May 12, 2017

"Health care is not like buying anything else. You cannot expect people to be good 'consumers' of health care."

"You're supposed to be vetting doctors and vetting hospitals and knowing what an MRI costs and knowing what a CT scan costs and a cardiac catheterization – how much does that cost? And is the cost different if I have this doctor or this doctor? Health insurance as a for-profit business is immoral... You want to make money off of me. And the reason you [don't want] to go to single-payer is not because you don't believe in it... It's because you know the insurance companies have a powerful lobby and they would decimate you.... I have no value to an insurance company. I can't do anything to their CEO, I can't do anything to their employee. Nothing. I can argue until I'm blue in the face. But a single-payer, run by the government? Yeah, it's got problems, but it's also got elections, and you're going to find that out in 2018."

Said a constituent in hospital scrubs, speaking, to applause, at a town hall held by GOP Congressman Tom MacArthur, reported in a Rolling Stone article titled "Americans Demand Single-Payer Health Care at GOP Town Hall/Tom MacArthur, the Republican responsible for resurrecting the AHCA, was pilloried by constituents Wednesday night."

176 comments:

damikesc said...

It's adorable that the moron thinks that the government is more responsive.

David Begley said...

For a period of time the CEO of an Omaha hospital posted all of its prices. He's long gone.

Todd said...

How about just doing this?

Carol said...

And yet...Medicare is single payer, except with Medicare Advantage, the govt lets you give your Part B premium to an insurance co and run with it. Lots of seniors like all the bennies though they're subsidized. I heard that's the direction fedgov wanted to go with all Medicare.

A local CEO told my club that the more specialists there are in a region, the higher the prices. Free market doesn't work. Medicaid pays .09 on the dollar. Local insurance guy told us Medicare pays less than that!

I don't know what to make of it all.


AReasonableMan said...

Thanks to the Emergency Medical Treatment and Active Labor Act, signed into law by Ronald Reagan, medical care can never be a free market. Free markets don't insist that you must be provided the product even if you cannot or will not pay.

damikesc said...

The VA cannot fire executives who have been convicted of felonies.

More responsive!!!

Bay Area Guy said...

There are problems with our health care. It's too complicated and we don't understand what anything costs.

However, none of these observations leads to the conclusion that a Single-Payer system, i.e. a government take-over of health care, is a good idea.

AReasonableMan said...

Medical care in most rural areas and even the smaller states is a monopoly business. No free market there either.

M Jordan said...

Price is no longer a signal in medicine because nobody really knows what it is. Even the pharmacies now have hidden pricing: hand then a NeedyMeds card and the price changes.

When price is unknown, the markets cannot work. Maybe the best thing the government could do is demand hospitals and doctors publish their prices. That's one reg I would support.

Cacimbo Cacimbo said...

These are rabid leftists who never voted for MacArthur and never would. They booed and chanted "shame" when he mentioned his own experiences navigating healthcare for his 11yr old deceased daughter. Sick, ugly people. Had Republicans behaved so despicably it would have received a week of front paging by media.

David Docetad said...

Today on my local South Florida NPR, there was a nice little health care story. It turns out that in Florida (and I think many other states) there are laws that prohibit a hospital from expanding the number of beds, or for opening a trauma center, without proving to the state that there there is a "need". The state house wanted to eliminate these laws apparently, but the state senate refused to do so. All of these regulations predate Obamacare.

Imagine the auto-industry or computer industry being muzzled by laws that prevent expansion without pre-approval to a state board. A board no doubt influenced if not entirely run by the biggest players in the industry.

Matthew Sablan said...

"And the reason you [don't want] to go to single-payer is not because you don't believe in it... It's because you know the insurance companies have a powerful lobby and they would decimate you.... I have no value to an insurance company. I can't do anything to their CEO, I can't do anything to their employee."

-- Republicans are the ones who pushed to weaken insurance companies by promoting competition and not forcing me, with the power of government, to buy from them whether I wanted to or not. Obama, and the ACA, empowered the lobby -- Republicans wanted to break it.

You have just as much "value" to an insurance company as you do any other business, that is, you are a valuable customer to them.

You can do loads to their CEOs and employees. You can boycott them. You can change your providers.

Dave D said...

If Health care is immoral if run for profit, then surely things like transportation, food and housing are also. What a crock!

Paul Zrimsek said...

I've a shrewd hunch that Rep. MacArthur knows about the elections already. He just got done winning one, after all.

Matthew Sablan said...

"Maybe the best thing the government could do is demand hospitals and doctors publish their prices."

-- I'd be fine with that; housing and medical care, two things that should be very clear-cut, do the most to hide their costs. If we can make fast food restaurants list out their calories, we can make hospitals list out their costs.

Fernandinande said...

Health care is like buying anything else. You can expect people to be good 'consumers' of health care.

You're supposed to be vetting doctors and vetting hospitals and knowing what an MRI costs and knowing what a CT scan costs and a cardiac catheterization – but they hide those costs, rather than advertising them.

It's like buying anything else without knowing the real price: you'll get ripped off.

And is the cost different if I have this doctor or this doctor? The costs are hidden, so I can't tell.

Food as a for-profit businesses is immoral ... You want to make money off of me, just so I can eat, survive.

And the reason you [don't want] to go to communal farms is not because you don't believe in it... It's because you know the farmers have a powerful lobby and they would decimate you.... I have no value to a farmer. I can't do anything to the farm owner, I can't do anything to their employees. Nothing.

West Texas Intermediate Crude said...

Single payer would fix some problems that we currently have with health care, but unfortunately, running a medical care system is simply not in the skill set of the government that we have.
Exhibit #1: VA
Exhibit #2: Indian Health Service
Exhibit #3: Military medicine (it does a good job at its primary prupose, taking care of active duty troops, but terrible at families and retirees, who often have to go to civilian facilities due to shortages of personnel).
Let a state make it work, then maybe expand that model, slowly and deliberately. Or we could try free market- it worked for the first 190 years of this nation's existence.

Kirk Parker said...

What David D. said. After all, no matter how much we might need medical care from time to time, FOOD is a much more urgent daily need.

DrSquid said...

Wow, scrubs huh? Yet the speaker still reveals an astounding level of ignorance, and arrogance. For profit insurance is immoral? Sounds like a judgment call to me.

It's that same intractable ignorance a progressive will rely on in essentially every issue. Did this healthcare genius pay attention during the on-going VA Hospital system scandal. What makes a progressive believe that government run medicine would be any different on a nationwide scale. "Oh, they just didn't do it right, it'll work great when we put the smart, scrub wearing folks in charge of healthcare for everyone." There is a lesson they will never learn: when there is no profit, when there is no incentive to do a little more work for a little more revenue, AND when you get the same pay even if you do essentially no work you get the system like the VA. All the effort is expended to create the illusion of productivity, and the patients are the ones who suffer.

In the hospital where I operate, the anesthesiologists recently entered into a new contract with a third party management company who now pays them a flat rate, and the hospital pays the management company for the services. What would you guess happened to productivity? What would you guess happened to incidence of complications? What would be the response of the scrub wearing genius at the town hall meeting to these questions?

I'd love to engage in a long discussion of this topic, but I've got to get back to work. I've got 28 more patients to see by 4 pm.

James K said...

Rolling Stone is the source? Yeah, I'm sure they randomly selected their anecdote. In any case, it's always amusing to read that some people still believe that government bureaucrats are benevolent and super-competent angels, while over-looking the VA, the Post Office, AMTRAK, the TSA, and all the other miserable failures of government, never mind the mediocrity or worse of all those single-payer progams.

Matthew Sablan said...

"And is the cost different if I have this doctor or this doctor?"

-- He must know the answer to this is yes, or he wouldn't have it asked as part of his rhetorical questioning. If he knows the answer is yes, it means he CAN find out, to some degree, what price things are.

rhhardin said...

Insurance companies buy your risk, risk you don't want to run. If you don't want the deal, don't buy it.

It's the law that screwed it up, taking over a market.

AReasonableMan said...

Fernandinande said...
Health care is like buying anything else.


This is nonsense. No one believes this.

MikeR said...

Does it matter that this man doesn't know what he's talking about? I work at a hospital too.
"government. Yeah, it's got problems, but it's also got elections" Was this man happy with the 2016 elections? Maybe he should rethink his words. If insurance companies are the problem, the solution is to move health care away from the model of using insurance for regular health care. Not to have the government and the insurance companies gang up on the rest of us.

Cacimbo Cacimbo said...

