Victoria Colliver, writing a column for the San Francisco Chronicle has an article entitled We spend far more, but our health care is falling behind : Australia, Canada, Germany, Britain, New Zealand spend less, serve better. The column is critical of Michael Moore’s new movie, “Sicko” but essentially concedes that the central point is not in doubt. Which, as far as I’m concerned, is fine. Moore is an advocate, not a documentarian. Where he is wrong, advocates for other positions are free to point out the errors. More commonly, where he is incomplete, advocates for other positions are free to fill in the blanks.
But, Moore’s movie brings to mind an anecdote I’ve heard attributed to LBJ, telling his campaign manager to call his opponent a pig fucker. The campaign manager says, “you know that’s not true.” To which LBJ said, “yeah, I just want to make him deny it.” The problem with opponents of Sicko, or more accurately, proponents of the current health care system, there seems to be more than a hint of bestiality with the way things are running right now. The U.S. ranks 37th out of 190 nations in health care services. That puts us ahead of Slovenia but behind Costa Rica. We made our way to the vaunted 37th spot by spending a higher percentage of our gross domestic product on health than any other country. We spend an average of $6,102 per person in public and private funds compared with France, the leader in providing health care to its citizens, which spends only $3,159 per capita. Like I’ve said before, we’re paying for universal health care, we’re just not getting it.
We need to follow the money to see where our dollars are getting wasted. I suspect a large percentage goes to paying for insurance company bureaucracies where the profit motive has created an incentive to take in premium dollars and avoid paying out on claims.
So, folks should feel free to point out Michael Moore’s errors, but they should be prepared to explain why it’s a good idea for us to keep spending twice as much as France on health care and not get nearly the return on our investment.
[tags]health care[/tags]
Just waiting for the “we have the best health care in the world” meme
I’m sure we do if you can afford it. But if you’re one of the other 30%, well I’d bet Canada’s system looks pretty damn good to you…
If you’re rich, ours is a great healthcare system. If I were poor, I’d rather be poor in Cuba.
I’d like more pragmatism in this debate, as you are doing. Our medications, technical skills, etc. are top-notch. But thanks to the insurance industry mainly as well as big pharma, and to some extent the doctors as well as the patients themselves, we are getting poor value for the money we are spending.
Then let’s have that pragmatism spread to other areas. Our defense spending is equal to something like the next 20 countries combined. Yet our military is being effectively countered with World War I technologies and some tactics like dug mines that date to the Civil War, all on a shoestring budget by third-world militias. We would have been better served by printing up money and flushing it down the toilet.
You’re right about the overhead being the main source of the problem.
According to Hoosiers for a Commonsense Health Plan, Medicare overhead runs about 3.1%. Investor-owned blues run more than 26%, and I believe Indiana’s own Wellpoint runs even higher. You can see here:http://www.hchp.info/sphi.html
Unfortunately, the clips on the website don’t include citations (which they do include in their presentations), but I think the national site (PNHP.org) has them.
Of all the candidates, Dennis Kucinich by far and away has the best solution. I know he’ll never get elected, but his HB 676 really rocks and it’s so simple.
I totally agree with Moore. For-profit health insurance is evil and wrong. And I’m not just saying that because I’m bitter. (Even though I am.)
Government has screwed up property taxes, my street is a mess, my tax statement is a mess, the BMV is a mess, the Iraq war is a mess, it is allowing Afghanistan to go out of control again – why should I trust it with my health care? In my opinion, government meddling with health care has been a major contributor to the health care crisis. A part of the blame is it panders to the health care lobbyists. Let the insurance companies compete in a truly free market, not one in which special laws and regulations are promulgated by government to favor them. I call it the corporate/government health care complex (with my apologies to President Eisenhower).
Part of the problem seems to be the number of players involved beyond patients and health care providers.
I don’t see how you can impose significant government control (especially single payer) without infringing on the liberties of members of the medical community.
That seems to produce something of an ill effect for the single-payer systems – I think that if tomorrow the government told me it would be outlining in detail how, where, and when I could do my job, and how much I could charge for it, my motivation would take a big hit.
I wish I had a better answer than the current practices – my concern is that we may rush to do something that makes some people feel good but has a net negative effect.
But I’ll try not to worry myself sick about it…
(T – Cuba? Really?)
One problem is that the insurance companies are allowed to make their own rules, pretty much. They love to deny services that clearly are covered by their policies, just to see if they’ll get away with it. Once I get on the phone, the vast majority of those decisions are reversed in favor of the patient. But if the service is a covered one, why should I have to spend 20 minutes on the phone explaining the obvious to them? When they deny coverage without basis, fines should be levied.
Cuba? Absolutely. It’s no place to be rich or middle class. But if you have to be poor somewhere, Cuba would be hard to beat. You have housing, food, healthcare. Not very good quality of any of these. But probably a better standard of living than you would have here as a poor person. Of course your situation may vary. How much assistance do you qualify for, etc? But an apartment in Cuba beats skid row here any day, I would think.
Two main problems with market based health care:
1. Transparency. Just try to compare prices between various providers. Hell, try to get a price list from one provider. Then, for giggles, see if anybody actually pays the price you see on the list — if you can get one.
2. Leverage. In many cases when you need health care you are essentially negotiating with a gun to your head. If you don’t get the service — sometimes if you don’t get the service *right now,* you’re dead.
