Apparently, the California Nurse's Association is preparing to run an ad in papers on Monday arguing that with average health care, Cheney would be dead:
Washington, DC –Print ads demanding health care reform will blanket Iowa newspapers on Monday Dec. 11. The California Nurses Association (CNA) / National Nurses Organizing Committee (NNOC) are running the ads as part of a national campaign pushing for guaranteed health care coverage for all Americans through a Medicare-based system.The ad uses recent headlines about Vice-President Dick Cheney’s heart procedure to point out the difference between the government-funded health care that the nation’s leading politicians enjoy and the precarious health care situation in which most Americans find themselves.
A news article about Cheney’s recent treatment for heartbeat irregularities provides the context with the headline: “If he were anyone else, he’d probably be dead by now.” The text highlights that factors such as the patient’s history and prognosis would likely lead to a denial of private insurance claims for most Americans, assuming that they had coverage in the first place.
Is this supposed to sell their plan to progressives?
Two ways to look at this. One is that the elite (Cheney) has health insurance. If this elite were not an elite, he'd be dead. The idea is that you too can have health insurance like the elite do.
Another way to look at this is that if everyone has 'average' health care, people like Cheney will die, which is another goal of the progressives.
Nice time to note this story from Canada, then.
No, it's supposed to sell it to conservatives.
In related news, rich people live in lavish, expensive mansions overlooking scenic ocean vistas. The National Association of Realtors points out that with a government run system of house buying, we can ALL live in lavish, expensive mansions overlooking scenic ocean vistas.
Come on. The reason expensive medical procedures are expensive is because... wait for it... they are EXPENSIVE. Simply declaring they are now cheap enough for everyone to afford doesn't automagically solve any problems.
In other news, the average Californian doesn't make the $212,000 that Nancy Pelosi does. So while we're legislating that everyone gets to have the same medical care she does, why don't we just declare that everyone gets to have the same salary as she does as well. This is obviously not going to happen, because we're willing to spread around one form of wealth by fiat, but not another.
The take away from the Canadian story seems to be that it's perfectly acceptable to game the system using your social capital, but completely unacceptable to do so using monetary capital.
Both of these stories are predicated on the idea that medicine is not like any other service, and you should not get what you pay for. Maybe this is good and maybe not, but I for one am skeptical of exceptions to rules of this magnitude.
Well, it looks like Josh beat me to the punch.
So I assume your contention (since you say this in a negative manner) is that you should get the medical care you CAN pay for? Which then brings up the corollaries, those who can pay more can have more (and better) medical care, and those who can only pay less get less.
Just checking...
Is this supposed to sell their plan to progressives?
Arrow was basically right. Progressives already support universal coverage. We just differ on the details (single-payer, mandatory insurance, etc.). This ad is aimed at people who argue that the free market should determine who gets health care and who doesn't.
liberalrob,
So I assume your contention (since you say this in a negative manner) is that you should get the medical care you CAN pay for?
I'd replace "can" with "do," but broadly speaking, yes. Just as with almost all other goods and services. We might want to guarantee the availability of some minimum standard of medical care for all (as we already do), but beyond that, people are, and should be, free to purchase more and better medical care with their own private wealth. Do you disagree?
Mixner: I can't talk for Rob specifically, but what I've seen various self-described "progressives" suggest is that the "minimum standard" should be very near to "the maximum possible", rather than a real minimum.
So it's not so much that people don't agree on a provision of minimum healthcare, as much as that some think that the minimum is almost the same as the maximum, and that it's simply wrong for anyone to not get care because someone else would be coerced to pay for it; their need becomes everyone else's obligation.
The difficulty is, naturally, that others do not share this belief that a random person's expensive needs entitle them to care at the involuntary expense of others.
The main difference, as far as I can see, is that those who do not support expansive care funded by coercion do see the point that it sure would be nice if everyone had all the medical care they wanted and it was paid for by Someone Else; they just think that the coercion (not to mention bureaucratic inefficiency and inevitable rationing and deadweight loss) is not morally justified.
