I am very "on the fence", so perhaps, I am not ready to make a big argument. Insurance, that is not tied to employment would be a big first step. Although I tip toward Universal health-care, more than anything, I would like to open up a thoughtful debate.

I would like everyone assured some level of health-care because I have seen several sad cases. My mother developed tuberculosis at the age of 19. She had a young child and was barely making ends meet. She was hospitalized for a year and a half. It is a big burden to start out your life with that kind of debt. Additionally, I started out at a junior college with a young woman who had asthma and could not afford preventative care. She relied on the emergency room for treatment. She died just before our golf class one day. Preventative care is surely less expensive than people who use the emergency room. The death statistics for uninsured car crash victims is also a strong argument for expanded coverage. Most 18 year-old people not able to fully support themselves and pay for insurance. Their life is a huge price to pay for this.

I worry also about over-crowding in the emergency room. When I had my first son, the care was awful. The explanation: the hospital was filled with uninsured patients who hadn't had any prenatal care. Therefore, they were high risk. I was not, so I was unable to get proper monitoring or pain relief during labor. I thought the charges were outrageous. It was explained to me that those who are insured pick up the cost for those who are not. That is why a box of Kleenex costs $18.00, etc (18 years ago). We are already paying for indigent health-care, so why don't we do it a little more cost-effectively and fairly?

I am not an idiot however, I do know that if there is Universal health-care, there will be rationing. That is why I liked Hilary Clinton's plan of a 3 tiered system. It would be impossible to fully cover everyone. The other possibility is akin to what Obama has proposed where people can get their own health-care through employers, etc. Pre-existing conditions would be covered and insurance would be portable. Of course if preexisting conditions are covered everyone must have insurance. Otherwise why not wait until you are sick. As I understood it, there might be government backing for those who cannot get insurance anywhere else. Of course, right now the powers that be are hammering out different policies, so the exact policies seem to change on a daily basis, and alas I have not kept up with all of them.

On the other hand, I think that the level of bureaucracy is already awful. I can only see this get worse with Universal health-care. Shockingly, I was not able to get a test for a parasitic infection. I even went straight to the lab. I was told that they needed a doctors orders. A total of 5 doctors did not think that a parasite was likely, they blamed it on my nerves, so no test was done. You might be surprised at the difficulty in getting a test if your doctor does not recommend it.

I do think that it will be harder to get tests that are paid for by insurance if it is run by the government, but at least if we do pay out of our own pocket, we will be paying for the test itself and and we will not be paying a premium for everyone who is not insured.

I make the comparison to public education because so many people who are staunchly against universal health-care can see the benefit of the public school system. If school was not a requirement, but rather a privilege for the wealthy, our country would be very different. I would likely be illiterate. Public schools also gave my husband the start that he needed. We worked hard to put him through 10 years of college, but at least we didn't have to pay for 1st through 12 grade.

Similar things happened to my parents. My mother was always in not exactly poor health, but not good health either, from her mid-40s. Hard to put a finger on , but it was a generalized malaise. She already had a weight problem, so when she went to the doctor and told of her sweating and fatigue, the first, second and third doctors all told her it was because she was fat.

She was given, over the years, diuretics, diet pills, iron, an 800-calorie a day diet, and finally was told that she was "lazy".

She went in for a knee replacement, and at a follow-up appointment when they drew blood it was pinkish......they thought it was an overdose of Coumadin. Further testing revealed that she had Non-Hodgkins B-cell lymphoma, and probably had for 15-20 years before it was discovered. She's in remission, but because it was discovered so late the treatment was intense and so now she has kidney damage.

My father had a dry cough that his primary care told him was just a 'dry throat', the cough lasted a good while. It would come and go, but since primary care said it as okay he didn't do anything about it. This was December through March. In June he got back pain, primary care told him to rest, and if it didn't get better, to come back. Two more visits before he was referred to a specialist. The specialist saw him, decided that his back pain was plain old lumbago, didn't X-ray him but gave him a sheet of exercises to do, and again 'come back if you don't get better'. He got worse and worse doing the exercises so he went back to the specialist who told him that a lot of people temporarily feel worse (muscle pain etc) when they start the exercises, keep doing them. He went home shaking his head, but did them two more days....and his back broke.

He was unable to walk or stand, so he went by ambulance to the local hospital. When they X-rayed him they found that three of his vertebra were broken, because they were infiltrated with cancer. They examined him and found that he was in Stage IV of esophageal cancer. The stupidity and cruelty didn't end there.......they decided he didn't warrant either a back brace or vertebroplasty. Vertebroplasty is infusion of bone cement into cancer-ridden back bones. When bone cement hardens, it heats, which destroys a good bit of the cancer in the bone, if not all. Then, when it's hardened, it's as if your back was never broken. I begged his doctors to do it and they said it 'wasn't necessary'. I also nagged for a prescription back brace, but he never got one. He lived the last three months of his life in agony with a broken back. Bastards.

If you're with the wrong HMO, your life isn't worth 2 cents. Co-workers of my father, two of them, also got esophageal cancer and both were caught early, and they're still okay, while my father will be dead four years this January.

A system like this, when it's really like Russian roulette, is lousy, I hope to God it doesn't get any worse.

...I don't think that my care would have been any better, but I imagine it would not have been any worse than what I was getting before I went on a full coverage plan...

So, she has better coverage now on a full coverage plan, but she supports a government solution that -- let's not play the silly pretend game, we know where this ends with the "consumer option" nee "public option" becoming quickly the "only option" -- will put her back in the box? Further, it will put everyone who's happy with their medical care in the box of being treated like she was when she was getting shuffled out the door with only cursory treatment?

Is there some sort of mental disconnect there? She's happy with her new health insurance, she apparently works for the government, she gets an excellent private insurance plan paid for by her employer who happens to be the government, she acknowledges the public health plan may be a step back -- and yet she backs it? Is she too out of it to realize that the government health insurance she gets from her employment will in no way mirror the minimal-care-for-all that will be the public option/only option?

Here's my healthcare plan: get rid of all the gatekeeper HMOs and let patients and doctors deal with the insurance companies themselves. Caps on how much the insurance companies can charge, get rid of the pre-existing conditions stipulations, and make malpractice insurance reasonably affordable again. Knock it off with the frivolous lawsuits by reining in the lawyers and capping awards that get paid on any individual case. Get rid of these overpaid CEOs of the HMOs whose only interest in the HMOs at all is how much money they can make from them. Start teaching personal responsibility in elementary schools because no one is teaching it at home anymore.

And, being a student of history, I always love to recall for the HMO haters: HMOs were created when Ted Kennedy earned his "liberal lion" label and decided government should get into fixing health care for the middle class in the first place. Hate your HMO? It acts as a bureaucratic gatekeeper? Then it's doing exactly what he hoped to "bend the cost curve" in today's language. Government run health care (there will be no insurance angle) will be that small-soviet model writ large.

Yeah, I had a reference to TK in my previous post, but took it out before I hit the submit button. Someone had told me a long time ago that he created the HMO model "as a way of atoning for the Kepchene debacle and as a way of appeasing a bunch of his peers who were hounding him about needing jobs, among other things". As in, TK said "Here, you can be CEO of this new HMO. Now please leave me alone about the whole Mary Jo thing, wouldya?"

