Really Smart Stuff From Sally Pipes On Obamacare
K-Lo interviews Sally Pipes, author of The Top Ten Myths of American Health Care, at NRO. A few essential excerpts:
We all agree that our goal is affordable, accessible, quality health care for all Americans. The question is how best to achieve that goal. First, insurance does not equal access to health care, especially if that insurance is government-provided. Medicaid is a perfect example. It offers a comprehensive benefit package far in excess of even the most lavish private plan. Yet due to low payments to physicians -- the very price controls that government leaders want to impose system-wide to control costs -- Medicaid patients often struggle to find doctors. The same is increasingly true for seniors under Medicare. Insurance does not equal access to quality health care, and access to quality health care does not require lavish insurance. That point is lost in this debate....Health care is a necessity of life, similar to food, clothing, shelter, and to some degree transportation in modern America. It's not a right, as traditionally understood in our constitutional system informed by the great truths of the Declaration of Independence's promise of life, liberty, and the pursuit of happiness. The American Revolution was fought and based on the natural rights of man. Society should be organized to assist individuals in providing these things through the protection of property rights and keeping taxes low so Americans can make their own decisions on how to spend their money rather than putting government in charge. Unfortunately, supporters of government-run health care and the mainstream media have been telling the American people that health care is a right, and that view has been gaining significant momentum over the last few years.
... When people say health care is a right, there is the underlying notion that it should be provided at zero price at point of consumption, or, worse yet, no cost at all, ever. This is impossible, as doctors, nurses, hospitals, pharmaceutical companies, and other providers in the system can't be expected to work for free. We don't expect other necessities to be free or provided by the government or paid for collectively. In fact, we'd be horrified if they were provided this way. A little known fact is that of all of life's necessities, save clothing, health care is by far the least costly. It's not until Americans become senior citizens that the average household spends more out of pocket on heath care than entertainment and dining out. Yet we don't decry the crisis in restaurant bills, football games, and rock concerts.
... Of the almost 46 million Americans counted as uninsured by the U.S. Census Bureau, 14 million of them are eligible for existing government programs but have not signed up. Another 17 million of them are earning over $50,000 a year but do not buy insurance because they feel it is too expensive. Two-thirds are young people between 18 and 31 who consider themselves "invincible." They would buy insurance if it were cheaper and available to cover catastrophes, which is why one has insurance. Because 64 percent of Americans get their insurance through their employer and insurance is not portable, many of the uninsured are just between jobs and hence counted as uninsured, even if they are only uninsured for a short period of time. There are only about 8 million uninsured that need some assistance.







People have no idea what is coming with government health care. There only thought is FREE!
They should listen to talk radio and hear people from Great Britain and Canada call in and describe their National government run health care.
I know a lot of people are going to say, but those are different countries.
Can anyone name me a well run government social program? I really would like to know this is not a rhetorical question.
David M. at May 19, 2009 5:45 AM
Blah blah blah blah blah.
I can't get insurance of any kind for my super-healthy 20-year-old. There is nothing available in the state of Maine. Nothing Nothing Nothing. —and unless or until this inequity is addressed and solved, all the bullshit about people who "won't buy insurance" is going to continue to be harmful, silly bullshit.
I don't want "free" I want "something". By "Something" I mean a plan that isn't a catastrophic hospitalization plan under which nothing qualifies as a catastrophe, and is so expensive that I have no money left to pay the doctor when I do need one. and by "so expensive" I mean $7200 per year for nothing comprehensive, just the minimal hope that the for-profit company will consider your coronary or car wreck "covered".
Deirdre B. at May 19, 2009 6:11 AM
I blogged a Canadian politician who came here to get her breast cancer treatment. I'm 45, and I could get insurance through Kaiser for $145 a month. Even signing up now -- I just looked. My insurance is higher than that -- because I have the Cadillac of Kaiser care, with no lifetime minimum. (The $145 plan comes with a $5 million minimum.) And I've had Kaiser since my 20s, independent of my workplace, and paid my health insurance -- made it a priority -- even when I couldn't afford a bed (I slept in a sleeping bag on a door propped up on two milk crates at one low point). But, I felt it would be wrong of me to stick my parents with my health care bills should something horrible happen to me (not that they'd necessarily mortgage their house to pay them...they might've just stuck me in some public hospital...and I don't think it's right to make other citizens pick up the cost of my care, either).
Why sane, capable people think it's within their rights to have other people fund their lives is beyond me. The other idiocy is...where do they think this money will come from. Oh, right -- other people's money. Taxes will rise for all of us, not just the easy-to-pick on rich.