In contrast, those calling for coercive payment for care for Everyone do not typically, in my experience, even admit that coercion of funds to pay for their grand plans can even be a moral issue. (Some do, of course, and their arguments are stronger for having to address that.)
It all comes down to if you see healthcare as a consumer good or a basic service.
If it's a consumer good, then the analogy of health care to houses makes sense. Just as it's absurd to expect everyone to have access to the same kind of expensive, luxuriant house, so too is it absurd to expect everyone to have the same level of health care.
If you see health care as a basic service, though, a more apt analogy would be to say "Nancy Pelosi makes $212,000 and has access to clean, plentiful drinking water. The average Californian also has access to clean, plentiful drinking water."
So, is health care like a house or like municipal water? If it's like water, I'd point out that clean water isn't free or easy to guarantee, but we make the investments necessary to get it, because we believe it's an important universal good.
I want to know why nurses are spending money to advance national, taxpayer-provided UHC. Although it's a goal I share with them, it's not obvious to me what's in it for nurses (or doctors, for that matter), as it seems likely UHC would make more robust forms of rationing more likely, and this could negatively impact the incomes of healthcare professionals. Maybe I read the post too quickly and missed something.
Peter Bautista,
Health care is mostly a private good, like housing, food, clothing, televisions and most other products and services. That's why it's mostly not a proper function of government.
A municipal water supply is mostly a public good, like national defense, police protection and the interstate highway system. That's why it mostly is a proper function of government.
Mixner-
Says you. My biggest gripe with glibertarians is their conflation with positive judgements of efficiency from the science of economics with their normative judgments on public policy. In other words, whatever the market says is, should be.
Because something is classified by economists as a private good, does not mean it should be classified as a private good.
Peter, I would consider electricity a "basic service," like water. I think it's reasonable to expect the state to see to the construction and maintenance of electric lines and generation capacity, and make sure every household can keep some lights and a refrigerator and other basic appliances running.
But if I had $212K, I would be using a lot more electricity than what I consider basic, and a lot more than I do now. I'd leave some lights and the radio on for my dog when I went out, and get a freezer and a better air conditioner and leave my computer running over night. More wealth gets you more goods even when we're talking about "basic services."
Electricity (and medicine) is a basic service at a certain level, but it's also a consumer good. My view is that everyone should be able to get some, and some should be able to get more. So Sigivald seems to have hit the nail on the head: how much is the "some" everyone should get? What's the "minimal amount" of a service -- electrical, medical or otherwise -- that we want to provide? That (entirely subjective) amount is what we're going to end up defining and legislating as an objective, necessary, basic public service.
A not-very-bold prediction: For medical care, that bar is going to be set very high initially, in order to sell people on how amazing nationalized health care is going to be. And then, when the bills start coming in, that bar is going to stink very low, just like the rest of the nationalized systems. Except once it's sunk, it's going to be very difficult for people to get care above that level on their own, outside of the state system.
We might want to guarantee the availability of some minimum standard of medical care for all (as we already do), but beyond that, people are, and should be, free to purchase more and better medical care with their own private wealth. Do you disagree?
Mixner: I don't disagree. This sounds like the most reasonable thing (to my lefty ears, at least) you've written. I'm just curious, though, what you describe above could apply to Britain, say, or France, no? In either of those countries people are free to use their own private wealth for "more and better medical care." Judging from your words, I reckon the main difference between us on this issue is what constitutes a "minimum standard of medical care for all." I think America's standard falls short of an acceptable minimum. You apparently don't.
I am an observer from the future. I am dissatisfied at your inability to provide all citizens with equal access to lifesaving synthwater and neural charging stations.
The implication that progressives wish death upon Cheney is a grossly unfair slander.
I hope he lives for many more years before he dies. In prison.
"...to run an ad in papers on Monday arguing that with average health care, Cheney would be dead."
Maybe the liberals are right about healthcare after all. Evidently they will devise a system in which everyone gets above average care.
Jasper,
Mixner: I don't disagree. This sounds like the most reasonable thing (to my lefty ears, at least) you've written. I'm just curious, though, what you describe above could apply to Britain, say, or France, no?
