First they came for the Jews
Nice piece on Smirking Chimp about Elizabeth Edwards. Here's the key graph for me:
Great places don't happen by accident. Paris has had zoning for 600 years. They've got a fabulous metro system. And this year they're putting in 20,000+ bikes at 1,450 stations. "It has completely transformed the landscape of Lyon -- everywhere you see people on the bikes," said Jean-Louis Touraine, the city's deputy mayor....Hold the presses. Damn. This turns out to be a no go.
The Socialist mayor of Paris, Bertrand Delano, has the same aim, said his aide, Jean-Luc Dumesnil: "We think it could change Paris's image -- make it quieter, less polluted, with a nicer atmosphere, a better way of life."
But there is a practical side, too, Dumesnil said. A recent study analyzed different trips in the city "with a car, bike, taxi and walking, and the bikes were always the fastest."
The Lyon rental bikes, with their distinctive silver frame, red rear-wheel guard, handlebar basket and bell, can also be among the cheapest ways to travel, because the first half-hour is free, and most trips are shorter than that.
"It's faster than the bus or metro, it's good exercise, and it's almost free," said Vianney Paquet, 19, who is studying law in Lyon. Paquet said that he uses the rental bikes four or five times a day and pays 10 euros (about $13) a year, half for an annual membership fee and half for rental credit that he never actually spends because his rides typically last just a few minutes.
"argument through anecdote", where the data plays a distant second fiddle to the heartrending stories about x person who didn't get good treatment. So single-payer advocates drag out some American woman who didn't get a breast exam until it was too late, and opponents counter with the Canadian guy who died on the waiting list to see an oncologist.This is infuriating. First of all, 90 plus percent of what I've read since becoming involved in this issue are articles chock full of incredibly boring data — as in Health Affairs. Personal anecdote doesn't convince me. I'm enough of a wonk that data convince me. Not anecdote. Although at a certain level, anecdote becomes data. For the most part, though, the books and articles on single-payer may use an anecdote as a classic WSJ lede style, where the writer "hooks" a reader with a real life example of why this issue is important in human terms. But if that anecdote is not then followed up by facts and analysis it's nothing.
She then suggests that moving to a French or Canadian system would require walking back the medicine we actually provide, telling people they can't have MRIs anymore. That's similarly incorrect. Care utilization in France and Germany is as high — and in France, higher — than it is in America. But they pay less per unit of care. And the technology isn't radically different. Germany actually has more CT scanners per million than we do, while the French have three less. The French and the Germans both have more physicians per capita and more acute care beds. Oh, and the French and Germans pay less, and don't have 47 million uninsured.One of the comments for Ezra's post is so funny and right on that I want to share it:
All this information — and more! — can be found in various data-heavy books on the subject, like Thomas Bodenheimer and Kevin Grumbach's wonderful Understanding Health Policy. The thing is, they tend to point towards the same conclusions Jon Cohn's book does, albeit with fewer anecdotes. One reason I spend less time arguing health care with libertarians these days is that it doesn't seem productive. If you really don't want to believe that other system's in the world are better, you won't.
The conservative argument goes like this:That's from Dean Christakos.
We can't have national health care because in countries that do, they have to wait 40 years for a hip transplant!
Liberal: No, as you can see, from the statistics here, not only are there not significant wait times, but wait times for those surgeries in America are larger.
Conservative: But what about the fact that in socialist countries there is only 1 MRI in the entire country, located in the basement belonging to the Prime Minister's mistress, requiring a 500 mile commute that grandmothers with cancer have died waiting to get access to? That's why we should never have national health care in America!
Liberal: No, actually, in many countries with national health care systems, the number of available MRIs per capita is equal or close to the number available in the United states.
Conservative: Oh yeah? Well look, Stalin was a socialist, and that resulted in the gulags and the deaths of millions? Is that what you want?
At the point, the average liberal will realize that no amount of facts marshaled in the defense of national health insurance is going to convince the conservative/anarcho-capitalist of the wisdom of the program and that the entire discussion is going to revolve around the conservative throwing out fallacious claims and the liberal correcting them with actual facts.
IBJ: Why do you think it’s wrong to build a for-profit hospital?
