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News & ArtsWednesday, October 7, 2009
Health The Health Care Debate
Posted by Jonathan Golob on Wed, Oct 7, 2009 at 10:50 AM
There really isn't much to debate.
The US healthcare system, in its present state, is a failure. It fails those with and without coverage. We spend more, care for fewer and are sicker than the citizens of any other industrialized nation.
We've studied it. Americans of all socioeconomic strata are less healthy on every measured basis than their UK counterparts—before or after adjusting for the less healthy lifestyles of Americans. Putting it even more bluntly, the richest Americans, lavished with the finest private health insurance our nation can muster, in the epicenter of global medical and biological research, have more diabetes and higher blood pressure than the poorest of English citizens. Even within our country, Americans within the Veterans Affairs system, a little socialized corner of our healthcare system, are similarly healthier than their privately insured doppelgangers.
As far as the uninsured in this country, an unprecedented phenomenon in the industrial world, allow the independent Institute of Medicine to state the case:
Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage.
The case for socialized medicine in this country has been made, and it has won. Back in June of this year, an overwhelming supermajority of Americans were in favor of a public health plan option. After the long summer—filled with hideous farces of Town Hall meetings, Teabaggers and endless anti-reform propaganda—support remained at supermajority levels. The Senate vote on the package seems to be a fait accompli.
The core of the opposition is an all out appeal to selfishness. Think of the taxes you'll pay. Seniors, think of what you'll be forced to share with those younger than you. You might have to wait in line for care if anyone can get it. The hideous core throbbing at the center of all this summer's hysterics is the toddlerization of Americans as selfish and self-centered consumers—relentlessly stripped of any sort of adult notions of empathy, responsibility for others, investment in the future or delayed gratification. The whole movement has been lead by paid-for shills for the moneyed interests endangered by healthcare reform.
The mob of mooks compelled by these appeals to selfishness—capable only of braying about 'socialism' and 'the constitution' with no sense of what either really represents—are the rhetorical equivalent of suicide bombers. This summer's protests reminded me of nothing less than Kermit Roosevelt's handiwork, undoing Mosaddeq's attempt to nationalize the Iranian oil industry. The intent was to drive terror into the hearts of the elected representatives Democratic supermajority—to generate the illusion of mass discontent. The absurdity of the arguments posed at the Town Halls—Death Panels! Marxism! Obama is Hitler for trying to provide Americans with healthcare!—was the entire point. The feeling of being strapped to a bomb generated by having these cretinous and credulous fools as countrymen is best diffused by ignoring it as bad theater.
It's worth considering why American doctors are so expensive, where the costs of drugs and medical devices arise. Healthcare reform is, astonishingly enough after nearly a century of struggle, about to happen. These are the points we should be debating and struggling with as the end details are being written.
(Illustration by Chris Rummell)
1
It doesn't help when you start off with an immediate false correlation:
That rich Americans having high blood pressure and diabetes, more so than the poor British isn't necessarily a sign of our health care system failing. It is a sign that the rich don't take care of themselves. Not to mention, the whole litany of food options available to the rich that the poor do not have, and the options of activity that do not require exertion.
I can't read the rest of the article because of this.
That rich Americans having high blood pressure and diabetes, more so than the poor British isn't necessarily a sign of our health care system failing. It is a sign that the rich don't take care of themselves. Not to mention, the whole litany of food options available to the rich that the poor do not have, and the options of activity that do not require exertion.
I can't read the rest of the article because of this.
2
well said. I like the term 'toddlerization' and accompanying description. the health care debacle is just one instance of this phenomenon. life itself is being made into a reality show... unreality called reality long enough becomes reality... so long as you imagine yourself as good and generous and thoughtful, then you are, even if your actions aren't. That guy in the Bush White House was right, but he should have been referring to all of us when he said "we make our own reality"
3
@1: Please go ahead and read the primary JAMA research article to which I linked. The point of it is poor people are sicker than rich people in both countries on every measured health outcome. Likewise, the more educated are healthier than the less educated in both countries.
The surprising thing, if you believe socialized medicine to be evil, is at each socioeconomic level, citizens of the UK are healthier than their equivalents in the US--whether you normalized to risk factors or not.
I think you might not understand what a false correlation means.
The surprising thing, if you believe socialized medicine to be evil, is at each socioeconomic level, citizens of the UK are healthier than their equivalents in the US--whether you normalized to risk factors or not.
I think you might not understand what a false correlation means.
4
"the uninsured in this country, an unprecedented phenomenon in the industrial world"
really?
do you know when health insurance became widespread?
do you know what " unprecedented " means?
really?
do you know when health insurance became widespread?
do you know what " unprecedented " means?
