A one-time school project gone terribly, terribly wrong.

11 September 2007

US Health Care Makes Me Feel Ill

Over at Omnibrain, Steve Higgins has started something of an uproar with a post containing this statemtent:
I can't think of one legitimate reason why people shouldn't be charged more for living an unhealthy life style. After all, the inflated health care costs are in large part due to peoples unhealthy life choices like smoking, drug use (drinking mainly) and obesity.
I had intended to speak to this in the comments, but it's really a post on its own.

You see, Steve lives in the US, where health is a commodity, measured and sold. It results in some ghastly gaps in health care, and means that politicians play football with people's lives.

Consider Bush's refusal to expand free health care for kids--despite the fact that it is his financial policies have resulted in more struggling families skimping on spending to get by as US debt skyrockets, the dollar sinks, and inflation drags at the paycheque.*

What Steve proposes, I feel, would result in a sharp decline in the number of poor people who carry insurance. As it is, some forty million--over ten percent of Americans--don't. If you raise the payments, a lot of them are going to decide that they can't afford it. Even if it's as low as ten percent, there would suddenly be 43 million uninsured people. And uninsured people cost the system more. Assuming they get treatment, although some hospitals will turn people away (and don't get me started on that merde).

But that doesn't tell the entire story. By far the greater problem, morally, ethically, and socially, is the vast number of people who cannot or do not carry sufficient insurance for all eventualities. The underinsured actually get a worse deal than the uninsured, since they pay into a system that may deny them treatment anyway (a polite way of saying "allow them to live or die"), based exclusively on whether they paid for the Gold Coverage or the Platinum Coverage.

Steve has a point. And what his point illustrates is the great failure of market-based health care. In all such systems, insurers cherry-pick the healthy, the wealthy, and the young to fill their vaults. And on the other end they pick and choose the drug brands, doctors, and treatments they will generously allow you to use. While their profit profile takes on Nepalese proportions. Let's face it, the companies in the health-care sector aren't in this for the good of their fellow human beings (assuming they themselves can be classified as such).

Against this sort of corporate profiteering, the consumer is helpless to do anything but bend over (Oh--but your plan doesn't cover the lube. You'd better brace yourself ... ). This is why the US must instead turn to the Canadian-type single-payer system of universal coverage.

Sure, not everyone gets the best of care. And waiting times for nonessentials are pretty steep. But generally, everyone (and by this I mean a far, far greater proportion of the population) gets what they actually need.

If you prefer to have unhealthy people paying more--the mechanism is in place, more or less: Smokers, for example, pay a minimum (in Ontario) of five dollars per pack in federal and provincial taxes. Tobacco tax revenue is 1.45 billion, and the government claims health care costs of 1.7. We could easily close that gap.

Except that that doesn't account for federal taxes in that five dollar cost, which go into transfer payments from the feds to the provinces, particularly for health care. In other words, smokers are pretty much financing their own health care costs. If I'm obese and I consume loads of junk food, well I cover some of that cost too.

An added benefit: No-one need worry about poor people. Since they're more likely to be smoking and eating piss-poor food anyway, they're funding the system as a result of the choices that force them to lean more heavily on that system.

Now one could argue that there are other costs. $2.6 billion in lost economic productivity alone in Ontario. But I'm looking at this the way a US "Health Maintenance Organization" would. In terms of the bottom line to health care.

So why do US politicians fight to let her kids stay uninsured? Beat$ $even kind$a hell outta me. Ask all those legislators who are taking bribes ... sorry, I mean "donations" from Big Pharma.

Canada's system has its problems, including rising costs, aging population, drive-by consumers, and the failure to allocate a proper place for private health care within the framework. But we have almost no uninsured people. If my life is at risk, they don't need to check my Blue Cross coverage to see whether I get the cheap drug or the expensive one.

And we barely need discuss whether to tax the fat, smokers, or drug users.

*(Side question: why is it that it's all Republicans who accumulate this debt? Aren't they supposed to be, like, all fiscally responsible or something? Yet Reagan was the first to break one trillion in debt, and HW put the country about $3tr in the hole. Finally--one thing Dubya's better at than his daddy! The US has accumulated nine trillion in debt: $9,000,000,000,000, and is on course to hit $11tr by the time the clown leaves office. Clinton, by the way, managed to leave the biggest surplus the US has ever had.)

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At 12:54 AM, Anonymous G Eagle Esq said...