Amy Alkon at May 19, 2009 6:13 AM
Deirdre, I feel for you -- you're one of the few who needs some help, but as Pipes illustrates, it's not the way people put it about all the uninsured. And untying health care from the work place is what needs to happen -- not making all of us go on the government plan.
Amy Alkon at May 19, 2009 6:27 AM
Deirdre, I have no idea about the market within the US. However, I had an expat policy through Goodhealth - very reasonable terms, good coverage. Their parent company is Aetna. Perhaps they have something domestic?
bradley13 at May 19, 2009 6:50 AM
Either Maine has insurance regulations that are restricting the market for insurance in that state, or Deirdre isn't being entirely candid - because that story just doesn't add up.
Micheal at May 19, 2009 6:58 AM
IIRC Maine won't allow insurers to take pre-existing conditions into account, so most left the state and those that didn't charge a lot more than they do in other states.
jacob at May 19, 2009 7:26 AM
Maine is not the only one. For some reason, politicians seem to think they can just legislate things, and companies will say "OK, I'll operate at a loss, then."
No, companies say "Fuck you, I'm outta here" and we get Dierdre's situation.
I forget which state, I think it's Virginia, you can't find an Ob/Gyn because they all left - they couldn't get insurance.
brian at May 19, 2009 7:59 AM
$145 a month!!! Where are you living? Without joining freelancer's union I couldn't find anything cheaper than $320/month in NYC as a healthy 26 year old non-smoker. I was often quoted at $800/month.
I think if you're basis of comparison is that everyone could get health care at $145/month than sure it seems perfectly reasonable. If you're where I am $320/month seems a lot rougher.
Flighty at May 19, 2009 8:31 AM
Personal Anecdote:
A guy I know, who owns three houses, a SAAB convertible, and goes to the casino each and every week, just had his second child here in Idaho. He also broke his leg in three places recently playing rugby, and needed titanium rods and pins. So more than $50,000 of medical bills. Guess what- no health insurance! He's otherwise perfectly healthy, ealry 30's.
Our community hospital couldn't deny him emergency room care for the leg, and the two children born were born under the best of conditions. All is being paid for by the rest of society, either through taxes or spreading the costs onto other patients.
Meanwhile, my family has Blue Cross with all the bells and whistles. It is expensive. Each year we get a reminder to get mamograms, physicals, etc. So my wife goes in for a physical, and the doctor finds a lump in her breast. She gets a mammogram, and it is not covered now, because it is "diagnostic" as opposed to "routine". So we end up for the last 6 months fighting with one clerk after another, and it looks like we are going to have to pay the roughly $500 out of pocket.
It's a system that needs to be addressed and some fairness brought back.
(PS- my boy recently needed his kindergarten shots- $270.00! I remember growing up and we all lined up at school like toy soldiers for a nomminal charge.)
Eric at May 19, 2009 8:34 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/05/19/really_smart_st.html#comment-1649266">comment from EricI live in California and joined an HMO on purpose because I can't afford bills like Eric's wife got. When I was in NYC from time to time, I'd have to go out to White Plains if I needed care -- that's where the NY Kaiser is closest to NYC. I pay $25 for a mammogram, I believe, and get them scheduled regularly (they are routine care for a woman of my age). I had to get an MRI for my boobs and I believe I paid $50 for that at an outpatient facility (they didn't have room at Kaiser -- for me, not that my boobs are THAT huge). An office visit is $25. My Ritalin costs me about $30 for a six month supply, although it should probably be $60.
PS As an epidemiologist friend told me recently, medications are MUCH cheaper in many cases at Costco (like, enormously so), and you don't have to be a member to go to their pharmacy. Check whether you can get a generic at Costco of whatever you're paying out the ass for at a regular pharmacy.
Amy Alkon
at May 19, 2009 8:47 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/05/19/really_smart_st.html#comment-1649267">comment from Amy AlkonOh, and I'm 45 and pay around $300 a month. If you're younger, it's much cheaper. And again, I signed on when I was young and healthy (now I'm older in the tooth and apparently still healthy). People are dumb to wait until they get some disease and then complain that they can't get reasonable health care. Deirdre's son is an exception, of course, and it's a situation that should be corrected. But, if you're 25 and just don't want to spend the money, well, fuck you -- I shouldn't have to have Obamacare and pay your way because you gambled that your appendix would be all kicky and fine until you die of old age.
Amy Alkon
at May 19, 2009 8:49 AM
Flighty should be thanking the New York Legislature, which does not allow the insurance she wants to buy to be sold in this state.
I suppose the next move will be to make the Prius the only car that can be sold in the state.