That someone could have been wrong, though. But it does make me wonder.

Ooops. KepECHne. Too early. Need coffee.

Here's the thing: If I read this correctly, your original writer essentially seems to believe that, with universal health care, her experience with the medical system would be far more likely to approximate her final experience described -- the one during which she had great coverage, got tons of tests, etc. etc. From everything I've seen of government-run health-care systems, though, that experience is atypical. Yes, you have health insurance. Guaranteed. What you don't have is guaranteed access to extensive, expensive testing, because it's expensive and often difficult to justify. You also don't necessarily have access to cutting-edge treatment if the cost/benefit equation doesn't satisfy the cost controllers (and such a system is unlikely to encourage the development of new, expensive treatments because there's a paltry return on them).

There's also another side effect. Americans have access to a truly dizzying amount and array of sophisticated screening equipment right now. There are certainly disadvantages to that from a limited-resources point of view -- screening everyone who comes in with a hangnail for eighty billion rare conditions (I exaggerate, but you get the idea) costs a lot and has a low return -- but the advantage is that if you want to pay for your own testing, you can shop around for an amenable doctor (and they do exist) and the testing equipment you need will be available. Under government-run systems, there's far less testing done, and so doctors and hospitals purchase far less screening equipment. The end result is that, while the government may not stop you from paying for a CAT scan out of your own pocket, if a CAT scanner isn't available for six months to a year, that "freedom" is a moot point.

I don't think people realize what an atypical system the U.S. has. I remember reading one popular blogger's experience with her daughter, who was reluctant to start walking and seemed to have some sensory issues. No one thought the child was terminally ill or anything, but she had two MRIs over a period of several months to make sure her brain was working okay. TWO. Which were scheduled rapidly after the original prescription for such. That doesn't happen anywhere else. There aren't enough MRI machines for it to happen for one thing, and the cost/benefit analysis would never permit such a thing. And I don't think it's the worst idea to look at our model and perhaps say that those situations don't warrant MRIs. I just don't think moving to a government-run situation will improve our ability to determine whether patients really need MRIs -- I think it will limit the provision of MRIs across the board.

The classic saying about health care is that you can have good health care, fast health care or cheap health care -- pick two. There are people out there -- quite a few -- who value security more than anything else when it comes to health care. And if those people are genuinely willing to accept the tradeoffs that come with their preference, fine. But if you're thinking that the advent of universal care will assure that you will have guaranteed access to what we think of today as top-tier health care, I suggest you adjust your expectations. The penny-pinching approach described in the opening parts of Amy's correspondent's e-mail is far closer to business as usual under a government-run plan -- in both scenarios, you have bureaucrats without medical degrees in control.

I am willing to accept that the U.S. medical system is in dire need of an increased level of real cost/benefit analysis. For one thing, a hell of a lot of testing is done right now to ward off future malpractice claims -- some sanity in that area that still allowed people to go after truly bad doctors would be welcome. But what is essentially being proposed now is an HMO on steroids, without real alternatives, enforced by the government. If the tradeoffs involved are acceptable to you, then I can understand why you'd support the health-care bill. But if you really think that you'll be able to continue getting good health care and fast health care, just more cheaply, you might want to think again about what your highest priorities are.

Flynne, I think it's KOpechne. :)

My insurance has paid out nigh on $1,000,000 for our little family all told. My rate increases haven't been out of line with anyone else's. I've never once been told I couldn't get something I need-we pay more for "open choice" so that we can go see a specialist if we feel the need, sans referral. I've had to make some phone calls about fully covering treatments on occasion, but that's ok. It's my health, why wouldn't I be willing to make those calls?

Under gov't healthcare (that is, the care the rest of us get under gov't, NOT the care those who run the gov't get) care will not only be rationed, it will be outright denied. If something is statistically rare, they will not bother testing period. Personally, we have a lot of "zebra" problems here, so we'd be dead under the gov't system. I don't think that's ok, just so that some people have some coverage.

You can pay for any test you want now, with cash, if you want to. You may need to prepay, but you can do it. To say you can't is absurd.

I am a huge fan of making health ins like car ins-beyond a certain minimum responsibility to other's health, what you buy is your business. You buy your own-not your company. You can buy from any company in the country that you want. And it doesn't cover forseeable maintenance items like vaccines. THAT would be true reform. Companies that gave crappy service would become known for that and go out of business, companies would have incentive to lower your rates to stay competitive.

I'm 50 years old, and have seen a few doctors in that time. I've seen some (not many) who I think aren't doing a good job, or who aren't paying attention, so I've changed doctors (not an option under government healthcare).

I've NEVER seen the kind of doctors I keep hearing about in the pro-government-run healthcare community, the ones who try to kill you if you if they think they can't make a pile of money from you, or who chop off your feet to make some extra cash. But if I did run across one of those, I'd certainly switch immediately!

I'm with Momof4 on this- my middle daughter has accrued about $500,000 in medical expenses in her 8 1/2 years. There were other expenses that were offset by grants when we agreed to participate in studies, which would probably tack on another $100,000. We have NEVER been told that something wouldn't be done. When we were at our busiest/ most costly times, our insurance carrier appointed a rep to go to directly every time (shout out to Amy W. at Humana). LOVED them. Helpful and courteous to the nth degree. Our premiums DID go up. Duh! why wouldn't they? Without them, we would have lost our home. I don't begrudge them the extra $200 a month they were asking.

We HAVE had doctors we didn't like that were in-network, and found one who was out-of-network and absolutely phenomenal. Guess what? We paid extra out-of-pocket cash to go see him instead. Why? My daughter's care IS WORTH IT!!!! So we don't vacation at Disney every Christmas. We know how to manage our finances.

Be persistent, get creative, do some homework, and negotiate with the billing department. Do you know how many of them practically piddle on the floor when you pay your bill the first month? They may even give you a discount just like they would the insurance company (we've gotten 15%) if you offer to pay it in its entirety, so they don't have to babysit and track your balance due. Negotiation in these United States is a lost art, but you'd be surprised what you can do with a medical bill.

Getting good care isn't an issue of insurance. It isn't an issue of finding a 'good' doctor. It is a matter of finding the RIGHT doctor.

I've received great care at times when I had no insurance. I've received horrible care at times when I had 'Cadillac' insurance. This isn't an issue of 'can she pay', this is an issue of getting poor medical care and not fighting back.

We all need to remember that doctors are just people. They are very well educated people, but people all the same. They have difficulties, memory lapses, and things that they have no knowledge of. If you aren't getting good and appropriate care from your doctor FIND ANOTHER ONE. Before I was diagnosed with FMS, I was in agony for years attempting to find a cause for my pain. I switched doctors more than once until I found someone who believe that my pain was real. She referred me to a local Rheumatologist (sp?) who required a 3 month wait to see him. When I received a letter in the mail saying that the doctor would only spend 15 minutes with me and wouldn't answer any questions, I called his office and told him to fuck off.

I then started a hunt to find another doctor and ended up driving 50 miles each way to see him. However my efforts paid off, and I was properly diagnosed and received medication and instructions that helped to reduce my suffering. If that doctor hadn't helped, I would have found another one and another one and another one until someone alleviated my suffering. Is that expensive? You bet your bippy...and my medical care is much of the reason why I am 35 and my husband and I share a one bedroom apartment and live very modestly. When it comes to health, I drew a pretty crappy hand. However, we need to start treating doctors more like employees and less like gods. If a doctor blows you off, go to the next one until you find one that doesn't.