"a polite way of saying "allow them to live or die"

Bonjour M Metro

A well-argued post :

.... or saying "allow them to go away and die" ....

but I worry about Monopolistic Health Provision by the real pseudo-god of the West, namely the State

Here in Inglaterra, we see the lavish extravagance, waste and expense of the NHS [National Health Service] - state-controlled Health provision with a Monopolistic mentality :

The more money the Government puts in, the less productive it becomes

For GPs [General Practitioners, operating at "Primary" Community level], the Higher their Salaries (ranging from £80,000 to £250,000 each), the less work GPs do and the more they complain about their mal-treatment

Her Britannic Majesty's Government hardly helps the cause with its customary dishonesty & hypocrisy

eg a few years ago, the kindly Mr Brown (may the blessings of Allah be upon him, may he rule for ever, he is beginnning to learn how to smile for the TV) announced a massive input of cash into the NHS ... and then promptly clawed most of it back with a massive increase in National Insurance contributions - a punitive tax on employing people, including nurses etc

... and there is the lavishly expensive, breath-taking levels of "[expletive-deleted]-you" incompetence

eg the National "confidential" Computer-Programme for recruiting Newly-Qualified Doctors for all NHS-Hospital jobs, which :

1. is open to anyone in the World to hack into for highly personal details

2. ensures that the better Doctors do NOT get job interviews, while their less able peers are favoured

So many newly qualified Doctors and Physio-Therapists are NOW emerging from expensive training but they cannot get jobs (you Canuckistanis would so gracelessly describe this as "unemployed despite lavishly expensive training paid for by the taxpayer") ..... while we are wrecking 3rd-World Health systems by getting their Doctors/Nurses etc to work in the UK

- if a pregnant woman in Malawi needs a Doctor, she will not find one - they are all working abroad

~~~~~~ and yet, it is the humble (often low-paid) folk at the sharp end (eg so many nurses) who make the system work - our Hospitals are such kindly places for suffering humans in troubled, painful times

Yr obedt servt etc

G Eagle

At 12:46 PM, Blogger Metro said...

This comment has been removed by the author.

At 12:49 PM, Blogger Metro said...

@Herr Adler:

I tend to agree that there is room for private care within the universal system. For example, a private clinic specializing in hip replacements and contracting, say, 80% of its business from the government would suit me fine, more or less.

I don't think I can comment on the NHS, but in Canada, the one thing that has not truly been tried is "thrrowing money at it".

We face a crunch in demand, while supply is dwindling. Doctors trained in Canada often get free education, and then once their five-year indenture is over, split for the states, where the grotesque operation of selling health retail allows a doctor to make considerably more than here.

$160,000 to $500,000? Those salaries are about comparable to US doctors. The rest of your statement there is, unfortunately anecdotal.

The incompetence you mention seems to be based in the administration, technological, and HR side of the equation. The question is, really: for the money you pay, can you rely on getting the treatment you need?

My last doctor firmly believed that all doctors should be on salary, rather than paid by the patient. It would lengthen visits and enable better, more thorough diagnoses.

And it would also allow him to say "Mrs. Smith, that's the last time I want to see wee Johnny in here for a case of the sniffles. I've told you before: he has a cold. Keep him home, feed him chicken soup, and it will go away in a few days. And no, you can't have either antibiotics or ritalin."

However, it would lengthen the current wait lists. And in rural Canada it is very difficult to find a physician. Witness the fact that Mme and I had to drag self into the emergency ward twice before a kind nurse tipped us as to who was accepting patients.

Regardless of the difficulties of getting one's health care provided by the same people who create the tax code, I infinitely prefer it to a system that allows twelve percent of the population to suffer needlessly.

Nurses in this country fought like hell to rid us of interns, orderlies, and volunteers such as candy-stripers. Now they complain that there's no-one to handle the dirty work, and it shouldn't be their job.

As to the problem of third-world doctors leaving for greener pastures--private care will only ever exacerbate the problem.

At 12:58 AM, Anonymous G Eagle Esq said...

Bonjour, M Metro

Vous avez un bon point .... vraiment, many bons points

For all its wastes & inefficiencies & corporate selfishnesses & sheer naffnesses, at least the NHS in Inglatterra is (generally) there, when you need it

Le vestre servant etc


At 9:51 AM, Anonymous G Eagle Esq said...

AHH !!!

Shiver me timbers - avast idleness

FFE has an interesting post on Health Care, to which you could make a helpful contribution

You should get over there and lodge a Comment

NOW, jumbly, boy, jumbly


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