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Posted by on Jul 27, 2009 in Health, Politics | 36 comments

The Curious Case of American Health Care

It’s very strange how two countries with such cultural similarities as the United States and Great Britain can be so different.

This past week’s debate on health care has been one which I have followed with close attention but yet have not been able to understand in its entirety. I do not understand how a country as influential and rich as America can let 30 million people live without any health insurance. I can’t understand how a hospital can refuse to treat someone in need of medical care because they haven’t paid their premiums.

30 million people? When I heard that figure I thought it was a joke, it couldn’t be right, not in America. 30 million? That’s six times the population of Scotland, five times the population of Ireland, almost the population of Spain and it dwarfs the population of my birth place, Malawi. That to me is staggering. Surely all people in America can agree that there is something wrong with a system that leaves 30 million people venerable and living without health care.

I understand and respect Republicans opposition to a nationalized health care system; it goes against the free market values that capitalist America has been built on. Of all people Bobby Jindel has been the voice of logical opposition to Obama’s health care reform plans, “Why do you need massive government bureaucracy to install competition in the market place? Why do you need a bureaucrat between you and your doctor? Why would you need a politician making decisions on what treatments you can or can not have?”

These are all very reasonable questions; does a national health-care service dilute the quality of health care service you get? Well, yes, of course it does.

But does a national health-care service rob you of choice? Does a government bureaucrat choose what doctor or even what treatment you have? Does a politician get in the way of a doctor patient relationship? No, well that has been my experience.

For instance, when my father was experiencing major fatigue and dizziness all we needed to do was to ring our local GP (general practitioner) and we had him seen to the very next day. He was then referred to an NHS doctor within a week where they then diagnosed him with cancer of the brain and offered him treatment within a month and a half. At this point my family were not happy with the timescale they offered SO WE DECIDED TO GO PRIVATE and get him treated immediately. We made the choice there was no politician involved and nobody was forcing any type of care we didn’t want.

The problem with the NHS system is that not everyone can be as lucky as my family, to have the money to go private. Some have to wait in the notorious queues NHS have been renowned for, but I always ask, what is the alternative? Privatized health-care which leave 30 million people uninsured?

I have to agree with Republican opposition to Bush/Obama’s nationalization of American banks (even though it looks like it was the right decision at this point in time) and the nationalization of car companies, but nationalizing health-care – I think that could be a lifeline to so many families that it is worth losing poll ratings and political capital for.

Surely this debate could be the one thing that unites American political division? Surely not all 30 million people uninsured are Democrats?

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Copyright 2009 The Moderate Voice
  • Ryan

    Those 30 million are *other people*. Who wants the rabble clogging up the system?

  • AustinRoth

    The ‘true’ number of uninsured most likely falls somewhere in the range of 15M – 30M. 46 Million and 8.2 Million Uninsured Americans Myths Busted

    CBO estimates of the cost of health care reform are now about $2T over 10 years.

    So, using simple math, the cost per month per uninsured person ranges between $555 and $1,111 per month.

    If the goal were simply covering the uninsured, it seems it would be cheaper and more efficient, and cause less effect on the rest of the population, if the government just bought those people private health care from existing insurers.

    But that would reduce the political power and control, and would eliminate the need for new Federal bureaucracies. So that will never fly either, as that is the real goal in Washington.

    • gcomeau

      And perhaps the most overlooked number in the debate is the number of INADEQUATELY insured in the US. People who think they’re fine because they have insurance and it’s giving them no problems when they visit the doctor’s office for a cold or a headache or a rash… but are sitting on a ticking time bomb that is going to blow up their personal finances completely if they ever get seriously, expensively ill and find out what their insurance company can do with all that fine print in their policy to let them refuse payment for the treatment they’re going to need. Last study I saw put the number of people in that situation at about double the number of uninsured. But they’re not complaining because most of them don’t realize they’re in that situation and the insurance companies sure as hell aren’t going to tell them as long as they’re willing to keep forking over their premium payments in blissful ignorance.