It is a shame lawmakers have destroyed the healthcare free market. A return to free markets is the answer, however, I expect we are moving toward full socialized medicine.Everyone will have free crappy healthcare, the rich will continue to pay for great healthcare and the upper middle classes will continue to pay insurance to get access to better quality healthcare. Basically what we already have, just without the pretense of making a few losers who haven't figured out how to game the system pay.

The Cracker Emcee said...

"It's adorable that the moron thinks that the government is more responsive."

It's incredible, too. Clearly the scrubs were a costume because anyone who's ever got a glimpse inside a healthcare provider knows that any improvements in care or services are as market-driven as a couple of burger joints on the same intersection. If my healthcare provider isn't making a profit off my care what possible motivation does it have to provide quality service. I suspect that liberal fantasists think the hospitals they see portrayed on Grey's Anatomy and Nurse Jackie are actually representative of reality.

David Docetad said...

The idea that the more complex something is, the more we need experts or government to do it or run it is very seductive. It makes obvious sense in the small: a complex machine needs an expert to fix it. But it is a literally deadly idea when applied to large complex systems of human interaction. See Venezuela.

Kirk Parker said...

EntirelyUnreasonableMan,

"This is nonsense. No one believes this."

I certainly do! What's wrong with the scrub-wearer's statement is that it's only in emergency situations that you don't have time to look at costs.

But health care is no different than any other emergency situation.

Let's say you live in Duluth, MN. If you're contemplating putting in a new furnace, you'll take plenty of time looking over all the offerings, comparing prices and features, etc. But if it's January 30 and the coldest weather in decades, and your furnace stops working... you'll be a little less choosy.

Birkel said...

I think telling consumers they are too stupid to understand pricing of products is a winning electoral strategy. I applaud Democrats taking this brave stance to protect us from ourselves. Only with Democrats do we get the multiple benefits of being told we must be protected, like children, from the normal risks of life while at the same time being called stupid if we disagree, which only proves how much we need the protection of those we would reject.

And to all you people in Podunk, USA who disagree I can say you are wrong by appealing to the authority of Anna Eshoo of California, USA.

Bushman of the Kohlrabi said...

The government running our healthcare system? What could possibly go wrong?

The Cracker Emcee said...

"Medical care in most rural areas and even the smaller states is a monopoly business. No free market there either."

Sure, if you access your medical care by mule and wagon. I live in a rural area and within a 30-minute drive are five hospitals and a plethora of clinics, specialists, and outpatient surgeries of every description. If you don't think they're competing with each other you're out of your tiny mind.

Ignorance is Bliss said...

You want to make money off of me... I have no value to an insurance company. I can't do anything to their CEO, I can't do anything to their employee. Nothing.

To the extent that this is true, it is not due to the free market, it is due to the lack of free market. Most people get their insurance through their employer. If people were buying their own insurance, then they would have power, the power to take their business elsewhere. They want to make money off of you. That is your power over them.

Birkel said...

@ AReasonableMan

Your Pauline Kael moment is amusing. Well done.

Grab your carry on.

AReasonableMan said...

Kirk Parker said...
I certainly do!


Then you choose to ignore the reality of the Emergency Medical Treatment and Active Labor Act, Medicare, monopoly services and the fear and uncertainty that non-medical people experience when they are in mortal peril.

AReasonableMan said...

The Cracker Emcee said...
I live in a rural area and within a 30-minute drive are five hospitals and a plethora of clinics, specialists, and outpatient surgeries of every description.


Where? Do you know who owns all the hospitals?

Ignorance is Bliss said...

AReasonableMan said...

Medical care in most rural areas and even the smaller states is a monopoly business. No free market there either.

I would be curious which smaller states have only a single doctor's practice. Do you have a list of such states?

sinz52 said...

The hard part for Republicans in 2018 will be finding a way to explain that single-payer is bad but they have no problems with Medicare.

If you believe single-payer is a bad idea, then logically you should conclude that Medicare is a bad idea. But saying that is a political disaster for any candidate running for office. The idea of Medicare for the elderly and Tricare for the military but HMOs for everybody else is real hard to defend.

Someone else in this discussion mentioned Medicare Advantage. If *moderate* Republicans like Collins set out to design a single-payer system or modify a Dem single-payer, they would probably insist on a similar "Single-Payer Advantage" option. It would be even harder for conservatives to denounce that type of program.

LilyBart said...

said...
It's adorable that the moron thinks that the government is more responsive.


This is the part that mystifies me. Some people think that 'everyone will pay a little bit more, and then everyone can have the healthcare they need'. Its a fantasy. Quality and availability of healthcare will decline, and the cost will ruin us. We won't get the healthcare we need, and they won't care. What government healthcare will do is make sure we all are treated like welfare cases - crappy care and no power to make our own choices!

VA patients are dying waiting for appointments, meanwhile the VA Hospital in my city is $1 billion over budget. http://www.denverpost.com/2016/09/21/aurora-va-officials-warned-repeatedly/

sinz52 said...

AReasonableMan said: "...EMTALA..."

In fact, that is the argument that free-market purists have made: "Get rid of Obamacare, Medicare, Medicaid, EMTALA, and COBRA."

That would be a logically consistent position--if free-market purists admitted that the free market works on a pricing mechanism, so that we would have to put price tags on human lives in a totally free health care market.

That's pretty much the way veterinary care has worked: When costs soar out of control, euthanasia becomes a viable alternative. You send your crippled old horse to the glue factory or have your pet dog or cat "put down."

Ergo: The laissez-faire solution to health care is Soylent Green. Always has been. Always will be.

bagoh20 said...

I buy things everyday that I have no understanding of the value or costs, but I can educate myself in minutes via the internet. Things I buy on Amazon don't even require leaving the site.

I get regular MRIs and have researched the costs from various providers in my area, even though I have no choice. The prices vary by multiples for no reason other than some providers know they can get that higher price through a system that hides it from the end consumer. Health care cost could be reduced by half through open market competition alone. If you bought your health care though something like Amazon, the costs would be far lower and the health care industry would surge from people buying up stuff they may not even need, but want anyway. That should be their choice and their right. Some people would save their own lives through this process and some would choose to die rather than spend the money.

Just imagine any other product that had a market system where you pay one company who then decides when, where, and if you can buy the thing by sending you through a labyrinth of gatekeepers and hurdles where you have to spend more time looking and waiting for an appointment with the salesman than it takes to buy, get, and use that product. All the time wasting your prepaid money to pay for that system and all it's paper pushers and gatekeepers. If it wasn't a life-saving product, you would never buy it.

Bob Ellison said...

The town-hall forum is disastrous for presentation and/or discussion of complex issues like health care. Senators and Congresspeople should learn this. The PR sucks, the people who bother to attend are mostly agitators, and the discussion is fact-free and myth-rich.

Real American said...

Health Care is too important to be left in the hands of politicians.

Kirk Parker said...

ARM,

" when they are in mortal peril."

And you, in turn, choose to ignore the careful distinction I made between emergency and non-emergency situations.

AReasonableMan said...

Ignorance is Bliss said...
I would be curious which smaller states have only a single doctor's practice.


The depth of ignorance revealed in this statement is remarkable.

If you live in Minnesota do you choose to go anywhere other than the Mayo Clinic for a serious illness?

Peter said...

"Health insurance as a for-profit business is immoral... You want to make money off of me."

But OF COURSE it's not immoral for the speaker to make money off of my illness.
In any case, we're back to basics: health insurance is a financial product, not a medical product. And much of its value to policyholders has become dealing with the opaque pricing of medical providers like you, so patient-policyholders don't have to.

"But a single-payer, run by the government? Yeah, it's got problems, but it's also got elections." Which is exactly what's wrong with it: it's run by government. And demnocratic government is inherently political, and therefore if it pays your medical bills then who gets what (and perhaps even who lives or dies) will be determined by who has the most effective political lobby.

$Billions for (mostly ineffective, yet stunningly costly) treatment for autistic children, palliative-only care for those over 70? Perhaps, perhaps not: with "single payer," it all depends on who's got the bigger, badder lobbyists, doesn't it? Is the reason why chiropractic and homeopathy are must-cover under ACA/Obamacare because they offer effective, based-on-sound-science treatments?



exiledonmainstreet said...



Blogger DrSquid said...
Wow, scrubs huh? Yet the speaker still reveals an astounding level of ignorance, and arrogance."

Scrubs are cheap and easy to order. (They serve pretty well as pajamas.) Of course, if he also had a stethoscope hanging around his neck, that gives him absolute moral authority.

LilyBart said...