BRODY: One of our principal failings, I think, is the emergence of the for-profit hospital and what it does to the existing network of not-for-profit hospitals. In my mind, there is an obligation that we have to provide for the poor and the underserved in our communities. What we are seeing is that this entrepreneurial spirit is undermining the traditional not-for-profit hospital’s ability to serve as the safety net in their community. It erodes our ability to generate the [profit] margin necessary to continue operations in [unprofitable] services. So you find hospitals cutting back....
IBJ: With all these problems, you’ve said in the past that we’re headed for a single-payer health care system, where tax dollars, funneled through the federal government, pay for everyone’s health care.
BRODY: I don’t know that I’ve ever subscribed to a single-payer approach. I think universal health care is something that we need and desperately. How we get there remains to be seen.
IBJ: Actually, during a panel discussion in September 2005, you said, “We have so many vested interests at stake here trying to protect the status quo that the inevitable answer, the ultimate answer, is a single-payer system that takes care of everybody and lets the providers compete for that business as necessary. It works in other countries around the world. It can work here.”
BRODY: Ultimately, I think we’ll end up like the education system. We’ll provide health care services for the entire population. And my guess is, given the nature of our society, we’ll allow for a two-tier system to evolve, where those with means or interest [are] accessing a different model than that available to the mainstream public. It’s a little bit different than the single-payer system. The single-payer is something like the post office [with] no UPS.
IBJ: Do you think that’s the best solution?
BRODY: I don’t know what the best solution is. I’m only one person. I think that there has to be a better solution than we have today. We’re one of two developed nations in the world without universal coverage. That’s a travesty. In effect, we offer health care services for everyone, but they have to access it through the emergency room or some other means. And everyone is paying for it through this cost shift that occurs.
It is no secret that health care in this country needs a fix. About 47 million people don't have any health insurance, including more than a third of families with incomes of $40,900 or more.I think what she means is that a third of the uninsured have household incomes of $40,900 or more, which is rather different than what this reads.
We in the United States are unfamiliar with the single-payer option because tremendous amounts of money are spent by the medical-insurance and pharmaceutical industries to keep us in the dark. They would lose big bucks if we chose to go this route...That's exactly right.
The corporate opposition to single payer exaggerates flaws that some systems have, or had, ignoring the fact that our health care is rationed by income. If you are poor, you may well get inferior health care all of your life. We could learn from problems elsewhere and thus develop the best truly universal health-care system of all.
is studying for a health and life insurance broker license. She takes the test next week and hopes to start selling health insurance to small businesses...I hear now and then that single-payer healthcare supporters really just want something for nothing, and think that they won't be paying for their healthcare "because the government is going to pay for it."
For medical care, her lifeline has been the support of two services in town. One is called Physicians Reach Out, a group of physicians who offer low-cost health care to low-income residents. The other is MedAssist, a free pharmacy for uninsured and low-income residents of Mecklenburg County, N.C.
Without them, she says she would have had to file for bankruptcy. "I had to have surgery to remove my parathyroid gland three months ago," Stewart says. "We tried to treat it with medication, but it got worse."
Although the hospital tab easily topped $7,000, Stewart says the payments were waived through the program, and she had only small doctors' bills to pay. Every few months they check her income to make sure she still qualifies.
"I thank them from the bottom of my heart," she says. "Because of my medication, hopefully I will live to be 80 at least."
She plans to buy health insurance as soon as her earnings as an insurance broker allow, and no, she doesn't expect to get a break on the cost because she's a broker.
"I'll have to pay the same as everyone else," Stewart says. "Health and life insurance is not something everyone wants to buy, but it's something you have to buy."
Kevin Wurtzbacher, 31, has been diabetic since 14, taking insulin shots. That makes the Valley Grove, W.Va., man an unlikely candidate for private insurance, and his job as a concrete worker is seasonal and doesn't come with health insurance. His wife, Julie, works as a waitress, and the restaurant does not offer health coverage.With a single-payer system, every young person working on the books would have a percentage — an affordable, reasonable percentage — of their paycheck taken out for a national health insurance program. Wurtzbacher's attitude would be seen as needing some educating, and his co-worker would be paying less and getting more.
Together, the couple make about $39,000. He now relies on a free clinic.