  • jwest


    As with so many people who are from countries with nationalized health care and who obtain most of their information about the U.S. from liberal sources, you misunderstand the basis of the delivery system here.

    First off, no one is ever refused heath care in the U.S. ………………. Never.

    Citizen, non-citizen, space alien, black, white, brown, yellow, green, stupid, ugly, fat, thin – it doesn’t matter. Whatever the problem, no matter the cost, everyone is treated for anything immediately. The idea that there is someone, somewhere in America who is being denied even the most expensive treatment is a liberal fantasy fueled by ignorance and prejudice.

    If someone is going to die from a lack of treatment, it would be in Great Britain long before it would happen in the U.S.

    Don’t feel bad about not having this information. There are people (liberals) who still believe there are poor people starving to death in this country. There are others (also liberals) who believe that people sleep in the street due to something other than their own choice.

    May I suggest you expand your reading list to include some more conservative websites so that you can have accurate information to consider along with fantasy inspired fables you find on the leftist sites?

    • Ryan

      If nobody is denied any treatment ever, then why does anyone bother with insurance?

      • jwest


        People buy insurance to protect their assets. Although it’s against the law to refuse treatment, it’s not against the law to charge for the services.

        If you don’t have any money, don’t bother with insurance. You have nothing to get a judgment against, therefore it’s a waste of time for the provider to pursue you. Of course, it’s against the law to hide your assets to plead poverty for free healthcare, but that’s another story.

        • Ryan

          Accordingly, if you’re bankrupt you get the best care possible since you have nothing to lose? What sort of bizarro world is this?

  • CStanley

    Others have beat me to it, but I was going to point out that part of your confusion results from inaccurate information (which, by the way, comes from all sides in this debate.)

    But you pretty much confirmed the main issue that conservatives warn against in a nationalized healthcare system with your own anecdote. While nominally your country provides coverage to all, the reality is that only the wealthy have access to timely treatment in a case like your father’s. How does that differ from the US, where proponents of universal coverage tell us that we currently have price rationing?

    The answer, as far as I can tell, is that citizens pat themselves on the back for providing healthcare for all, but then those that can afford it exempt themselves from the system that you’ve created to help the poor. So how have they been helped, really?

    • Ryan

      CS: In socialized systems, if you can’t afford the quick treatment you still get it eventually. In the US if you can’t afford it you’re just fucked.

  • AR, big numbers are scary. The exponential function even moreso. The cost of health care increase WITHOUT reform is not 2 Trillion, it’s 4.8 trillion. Trying to scare people with the big number doesn’t work so well when we look at the rising cost of private health insurance. For those unfamiliar with the exponential function, it’s what’s called compounding in financial terms. Without going into the full equation, the rate of increase, x, divided into the number 70 gives the doubling time. Private health insurance has been rising at 7% per year (inflation has been around 2.5% for the same period). The doubling time is 70/7 or 10 years. The cost of health care will double, with or without government action. Those asking how we’ll pay for a 2 Trillion tab, tell me how we’ll handle a 4.8 trillion one.

  • CStanley

    Not true, Ryan. In the US, you’ll get treatment, albeit inefficiently, at the ER. And obviously the point in an anecdote like the author used here, many patients in socialized systems won’t survive long enough to get care once they’re put on a waiting list.

    GD- The function that many of us are concerned about here is called addition- as in, adding the $2T for reform to the total that’s already predicted to rise by 4.8T. If the CBO is correct in saying that we can’t necessarily expect reduction in costs but we can expect that increase, then we’re looking at paying a much larger amount without any tangible improvements.

  • jwest

    Years ago, the poor went to a “Charity Hospital” funded by donations from the community. The care was adequate, but not at the level of the paying customers.

