OH, WELL IN THAT CASE…

Whenever conservatives complain that government-run health care would result in someone interfering with decisions that should be made by patients and doctors, limiting individual choice, and restricting or rationing access to certain kinds of care I ask the same question: What the hell insurance do you have? Because my insurance company does all of that, and then some. And over my working life I've had insurance (HMO, PPO, hybrid) with several large providers (Aetna, Humana, BC-BS) and this was true of all of them. There was a rule book. There were gatekeepers. There was ruthless cost cutting. And the restrictions on doctors and patients imposed by the insurer were too numerous to count.

It forces one to wonder; if this hypothetical Freedom is so important, why does the name tag of the person interfering with it matter? Why is it the worst scenario imaginable for a Government Bureaucrat to tell you that you need a referral to see a specialist but a victory for the glorious free market when the functionary imposing that rule on us works for Wellpoint? The distinction seems beyond meaningless.

We see the same thing unfolding as Republicans in Congress roll back nearly every regulation intended to protect privacy on the internet. The worst thing Joe Trump Voter can imagine is The Government invading our privacy. But if Comcast wants to do it and then sell access to your private information (including potentially to the government, of course) then…hurrah for capitalism?

Anti-government invective paired with pro-business propaganda has produced some monumentally strange results in the belief systems of many Americans.

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64 Responses to “OH, WELL IN THAT CASE…”

  1. Rich S Says:

    I never get a response to that question. Do you? Do they ever answer?

  2. sad Says:

    "It forces one to wonder; if…"

    Dude… They're just trying to win.

  3. carrstone Says:

    'Restrictions', as you call them, are an expression by an insurer of how he defines his product and how he wants to sell it. If we had a perfect capitalist world, you would be free, as a consumer, to buy from Anthem or another supplier, just as we were promised. Oh wait …

    The bureaucrat administrating the 'process' on behalf of Anthem is dependent on the success of Anthem for his job, the bureaucrat administrator working for the government, like some university professors, has tenure and goes home at 5. Or can be found at some junket having his photograph taken in the bathtub while swilling his fave tipple.

    In Anthem, are there bureaucrats with a power complex? Sure. You already know the answer to that question when it's asked about government employees [and some university profs], don't you?

  4. wetcasements Says:

    Health insurance bureaucrats don't cure cancer, doctors and nurses do.

    Single payer means we'd spend half as much for over twice as much care, and life and death decisions wouldn't involve bureaucrats.

    All problems solved. Single payer is where we're headed, like an honest-to-Jeebus actual first-world nation.

  5. Juz in Oz Says:

    The horror of the US health system has us Australians alternating between hilarity and grief.
    Every Australian taxpayer pays a Medicare levy of 1.5% on their taxable income.
    Every and I mean EVERY Australian has access to free healthcare. There is a private system, and private health insurance which covers you for the things Medicare doesn't – dentistry, physiotherapist and much else.
    You get cancer?
    You're in a ward, you get an oncologist, you get your treatment and you go home. (Breaking Bad couldn't be set here…!!)
    You slice your hand open in the kitchen? You go to ER and they fix it for you FREE OF CHARGE.
    You're injured on the road?
    Oh we have the Transport Accident Commission, paid for with our car registration – about $600 a year, and if you're in a car, a motorbike, a bicycle, a bus or on foot, YOU GET TREATED FREE OF CHARGE.
    I had brain surgery ten years ago and the only expense was $12 for car parking.
    Medication I pay $14 for costs over $100 in the US.

    you guys really need help.

  6. Talisker Says:

    An honest answer to the question posed by Ed would be that if you're filthy rich in the USA, you can get exactly the treatment you want, exactly when you want it. This is not necessarily so in single-payer health care systems, which tend to allocate care on the basis of clinical need.

    To many Republicans, the interests of the filthy rich take priority over all else (see also: tax policy). For those who are themselves billionaires, this makes sense, but they are a tiny minority. For the rest, some may believe they themselves will be wealthy one day, others may have a sort of serf mentality that the rich really are Superior and Deserve To Rule over people of lesser wealth.

    @Juz in Oz: Yes, exactly. My experience of the Canadian and UK systems is similar.

    For family and professional reasons, I could move to the USA and have a pretty good life there. But I refuse to risk the healthcare system. Obamacare or not, good employer insurance or not, I won't take the risk it's going to bankrupt my family and then kill me. I'm sure I'm not the only one.