Yes, it could apply to any country, including the United States. The U.S. guarantees a certain minimum standard of medical care just like other countries do.
In either of those countries people are free to use their own private wealth for "more and better medical care." Judging from your words, I reckon the main difference between us on this issue is what constitutes a "minimum standard of medical care for all." I think America's standard falls short of an acceptable minimum. You apparently don't.
Well, I don't know about "the main difference," but it certainly seems to be a major difference. You favor "single payer," which isn't a guarantee of a standard of care, but a drastic reform of a huge share of our national economy. But what minimum standard of guaranteed care do you believe to be acceptable, and why?
In my view, the only things the government should properly guarantee are basic biomedical research, public health measures (clean water standards, air pollution standards, mass immunization, etc.), emergency care, general health care services for the indigent and elderly, and perhaps some kind of "catastrophic" coverage for everyone else. But beyond that, it should all be private and voluntary.
"I hope he lives for many more years before he dies. In prison."
Why has Vice president Cheney become the focus of so much (impotent) rage? Everything I've seen indicates that he is doing his best to protect America's interests, and for that we owe him our gratitude.
It now seems that the Bush/Cheney foreign policy was successful in deterring Iran from continuing its nuclear weapons porgram. It certainly had that effect on Lybia.
"a more apt analogy would be to say "Nancy Pelosi makes $212,000 and has access to clean, plentiful drinking water. The average Californian also has access to clean, plentiful drinking water."
Peter,
do us all a favor, find some cites that back up your assertion: "The average Californian also has access to clean, plentiful drinking water"
also, define clean, in that context.
rickm,
Because something is classified by economists as a private good, does not mean it should be classified as a private good.
Do please explain how you think "health care" qualifies as a public good. You might want to look up the definition of the term first. I agree that certain health-related services are mostly public goods (a clean water supply, for example). But those services are not part of, or are only a small part of, the set of goods and services provided by a nation's "health care system." The vast majority of goods and services provided by a "health care system" do not remotely qualify as public goods.
Peter Bautista:
"... clean water isn't free or easy to guarantee, but we make the investments necessary to get it, because we believe it's an important universal good."
And to understand some of the consequences of the government's involvement in procuring water, read "Cadillac Desert". It isn't pretty, but it's what you'd expect.
Mixner-
Perhaps I wasn't clear. Often, I find that libertarians attach normative judgments to the positive judgments of free-market economics. In other words, the government should (thats the normative judgment) only provide things that economists classify as public goods (thats the positive judgment). So, the normative judgment on whether health care should be provided by the gov't (or subsidized, or whatever) is informed by whether economic theory classifies heath care as a private or public good.
Rickm,
My biggest gripe with glibertarians is their conflation with positive judgments of efficiency from the science of economics with their normative judgments on public policy. In other words, whatever the market says is, should be.
The reasoning behind this is that "the market" is the best (but admittedly not perfect) indicator of society's desires. It's much easier to vote for something if it's going to be paid for by other people's money. As any parent knows, those same desires mystically disappear when you have to pay for it yourself.
If the market is the best indicator of society's desires, then (assuming said indicator is effective in some way) how do you explain the near-total absence of a ideal free-market society to flourish under a democracy?
Why is the only place where a radical free market economy was ever implemented done so under a dictatorship?
rickm
Why do you think the government should provide private goods? Or is it only this particular private good, rather than private goods in general, that you think the government should provide? If the latter, why this particular one?
"Why is the only place where a radical free market economy was ever implemented done so under a dictatorship?"
Rickm,
Don't be coy, what(where) are you referring to?
Well, obviously, I don't think the government should provide private goods as a matter of principle. Nor have I ever heard anyone argue that case.
I think there are enough inefficiencies in the health care market to suggest that a third party could make the system more equitable. As of now, if you don't have health insurance, either because you can't afford it, or your employer does not provide it for you, and you are sick, you're screwed.
