Wednesday, September 2, 2009

Another editorial about the health insurance debate

It seems the hot topic around the U.S. Blogosphere lately is health care. I have done a post or two about it myself. There is a large commotion about it around the country, with protests and so forth. A common reason many bloggers and others give for wanting to go with a government-run health program is that they paint private insurance companies as big bad ogres who band together to overcharge and underpay.

As a person who seeks clarity so he can make logical, non-emotional decisions, I wonder how many out there actually stop to remind themselves just what insurance is? Or what the benefits of free enterprise are? Or what the proper function of government is?

Before one even considers what insurance is, or is supposed to be, one needs to remind himself of the basic differences between capitalism and socialism, and which is better at what. On the same subject is reminding ourselves the difference between a for-profit enterprise, and a non-profit enterprise. Armed with a clear definition of these things, we are better equipped to make unemotional choices.

1. Capitalism and socialism. Just a reminder: capitalism is simply when things are mostly run by private people, or by private people who form groups, whose primary motivation is profit rather than altruism. Government’s job is to watch and to regulate. Always, the government's main job is to watch out for the people who must do business with these private people or groups of people. Socialism is where the government itself acts as the “business” and the money to run the "business" comes from the people, like it or not. Socialism is often necessary for very large undertakings, or when there is a need for something but little or no financial incentive for the private (profit-driven) sector to do the thing. It does not follow that government-run operations are more frugal or responsive to consumer needs than are privately-run operations.

2. Non-profit enterprises. Some people are under the impression that “not-profits” don’t turn a profit. This is because the name is somewhat misleading. People also assume that non-profit organizations are simply altruistic and working for the public good. This is also not always 100% true. The misconception is from the names, and from a tax standpoint. (This paragraph is only referring to non-profits in the USA - other countries have their own definitions and systems.) When a for-profit company makes a profit, those profits are taken by the owner or divided by the shareholders. Taxes are paid on those profits by the individuals or by the corporations. A non-profit doesn't call its profits by the name of “profit”. It refers to profits, instead, as “surplus funds.” These surplus funds are sunk back into the core operation - for example to double their executives' salaries - and make sure, in the end, all funds that have been collected have been properly “spent” so there is no “profit” to pay taxes on. You have to get permission from the government to be a non-profit and you have to abide by their special regulations. With regard to health care, many health care organizations are non-profit from a tax standpoint. Although many health organizations are charitable or otherwise altruistic, It doesn’t always follow that non-profits are more frugal (or even more public-minded) than are profit organizations. Some are, but it is not an automatic assumption.

3. Insurance is one of the oldest businesses ever conceived, begun, probably, with the Chinese shipping businessmen in ancient times banding together to spread the cost of a disaster over many people. That basic concept and purpose of insurance hasn’t changed. Today, groups of people band together and put money in a pot periodically, for the purpose of reducing the impact of occasional losses. Those who have a loss, take money out of the pot. It doesn’t matter if the potential loss is your car, your home, your life (your family’s loss of income) or your health, or the threat of a liability lawsuit that would ruin you financially. It’s all the same principle. Insurance companies exist because it is inconvenient and not economical for individual persons to search out other people in like situations, and determine how much to put in the pot. It is also inconvenient and uneconomical for individual persons to take time from their regular jobs to investigate and pay claims to people in their group who have losses during the insurance contract period (the period for which premiums - the money in the pot - are covering.) It does not follow that having one big company with no competition, in the form of the government, will mean you will put less money in the pot, or that your claims will be processed more fairly and more promptly.

In summary, I believe the government better serves the people by watching and regulating (governing) than it does by running enterprises directly. Other people disagree with this thought very much. I believe greed is inherent in capitalism, and that collusion and corruption take place when government doesn’t do its job of oversight. I believe this lack of the government doing its duty tends to allow the marketplace to become perverted and individual citizens suffer from the resulting unfairness. BUT I believe the problem lies more with the government’s lack of doing its job of regulation (governing) than with many private companies competing for your business.