Has it occurred to people that the government wants us to all be 'welfare cases'? It empowers them. And we're all left to be grateful for the scraps they give us.

How is it that a 'system' that promises equity just ends with the average person poorer and dis-empowered and the government people and their friends wildly rich?

AReasonableMan said...

sinz52 said...
In fact, that is the argument that free-market purists have made: "Get rid of Obamacare, Medicare, Medicaid, EMTALA, and COBRA."

That would be a logically consistent position--if free-market purists admitted that the free market works on a pricing mechanism, so that we would have to put price tags on human lives in a totally free health care market.

That's pretty much the way veterinary care has worked: When costs soar out of control, euthanasia becomes a viable alternative. You send your crippled old horse to the glue factory or have your pet dog or cat "put down."

Ergo: The laissez-faire solution to health care is Soylent Green. Always has been. Always will be.


The free market purists are cowards and never openly advocate this because they know it is not acceptable to most people, but this is what a free market would look like.

If I can't afford a car I catch the bus. If I can't afford medical care I die.

tcrosse said...

If you live in Minnesota do you choose to go anywhere other than the Mayo Clinic for a serious illness?

Yes, you do. I won't bore you with a list of excellent medical facilities in Minnesota other than the Mayo Clinic.

Matthew Sablan said...

"If you believe single-payer is a bad idea, then logically you should conclude that Medicare is a bad idea."

-- Medicare is a bad idea, but the alternative is worse. Likewise, a pure single-payer, operated by the government, is even worse than what we currently have.

LilyBart said...

...and we haven't had a 'free market' in healthcare for quite a long time - so don't blame the free market.

Ron Winkleheimer said...

It turns out that in Florida (and I think many other states) there are laws that prohibit a hospital from expanding the number of beds, or for opening a trauma center, without proving to the state that there there is a "need".

Alabama is the same way. A former governor went to prison a few years ago because he appointed healthcare company CEO to the board that grants those approvals after the CEO had made a $100,000 dollar contribution to something or another that the Gov was involved in.

I cannot see the point of these laws other than to allow the already existing players to restrain others from competing with them.

Rumpletweezer said...

The government has created a situation in which the only entity interested in controlling costs is the insurance company. The insurance company controls cost by denying coverage for procedures and drugs. The patient has no incentive or ability to control costs. This will not change under single payer.

Matthew Sablan said...

"If I can't afford medical care I die."

-- Except, you know, for all the charities that have existed to help people get care; both religious and non-religious hospitals that provided care for the sick and poor, with examples even being recorded during the plagues.

mockturtle said...

"Said a constituent in hospital scrubs"

Was he/she on his/her way to work or on the way home? In either case, it's bad practice to wear your hospital scrubs in a public environment. My guess is that it was not a medical worker at all.

TreeJoe said...

These arguments have gone down such rabbit holes of illogic...

If health insurance for-profit is immoral, then health care for profit is certainly immoral as are higher salaries for different levels of healthcare workers beyond a benchmark to hours and a fixed hourly rate for a role.

While we're at it, a fixed cost for a procedure or care makes no sense. Just post hourly rates and estimated hours for certain common items.

Let me give everyone out there a hint: the automotive industry does this with cars. $100-200/hour which includes overhead, estimates for common items, open fees for diagnostics.

It's not that hard people.

....

Lastly, significant profit motive in the provision of healthcare services may be immoral when it's not tied to outcomes.

But take profit out of it, and you know what you get? The VA. The nation's largest single system health care provider.

How's that working out?

Ron Winkleheimer said...

Scrubs are cheap and easy to order. (They serve pretty well as pajamas.) Of course, if he also had a stethoscope hanging around his neck, that gives him absolute moral authority.

I saw an article that stated that a study had found that hospital workers are spreading all kinds of nasty germs when they wear scrubs home from work.

LilyBart said...

Medicare only 'works' as well as it does right now because we have a private insurance market. Basically, private insurance is 'subsidizing' medicare. For the most part, medicare reimburses at lower rates, and doctors have to limit the percentage of medicare patients in their practice to avoid financial distress. When my mother went on medicare, she discovered this little joy.

bagoh20 said...

People talk about single payer as if under it you can avoid dying from lack of care, while the experience including in our own VA system is exactly that. No system will be able to provide unlimited resources to save you, especially when some measures cost more than an average patient's lifetime earnings. The only difference is what mechanism is used to let you die. In an open market system that thing would be your choice and finances and charity, in a single payer system it is just finances, and someone else's choice.

Ignorance is Bliss said...

AReasonableMan said...

If you live in Minnesota do you choose to go anywhere other than the Mayo Clinic for a serious illness?

There may be a great restaurant in town, one that I would choose over every other. That does not mean that the restaurant has a monopoly. It just means that it is better.

If I lived in Minnesota, I might well choose the Mayo Clinic. Or, I might go to Abbot Northwestern. Or St. Cloud Hospital. You see, there are multiple hospitals with nationally ranked specialties.

Sebastian said...

Real healthcare reform is unlikely: the current system serves too many vested interests, most Americans want access to other people's money, and keeping people dependent on government is a boon to a large segment of the political class.

But single payer is not the only alternative to the current system -- the French and the Dutch have mixed systems, with some competition and consumer choice, and of course different trade-offs.

AReasonableMan said...

Matthew Sablan said...
the charities that have existed to help people get care; both religious and non-religious hospitals that provided care for the sick and poor, with examples even being recorded during the plagues.


Any idea what 'health care' cost during those periods and what the outcomes were? They make Mother Teresa's operation look like successful healthcare.

bagoh20 said...

"If I can't afford a car I catch the bus. If I can't afford medical care I die."

What if the bus doesn't come, becuase they get paid either way, and just didn't have much incentive to show up today or make sure enough buses were available? Now you can't buy a car or hire a taxi, becuase that's illegal.

LilyBart said...

Look, if you people want to be in a Healthcare collective - be my guest! I just don't think the voters have the right to involuntarily force me into their collective.

“The state is that great fiction by which everyone tries to live at the expense of everyone else.” ― Frédéric Bastiat

“When plunder becomes a way of life for a group of men living together in Society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it." Bastiat

“But how is this legal plunder to be identified? Quite simply. See if the law takes from some persons what belongs to them and gives it to other persons to whom it does not belong. See if the law benefits one citizen at the expense of another by doing what the citizen himself cannot do without committing a crime.” ― Frédéric Bastiat, The Law

All mankind... being all equal and independent, no one ought to harm another in his life, health, liberty or possessions. John Locke

mockturtle said...

Take a good look at the CEO salaries at 'not-for-profit' hospitals some time. I think Chuck Grassley did an investigation a few years ago on hospital executives' pay. IIRC, Michelle Obama made something like $320K as a vice president of 'community relations' at a Chicago hospital while Barack was senator.

holdfast said...

I tried single payer for about 26 years. Didn't like it, moved to the 'States. Oh well.

By the way, having government single payer is sort of like a really obnoxious, unresponsive HMO. I remember when I first moved to the US and the cheapest plan at my employer was an Oxford HMO. All my colleagues hated it, and silly me I thought it was pretty much the best thing ever.

Ron Winkleheimer said...

Any idea what 'health care' cost during those periods and what the outcomes were? They make Mother Teresa's operation look like successful healthcare.

Dude, there are hospitals providing charity care right now. Ever heard of St. Jude? The Shriners.

http://www.chsli.org/

https://www.catholiccharitiesdc.org/health-services

https://www.ebaptisthealthcare.org/community/Charity-Care

Seriously, how can you be unaware of this?

whswhs said...

It's all very well to talk about the power of elections. But the party that strongly stands behind single-payer is also the part that assumed that they were guaranteed a win in the 2016 election, and when they didn't get one, did everything short of proclaiming open civil insurrection against the other party, and demonized its candidate. And now they're doing their best to be a roadblock to any changes in what they did about health care when they were in power. I don't think what they're actually envisioning is electoral feedback on how their health care system works; I think they're envisioning the government giving the people what's good for them, and the people taking it and liking it.

And the choice isn't necessarily between a government health care system and an insurance company health care system. If we''re talking about radical changes—and single payer would be one—then we could also look at doing away with comprehensive health insurance in any form, and having people pay for routine health care out of pocket, with insurance reserved for major illnesses and operations. After all, when your sink gets stopped up, you don't expect your homeowner's insurance to pay the plumber. And all those arguments about the limits of consumer choice apply just as much to household emergencies. So do you want the government to provide single payer home repair, and have to request a government plumber or electrician every time someone breaks down?