I have never met an doctor that wouldn't work with you on payments, or provide samples when you couldn't afford the medication. It isn't easy getting good care without insurance, but it is certainly possible.

-Julie

Agree regarding healthcare, but not education.

Universal education for children is considered a public good, a benefit to all persons, whether they have children or not.

The children in middle school now, will be your doctor, lawyer, architect, nurse, etc. when you have aged and can no longer perform those functions...but still need to drive, fly, shop, buy medicine, etc.

All of that came from someone elses child. Why should only the people bearing the responsibility for making all that possible, bear all the cost, when everyone else benefits just as much as they do?

Or more to the point, take a look back before universal education.

Nothing creates an unbreakable class system like a layer of knowledge held by few, and a layer of ignorance from the uneducated below.

Name ONE country, that has benefited from the absense of a public education system, and I will concede an alternative is possible.

Damn straight, Julie.... we live in northern Illinois and used to drive to Detroit (370 miles) twice a year to see a pediatric neurologist who specialized in my daughter's diagnosis. Not that there isn't a ped. neuro. in our city; there were three at the time, but none of them knew about her diagnosis. One of them was flippant enough to say "How hard can it be?" Fired his a$$ on the spot. We now drive 80 miles into Chicago to see a doctor who has the technical skills but lacks the necessary communication component (from a certain religious group that struggles with talking to women, let alone respecting their knowledge, if you catch my drift). We will soon be going back up to Madison, WI (78 miles) to see their phenomenal ped. neuro team.

Also told a neurosurgeon he wasn't qualified to perform surgery on our daughter; everyone else (all professionals) in the room laughed except him, but they knew I was right. He'd never performed the recommended operation on someone like my daughter (she has a very unique cerebral-vascular makeup), and I was not about to let him "learn" on her. He was busted, and he knew it.

Thank you Amy- I had a conversation with an acquaintance about "having it all". She wanted taxpayers to cover her fertility treatments (head-scratcher- why have kids if you can't afford the fertility treatments?). I asked her if she would go into a restaurant, order a dinner, then ask the waiter to deliver her check to the well dressed couple at the next table, or just average her bill into everyone else's. Food is essential to life just as health care, but I would NEVER expect someone else to pick up the tab.

Let me throw in what a friend of mine is experiencing under our current HMO system.

Several years ago, J. developed a condition called Polycystic Kidney Disease. It's just what it sounds like...your kidneys fill with cysts, slowly killing the healthy tissue. This was not his fault, and is in fact genetic--his biological mother died of it.

The only treatment for PKD is dialysis until a transplant can be done.

Going on dialysis meant he was unable to work. Being unable to work meant he was unable to pay insurance premiums and so he lost his insurance.

J., through no fault of his own, is now on welfare and food stamps and living in gov't subsidized housing. And he will likely have to declare medical bankruptcy. And, since he has a pre-existing condition (he recently did get his transplant) he will have a difficult time getting insurance. The only way to afford his anti-rejection meds is to stay as he is...living on welfare.

(he did recently get his transplant)

That seems pretty significant for a parenthetical statement.

Why is welfare the only way to afford medication? Wouldn't a job be more helpful?

I feel like I'm missing something.

Does anyone care to take a guess about how many GOOD doctors will up and leave the profession if Universal Healthcare is passed.

Here's the deal. This current bill does not deal with REFORM. It is a massive entitlement program. That is all this is.

* No tort reform (reduction in spending)
* No elimination of bureaucracy so that insurance companies can compete across state lines (there are over 1,600 to choose from - how many does Texas have?)
* No addressing of the problematic situations with Medical Schools and their selection process (and involvement with Pharmaceutical Companies).

Also, to the original LW, Texas (although probably one of the best and most fiscally responsible and business friendly on MANY things) makes it VERY difficult for healthcare and insurance companies to operate in. Very difficult.

It is important that we be cautious when engaging in civil and lively debates about healthcare reform to point out 1) this is not what the current bill is doing; 2) the massive tax increases that will occur and 3) government has caused this problem to begin with - all in no particular order.

You want better coverage in care - I would suggest putting everything into identifying, uncovering and demanding change to the government stronghold that is choking the life out of the healthcare system. I guarantee - problem would be solved with less government involvement. I'd bet my hands on it.

Heck, Feebie, I'd bet my tonsils on it.

Going on dialysis meant he was unable to work. Being unable to work meant he was unable to pay insurance premiums and so he lost his insurance.

I've known of several people on dialysis that were able to work. I actually dated a young man in high school that had a genetic kidney ailment (as did his brother). His brother was on daily dialysis and still held down a full time job. I know that this is anecdotal, but dialysis > can't work.

How often were his dialysis treatments that he was completely unable to work? Most people receive dialysis a couple of times per week and most dialysis centers are open very early and very late to allow people to work. FMLA forces an employer to allow employees up to 12 weeks of leave per year if the employee has at least one year seniority, and it can be taken in hourly increments. Doing the math, that would easily be enough to cover twice weekly dialysis and other assorted doctors appointments.

Also, why didn't this guy have any disability insurance? Why isn't he on SSDI/SSI (most disability insurance providers require that you apply for SSDI when you start getting benefits)?

I agree with Robin, something is missing from this story.

-Julie

but dialysis > can't work.

That should read:

but dialysis doesn't equal can't work. I tried to use a symbol and it was eaten.

-Julie

I wonder if it works if you underline it:

u

hmmmm > I guess math symbols don't work,but up above the tag didn't work on the 'u' either.

"A system like this, when it's really like Russian roulette, is lousy, I hope to God it doesn't get any worse."

What an awful story, crella. And, you're right, this system is only fair for some. Unfortunately, we don't all have access to Kaiser Permanente, which sounds great, and I would love to have it. But, based on your geographical area, you are given limited options for good insurance - even fewer for those of us self-employed. And if you develop an illness, like Jennifer did, then the rise in premiums can make it impossible to afford.

That should at least change if we are to keep private insurance. Make them nationwide. It's not fair that some people in some places can get excellent private coverage and others cannot.

This is an excellent article that someone posted on a previous health-care thread, and it addresses what Jennifer is saying about how we pay doctors:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true

Amy and other readers, I have a couple of questions for you.

Have you ever nursed a beloved or even a not-so-beloved family member while they slowly wasted away from cancer? Have you ever personally ridden that roller coaster of hope and despair that comes with a Stage IV prognosis? Have you ever listened to your dad weeping in the shower because your mom threw up and had to go to the hospital to have tubes in her nose, and out of her intestines?

Second question. Have any of you applied your prodigious skills as a researcher and critical thinker to seriously comparing and evaluating EACH of the government-run options in countries like France, UK, Canada, Israel, etc? Some of the claims you continue to believe about the bugbear of universal healthcare can play out very differently from one country to the next.

Sometimes there's a smug and flippant tone to the folks who think that everyone should just suck it up, and up, and up... it may not change what the "right" thing to do is, as if anyone really knows, but when you're suddenly ill and in pain, and afraid, that's not the time to suddenly be a smart shopper!