  7. Aurora S Says:

    I don't get how Americans have this silly notion that health insurance companies have *anything* to do with health. They're banks, and nothing more. Their sole purpose is to finance your treatment. Unlike buying a house or insuring a car, you have no choice in whether or not you will get sick and die. Everyone will, full stop. There is a word for taking advantage of that fact while preying on the human instinct of self-preservation: it's called "profiteering".

    Alright, Mr. "Perfect Captitalist": say your kid gets leukemia. Will you look at yourself in the mirror and blame yourself for not preventing your kid's cancer enough? How about for not being rich enough to cover the cost of treatment? Not living in a place with more abundant or convenient health insurance options? Or maybe you'll say, "Humanity will be stronger if my kid dies anyway, because he won't get a chance to breed, and Survival Of The Fittest." Because by choosing any other option, we might commit the cardinal sin of interfering with private business, and it's better to let that miraculous invisible hand of the market slit your child's throat than to risk something so ghastly.

    For the irony-deficient among us, something to think about: Australia is a former prison colony to which, for example, triple axe murderers were exiled–and the people think the US's health care operation is cruel and brutal.

  8. Aurora S Says:

    @Juz in Oz, Talisker —

    The problem conservatives have with programs like single-payer healthcare is not "choice"; it's "equal access". "Choice" is a euphamism. They don't think that everyone deserves equal access, and they believe that health is a privilege, not a right. The idea of a level playing field terrifies them. To those accustomed to privilege, equality feels like oppression, after all.

  9. Talisker Says:

    @Aurora S: Yes. The feudal mentality extends downwards as well as upwards. Never mind that we could all have better healthcare at lower cost; it feels good for me to compare my dysfunctional care with yours, which is even worse.

    It reminds me of a scene in the novel Good Omens, in which Aziraphale tells a televangelist's audience something to the effect of: "You won't be up in Heaven looking down on the unbelievers dying on the parched and radioactive Earth below… if that's your idea of a morally acceptable time, I might add."

  10. Well paid socialist Says:

    What the Republicans don't like is that if "government bureaucrats" made as big a mess of health care as insurance company bureaucrats do every day, it would be a political issue. Don't like your government bureaucrats? Vote for somebody who promises to make it better. Don't like your insurance company bureaucrats? Get a better job, you lazy bum! Or complain to your HR department. They love that, and absolutely won't put you on a list to cut when it's time to make the shareholders happy.

  11. TheDr Says:

    Interesting article about Pharmacy Benefit Managers and the hidden costs this additional level of "free market" goodness adds to the health care system. It's long but worth the time.

    http://prospect.org/article/hidden-monopolies-raise-drug-prices-0

    But if an unaccountable government bureaucrat imposes moderate inconveniences on the provision of healthcare, the pitchforks come out.

  12. geoff Says:

    All the whining over the ACA about 8 years ago cracked me up. OH NOES HE SAID IF U LIKE UR DR. U CAN KEEP UR DR. BUT NOOO!! I was like, have any of you people ever HAD insurance? I had employer provided health insurance (in the USA, you crazy foreigners with your crazy single payer systems) and it was ALWAYS changing. (Did you get the proper referral? Is that specialist In Network? No? Sorry, we won't be paying for that.) And the premiums were always going up, and the deductibles were always going up. The ACA is unsustainable? The whole goddamned jerry-rigged Rube Goldberg "health care" system is unsustainable.

    @katydid, very sorry to hear about your sick friend yesterday. And it makes me angry that Republican talking points trump (ha) so many people's experience that we are unable to come up with a humane health care system in the richest fucking country on the planet.

  13. Major Kong Says:

    If you drill down far enough in any conservative/libertarian argument you'll eventually get to "poor people just need to die".

  14. democommie Says:

    @ Major Kong:

    Not until we get whatever we can out of the ones that deliver goods and labor. It reminds me of a gentle sorta "Arbeit macht frei".

    I was just googling to make sure that I had the German right and came across this completely unironic bit:

    https://www.google.com/webhp?sourceid=chrome-instant&rlz=1CAACAY_enUS730US731&ion=1&espv=2&ie=UTF-8#q=arbeit+macht+frei+walmart&*

    I was just going to put a link to the photo, but it's even weirder witht a little context.

    Walmart + "Arbeit Macht Frei" image = entire GOP healthcare and labor strategies.

    "'Restrictions', as you call them, are an expression by an insurer of how he defines his product and how he wants to sell it."

    Really? Is it possible, even for a Randick like you to be that fucking stupid?