Ron Winkleheimer said...

Also, Mother Teresa didn't provide healthcare. She ran a hospice.

AReasonableMan said...

bagoh20 said...
Now you can't buy a car or hire a taxi, becuase that's illegal.


False, misleading and slightly hysterical analogy. Private care systems operate in parallel with single payer systems in most countries that have this system. But, I am not advocating single payer if there is a better system to minimize costs and provide a basic level of care. It is, however, a true free market system since that is clearly unacceptable politically, whatever your moral standards might be.

bagoh20 said...

Imagine any other product you regularly use being provided though a single payer system, or even the system we currently use for healthcare. Imagine if food, housing, clothes, furniture, etc were single payer. Would you get nice stuff? Would it be a good value, good quality? Would it always be available when you needed it? Would you be buying what you really wanted on the black market, while still paying for the government cheese?

AReasonableMan said...

Ron Winkleheimer said...
Mother Teresa didn't provide healthcare. She ran a hospice.


This was my point - death panels.

320Busdriver said...

Post the effin prices

The health care lobby spends more $ than defense, aerospace , and oil/ gas combined.

Sign the petition:

https://www.change.org/p/end-predatory-healthcare-pricing

Bob Ellison said...

Ron Winkleheimer, ARM's point is still solid. "Non-profit" is a weasel term, and "charity" is running fast to catch up. As mockturtle points out above, there's a lot of money to be made working for or running such organizations.

AReasonableMan said...

Ron Winkleheimer said...
Seriously, how can you be unaware of this?


What fraction of their funding comes from Federal, state and local government?

Kevin said...

So the paid protesters are wearing hospital scrubs now? If the VA worked he might have a point.

Bob Ellison said...

Nobody wants to pay 17% for health care, but that's what we consume, on average. And it goes up as a percentage of GDP every year, much faster than inflation.

We all want someone else to pay.

wwww said...



This political moment reminds me of a job offer.

Somebody offers a job offer of xx$$ per year and benefits.

If you take it, then it's a deal.

But if you negotiate, they can withdraw the offer. It's dangerous to negotiate unless you're willing to walk, unless you're willing to open up the deal for re-negotiation.

Obamacare was partly based of Romneycare and ideas that came out of conservative think tanks about health care. The "plan" was for it to be a compromise. That was the "deal" sold to progressives who wanted single-payer or a public option.

David Frum wanted Republicans to compromise and move it more towards a free market idea. McConnell wasn't interested in compromising, and it was a brilliant political move.

But the rejection of the "deal" means it's all up for re=negotiation again. Rs walked and now Ds want to walk. Ds are going to be less interested in compromising in the future. Does that mean ideas of a public option? Ideas of single payer?

Seems to me that's the political temperature. Walking away from the compromise opens the deal back up.

This times both sides are less interested in compromise.

DanTheMan said...

>> Michelle Obama made something like $320K as a vice president of 'community relations' at a Chicago hospital while Barack was senator.

She was making about 100K a year when he was a state senator. He got elected US senator and they *tripled* her pay.

Not a smidgen of corruption there. No sir.

Known Unknown said...

"Free markets don't insist that you must be provided the product even if you"

But health care one must admit is a commodity. There are only so many hospitals and so many doctors and nurses, etc.

bagoh20 said...

"False, misleading and slightly hysterical analogy."

You started it, but the bus still didn't show up when you needed it, even though the politicians promised it would, and you paid for it with your taxes. The next day you send a strongly worded letter to your congressman, as the bus driver who didn't show, sleeps with dreams of soon living on his pension. He never hears of your ruined day, and so it happens over and over. I mean how many dead veterans did it take to get nothing fixed at the VA?

Known Unknown said...

"Health insurance as a for-profit business is immoral... You want to make money off of me."

Ha ha ha. What the fuck does the word "insurance" mean? What dummies.

Known Unknown said...

"I cannot see the point of these laws other than to allow the already existing players to restrain others from competing with them."

Regulatory capture? You don't say? Well I'll be.

James K said...

Medicare is a bad idea, but the alternative is worse.

Not following this. It's a good idea if it's better than all the alternatives. It's not. The free market can provide health insurance efficiently (or more efficiently than the government) if it's allowed to.

Crazy Jane said...

I'm all for posting prices.

We have a high-deductible policies and typically don't hit the deductible. But we take a couple generic medicines, and our pharmacy benefit plan's in-network prices range from $20 to $90 per month for a couple of them, varying by pharmacy. So we check prices and look for coupons online. It's not that difficult.

For non-emergency care, I'd be happy to shop. I don't see why expensive technology like MRI and breast-scanning machines don't run two shifts a day with price differentials for people who want to limit their out-of-pocket expenses. I don't see why, if I have a thyroid problem, I can't order my own blood tests from the lab of my choice, at my convenience, to keep track of my TSH score.

Again, this wouldn't work for emergency care. In fact, there are several empty hospitals in my state that make their money by jacking up prices for emergency services and posting ER advertisements on highway billboards. So that's fraught too.

Essentially we are responsible, personally, for maintaining our health. I don't see why we can't be allowed some small degree of agency in managing the expense.

Gahrie said...

She was making about 100K a year when he was a state senator. He got elected US senator and they *tripled* her pay.

And when they moved to Washington D.C. they never filled the position.

khesanh0802 said...

What we need is a National Hospital League with Roger Goodell as the Commissioner. Then you can have salary caps, every one can know everyone's salary, rookie doctors regardless of specialty can be restricted in their pay, hospitals can have a draft every year and doctor free agency. Of course we'll never know how much money the owners make, but we won't care because we'll have our Fantasy Hospital league to keep us deplorables happy. In fact it will be just like a nationally run health care, except we'll have Roger to boss us and we all know how bright he is. (Go Pats!)

Seriously, I live in an area where there is essentially a duopoly of health care providers- Mayo ( who I have no complaints about except for prices) and, on the other side of the river Gunderson-Lutheran. In many other parts of MN there is only a single provider within a reasonable distance of those needing health care. Even with that restricted network if all hospitals had to publish a price list for services I would bet you would see some competitive price cutting going on just because there would be people able to ask the question "why does service X cost so much here vs. the cost in Rochester, or in a Twin Cities hospital?" It may be hard to shop for service, but a published rate for service might see a patient decide he'll get a ride to The Cities to save $3,000 on an operation rather than stop in Rochester. If nothing else it would be obvious when price collusion among hospitals is occurring.

The reality is I don't want some government apparatchik involved in deciding where and when I receive health care.

Rene Saunce said...

ARm's bullshit comment on Reagan - LOL.

Ambrose said...

Well I initially thought this was nonsense, but as the Rolling Stone helpfully points out, this person was wearing hospital scrubs, so clearly he must be a healthcare policy expert.

stlcdr said...

Would they also support the current government, right now? Because that's the government that's going to run it.

Would they stand up and cheer if, lets say, trump says that we are going to have a single healcare provider established by my executive branch and the republicans in office.

While there are a few branches not touched by the executive branch, the current FBI situation demonstrates that people wanting 'government control' of any given thing is either very dim or being disengenuous. Either should not be trusted to even change the oil in your car.

Rene Saunce said...

The idea that American consumers are stupid, is ignorant of the facts. Are they deplorable too?

British government run health care system is a disaster for anyone who is sick.

Bob Ellison said...

Crazy Jane said, "I don't see why, if I have a thyroid problem, I can't order my own blood tests from the lab of my choice, at my convenience, to keep track of my TSH score."

Yes! I know what lab tests I need, yet I have to pay $75 for a five-minute doctor to make out a lab slip for them.

And I have to pay again to get that doctor to refill my insulin. Without it, I'll die. It's not rocket science. Not as though I'll walk up one day and doc will say, "Bob, you don't need insulin anymore!" (Well, maybe if he's a homeopath.)

mandrewa said...

Cars and computers are extraordinarily complicated things and the great majority of the people that buy them don't get the real differences between what's available. The market nevertheless works well, in fact very well, because there is a portion of the population that does understand these things, and they are intelligently selective in their purchases.

Since the market in cars and computers is highly competitive with many choices, the relatively small pressure that these very informed consumers exert is sufficient to steadily improve the offerings over time. In fact they have totally transformed things. Current cars and computers are many orders of magnitude better than what was first invented.

The result of this is that a person that is totally uninformed and not very wise can buy the worst car out there and randomly buy a computer and still have machines that deliver a lot of functionality and in some larger sense are very good.