MarkD at May 19, 2009 9:41 AM
Leonard Peikoff wrote a good article a while ago on this topic and is still relevant. His focus is on the moral aspect. Showing that implementing the idea would be a disaster is not enough, if people still think it is a moral ideal.
http://westandfirm.org/docs/health-care-is-not-a-right.pdf
newjonny at May 19, 2009 10:36 AM
I don't know if Deirdre's son is an exception. I have two young healthy friends who were denied Kaiser coverage in California recently; neither had significant previous conditions. (Of course this is all based on anecdotes so doesn't really mean much.)
Sam at May 19, 2009 11:39 AM
The propaganda for universal health care has been so successful that it has given people totally unrealistic expectations. If you see a story on a news site about someone being denied payment by an insurance company, if the website accepts reader comments, there are immediately dozens of comments saying, “This is why we need universal health care now.” Except that won’t solve the problem. This happens when an insurance company or HMO searches for ways to avoid paying claims because they are trying to save money. That won’t change when the government takes over.
In fact, it will probably be worse. It is hard and expensive but it is possible to sue an insurance company and, occasionally, even win. Do you think you’ll be able to get the government to change its mind when they’ve decided you don’t really need and MRI or back surgery or that expensive blood pressure medication? As hard as it is to fight a big corporation like an insurance company, fighting the government is a thousand times harder. Have you ever tried getting the IRS to fix a mistake?
My great fear is that we will start down the path towards socialized medicine. Then Americans will discover it isn't the "merry medical wonderland" they thought it would be and demand politicians pull back. If that happens we will end up with some horrible hybrid that is the worst of both worlds.
Gordon at May 19, 2009 12:13 PM
Here in NJ you cannot buy decent private health insurance, and what is available is astronomically priced; about 1500 per month for a family plan. The only way to get anything decent and halfway affordable is through a company, and even then it's close to 1000 a month. From what I understand, this is a function of govt. meddling in the insurance market.
kishke at May 19, 2009 12:59 PM
I would advise all of you to forget about the Canadian health care system. It is involvent. Most Canadians simply do not know it yet. We ration and cap, and still it is insolvent.
Anyone serious about providing affordable health care to the entire population should think about immediately removing gov't from the industry ... FDA included.
Charles at May 19, 2009 1:10 PM
Telling the American middle class and lower socioeconomic cohorts that health care will not be provided by government in the near future is pretty much telling your kids to stay in bed Christmas morning until the parents are done sleeping in. Good luck with that.
I suppose it is possible that the kids and voters would listen, but only at the tip of a bayonet.
I have resigned myself to watching American health care diverge onto two tracks, public and private. The former will become a huge and expensive bureaucracy filled with inefficient yet costly employees and practices, all delivering piss-poor outcomes relative to the money spent. The private industry will be tied down by idiotic mandates and regulations, in a pretty obvious attempt to make it as inefficient and costly as the government-run providers. Still, the private market alternative will provide a better, cheaper service.
Pretty much the same thing you see in education, only far more massive and corrupt.
Spartee at May 19, 2009 1:23 PM
Not that I agree with it, but here is an article on this topic:
http://www.uexpress.com/asiseeit/
-Julie
Julie at May 19, 2009 2:15 PM
Sort of on this topic-saw an ad for the vaginal infections test kit today. How great is that? We need more stuff like that. Why should an MD have to tell me "yep, you've got yeast!". Same for strep throat and any number of other common and easily treatable illnesses. We should be able to do this stuff ourselves.
We just moved 3 weeks ago, 15 miles away from the old place. DH was told when he called his work to change the address, that means we have to switch insurances. ??????!!!!!!! Why, they can not explain. WHat that means for the birth I just got out of the hospital for, I do not know. I am very unhappy, I really liked Aetna. His job-while I love "they" pay for a large chunk of it-shouldn't make us change just for moving 15 miles. Crazy.
momof4 at May 19, 2009 6:39 PM
> We should be able to do this
> stuff ourselves.
Why do people think professional medicine hasn't drawn the line between 'scrip and patent medicines well enough already... except that nobody like cutting checks to doctors?
Is Jody watching? No? Good. I'd rather be a junkie in a New York City jail than....
IOW, I still loves me some Western Civ, L.A. Style
Crid [CommentCrid@gmail.com] at May 19, 2009 7:35 PM
Well, I did until I read this from McArdle, who reminds us what I'd voted for this afternoon....
Crid [CommentCrid@gmail.com] at May 19, 2009 8:32 PM
>>Is Jody watching? No?
Oh she watches through narrowed yellow eyes from her lair, Crid...
(Kipling echo just for you!)