    I've had a number of healthcare plans and not one, EVER, announced in an ad that they would not be covering a list of procedures, medications or medical devices. Not one of them. Ever.

    Go find one, putz. Bring it here. Show it to us. Or shut the fuck up.

  15. Tim H. Says:

    I read somewhere that societies with single-payer healthcare saw more people starting businesses, since they wouldn't lose access to medical services by leaving becoming self-employed. I'll take that to mean the suppression of human potential is a conservative value.

  16. Juz in Oz Says:

    This thread is just incredible. All y'all are arguing over this insurance company or that, single payer vs whatever, and you don't get how badly you have screwed yourselves.
    What the hell is wrong with you?????
    All over the world, people are paying a little extra tax and have FREE GODDAMN HEALTHCARE, and you lot with your American Exceptionalist brain fart, are still arguing?????
    I HAD FUCKING BRAIN SURGERY AND IT COST ME NOTHING.
    I GOT HIT BY A CAR AND IT COST ME NOTHING.
    it is very fucking easy: everyone pays a little extra tax, and everyone has access to healthcare.
    Someone please, PLEASE tell me what is wrong with you and your country that you can't get your heads around this.

  17. Safety Man! Says:

    I've got an ex-Army friend that drank way too much of the koolaid about the freeloaders, yards yada whatever. He also has a special needs daughter. I have no idea why he can't grasp that the person they want to cut is him.

    He is also the same one who was gushing about Putin during Obama's presidency, so I guess you can't fix stupid.

  18. Jestbill Says:

    I really wish someone would stop and talk to HS students about the invisible hand.
    Y'see, if business owners ran their businesses and dealt with customers, the invisible hand *might* work–might be a reasonable concept.

    But once the business gets a little bigger, so the owner is a coupla steps above and away from customers, everything changes. Boss tells regional manager to accomplish some task, RM tells unit manager to do it locally, Boss is not responsible if doing the task is illegal, wasteful, or stupid.

    If unit manager can move up the chain before the S hits the F, he'll be home free.
    Invisible hand becomes fig leaf.

    What's wrong with our country? LOL! Everything! Wanna make something of it? HuH?

  19. Talisker Says:

    @Juz in Oz:

    "The shop is the way it is because it is the way it is. If it wasn't the way it is, it wouldn't be the way it is." — Bernard, Black Books

    Really, it's not that mysterious. Tradition, vested interests and fear of change.

    The nearest equivalent I can think of is the British system of government. It's the only country without a written constitution. Instead it has a tangle of legislation, precedent and unwritten custom, with endearing features like people with seats in parliament by hereditary right. The whole thing is utterly illogical, held together with string and duct tape, and changes fundamental rules on the fly in a process closely resembling Calvinball.

    Why is it done this way? Because that's the way we do it here, and we don't need any newfangled ideas from Johnny Foreigner, thank you very much.

    (As previously noted, I'm of Canadian/UK origin and find the US health system as horrifying as you do.)

    @Tim H: It's better understood as a feudal mentality than a capitalist one. Efficiency is irrelevant, what matters is maintaining the hierarchy.

  20. Heisenberg Says:

    @Aurora: "To those accustomed to privilege, equality feels like oppression"

    Nice.

  21. postcaroline Says:

    @Juz in Oz – I didn't see this thread as people arguing over the virtues of single payer vs whatever. It seems to me just about everyone agrees that single payer is the desirable option and the prevailing US system stinks out loud. The "arguments" are more like people debating why single payer is scary to *other* people.

    And yes, I think for any of us in the States who are not so wealthy as to have a choice of practitioner irrespective of an insurance plan (i.e., most of us), it is hard to imagine how a government-managed system could be worse. One of the other "nightmare scenarios" I've been told about single payer systems is you can't get care when you need it, you have to contend with long wait times. Recently my infant daughter was referred to a specialist for a consult. When I scheduled the appointment, I was told the first available slot was in four months…eventually I was able to get an appointment sooner by agreeing to travel to PEORIA (shudder).

  22. Ten Bears Says:

    I am a little tired of Kool-Aid drunken tirades from both the Retards and the Weasels about how great “insurance” is… in concept. That’s not how it works in the real world. Pooling of risk is a canard. Just as banking is no longer the local blacksmith harboring the villagers’ meager coinage, insurance, this “pooling of risk” bandied about by both sides, is not the villagers kicking one of their meager coins into a pot at the blacksmith shop “just in case.”