People with serious conditions who are worried about becoming too ill to work... I guess that's never happened to you, Amy, because you've always bragged how healthy you are, how well you've managed your life, and that's terrific... but how well do you really understand the situation of people who haven't been so lucky or so smart as you?

Universal education is a benefit because we need a well-trained and well-educated citizenry. But we also need healthy citizens who are educated on how to take care of themselves so they don't spread disease or become needlessly disabled. I don't know if universal health care is the answer but I see Republicans blocking everything they can, and in the meantime, I think we as a nation are rushing straight over a cliff.

It's not fair

First let me say that I am not attempting to pick on LovelySoul..an obviously kind hearted and intelligent woman. You were just the last one to mention it before I lost my cool. That is the only reason I'm quoting you.

This is something that drives me more than a bit batty, and as I sit at work with a fever that won't go away I bristle at this idea. I'm going to propose an idea that is new to some, old to others, and will be revolutionary to many.

LIFE ISN'T FAIR

It sucks, but that is the reality. Life will never give you everything that you feel you deserve, you will never be free of difficulties, nor will you be able to find the error that causes the world to be less than 'fair' to you. Life was not made to be fair. It was made to see who the strongest are and test their abilities at the task of survival.

Much of our nanny-state comes from people attempting to create a government that will make the world fair. There will never be enough laws to ensure fairness for all. Fairness (equality) for all is called communism. No one gets any more or any less than you do. We have all seen that it doesn't work. The best that we can hope for is to eliminate the restrictions and allow the market and the business owners to determine where insurance companies will offer their products.

If we open the market, there will still be people who don't have as many choices in doctors or insurance providers as others. This isn't 'unfair' this is one of the costs that you pay for living where you do. If you need better care, either move or travel to receive your treatments. I'm not the only one who has done this. But don't cry to me about 'fair'.

Fair is merely the last bastion of a week argument. If something is bullshit, poor policy, ineffective, or discriminatory, call it that. But nothing is 'fair' and the word (if it every had one) has lost all meaning save one: It indicates someone who expects others to provide something to them that they haven't earned or that they cannot get on their own. How is that 'fair'?

-Julie

Julie, please read that article I linked. Everyone should read it before forming an opinion about health care. It's written by a doctor, who explored the issue in depth, and I think it brilliantly depicts how health care services vary from region to region, even town to town, and what the reasons may be.

You're right, we'll never have total fairness or equality. Using our school system as an example, many of the best elementary and high schools are concentrated in certain fortunate areas, such as the mid-east. The quality of education there as opposed to, say, Alabama, is vastly different. But it's not supposed to be. It's not what we're striving for.

We should at least be looking at ways to offer roughly the same level of health care for all our citizens, whether public or private.

Sometimes there's a smug and flippant tone to the folks who think that everyone should just suck it up, and up, and up... it may not change what the "right" thing to do is, as if anyone really knows, but when you're suddenly ill and in pain, and afraid, that's not the time to suddenly be a smart shopper!

I am ill, and have been for decades and will be for the rest of my life. I do not intend to be flippant, only attempt to get people to understand that when you are ill, in pain, and afraid, that is when you most need to be a smart shopper. Your ability to find the right doctor can make the difference between remission, lifetime illness, and early death. And who do you expect to 'suck it up' for you? Your neighbor? The lonely widow? The family of four down the street? Eventually the money will run out and then everyone will be screwed.

-Julie

Well, first let me say people need to pay for their own health insurance, and not expect other people, the government or employers pay for it.
I maintain three estates and two vacation homes, and employ many people doing so. My employees buy their own insurance, if they want it. They are not forced to work for me.
I am glad when I hear Amy Alkon say she has slept on cardboard boxes to pay for her health insurance, and would do so again, if need be. She has chosen a profession that is nearly worthless to society, and so she has chosen her income level.
If she ever needs a job as a maid, so as to continue paying for her health insurance, she is welcome to say so here, and I will see what I can do.

"She has chosen a profession that is nearly worthless to society..."

Then, why are you here, Sir Buttsworth?

I'm flabbergasted that this woman thinks public education is "honorable" in any way. It's an unmitigated disaster, and I think this woman has had one too many blood clots on the brain to think straight anymore.

Name ONE country, that has benefited from the absense of a public education system, and I will concede an alternative is possible.

Posted by: Robert at November 23, 2009 8:43 AM

Name me one country that has horrid public education as we do. The simply fact is knowledge is already stratified among certain groups due to culture, not your vaunted public education system. Specifically REAL knowledge like math, history, science. Not your fake, psuedo-PC "knowledge".

From the article linked above:

"Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys."

See, I just want access to something like Kaiser Permanente too. Whether we go private or public, we need to spread that approach nationwide.

I skimp and save to afford health insurance too, and I have the highest deductible possible, but I don't have an option like that. Despite excellent health, my insurer raises my premiums every year, until eventually, I have to switch - choosing among my ever-decreasing options for private insurance. And I'm all too aware that I can only play that shopping around game until I get a pre-existing condition. Then, I'm stuck.

They should all function like Kaiser or Mayo.

We should at least be looking at ways to offer roughly the same level of health care for all our citizens, whether public or private.

Why is it the job of the government to ensure that everyone get's equal access to everything that they want? Seriously, I understand the need to strike out against discrimination. However, homogenizing the medical access will just reduce the availability in larger cities, it won't perceptively increase the quality provided to the average citizen.

Plus, how do you measure 'level of health care'? Are you talking about the number of doctors? Number of hospitals? Number of MRI machines?

I did read the article, and it doesn't surprise me. The idea that doctors are pushing towards an over-utilization of technology available isn't shocking...but it is very much why you need to be careful in picking your doctor. I argue about every test, refuse every surgery but those that are life-critical. I've told many a doctor 'medicine first/surgery later'. I pick my doctors based upon this and other requirements. I won't go to a doctor that won't think.

But you won't be able to standardize care without massive bureaucracy. That won't force doctors to think more, it will reduce their options and their ability and need to make judgment calls. I believe that we need to educate the patients and they will force the doctors to provide an appropriate standard of care.

-Julie

The sheep bargaining with the wolves never works, as the doctor said in the article, Julie.

These collective approaches are proven effective. They improve care while lowering overall costs. I don't understand why you'd be against expanding an effective approach.

The government doesn't have to run it, but government is already in the position to oversee and try to have these successful approaches implemented on a broader scale. They are already paying the medicare costs, so it's in government's interest.

I admire how you shop around and demand good care. An educated consumer is always better off. But I'm betting you have health insurance provided through your employer. Many of us do not.

Lovely Soul--
I meant that Alkon's contributions have no or little financial value to society (as determined by our market system), though they may have ample social value.
Let us hope her book does well--although Sarah Palin seems to have taken all the oxygen out of the room for 45-year-old female right-wingers with a grudge.
So, it may be back to the cardboard boxes for Alkon--and I admire her for that. And if I may say, I expect Alkon would proudly perform maid's work to keep her health insurance intact.

Buttsworth, Amy will never be anybody's maid. And you're misguided if you think there's no value to words. Ask Steven King or J.K.Rowling. An Andy Warhol piece just sold for over 33 million. The market determines what has financial value, and Amy seems to be doing quite well. My bet is that you'd be scrubbing her floors before she'd be scrubbing yours.

brogdin buttlesworth - you are mistaken if you think that capitalist pigs only view everything through the profit prism. They need socially valuable things too. Does not a capitalist bleed red as you or I?