So the fact that most people don't understand medical stuff is not truely a barrier to a market improving the quality of medical care. Many other markets have the same issue and they surmount it easily. What's different about the medical market which makes it difficult to function as a market is two other issues.

The first and most important issue is a lack of responsibility. The car buyer has to give up something valuable to get the car; they have to give up money. Therefore the car buyers are trying to maximize functionality per dollar. And that's most of what the market needs to work its magic.

No such dynamic applies to the medically insured. Since they are not spending their own money they have no incentive to maximize functionality per dollar and most people think and act like the more expensive it is the better. So this means that the choices of the medical insured are not constructive. They steadily make things worse not better. They lower the functionality per dollar.

So in response to this, many insurance plans don't offer choice. They make the choice for the people that buy their medical insurance. So it may sound like this could work. The insurance company hires people that are expert in medical stuff and expert in maximizing functionality per dollar. And they make intelligent choices and they improve the market.

Sadly this is not what happens. Actual experience shows that the hired experts are routinely bad at making these choices. They don't make things better. And this is true around the world, not just the United States.

Why this should be, should be a matter for study. Part of it I can guess at. Defining what is 'better' is hard. The multiplicity of views of even mostly uniformed consumers seems to be far better at finding what's 'better' than a small number of experts.

Another explanation might be that the experts are not really responsible. They are not really giving anything up when they choose a more expensive option, and in turn they don't suffer if they make a bad choice.

Another explanation might be the tendency towards conformity or group thinking. Just as a hunch group thinking may be bad at improving things. And the 'experts' might be especially vulnerable to group thinking when we look at their real incentives.

(This has gotten long enough. I'll post the rest of my thoughts on this later, maybe.)

AReasonableMan said...

bagoh20 said...
I mean how many dead veterans did it take to get nothing fixed at the VA?


Despite all the demonization of the VA actual vets generally prefer the VA to the alternatives, though you could reasonably argue that this is because the alternatives are so bad.

Rene Saunce said...

Here's the collective left's understanding of How Insurance Works.

You own a home and you do not buy ANY insurance to cover your home. The Home burns down. Leftist goes to insurance company and demands a payout - because fairness.

Rene Saunce said...

Mockturtle

Take a good look at the CEO salaries at 'not-for-profit' hospitals some time. I think Chuck Grassley did an investigation a few years ago on hospital executives' pay. IIRC, Michelle Obama made something like $320K as a vice president of 'community relations' at a Chicago hospital while Barack was senator.

Leftists lie and hide behind "not for profit" - while they profit.

Ron Winkleheimer said...

This was my point - death panels.

Hospices are not death panels. Hospices are where you go, or who come to you when further medical care is only prolonging the inevitable.

As for your other point, since the politicians tell us that they are taxing us to fund the public good, what difference does it make how much money they are receiving from the government? Also, seems kind of irrelevant to the fact that you didn't seem to know that various charities provide medical care. I mean, you've never even heard of a free clinic?

exiledonmainstreet said...


"Despite all the demonization of the VA actual vets generally prefer the VA to the alternatives, though you could reasonably argue that this is because the alternatives are so bad."

No veteran I know uses the VA if he or his spouse have insurance that gives him other options.

The body of a deceased veteran was stored in the morgue of a VA hospital for so long it decomposed. That might have something to do with their reluctance:

http://westchester.news12.com/news/vet-s-body-decomposes-at-va-morgue-for-4-months-1.13604352

Kirk Parker said...


"the French and the Dutch have mixed systems, with some competition and consumer choice, and of course different trade-offs."

Michael Kennedy has written some very positive things about the French system; I had no idea the Dutch were similar.

Matthew Sablan said...

"Ds are going to be less interested in compromising in the future."

-- Consider they literally locked Republicans out of meetings, this is probably the safest prognostication in the entire thread.

Dave from Minnesota said...

One plan proposed by Republicans (I do not recall who) is to do more of a voucher system. Vets can go to their local hospital of choice vs a VA clinic.

I see the VA van from Rochester Minnesota going to the VA in Minneapolis. So these veterans live within the shadows of the Mayo Clinic, but have to take a van 95 miles (each way) to a government run facility for treatment.

Matthew Sablan said...

"Not following this. It's a good idea if it's better than all the alternatives. It's not. The free market can provide health insurance efficiently (or more efficiently than the government) if it's allowed to."

-- Medicare was meant to be a targeted fix to a specific problem; not the catch-all it evolved in to.

You can have to choose between bad choices. The free market can provide health insurance effectively, but Medicare was never supposed to be solving that problem. It was instead supposed to be a safety net for those who could not afford insurance (the elderly, those unable to work, etc.)

mockturtle said...

I mean, you've never even heard of a free clinic?

I volunteered at one for several years. Most communities have them.

Known Unknown said...

"Despite all the demonization of the VA actual vets generally prefer the VA to the alternatives, though you could reasonably argue that this is because the alternatives are so bad."


I'd love to see a citation for this.

Chuck said...

"If you think health care is expe3nsice now, wait until you see what it costs when it's free."
~ P.J. O'Rourke, The Liberty Manifesto, 1993


I agree with the rather obvious point that no one can negotiate or price-shop for medical procedures when they are having a heart attack, or some other emergency. In many cases apart from emergencies, it is just not possible to negotiate or shop.

But that's one of the good things about private health insurance. Your employer (or you) shop for the best policy. And the insurer shops for the best prices on a long-term basis, including emergency and quasi-emergency care. To be able to provide the best deals to shoppers when they actually are shopping. Let's set it up so that at every possible level of health care, shoppers are price-shopping at all levels.

SGT Ted said...

Canned, staged, astroturfed bullshit. Complete with costumed actors spouting pre written lines about how WONDERFUL Government run healthcare.

"But a single-payer, run by the government? Yeah, it's got problems, but it's also got elections, and you're going to find that out in 2018."

Hey, asshole, we have elections right now and the VA remains completely unaccountable, because of Government unions lobbying and purchasing themselves rules that make them damn near unfireable, as well as setting up a crony system of hiring insiders over other, far more competent people.

These assholes always avoid the glaringly obvious conflicts of interest: voting themselves government union jobs for life with the same zero accountability to patients as the VA. They want a guaranteed paycheck from the rest of us and want to use Government force to obtain it.

Fuck these people.

Chuck said...

"...expensive..."
Can't explain that typo...

mockturtle said...

"Despite all the demonization of the VA actual vets generally prefer the VA to the alternatives, though you could reasonably argue that this is because the alternatives are so bad."


I'd love to see a citation for this.

Me, too. I know my brother had nothing but problems with the VA.

Known Unknown said...
This comment has been removed by the author.
Known Unknown said...

"If I can't afford a car I catch the bus. If I can't afford medical care I die."

Your analogy is shit. The bus isn't a car but it's still a mode of transportation. Often provided by the State.

People keep acting as if insurance and care are the same things. They're not.

Ron Winkleheimer said...

I know a guy who uses the VA for some services and says he has not had any problems. But, we are in an area where there a quite a few very good hospitals. I don't know if that would be a factor or not. It seems like some VA hospitals are at least adequately well run, while others seem to be about two steps above Venezuela. And the ones that are badly run cannot be fixed because public service unions.

SGT Ted said...

"Despite all the demonization of the VA actual vets generally prefer the VA to the alternatives, though you could reasonably argue that this is because the alternatives are so bad."

What the fuck? Put the bong down.

Inga said...

Looks like the Insurance Industry is looking at Single Payer and finding a way to make it benefit them.

https://www.vox.com/policy-and-politics/2017/5/12/15629716/aetna-ceo-bertolini-single-payer

"The chief executive of one of the country’s largest health insurance companies says he is open to having a single-payer debate.

Single-payer, I think we should have that debate as a nation. But let me remind everybody that Aetna was the first financial intermediary for Medicare. We cut the first check for Medicare in 1965 to Hartford Hospital for $517.57.

The government doesn’t administer anything. the first thing they’ve ever tried to administer in social programs was the ACA, and that didn’t go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let’s have that conversation.

But if we want to turn it all over to the government to run, is the government really the right place to run all this stuff? And that’s the debate that needs to be had. They could finance it, and if there is one financer, and you could call that single-payer. ...

We’re going to pay for it one way or another. What we have to do is we have to get the costs right. We have to get people healthy. It’s not about who is paying the bill. It’s about what we’re doing to get the costs down. The Democrats are now saying that with the new Republican bill, wait there is nothing in here about getting costs down. That’s the point. And so that’s the place we’re headed as a company. It’s not just about paying the bills."