    Times changed and people decided that the law should be that any hospital needed to treat anyone who walks through the door regardless of ability to pay. Michell Obama was paid over $300,000 per year to run a program to dump these money-losing transients on to other facilities so that her hospital wouldn’t take the hit.

  • CS, I think the deal is, if I go to the public option, I get the 1/2 off, while you keep the full fare. You prefer capitalist bureaucrats denying you care, I’ll take the government ones. Let’s make it a choice.

  • CStanley

    False choice, GD, since the private insurers will have to abide by the decisions of the govt as well. Plus, now in addition to paying my full fare I’ll be paying more in tax dollars too.

    • Gegenschattenbild

      Yes, CS, and as we all know, private insurers have no influence at all over the government policies by which they’ll have to abide.

      • CStanley

        Yes, CS, and as we all know, private insurers have no influence at all over the government policies by which they’ll have to abide.

        Of course they do, Geneshattenbild, which is a problem that should be addressed. Addressing it by creating a direct govt bureaucracy which will be bought and sold makes no sense though.

  • DdW

    Someone said:

    “If someone is going to die from a lack of treatment, it would be in Great Britain long before it would happen in the U.S.”

    According to a recent Commonwealth Fund survey of adults with chronic illness in several European countries and in the United States:

    Far more Americans reported forgoing health care because of cost. More than half (54 percent) reported not filling a prescription, not visiting a doctor when sick or not getting recommended care. In comparison, in the United Kingdom the figure was 13 percent, and in the Netherlands, only 7 percent. Even among Americans with insurance, 43 percent reported that cost was a problem that had limited the treatment they received. According to a 2007 study led by David Himmelstein, more than 60 percent of all bankruptcies are related to illness, with many of these specifically caused by medical bills, even among those who have health insurance. In Canada the incidence of bankruptcy related to illness is much lower.


    As a “final comment,” in last week’s New York Times Sunday magazine article on health care, Singer says:

    “It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.”…as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.”

    I wonder why so many people who are going to die from lack of treatment would respond so positively?

    Who in the hell is Singer, you ask>

  • Kastanj

    “Not true, Ryan. In the US, you’ll get treatment, albeit inefficiently, at the ER.”

    Yup, people who can’t afford insurance or are screwed by their insurers end up in the public system. Who pays for that? You do.

    “And obviously the point in an anecdote like the author used here, many patients in socialized systems won’t survive long enough to get care once they’re put on a waiting list.”

    So, a person doesn’t survive while being on the waiting list sometimes in socialized systems. So, in the US a person who is rich enough to have insurance doesn’t have to get on the waiting list? Of course not.

    There is not an only option to the US system, like to have every person get on the public system’s waiting list *even if they have the money to pay privately*. That’s a false dichotomy.

    It’s possible to have a system where you get to spend all the money you want in order to have all manner of care and avoid rationing as much as possible, but also pay taxes so that others not only can get better insurance and more reliable coverage (without which they’ll end up being cared for with your money anyway) but also not have to get in such a condition that they have to get on the dreaded Waiting List.

    People don’t die more in the other systems, despite the Waiting Lists and Rationing.

    • Dr J

      Kastanj: “People don’t die more in the other systems, despite the Waiting Lists and Rationing.”

      Yes, they do. Our cancer survival rate is a good notch higher than Europe’s.

      And I find these we-pay-more-but-get-less claims suspiciously simplistic, because one tends to get what one pays for. There are many dimensions to health care, and we might well have advantages like shorter waits, more choices, more latitude to sue if you’re wronged, or other things that don’t show in longevity stats but which people value nonetheless. It would be interesting to find more comparative data.

      Ever try to buy ibuprofen in Italy (like I did last time I was there)? If you’re used to getting 1000 for ten bucks at Costco, you’ll find it frustrating and crazy-expensive at five euros for a pack of ten. But you’ll probably live to tell the tale.

  • Kastanj

    ” So, in the US a person who is *not* rich enough to have insurance doesn’t have to get on the waiting list?”