    The banking and insurance we now enjoy stems from when goldsmiths began hording the villagers’ meager wealth, including the pot down at the blacksmith shop that all the villagers kicked a coin to “just in case.” And we are all – though we boomers moreso than most – as conditioned to accept this as right and proper as we are conditioned to resent it.

    “Pooling the risk” is as thoroughly a canard – a talking point, a dog-whistle – as “faceless government bureaucrat between you and your doctor.” The faceless bureaucrat between you and your doctor is not a public servant, the faceless bureaucrat between you and your doctor is an insurance company flunkie most likely making two dollars a day in a country where labor costs are low because their government provides single-payer universal health care.

  23. Major Kong Says:

    @Juz in Oz

    Yeah, but you live in a civilized country.

  24. Tim H. Says:

    Talker, would that explain why so many civic monuments are phallic?

  25. Rugosa Says:

    "Why is it the worst scenario imaginable for a Government Bureaucrat to tell you that you need a referral to see a specialist but a victory for the glorious free market when the functionary imposing that rule on us works for Wellpoint?"

    It's simple, Ed. When health care is paid for by an insurance company, the company – and its highly paid CEO – make money. Publically funded health care doesn't do any good, since it doesn't make a few people rich at the expense of the many. Privatized health care that is expensive and hard to obtain is two treats in one – makes money for a few and causes suffering to the unwashed. The latter is a perk for capitalists; it makes the money all the sweeter.

  26. Matt Says:

    One word: PROFIT

    Denying people health care to stay within budget is "GUBMINT OVERREACH", but denying it to people so the CEO can buy moar hookers and blow is the holiest sacrament in the GOP's religion.

  27. swkellogg Says:

    At some point all the platitudes and Luntzian language bending are going to ring hollow. For many reasons (environmental, automation, etc.) we are rapidly approaching the tipping point where no amount of propagandistic double-talk about "freedom", "free markets" and the like is going to quell the anger that comes with the realization that those who wield power have you in lockdown and are engaging the means of your extermination in the name of profit maximization (all in service of their own misguided ideas about self-preservation). To this end, trump may actually be doing us a service insofar as his huckster-cum-POTUS routine of governing through slogans promising simple solutions to complex problems is being revealed for the fraud it is by his daily displays of gross incompetence.

  28. GunstarGreen Says:

    The nametag matters because a Government agent will, barring cases of corruption, tell you to get in the back of the line no matter how much money you have. The Aetna/BC-BS/Anthem agent will gladly skip you directly to the front of the line if the money's good enough, and won't even feel that subtle twinge of having done something improper.

    Basically every "problem" with single-payer stems from the fact that single-payer treats EVERYONE and treats everyone the same. The American healthcare system is only "the best in the world" if money is no object and you can just keep throwing dollars at your particular problem. The right-wing talk radio favorite phrase for this is "people come from all over the world to use our health system!", conveniently neglecting to mention that those people are able to do such a thing because they have so much money that it is nothing to them to drop whatever they're doing, abandon their job/life for six months, and fly halfway across the world to pay entirely out-of-pocket — all on their own dime.

    Suffice it to say, the average American citizen can't do that.

    "Muh Freedom" is just the quarter-assed smokescreen thrown up to placate the rubes for whom "because freedom" is a short-circuit for any and all critical thought.

  29. c u n d gulag Says:

    Juz in Oz,
    All, and I mean ALL, problems in America, stem from bigotry.

    So, all problems relate to racism, misogyny, xenophobia, homophobia, and religious intolerance.

    But mostly, it's all about racism.
    Too many of our white people – and especially, uber-"Christians" – are pissed-off that brown people are now legally the same as them.
    They much preferred the old 3/5ths of person days. When black people knew their place and had no rights, and women didn't either!

  30. Prairie Bear Says:

    @ Juz in Oz: See, what you don't understand is, if you hadn't had that system and known you could get things treated for free, they wouldn't have happened anyway. You would have been more careful in traffic and not gotten hit by a car in the first place. And you would have taken better care of your brain. Somehow. And not needed surgery.

    OK, that was snark, hope that was obvious, but that is actually one of the arguments that gets used here, is that insurance will make people more careless.

    Also: this is pretty much in the category of preaching to the converted, but I'm trying to share this film "Healthcare at the Tipping Point" around to get more people watching it. It's just an hour long and is great. At this URL: http://fixithealthcare.com/

  31. Safety Man! Says:

    @GunstarGreen

    One of the biggest red flags related to your post is the TSA precheck. If you pay the TSA enough money, they will in fact give you preferential treatment as a matter of policy. I can easily see a speedpass version of single payer if we're not careful.