5
@1 -- If you can't finish reading it, then you will ill-informed (ha! ha! a little healthcare humor for you). You'll be subject to your own stupidity because you won't know if he's correct or not.
But then way too many Americans don't make decisions based on information as much as opinion.
Take a look at them thar Teabaggers and such.....
But then way too many Americans don't make decisions based on information as much as opinion.
Take a look at them thar Teabaggers and such.....
7
65-75% of all health care spending goes to treat easily preventable lifestyle related disease.
The health or lack thereof of Americans is a function of their lifestyle choices and not the national health care system.
The system is crap but it is possible to make it worse.
Failing to recognize the above central problem dooms any attempts at reform.
The health or lack thereof of Americans is a function of their lifestyle choices and not the national health care system.
The system is crap but it is possible to make it worse.
Failing to recognize the above central problem dooms any attempts at reform.
8
@7: Ah yes, the old "take responsibility for your lifestyle" code that conservatives use when they need to blame the victim. Poor people are poor because they're lazy, sick people are sick because they make poor "lifestyle choices" (that phrase gets used to condemn lots of other things you don't like, doesn't it?)
Read what Golob said. Even controlled for our unhealthy lifestyle our outcomes our worse than under single-payer systems.
I'm all for people taking responsibility for their choices, and incentives to encourage this might be a feature of a reformed system, but if you're using it as a form of hand-waving to dismiss the very real need for healthcare reform then don't be surprised if your arguments are written off as pure callous selfishness.
Read what Golob said. Even controlled for our unhealthy lifestyle our outcomes our worse than under single-payer systems.
I'm all for people taking responsibility for their choices, and incentives to encourage this might be a feature of a reformed system, but if you're using it as a form of hand-waving to dismiss the very real need for healthcare reform then don't be surprised if your arguments are written off as pure callous selfishness.
9
The linked article about why doctors are so expensive is infantile bullshit dribble.
School teachers usually have Masters degrees and many now have PhDs (not that it does anybody any good...)
They don't pull down $300K a year.
School teachers usually have Masters degrees and many now have PhDs (not that it does anybody any good...)
They don't pull down $300K a year.
10
@4, i believe he is referring to the unprecedented proportion of uninsured people in this country as an industrialized nation.
11
8 years of education = $800,000 debt, really?
also, haven't doctors lobbied for limiting the supply of doctors?
also, haven't doctors lobbied for limiting the supply of doctors?
12
8
So sorry if the Truth burns your Liberal PC ears.
Cover them...
65-75% of all health care spending goes to treat easily preventable lifestyle related disease- caused by obesity, alcohol, smoking, etc.
How much better would the system be if 65-75% of the trillions being spent now could be redirected to care for people who actually can't help being sick?
So sorry if the Truth burns your Liberal PC ears.
Cover them...
65-75% of all health care spending goes to treat easily preventable lifestyle related disease- caused by obesity, alcohol, smoking, etc.
How much better would the system be if 65-75% of the trillions being spent now could be redirected to care for people who actually can't help being sick?
13
The main problem is that too many Americans are terrified of having anything different happen. They're locked into their routines, for better or worse.
This country hasn't even adopted the METRIC SYSTEM, for fuck's sake! Why? Because too many people are too afraid of doing something differently.
This country hasn't even adopted the METRIC SYSTEM, for fuck's sake! Why? Because too many people are too afraid of doing something differently.
15
It pleases the Left to think that anyone who disagrees with them must be Selfish.
Or a Bigot.
Or a Racist.
Or a Homophobe.
That way you never have to confront the actual positions of the other side.
Or a Bigot.
Or a Racist.
Or a Homophobe.
That way you never have to confront the actual positions of the other side.
16
It pleases the Right to think that anyone who disagrees with them must be Socialist
Or a Communist.
Or a Nazi.
Or a Nigger.
That way you never have to confront the overwhelming evidence presented in favor of real reform.
Or a Communist.
Or a Nazi.
Or a Nigger.
That way you never have to confront the overwhelming evidence presented in favor of real reform.
17
@12: So just let smokers/overweight people die? Is that what you're suggesting? And what about the people who "can't help being sick" -- what do you propose doing for them? I don't see anything in your comment to indicate you have any ideas about how to improve our system, or any notion of who you imagine will get to decide who deserves care and who doesn't based on their "lifestyle choices."
Like I said, if your "personal responsibility" rap is really a cover for your belief that you shouldn't have to pay a dime towards helping out somebody who isn't you, then prepare to be dismissed as an unserious misanthrope.
By all means, tell me some truths that will my "liberal PC ears." I can't wait.