I believe that many big enterprises, like universal health insurance, are STILL not big enough to warrant the government taking over the enterprise directly. Let the government run big things like courts and armies. Let the other big things be run still by private enterprise, many private enterprises competing with one another, but acting under the same government rules as all the others.

I believe if the government is unable to properly regulate the private marketplace, it is unreasonable to expect the government to properly regulate itself in the same operation.

Without competition, there is no incentive for either good service or price competition - or an incentive to save money in daily operations. The government has never proven it’s ability or desire to control costs, and it never will.

Instead of criticizing greedy and uncaring insurance companies, we might be better served by insisting, forcefully, that our government do its job of governing them. That way we still have the benefits of competition that we would lose if government were to simply take over.

A few further words about insurance companies.

If you are a person who has just suffered a loss, for example you've had your home catch on fire or you have a major sickness, your main concern is payment. The only thing you care about is that the insurance company act promptly and treat you fairly.

On the other other hand, if you are a person who has insurance and has NOT suffered a loss, your only concern is keeping your premiums as low as possible.

This creates a continuing dilemma for insurance companies at both ends of the spectrum.

First, how does the insurance company decide how much money each member has to place in the pot each premium period?

Insurance is a business of predicting the future and of hedging bets. This is true whether it is run by a private insurance company or by the government acting as an insurance company. The main difference is that the government is not accountable for cost containment and has an unlimited supply of captive premium-payers. It cannot be run out of business if it is imprudent or incompetent.

Insurance, like all other businesses who survive in the long-term, must also be in the business of controlling expenses.

Predicting the future is largely a matter of keeping records of what has happened in the past and properly interpreting those records. This is what your tv weatherman does. In the insurance industry, these records are called actuarial records, and are gathered and interpreted by people called actuaries. Based on the interpretation of these predictive records, certain rules arise. For example, it soon becomes obvious that not all risks are the same and therefore not everyone can be charged the same price.

These rules are enforced by people called underwriters. They make sure that people who apply for insurance are properly investigated and placed in the proper rate categories so the risk can be determined and fairly rated. That is why your teenage son doesn't pay the same for his car insurance as a 45 year old rural couple who live on a farm. Insurance prices (premiums) are based on perceived risk. It is a numbers game, pure and simple.

Also, if an insurance company is prudent and fiscally competent (and lucky), they will not have huge losses that have to be made up by increasing your premiums after the fact.

There are many ways an insurance company can control their costs at the other end, and thereby offer cheaper rates to ALL of its customers. Like other businesses, they can keep an eye on business operation costs such as utilities and employees. Insurance companies also invest the premium dollars (short-term for casualty insurance, long-term for life insurance) and use the investment profits to help keep premiums lower. Another way that insurance companies strive to keep costs down is by the prudent investigation of claims and the wise disbursement of claim dollars. This they owe both to their business and to the premium-paying public. However, this last is a sore point with the current government health insurance crowd. They assume the government would somehow treat them better when it comes to paying claims.

A more humane approach to paying health-care claims is needed, whoever does the paying, rather than the current cut and dried rigid insurance company rules. Again, this is an opportunity for government, and for government to do what it does best - regulate and govern: Use public input to make up rules, and then enforce those rules. The function of government would seem simple on the surface.

I am resisting the temptation to talk about industry lobbyists, which are another method businesses (including insurance companies) use to keep costs down and thwart rule-enforcement, so I will stop here.


  1. So, do I understand you correctly, the proposal is that your government will be acting as an insurance company, and not that they will pay all medical costs? I'm sorry, I haven't been following your debates as closely as I might.

    I've had a number of dealings with insurance companies, and while some claims have been dealt with reasonably, none have been speedy, and one case in particular they did all the dodgy dodging you could expect from the worst. If my health care had been involved, it would have been worrying to put it mildly.

  2. What I find intriguing is that, for so many talking this subject, they are discussing single payer healthcare - which is being discussed, but isn't what's being pushed at the moment.

