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Why I'm against any kind of market-based approach to universal health care.

Mary makes a well-written case for Single Payer health insurance at Pacific Views today.

"America's health care system is imploding. Despite the fact that America devotes more of its GDP to health care than any other developed country, the real outcome for a significant portion of our country is miserable. And despite all the initiatives that claimed to fix the problem, the problem is getting worse."

As someone who administers state Medicaid in Pacific County and who becomes aware of as many uninsured citizens in an hour as an enterprising researcher could find in a day, I consider the above seriously understated.



foto:bigpicture.typepad.com

"Getting worse" actually means something far fouler smelling than what you see in Sicko.

Mary has more:

"Universal health care is particularly unsuited for a market-based approach because people are unable to do a lot of comparison shopping when they are sick and the overwhelming need for health care is when someone is sick, not when they are well."

A market-based approach in this country is the failed altruism of corporate capitalism which for decades has trumpeted the idea that the market could and WOULD take care of society's poor. That by definition is an impossibility given the formal constitutional definition for a "corporation."

That definition literally justifies - even encourages - a single-prioritized bottom-line profit-based approach to enterprises supposedly created to accomplish public good because individuals and small communities cannot create sufficient capital to accomplish it by themselves. It's an approach that has everything to do with some sort of corporate right (a la a human citizen/person's right) to the pursuit of happiness - precisely because corporate pursuit of happiness is pursuit of profit, not public good. It would be like giving a giant leech a constitutionally guaranteed right and protection to suck up the life blood of  every citizen and community.

... unless of course one "conservatively " defines "public good" as equal to what's good for business.

I'm against any kind of market-based approach to universal health care.

Our objective should not be that the highest priority is what's good for business in this regard. That's the attitude immediately and transparently  revealed  as harmful and inadequate when ideologically, an American president attempted to suspend minimum wage in the Katrina disaster area;

when he immediately asserted opportunity for profit before securing a disaster area;

- suggesting that the public good is best served if profits are prioritized first.

It borders on oxymoron to even suggest that government should be run as a business first and foremost. One primary reason is that profit unreasonably gets asserted as more important than the public good.

Bushco has amply demonstrated the failure of corporate capitalism to successfully care for its citizens or even to wage war (as if waging war were a constitutional obligation rather than national expediency) in the most economically wise and efficient manner. The Medicare D Supplement in reality is a massive act of corporate capitalist foolishness birthed by greed and lobby payments - not honest public discourse on the highest public good.

Speaking "capitalistically" and "market-basedly" we do not - when our house catches fire - call the fire department and make arrangements to pay a deductible before they will come. Our taxes have already paid for that.

... or if we hear an intruder in the house, we do not call the police and negotiate a deductible or co-pay term before they come out to keep us safe. Our taxes pay for that.

... Why the hell do we do that to ourselves regarding our most precious personal asset - health?

"Because taxes could go up," defenders of the market-based capitalist religion declare.  To which even non-MBA's like me who have spent hundreds of hours at the kitchen table working out budgets reply,

So it's all in the budget priorities. We must be spending too much somewhere else, eh? Like perhaps on a paranoid and insecure  but profit-driven wide-eyed defense and weapons industry?

The assumption is false and we are asleep. Market-based corporatists want us to stay that way.


It is all about bull shit ...the selling of bull shit ... the buying of bull shit ... the lying about bull shit ... and the harming of an entire society by overdosing on bull shit.

When a wild-eyed elderly woman comes into my office saying she's heard terrible horror stories about socialized medicine in Canada I'm ready to throw up or throw my hands in the air.

Think about it. 

 Great Britain apparently (at least per Sicko) launched their version of socialized medicine right after WW II when they were not far removed from financial insolvency. They ain't even come close to scrapping it.

Why not?

Well hell, because maybe what they've got - what Canada and France have - works fine enough that their national public good and well-being far outweighs whatever problems come up. Regardless of American corporate lies, those problems certainly are not the nightmares our  lobbied-and-prompted politicians, insurers and care providers constantly try to scare us with.

How DO they pay for it? With taxes of course.

Why COULDN'T we pay for it with taxes?  We could, of course.

We might have to give up or cut back to reasonable levels some other kind of spending - like defense.

Of course we could and of course we should.

Those opposed to cutting back military spending are not driven by fear of a massively global military monolith with resources approaching a trillion dollars and planning an all-out attack and invasion of our homeland.  They are driven by a fear of loss of profits.

Get the terrorists yes ... but with honest police work and funded actions appropriate to legitimate need as a wise economic response.