"They are already paying the medicare costs, so it's in government's interest."

Wrong-I, and you, and you, and you....-are paying medicare costs. It's in MY personal interest to keep what I already have, thanks. I don[t give a rat's ass what's in the gov't interest, since the gov't interests SHOULD be ours. I fully agree that the gov't should not tell you who can and can not sell you insurance in area _____ though.

Ok, VI, you saw a stage 4 diagnosis. Do you realize under single payer there would have been NO treatment but pain management, which itself will be crappy since the gov't doesn't want poor people getting addicted to their pain relief, right? WHat about your crappy situation do you think the gov't could have improved one iota?

"We should at least be looking at ways to offer roughly the same level of health care for all our citizens, whether public or private."

REDUCE GOVERNMENT INVOLVEMENT AND BLOCK ANY ATTEMPT THEY MAKE TO GET MORE INVOLVED.

JEEZUUUSS.

Hello? We would not have even Half, not even half of these problems people continue to bitch about if it weren't for the involvement of the government in this system.

The sheep bargaining with the wolves never works, as the doctor said in the article, Julie.

Ooooo...the article said it so it must be true! We all have the right to refuse medical treatment, get full disclosure and get second opinions. If a doctor suggests a treatment or test, start out with asking a simple question, "Why?". If the answer isn't good enough, you can refuse it. Why is that such a hard idea?

I'm not talking about haggling over price, I'm talking about evaluating whether you truly need the next test, or surgery, or medication, or office visit, and making your own decisions. How is that 'sheep bargaining with wolves'? I'm the one with the checkbook.

The government doesn't have to run it, but government is already in the position to oversee and try to have these successful approaches implemented on a broader scale. They are already paying the medicare costs, so it's in government's interest.

The government isn't good at anything other than expanding its control. Considering all of the examples of horrible care provided by the government (military medicine as an example) why do you want them in your business?

These collective approaches are proven effective. They improve care while lowering overall costs. I don't understand why you'd be against expanding an effective approach.

I have no problem with a private clinic or private citizens deciding that this is how they want to practice medicine. My issue comes from the desire you seem to have to allow the government to manage it. I want the option of going outside this 'network' if they suddenly decide that my care isn't 'needed or appropriate'. If the government runs things, I won't have that option.

I admire how you shop around and demand good care. An educated consumer is always better off.

Educated patients aren't born, they are made. I'm working on a project now to make a whole bunch at once.

But I'm betting you have health insurance provided through your employer. Many of us do not.

But that is your choice. I work a crappy job during the week to ensure that I keep that insurance and do all of my writing and other projects when I'm not feeling like death at home. I have many preexisting conditions and couldn't get affordable insurance on the free market if I started offering free blow jobs to insurance executives. It isn't that I am some 'privileged' person that managed to find the Holy Grail that allowed me employer sponsored health coverage. I made conscience decisions to ensure that I consistently maintain that coverage and stay in jobs and situations that I don't always like because I understand that coverage is important. Why is that level of personal responsibility so foreign and astounding?

-Julie

"The best thing to get us over our fear of Universal health-care is to look at Universal education."

Actually that IS why many of us fear it. We see how bad expensive and screwed up public education is and we know it will be the same for healthcare.

Actually that IS why many of us fear it. We see how bad expensive and screwed up public education is and we know it will be the same for healthcare.

Only a bad education doesn't generally result in a slow, agonizing, painful, miserable death.

I am one of the few Libertarians who believes in public education. Republics need an educated populace. However, no one could call our current system 'successful'.

I would love to see the government withdraw all the bullshit legislation for education and require all children to be educated from 5 until they reach a predetermined level of functionality or it has been determined that the child is completely unable to learn to that level (in the case of developmental disabilities). Then let the local community or family decide how to offer that education. The child's level could be determined in an annual taking of the college entrance exams starting at the age of 13. Sure would make things simpler, huh?

-Julie

Momof4: This "crappy situation" was a long time ago. To be honest, after watching several people die a slow & agonizing death after getting a terminal prognosis, I wondered why they DIDN'T just opt for hospice. And I wondered why my dad didn't just accept the facts. But that's like going to a brain-injured veteran who still jumps at every noise, and just telling them to snap out of it. Human nature isn't totally rational, especially under stress and grief.

It's that tone that I sometimes see in writers on this blog - kind of a "Well, it sure sucks to be you" attitude, followed by, "I'm sure glad it's not me!" Yes, sometimes it does suck to be you (or me, whatever), and the rest of us can't fix it, but that's no reason to be so smug about it or to assume, as we often do, that if only they'd been a little more proactive, less trusting, less this, more that... that they wouldn't have any problems!

People have asked, "Well why didn't X just go and buy insurance?" only to be told that the option just wasn't available to the person at the time. They assumed that the person was lazy or stupid, because it never occurred to them that the situations out there are not easily reducible to smug and simple solutions.

The truth is no one really knows how things will work under any sort of major change. We have some teaching cases like Massachusetts where their health care mandate has done some unexpected things in the market. So... does that mean we should keep the status quo instead of trying something new?

I'd at the very least like to see health-care portability and inter-state competition, and even that won't happen unless some kind of laws get passed.

I think "there but for the luck of the draw go I" every time I see someone who's sick, or homeless, or crazy. Yes, I worked hard to stay away from physical and mental pitfalls, and maybe I deserve a small pat on the back for that... or maybe not! I think it's mostly luck, frankly.

Back to my first point: all these medical heroics directed at clearly terminal patients seemed like a huge waste of services although I would never say that unless it was ME with the cancer - and no, I don't know if I'd actually have the guts to refuse treatment if push really came to shove.

JulieW: "Only a bad education doesn't generally result in a slow, agonizing, painful, miserable death."

Actually, it can, and even when it doesn't, it can sure lead to an agonizing and miserable LIFE.

Only a bad education doesn't generally result in a slow, agonizing, painful, miserable death.

Oh, but it can.

A bad education means fewer higher-level skills, which translates into less employability which translates into the need to take lower-level jobs, many of which come with long-term health hazards.

Years of throwing freight take their toll on the back and knees. Years of working in dust and other pollutants take their toll on the lungs.

====================

And a public health system that works like the currently over-politicized public education system won't lead to a healthy populace.

We need a healthcare system that works - and a government-as-single-payer one won't.

We're already paying for a wasteful and badly run system. Of course, government is using taxpayer funds. So, what's wrong with trying to expand these new approaches that we know improve care, as well as reduce costs?

It's like rejecting educational reforms that have proven to work in other places, Julie. If you believe in public education, why would you be against expanding great ideas across the board?

The educational system sucks in many, if not most, places, but it's heavenly in some districts. The lucky kids who grow up in those states get the benefit of what is basically a private education in others - for free. Just like health care, it's terribly inequitable.

So, fine, we could just continue to run health care the same way. Keep using the same lousy, haphazard methods in most of the country, while a few benefit from innovative and intelligently applied new approaches. If you live in Northern CA or Grand Junction, lucky you. If not, oh, well.