    Sorry to double post, but that was a necessary editing.

  • adelinesdad

    In the debate over free market vs. government run health care, one point that is often lost is the driver for innovation. It is true that the free market alone creates a problem of access for the poor, and as advances in health care are made, that problem only gets bigger as new (and expensive) treatments are available that didn’t exist before. This is a good thing–the innovation). But the problem of access is certainly a problem we need to figure out.

    However, what about innovation? Free market drives innovation much more effectively than governments do. Profits serve a very useful purpose. As one example, let’s look at the much criticized drug companies (yes, those big evil ones that are destroying the soul of America–yeah, those ones). According to the numbers here ( and my rough calculations, over half of all of the medical R&D spent by drug companies is from companies based in the U.S. And countries around the world benefit from that R&D, but because of price controls, many of them don’t contribute to the cost of that research. I’m not talking about profits here. I’m talking about money spent directly to research new medications to help people get better.

    As anecdotal evidence, I have a son with a chronic disease. It is a rare disease and so I’ve done quite a bit of research on it. Where are all of the researchers located that are researching this disease? Where are the medical equipment companies located that manufacture innovative equipment that helps him live a somewhat normal life? I’ll give you one guess. I’m relatively confident that in a socialized system, my son would probably have not even been diagnosed correctly as it’s a disease that is pretty much unknown everywhere else. That’s just one anecdotal account. Feel free to ignore it if you please.

    Free-market innovation not only helps to create new ways to treat illnesses, but also helps to create cost-saving mechanisms.

    So, we need to find a way to balance access and innovation. In my opinion, that means a system based on free market principles to maximize innovation, combined with regulation to ensure people are treated fairly, and financial help for those who can’t afford a basic level of care.

  • binckeslaw

    Self employed people need access to affordable health care plans that provide the self employed with a business deduction for health insurance premiums. Self employed individuals are not currently allowed to include the cost of their healthcare premiums as a business expense. They also have no leverage in establishing the price for the insurance. Corporations and bigger businesses can deduct the costs of health insurance they purchase for employees because the purchase is considered group health insurance. They can also buy coverage for lower per capita premiums. The consequence of denying the self employed the business deduction on their business return is that the self employed have to pay self employment tax (over 15%) before they are allowed to take a deduction for health care premiums on their personal tax return. As a self employed individual I pay nearly $1,100 per month to cover just myself in a basic HMO that is one step above a basic hospitalization plan. I pay self employment taxes on that money before I pay the premium. My total monthly health care cost, which includes the monthly premium plus the self employment tax, will go down by an amount equal to the self employment tax if my health insurance premium is treated as a business expense. The monthly premium will go down if there are provisions in the new plan so that the self employed can access group rates. Any health reform plan that levels the playing field for the self employed by permitting us to write off health insurance premiums as a business deduction on schedule C and provides for access to group rates will be supported wholeheartedly by the self employed. Any politician who opposes those basic reforms for the self employed will be driven out of office by the very same self employed voters that they claim to represent.

  • CStanley

    “And obviously the point in an anecdote like the author used here, many patients in socialized systems won’t survive long enough to get care once they’re put on a waiting list.”

    So, a person doesn’t survive while being on the waiting list sometimes in socialized systems. So, in the US a person who is rich enough to have insurance doesn’t have to get on the waiting list? Of course not.

    No, my point here Kastanj was that the author apparently sleeps with a clean conscience at night thinking that his country takes care of all, and yet by his own example he shows that their healthcare system doesn’t do a better job taking care of poorer individuals than the US system does (or at least the only reason he thought that the nonwealthy in his country were better off than in ours is that he wasn’t aware of the fact that here, the individual would seek- and get- emergency care when he began to have severe symptoms.) Basically the only difference is that the UK individual gets a diagnosis earlier and then sits around knowing that he might not live to see treatment, whereas in the US the guy is unaware of a serious condition until the symptoms become urgent enough to go to the ER.