    The current proposal includes (a) a requirement that all people have health insurance, (b) increased regulations and oversight of those companies (which I agree is long overdue), and (c) a provision for a public option to compete with private options. Ironically, this last does three things - it keeps the health insurance companies honest, it provides an alternative to make sure everyone has an option, and it puts pressure on the government to have an effective public option because, if it's not effective, it won't be able to compete.

    Personally, I think that addresses your concerns - and mine (though I'm of the opinion that a single payer system would be far more efficient and save a wealth of overhead on both the insurance side and the medical side). However, if standardized insurance forms were devised that all companies, public or private, were to use, that could also help with administration.

    I work for a not-for-profit. If our company has a surplus (since we support the government), we PAY IT BACK. And we've done so on several occasions. Just sayin'.

  3. @A. - I think it will certainly end up ACTING like a big insurance company. Any entity who collects money for the purpose of paying for the health care of individuals and then doles it out as it sees fit is an insurance company by my definition, except that this one will have no reason to run its business well. Your own insurance company that pays for your health care in the UK is very expensive indeed. Oddly, many in your country think it's free. Go figure.

    Your statement "...and not that they will pay all medical costs..." belies your believe that the government has some sort of magical outside income they use to pay things with. Sorry. "They" get their money from YOU. Therefore,YOU (meaning your country's taxpayers) pay ALL medical costs.

    Insurance companies pay medical bills. The U.S. government will soon be paying medical bills instead, in some form. Same-same, with that one exception of not having to be accountable to their clients, cost-wise. They will at first, of course. But if our government is true to form, it won't be even a complete generation before they will be doing things no private insurance company would ever think of doing.

    Sorry to sound so adamant on keeping government out of private enterprise except to govern it. :)

  4. I certainly don't think our health system is free to run and doubt whether anyone in this country does. But we don't have to pay for each and every treatment or appointment up front, nor do we have to justify the cost to anyone, nor the need.

  5. Uh, Relax Max, Great Britain pays less per capita for health care than pretty much any industrialized nation (except Japan - which gets theirs through VERY strict cost controls. An MRI in Japan cost 1/15th of what ours cost)- just over a third of what we pay per capita (and less than what our government ALREADY pays per capita for healthcare).

    Given the stats, though, we are NOT getting our money's worth. That, in a nutshell, is the problem. If our stats were at the top of the list, we wouldn't be having this discussion - we'd have the best healthcare and we'd be paying for it. Right now, we're just paying for it.

  6. @Stephanie - I wish you would explain "single-payer" to me. I have heard that term used lately and I don't really know what it means. It sounds suspiciously like political jargon of some sort. Does it mean that the payment will come only from the government (or it's contractor) rather than from many insurance companies? I think I am for uniformity of forms and submission procedures (not sure yet) and I KNOW I am for a central medical records system (I never thought I would say that out loud, being such a privacy nut, but I find I DO believe that.) There are many unanswered questions in my mind though. It seems to me that if the government would just acknowledge their blame for not doing their regulating and oversight job in the past, and then vow to make changes and start doing that job, then there would be little left to have to revamp.

    I also don't REALLY believe all people should be forced to participate in any national program, or be forced to carry insurance at all if they can otherwise prove financially responsibility. Millions of wealthy persons now don't choose to carry health insurance and prefer to pay for their own medical bills. Often we just think of the poor, and I think all the poor should be covered. But when you compel rich people to pay into the system against their will, it is no longer really insurance, but simply another tax on them.

    Many young people who feel they are healthy and invincible also do not carry health insurance today. Those, I would still make participate. They are not like the weathy in that they can't pay for their care if injured or sick. If a healthy young person goes to sleep and runs his car into a tree, he would still expect the police to respond and an ambulance to come and take him to a hospital who would be expected to let him make payments over time. So I wouldn't give the young people a choice.

    Return the surplus money to whom? Heh. You sound much more like an open-ended government contractor than a true 501 non-profit, but I will take your word that you are a true non-profit. Who are your other clients besides the government? Never mind. Don't answer that. I am being argumentative now. :)

  7. @A. - "But we don't have to pay for each and every treatment or appointment up front.." Get real. You do too. You pay FAR in advance, every time you draw a paycheck.