Static Ping said...

The article is pretty well written. However, I do very much get the idea that the author has cleaned up the quotes from the protesters. The audience is far too eloquent with no stumbling whatsoever, which is very unusual for angry people. I'm sure they got their ideas across but it feels like one of those ancient histories where some famous person gets a 10 page speech that was completely fabricated but reads well, or perhaps more like the sports page where none of the athletes ever curses, speaks broken English, or joins the "um, you know" chorus.

Anyway, going through the quotes:

"It shouldn't be a market! My health care shouldn't be market," one yells. "When did we become a society that doesn't care about each other?"

The second part is a complete non sequitur to the first part. I cannot think of any better way to become a society that doesn't care about each other than to make the government responsible and remove it from society's concerns. The first part makes no sense. As long as there are limited supplies and extensive (infinite!) demands, there is going to be a market. There is no option to not have one. The question is what kind of market do you want. So the first quote, which the author apparently thinks is a winner, is not showing much promise.

I have family in Canada. They get coverage under the under government. They are taken care of, and nobody has any complaints.

I am not sure what the speaker is referring to by "nobody." If it is the speaker's family then this may be accurate, but it probably also means none of them has needed significant medical care. When I don't see my doctor for 3 years, I don't have any complaints about my medical care either. However, Canada is notorious for rationing catastrophic care to the point that patients with cancer have to go to private clinics or the United States, else they will die by the time they get an appointment. The emergency room in Canada is also notorious for very long waits to the point that many people give up and go home. I suspect this person also thinks that Cuba has the best medical care in the world. Or maybe it is Canada, Illinois or something.

"You said, 'Would I like some bureaucrat in Washington to make decisions about my health care if we had single payer?' And I said, 'What makes that anything worse than some employee of an insurance company?'"

This person lacks imagination. Also, aren't they here because they are complaining about how Washington is making decisions about her health care? I mean, seriously. Stay on message!

Static Ping said...

MacArthur looks at her and says, earnestly, "I think there is a difference. What I have found, in 30 years in the private sector, and now a couple of years in the public sector, is that government bureaucrats can be very dangerous when they have power."

The room erupts into grim gales of laughter.


Laughs the people who are almost certainly filled with a high percentage of people who are terrified, horrified, and/or stupified by Donald Trump as President. The President technically is in charge of the bureaucracy. They have not thought this out at all.

Geoff Ginter, wearing blue hospital scrubs, isn't buying it. "Health care is not like buying anything else. You cannot expect people to be good 'consumers' of health care," Ginter says. "You're supposed to be vetting doctors and vetting hospitals....

Well, yes, buying health care is not the same as buying cupcakes or gym memberships or cars. I thought that was pretty much a given. But the thing is that everyone is not an expert at all things we need to buy, and for that matter most of are experts on very few things that we buy. That's why we research before we buy and in this world there are lots of resources to do just that. I think the assumption here is the government will be an expert on health care for us, but given how they run the V.A. it is obvious that they are not experts on health care. This is more magical thinking.

However, he does have a point that the health care market is more obtuse than most markets. Much of this is because of the government, which he does not realize. But he's wearing scrubs so I guess that makes him an expert. I dressed as a bunny once for Halloween and my vertical leap did not improve, but what do I know. Maybe if I wore scrubs it would become clear!

Static Ping said...

"Health insurance as a for-profit business is immoral," he bellows, as the whole room breaks into applause.

How many fallacies do we have here. First, non-profit does not mean benevolent. Just because the goal is not to please stockholders does not mean the organization is not selfish. There are plenty of non-profit organizations with the main focus of maximizing the salaries of its employees. Second, the goal here is to provide the best health care system possible. If the best health care system is for-profit, then it would be immoral to use any other arrangement. The person has assumptions here which are unquestioned. Third, by extension he is saying that making money on life or death decisions is immoral, which would mean that growing food for profit or building houses for profit is immoral. Basically, he has gone full communist. Never go full communist. Fourth, for some reason he implies that not only is government moral, but that government bureaucrats who mostly will never meet any of the patients, who are generally immune to being fired, and have no profit motive will be moral or, for that matter, give a s***. You get the idea that you could sell him a genuine Superman suit and he would immediately jump off a building so he could fly. (It's cheaper to sell him the Green Lantern ring.)

"But a single-payer, run by the government? Yeah, it's got problems, but it's also got elections, and you're going to find that out in 2018."

Well, yes, assuming you live long enough to see that election. With single-payer, good luck with that. Maybe there is some private clinic in Canada that can take you for a reasonable fee....

Kirk Parker said...

mockturtle,

"it's bad practice to wear your hospital scrubs in a public environment"

Interesting! Say more: bad from a technical, social, or other aspect?

I ask because just an hour ago I was dropping my wife off at our downtown transit center, and the line for the Express Bus to University of Washington had a lot of people in scrubs. No idea if they were students at the UW medical school, or just employees of the UW medical center.

Russ Wood said...

Competition, not government is the key. There is no personal service that I receive from government agencies that is as good as the services that I receive from private providers in competitive markets.

rehajm said...

Here's one hospital's amazingly low price list. Amazing...

Beaumont said...

Wood Said: "Competition, not government is the key. There is no personal service that I receive from government agencies that is as good as the services that I receive from private providers in competitive markets

Seems to me that the U.S.'s amalgamation of private and publically funded healthcare is leading to a reduction in the quality of care at the highest possible prices relative to other advanced nations.

rehajm said...

Health insurance as a for-profit business is immoral

Imagine the type of people who will sacrifice themselves to enter the medical profession in a non-profit model.

mockturtle said...

Interesting! Say more: bad from a technical, social, or other aspect?

Potential to spread bacteria either to the hospital or from it.

Robert Cook said...

"However, none of these observations leads to the conclusion that a Single-Payer system, i.e. a government take-over of health care, is a good idea."

How about looking at all the countries in the world where it is the norm? I've never heard of these nations' citizens clamoring for their single-payer healthcare systems to be dismantled in favor a "free market" (sic) for-profit healthcare model like ours.

mockturtle said...

Obama insisted that physicians were being 'overpaid' by Medicare and reduced their already low reimbursement rate. If this is not reversed, we won't have any doctors willing to accept Medicare patients.

mockturtle said...

I've never heard of these nations' citizens clamoring for their single-payer healthcare systems to be dismantled in favor a "free market" (sic) for-profit healthcare model like ours.

I know Canadians who have come here for medical procedures rather than endure the long wait and those I know in the UK never use the NHS.

Rusty said...

mockturtle said...
"Interesting! Say more: bad from a technical, social, or other aspect?

Potential to spread bacteria either to the hospital or from it."

Because part of my hip surgery was on medicare I had to have it in a hospital. Not a local hospital but one 15 miles away. The reason being that the surgeon controlled the operating theater and the recovery area. That whole wing belonged to his practice.All being completely seperate from the rest of the hospital.
Curious Georde can tell you what a pain in the ass infection is in this case.

Rick said...

You're supposed to be vetting doctors and vetting hospitals and knowing what an MRI costs and knowing what a CT scan costs and a cardiac catheterization – how much does that cost? And is the cost different if I have this doctor or this doctor?

This talking point is an effort to find a problem. You don't have to evaluate the provider's cost structure personally. Specialists can do this just as they do for investment funds (Morningstar) and other activities. These objections are incredibly weak and demonstrate people are using them as a justification for positions they have for reasons they are unwilling to admit to.


Health insurance as a for-profit business is immoral... You want to make money off of me.

This is economic illiteracy. Does the speaker believe doctors shouldn't be paid?

Not only is this crazy in itself it's absurd people on the left find this compelling enough to highlight.

Robert Cook said...

"Here's the collective left's understanding of How Insurance Works.

"You own a home and you do not buy ANY insurance to cover your home. The Home burns down. Leftist goes to insurance company and demands a payout - because fairness."


False. No one "understands" that a person who doesn't have insurance would have a right to claim a payout from an insurance company in the event of a disaster.

Here's how insurance actually works:

You pay an inordinate amount of your income for your monthly premiums, then you get sick with a serious illness, and your claims are denied because those working at the insurance companies get bonuses for denying claims, or your insurance is canceled because they discover you had a cold one time that you didn't list in your health history and so you are said to have obtained your (dearly bought) insurance by fraud and you go bankrupt or die.

Rene Saunce said...

It’s worth remembering amid the brouhaha over the GOP’s tumultuous efforts to come up with a replacement: Obamacare still isn’t working. Many of its most valuable achievements are not sustainable. The Wall Street Journal.

