Healthcare in the US

why should we hand it out to such ingrates?

makes it so conducive for argument. Or upsupported statements like,

Private and Public Health care coverage produces the same result in treatment

then later mentioning the varying levels of medical specialists in American vs Canada, which of course don't mean shit if you're too broke too ever see one.

Still, ignoring all this, the tone of your posts is illustrative.

Much of the traction against and framing around doing American universal healthcare has a core of "I shouldn't have to pay for health care that I can't immediately see as benefitting me." I.E. only those who can afford it are worthy(the rich as Blessed by God), and poor folks are poor 'cuz it's just their own damn fault, thus ain't worthy for our help. "Ingrates" in our own borders, even!

Poor folks obviously chosen their status, so they should have to live with the consequences. If you spoil them by reducing their costs to a level they can actually afford, they'll never develop the thrifty, hard-working, disciplined character required for success in our obviously meritocratic society. Why, all those poor black folks in New Orleans were stuck in that city since they were spoiled by relying on government.

Why, just look at our Dear President! He'd never have been so successful in life as oilman, ball-team owner, or elected official, were it not for his rugged individualism! Everything he's enjoyed in his lifetime was all earned thru the determined sweat of his own brow, and a product of his labor and his labor alone.

Etc.

So, to thses folks, it doesn't matter that having a baseline, minimal level of treatment for everybody would save plenty of dosh for all in the end, it's all seen in the framing of "the gubmint is taking my money to pay for those lazy, undeserved layabouts." It's a framework entrenched so deeply that no amount of actual facts will dislodge it, as Lakoff would say.

xpost: again, wot Ed said.

Bullshit. Disease prevents consumption of goods. Businesses of all types cannot profit if consumption falls. Businesses are thus incentivized to search for ways to cure disease, prevent disease, or provide care for the afflicted to support further consumption. Q.E.D.

Tim F. at Balloon Juice has been posting about this off and on for a bit (see here for his thoughts last month re: this issue and Obama, specifically:

Needless to say, tossing together American industry behind universal healthcare isn’t beginner chess. Somebody will have to overcome business leaders’ instinctive mistrust of socialist-sounding ideas and Democrats in general. Then we can even start talking about problems like institutional inertia. For that reason it seems unlikely that John Edwards, career trial lawyer, will make much headway. Fairly or unfairly Hillarycare gives me shudders. Obama, though, has a knack for making unlikely friends, a pragmatic tendency to look for common ground and little to no skeletons to get in the way. The idea of marshaling American industry against American insurance may be a fool’s errand for any pol, but I have an odd feeling that Barrack Obama may have what it takes to pull it off.)

Today, he's noted what looks like a big sea change at work -- WalMart and the SEIU joining up on healthcare matters. From the head of SEIU:

It is time to admit that the employer-based health care system is dead—a relic of the industrial economy. America cannot compete in the new global economy when we are the only industrialized nation on earth that puts the price of healthcare on the cost of our products.

That is a major drag on American business competitiveness, and job creation—and it is a stupid 21st century economic plan as well.

American business by 2008 will pay more for health care than they will make in profits. That is untenable.

...

It is time – in fact it is long overdue – for America to come together and insure that every man woman and child has quality, affordable health care by 2012.

That seems to be widely accepted everywhere but Washington, D.C.

We can’t keep tinkering, hoping that incremental change will fix our broken health care system. We need fundamental change, meaning new thinking, leadership, and new partnerships; some risk taking, and compromising.

And that’s why I chose to be here today, standing with several major corporations—some of whom I don’t always agree with, and of some of whom, frankly, I have been critical.

Which is why this partnership of unlikely allies offers even greater hope that we can finally stop talking about health care and do something about it.

That’s what we all owe our country.

Tim F.'s thoughts:

It is about time somebody figured out that Democrats need powerful allies to move healthcare reform forward, and it will never be the insurance biz. I have only pointed this out now in three separate posts. You can read those to get the gist of my point so I will just observe that it is very, very exciting to see Stern working together with Wal-Mart on this. For one, Wal-Mart is the single largest employer in America and a heavy contributor to party politics. That’s a lot of pull.

Equally interesting, Stern’s SEIU is naturally positioned to represent Wal-Mart’s 1.2 million employees in America. As most know Wal-Mart practically stands by itself in the fierceness of its union-busting policies. It has a history of forcing employees to watch misleading anti-union propaganda, firing managers who don’t stop meetings and closing entire branches when the union gains a foothold. Wal-Mart and Andy Stern come pretty close to sworn enemies. Seeing Stern and the Waltons working together on this is about the best possible illustration of my point that real progress will necessitate making some awkward friendships.