    Basically, I’m trying to express that there’s no such thing as a free lunch. If people are serious about providing equal access to all individuals for the best medical care in all situations, then they have to accept that it is incredibly expensive (plus, we’ll need to invest heavily to increase the supply of providers and med tech equipment and facilities.) The alternative it to realize that we’re all going to have to give up the access that the more well off individuals currently enjoy, to create more equity.

  • CStanley

    As an aside- note that the author of this post is making a variation of the sales pitch for universal coverage which claims that we can simultaneously keep what we currently like in our system while also providing it to those who currently don’t have access.

    Logically, this starts to fall apart as soon as you begin thinking about the details. And that’s largely why Obama and the Dem Congress have failed in their efforts to sell this plan- people instinctively know that it can’t be true- you simply can’t REDUCE costs by adding coverage for more people, without reducing the amount or type of coverage that is currently enjoyed by the majority of citizens.

    Even Ezra Klein has realized this problem with the president’s rhetoric, and he’s now advocating that the plan should be sold to the public on the basis of being the right thing to do, the moral imperative. I don’t have a gripe with people who speak honestly about it in that fashion, and I’m sympathetic to the argument of ethics and morality as well. The issue of course is whether or not the cost is sustainable- and I don’t see how it can be. We already have a system that’s 60% public, and just about everyone agrees that the costs of that are bankrupting us- so how can we start thinking about adding the other 40% (or some portion of it) without addressing the costs first?

  • adelinesdad, innovation is great and profit motive a good driver. Quick, name a single innovation of INSURANCE companies that has improved health care. Innovation in insurance companies is just new product development which equals a spiffy new way to position, pitch and sell a new insurance “product”. Who cares? The role of insurance is VERY simple: assess the claim. send the check.
    I just don’t see any “disruptive technology” in that role that has ever or can ever make a difference. Do you? Imagine the greatest minds in the world devoted tirelessly with unlimited resources and time to innovating in insurance coverage. What in your wildest dreams could they come up with that would make a difference? Now stop. Try to remember that insurance companies are not in business to provide health care, nor even to pay for health care. They’re in business to make money, and as much as possible, to AVOID payment of claims. The very thing we pay them to do, they try very hard NOT to do. That’s the model you guys so admire that you’ll fight tooth and nail to protect the profitability of the guys who try NOT to facilitate your health care. Wow. They’re laughing all the way to the bank (insurance company profit up 500% under Bush. AVERAGE top salary $14 million).

  • binckeslaw, I’m in the same situation. We subsidize the insurance of those, like CS probably, and Dr_J, who fight for the for-profit insurance-mediated model. After all, they don’t want their taxes to help anyone else. They want our taxes to help THEM. Pardon me if I’m wrong. If I am, will you support elimination of tax deductions for health insurance? As Dr_J (not a real doctor) has often argued, making people pay the full cost of everything should increase competition and drive down prices. How about it? You guys can afford the extra $2,000 a year that we currently pay for you. Why should you get a free lunch?

    • Dr J

      GD, your repeated mischaracterization of my POV sure gets tiresome. Like I’ve said dozens of times, the insurance-mediated model is the number one problem in our system, which is why cementing it into a government-run-insurance-mediated model that becomes an enormous entitlement we can never change is the worst thing we could possibly do.

      Those tax deductions are the third nose of American health care, the most freakish aspect of our system, and the main thing that keeps the insurance companies in their throne and market from working well. Not only do I support their elimination (or extending them to individuals, or something that removes the distortion), if we could change only one thing in health care policy, it should be this. I’ll be happy to take the extra cash from my employer in lieu of health benefits, even though I’ll inevitably end up paying more overall.

      Of course, labor unions are big beneficiaries of those deductions, and less civic-minded than me, so they’re opposing them. I’ll be shocked if the Democrats do anything to fix this problem.