ARM disagrees, because talking point memo collective BS talking points.

Rick said...

Robert Cook said...
I've never heard of these nations' citizens clamoring for their single-payer healthcare systems to be dismantled in favor a "free market" (sic) for-profit healthcare model like ours.


Over 80% of Americans were happy with their own healthcare arrangements prior to Obamacare. Why would Cook and the left generally cite this as proof of anything given that the same was true of Americans?

Rene Saunce said...

The top largest mega insurance companies want tax payer dollars to prop them up. AKA - single payer.
gosh - what a surprise.

mockturtle said...

Cookie, that's rubbish! While I am now on Medicare, I had private insurance most of my life. I never had a claim denied and they paid the provider promptly, unlike Medicare or worse, like the VA.

Matthew Sablan said...

"You pay an inordinate amount of your income for your monthly premiums, then you get sick with a serious illness, and your claims are denied because those working at the insurance companies get bonuses for denying claims, or your insurance is canceled because they discover you had a cold one time that you didn't list in your health history and so you are said to have obtained your (dearly bought) insurance by fraud and you go bankrupt or die."

-- When did that happen?

Rick said...

Here's how insurance actually works:

You pay an inordinate amount of your income for your monthly premiums, then you get sick with a serious illness, and your claims are denied because those working at the insurance companies get bonuses for denying claims,


These are lies in support of scare tactics. This was against the law before Obamacare.

It's a shame the far left will say literally anything it deems supportive of its politics and any relationship with reality is irrelevant. It makes adult discussions impossible.

Rusty said...

Robert Cook said...
"However, none of these observations leads to the conclusion that a Single-Payer system, i.e. a government take-over of health care, is a good idea."

How about looking at all the countries in the world where it is the norm? I've never heard of these nations' citizens clamoring for their single-payer healthcare systems to be dismantled in favor a "free market" (sic) for-profit healthcare model like ours."


Anecdotal, but nonetheless indicative.
Not too long ago-five six years- my daughter and I were swimming at a hotel pool in Toronto, my wife was there for a confrence. I got to talking with a guy from Winnipeg. He was at the hotel because his flight to Chicago wan't until the next day. He was going to Chicago to get an MRI or CAT scan( I don't remember which). I surprised to learn that at that time in Canada there was a six month waiting period for an MRI or CAT scan. There being only five or six machines in the whole country. He chose Chicago because _ I don't remeber what was wrong with the guy- he could get admitted into a hospital right away. Instead of months.

The surgeon that did my hip did seven of them that day. Seven surguries 3 hips and four knees. It was one month from the time I was diagnosed to the surgery. He would have admitted me right away but I was 15 pounds overweight. I was in the hospital overnight and sent home the nexted day. I walked to the car. With a walker albeit, but I walked nonetheless. PT started that day.
I wonder how long it would take under Canadas healthcare.
Here's a thought.
How well are native americans looked after on reservation healthcare? The ones without casinos, that is.
That should be an indication of how well you'll be looked after under single payer.

Rick said...

Matthew Sablan said...
[Ds are going to be less interested in compromising in the future.]

-- Consider they literally locked Republicans out of meetings, this is probably the safest prognostication in the entire thread.


What does less than zero mean in this context? I think zero is the limit and thus the real effect is "no change".

Rick said...

Despite all the demonization of the VA actual vets generally prefer the VA to the alternatives, though you could reasonably argue that this is because the alternatives are so bad.

Vets go to the VA because it's free to them, not because they prefer the care.

Big Mike said...

I'd like to take everyone who advocates for single-payer and put them and their families under VHA care for the rest of their (shorter than expected) lives. We actually had a pretty good system until Obama and the Democrats screwed it up in 2012. God damn every Democrat to the deepest pit in Hell

Unknown said...

So elections from now on are to be single issue:

unlimited delivery of health care below cost?

And that includes free condoms, without which Sandra Fluke would die?

Kirk Parker said...

Rusty,

Ok... but where do you live, that you don't consider a 15 mile radius to be local for items of significant expense and critical importance?

Lovernios said...

Rene Saunce



Here's the collective left's understanding of How Insurance Works.

You own a home and you do not buy ANY insurance to cover your home. The Home burns down. Leftist goes to insurance company and demands a payout - because fairness.


Actually the Left's understanding is: You don't own a home. The government does. You get to live in it according to your "need". If it burns down, they put you up in a welfare motel, and put you on a waiting list for public housing. When the house is rebuilt it goes to the next person on the list, preferably an illegal immigrant, or someone else more "deserving" than you.

Rusty said...

The Fox valley here in the peoples republic of Illinois.
I have two other Hospitals and several surgury centers within 5 miles of where I live.
I had to go to St. Josephs in Elgin.

Kirk Parker said...

Rusty @ 11:14am,

Remember a few years back, when the big medical arbitrage news was the province of Alberta sending all their difficult OB cases to Billings, MT?

Kirk Parker said...

Rusty,

I'm not at all disputing the facts of your case.

I'm disputing your claim that 15 miles is "far" for a major, major expenditure. Good grief, we aren't living in Old Blighty.

gravityhurts said...

I love it when people say those old folks love sponging off medicare. The old folks don't have a choice. You are forced into medicare by the government. In my ideal world, you would purchase hospitalization insurance and pay as you go for everything else.

n.n said...

Insurance is a government-regulated business with capped profit margins. So, the problem is unlikely to originate in that area. Then again, there was the last economic catastrophe driven by Fannie and Freddie, both government entities, that destroyed more than a few Democrat-operated corporations.

Is the cost of medical care considered before or after excessive immigration (e.g. catastrophic anthropogenic immigration reform forced by social justice adventures)?

Is the cost of medical care considered before or after abortion and cannibalism of over one million Americans annually?

Is the cost of medical care considered before or after the majority of wars started, sustained, and progressed by Democrat administrations?

Is the cost of medical care considered before or after government's $20 trillion debt?

Is the cost of medical care considered before or after anti-capitalist practices (e.g. monopolies and practices) prevent cost controls and force catastrophic, recurring adjustments (e.g. depressions)?

n.n said...

It's not health care. It's medical care.

It's not affordable. It's financed.

It's not available. It's redistributed in progressive slices.

Affordability may cost less than "free".

Availability will improve with the end of [class] diversity and excessive immigration.

Reconciliation depends on rejection of the twilight faith and selective-child policy.

n.n said...

Health care reform begins with education reform, which means the public school monopolies and teacher unions that leave children behind will need to be resolved. The normalization of dysfunctional behaviors will need to be reversed. Sexual education (e.g. planned parenthood) will need to be replaced with teaching biology and religious/moral philosophy. Think of the babies!

JohnAnnArbor said...

Not too long ago-five six years- my daughter and I were swimming at a hotel pool in Toronto, my wife was there for a confrence. I got to talking with a guy from Winnipeg. He was at the hotel because his flight to Chicago wan't until the next day. He was going to Chicago to get an MRI or CAT scan( I don't remember which). I surprised to learn that at that time in Canada there was a six month waiting period for an MRI or CAT scan. There being only five or six machines in the whole country.

Canadians pay for care in America that is supposedly free in their country. In some cases, their health system actually pays for their people to go south for care!

Occasionally, a Windsor ambulance crosses into Detroit because it can't get quick care in Windsor.

(Fun riddle: which direction is that ambulance going when it goes from Windsor, Canada to Detroit, Michigan?)

Rusty said...

Hey, Kirk I was originally scheduled at a surgury center five minutes from my house.
I know in Kansas 15 miles is a jaunt around the corner , but here in the Chicago suburbs we're spoiled. There are three places in that same 15 mile radius that are just for MRIs and CAT scans. Storefront MRIs if you will. $5500 if you're covered by insurnce. $1500 if you pay cash.

Gabriel said...

Single payer will be administered by insurance companies. Most Medicaid members are in managed care now. The government pays the insurance company a premium and the insurance company pays the member's bills. The insurance company negotiates with the doctors to provider care for their members.

It is this way because the government is not an insurance company. The government can write checks when claims come in, but they cannot manage care. So even though the government pays low rates, they cannot influence utilization by members.

CMS has been, for several years, pushing for more managed care for Medicare and Medicaid, and for provider groups to be more like insurance companies themselves, with more of their compensation tied to who they treat as opposed to services they perform. If we're lucky single-payer in the US ends up like France. But the (un?)intended consequence will be that big provider groups get bigger, small ones pushed out or absorbed by big ones, provider groups acting more like insurance companies and insurance cpmpanies acting more like provider groups.

exhelodrvr1 said...