I can see that there is a certain smugness in these attitudes, like Vi says. You may be fortunate enough to have good, affordable health care coverage, in an area with efficiently run hospitals and great doctors, but we have to think about how to offer that to everyone. I'm not suggesting that those who can pay for it shouldn't - as I am more than willing - but we'll all pay less in the long-run if we expand the efficiency and quality of the system nationwide.

I'm not suggesting that those who can pay for it shouldn't - as I am more than willing - but we'll all pay less in the long-run if we expand the efficiency and quality of the system nationwide.

I'm saying that I am unwilling to see these ideas implemented. I'm saying that the government shouldn't be the one to implement it. You've said yourself that what we currently have in governmental social system is a mess. What makes you think that the government will do a better job with health care? Why not bring this to the AMA and other medical organizations, discuss this with them and elicit a change internally? Why must the government bring down the hammer of Thor and screw everything up?

-Julie

I hear ya vi and thank you lovelysoul for the link to the article. Interesting.
Jen

"So, what's wrong with trying to expand these new approaches that we know improve care, as well as reduce costs?"

Know? We know will improve care? How do you think that will happen by adding 30 million people to the pot, and how in the hell does it reduce costs?

Once again, this is not reform. This is not reform, this is not....

If this was reform we would at the very least see tort reform and the ability for insurance companies to compete across state lines. THAT reduces costs.

What improves care? The same damn thing, by untying our doctors from undeserved litigation and freedom to give the proper care to patients who require it and not having to run a bazillion tests for the ones that don't (just so they won't get sued by some low-life attorney). Allowing different policies for different patient needs to be decided individually and to work directly with their doctors. You don't have a good doctor - you would have the ability to go take your business elsewhere... (thus, improving care through competition).

Once again, if the majority of good doctors quit because they refused to work for peanuts under a universal single payer health plan - HOW THE HECK DOES THAT IMPROVE CARE!!??

"And, you're right, this system is only fair for some. "

Yes, and the more I read of children getting treatment,or others' stories of great treatment, I wonder if my parents got shuffled off with the cheapest possible treatment because they're in a lousy HMO or is it because they're old?

I think the whole primary care 'gatekeeper' system is a crock. My father kept saying 'This doesn't feel right, something's different this time'.He'd had back problems all his life, and had a laminectomy in '79. He knew it wasn't strained muscles alone, and it didn't feel like the pain of a herniated disk, which he was well used to. I wish he'd had the option of going to a specialist without the referral, he would have been there months earlier. If you have a primary care who's bored on the job, you're sunk.

His third round of chemo hit him like a Mack truck. The vomiting was terrible. Regardless, he got the standard 3 pills....everyone is supposed to stop vomiting in three days. When he didn't we called the cancer center for more meds. 'We can't just give those out like candy you know! You DO realize he's terminal!?" Hurry up and die already, we can't spend any more money on you!

I was SHOCKED. We, early on, told him to come to Japan and we'd get him treated, but it was too big a step for him to contemplate. We had friends here who wanted to put a stent in his esophagus, cement his back and then go with palliative care from then on. They predicted he'd have 6-10 months, might even see another Christmas. Instead he got heavy chemo, no stent, nothing for his back and died vomiting in a dark room 8 weeks from the start of treatment.

What did hospice say when I told them that the downturn was directly related to a reaction to chemo and if we got some nutrients into him he'd be better? "Women always have this thing about feeding people.' Well ya, if you don't they tend to die pretty quickly.....

Yes, America has one of the most advanced medical systems in the world, it's just that getting access to it's a bitch.

Sorry, had to do the quick and dirty version of the story because I had to go to work.

I believe he *is* on SSI/SSDI as well. Frankly, I can't remember his particular govt support package. I do know that his dialysis clinic set him up for counseling to walk him through all this stuff. Incidentally, his doctors are bleeding heart hippies who wear Birkenstocks and bike to work and went into medicine because they *care* about people, not to make a squillion dollars a year.

Yes, he can work limited hours. But not enough to live on, or pay what would be exorbitant HMO premiums at this point. And should he make even a penny more than they say he should he has to pay it *all* back. Not just the overage. No squirm room here at all.

And, again, he now has a pre-existing condition. A whopping, major, pre-existing condition, and anti-rejection drugs are really, really expensive.

Once again, people, once you become too sick to pay your premiums, *you are fucked*.

Amy, you keep saying that you, as a healthy person have no desire to subsidize the sick and the poor. Honeybun, that's how an HMO works. That's how all insurance works.

In my friends case, since an HMO will no longer take him, he has been shuffled off to the taxpayers. We are all paying for the sick people in our country one way or the other.

The only way to pay only for what we use as far as healthcare goes is to go back to the old fashioned system whereby we pay Drs directly for their services, whether by chickens, the barter system, or actual money.

And frankly,Amy, it makes me sad that you seem to have no desire whatsoever for our government to take care of people who haven fallen on hard times. Yet you beseech people on a regular basis to buy stuff through your "mall" because newspapers won't buy your column? And how isn't that a subsidy? To be consistent here, Amy, you really should take your links to Amazon down, instead of whining that you have tied yourself to a dying industry and you are having a hard time supporting yourself. Is it anybody elses fault in the world that you refuse to get an actual job? Not meaning to be mean here, if this is working for you more power to you. But if you are asking for donations to live on then you have set up your own version of welfare.

"I'm saying that I am unwilling to see these ideas implemented. I'm saying that the government shouldn't be the one to implement it."

Wow, Julie. Do you realize that the government is the one funding medicare? So, you're okay with the enormous waste of taxpayer money?

The government is really us, as archaic as that idea may be. If enough of us said, "This is a waste", they would listen. And, whether you like it or not, we are still paying for medicare, so we are paying for this waste, whether you believe government should be involved or not.

So, why should any taxpayer be against a new approach that would increase care and reduce costs? That would be beyond stupid.

Deathbysnoosnoo, are you really having that much trouble distinguishing between an individual who solicits voluntary donations for the support of her creative endeavors (which are otherwise enjoyed for free by her devoted fans) and someone who forcibly deprives others of their resources, giving them no choice in the matter?

If enough of us said, "This is a waste", they would listen.

No, if enough of us voted against them they'd listen. The only reason they are listening now is because their jobs are threatened if this shit sandwich gets shoved down our throats.

So, why should any taxpayer be against a new approach that would increase care and reduce costs? That would be beyond stupid.

They shouldn't. However no such approach has been suggested. And if you believe that a government takeover is going to reduce costs without a massive increase in mortality, then you're smoking a little too much happy grass.

And frankly,Amy, it makes me sad that you seem to have no desire whatsoever for our government to take care of people who haven fallen on hard times.

There's a difference between "fallen on hard times" and "you pay for my drugs so I can buy a nice TV".

I have a nice TV, but I also pay cash for my medication. I get to make that distinction. Someone who isn't paying cash for their meds might want to consider postponing that new TV. the present system, and indeed anything that our lovely government of eighth-graders has proposed would only further encourage such irresponsibility.

OK so all you anti-big government types who don't want the Gummint getting into our health care: Do you want the government out of our roads, too? Next time you drive on the freeway, or fly an airplane anywhere, think about that.

All ye local-government folks, what is the Federal government really good for? Anything? Maybe all policing and defense should be local, too. No more FBI, no more military! And let's print our own money, too. What a great idea!