    You may be talking about our "deductible" or "co-pay" that we have to pay even if we have insurance (usually). Well, that's true. Deductibles are a way of insurance companies not paying big overhead costs to pay small claims. You are correct if that is what you were talking about.

    Not having to justify costs is a sign of no competition in the marketplace. In fact you HAVE no medical marketplace. I mean, if you are wealthy, can you go see a private doctor for all things? (Assuming you still agree to help pay for the heath care of others?) Perhaps. I guess. Withdraw that.

  8. @Stephani B - I would rather pay more than have the nightmare of government price controls. It starts small and seemingly benevolent, but spirals into other areas until the marketplace is artificial and unattractive to investors. The government does NOT know best.

    Where are you getting your stats? I would really like to verify those. Help me. Both sides of this debate, nationwide, have their own talking points list. For example, both sides bring out people from Canada; one group of Canadians tell how happy they are with the Canadian system, and the other group of Canadians talk about how long they have to wait for special procedures to be approved. I hope you didn't just peel those stats off the pro-government health care group's talking point list. Or, if you did (I sometimes do, too, I'll admit) I hope you checked them out. As Obama would say, they sound fishy. But you are smarter than that. I don't trust either side.

    As your old hero Ronald Reagan used to say, "Trust, but verify." :)

  9. I have to ask - how the sam hill do you pick your topics? Do you open a newspaper or encylopedia at random? Inquiring mind wants to know ...

  10. The stats come from Wikipedia which, in turn, comes from the World Health Organization. WHO has extensive reports running over years that clearly show trends and exhaustive data on not only industrialized nations but those that aren't.

    I've read the WHO reports directly (which is why I was comfortable linking the Wikipedia chart), but they're big pdf monstrosities where Wikipedia's are easy to read.

    It's one thing to pay more and get a better product, Relax Max; it's something else to get something worse while paying a premium - and I'm convinced that's where we are. I also believe much of it isn't money in the pockets of our medical practitioners but in a horde of profit-hungry middle men/women. I understand being leery of cost controls (it's an issue in Japan), but it's another to allow endless and limitless profit on the misery of the ill. I don't believe the health insurance lobby would fight so damn hard if that weren't the situation (we are one of the only industrialized nations that allow insurance companies to profit on the misery of others, by the way). US admin costs are upwards of 20% (some estimates put it closer to 50%) whereas other universal healthcares average well below 5% (as, indeed, does Medicare). Japan's is less than 2%. Again, this data is out there. The money we spend on healthcare (and that's we the people spending it, whether it's premiums, deductibles/fees from our own pockets or taxes) should be spent on the medicine or we're doing it wrong. Medical reimbursement is the last thing I'm worried about cutting back, but I am worried that reverse incentives mean we are overtreated/overtested (especially when there are life-threatening side effects) yet insufficiently cared for.

    As for letting the uber-rich opt just like what's allowed for car liability insurance, OK (I doubt it will make much difference. There's a limited number of folks who can demonstrate being able to cover, say, a couple million in healthcare costs and, even if they can, why would they? People don't often get rich by leaving themselves open to an unexpected illness costing them millions when the burden can be shared by many. If it makes sense for regular people not to pay it out of pocket, it makes sense for rich people, too.)

  11. I'm an independent verifier from way back. I'm surprised from your responses you didn't know more about this.

  12. You asked about single payer - that's when there is one place that provides all the funding for healthcare (which may or may not also own all the healthcare facilities, as is the case in UK or as is the case for the VA health system). Medicare is such a system. Many providers, one payer. There is a proposal for single payer. Wikipedia has an excellent explanation of different types of health care system linked here: US Health Care Reform. I recommend reading it, but also following links, especially where they go to relatively unbiased sources (such as WHO); that's what I've done.

    However, most of the hoopla out there is for the current proposal on the floor, which is NOT a single payer system. This last link has a nice summation largely devoid of much of the inflammatory language of either side (in my opinion).