  32. Major Kong Says:

    I think there was a Simpsons episode where they went to Canada.

    Homer goes: "Woo hoo! Free health care!" and runs in front of a bus.

  33. Aurora S Says:

    @Safety Man!

    They have something similar within healthcare now– they're "membership plans". You have to pay a membership fee directly to your doctor's office in order to maintain your status as a patient. This is irrespective of insurance. I used to work for a doctor in which they had membership patients and regular patients, and the membership patients could be fit in whenever, but the regular second-class patients had to wait, sometimes months. In reality, there were almost always reserved membership appointments free, but they were reserved for the membership only. When people would protest about it taking so long to see their doctor, we had to encourage them to sign up for the membership program. You can imagine how well that went over. You could count on being screamed-at about how "this is Obamacare".

    Eventually, the practice became membership-only. This is not an uncommon practice around the D.C. area. What about the people who don't have the money to pay an extra few hundred dollars a year just to be able to see their doctor, you ask? Well, they either try to find another practice that doesn't have a membership program with doctors that take their insurance, or they go to urgent care (which is more expensive).

  34. J.D. Says:

    @Carrstone

    Competition in markets only works where there is an effective market. The health insurance market isn't one, for two reasons. First, we have largely agreed that everybody has a right to be provided health care when they need it, regardless of whether they are willing or able to pay for it. This means that sitting out of the market either isn't an option (under the ACA) or shunts the costs onto others (pre-ACA), both of which heavily distort the market's incentives. Second, health insurance is an incredibly complex product, and the consumer doesn't have anywhere close to perfect information on it. Most consumers choose insurance based solely on premium and deductible, which means insurers are free to fuck with the other qualities of the insurance in a way that hurts the consumer.

  35. mothra Says:

    What you also leave out is that fighting insurance companies for coverage for needed healthcare is exhausting and debilitating for someone who is already ill. Plus, if you are not very well educated, you may not even know you CAN fight the insurance company, much less know what to do, what letters to write, etc. So you just die.

  36. sheila in nc Says:

    @ Juz in Oz and others,
    Don't forget that we have allowed the price of health care and drugs in the US to climb to heights unseen in any other part of the world. It's expensive enough to get sick/injured in America that we are way beyond the capability of just a small tax to cover the costs. Perhaps we could have managed it 30 years ago, but not right now, not until we've "bent the cost curve" a little more.

  37. democommie Says:

    "All, and I mean ALL, problems in America, stem from bigotry."

    I've been thinking this for decades and saying it for at least the 15 years.

    What's utterly bizzare is that I have hispanic, asian, african and good ol' whitey blood running through my family and EVEN the minority partners seem to think racism is just not all that–becasue they HAVE been assimilated. And there may also be a modicum of, "Do not call attention to yourself", at work. It's fucking ridiculous.

    "Homer goes: "Woo hoo! Free health care!" and runs in front of a bus."

    And it's run as a documentary at RepuKKKliKKKlan Congressional health care planning seminars. Okay, I was kidding. There are NO RepuKKKliKKKlan Congressional health care planning seminars.

    "One of the biggest red flags related to your post is the TSA precheck. If you pay the TSA enough money, they will in fact give you preferential treatment as a matter of policy."

    And we all know one group that has money to burn; the Saudi Oilgarchy has oodles of cash and lots of raffish looking young tribal/business scions who like to travel all over, expeshly to U.S. cities with tall buildings.

    What could go wrong with that policy?

    "Eventually, the practice became membership-only."

    At which point it became tiered membership? "Oh excuse me sir, your perforated ulcer/ruptured appendix/cholera/necrotizing fascitis is going to be seen in about 3 weeks, unless you're a PREMIUM member. Oh, you'd like the upgrade? Excellent!".

    The other feature of it becoming COMPLETELY membership is that–guess what?–you won't be seeing Dr. Whosis (he's at a "Flip that hospital" program in the Marquesas) but Dr. Mshsqmaskwunuzzicello, a graduate of the Somali National University of Medicine, accredited by, um,ar;dkf[oa;xkadmfmadoikg/f; /. Just put on that lovely DKNY johnny and he'll be right with you. Oh, I'm sorry, you DO speak Somali? No? Well, fortunately for a slight additional charge we will provide a NT (Nurse Translator) to help you in understanding your care options.

  38. Mo Says:

    [fresh from taking a break to chew the carpet after reading JuzInOz]

    We can't have nice things because 62 million of us are stupid and can vote. It's as if the USA has an ass wart so big it has to be dragged around in a little trailer.