Sarcasm aside, there is a huge amount of infrastructure that most of us take for granted, and without certain centrally enforceable obligations and protections, I think all our lives would be very, very different than what they are today.

"The truth is no one really knows how things will work under any sort of major change"

So let's just jump right in NOW and hope like hell it's change that works! That works soooo well in other areas of life, after all.

VI, if you can[t see the difference in other people paying for your healthcare, and ALL of us paying for roads we drive on, our goods are driven on in trucks, etc etc, and gummint providing for the common defense (wait where have I heard THAT before??) then you are really thick. Don't like your lot in life? Change it! This isn't India, we allow people to work and move up. We just draw the line at CARRYING you up that ladder so that you don't have to exert yourself.

SInce when is Amy asking for a hand-out, also? She's saying IF you buy something, why not do it through her. It costs you nothing and gets her something. Do you need to look up the definition of hand-out?

Some posters have suggested that I am addled because I would like a more secure health-care system. Although I am healthy now, I have had juvenile arthritis, asthma, colitis, heart disease, strokes, cancer, thyroid problems, and chronic infections (thank you genes). What are the chances that I will be able to maintain secure employment long term?

I do not have the confidence born of good luck and good family support. I dropped(?) out of school my senior year during which I had 2 sinus infections, 2 cases of pneumonia, 7 cases of strep throat, rheumatic fever, and a flare-up of juvenile arthritis. This led to a drop-kick out of the house. I managed to avoid the temperatures that dropped into the teens, but was not able to get and maintain insurance. I am happy for those of you who would NEVER let this happen to you.

I would rather help those who cannot care for themselves or educate young children than be the recipient of such help. Fortunately, that is likely how it will turn out. My husband and I have built a successful business. However, I am never fully confident that even the best laid plans will not go awry.

i just have to disagree with the idea that most doctors order or don't order anything based on what they will be paid...it's not that simple.
most of the doctors i work with honestly want the best for their patients and do their best to get it. they actually work really really hard to do the best thing for the patient, sometimes against the administration of my hospital. their hands are tied though - if they order too many tests, they get kicked out of the hmo, and then they can't help anyone. they can't keep people in the hospital longer than the hmo says without a new diagnosis. yes people should have the right to pay their own bill - but the hospital often DOESN'T get paid these bills, and then they lose a lot of money, and how do they stay open that way? it's a losing system.
i don't know if universal health care is the answer or not. i think there will be a lot of problems with it. i think there will be lot of problems with ANY system. but i do think we have to try SOMETHING different. it's long since past time. and if we don't like the something - try something else. shit or get off the pot.

Do you want the government out of our roads, too? Next time you drive on the freeway, or fly an airplane anywhere, think about that.

Actually, come take a peeky-boo at how the government has handled the roads here in IL. I-90 was supposed to have its tolls removed after they had raised enough money to pay for the construction of the roads themselves. Ten years past that was achieved, those tolls are still in place because too many people rely on the funds they generate. Reminds me of how lotteries were supposed to fund schools, and taxes on cigarettes were to go to health care for smokers, ha ha ha....

But I'm sure they'd never do that with health care.

momof4: VI, if you can[t see the difference in other people paying for your healthcare, and ALL of us paying for roads we drive on,

Yes, ALL of us pay for the roads, and we pay the same amount in taxes whether or not we ever use that road!

I think ALL of us should pay for our own health care but with some risk pooling. People should pay enough that they have to think about medical care, but not so much that they put it off.

juvenile arthritis, asthma, colitis, heart disease, strokes, cancer, thyroid problems, and chronic infection...

How is it that such a concentration of people here have such horrible medical histories? Do threads like this bring the lurkers out, each with a tale more awful than the last? While you folks have my sympathy, I do want to remind people: these are exceptional cases. One should not tailor a system to the exceptions.

Having lived in several countries, I can tell you that I much prefer a system where the patient is in control, not some faceless bureaucrat. You pay your own insurance, and a part of your own medical costs - in return, you are in control of your treatment.

Where I live now (Switzerland), the health care system was changed from free-market to strongly regulated about 10 years ago. Everyone is required to buy insurance from a government approved provider. Share costs across the whole population, so that chronically ill people are covered at fair rates. Make sure that even the poorest have coverage. All very well intentioned. Sound familiar?

Since then, health care costs have exploded. I now pay around four times as much for health insurance as I did under the old system, and yet GPs are closing their practices, because they can no longer make a living. Where does all that money go? In January, rates will go up another 20% or so - and those of us who have chosen high deductibles will be penalized even more. No end is in sight - the whole mess is spiraling out of control. This is where the USA will be in 10 years, under Obamacare.

If you want an example closer to home, look at education: the general decline of the schools in the USA corresponds directly to the amount of federal involvement. "No child left behind" automatically means "no child gets ahead". You are entitled to the same level of care as the poorest tramp on the street. That is the future of health care, if you put it in the hands of the government.

Sez Ms. Alkon: "Actually, I'd like the government IN our roads."

And people actually believe that FedMed (or whatever the bureaucracy will be called) will be any more responsive than CalTrans?

Brian, I wasn't speaking of the current health care reform as a new approach, only the conclusions in the article. We need to demand real reform that follows the lead of systems like Kaiser Permanente and Mayo Clinic. And I don't care who implements it - the AMA could, Julie. I didn't say it had to be government, though government should certainly adopt these new approaches with medicare.

I just want access to a system like Kaiser Permanente. I think we all deserve the same quality care at reasonable rates that Amy gets. It shouldn't only exists in pockets of the country.

My choices are pretty much limited to Blue Cross/Blue Shield or Humana. I have Humana. I have a $5000 deductible, and a $10,000 family out of pocket limit. We hardly ever use up the deductible. I pay for preventive screenings and doctor visits, don't smoke, and am not obese.

Our premium is around $500 per month for myself and 2 teens. I don't mind paying; what I mind is being treated like shit, and like I'm not valued by the company I'm paying.

Even though we are extremely healthy, and rarely cost them anything - only MAKE them money - they raise my premiums up about $40 - $60 every year. I'd understand if I crossed into a higher age bracket, but this is EVERY year. It doesn't take long before it becomes unaffordable, and I have to look for another company.

What I don't get is why good health is not treated like good credit. If you have good credit, companies COMPETE over you - offering lower interest rates, balance transfers, etc because you've proven yourself responsible in managing money, so you're a lower risk. Even car insurers compete over you. How many "Geico" adds are there?

Yet, the health insurers act like they're playing a game of hot potato with their best customers - passing us around, never holding us very long in case we actually get sick on their watch.

I get that they're dealing with diminishing returns. Eventually, I will get sick and cost them more than I'm making them. But why run me off before then?

They probably have some actuarial tables or something that tells them this is a good business model, but as a business person, I just don't see it. Chasing away your biggest money-makers seems stupid.

So, I would be glad to keep health care totally in the realm of private insurers if they hadn't proven to be such idiotic bureaucracies themselves.

If anything good comes from this reform, maybe it will be that private insurers will become more competitive and efficient. I've already noticed that Humana is being much nicer - they bent over backwards to resolve an issue that would've normally been a put-me-on-hold-forever nightmare.

vi:

All ye local-government folks, what is the Federal government really good for? Anything? Maybe all policing and defense should be local, too. No more FBI, no more military! And let's print our own money, too. What a great idea!