You can't really sell anybody not obsessed with equality on a public health-care plan by talking about what that plan will do, and at what cost: the details are too awful, and the misrepresentations, like "we'll pay for it out of the increased efficiency of government," too transparent. So you sell it by pointing out that private health care is unequal and expensive, and you hope that this will generate enough indignation that people won't notice that public health care will be worse. That's why the people most eager to have public plans, which always limit care, complain the loudest about the fact that private health insurance doesn't pay for everything someone might want.
MEH-
I think the filter blocks short comments (how else could Alan Gunn get through?) so I have to write a bunch of gibberish to answer your question (nothing new here). My reference was to Chile.
The market is the best indicator of society's priorities: what it is willing to pay for when forced to allocate scarce resources.
Society's desire on the other hand, is mostly likely to have everything provided for free with a super-size side of Swedish Bikini Team.
Or maybe that's just me projecting again.
...how do you explain the near-total absence of a ideal free-market society to flourish under a democracy?
I'm not sure what you're asking, or even if it's really intended as a question...?
Let me refine my statement:
"The market" is the best (but admittedly not perfect) indicator of society's desires for goods when they must pay for them.
Politics/Democracy is the best indicator of society's desires when they can force others to pay for them instead.
"The market" is you and I negotiating a deal to buy your land.
Politics/Democracy is me taking your land from you by using threat of force via gov't policy.
Society is better off in a macro sense if we stick to the market as much as we can. The government is often a blunt instrument at best.
...how do you explain the near-total absence of a ideal free-market society to flourish under a democracy?
Perhaps the answer is that our "democracy" has allowed the poorer majority to displace the "market" with a brand of socialism over the years (to it's advantage) and only a dictatorship can keep that from happening?
"Nancy Pelosi makes $212,000 and has access to clean, plentiful drinking water. The average Californian also has access to clean, plentiful drinking water."
Nancy Pelosi is far more likely to be drinking Evian than a poor person. A poor person is far more likely to be drinking city water that is safe but tastes kind of funny than Nancy Pelosi.
"how do you explain the near-total absence of a ideal free-market society to flourish under a democracy?"
Because the people have a short-term incentive to vote themselves bread and circuses.
In addition to Chile, British-ruled Hong Kong is a good example.
rickm,
As of now, if you don't have health insurance, either because you can't afford it, or your employer does not provide it for you, and you are sick, you're screwed.
How large is this group of people? How serious of a social problem is this? How much less of a problem would it be if some or all of this group had health insurance? Do you know the answers to these questions, even roughly?
It's hard to give any clear sense to your phrase "you're screwed," but health care services are certainly available to the indigent uninsured for free or at very low cost. Of course, just because a service is available to someone doesn't mean he will use it, and doesn't mean it will have much effect on his health if he does.
"Perhaps the answer is that our "democracy" has allowed the poorer majority to displace the "market" with a brand of socialism over the years (to it's advantage) and only a dictatorship can keep that from happening?"
And you think that is an argument for
"Perhaps the answer is that our "democracy" has allowed the poorer majority to displace the "market" with a brand of socialism over the years (to it's advantage) and only a dictatorship can keep that from happening?"
And you think that is an argument for your side?
My dad had atrial fibrillation like the Veep. He also had excellent health insurance. But here's an interesting point for you, he still would have died prematurely regardless of his health insurance, because the many cardiologists he saw (and he went to some top-notch places: Mayo Clinic, Cleveland Clinic, Johns Hopkins) considered him a lost cause because he was so old. Having great insurance is no guarantee of getting the correct treatment. Really the only way to do that is to become a crusader, which is hard to do when you are desperately ill.
And to understand some of the consequences of the government's involvement in procuring water, read "Cadillac Desert". It isn't pretty, but it's what you'd expect.
OTOH, California exists as a large, populous state that contributes greatly to the US and world economy.
Nothing is free, not water, not health care, which was my point in bringing up the analogy.
Of course there is a price to universal health care, just as there is to universal water. The question then becomes one of perspective - is it something worth paying the price for (as we have decided to do with water), or not (as we do not do with sea-side mansions).
Which is all, again, just a way of saying, is healthcare a luxury good or a basic service?
