Yeah, this paragraph on the coming health care debate is a non-sequitur:
Harvard
economists[they're not economists, they're docs — how did I miss this?? Another mistake. — Charley] David Himmelstein and Steffie Woolhandler have estimated the bureaucratic waste from private medical insurance is some $350 billion per year, or just under 2% of GDP. On these merits alone, enacting universal healthcare is worth it.
… and unfortunately, you're going to hear a fair amount of talk on the left that “universal [access to] health care” will in and of itself fix health care economics writ large. Under the Democratic plan(s) currently under consideration, a good chunk of that “private medical insurance waste” will stay in the system, unless it's somehow legislated away.
Himmelstein and Woolhandler are well-known single-payer advocates; that means they advocate government taking over all financing of health care (bye-bye insurers) — though critically, not delivery of care. Under their plan, docs would still be private, not employees of the state a la Great Britain.
The Democratic plans (Obama's, Baucus's) are not single-payer. Not even close. They are multiple payer systems; they preserve the private insurance industry. (Why some people insist on inveighing against single-payer, I don't know; they might as well focus on the great liberal plan to re-adopt the Fairness Doctrine.)
As I linked to yesterday, Maggie Mahar points out at some length that we could get a universal health insurance law that gets everyone covered (or “covered”), and still have mad-crazy costs and a mad-crazy under-insurance problem.
And again, that's one of the reasons why it's important to have a public option for health insurance. Public competition with the private sector has been very beneficial to the consumer in the area of student loans, for instance; it would also be a very good baseline for the newly revamped insurance market.
If government can do a better job than the private sector at providing certain things, then it ought to be allowed to do so. All else is free-market-fundamentalist cant, which obscures the role of moneyed interests in trying to keep government out. Give us the choice — ironically, let's let the market decide if government can do a better health plan.
You obviously have little experince dealing with simpleton federal bureaucrats. Want a real treat. Call the IRS looking for guidance on a tax return. I once called the dept of the navy looking for the phone number for the quarter deck for the USS Constitution to get a saolor a ride to his command. The woman on the other end of the phone had never heard of the warship USS Constitution.
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p>Doctors are currently fleeing Massachusetts for various reasons, mostly malpractice insurance and tort abuse.
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p>You people don’t get it. Our healthcare system is going up in flames as we speak. Why pour gasoline on it?
…given the rather poor performance of the private sector of late. Of course, I do have to admit that guys like Bernard Madoff indicate that the market can be operated VERY efficiently indeed.
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p>Also…
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p>This is truly an outrage. How do we allow this to happen in this country? The only real option is to hand over the military to the private sector. Naturally they will run it better. And, dammit, every phone operator will know the USS Constitution like the back of his or her hand.
privitization is the answer to everything. The private sector always runs things better…
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p>MCRD is factose intolerant.
My wife is a doctor, and most of our friends our doctors, so this bit about doctors fleeing MA is news to me. I am sure you will find a doctor or two who claim to be leaving for this reason, but there is no net outflow of docs as far as I know.
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p>And for every story of government incompetence you can relate, I can tell you two of private sector incompetence. Big organizations always have more than their fair share of bozos, and there is simply no way to make healthcare small. There is going to be major bureaucracy no matter who is paying for it.
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…does EVERY other industrialized nation have public health care for everyone? It must work on some level.
1) selling stamps at the post-office? (standing in line here reminds me of food lines in the CCCP) 2) driving to work in a snowstorm? 3)Being available on Friday afternoon at any governmenet office, state or federal, to answer the phone 4) giving away taxpayers’money to pork projects which benefit friends of the government 5) giving 10 different answers to the same question at both state and federal tax agencies 6) interfering in people’s private lives and personal freedoms–see prop 8 in California 7)and the list goes on and on. Charley, I hope you never have the experience of being sick in a “peoples” hospital. Do you really want to entrust your health to these incompetents?
So, the public insurance option is a double-dog-dare: Public vs. Private insurance. You’d have a choice.
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p>Are you ready to make it interesting? Or is such competition inherently a bad idea? We’re calling the bluff.