Read the Constitution some time. The FBI has no reason to exist, ditch it.

The military is explicitly required by the Constitution, it stays. Ditto printing money.

I can't find anything about forcibly extracting money from the populace under penalty of imprisonment for health-care cost spreading. In fact, the founders would have called such a scheme by its proper name: extortion.

vi:

Yes, ALL of us pay for the roads, and we pay the same amount in taxes whether or not we ever use that road!

Wrong again. If you aren't buying gasoline, you aren't paying taxes for your lack of use of those roads. Your proxy usage (shipping, etc.) is covered by the costs you pay for goods and services.

The government is always the least efficient way to deliver anything. The federal government doubly so.

lovelysoul:

I just want access to a system like Kaiser Permanente. I think we all deserve the same quality care at reasonable rates that Amy gets. It shouldn't only exists in pockets of the country.

Then petition your state legislature to stop sucking dick and start allowing real competition in the health care payment industry.

@Ms. Alkon: "I was being facetious." I know.

"[Y]ou could literally die waiting to turn..still...years after I started calling."

Years? That's an awfully long time to wait to make a left! I know, I know, stop throwing things!

Wow, Julie. Do you realize that the government is the one funding medicare? So, you're okay with the enormous waste of taxpayer money?

Actually no, I am appalled by the waste of funds, but nothing in this new bill directly deals with the lack of auditors, or any of the other issues that cause medicare to be such an albatross. I would prefer that we get rid of medicare all together..but that will never happen. I don't understand why advocates of governmental intervention in the medical market always say, "Look at how awful medicare is. Let's fix the problems with it by making it much bigger and make more people qualify for it."

So, why should any taxpayer be against a new approach that would increase care and reduce costs? That would be beyond stupid.

How would what is being proposed increase care and reduce costs? Give me examples. Otherwise you are just saying, "It is going to work because I think it will."

OK so all you anti-big government types who don't want the Gummint getting into our health care:

That is right.

Do you want the government out of our roads, too?

Sure. Privately owned toll roads tend to be maintained better, have a greater level of service and have repairs handled more efficiently and effectively.

All ye local-government folks, what is the Federal government really good for?

Military, printing money, signing treaties, and things that cannot either be handled at a local or personal level. If it is something I can make my own decision on...then the government should stay out of it and allow me and others to pay the consequences.

there is a huge amount of infrastructure that most of us take for granted, and without certain centrally enforceable obligations and protections, I think all our lives would be very, very different than what they are today.

But why add to that when it isn't absolutely required? Why restrict our abilities to make decisions for ourselves? This is very simply a decision about who knows best. This country was founded on the idea that anyone can succeed with talent and hard work. Would it be easy? No, but reduced governmental intervention is part of what allows that upward mobility. The more the government is injected into our personal affairs, the less mobility we will have. What you are really saying is, "I think Americans are too stupid to make their own medical and financial decisions, so the government needs to step in and make them for us."

I do not have the confidence born of good luck and good family support. I dropped(?) out of school my senior year during which I had 2 sinus infections, 2 cases of pneumonia, 7 cases of strep throat, rheumatic fever, and a flare-up of juvenile arthritis. This led to a drop-kick out of the house. I managed to avoid the temperatures that dropped into the teens, but was not able to get and maintain insurance. I am happy for those of you who would NEVER let this happen to you.

Bad shit happens to everyone. I bet if we were all to sit in a circle and compare horror stories, we will have a pretty significant competition going here. Bad shit happens to everyone. I was lucky to survive my childhood. However, I made getting insurance a priority and have made a point to get the skills required to work in large companies so that I could get insurance. I maintained that insurance through a year on disability (including SSDI that I am being forced to pay back ...a story for another day) and transfers to other companies. It can be done...but you have to decide that it is worth doing. I would love to start my own business, but I have a clear understanding that I wouldn't be able to get insurance without a large pool of employees to balance things out, even though my expenses are likely less than those of an obese middle aged smoker. Why should I be forced to supplement your business by paying for your insurance and medical care? I sacrificed to get mine. You didn't. We should both reap the rewards of our decisions.

While you folks have my sympathy, I do want to remind people: these are exceptional cases. One should not tailor a system to the exceptions.

As one of the exceptions, I agree. We cannot tailor a system exclusively to cover people like me. People like me have had much advance notice about how screwed up they are. We should take action to care for ourselves.

And I don't care who implements it - the AMA could, Julie.

And that is my point. What you are asking for is something that needs buy in from the doctors. We need buy in from the medical schools to teach new doctors this method. We need buy in from teaching hospitals to make it work. We also need to convince patients that oftentimes interventionalistic methods aren't always the best. It is a huge task, but someone managed to convince the enter country that fat is bad for you, so with the right propaganda, we have a real shot. I'm currently working on a business plan to educate patients as well as to create a non-profit to advocate for a few of my medical issue pet projects. We could all be doing something like this...we just need to take the initiative.

-Julie

"How would what is being proposed increase care and reduce costs? Give me examples. Otherwise you are just saying, "It is going to work because I think it will."

I hate to keep referring to it, but it's in the NY Times article. This approach has already been proven to work in several areas - including Northern CA, where Kaiser Permanente is, and Amy raves over her care and stable insurance rates. It's not my personal assumption. In fact, what impressed me most is that a lot of factors I (and most of us, including the author) originally presumed resulted in higher costs, such as malpractice suits, were not really the cause.

OFT STATED: cheap/free healthcare is a 'right'. it's not like car insurance since you don't HAVE to drive to stay alive/healthy.

MUSINGS: food and shelter are also inarguably things humans need to stay alive/healthy. does it follow then, that some should not have more/better quality than others?

HMMM: should food and shelter also be legislated to be cheap/free? should all homes be razed and unform mediocre shelters be constructed? (no view for YOU!) should all groceries (especially gourmet grocery retailers) be closed and people get their food ration tickets to be used at government-run food centers?

DOUBLE HMMM: we already see the rousing 'success' of our limited but yet unsustainable and fraud-ridden social programs run by the government such as Section 8 housing, food stamps, medicaid, medicare, schip.

TRIPLE HMMM: does increasing the scope and cost of said programs mean increased quality of life, a change to sustainability from unsustainable?

CONCLUSION: EGAD! i'm entirely weary of the ludicrous crowing for communism because someone had a problem with their healthcare provider!

You guys are SO not going to believe this, but I just got, in the mail, a check from the mental health facility that I was taking daughter #2 to for counsleling last year, to the tune of $285!! No FOOLING! The letter stated, in part "After we received payment from your insurance they left you with a copay of $15 instead of $30." Which is what I had been paying for every visit. Amazing! There is honesty in healthcare out there. I have proof!

Lovelysoul wrote:
"Yet, the health insurers act like they're playing a game of hot potato with their best customers - passing us around, never holding us very long in case we actually get sick on their watch."

LS, term life insurance is a lot cheaper than whole life insurance, because it contains no capital accumulation component. In a life arc with predictably increasing health risks, a viable health insurance scheme must include such a component. The financial arrangements have to be consonant with reality.

HSAs are a decent start. Too bad they're toast. Can't have some people getting more health care than others.
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phunctor