The couple's income qualifies them for low-cost care from Wheeling Health Right, in Wheeling, W.Va., which is funded by state, city and county governments, grants from foundations and donations. It is a popular spot and even draws patients from across the river in Ohio.
Their 4-year-old daughter is covered by a state program. Wurtzbacher's insulin and supplies cost him only $2 a prescription through the clinic. He's appreciative of the program, which also provides him with eyeglasses.
One of his co-workers, a man in his 20s, buys insurance on the private market, a move Wurtzbacher says doesn't make much sense.
"There's nothing wrong with him, and he's paying for health insurance," Wurtzbacher says.
I've decided that as a healthy young person, I resent the elderly and the sick. They're the reason health insurance costs so much! If those people with diabetes, cancer, and other chronic diseases would take responsibility for their own health, instead of relying on the same insurance that I have to pay their medical bills, I wouldn't have to pay so much for my health insurance! Their presence in the same insurance risk pool as me is unfair.
In fact, I'm fed up with the whole concept of health insurance. It's really just a cross-subsidization of the sick by the healthy, and in America we shouldn't have to tolerate these collectivist wealth-transfers. So I'm gonna get myself an HSA!
They're a great way for people like me to stop subsidizing the old and the sick with my hard-earned money. If I go out and buy some health insurance with a really high deductible--more than $1000--then I can go to the bank and open an HSA. I can contribute $2600 or the amount of my deductible, whichever is less, every year to my HSA tax-free! The money rolls over each year, and I can withdraw it to pay for medical bills without any tax liability. That way, if I ever sprain my ankle playing Ultimate Frisbee, I can use the money in my HSA to pay the bills. But the best part is, I won't be in the same insurance risk pool with all those costly old and sick people anymore! They're not going to go for a plan with such a high deductible--it would cost them way too much, seeing as how they're always going to see their doctors for med refills and chronic pain.
Now, I know that when I drop my regular insurance plan and get an HSA instead, I'll be driving up the price of the old plan. But I don't really care. This is America, and if the old and the sick can't afford their insurance premiums, that shouldn't have anything to do with me.
S.B. 1371 would insure all residents of Connecticut through a single, statewide health plan covering comprehensive health services typical of private employers in New England. A single insurer would serve as statewide claims administrator, in the same way that regional insurers administer claims for the Medicare program today. Individuals and employers could purchase additional coverage, but everyone would be enrolled in the statewide plan.
To fund the plan, each employer above a certain size would contribute a certain percentage of payroll. Individuals would make contributions on a sliding scale, based on income.
This plan is called “Connecticut Saves,” because it would lower health care spending while covering all the state’s residents. Large administrative savings would result if health care providers have only one major insurer for all patients under age 65, rather than multiple insurers, each with its own unique system for submitting, processing, and evaluating claims. Savings would also result through eliminating the majority of health insurers’ administrative costs.
Low-income residents previously eligible for other programs would receive the bulk of their care through this state plan, giving them access to the same reimbursement levels and the same health care providers that serve middle-class residents. In addition, low-income families would receive supplemental services and protection against cost-sharing.
A prior version of this proposal was analyzed by Dr. Jonathan Gruber of the Massachusetts Institute of Technology, who found that it would lower employers’ health care costs by $600 million a year and give households more than a billion dollars a year in additional resources that could be devoted to purposes other than purchasing health care. As a result, based on the REMI macroeconomic model for Connecticut, the earlier version of this proposal was projected to add 6,000 to 11,000 new jobs to the state’s economy and to increase state GDP by $660 million to $830 million a year.
The survey also found that 9% of U.S. employers plan to offer only a high-deductible health insurance plan next year to employees, compared with 5% in 2007, Reuters reports.How about that quote, that it's one thing to offer the junk insurance plans, but "it takes more than that to get employees to enroll."
The survey included 573 large companies, defined as companies with greater than 500 employees (Dixon, Reuters, 3/15). The companies employ a total of 11 million people (AP/Chicago Tribune, 3/16). The survey found that 38% of companies offered a high-deductible plan among several different options in 2007, up from 33% in 2006.