  13. Max.

    The British National Health Service was born of high ideals. Universal social medicine. Available to all and free at the point of use. Like so many high ideals, it's flawed, but a damn sight more desirable than a system where a hospital turns you away, because you have no insurance or can't pay.
    It is true that all of us in Britain who are in paid employment or who have an income above a certain threshold level pay taxes to our government, just as you do.
    Out of the government's total income, a portion is allocated to run our nationalised health system.

    At point of use, almost all of the service is free. I could visit my doctor once in the year or several times weekly, I could not need a hospital at all, or I could have bones in all my limbs set, and a heart-lung transplant, and the amount deducted from my earnings would not change.
    If I need a few prescription items, each item would incur a charge of £7.20p
    However, if I forsee that I'm likely to need above a certain number of items in a year (and I do), then I can buy a pre-payment certificate for £104:00, and not pay anything further no matter how many items I need, for that year.
    Some people are exempt from charges. People of pensionable age and over (65 years age), pregnant women, diabetics, cancer patients, patients on dialysis, and several other groups.
    My experience of the NHS? Well without it I'd be dead several times over.
    I used to have private medical insurance too. I could thus jump the waiting list, and get quicker access to specialist treatment. Get a private room in an NHS hospital, or be treated in a private hospital. Nicer surroundings, better meals, politer staff.
    I'm not in that scheme now. I think we have a good system, it has its flaws, and is often wasteful of money, but for the most part I believe the system's goal is to treat patients and cure them wherever possible, as quickly as possible.
    There is NO profit motive in providing unnecessary procedures, nor is there an incentive to keep each and every patient as a regularly returning customer.

    Our system is flawed, undoubtedly. I believe it COULD provide better healthcare, I believe it could reduce costs, but overall it's pretty good.

    I think a country that considers itself enlightened and civilised should be prepared to care for its less well-off citizens, no person in need of healthcare should be turned away, refused care because they have no insurance, or no money.

    And yes. I do believe that those whose income is great should be taxed to subsidise the care of the poor. We have, in this country people whose weekly income is greater than the average worker's annual income. The crazy thing is, often these high earners get it because they're good at kicking a bag of air about.
    If I'm earning so much that I can buy islands, flit around the globe, have a fresh ferrari every week, then maybe I shouldn't begrudge sharing a bit more wealth with the needy.

  14. Everyone has made some very good arguments. I have learned a little about what I want and Sobriquet, my biggest issue is with the elderly living on fixed incomes. My MIL is one of those and there are certain things she can not do or receive because Medicare does not cover it. She also receives a whole ten dollars in food stamps. If she does not want them then she loses some of her other benefits in other areas. I cannot even help pay her electric bill because she has to show where every penny goes. There are many things our country needs to work on, insurance coverage for the poor but one of them.

  15. @Canucklehead - How do I choose the topics to blog about? Well, I ask myself, "Would this be of interest to a beer-swilling, hockey-watching, spare-time Canadian comedian with a red beard who works for the phone company and is sexually involved with a llama, and if the answer is "yes", I move on to some other subject. Take this post, for example. You have free health care and no defense budget, so you what do YOU care?

    Where have you been? What do you WANT me to post about? Shall we reopen the pub? I'm game. I will be over in just a few minutes.

  16. @Soubriquet - I'm not necessarily fighting this thing, I just don't think our politicians are smart or honest enough to pull it off. If we can find a plan that everybody likes, and can figure out a way to find jobs for the millions of Health Insurance company employees who will lose their jobs, I'm game. But there is no way our congress is smart enough to write such a bill. At least they haven't come close so far. Maybe we can just find the wording of the plan you guys came up with and use that exact wording. Minus all the extra "U"s, of course. :)

    People don't get refused treatment here because they have no money or no insurance. Stop watching the BBC lying sacks. It is true that doctors are not required to give them comprehensive long-term treatment, only stabilize them. So you are sort of right, and for sure we need change. And you are also right about unnecessary tests and procedures, but not for the reason you think. It's because doctors here are so afraid of being sued. First thing, if we want to contain health care costs here, is to kill all the lawyers. Which should have been done a long time ago anyway.