And you think that is an argument for your side?
Actually, I was just trying to answer your question logically. We can probably both agree that a dictatorship is a bad idea, but it does have some plusses in that it can get things done (or block them) quite easily.
If some dictatorship like Chile can do a better job of maintaining a good market system than our own democracy, then maybe the problem is us. But that doesn't invalidate a market system.
My argument is that, like Ralph's comment above, people have a short-term incentive to vote themselves whatever they want...and politicians have the same incentive to do what's expedient...as long as they can do so at others' expense.
And the more they vote themselves, the more they see as their "right" to have provided for them.
Peter says:
...is it something worth paying the price for?
This is the right question. I'm just saying that people will give two answers: one when they pay for it through the market, and another when it's "provided" by the government.
Historical context:
The "voting themselves bread and circuses" problem was quite well known to the folks who founded the US, and many were therefore quite adamant about wanting "a republic, not a democracy." And in early days only landowners could vote, and the Senate was picked by state legislatures rather than direct vote.
The names of our two major parties, and their relative positions on redistributionism are no accident.
It's clear that over time the way the US is run has become "more democratic" in both senses, but it is not universally accepted that that is synonymous with "better."
TakeFlight,
I believe we should have universal healthcare, but I'm open to a variety of ways of getting there (including through the market).
However, I get the feeling that a lot of people who push "the market" actually do not want universal healthcare. It's not a question of differing tactics but, rarity of rarities, an actual, substantive difference in goals.
BTW, Chile has not been a dictatorship for some time.
Peter-
And after Pinochet, many of the free market reforms were rolled back.
Not arguing they weren't, just thought it was kind of weird to see Chile referred to a dictatorship (it wasn't clear to me from context what dates were meant) Just injecting some gratuitous freelance factchecking into the thread... :-)
Honestly, I don't really know where I stand on the actual UHC issue. I was mostly responding to Rickm's gripe about glibertarians.
I suspect there are two main political camps: (1) anything is better than what I have right now, let's do something, and (2) my coverage isn't bad, so let's not f___ anything up by doing things that might have unintended consequences.
I would be in #2 above.
I would also eye any (further) government action with a very skeptical eye.
Ralph Phelan,
re: "Historical context"
I agree 100%, and it is my very real fear that as a nation we may already be too far down that path where "as soon as the individual learns he can vote himself benefits from the public treasury, he will abuse that right until the trough is empty."
What about a combination of public and private: public care for everyone, and then additional private hospital and medical services for those who want to pay for the special attention?
I don't mean to sound dense. Perhaps this is something that everyone knows would never work, but I haven't heard the arguments....
Dean,
That's what they do in the UK. The problem is that because public care is free, and private care is unsubsidized, the marginal price difference for care greatly exceeds the marginal quality difference unless you're rich enough to pay for high levels of luxury care. Thus, there is no private market for anything but luxury care.
So the practical effect is that everyone is forced into the (lousy) public system except for the very rich.
The real question with healthcare is how do want it rationed - by price or triage. If you think price should be the determinant keep your current system otherwise look at the many and varied universal healthcare schemes around the world(the US is the exception) and select the best of them.
Rob Lyman,
the UK system can't be that lousy considering it has a better child mortality than the US.
The Doctor,
The real question with healthcare is how do want it rationed - by price or triage.
They're not necessarily exclusive criteria. How about using both? That's what we do now. That's what all countries do. Even in Canada and Britain, you can get much better health care if you're rich than if you're poor.
the UK system can't be that lousy considering it has a better child mortality than the US.
It can be pretty lousy regardless of its child mortality rate. Infant mortality rate, or any other single aggregate health-related statistic, doesn't tell us anything meaningful about the overall quality of a nation's health care system.
"Infant mortality rate, or any other single aggregate health-related statistic, doesn't tell us anything meaningful about the overall quality of a nation's health care system."
>>>
So what does ultimately determine the overall quality? I suppose it's subjective to a point, depending on how you weigh certain aspects versus others. How do you all make that determination?
" "as soon as the individual learns he can vote himself benefits from the public treasury, he will abuse that right until the trough is empty."