  • CStanley

    GD, I’m not sure how many times I have to answer that question in order to satisfy you (or perhaps your real goal is to ask it at some point when I might not notice your post and might fail to reply, so that readers who haven’t seen our other exchanges will be left with the implication that I’m fighting to protect my own financial advantage.)

    But here it is again: I believe that the whole employer based scheme is highly flawed and we should gradually move to eliminating it. Part of that process has to include levelling the playing field for people who purchase health insurance on their own. My preference would be for EVERYONE to be able to buy (at least basic or catastrophic health plans) with pretax dollars, but if a move to tax the employer based benefits was part of a comprehensive plan that actually made sense and helped solve more problems than it created, then I would fully support that even though my own taxes would go up.

    So, I’ll await your retraction of the baseless personal attack:
    After all, they don’t want their taxes to help anyone else. They want our taxes to help THEM.

  • My pleasure to retract that CS and Dr J. Now, how will we pay for whatever plan you propose? Allowing everyone to buy insurance with pre-tax dollars would be fair, but we’d need massive tax increases to cover it. It would be great for insurance company profit. Stripping the deductions for insurance would be very positive for tax revenue, but would likely result in even more uninsured.

    I’m very interested in what you think would take the place of private insurance, since you oppose a public option. Is there a third way? Or maybe you just oppose *employer* based insurance, as I do. The cost of insurance, whoever pays it, will double in 10 years, while the most optimistic view of economic “recovery” is the economy doubles in 40 years. And middle class buying power has been stagnant for 30 years. How do we pay for insurance premiums climbing at over four times our income increases?

    In 10 years, it will cost $25,000 to insure a family of 4. Think about that. Median income for the bottom quintile is $14,000, median income for all Americans $45,000 ($38,000 30 years ago).

    • Dr J

      Simply shift the deduction, perhaps gradually, from businesses to individuals.

  • CStanley

    Allowing everyone to buy insurance with pre-tax dollars would be fair, but we’d need massive tax increases to cover it.

    Unless it would require massive tax increases greater than what will be required to pay for the plan that you support, I have no greater burden of proof to provide a source of revenue to pay for this than you do to support your preferred plan.

    I simply argue that at least the disassociation of insurance from employment will solve several current problems without creating new ones: it will stop people from losing coverage every time they lose a job or change jobs, and it will be the one single factor that will do more to encourage actual competition in the insurance marketplace and get consumers in the position of actually being able to shop for plans that suit their individual needs and enable them to drop one company in favor of another one that will compete for their business. There are of course a number of other steps that would make this work better- allowing people to enter pools for greater bargaining power, regulating the insurance companies to prevent them from soliciting only healthy, low risk individuals, etc.

    There’s nothing in the current proposals that even comes close to adding as much probability of competition and real downward pressure on costs (rather than just price fixing, which is what govt run programs do.) So when you correctly identify the problem of rising costs, and point to the fact that at the current rates it will be completely unaffordable in 10 years, I’m baffled as to why you don’t look at this option to potentially mitigate the actual costs.

    After all, it’s true that median income families will be unable to afford $25,000 a year in ten years- but it’s also true that there aren’t enough rich people to pay the bill for all of those lower income families, either.

  • adelinesdad

    “Quick, name a single innovation of INSURANCE companies that has improved health care”

    Healthy-choices incentives such as reimbursing gym memberships and CSAs. The insurance companies win since they encourage more healthy behavior (thus reducing claims), and consumers win since it reduces their costs. I believe this idea needs to be expanded such that insurance companies have more freedom to charge based on health behavior. The current bill (HR 3200) would actually prohibit this:

    And I’m growing tired of the “insurance companies are in business to not pay” argument. You can say the same for every other industry in which there is some form a pre-payment, from movie tickets to life insurance. And yet somehow it alls works out because businesses typically don’t like it when their customers complain about them to their friends, government, and consumer protection agencies. They especially don’t like that kind of thing when there aren’t barriers to consumers switching coverage, as there is today–employer based coverage that severely limits choice, and laws prohibiting cross-state insurance.