    "I think a country that considers itself enlightened and civilised should be prepared to care for its less well-off citizens, no person in need of healthcare should be turned away, refused care because they have no insurance, or no money." Ok, you got that from an Obama speech, right? But I would agree with that.

    And of course rich people should pay more in taxes so poor people can be covered. I didn't say that. I just think the government should be straightforward and just tax them instead of requiring them to pay insurance premiums they don't want or need. But sure, take all their damn money. That will make them want to go out and work harder. Kidding. Just take a LOT of their money.

    I resent you saying our system has people who prey on the misery of others and who want them to be sick forever until they run out of insurance coverage. You are right, but I resent it.

    I was going to argue with your statements about cheap prescription coverage but I can't find the right key combination on my keyboard to make a pound sign.

  17. @Stephanie B - I just read all your links. Jesus.

    Just tell me next time. It's not like I don't believe you. Have I ever acted like I don't believe you?

    But I do know more now than I did before. (Although I really knew a LOT before.)

    Are you SURE we can pull this off? It's pretty scary. Do we really have to start completely over?

  18. @Ettarose - Finally a voice of sanity. Well, you are a poster child for what is wrong with our health care in this country. (I don't mean that in a bad way, I just mean you are experiencing some of those cracks in the system a lot of people are falling through lately.) I hope something gets changed, somehow, someway. I will admit I don't think your MIL would have the same problems in Canada or the UK.

    It's so good to see you, btw.

  19. No, I don't believe Ettarose's MIL would have the same problems in the UK. There would be no question of some situations not being covered. Everything is covered for everyone. All prescriptions are free from the age of 60. All. From the age of 65 you are offered free flu and pneumonia vaccination. From the age of 50 you are offered free bowel cancer screening. From the age of 50 women are offered free breast and cervical cancer screening.

    There are attendance allowances for anyone needing extra care. If you have cancer, you have free prescriptions no matter what age. If you are terminally ill you can have all nursing home costs paid.

    There are other benefits available for older people, even more for the over 85s, but they are not linked with the NHS.

    I'm not sure what your argument with Soubriquet over cheaper prescription charges can be, but I feel sure we have the wherewithal to imagine a £ sign if alt-156 doesn't work for you.

    To answer your response to me, though I have to believe you were just being difficult, even if I'd never worked in my life I would have free treatment, and it wouldn't be a limited form of treatment. You know perfectly well what I was talking about. And yes, people who can afford it, or people whose employers choose to offer it, do have access to private medical care. One recent personal example leads me to believe it's not always as superior as they like to make out.

  20. I'm aware that, in theory at least, your hospitals are expected to give emergency care regardless of an individual's financial circumstance. And then seek someone to bill.
    However, I'm not talking about just emergency care, I'm talking about the whole picture, the pain in your hip, the dizzy spells, the ingrowing toenail...
    It's all covered by the NHS, regardless of your circumstance.
    As for the BBC lying sacks, I wouldn't really know, because I don't have a television. On the occasions I do see television news and documentary, I like to watch various different news channels, just as I vary the newspapers I read, and am well aware of their biases.
    I do speak to real live americans too, in some cases ones with experience of both here and there. I know what it means to debate whether you can afford a visit to the doctor, or whether feeding the kids is more important.

    Obama speeches? I've never read or heard one.I hold no brief either for, or against Obama, I just think whoever he may be he's got to be an improvement on his predecessor.
    Cheap prescriptions? No, i didn't mention cheap prescriptions. Sometimes the pharmacist will point out that you can buy the same or equivalent product for less without a prescription. I think some would cost more, some less.

    Taxation? We have so many taxes and taxes atop other taxes that I can't say what proportion of my earnings go straight back to the state.
    We pay national and local taxes, income tax, "national insurance" and so on... But almost everything we buy, we pay Vaue added Tax on it. Don't ask what the concept of v.a.t. is. It's easier to explain cricket. Put simply, it means that every time something changes owner, the government snatch 15% of the price. Food is exempt.