ARM,
So under your system, who determines who gets what level of treatment, and how quickly they get it? And will those decision-makers be elected, so that we can vote them out if we don't like the decision? Please make their term no more than 30 days, so that we can make sure they will be responsive to our disagreement.

Ignorance is Bliss said...

Robert Cook said...

How about looking at all the countries in the world where it is the norm.

Okay, lets look at them.

How many of them have sent men to the moon?

I didn't think so.

Gabriel said...

@Ignorance is Bliss:How about looking at all the countries in the world where it is the norm.

When people like Robert Cook do this, they present the good side of care in each nation, without presenting the bad side. Every nation that has gone in this direction has had to make tradeoffs and has had to make different tradeoffs.

And the people who would have us emulate them have no desire to fairly represent these tradeoffs.

kennymac said...

Trying to decide if Cookie and ARM are merely stupid or fucking liars.

SukieTawdry said...

How about looking at all the countries in the world where it is the norm?

Contrary to what most people apparently believe, single-payer systems are not the norm. In fact, they're relatively rare.

mockturtle said...

Gabriel suggests: But the (un?)intended consequence will be that big provider groups get bigger, small ones pushed out or absorbed by big ones, provider groups acting more like insurance companies and insurance cpmpanies acting more like provider groups.

This is happening now. Bigly.

Viejo Loco said...

For all of you (and them)and that ignoramus in so-called "scrubs" about government single payer, I have three words for yo; "National Health Service". Forget about Hip replacement, knee replacement, expensive chemo therapy. To that I add that darling "Liverpool Pathway". Look it up. "Free" Healthcare" is worth what you pay for. I believe the Chinese have said "be careful what you wish for".

320Busdriver said...

Jack Wennberg of Dartmouth and the healthcare Atlas project did determine why medicare spending per enrollee varied so much by region. It was not due to how sick people were, but the supply of medical resources available in that region that determined how much was spent. The more resourcesavailable, the more $ spent. Obama enlisted Wennbergs help in his push for reform , but in the end it was ignored as Obama wasa poor leader in the attempt to solve the problem of rising costs.

More at this link

http://dartmed.dartmouth.edu/fall13/html/from_pariah_to_pioneer/

Krumhorn said...

This is a subject on which the lefties are unfathomably 100% wrong. Not even 99%. Virtually every assumption about their solutions is governed by the impact on those least able to cope in a free market. The flow-down of those solutions so thoroughly distorts the market for the rest of us that a nasty train wreck is inevitable

And even if we were to completely solve that problem in a way that preserves the prerogatives of the rest of us, it won't be long before we get to the equal outcome/social justice arguments that paralyzes every conversation

Really, the lefties are nasty little shits who completely suck the heart and soul out of freedom. And ARM and Cook and Freder, I'm talking directly to you.

- Krumhorn

Todd said...

I will repost... Read this and this on a "better" way to solve the heathcare situation.

Hammond X. Gritzkofe said...

I think the Federal Government should start a Travel Insurance program. The Government already owns the roads. Travel would be much safer and cheaper if the Government also controlled all the vehicles.

People could still walk or bicycle on their own, but any motorized transport - car, van, train, ferry, or aircraft - would be provided by the Government.

Best thing, it would cost less. For the same monthly premium everyone could travel as much as they needed - whether to Walmart twice a week for shopping, or frequent commutes coast-to-coast.

No one would have to worry about availability or paying for travel if there were a sudden need - say. Availability and accommodation would be the same for all citizens - and for non-paying non-citizens too.

mockturtle said...

Hammond, Cookie would heartily approve, I'm afraid.

Bill Peschel said...

So we have the state and federal government imposing its regulations and insurance companies manipulating pricing to stay ahead. Let's not forget the American Medical Association, which regulates how many doctors can be trained. They were also responsible to getting legislation passed to forbid organizations from getting together to hire a doctor to treat its members (called "club doctors" I believe).

Every aspect of the system for the past six decades has been manipulated and constrained to reduce competition and increase profits. Every major group is responsible, so they all have a stake in keeping it in place.

(The same reason the politicians who killed Glass-Stegall didn't want to prosecute the banksters for trashing the economy for profit; it was the pols who caused the problem in the first place.)

This was a problem caused by both parties, and if we had an honest news media, more people would realize that.

Rusty said...

kennymac said...
Trying to decide if Cookie and ARM are merely stupid or fucking liars.

I think we established ARMs dishonesty many times over. Cook is just delusional.

People with public sector jobs think we ,who aren't paid by the taxpayer, have nothing to complain about.

mockturtle said...

People with public sector jobs think we ,who aren't paid by the taxpayer, have nothing to complain about.

People with public sector jobs usually have great benefits and generous pensions. A retired state employee friend once whined that she was afraid she might not get her usual annual cost-of-living pension increase. I pointed out that most private sector workers not only don't get pension COLAs but don't usually get pensions.

n.n said...

This was a problem caused by both parties

Case in point, while the inflated asset crisis of the early 21st century had a Democrat face, it had a Republican rump as evidenced by legislative countermeasures failing in committee. There are elements that are either complicit or clueless how to unwind the ball of yarns without forcing catastrophic anthropogenic global warming. So, they do their best to suppress the American voice through promotion of [class] diversity, redistributive change, excessive immigration, protection rackets (e.g. civil rights businesses, press), and indoctrination of captive audiences.

n.n said...

Krumhorn:

The realignments, sometimes catastrophic, are inevitable, but, more so, they are recurring with regular frequency. Every decade or so.

AReasonableMan said...

Rusty said...
I think we established


The only thing you nitwits have established is that you don't know shit about healthcare.

Gerard Grosso said...

Ah! A Deep Thought from a mentally challenged non-savant.
Nothing to learn here, move along please!

cyrus83 said...

It amazes me with the whole single-payer discussion how it never seems to occur to its proponents that the single-payer - the government - might not have the best interests of the individual in mind.

Once in a situation where the government is the single-payer for everyone without the means to pay for care out of pocket, it can impose whatever conditions it likes and there is very little recourse any individual has in the face of a negative outcome. An insurance company can be sued. The government is not going to allow itself to be sued by trial lawyers and you can bet no bureaucrat is ever going to face punishment for any decisions that screw people over short of directly ordering a patient's death.

In the beginning it would probably be something like a general nuisance regime - extra forms and referrals before getting specialist care, requiring participation in courses on government approved diet and exercise regimens, annual visits/tests to be eligible for certain things. Later as budgets get tighter they may impose unrealistic reimbursement schedules for certain procedures - say $2500 max for a heart bypass - without any concern that nobody can offer the treatment at that price without losing money, or delay payments to providers by months/years. In the end, they may even say nobody gets tested/treated for certain things until they're a certain age, and they'll probably also introduce an age cap beyond which people don't get anything aside from a nursing home, food and water, and a free death injection.

That may not all sound imaginable, but if the government did happen to impose any one of these things and they were the only payer in town, exactly what would be the recourse? Congress isn't going to care, the healthcare bureaucracy isn't going to care, the providers might give you a look that displays their disgust and helplessness, the media will bury these stories to protect their sacred utopian Hell, and if lucky you might be able to visit a third world country and receive the care you need by paying in cash.

Gabriel said...

@cyrus83:Once in a situation where the government is the single-payer for everyone without the means to pay for care out of pocket, it can impose whatever conditions it likes and there is very little recourse any individual has in the face of a negative outcome.

You say that like it's a bug, but it is a feature. There is no stakeholder in healthcare, except the patient, who does not have powerful financial incentives to favor the state of affairs you describe.

Rusty said...

AReasonableMan said...
Rusty said...
I think we established

The only thing you nitwits have established is that you don't know shit about healthcare.

However, we've established we know a hell of a lot more than you do.
You, as always, are long on vitriol but short on the actual mechanisms that make a market.

0_0 said...

I have Kaiser Permanente.

It's nonprofit.

It's THE BEST!

AReasonableMan said...

Rusty said...
short on the actual mechanisms that make a market.


There is no evidence that health care can be wrangled into something that operates like a free market. Most people are always going to want full coverage from insurance.

Gabriel said...

@AReasonableMan:Most people are always going to want full coverage from insurance.

The same is true of any other good or service. Most people are always going to want someone else to pay for it 100% if they can.

But health care is a service provided by other humans, and so you have to compensate them for their time, their time in performing the service and their time in acquiring the knowledge and experience that makes their service worth having.

Which is no different from any other service, whether it's health care, law, or plumbing.