union (publishers of Consumer Reports) had to say about Consumer Driven Health Care:

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              So-called “consumer driven” health care plans, which have defining features of high-deductible coverage and (possibly) tax-advantaged employer contributions to health reimbursement or savings accounts, may create serious problems for the U.S. health care system. Consumers Union believes that this coverage is misnamed, misguided from a policy perspective, and a dangerous distraction from the need to solve the health insurance crisis that faces 43.6 million uninsured consumers and tens of millions of underinsured consumers. Our testimony also addresses issues raised by health savings accounts, as included in the recently enacted Medicare bill and the President’s new proposals. These proposals are likely to accelerate the erosion of current coverage by adding tax benefits for high-deductible coverage.

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              That’s their emphasis, not mine.

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              As for “keeping what they’ve got”, any number of Americans are extremely worried about exactly that.

              1. No learning When consumers buy cars, tomato sauce, or sound sytems, they are likely to buy another car, can, or system in the future. They can learn from mistakes and adjust behavior. Responding to one’s health needs is another matter. Some people mistake anxiety for heart attacks; some do not get enough tests after an infarction even now. This is harder to evaluate than Hunts vs. Progresso. If you die from it, you’re not going to be around to learn from your mistake.
              2. Public costs, not private costs Diseases like diabetes have tremendous social costs. An earlier response reduces the social burden. This is like the risks with helmetless motorcyclists or unbuckled motorists. As a society, we’re not willing to just let people suffer for a “small” mistake, but a small mistake has a chance of causing a major expense. Aggregated, that becomes a big expense. A free market system encourages medical “consumers” to take risks. We get the unpleasant choice of paying extra or watching misery.

              • But I don’t think a blog’s a particularly good forum.  I hope I’ve made it clear that although I’m very free-market oriented, that not the point of my comments.

            • It’s not clear at all that we should describe the current healthcare system as “a soft 18”. Moving to a free market system on this, conformant to libertarian orthodoxy though that may be, seems like more a fringe position than single payer. Are there even polls evaluating it — among more than just readers of Ayn Rand?

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              U.S. businesses are under pressure to provide employees health insurance. This has given other countries a competitive advantage in wooing factories.

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              Further, it’s unclear to me that the leading cause of bankrupcy garners such comfort. The current conservative domination of the rhetorical environment pushes single payer to the extremes of acceptable opinion. If the Republicans continue to crater, that might change.

              • A soft 18 is a pretty good hand.  That’s what most of us have in medical coverage.  How can you reasonably disagree with that? 

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                Don’t think polls and macro, if you have insurance, just think of what you have and remember that the uninsured in the US are in the minority. 

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                You don’t need a link to know that the minority in US is uninsured do you?  The majority of Americans are holding the soft 18.

                • if you have insurance, just think of what *you* have and remember that the uninsured in the US are in the minority.

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                  and btw most people don’t need polling data or studies to know that it is wrong and it is a disgrace that we as a society of civilized caring people tacitly accept the fact of 47 million “minority” uninsured in our country.

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                  add to that the royal rip-off that our current hc system is and i do believe we’ve got the makings of a social movement for universal coverage reform.  hey, i see santa coming over the hill!  no, it’s barney frank in a new red suit and he’s holding congressional hearings on the need for a national health insurance program!!

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                  to learn more read “Frank Leadership”, a dec. 9 glob op-ed by bob kuttner http://www.boston.co…

                • you’re supposed to double down with a soft 18 against a dealer’s 6 – i.e., it’s profitable versus simply holding.  double on soft 18 versus 3, 4, 5, or 6. 

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                  perhaps you SUBCONSCIOUSLY BELIEVE single payer is the “right” thing though you correctly realize people are risk-averse and tend to hold….hence your choice of analogy?  đŸ™‚

  3. Trav said:

    It’s a little disappointing Robert that in this discussion the fact that we increased local aid significantly, to the tune of 15 to 17 percent last year and held harmless the municipalities during the entire fiscal crisis of three and four years ago. We have given significant aid to the municipalities across the Commonwealth and there continues to be a need. What has to occur is there has got to be greater fiscal responsibility on the part of municipalities to control their spending as it relates to the financial growth we’re experiencing in the economy. You can have growth in the economy at 3.5 percent and have increases in local municipal spending of 11 and 12 percent. You’ve got to renegotiate some of these collective bargaining agreements, some of these other outstanding agreements with the unions and other officials that are more in tune with the times. And everybody I believe has to give a little. If the suggestion is that there is new revenue available for additional property relief to the citizens of the Commonwealth, I think that’s going to be hard to demonstrate.

    Oh really?  Check out the cherry sheets.
    Arlington, total receipts, FY02:  $18,616,604
    Arlington, total receipts, FY07:  $15,600,746
    That’s 16.2% less than we received five years ago.

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    In 2005, we passed a $6 million override.  A modest 3% increase in local aid would have brought our state money up to $21,581,746, or $5,981,000 more than we are currently receiving.  We raised property taxes and cut services, as our override just filled the hole from the state’s disinvestment.

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