    I wonder why the rest of the capitalist system hasn’t yet figure out this novel new business model that apparently can only be solved by having the government become a player in the industry: take payment but then don’t provide the promised (and contractually binding) goods or services? Now that’s innovative.

  • DLS

    I suppose some would wish that we had followed Britain’s example specifically after World War II (perhaps envisioning this happening if FDR were still alive and “unfinished” work in the USA interrupted by the war were able to proceed after late 1945) and we not only had a National Health Service but also the specter realized of public ownership and control (when not merely heavily unionized) of many sectors of the economy that were and remain private in the USA.

    In addition to routine denial of medical care to the elderly and other “unsuitables,” would we be the Sick Man of the Western Hemisphere, have ads teaching us how to shave in the dark after the next power failure or strikes at the generating facilities, and so on?

    Imagine a Reagan rescue that combined Reagan with Thatcher in the 1980s…

  • DLS

    “Healthy-choices incentives such as reimbursing gym memberships and CSAs.”

    Unfortunately, not only did you debunk a myth, but the intelligent public does _not_ want the federal government acting (again) as a surrogate parent and telling us what lifestyle choices we should and shouldn’t choose, act like a sappy version of Singapore with politically correct social engineering that bombards us with stupid advertisements telling us to feel good about and pursue this while feeling bad and avoiding that activity, in the name of “good health,” and so on.

    And I’ll add, even if the effort is largely wasted again, that what people are talking about is not “insurance” and “coverage” of catastrophic events that normally don’t happen and what we wish to avoid, but pre-paid compehensive health care. What the correct, accurate word “entitlement” conveys here is appropriate.

    It’s also wasted again to note aloud that in addition to doing much more logical, smart things involving current programs than what the Dems are attempting, why haven’t (especially during a recession, when a costly new initiative by Washington is anti-stimulative, and makes the least sense, including by those who supposedly are doing well at trying to stimulate the economy out of recession at the same time) the Dems begun simply by trying to get Medicare (and Social Security) costs under control, make them sustainable before initiating one or other (transparently) incremental activity to expand the scope of it?

  • DLS

    “We already have a system that’s 60% public, and just about everyone agrees that the costs of that are bankrupting us- so how can we start thinking about adding the other 40% (or some portion of it) without addressing the costs first?”

    Entitlement reform was vigorously opposed by the Dems during the Bush years. Accompanying their bogus claims of “change” was a vow by Obama to pursue … entitlement reform now. This should have been undertaken before any expansion of health care, or other entitlements, of course, but it hasn’t been.

    And during a recession would be the time to do it, expanding the entitlements (and their costs) afterward, with lower cost increases if the reform were meaningful. But we haven’t seen that, and couldn’t expect it.

  • adelinesdad


    “The intelligent public does _not_ want the federal government acting (again) as a surrogate parent and telling us what lifestyle choices we should and shouldn’t choose”

    Right. But private enterprise (not the government) ought to be able to offer price incentives to those who make healthier choices. Especially since the companies will be restricted from basing their prices on anything else substantial, this would go a long way to controlling cost over time, as it would become a significant incentive to make healthy choices. As I mentioned, the current plan that I’ve looked at (HR 3200) actually forbids varying premiums based on health choices. I like the fact that it forbids varying premiums based on health *status*, but that practice needs to be replaced by something that is fair but still encourages improved health, rather than just charging everyone the same amount.

    And I note your point about health insurance not really being insurance. I agree. Most insurance plans are a combination of insurance and pre-payment. This causes some unique challenges, such as people who are “uninsurable” because of pre-existing conditions (which we need to do something about). In their case, it’s not the insurance that is expensive (a cancer patient is no more likely to get in a car crash than anyone else), it is the pre-payment.

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