  21. @A. - You just about have me convinced. As I say, I am mostly already convinced of the need for reform, but I am worried about our conversion from our present system, and worried About Congress watering down any bill until it doesn't accomplish all we want (due mostly to pressure from special interest lobbies who pay for politician's elections.)

    One more question. You my not be old enough to answer this question. Before your present health program was in place, what did you have? Was it a system of private health insurance companies like we have here? If so, how did the conversion go? Did it take years? Did it happen in phases or all on one date? Was there opposition at the time? Maybe someone older than you will see this question (questions?) and answer it for me.

  22. @Soubriquet - My unusual humor didn't come across very well, and for that I apologize.

    Our hospitals DO provide emergency care to the uninsured. And the cost is largely written off rather than chased. If the facility receives ANY public tax support - and only a handful don't in some form or another - they cannot legally refuse to see indigent patients who show up. They agreed to this when they took the tax money. The people who pay for this care/loss are the other patients who have money or health insurance. This is done by charging them more than they normally would. It is a large part of why our insurance premiums are disproportionately high. This needs to be changed, and going to your type of system would accomplish this. In addition to this, there are public heath programs in place, both by the U.S. Public Health Service, and by private health providers, which provide wellness care to targeted needy groups at no charge. An example would be free immunizations for children whose parents can't afford them, but there are many programs which target underserved segments of our population. If provided by PHS, then the cost is paid by taxes. If the care is provided by private groups or foundations, then the cost comes out of their fund raising or endowment monies.

    Millions of people are NOT going without heath care if they seek it. This was the point I was trying to address when I mocked the BBC for doing outrageously false and sensationalistic stories about Americans by the millions languishing without hope or access to health care if they don't have money, and why I took exception to your blanket statement that living off the misery of others is widespread.

    But the more pressing point is that these services are fraught with red tape and bureaucracy, sometimes hard to find, tedious to qualify for, and wasteful in their overlaps and duplications. If for this reason alone, this patchwork system needs to be replaced by something streamlined and more responsive. In a perfect world (without politicians and demagogues and axe-grinders) I favor a universal health program. My opposition is only that input by experts is not happening in an orderly fashion and I fear that our current patchwork system will be replaced by another bandaid instead of true reform. I apologize for being so blunt in my statements. It is a failing of mine.

    Additionally, I do not accept that there are Americans who MUST choose between food and health care. It exists because of pride, but not out of true lack of programs. If you are poor and sick, there are programs that let you see a doctor. If you are poor and hungry, there are programs that GIVE you food. If you are poor and homeless, there are programs that pay your rent.

    I'm sorry, but there is just too much hysteria and misinformation out there that is being presented as fact by people who would profit from this or that universal health plan.

    Again, it bears repeating that it is very desirable that we reform this patchwork with a single streamlined program. Like you have, or something very like it. The fact that various assistance programs exist does not mean they are easy or instantly responsive - and that is what we need.

  23. @Soubriquet - I don't know much about the VAT which is used in many parts of the world. I know what it stands for. I have never understood what value is being added. And I don't like it that double or triple taxing occurs on sequential transactions.

    Back during our glory days of Lyndon Johnson and Jimmy Carter, we had what they called a "tax surcharge". You figured out your income tax and then you added a percentage to it just for the hell of it. Unless you were poor of course. That didn't last very long because it was stupid and oppressive. It gave the government more money to waste, but it left the citizens with less money to hire workers and buy food with.

    VAT? Just another way to squeeze more money out of the citizens. In view of that, I am surprised we don't have it here yet. There is one feature I love about VAT though, and that is that ALL people rich or poor pay it if they have the money to spend to buy something. It is an equal opportunity tax at least.

  24. I disagree with you on people not making choices between necessities and health care. In general, though, I don't think it is the very poor making those decisions, but people in the middle class.

    It's been so expensive to go to the doctor (even with insurance) or to the hospital even for routine procedures that many choose not to, so the pain in the back, which could be a kidney infection or a slipped disk or tumor, go on until there is not choice but to go - when the costs are astronomical and the implications mean death or, at the least, financial ruin.