...

Finally, I would love to see the right wing boycott Wal-Mart over this. In rural America Wal-Mart has long since quashed the competition. Where else ya gonna go?

His commenters are generally skeptical. *checks watch and waits on Dr. Morb and Roger Fidelity's first posts*

A family friend of ours just had a major stroke at an unusually young age (late 30s or early 40s, I think) and has no health insurance. Her family and friends basically have to take a collection to pay for the treatment. I know this isn't a new or unique story, just a part of it that happens to touch me. This system fucking sucks. Fuck this country.

^^^^^^^^^^^^^

Is this being discussed elsewhere? http://www.nytimes.com/2008/12/03/health/03nice.html

Going out on a limb, I'm going to guess that the real problem is not the British NICE putting a price on six months of a person's life, it's what the drug companies are charging to begin with.

How any course of pills can be 50k is completely and totally beyond me. Patients should be folded into ongoing studies of drugs with FDA/NICE clearance and some cost benefit should be available to the patient in a private system. I am slowly starting to labour under the 'truthy' feeling that in many ways it was easier to suffer with cancer in the early '70s than it is now.

How Pharma and Insurance Intend to Kill the Public Option, And What Obama and the Rest of Us Must Do

http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/06/the-public-option-smokescreens.php/

Once those who want to kill the public option without their fingerprints on the murder weapon begin to agree on a proposal -- Snowe's "trigger" or any other -- the public option will be very hard to revive. The White House must now insist on a genuine public option. And you, dear reader, must insist as well.

This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers -- one that gives the public insurer bargaining leverage over drug companies, and pushes insurers to do what they've promised to do. Don't wait until the concrete hardens and we've lost this battle.

can't make this shit up

have to wonder if it would have been easier to just apply for medicaid

amazing

http://mit.zenfs.com/102/2011/06/James-Verone.jpg

http://www.nytimes.com/2011/08/23/opinion/cut-medicare-help-patients.html

good piece by the third emanuel brother - wasn't sure how i was feeling about him at first

Single-payer has the momentum!

I've talked to liberals who aren't thrilled with Obama's health care plan but nonetheless think it must still be worthwhile, because a) after all, Obama likes it, and b) it at least does something. The fact that the something it does is to entrench corporate power over health care in the US to the point where it would take a nuclear bomb to dislodge it, not to mention to put a lengthy debate about universal healthcare off the national agenda for decades, either doesn't occur to them or is subsumed by their knee-jerk partisan instinct to at least politely nibble at whatever shit sandwich the Democrats happen to be feeding them at any given moment. And the imperative of dining on that questionable meal also makes them willing to spin tortured rationalizations around the notion that it's ok for the government to compel us to buy a product from private for-profit corporations for our entire lives.

So it's left to conservatives and their knee-jerk partisan instincts to try to nullify this government gift to some of the most predatory and exploitative corporations in the US. Thanks for doing what you can to save universal healthcare from the ongoing assault by Democrats and their misguided liberal supporters, 26 Republican attorneys general and governors!

http://www.tinyrevolution.com/mt/archives/003549.html

While my wife went on a 1.5 year (unpaid) childcare leave from her job, we had to switch to my health benefits (hers are better). Now we want to switch back because we pay so much less for hers, but it means switching all our doctors again because they're not in the network of her plan. Such a ludicrous system.

Sitting by work phone waiting for the mail-order mega-pharmacy used by my health plan to arrange shipment of my cancer drug. Waiting out the last few hours before the deadline after the hematologist's staff SENT THE PRESCRIPTION SIX DAYS AGO never really gets fucking old, even the 20th time.

they are called EXPRESS SCRIPTS

avoid if you can

ugh, I have to go through Express Scripts too. you have my sympathies x1000000

maybe 500,000 more and we can agitate for their annihilation

^ still in favor of this. i would burn them to the fucking ground if i could.

scares me, I go through them now and the auto-refills have been timely? I have a pretty unchanging prescription, though

the problem I have is specifically with Accredo

the Blues (Cross & Shield) may be singin' the blues

http://www.ajmc.com/focus-of-the-week/0515/Antitrust-Lawsuits-Seek-to-End-Cartel-Like-Behavior-Among-Blues-

This morning there was an oldish man asking for money on the subway and he was in a wheelchair, and when I looked down and I saw that he was barefoot and had what I guess you would call an open wound or sore on his foot, but it was gigantic, like maybe an inch long and the width of his entire foot and half an inch deep and raw as fuck. It just made me wonder, can someone with a wound like that and pretty obviously uninsured seek treatment at an emergency room? What can they do?

yes he can

Say it's something that requires multiple treatments to really heal, can he just keep going back?