Government may or may not be ideal – I think it would be hard for a substantial chunk of the American population to get worse than they’re getting (or not getting) right now. But, for all the crap our government takes, I think it by and large does a good job. My roads are good, thanks to various highway departments at the local, state, and federal levels. I feel safe in my community because of my city and county law enforcement departments. I feel confident that my contracts are enforceable because of the court system. When someone is sentenced to prison, he usually stays there until a court releases him because the Sheriff’s Department and Department of Corrections do their jobs. Water in my community drains pretty well because of the county surveyor and the drainage board. My food almost never makes me sick, in large part because of federal standards. When I file a summons, it gets served on the defendant because of the County Clerk and the Sheriff. Buildings are generally safe because of the building inspector and building codes. I have decent parks I can take my kids to because of our parks departments. Water isn’t filled with sewage. Air isn’t generally lethal with pollutants.
Is there room for improvement? Sure. But I’m not real confident of market based solutions for many, if any, of the above described services.
Doug –
I don’t think we’ve had anything approaching market-based health care for a long time – too much disintermediation between patients and providers. Not a lot of good coverage choices when you are acting as an individual, I think.
I wonder what the effect would be of making health insurance portable among employers – possibly by making it illegal for an employer to designate the insurer, but letting them pay the employee an untaxed allowance to be used for health care?
It could be paid direct from employer to the employee’s designated insurer, or possibly to a medical savings account, if that’s what the employee preferred.
(At least it would be easy to compare employer health benefits.)
Or maybe ideas like that are why it’s a good thing I’m not in charge of health care…
As Moore observes in his film, insurance companies are obligated to maximize profits, and what principle does every businessman in America follow to achieve that goal? Why, it’s the same philosophy the insurers already act upon: take from the customer the largest amount of money you can find any way to persuade him to part with, while delivering to the customer the least amount of goods or services (in this case, health care coverage) you can persuade him to accept. There’s really no reason to believe that, if allowed to “compete in a truly free market”, we wouldn’t see more of the same, only amplified a thousand fold.
I’ll second the notion that the problem is the insurance companies. It’s silly that we rely on isurance for every aspect of health care. We don’t do it with our cars.
Think what that would be like if we did- we’d have to check with an AMO before getting an oil change, and then only go where they tell us, and we’d wait in line for an hour, and they’d rush the car through, and it wouldn’t really cost us anything but the co-pay of $20, so we’d think it was better than having to pay the $30. But the real cost goes up because the insurance company is a needless layer of bureaucracy that must be paid for.
Back to health care, if we got rid of insurance for routine things we all know we’ll need- check-ups and the like, we would take a lot of the bureaucracy and drag out of the system. Heck, we might even be able to get right in to the office and get competitive pricing- just like we do when we drive right up to the Quickie Lube.
I agree that it’s silly to use insurance as more of a prepaid subscription for health care than to merely manage risk.
On the other hand, some structure should be in place to encourage people to use preventative care, even if it’s going to come out of their own pocket. I can see someone putting off dealing with an annoying medical condition, hoping it just goes away, until it gets serious and the treatment expense won’t come out of his or her pocket.
Quite agree about the importance of preventative medicine, although to my thinking, the word “preventative” is all the incentive that should be necessary. What else? A medal on one’s chest? If you own health isn’t worth looking after, what is?
Before you start feeling all warm & fuzzy about government stepping even farther into health care, you may want to think back to the days of 1973 when Ted Kennedy pioneered, pushed, and passed HMO’s into our health care system.
You’ve got him to thank for the massive layers of red tape and regulations foisted on insurance companies “for the good of us all”.
Do you really want Teddy & Hillary etal to break it off in us again?
why does Anthem require a life insurance policy, which they sell, for all employees?
In a perfect world, sure. But, let’s use another automobile analogy. You ought to go get your oil changed. If you don’t, you’ll have to pay for the consequences if you then have major problems — either paying for major repairs or doing with out a car when it breaks once and for all. With health care, however, unless we’re prepared to resolutely just let people die when they get really sick because they declined to go get periodic check ups, we’re going to end up paying when people ultimately receive catastrophic care they can’t afford. I’m not saying that this sort of “tough love” might not be the best solution. But, it’s just not going to happen, so we’d best come up with another plan.
I’d sure love to live in the utopia that would surely come to pass in a world of unregulated insurance companies.
Using the automobile example even further, when I fail to put oil in my car, I pay for it.
Right now, when other people fail to keep fat out of their bodies, or tobacco, or you name it, we all pay for it.
It isn’t tough love. It’s justice. It is unjust for one to pay for the health care of another who didn’t care to bother to care for himself. But because we have this injustice that masquerades as love, we have a distopian situation.
Doug, regulation of the insurance companies is precisely why costs are out of sight. Once they got involved, it was a loser for everybody. Ted & Co. want to correct this abomination with a new abomination.
Are you saying that things would be better with an unregulated insurance industry? If so, I disagree. I don’t think market forces work very well in this area.
Bargaining power is very unequal as is the level of information.
With respect to bargaining power, there is more of a disparity than your average individual versus MegaCorp imabalance since you’re talking about, in many cases, life and death issues. And, the nature of the information is of a nature that’s so technical John Q. Public probably isn’t going to be able to educate himself with a plausible level of effort.
Actually, I would argue that the forced involvement of insurance companies by government is the problem, as regards health care.
Some people do all the right things and still get sick. Some people don’t have access to preventive care. Junk food is easily accessible and very cheap–it tastes good, too, once you develop a taste for it. We all want simple, easy answers. We all want to sit in judgment of others. We want to offer up our own “solutions” as if we know everything there is to know about health care, disease causation, the insurance industry, etc. There is not a simple solution to this complex problem.