  39. democommie Says:

    @JD:

    I'm virtually certain that Clappstrain gives somewhat less than a fuck about whether any of the people that aren't HIM get jack shit. Sorry, I know you try to humanize him, but it's just not really possible.

    Now, if he were to get hit by a car and have some employee from a nice for profit ambulance firm remove his wallet and its contents (because he's so poorly paid that thievery is a sort of "employee incentive program") then delivers him unconcious to the nearest ER instead of a much better trauma center a few miles further on–because they give him a "taste" every onecetinawhile.

    He's examined by a NA (Nurse Accountant), who determines that his injuries are not life threatenting, but his lack of money IS threatening to the company's profit, so he's bundled off to the local "free clinic" where he contracts a urinary infection, decubitis ulcers–and tuberculosis from a patient who is mis-diagnosed as a COPD case–all of which are treated with ibuprofen. After he dies, he realizes what a fucked-up load of shit it is to be happy when others, less fortunate, are treated as disposable. Too bad, so sad, maybe in his next life–if he doesn't come back as slime mold–he'll get it right, the being a human part.

    I know it's a sad story and I'm an evil fuck. I can live with that.

  40. Mo Says:

    Do you suppose there's an alternate universe where, upon passing of the Universal Medicare and Guaranteed Basic Income act, the body of Reagan is exhumed, a wooden stake is driven through its chest cavity, then hanged and set alight over Rockefeller Square while crowds roar and drink free beer from the tanker trucks in place for the occasion?

    Anti-government invective paired with pro-business propaganda has produced some monumentally strange results in the belief systems of many Americans.

  41. Reilly Says:

    @ Sheila – I'm inclined to see at least some of those costs as originating from structural aspects of the very system we're seeking to change, rather than fundamental aspects of the care itself or of the population being treated. In other words, make the changes, and the costs lessen or disappear.

    What springs to mind for me is patent abuse (particularly the tactic of making tiny, clinically insignificant incremental improvements to existing meds in order to gain an extended term of protection). Or the massive overhead associated with multiple private insurers, all with their own multiple layers of administration.

    Higher costs may even owe to the very concept of treating health care as a "market" when it can never truly function as one, because it doesn't lend itself to no-action alternatives. I'm sure IKEA would love to get $500 for a basic bookshelf whose raw materials cost them $30. But IKEA knows you can get along without that shelf. And the $80 sale that actually happens helps them a lot more than the $500 sale that never will, or the $200 sale that *maybe* might. This price-balancing function simply does not exist when the no-action alternative is "keep feeling like shit and/or die" instead of "go without a bookshelf".

    In a health setting, even mid-grade compromise alternatives (// buying a used bookshelf on Craigslist) are limited in their applicability. You might suck down some ibuprofen for a badly turned ankle or recurring headaches, but a broken leg is a broken leg and needs intervention. And even the headaches, if they persist long enough, might be worth getting looked at for the sake of identifying some larger, underlying problem…

  42. Land_planarian Says:

    Hell, I'd go a step farther and argue single payer is more likely to give you meaningful competition between providers.

    Right now, I can barely chose my doctor from the handful in-network on the insurance my job chooses. In a system like California is trying for now, where everyone gets the same plan, I could choose doctors because they were recommended to me, had the shortest wait times, were fluent in a language I needed, were closer to my house, whatever.

    If I got a doctor I didn't like, it might be some hassle to get a new one, but I wouldn't have to freaking change jobs or pay 100% out of pocket to get away from them.

    What we have now puts the cost-saving incentives in the hands of totally different people than those of us dealing with the quality of the product. It's the worst of all possible worlds.

  43. sheila in nc Says:

    @ Reilly: I'm sure you are correct. My only point is that with so many years of allowing health care to serve as a profit center, there will be political and economic pain — lots of it — when we try to turn that around. One person's waste/fraud/abuse is another person's take home pay. I remember that point being made during the original ACA discussions.

  44. Reilly Says:

    @ Sheila – Sad but true. There is indeed a constituency for every inefficiency, as this piece on pharmaceutical benefit managers also illustrates.

    http://prospect.org/article/hidden-monopolies-raise-drug-prices-0

    I wish I had a better background to speculate about what could / should be done to buffer the shocks associated with sudden change…

  45. democommie Says:

    @ Reilly:

    "Or the massive overhead associated with multiple private insurers, all with their own multiple layers of administration."

    If there was a hell, and I ran it (which is why there is no fucking way it exists) I would have a special place for the "form police".