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p>BTW, I mentioned student loans. Better deal from the feds, my friends.
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p>[Time for new talking points to be dropped … the leaflet plane will arrive soon.]
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p>Again, the Stafford loan business doesn’t compete with the private markets in the student loan business.
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p>So the fed is a better deal but not an alternative but rather just the minimum: $31K (the subsidized Stafford limit) over the life won’t pay for 100% of the school.
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p>Further, there are those that argue that the various higher education subsidies like Stafford have been a key driver in greater than inflation tuition increases. After all, if you know that, regardless of credit, any student can get a $31K loan, then probably the school will charge at minimum $31K, plus an amount the student antes up.
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p>By comparison, a similar Government health program providing a minimum coverage would probably behave much like Medicaid does now.
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p>Medicaid has certain minimums it will pay, and that sets the floor for that particular procedure or item. If there is heightened demand for the particular procedure, then doctors, dentist, nursing homes, etc … suddenly don’t seem to have room or time for the Medicaid recipients but do have time for the private insureds.
You mean like Boston Medical Center, a public institution with a high proportion of indigent patients and the biggest recipient of funds from the free care pool? I wouldn’t mind being sick there (if I have to be in some hospital).
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p>The biggest difference between the healthcare in the US and in countries with socialized medicine is not in quality but in access and cost. In those countries everyone has access to quality healthcare they can afford, which is definitely not the case here.
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How about “free” health care in both the old Sovok (dust bin) and the new Russia. I was in one of 30 cots in a filthy room with one toilet; kid next to me died and no one knew it or cared; my friends brought food in so that I would have something to eat and drink; and they couldn’t find out what was wrong with me (I had pneumonia). What you don’t seem to realize, with the exception France where it seems to work, most people only go hospitals in socialist countries to die.
US-style care, with 47 million uninsured, millions more under-insured … or a “cot in a filthy room”?
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p>There’s kind of a lot in between, Edgar. That’s definitely for real. Your black/white view of things is not for real.
The inbetween is what we have now. Those uninsured people do get good care in emergency rooms. You want to go the other way with full governmental control; who is the one with the black/white view of things? I’ll take the “inbetween” any day.
Care in emergency rooms is fine for emergencies and urgent care. It is not sufficient for the ongoing needs of those with chronic illness, for cancer care, for behavioral health and a wide range of other needs.
Why don’t you try using examples from other 1st world nations with socialized medicine? England, France, Canada, Germany, Sweden, etc.
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France’s system works. I know this from first-hand experience. As for the others, don’t be naive. Talk to some patients from those countries.
… other systems for medical care.
Although a bastion of liberalism, the magazine does a good job on both socialized and single payer health care. I won’t live long enough to see it, so I only hope that your idealistic belief in these governmental systems doesn’t come back to bite you in a time of need.
… there are other systems out there with much less participation by the private sector and they produce better results at lower cost. Not sure how better to show that it’s possible for non-private systems to work well than to exemplify other real world examples.
It seems to me that single-payer healthcare is achievable but it would require all of the Democratic Party to get behind it.
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p>Why this doesn’t happen? Special interest money? Political risk avoidance? Personal fear of antagonizing one’s current insurer?
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p>2. It’s going to take far more than just the Democratic Party to get behind it. The entire party may be able to push through the government option and, if it’s a good one, soon the rest of the country will fall behind it.
Steffie Woolhandler and David Himmelstein are primary care physicians at Cambridge Hospital and Associate Professors at Harvard Medical School. I know of no reference anywhere else to either of them being economists, let alone Harvard economists. The couple have chimed in over the years in Cambridge on topics such as single-payer health care and rent control.
I actually knew that … and my eye just glossed over that factual error. Thanks Robert.
Is my understanding correct that Obama basically wants to do nationally what Massachusetts is already doing? Frankly, I’m less than impressed with what we’ve done, and this issue was one way in which I favored Clinton in the primary.
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p>It’s inaccurate to claim there’s competition between the public and private in the loan business. The practice is to max out the Stafford loans ($31K) then turn to the public for the balance. The public and private don’t compete at all.