>>>.
TakeFlight, while that is a nice aphorism, and probably holds some measure of accuracy, doesn't it amount ultimately to little more than a slippery-slope argument?
"Society is better off in a macro sense if we stick to the market as much as we can. The government is often a blunt instrument at best."
>>>>
I've heard that when the overhead and profit are taken into account, the efficiency of HMOs and PPOs is much worse than government run systems. I'll have to look it up, but I thought that was pretty well accepted.
Also, strictly in terms of a society's axiological priorities, to what extent do we want profit to be the motivating factor for health-related decisions? Sure, it saves money to deny the 29 year old woman a mammogram despite the fact that her mother and both grandmothers had breast cancer before age 45, but is that what we want as a society? Does the "government is the mafia" shibboleth really hold that much water when we are talking about preventive public health issues? I don't want the government to run my life, but on the other hand I don't want some scumbag insurance company to tell my wife that they aren't going to even think about covering something her doctor tells her she needs, especially if the cost is prohibitively expensive.
How do you best achieve patient protections and affordable coverage while avoiding an inefficient bureaucratic train wreck?
The Doctor,
I have seen it asserted, although I have no proof that it's true, that US infant mortality is high because extremely early births are given heroic measures here and often die after a day or two, while they would simply be recorded as stillborns in any other country. Again, I can't confirm that.
Additionally, infant prematurity and mortality is a function of prenatal behavior by mom, which can't necessarily be laid on the health care system. The UK's system has some serious problems, especially with elder care and infection control.
That said, my point was that Dean's idea results in a public system for most and a luxury system for a very few, not a range of qualities at a range of prices. Maybe you (and he) are fine with that, but it's important to know how things play out in the places they've been tried.
Mixner, private health care is illegal in Canada. Rich Canadians get better care because they come to the US.
to what extent do we want profit to be the motivating factor for health-related decisions? Sure, it saves money to deny the 29 year old woman a mammogram despite the fact that her mother and both grandmothers had breast cancer before age 45, but is that what we want as a society?
Is there really someone "denying" the 29 year old a mammogram, or are they just not paying for it? Can she not pony up the money herself if she thinks her risk is high? How much does she think her own life is worth?
This is a good example of why market allocation is more efficient than bureaucratic allocation. People who think themselves at high risk while young can choose to pay for screening, while others can wait until they are older. People without a family history don't waste resources when the odds of cancer are low, but people at high risk still have the screening available to them if they want. There's no need for bureaucratic rationing because people ration it themselves automatically based on their perceived risk.
I wrote a Medicaid prescription for a patient today. And?, you say. Well, I had already sent it as an prescription 3 months earlier. So is it a typo and should the sentence read: 'Under a single payor system all efficiencies (like 'getting things done') will be rung out of the the health care system.' Oh, mean water department!
There are a lot of people in the US who would answer "no" when asked "Should the government establish a system to guarantee health insurance for every American?", but would also answer "no" to the question "Should people be denied life-saving care because they cannot afford it?"
This ad is aimed at them. It's a brilliant ad, and further evidence that nurses are smarter than doctors.
TakeFlight, while that is a nice aphorism, and probably holds some measure of accuracy, doesn't it amount ultimately to little more than a slippery-slope argument?
Well I would submit that it has a much greater measure of accuracy in describing the built-in bias of democracy, and while not 100% accurate in it's conclusion it is certainly more than just a kitchy phrase.
I've heard that when the overhead and profit are taken into account, the efficiency of HMOs and PPOs is much worse than government run systems.
My thought is that the current HMO/PPO/insurance set-up we have looks more like a government run system than a private one...thus the aversion to replacing it with a more gov't one. I do think we've got to get rid of the HMO/PPO/"insurance" -based system that we have, for sure.
What about some kind of medical loan system, like our student loan system? You would be able to have access to money (isn't this the real problem?) at a nominal interest rate, thus preserving the incentives to act responsibly with life & healthcare decisions and ability to make your own choices, while being able to "afford" an expensive procedure.