    They would, of course, be in flaming shit, up to their necks. Their bodies would be covered with suppurating sores, burst blisters streaming unspeakable ooze and imps (or, just chiggers–they may be worse, actually) continually prodding them with their little pitchforks. And being up to their necks in shit? That's only for their "tea interval".

    In the event, those things are NOT the punishment. The punishment is that they have to fill out forms FOR FUCKING EVER. Forms which are always missing pages, having blocks that are far too small to write in and are, devilishly, actually deemed obolete by the time you get to page 11,471,093,852,774,932, where you will also be informed that regardless the color of ink in the pen you used to fill out the form, it is WRONG!

    I actually had warm thoughts when I finished that.

    My experience with the VA is that I sometimes don't get what I want. I also don't always feel like my caregivers are paying attention to what I'm telling them. I don't always get "cadillac" health care delivery; at times it feels Yugo or even Trabant level.

    I have had similar experiences with all but one health care delivery system that I dealt with when I paid for my coverage (out of pocket or in the form of my wages being used by my employer to pay for it).

    The noticeable difference to me, between those two systems? I don't pay for VA care. Here's another bonus. I very rarely deal with people who aren't qualified to do their jobs.

  46. democommie Says:

    "I wish I had a better background to speculate about what could / should be done to buffer the shocks associated with sudden change…"

    Well, we could tell them that they can go on teh WELFARE for, like, 18 months and go back to school to learn a useful trade (for a shit paying job) while they're eating whatever they can get on a $70/month EBT and good luck with the daycare thing.

    Nah, not for the cubidrones, that's the program for management, fuck those other people.

  47. Safety Man! Says:

    @Aurora S

    That really explains so much. I live and work around D.C. and just had a conversation with another transplant coworker this very week about how bad the doctors are here. Obviously we're just not part of the clurb…

    To you and anyone else trapped in the area, we should all meet up for, what else, gin and tacos sometime.

  48. Older Says:

    Juz in Oz, I live in the US.

    I have coverage much like yours. I can go to whatever doctor I choose, including naturopaths, I get treated promptly (except when, as has happened, medical science doesn't know what to do with my apparent symptoms), my husband had brain surgery and I think the total cost to us was about $100. I do get the occasional bill, but that's because I have opted for some out-of-the-way treatments.

    It's true, I do pay a premium for this, but so do you (that's your 1.5% of taxable income). My premium is a little higher, but not all that much. Oh yes, and emergency room visits, instead of being the budget breakers they are for most Americans, are Completely Free. And can be, and have been, accessed by my children, simply by identifying themselves at the emergency room.

    What is this amazing plan, you may ask, and why do not my fellow Americans have the same coverage?

    I've often wondered that, and since I used to be a statistician, I figured out once, just for my own amusement, what it would cost to cover us all with this sort of insurance. Turned out it could be done just with the money that is already spent by all the current spenders: Medicare, Medicaid, private insurance expenditure, including employer contributions and a few things I can't remember right now. We would need to subsidize the poor, but we already are.

    What I have is FEHB, the Federal Employees Health Benefits Plan. In the military, it's called Tri-Care. It is available to all federal employees, all postal employees, and I think it covers some or all railroad employees. Every year, we get a big book (a website now) listing all the variations that are available on this plan, so we can change if the one we have isn't satisfactory. We cannot be refused by a new plan. We are *covered.*

    This is the fabulous plan that the senators and congresspersons have, that we hear so much about.

    But I have it too.

    I'm not sure why President Obama didn't just extend it to everyone by a presidential order, instead of having his people develop this Dr Seuss animal of a plan. It would have taken a while to work out all the details but it would have been a lot easier for people to grasp, intellectually and it would have been easier to navigate the choices.

    But I have hopes. Most of the countries that now have sensible health coverage started with less satisfactory plans, and changed them gradually to reach the ones they have now.

  49. Katydid Says:

    @Aurora & Safety Man!, I think we're all neighbors. How funny is that? I wouldn't say no to a meet-up.

    Also, I can confirm that "concierge physicians" is a thing in my area; one practice just opened not far from me last year and I actually gave some thought to joining. However, my insurance took a turn for the worse and I've got a $10k deductible on top of an $800/month premium (but, hey, the company will deposit $100/month into an HSA provided you're cool with giving some never-heard-of, out-of-state bank all your personal information including your SSN, mother's maiden name, etc. because those banks NEVER get hacked). Can't afford the $2500 concierge fee above and beyond the cost of having insurance.