But do we really need full-monte massive military assaults with nukes, 37 divisions plus the 4th, 5th , 6th, 7th, and 8th Fleets and the 98th, 99th and 100th Bomber Wings ... hell no!!

But of course that's another story to debate elsewhere whenever we get serious about sourcing and budgeting much more important issues, like being 37th in global health effectiveness.

Besides, that attack and invasion has already occurred.

It began years ago when we naively swallowed corporate bait-and-switch philosophy - without any critical thinking or understanding that lobbyists were serious (they always MEANT business) - hook, line and sinker.

We were attacked and invaded by corporate sharks who only got more openly savage about it after 2000 when Dirty Dingus McBush open the trapdoors and helped the corporate Trojan Horse drop a massive pile of stinking biscuits smack dab in every living room and homeless shelter in America.

So in terms of market-based medicine for America, our medicine-based marketing sharks would be the ones in ICU if we ever woke up,

if we ever narrowed our wide-eyed naïveté

and went shopping for a better system.   

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I recommend pushing it hard--it can get some otherwise recalcitrant people to see the light.

What would happen to the cost of firefighting if there were two or three fire departments per city competing for business?  With several times the capital investment to put out the same number of fires, the cost would obviously skyrocket.

Studies clearly show that when you compare cities of the same size, the more hospitals in town, the higher the health care costs.  Health care clearly follows the rules of fire department economics, not iPod economics.

A very common wingnut meme is "As long as you want the government to give everybody free health care, why not give everybody a free computer too?"  They are deliberately making a category msitake, and you should counter by putting health care back in its proper category.  Just say " My government gives people something far more expensive than a computer--you can get a whole free fire engine with trained operatives to run it."  The catch, of course, is that you can't take advantage of this wonderful offer unless your house or vehicle is on fire.  The analogy to heart attacks ought to be obvious.

by eridani on Sat Aug 11, 2007 at 11:41:22 PM PST

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Illness should not be a profit-maker for huge companies.  They're not even profiting off health -- which they lose $ from -- they're profiting off the failure of health.

There's no logical or issue connection between what insurance companies do and the business of helping people get well. It's a parasitic industry. I appreciate what Marty G says on Mary's Pacific Views piece:

In my opinion, these people [meaning the insurance adjusters/clerks who make the reimbursement decisions] are making medical decisions with no medical training whatsoever. My question regarding insurance companies is this: Why should someone with no medical training or background at all decide what medical care someone should receive? We have people with no more than a high school education second guessing medical specialists in their care of their patients. Does this make any sense at all?

by noemie maxwell on Sun Aug 12, 2007 at 03:32:37 PM PST

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Thanks to Dan at On  The Road To 2008 for the prompt.


 NYT:Editorial
World's Best Medical Care?
 

[excerpts]

Michael Moore struck a nerve in his new documentary, "Sicko," when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.

... Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage.

... Access ... Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention ... The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. ... even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room.

... Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens.

... We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.

... Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the "right care" for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place.

... With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has "the best health care system in the world" and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world's most powerful economy should be able to provide a health care system that really is the best.


Arthur
You sure you ain't staking too much on yer theories? Not enough common sense?

by Arthur Ruger on Sun Aug 12, 2007 at 07:25:40 PM PST

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/story/2007/8/11/144533/282

The argument that "We can't afford it because our taxes will go up" is totally wrong-headed. We are ALREADY PAYING for this mess.

We pay for it in our insurance premiums at work and in the portion of the premiums paid by our employers (which otherwise could go to either higher direct wages or lower prices of goods and services).

We are paying for it in the tremendous overhead costs for administration of the insurance claims processing. The top 25 health insurance companies take in over $284 billion in revenue (http://www.investor.reuters.com/business/BusRankingsCompanies.aspx?industry=INSACC&target=busran kcomp&rankcategory=2). That's almost $1,000 per person for the whole population of the U.S.

We are paying for it in our taxes for the government-funded emergency medical care that is provided to the 47 million people who have no other coverage. We are not yet so cold-hearted a nation that we will refuse health care entirely to the indigent or those with no coverage. But we will only provide emergency care through the public hospitals.

We are paying for it in our bloated co-pays. The pharaceutical coverages are possibly the worst offenders on this. A few years ago my medical insurance changed to only allow me to order a 30-day supply of my prescriptions. Prior to that, it had been 60 days. Since I pay a co-pay on each refill, this doubled my actual expenses.

And finally we are paying for it in the lousy health outcomes we get. It is well documented that preventative care yields lower overall health care costs AND better health than delayed, emergency medical care. This affects everyone, from fetuses to seniors. And better health contributes to better business efficiency, too.