Like I said, if your "personal responsibility" rap is really a cover for your belief that you shouldn't have to pay a dime towards helping out somebody who isn't you, then prepare to be dismissed as an unserious misanthrope.
By all means, tell me some truths that will my "liberal PC ears." I can't wait.
18
To my mind, this is the one of the biggest and worst changes in American culture in the past 50 years. Historically speaking, Americans haven't been a particularly empathetic or responsible bunch, but they at least had a concept of working and waiting for things they want. Sixty years after the Great Depression, that virtue seems to be practically extinct.
delayed gratification
To my mind, this is the one of the biggest and worst changes in American culture in the past 50 years. Historically speaking, Americans haven't been a particularly empathetic or responsible bunch, but they at least had a concept of working and waiting for things they want. Sixty years after the Great Depression, that virtue seems to be practically extinct.
19
17
The current system rewards unhealthy irresponsible behavior and penalizes healthy responsible behavior.
You always get more of whatever you subsidize and we have a bumper crop of unhealthy irresponsible people.
If Obama and the Democrats only strengthen those perverse incentives they will make the system worse and more expensive.
It is possible to make things worse than they now are...
The current system rewards unhealthy irresponsible behavior and penalizes healthy responsible behavior.
You always get more of whatever you subsidize and we have a bumper crop of unhealthy irresponsible people.
If Obama and the Democrats only strengthen those perverse incentives they will make the system worse and more expensive.
It is possible to make things worse than they now are...
20
How about one of those personal horror stories everyone is so fond of:
Monday morning I'm on my way to work when I start to feel tingling in my right arm and pressure along my back. A nice lady calls 911 and I am told it's not a heart attack by the fire techs. Since the 60 just pulled up I decide to hop on and get dropped off at the Polyclinic where my doctor is. (I knew I didn't want an ambulance bill on my hands.) A few mins in the waiting room and the pain is escalating, she sends me to the ER.
I'm a healthy 26yo, eat a good diet, bike and run. Somehow I pulled a muscle in my back causing a little nerve damage so now half my body is numb, I can't even open my right hand all the way.
I have insurance, but I have a $2000 deductible and 20%coinsurance. Even as a 'fully covered working adult' I am going far into debt because of a freak accident.
I'm at work right now because I can't afford to take the time to rest my doctors suggested.
Monday morning I'm on my way to work when I start to feel tingling in my right arm and pressure along my back. A nice lady calls 911 and I am told it's not a heart attack by the fire techs. Since the 60 just pulled up I decide to hop on and get dropped off at the Polyclinic where my doctor is. (I knew I didn't want an ambulance bill on my hands.) A few mins in the waiting room and the pain is escalating, she sends me to the ER.
I'm a healthy 26yo, eat a good diet, bike and run. Somehow I pulled a muscle in my back causing a little nerve damage so now half my body is numb, I can't even open my right hand all the way.
I have insurance, but I have a $2000 deductible and 20%coinsurance. Even as a 'fully covered working adult' I am going far into debt because of a freak accident.
I'm at work right now because I can't afford to take the time to rest my doctors suggested.
21
@19: So what sort of program of incentives would you support? Are there any cost-saving measures you would support other than denying care to those you consider unworthy?
22
@19- Why is it that people in country's that do have universal care people take better care of themselves? It seems reality contradicts your precious theories.
24
@1, even the rich are enabled in their dysfunctional attitudes toward health and well-being by the current fee-for-service system, which rewards doctors and clinics (including the world-famous one I formerly utilized while overinsured) for running all possible tests and procedures, as well as trying multiple brand-name drugs to see what works.
Changing to a system where doctors are paid based on outcomes (pounds lost, blood pressure points dropped, blood glucose control, etc.) lowers costs, sharpens their skills, and changes their interactions with patients in ways that turn patients into clients (a word I greatly prefer)--in other words, more-active participants in their own health maintenance and less an inanimate object like a car on a lube rack.
Changing to a system where doctors are paid based on outcomes (pounds lost, blood pressure points dropped, blood glucose control, etc.) lowers costs, sharpens their skills, and changes their interactions with patients in ways that turn patients into clients (a word I greatly prefer)--in other words, more-active participants in their own health maintenance and less an inanimate object like a car on a lube rack.
25
21
22
What is your theory?
Why is the rate Type 2 Diabetes doubling in adults and becoming an epidemic among fat children?
Are our hospitals and doctors infecting Americans with diabetes? Maybe Republicans are putting it in the drinking water?
22
What is your theory?
Why is the rate Type 2 Diabetes doubling in adults and becoming an epidemic among fat children?