    I have good insurance and a good salary, but we are a one income family. Although I do NOT fail to take my children to the doctor, I often forgo trips to the doctor myself. So far, I haven't had any life-threatening ailments, but, if I get one, I'm likely to be the last to know.

    I can go to the doctor, though, without my children going hungry. For people without insurance or with insurance living closer to the edge than I (but not indigent or destitute), they choices are harder.

    And note, though the hospitals won't go after someone say homeless or indigent, someone with a job might be paying hospital bills for years, even if they're making just over the poverty level.

  25. @Stephanie B - You make some good points. I have a habit of narrowly focusing on the poor, who do seem to get a lot of government attention. But, yes, what does someone who is making too much money to qualify for some of these programs do? What if they are making too much money, but not enough to be able to afford decent health insurance. These are the people who, if they go for treatment, are going to be hounded for payment by the facility. So they don't go because they don't want to be without health OR good credit. This I agree with you.

  26. "How does it feel to have health insurance contributions deducted from your paycheck, then find out you didn't actually have insurance, and now are expected to pay thousands in medical bills? Ask employees of Turbine Airfoil Designs Inc. in Harrisburg.

    TAD stopped paying toward its Capital BlueCross group plan in October. TAD employees said they didn't know that. For five months, their believed coverage remained in effect. Or so it seemed, since their insurance cards remained valid.

    In March, Capital sent TAD employees letters saying their coverage had been canceled retroactively to Oct. 9. Now some TAD employees face five months' worth of medical bills. Some have bills totaling $10,000 or more. State agencies are investigating.

    "I have collectors calling here pretty much on a daily basis," said Jason Beachler, 39, of McAlisterville. He said he has $3,000 in bills from incidents including an emergency room visit after his wife got glass in her eye.

    Gary Murdock of Monroe Twp. has $12,000 in bills stemming from medical care for this two children. "I was paying for family coverage ... $200 plus per month. Where is the money at?," said Murdock, 33.

    TAD, on North Cameron Street in Harrisburg, makes parts used in airplane engines. John Walton, the Dallas-based CEO of TAD, acknowledged the lapsed coverage. He also said TAD managers never expected health benefits to end, and he maintains Capital should not have terminated coverage.

    He said TAD missed the payments because of the recession, and because it has been in desperate financial straits since late last year. When asked who is responsible for the medical bills, Walton said TAD is responsible.

    Meanwhile, TAD has laid off workers and is struggling to stay alive."

    I wasn't searching for any examples, but this news item popped up and smacked me in the face. People here facing the loss of their jobs, who have had medical treatment whilst believing themselves covered. The hospitals also believed them covered. Now, the prospect of unemployment plus significant debts to pay.

    I understand you when you say you do not trust government beaurocrats to run a health insurance scheme, and I can see that changing the way in which your medical systems run would be a daunting task.
    The creation of our National Health Service came about in the immediately post WW2 era, in a country that was used to pulling together, to looking after its weak and vulnerable. A country that was still under food-rationing, (also fuel and clothes rationing) there was a sense of working to use limited resources in the most economic ways possible.

    Look up "Remote Area Medical", and you'll find a charity that works in central and south america, running the same sort of mobile field clinics in Tennessee, Virginia.

    "RAM's Reach Across America:-
    Along with the amazing outpouring of interest and support that occurred after CBS's 60 Minutes profiled one of our expeditions, RAM has received many requests to conduct RAM expeditions in other states, from as far away as Washington and California.

    As part of our response to these requests, we are working to develop additional aviation capability to minimize the logistical hurdles that are inevitable in trying to reproduce in other states what we have been doing in Tennessee and surrounding states for so long.
    For many years, RAM has depended on aging aircraft, such as our C47/DC3, to transport cargo and volunteers when necessary. While these legacy aircraft have served us well in the limited regions in which we regularly perform expeditions, many factors make them less-than-ideal for nation-wide operations."



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