Okay. Just to be clear, can you explicitly say that you think that the ability to not die of cancer — hell, the flu — should be reserved for the wealthy?

No that is not my position. Your example is a bit of a hyperbole though. Yes insurance may deny your claim for some underhanded reason, but I'd rather deal with them than the government. At least with the insurance companies there are avenues for recourse with which I've had some success. I have worked for a health clinic in the past and saw first hand that patients without insurance (some so poor they couldn't afford the trip there) routinely received care for very expensive diseases inluding cancer and HIV without regard for ability to pay.

It makes no sense to throw out something that the vast majority of US citizens are satisfied with to serve a relative few only to worsen the care of everyone in the form of loss of freedom and diminished level of care.

Stu

A vast majority are satisfied? Really?

Explain these poll results then.



When you bring in comparisons between socialized programs like Medicare vs. private insurance, people are more happy with the government programs.



If you think I'm cherrypicking bad data, please show me polling that shows Americans love the system as-is.

It also seems a lot more cost efficient to enhance the current processes rather than throw them out.

You're still making the baseless argument that the government will be your healthcare provider. Yes, there may (or may not) be an insurance company that "is" the government, but it is only one of many.


That's great. Was anyone being treated, for, for example, pneumonia? Do you think that the common cold or flu that that developed from would have been easier to treat and less dangerous to both the patient and the people around him or more difficult and more dangerous?

And what about those people that really couldn't afford the trip that never got there at all, but could have gotten to their local hospital that doesn't have a free clinic?


Ignoring for a second Tony's point that the vast majority are not satisfied, what is your basis for saying that the current system is being "thrown out"? As far as actual insurance coverage, all that's being done is providing group health insurance for people who can't currently get any.

I can only answer that with this which states that 68 percent of Americans like that care they now receive.

Stu

I suppose it is baseless if you turn a blind eye to logic. The bill as it is written explicitly prohibits private insurers from issuing new policies to individuals starting the year in which the bill is put into law. This combined with the fact that the government plan will effectively undercut the "competition" with an unlimited money supply courtesy of the US doesn't leave much to the imagination as to what the end result will be.




Yes they were actually. Of course just as many contracted it in the hospital, but poor or not how many actually go to the doctor for the flu or cold?



There was transportation provided to those needing it.

Stu

No, what the poll says is that, of people who have health insurance, 68% rate it as good or excellent. I think. He's clearly talking about that poll, but the numbers don't quite add up. I guess that there's some rounding error.

There are reasons that no one but Fox uses Rasmussen polls, like that he misinterprets his own data, and that it's always an outlier to the conservative side. (That said, once you account for that bias, they seem fairly accurate.)

In the same poll, only 48% rate the US heathcare system as good or excellent, with 49% rating it as fair or poor. And another 4% who don't know. Which adds up to 101%.

No, it states that 68 percent of Americans have insurance coverage that they rate good, or excellent.

I fall into that category, but only because I elected to go on COBRA, after losing my job, and the only reason I elected to go with COBRA is because the government subsidized it. (For the non-Americans, health insurance is typically provided as a benefit by employers. If you quit, or lose your job, the government stipulated that you have the option of continuing to carry that policy for a limited time, provided you pay the full premiums. Without the subsidy, I think the cost of our coverage under COBRA would come to just over $1000/month.) Come November, when my ability to be on COBRA goes away, I don't know what I'm going to do. I don't think I'll be able to continue to afford the insurance premiums on a similar policy. For what it's worth, I have no vision or dental coverage, either -- we dropped those due to cost.

So basically the way health care here works for us, is that we lose both sources of income within a month, and, because our health care was tied to our employer, get to enjoy a brand new (large) monthly bill. Obviously, we'll pay that with the money we're not earning now?

Am I satisfied with the care I receive? Yes, absolutely. The doctors we see are great. Am I satisfied with my insurance coverage? Mostly (see my above post about getting stuck with a $250 bill for three stitches). Am I satisfied with the coverage for how much I'm paying? Only because it's currently subsidized by the government. Am I satisfied with the US health system? Hell, no. Not even close.

Yes. Individual, non-group policies. This is to protect the new group policy marketplace. Right now, if you aren't eligible for group insurance, your only recourse is to buy individual coverage, which restricts pre-existing conditions, is deniable, and often very pricey, except for the few who are in perfect health, for whom it is generally marginally less expensive than a group plan. However, if everyone who can get it less expensively does, then you're left with only sick people in the group plan, so the rates will skyrocket. The reason that insurance companies make group plans is on the bet that there are a significant number of healthy people mixed in with the unhealthy ones. If they knew that everyone was unhealthy, they wouldn't be interested.

So yeah, there are a few people whose potential healthcare costs would go up: those people who would get good individual rates but who currently don't have an individual policy. But the existing policies won't get cancelled, so those people are all set.