  50. Katydid Says:

    @April–a comment from the last post because I'm not sure if you'll come back–the kid who went over to China to teach English is a 20-year-old American, born and raised in America to English-speaking Caucasian parents. However, anytime I've spoken to the kid, he's just grunted incomprehensibly, which is why I joked that I have no idea how good his English is.

  51. Redleg Says:

    The freedoms of the corporate masters always outweigh the freedoms of regular folks.

  52. Katydid Says:

    Also, because nobody's brought this up: the same people having heart attacks at the idea of anything coming between a patient and their doctor are the same subset of humanity who will fight to the death to keep a 10-year-old victim of an abduction and gang-rape from getting a Plan B pill.

  53. April Says:

    DC – So far, at least, the AMA maintains very strict standards for Foreign Medical Graduates. My ex graduated 1st in his Medical School class from ENGLAND and you can't imagine the hoops he had to jump through to get his American Medical License. That could change in the future, of course, but for now anyone who can legally practice medicine in the US is a legitimate doctor with a real education.

    The rest of your post is spot-on as usual.

  54. April Says:

    Katy -Ah. Missed the joke. Sorry. (I'm in a bit of a funk here…got a bit of a cold which makes my China-hating all the worse.)

    Re. insurance – my cousin worked for Atena for about 20 years. We were discussing health care and I asked VERY SINCERELY "What is the point of medical insurance? What value do they add to medical care?" Never got an answer, because of course there isn't one.

    Fucking repugs. And Jus Oz, like others have said – that's why we can't have nice things.

  55. April Says:

    DC – A slight correction…that should have read "anyone FROM A FOREIGN COUNTRY who can legally…." Native-educated physicians have far fewer hoops to jump, so quacks can slip through the cracks.

  56. Khaled Says:

    @Major Kong: Paul Ryan is the type of person who heard the Dead Kennedy's "Kill the Poor" in college and said "that's a good idea!!!!!"

    There is no free market for health care. None. You cannot have a free market when the alternative is death and time is an issue. If you're crashing, you go to the nearest place that can save your ass, everything else be damned. If you're in an ER, it's because you're either broke and it's only place you can go or something bad is happening. You can't "shop around" or "compare" when your health/live is on the line.

    @Katydid I'm so sorry to hear about your friend. The difference b/w most of the people here and Republicans is that we hear a story like that and say "There but the grace of God go I" and the GOP says "should have worked harder and not fucked up your health care."

    Does anyone else remember a Town Hall debate in 2012 (I think) where someone asked one of the Pauls (I think it was Ron, it could have been Rand) if they thought that Drs should be forced to treat those without insurance (or something similar, I forget) and someone in the audience shouted "LET 'EM DIE" and there were cheers and applause? I remember it. That's what we've got now, a bunch of people on one side of the aisle that literally cheer poor people dying because they're broke. Kill the Poor indeed.

  57. schmitt trigger Says:

    "The American healthcare system is only "the best in the world" if money is no object……."

    Money is no object, as long as you don't have to spend it.

    And the American Healthcare system is the best in the world, as long as you don't have an urgent need to use it.

  58. Skepticalist Says:

    Without the evils of ACA one will have access to any doctor or plan they want.

    Great. One can have access to a Rolls Royce too.

  59. democommie Says:

    @Older:

    I'm glad to hear that your experience with Tri-Care has been positive. I have a next-door neighbor whose has not. I've had pretty much positive experience with the VA; other people I know, not so much–considering my notable lack of patience and kotowing fu, I can't imagine how my experience is better than theirs', but, there you are.

  60. Talisker Says:

    @Ten Bears: Pooling risk works just fine. People pay into a collective fund, which pays out for anyone in need. Single-payer systems work on the same principle, it's just that the payments are taxes instead of insurance premiums.

    The thing about health care is, anyone could need it at any time, and it could be really expensive. This pretty much demolishes any notion of consumer choice. If I am shopping for car insurance, I can compromise on levels of cover and accept a certain level of inconvenience. If I need a heart bypass, I fucking well need one right now. And obviously, not everyone has a car, but anyone could potentially need health care.

  61. democommie Says:

    "And obviously, not everyone has a car, but anyone could potentially need health care."

    I think I felt you thinking, "Everyone has a heart.", but then you rememberred the current squatters in the WOH and said to yourself, "Not everyone has a heart.".

  62. democommie Says:

    "The Towerbillies of D.C.", coming to you for as long as the morons keep voting them in.

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