Jody Tresidder at May 20, 2009 6:37 AM
Digression from topic: Momof4 -- shortly before this, you were Momof3, right?
old rpm daddy at May 20, 2009 7:09 AM
Yes, I was momof3. I know have a 4 day old baby boy added to the mix :)
Crid, patent medicines are available without a script, yes. That doesn't help much when you have to see an MD to tell you to use one. There is no reason basic common illness testing should not be available over the counter. I imagine drs get a bit bored diagnosing the flu and sinus infections, don't you?
momof4 at May 20, 2009 10:02 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/05/19/really_smart_st.html#comment-1649475">comment from momof4Congratulations!
Amy Alkon
at May 20, 2009 10:14 AM
m4 -
Have you been to Wal-Mart lately? They have walk-in clinics in many of them now. Same with CVS.
brian at May 20, 2009 10:38 AM
The absolutely freaking-scariest part of Obamacare is when I heard someone talking about how some of us "use too much health care"! WTF! Do you understand that means they are STARTING from the position that health care will be rationed!
Here's an example of what that will mean: a year and a half ago I had a complete hysterectomy. After the complete tissue testing was done it was discovered I had a small endometrial cancer. I was originally going to have an endometrial ablation (scraping), which would have merely hid the cancer, possibly until it caused my death. I went with the hysterectomy based on personal preference. Under rationed health care, I wouldn't have the option of a preference (what's the bureacrat gonna choose--the 3K$ ablation or the 30K$ hysterectomy?)and I would be sitting here now a ticking time bomb.
Karen at May 20, 2009 11:06 AM
Karen - where were you two months ago?
When Duh One announced his budget, he included the creation of a federal office whose sole purpose was to intimidate doctors into not offering expensive treatments, but rather telling people they ought to accept a hopeless diagnosis and go die already.
Although it hasn't happened in other systems (yet), look for euthanasia to be offered as the only "covered treatment" for certain expensive ailments.
brian at May 20, 2009 11:43 AM
m4, you might get screwed, because your family will have to meet the deductible with the new insurance company. I hope they didn't make you switch until after the birth. My job covers both Husband and I through BCBS TX, and I am on the same plan as our employees in Laredo. It's really odd that they would make you switch because of a move, I've never heard of that.
brian, Wal-Marts around here probably have the walk-in clinics, but the CVS's are still pretty small, usually.
ahw at May 20, 2009 12:00 PM
K-LOL interviews people? I had no idea that she did anything for NRO other than write breathless, vapid, paeans to whichever theocrat currently serves as her virginal adolescent crush. Her intellect makes Jonah's look positively scintillating.
OK, enough with the pure snark.
Regarding Crid's reference to the McArdle post above. I'm actually kind of pleased that none of the ballot measures passed yesterday. California is currently ungovernable. It will take a crisis before we fix our systemic problems (primarily, the supermajority requirement to pass a budget and the initiative process). If the initiatives had passed, we just would have papered over the real problems yet again.
Cheezburg at May 20, 2009 12:55 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/05/19/really_smart_st.html#comment-1649502">comment from CheezburgVoted against every one of them. The voters were too stupid to understand the last one, tying balancing the budget to legislator pay. They'll just raise taxes to balance it -- nothing prohibiting them from doing that. But, people are not that smart, and don't prepare to vote, so they just glance at the bill of goods they're being sold and go "Oh, okay!"
Amy Alkon
at May 20, 2009 1:20 PM
Not to argue with Deirdre, but I thought Maine had a state insurance policy--Dirigo_Health.
http://www.dirigohealth.maine.gov/
Kate at May 20, 2009 5:15 PM
> our systemic problems (primarily,
> the supermajority requirement
Nope. It's the fat contracts (contracts!) for public service employees... The noisemakers who so effectively hounded Schwarzenegger in the second year of his term.
We are so fucked. Fucked.
Children will have no books in school because a few DMV counter-girls from 1982 have successfully demanded fat retirement.
(If Stewart says I'm wrong about this, she's right. But otherwise you are compelled by horse sense to take my word for it.)
Crid [CommentCrid@gmail.com] at May 20, 2009 10:26 PM
You may be right about the contracts having a role; I know the corrections union has totally undue influence.
I still contend that the initiative process that allows the idiot voters to create mandatory allocations of funding that can't be used for other purposes is a huge problem. And the supermajority requirement to pass a budget, combined with gerrymandered districts that render nearly every legislative seat non-competitive means that it is not easy to fire people who every year fail to agree to a budget that does anything other than apply band-aids and avoid solving structural problems, is another.
Cheezburg at May 21, 2009 7:53 AM
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