Of course, your argument is going to be that their rates will go up to subsidize the new group. But the new group marketplace is based on competition. It's dumb for Aetna or BCBS to sell policies that lose money, and there's no reason for them to do it.


Both my wife and I have been to the doctor for the flu in recent years and been given Tamiflu. (Which really seems to help, by the way.) More to the point, if they went to their doctor for a normal checkup, they would have been that much more likely to get a flu vaccine and never have gotten it at all. And there have been recent flu vaccine shortages where it was rationed to the young, elderly, and those with immune problems: those people who are more likely to develop into pneumonia. And only a doctor can really say that a patient is immune compromised.

The article I linked to specifically states that "68% of American voters have health-insurance coverage they rate good or excellent" which would mean that 68 percent of Americans have insurance and rate it as excellent. It does not say of those with insurance, it says American voters. You can argue that the guy doesn't know what he's talking about but his polls tend to more closely reflect reality.

Stu

I don't feel like I responded to this adequately.

There are a variety of illnesses that are easily detectable and treatable in their presymptomatic stages, but become difficult to treat and potentially fatal once someone notices that there's something wrong. Prostate cancer, for example.

Since the uninsured poor cannot afford to see a doctor on a regular basis for a checkup, those illnesses fester until they are huge problems.

And affording is not limited to the cost of the doctor. Free clinics tend to have huge waiting lines, and, while I'm sure that they would be happy to provide an exam to patients, changes are that they are going to spend a full day at the clinic, if not more, in order to get it done. These uninsured poor people are far more likely to be working jobs for low hourly wages, which means that they're also losing money by going to the doctor. It can honestly sometimes be a decision between healthcare and food.

If they had insurance, though, they could schedule an appointment with a doctor for a specific time, one likely to be closer to their home or workplace than wherever the free clinic is, and only lose an hour or two of pay.

So, to repeat, are you saying that the poor should die because they can't afford to get screened for preventable illnesses?

As I stated previously, between individual policies becoming illegal and the unfair advantage the gov. plans will have, the writing is on the wall for private insurance.


That is naive as hell to say. Suppose you move out of state or wish to change your coverage? Well you're on the government plan then because you can't have a new private policy. People do change plans or at least they used to be permitted to do so.


I'm glad you made it through okay, but that doesn't mean everybody thinks like you. Just because they can avail themselves to a doctor visit after every sniffle doesn't mean they will.

Stu

No it would make sense to allow them get preventative care, but you're making an assumption that is not warranted- namely that because it is available to them that they will take advantage of it.

Stu

From the article:


From the (apparent) actual poll:


Now tell me you come to the same conclusion. The only logical conclusion is that Mr. Rasmussen is misinterpreting his own poll, or at least misspeaking.


I just realized that I was conflating Rasmussen and Zogby. Rasmussen is definitely reputable, if slightly conservative leaning. So I take back what I said about Rasmussen's reputability. He's still misrepresenting his data in this instance, though. Unless he's referring to a different August 1-2, 2009 poll he made of 1000 likely voters about healthcare issues.

I still contend that the government plan(s) will not have an unfair advantage, but I understand your point, in general. I do wish that an official amendment would be made so we had more to base this on than a months-old proposition. I have two questions, though:

If the government plans were definitively not included — that is, say, the bill contained a provision that it was illegal for the government to provide health insurance directly — are you still opposed? I realize that this is theoretical; I'm just trying to see where else you sit, ignoring that particular issue.

Also, on one hand, you say that the government is incapable of providing good resources: FEMA, Medicare, etc. On the other hand, you say that the government health plan will be so good that it will totally destroy any other private option. Those seem like opposing viewpoints to me. Can you explain?


That's a fair point. I'd totally be down with making it legal to provide individual plans to those who currently have individual plans. Basically grandfather those people permanently.

Not much we can do about people who refuse to see a doctor. But I think it's equally unwarranted to assume that people would not take advantage of it.

An n of 1000 is hardly unique.

Stu

I don't follow. Are you saying you think there is another Rasmussen poll conducted on August 1st to 2nd, 2009 of 1000 likely voters about their perception of quality of healthcare, and that he's basing his statement on that other poll?

If they came up with something that truely reduced costs, expanded availability and had no potential to limit my own choices and anyone else happy with what they had that would be great. Unfortunately, the true intent of this bill has been craftily veiled with health care reform to give government more control over our lives. As such, meaningful, effective legislation will not be forthcoming.



I don't contend that it will be good, anything but, but the plan will take over using force via coercion and economic realities via employer-paid coverage passed on to the government plan.

Stu

I'm saying the source from the WSJ article could be different from your cited poll since I don't see any of the numbers in the article in the poll.

Stu

Let me quote again from the article (emphasis mine):

Here is what looks to be the poll on RasmussenReports.com. The demographics match, the topic matches, and the dates match.