Are our hospitals and doctors infecting Americans with diabetes? Maybe Republicans are putting it in the drinking water?
26
@20, a stretching class, time in a Jacuzzi, and/or a couple of sessions with a legitimate massage therapist can work wonders for that kind of pain and are bargains compared to ER visits. You can always do the MRIs and injections down the road :)
Hope you feel better.
Hope you feel better.
28
Right on, Golob.
Except for the Senate "fait accompli" part. Exactly what is being accompli'd? Not a public option.
Except for the Senate "fait accompli" part. Exactly what is being accompli'd? Not a public option.
29
Let me check:
two wars, which we've now fought longer than WW II and are almost at the longest mark (the Civil War). Check.
massive deficit and we still have tax cuts for the rich. Check.
mass stupidity amongst the Republic Party demanding even more tax cuts that we can't afford. Check.
Um, what were we winning again?
two wars, which we've now fought longer than WW II and are almost at the longest mark (the Civil War). Check.
massive deficit and we still have tax cuts for the rich. Check.
mass stupidity amongst the Republic Party demanding even more tax cuts that we can't afford. Check.
Um, what were we winning again?
30
@26 Thanks, but all that testing has already happened because I had no idea why my body was in such pain and the doctors wanted to make sure there wasn't any serious damage that needed surgery. In the long run I should be okay, I have an acupuncture appt tomorrow, but I'm still in a lot of debt for having a little bad luck.
How does my case work for all those who talk about personal responsibility?
How does my case work for all those who talk about personal responsibility?
31
@25: My theory is that your healthcare reform proposal "Let fat people die" is not a workable solution to the problems at hand.
My other theory is that it makes people like you feel better about making all public policy decisions based on the most narrowly-defined self-interest to tell yourself that the people who suffer as a result "have it coming."
My other theory is that it makes people like you feel better about making all public policy decisions based on the most narrowly-defined self-interest to tell yourself that the people who suffer as a result "have it coming."
32
Oh, John, I wish I could believe you. I wish real health care reform with a real, strong public option were a given at this point but I'll believe it when I see it. Biggest problems? Republicans are shitheads who think of nobody but themselves and Democrats are worthless pussies who couldn't push health care reform through a wet paper bag.
Let me also add to your list:
"stripped of any sort of adult notions of empathy, responsibility for others, investment in the future or delayed gratification."
Sense of community. This, I think, is the one special thing that "real America" supposedly had. A sense of community, of oneness with your neighbors, of caring about the people around you. Supposedly this is what once made small town living worth living. I'm finally in a place (right in the middle of a city) with an amazing sense of community. If more people had that we'd start realizing there's benefit to caring about community, your neighbors and other people in general, rather than MEMEMEMEMEMEMEMEMEME!!!! (did that sound like beaker from the muppets?)
Let me also add to your list:
"stripped of any sort of adult notions of empathy, responsibility for others, investment in the future or delayed gratification."
Sense of community. This, I think, is the one special thing that "real America" supposedly had. A sense of community, of oneness with your neighbors, of caring about the people around you. Supposedly this is what once made small town living worth living. I'm finally in a place (right in the middle of a city) with an amazing sense of community. If more people had that we'd start realizing there's benefit to caring about community, your neighbors and other people in general, rather than MEMEMEMEMEMEMEMEMEME!!!! (did that sound like beaker from the muppets?)
33
The proposals now before Congress address almost none of the efficiency issues. I will be happy to make a bet with you, Jonathan: ten years post-reform, in 2020, the U.S. will spend an even larger fraction of its GDP on health care than it does now. That fracion will continue to be larger than in Switzerland, and mean life expectancy in the US will continue to be lower than in Switzerland. (I pick Switzerland so you can't just say "that's because the U.S. still won't have single-payer". Switzerland does not have single-payer.)
34
31
Just as we thought.
You got nothing.
And you'll get nothing.
Kiss your Single Payer goodbye.
and good riddance.
Just as we thought.
You got nothing.
And you'll get nothing.
Kiss your Single Payer goodbye.
and good riddance.
35
@31
I don't know how to break it to you, buddy, but your fat friends are going to die. Sometime. The only question is how much of your kid's money are you going to throw in the hole with Fatty. How much public money will you waste keeping his bloated corpus alive a few extra months or years. How much are you going to borrow from China on the promise that your kids will pay it back. (You do realize that 43¢ of every dollar Obama spends is borrowed, don't you...) You should sit down with your kids and have a talk. Before you mortgage their future to keep Tubby alive a few extra months.