All things considered, it is a good position to be in. I mean, that we actually have procedures and are able to argue about how best to fund them, vs. not even having them at all....
Mixner, private health care is illegal in Canada.
No, it isn't.
So what does ultimately determine the overall quality? I suppose it's subjective to a point, depending on how you weigh certain aspects versus others. How do you all make that determination?
In order to compare the overall quality or performance of different nations' health care systems I think that at a minimum you would need a large set of statistical data representative of all major areas of prevention, diagnosis and treatment of diseases and disorders. Of course, as you suggest, it's not just an empirical question. But you certainly couldn't produce a serious answer without a lot of empirical information. The idea that we can meaningfully rank health care systems as "better overall" or "worse overall" on the basis of infant mortality rate or average life expectancy or a handful of other such numbers is absurd.
No, it isn't.
It's just this sort of enlightening and informed dialog that makes blogging so special.
From that well-known right-wing propaganda rag, The New York Times:
The article goes on to discuss a private hospital which operates unmolested.
So private health care is illegal, but not unavailable, because apparently there is a black market which the authorities ignore.
I'm open to the possibility that the NYT is wrong here, but a link would be nice.
I am curious about the ages of those posting here.
I am 56, make a good living but doubt I will be able to afford health insurance much longer. My rates with the largest insurer in the state typically go up about 20% per year if I maintain the same deductible levels. Or I can hold my increase to merely 10% if I raise my deductible 60%. That 9 years to Medicare is a long way off.
I would imagine most of us who have lived with the system for a long time have had enough battles with the insurance companies (or been caught in the middle of provider battles with the same) to look forward to something better. Those of you who have not really needed the system yet probably feel differently. But the system is getting far more expensive and bureaucratically corrupt, so time will tell.
Those of you who are 30 need to be socking away some impressive bucks for your health care needs in 25 years. You really, really need to be taking into account not having insurance. You might laugh, but what is waiting for you (if you qualify) are premiums of about 30-40k a year with 30-40k deductibles and maybe 50k out of pockets. Unless you are an elected official, I guess.
And the point about Cheney is that he is far, far removed from being insurable, no matter the premium. People in his condition cannot get insurance, period. My 50-something business partner went over a year without insurance because he was not insurable due to high blood pressure. Sure Cheney is a wealthy guy and could pay for it out of pocket. To me his wealth is not the point, his health is the point.
It is stupid to have a society that people at age 30 should allocate the majority of their savings to future health care costs. It is equally stupid to have people in their 50's make decisions that short change their health significantly in order to keep their home or send their children to college. But that is what should and is happening now in the US, but not in France and Japan.
I cannot imagine how this makes us a better society.
How are uninsurablity and high premiums for people in high-risk catagories surprising or shocking? If your house burned down nearly every year, your homeowners premiums would be high, too.
It is stupid to have a society that people at age 30 should allocate the majority of their savings to future health care costs.
So instead we should have a society where people in their 30's should be prevented from saving because a huge chunk of their income is taxed away and allocated to health care for people in their '50s?
How are uninsurablity and high premiums for people in high-risk catagories surprising or shocking? If your house burned down nearly every year, your homeowners premiums would be high, too.
It is stupid to have a society that people at age 30 should allocate the majority of their savings to future health care costs.
So instead we should have a society where people in their 30's should be prevented from saving because a huge chunk of their income is taxed away and allocated to health care for people in their '50s?
Rob Lyman,
In Canada, private health care that duplicates the services provided by the public system is, or at least may be, technically illegal. Private health care that supplements the public system is not. And as you note, even the law against private health care that duplicates the public system is widely unenforced.
And I say "may be" technically illegal because since the Chaoulli ruling by the Canadian Supreme Court, the status of the ban on duplicate private services is unclear. It appears that the ban is unconstitutional, at least in Quebec and possibly throughout the entire country.
So instead we should have a society where people in their 30's should be prevented from saving because a huge chunk of their income is taxed away and allocated to health care for people in their '50s?
No, we shouldn't have that either. Who is arguing that we should have such a system?