Individual and group (i.e. via employer) private health-insurance schemes manage to co-exist in the UK (and alongside, of course, free health-care for all paid for from general taxation); I'm not sure how we avoid the trap you describe, but perhaps it's through tax incentives for employers to operate the group schemes?

All the UK companies I've worked for which were big enough to have group health-insurance schemes, were US-owned, which might have influenced how important they viewed the offering of health insurance as a perk. Several co-workers (possibly including me -- I can't even remember) opted not to take it up, though, because it's a benefit in kind but is subject to income tax in real money -- which means that, as an employee, even if you're getting it "for free", you're effectively still paying 40% of the price.

Peter

I don't think 1000 samples is enough to form any kind of conclusion from. That, and polls/surveys can be worded/prompted for the response they want either in the words or the prompting of the person giving the poll/survey.

I'm sorry. I even downloaded some diagramming software, but I just can't parse that sentence.


Okay. How about if one of the plans was to guarantee coverage for tinfoil hats?

Pollsters would disagree with you, but fine. Stu was the one that said the vast majority of Americans liked the current system. When presented with polls that showed the opposite, he came up with another that still showed his statement to be untrue, but which had been misreported.

If you don't think that polls are accurate, we can throw out all polls and all argument based on popularity, at least until someone goes around and asks the entire populace.

I thought this was nicely done.

Peter

By my understanding, private insurance in the UK is supplemental to NHS coverage. You might never use it in practice, but you don't relinquish it either. Basically, having NHS coverage is the default state below which you cannot fall.

Not ever having worked in the UK, I can't know this for certain, but I'm going to make a guess:


It seems to me that providing group health insurance is a perk, akin to a free gym membership: something that you might say "ooh, that's nice" in reference to.

Most of us in the US would simply refuse to take a job that didn't provide health insurance. It's a virtual requirement for an employer to attract any qualified employees. Notably, this leaves out positions for which there are little to no qualifications, like minimart clerk, or burgerflipper.

You can have that competition in the UK because it's not really a big deal for someone not to have access to group coverage and also be denied for or priced out of individual coverage.

But it is a big deal in the US because we don't have that base level of care. And that's the problem we're trying to solve, but the proposed solution is not to have an all-encompassing NHS-like service, because it's politically unfeasible.

The current proposed solution is to make the entire US populace a group and let them choose from amongst competing plans, just as if your employer provided multiple options, which many, especially the larger ones, do. However, a large portion of these people don't have individual insurance for a reason: that they're a bad risk. If you let the good-risk people get individual plans, you have an all-bad-risk group left, and that means that their premiums would be very high, and the costs would be unaffordable, and more people would have to be subsidized, costing the taxpayers that much more. So if this tenet wasn't in the legislation, we'd have people (probably the same group of people) complaining that it'll cost too much.

I feel like I'm not making my point well. Let me know if that makes sense or not.

Just to add a different perspective here... Not all insurance is created equal. I am not poor, and I have health insurance. My health insurance, which is tied to my pension, is practically useless. I don't have the words to express my dumbfoundedness (is that even a real word) when I found out, was told in these exact words, that my insurance does not cover preventative care. The last time I had a routine physical exam, my out-of-pocket expenses were in excess of $600. Things like cholesterol tests, PSA tests, the doctor's examination fee: not covered. And something like a colonoscopy, not in your wildest dreams. How the insurance company can imagine that they will be money ahead by spending half a million dollars on someone with advanced colon cancer rather than $1200 to catch it early is beyond my comprehension.

Or maybe it's not. Let's do the math. The risk of someone contracting colon cancer in the US is about 7%. So out of 1,000 people, 70 will develop the disease. If those thousand people followed the common screening guidelines (colonoscopy every 10 years starting at age 30, every five years starting at age 50) and they lived to age 70, that would be seven colonoscopies per survivor, at a total cost of about $8400, times 930 people who don't get the disease plus at least some screenings for the people who do, and you're looking at (in round numbers) about eight million dollars in expense for preventative care. So, if the cost of treating colon cancer is less than $110,000 per person (and it may well be, I have no idea) then it would be cheaper for the insurance company to let people get sick and die.

Go figure.

tanstaafl.

I think they screwed up one very important point:

This is ridiculous. If the insurance companies profited less to insure more people, then they would profit more to insure fewer people, and the best profit-making decision for an insurance company would be to shut down.

I'm not saying that premiums won't go up, but it's not an inextricable law that more people means higher premiums. Assuming that the currently uninsured populace is significantly worse-risk than people under existing group coverage, then it follows, but no one's shown that. And I wouldn't be surprised if that were the case (after all, they've had almost no medical attention), but I don't think you can make that assumption without at least stating it, and preferably offering some real evidence.

It also fails to note the long-term cost (that the taxpayer currently pays) of failing to provide preventative care.