The median percentage of employees enrolling in these plans was 7% in 2006 and 8% in 2007. Ted Nussbaum, director of health consulting at Watson Wyatt, said, "Employers can offer these plans, but it takes more than that to get employees to enroll." The study also found that companies with at least 10% of their employees enrolled in high-deductible plans coupled with health savings accounts saw health care cost increases of approximately 6.5%, compared with an average increase of 8% across all employers surveyed. Gail Shearer of Consumers Union said, "There is a concern about whether we are working our way toward a system where high deductibles are the norm and consumers don't have a choice," adding, "If you are a person of low or moderate income, if the deductible is very high, there will be financial barriers to care" (Reuters, 3/15).
In addition, the survey found that 33% of new hires will receive financial support for medical coverage during retirement from their employers, compared with 43% of current workers (AP/Chicago Tribune, 3/16).
Private is not better than public when it comes to health insurance.And yet the commenters don't get it — many of them, anyway.
Private health-insurance companies spend a greater percentage of dollars on administrative costs than government programs such as Medicare. Private companies also use health dollars to pay outrageous CEO salaries. UnitedHealth Group Inc. paid a former CEO $8 million a year. He also had unrealized gains on company stock options totaling nearly $1.6 billion.
Try finding a government worker with a personal jet.
Like the creature from the Black Lagoon, the health insurance monster has returned, creeping back onto the public stage. After President Clinton's jury-rigged pen to contain the monster collapsed in 1994, it never really went away. Political leaders tried to ignore the beast or deal piecemeal with its ravages, but it pushed more unsuspecting civilians into the uninsured pit, devoured more family budgets, squeezed even giant corporations' ability to compete globally, and raised fear and insecurity among the populace.He quotes economist Jared Bernstein of the Economic Policy Institute in describing the Right-wing's philosophy of healthcare (and everything else) YOYO (you're on your own) economics.
Now its depredations have become too loathsome to ignore for even cautious politicians and business executives -- who still are inclined to see the monster as one of their own
No plan worth having will win without a massive grassroots organizing and education campaign. And Medicare for all is the one most likely to do so, while simultaneously strengthening progressives politically....
Eventually, Medicare-for-all advocates might have to settle for a compromise. But the opportunity for major change in the health care system doesn't come around very often. Since any change will require a massive effort, why not fight for the best?
Health care is not something that can be left to "market forces", because such market forces leave people with illnesses or chronic conditions out in the cold. It's impossible to comparison-shop for coverage when your choice is among premiums that are Exorbitant, Preposterous, and You've Got To Be Fucking Kidding Me -- and that's assuming you can find coverage.Brilliant at Breakfast, by the way, is a great blog name, isn't it? The site begins with a quote from Oscar Wilde: "Only dull people are brilliant at breakfast."
I'm a Canadian. Despite what you might hear in the US, the health care system here has never let me down, nor let down anyone I know.
Sometimes you have to wait -- and if you go to the emergency room for a sniffle you will surely wait -- but I've been seriously ill a few times and been treated promptly and professionally. And I have never paid a dime for it. And when I go to a neighbourhood clinic for my sniffle I wait 10-20 minutes and am seen by a friendly professional who treats me. If I need a specialist I am referred. Everything works as it should and I don't pay a dime for any of it.
File the boogeyman stories you hear about Canadian medical care in the same file as the "Global War on Terror": manufactured facts to sell an agenda that does not benefit you.
Ms. Readling said she often woke up at night, terrified of the cost of getting sick without insurance.
“Anything that goes wrong with my health could destroy me financially,” Ms. Readling said. “I could be ruined.”
She said she had never voluntarily allowed her insurance to lapse and could not understand why she was being blackballed.
“What did I do wrong?” Ms. Read-ling asked. “Why am I being punished? I just don’t understand how I could have fallen through this horrible, horrible crack.”
Knowing her health benefits from her prior job would expire in January 2006, she began shopping for a new policy in May 2005. But in June 2005, she learned she had cancer.
“At that point,” Ms. Readling said, “I called everybody I could think of, begging for help. But no insurer would touch me.”
Barbara Morales Burke, the chief deputy insurance commissioner of North Carolina, said state law did not guarantee the availability of health insurance for individuals. “Most insurers decline to issue policies to those individuals whom they deem to be too risky because of their medical history,” Ms. Morales Burke said.