Yes.

That's one of the main arguments for why single-payer healthcare is essential -- you'd be extremely hard-pressed to find a politician who will advocate turning away people at the emergency room when they're not able to show proof that they could pay for treatment. So the ER becomes the treatment center of first resort for those without the ability to pay, when it should be the last resort due to immediate need for treatment.

I had a number of little debates with acquaintances during the Affordable Care Act ramp-up about this -- no one will advocate turning people away from the emergency room, but its use for things that preventative care could address, or for situations that are not actual emergencies, combined with an inability for people to pay, is one of the things that raises the cost of healthcare across the whole system.

So you either have to admit that all people, regardless of their economic or social status, deserve emergency care, and that non-emergency services would be a much more cost-effective solution for people without insurance.

Some cities have started integrated facilities that put together medical treatment, case management, and shelter options, especially for people who would be arrested for acting out due to mental health issues or those who would be arrested for vagrancy, but those places are still far in the minority.

The entire system is kind of rigged right now -- people who oppose single payer healthcare do so on a number of stances, but the basic ones flush out to:
- The spoken stance: Barring any personal cost, people will seek out many more medical services than necessary, and the system can't take the load and the overall cost will be greater due to people running to the doctor or hospital all the time. The quality of care will go down due to an inability to address demand.
- The unspoken stance: If you can't afford medical care, you don't deserve it.

The former is possibly true, especially when it comes to specialists that people _should_ be referred to but currently are not. On the other hand, few people argue that the huge-ass lines at ERs would shrink.

The latter is a weird moral point and actually ends up costing more -- people get emergency care that they could have avoided with routine medical treatment, and even the crankiest poor-haters are hard-pressed to admit they think poor people with infections should die outside the hospital doors.

Barring any personal cost, people will seek out many more medical services than necessary

This is such a weird idea, as if health care were like candy.

But even if it were, why would single-payer, free-at-the-point-of-service provide any more incentive to milk the system than private health insurance? In both cases someone else is paying.

because poor people will come in all the time, they love their handouts, Tracer!

(also not really true but definitely a talking point)

My family health insurance premium (through employer) just went up 18%. Thanks Obama.

why are urgent care centers nearly as ubiquitous as starbucks lately?

I have wondered this as well and researched a little out of curiosity. The best explanation I have seen is that we are basically in the "arms race" phase of the industry, where every company doing this is just trying to get a foothold, build a brand, and battle to be the future dominant player, costs be damned. We have so many of them in my neighborhood and it's kind of depressing when you think about all the restaurants and stores not filling those spaces.

I find having one useful, but there are clearly way more than we need or than are sustainable.

They also cost more than regular doctors on my insurance plan now, so I'm hesitant to use them now unless I really have something in the sweetspot between not enough of an emergency to go to the hospital, but enough of one not to wait for a doctor's appointment, which is rare.

However, I have found the resulting experiences mostly good -- short wait times, nice, clean new facilities, and good doctors. The time I minorly injured my head (but produced a lot of blood) at the gym, I was literally able to walk across the street and get it stitched up immediately, go back to the gym, shower, and return to the office with no one knowing.

Occurred to me today that health insurance is a very odd product inasmuch as you pay a lot of money for it and then assume that the company that provides it is always opposed to your best interests.

why are urgent care centers nearly as ubiquitous as starbucks lately?

I'm guessing it's because they can be run very cheaply with most of the 'doctor' labor being pushed off on a nurse practitioner or physicians' assistant and 10-12 rooms in the building that can be filled with patients - the last ten times I went to an urgent care place I never saw a 'real' doctor. Which would be fantastic, if it wasn't more expensive than a regular doctor and all that - there's no reason you need a guy who went to med school to tell your kid she has an ear infection.

As I noted above, they are also not necessarily being run profitably right now. They are in the "start-up" phase, where they have lots of capital behind them and are just trying to get position in the market. The ones near me are so empty at normal times that there's no way they could be making money yet.

A lot of hospitals are getting into urgent care to send business to big buildings and catch new patients with insurance but have not yet gotten a primary care physician.