If we replaced this incredibly ineffective and horrendously expensive disaster of a system with true universal health care, the actual costs would go DOWN tremendously, not UP. We would have more money in our pockets, not less, and we would be healthier to boot.

by Gordon Glasgow on Tue Aug 14, 2007 at 05:35:26 PM PST

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Good post. Spot on.

I have a hard time articulating my views on these things, because I've got so many unconnected points stuck in my head, without a thesis (synthesis) to tie it all together.

Open Markets

There is no free market. That's religion.

There are open markets, gray markets, and black markets. The most efficient are open markets. Attributes of open markets include:

 - symmetrical information, meaning both sides of the deal of the same information (aka "are well informed")

 - contract law, which tells everyone the rules to play by

 - fair and impartial judiciary, so that disputes can be resolved

 - minimize "externalities", where costs are not on the books and so therefore unaccounted for

Free Choice

Open markets require free choice. The free market cultists do not acknowledge that in their laissez-faire (feudalism) system, choices are constrained.

For years, I paid for my own health insurance. Now that my employer covers some of the costs, I really don't have the choice of moving on. I'm, in at least some ways, no beholden to my employer.

This constraint on the free movement of labor is exactly why capitalists criticize socialists: it's bad for the economy.

Externalities

Having read up on environmentalism/ecology, economics, and environmental economics, I, like most "greens" that I know, regard stuff like pollution as an accounting problem. If the costs aren't on the balance sheet, they're not factored into the decision making process.

When someone pollutes, or spoils a commons, or over exploits a resource, that's simply a form of theft. Some favored party/person is profiting at everyone else's expense.

So it is with health care.

The Public Good

Citizens invest in fire stations to protect the public good. The preventative costs are minimal compared to the costs of disaster.

It's a public health and safety issue. When we all do better, we all do better.

Health care is also a public health and safety issue. Enlightened societies invest in health care to protect society's investment.

Business Climate

Just like with fire stations, public schools, and pollution, we're now sophisticated enough to determine how health insurance policies impact our economy.

Companies like Toyota have located new facilities in Canada. Because the local workers are better educated and more healthy. So productivity is higher. And Toyota direct investment in each employee is lower.

Domestic companies, who previously opposed universal healthcare, are now totally on board. The reason is competitiveness. The foreign competitors, based in countries with universal healthcare, have less overhead and are therefore more competitive.

It's pretty straightforward. If society chooses to save money by switching to universal healthcare, it'll grow the economy.

Cultural Maturity

Our current laissez faire (free market) system is feudalism. Very old school. Pretty easy to understand. The profiteers love the system. Everyone else can eat cake.

Universal healthcare, single payer, and the variants are all products of a socialist worldview. In the same way that fire stations, public schools, and clean water are socialist. Don't be too shocked, the USA has had socialism lite in various forms since WWII. Social security, collective bargaining, trust busters, electrifying the country, etc. For the most part, these programs have worked out great.

Above, Arthur says he's against any market-based solution. I'm not so sure.

Currently, unbridled corporations profit from disease, ill-health, and NOT providing health care. That's clearly against society's self-interest.

Markets are based on incentives and rewards. If we want to encourage innovation and increase productivity, many would argue that you need to right incentives.

I'm not original in suggesting that we should find some way to reward keeping people, society as a whole, healthy.

The book Natural Capitalism says we need retool our economy by switching from consumption to services. They give a couple of examples of companies doing just that (on their own, without any government incentives).

Imagine we have universal healthcare, maybe an expanded single payer system like Medicare. You still have corporations. Everyone still uses money. People in healthcare still need to earn a living.

Right now, Medicare and others ration healthcare. (Much, much more equitably than the private insurers, but it's still rationing.) Saying what is covered and how much they'll pay for this and that. It's not a bad system. But it's inefficient. And there's this constant downward price pressure, much like WalMart treats their suppliers.

I hope someone figures out a system to incentivize keeping people healthy. So that as the patients do better, the people in healthcare make more money.

Such a "share the wealth" system would have a certain logic to it. I have 1,000 patients. I keep them healthy. Fewer sick days. Higher productivity. Fewer complications and major hospital visits and surgeries and whatnot.

Those 1,000 patients with their improved health will be wealthier. As their healthcare provider, having made an investment in their well-being, I should be rewarded for my contribution.

Just something to think about... Maybe get some people past the ideological logjam (meaning the illogical opposition to saving money by improving public health).

by zappini on Thu Aug 16, 2007 at 04:58:33 PM PST

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