Mixner,
The ruling dealt with private insurance contracts rather than actual care, which I must admit made me wonder if the NYT saying "private care is illegal" was confusing "care" with "insurance."
Brooksfoe,
If most of my savings is going to be dedicated to health care (what's wrong with that, BTW?) when I'm 55 (why don't I have a job when I'm 55 to help cover these costs?), and you want me to pay for the care of people who are 55 now, then you're going to have to tax away much of those very savings to cover those costs.
Unless, of course, health care today is vastly cheaper than it will be when I'm 55. That's an argument I haven't seen. Alternatively, we could drastically ration care for people over 55. That would certainly make it cheaper.
Fundamentally, people who demand "affordable" insurance when they are in high-risk catagories or with pre-existing conditions aren't asking for affordable insurance. They're asking for somebody else to pay for their health care.
When what they should really do is just not be in a high-risk category and not have a pre-existing condition; then they could get insurance and be covered. What is wrong with these people? Can't they see that the market is telling them, don't be sick? Why should it be any responsibility of mine that these people are willfully ignoring the warnings?
Of course, I'll never be 55, and if I am I'll be fabulously wealthy because of my brilliant career choices and frugal savings plan, so if I were 55 and I did become ill I wouldn't need insurance. Why can't everyone be as successful and frugal as I am? Why should it be my problem if they aren't?
What a philosophy.
This is what happens when I have to work way late Friday night to rush a project to completion: I miss out on gems like Mixner's, here.
Astounding. So my ability to get treatment for my (insert major medical problem) should be exactly like my ability to buy a nice house vs. a crummy one, or a big 1080p plasma TV vs. an old 19-inch CRT model. If I can't afford a big house, I don't get to live in one; similarly, if I can't afford drug prescriptions, lab work, and the odd recurring office visit for monitoring, I don't get to live, period.
Just boggles my mind.
liberalrob,
You're totally missing the point. I make no moral judgments about people who are sick; I'm just pointing out that the fact that insurance is expensive for those who are sick, or old and therefore likely to become sick, is predictable. Your premiums must cover the average cost of people like you; if you consume a lot of care, then your premiums will be high unless you can get somebody to subsidize you. Duh.
Nat doesn't want "affordable health insurance". He wants somebody else to pay for his medical care. Now, maybe it's a good idea to have somebody else pay for his care, fine, make that argument. But don't say I'm a bad person for pointing out that such a plan requires you to take money from those other people.
If I can't afford a big house, I don't get to live in one
Well, actually, aren't we all holding our breath to see how this one comes out....?
the fact that insurance is expensive for those who are sick, or old and therefore likely to become sick, is predictable.
It's only predictable after you've gotten sick. A national health insurance system takes as the moment of moral choice the point before you know whether you're going to be a sick person or a healthy one (i.e. birth). This is a basic Rawlsian concept of fairness: you should design the system without knowing whether you're going to be a sick person or a healthy one.
On the "old" count, we have a philosophical difference as to whether it is the responsibility of the young to take care of the old. Perhaps I've been in Vietnam too long and have absorbed too much Confucianism, but it seems to me that my Jewish heritage also teaches me that, yes, it is the responsibility of the young to take care of the old. I don't think we ought to socialize the national responsibility to ensure that the old can go on Yucatan cruises. But we should socialize the national responsibility to ensure that the old get bypass surgery, so they can live another ten happy years rather than dying.
This is especially true since, while old people get the bypass surgery, young people perform the bypass surgery, and are paid for it. The US does need to restrain health care cost inflation, which is out of control, but it's also important to remember that the health care industry is an engine of economic growth. I don't see why having a part-private universal health insurance system pay for that industry makes any less sense than having a part-private non-universal health insurance system pay for it.
we have a philosophical difference as to whether it is the responsibility of the young to take care of the old.
I don't think that's true at all. I'd say it makes sense for the healthy and able-bodied to take care of those who can't take care of themselves, which includes the elderly.
I don't consider 55 elderly (and that's where we came in, with Nat), though, and in most cases a 55-year-old should be able to provide for himself.