I don't know how to break it to you, buddy, but your fat friends are going to die. Sometime. The only question is how much of your kid's money are you going to throw in the hole with Fatty. How much public money will you waste keeping his bloated corpus alive a few extra months or years. How much are you going to borrow from China on the promise that your kids will pay it back. (You do realize that 43¢ of every dollar Obama spends is borrowed, don't you...) You should sit down with your kids and have a talk. Before you mortgage their future to keep Tubby alive a few extra months.
36
@34: What's your plan? I've asked you three times. All you did was quote some statistics about childhood diabetes.
I'd be happy to tell you what I think about the existing proposed plans on the table. Short answer: Although I'd prefer a single-payer proposal, I would lend my support to a plan that included meaningful regulation of the insurance industry in conjunction with a public option.
Also, why are you using the royal "we?"
I'd be happy to tell you what I think about the existing proposed plans on the table. Short answer: Although I'd prefer a single-payer proposal, I would lend my support to a plan that included meaningful regulation of the insurance industry in conjunction with a public option.
Also, why are you using the royal "we?"
37
The system is not a failure if your main concern is rewarding those who deserve, and punishing those who don't deserve. That's the prime concern of some folks. They just don't say it very clearly.
39
The American system of health care is an utter failure. It is rationally unsupportable.
To prove this, you really don't need to go beyond three simple facts:
* Health care outcomes in the USA are approximately the same as outcomes in the UK (the UK is a bit better overall).
* The United States government spends $3076/yr per capita on health care.
* The United Kingdom government spends $2908/yr per capita on health care (or $2457 in PPP dollars). (Source: World Health Organization)
That's government health care *only*.
For $3076 in taxes, in America you get Medicare, Medicaid, the VA, and coverage for government employees.
For $2908 in taxes, in the UK you get to walk into pretty much any hospital or clinic and get coverage for free. Everyone. Plus, prescriptions are $12.
If we took the entire health system in the US and threw it in the toilet and replaced it with the UK health system, everyone would get a tax cut. Plus you wouldn't need insurance at all.
To prove this, you really don't need to go beyond three simple facts:
* Health care outcomes in the USA are approximately the same as outcomes in the UK (the UK is a bit better overall).
* The United States government spends $3076/yr per capita on health care.
* The United Kingdom government spends $2908/yr per capita on health care (or $2457 in PPP dollars). (Source: World Health Organization)
That's government health care *only*.
For $3076 in taxes, in America you get Medicare, Medicaid, the VA, and coverage for government employees.
For $2908 in taxes, in the UK you get to walk into pretty much any hospital or clinic and get coverage for free. Everyone. Plus, prescriptions are $12.
If we took the entire health system in the US and threw it in the toilet and replaced it with the UK health system, everyone would get a tax cut. Plus you wouldn't need insurance at all.
40
Hopefully we'll get something from the federal government, but why isn't the state government doing something? You'd think they could at least pass something like Massachusetts, if not an outright statewide single payer system (if that's even legal under federal statutes).
41
@39: Elladan, could you please link to sources of your information? I don't doubt it, and if it's accurate, I'd like to be able to repeat it with proof of its accuracy.
42
39
the $3000 figure you cite is only what the government spends. the private sector spends another $3000 a year for every man-woman-child in the country. you suggest slashing what the country currently spends on healthcare in half and covering everyone. you must be smoking some really good stuff.
the $3000 figure you cite is only what the government spends. the private sector spends another $3000 a year for every man-woman-child in the country. you suggest slashing what the country currently spends on healthcare in half and covering everyone. you must be smoking some really good stuff.
43
Phil @41: Certainly. Source: World Health Organization, http://www.who.int/whosis/whostat/2009/e… - you want table 7.
@42: The UK covers everyone for half. The UK also spends MORE than the OECD average to do it. For comparison, take a look at Finland: $2455/yr per capita government, $3232/yr total including private. The amazing thing is that people in this country put up with spending twice as much as everyone else for worse outcomes.
Plus, I've been using the "exchange rate" numbers the WHO publishes. Their PPP numbers are a more accurate depiction of just how bad the US health system is.
@42: The UK covers everyone for half. The UK also spends MORE than the OECD average to do it. For comparison, take a look at Finland: $2455/yr per capita government, $3232/yr total including private. The amazing thing is that people in this country put up with spending twice as much as everyone else for worse outcomes.
Plus, I've been using the "exchange rate" numbers the WHO publishes. Their PPP numbers are a more accurate depiction of just how bad the US health system is.
44
A consumer economy does not encourage a "sense of community," a consumer economy encourages a sense of "when will I have a flatscreen TV in every room???!!!"
Make the Boomers pay for health care reform. They're the ones who fucked this all up.
Make the Boomers pay for health care reform. They're the ones who fucked this all up.
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