Single-payer nightmare

Hoo-ray for single-payer health care:

[www.reason.com]

It's not the concept that's at fault, just the particular system, right? Right?

Kyle

Actually, in this case, it really does seem like the particular system. The convoluted logic - combined with an inconsistency of application (which at least mitigates the damage of the stupid policy) - is what makes this individual case so appalling.

The problem is that when you give the government control over health care you are setting up a situation where things like this are bound to occur, to a greater or lesser degree.

Not that insurance companies can't and don't make troubling decisions about what they will or will not pay for. But at least in that case the customer and company have a contract saying what they agreed to in advance. Not so with nationalized care.

KeithK
Not that insurance companies can't and don't make troubling decisions about what they will or will not pay for. But at least in that case the customer and company have a contract saying what they agreed to in advance.

And the insurance company implicitly agrees to disagree about what they have agreed to, and their lawyers are usually better than (or, at least, outnumber) yours. It is a really difficult question however you look at it.

KeithK
The problem is that when you give the government control over health care you are setting up a situation where things like this are bound to occur, to a greater or lesser degree.
...
Not that insurance companies can't and don't make troubling decisions about what they will or will not pay for.

I'm impressed Keith... a reasonable acknowledgment that both systems are significantly screwed up in their own way. Proponents of one side or the other often pull out all sorts of examples of disgusting behavior of the other system, ignoring all the examples of the disgusting behavior of the system they propose.

But at least in that case the customer and company have a contract saying what they agreed to in advance. Not so with nationalized care.

Disagree, considering nearly every contract you've ever signed probably says that most things are "at the discretion of [the company]", followed by a nice catch all statement at the end that gives you the company the right to 'change any policy at any time without notice' or some such.

Well, seeing that I'm dealing with a single payer (Medicare) and private insurance companies all the time, let me say that both have problems, but Medicare is a lot easier to deal with. They have their rules, but they are easily spelled out. Dealing with the privates is a disaster.

The head of my former training program at U of Michigan gave me the most absurd example yet. He was trying to get a drug for a patient which was off-label. That means using it for a condition that is not FDA approved. They denied it and he asked for a reconsideration, and wanted to know who would be making the final decision. Well this was a plan sponsored by U of M and he was told that since he had the most knowledge at the U about the medical condition, he was the final decider.

Fine he told them, he'll approve it for his patient. The bureaucrats (they exist in the private sector just as in the public sector) told him that he couldn't approve it yet, as it had to go through all the appeals before it would get to him. So the patient had to wait. Fortunately he waited knowing that it would be eventually approved. Others can't wait and end up being treated with an inferior program.

In fact while I'm posting this, CNN is doing a story about a patient whose insurance company canceled her policy once she had the diagnosis of cancer made. It's easy to find terrible examples in any system, but there must be some reason why the rest of the world has a different system than we do.

Jim Hyla
In fact while I'm posting this, CNN is doing a story about a patient whose insurance company canceled her policy once she had the diagnosis of cancer made. It's easy to find terrible examples in any system, but there must be some reason why the rest of the world has a different system than we do.

And an arbitrator awarded the patient $9 million including ~$8 million in punitive damages.

ugarte

Jim Hyla
In fact while I'm posting this, CNN is doing a story about a patient whose insurance company canceled her policy once she had the diagnosis of cancer made. It's easy to find terrible examples in any system, but there must be some reason why the rest of the world has a different system than we do.

And an arbitrator awarded the patient $9 million including ~$8 million in punitive damages.

Thanks for finding that.

Jim Hyla
In fact while I'm posting this, CNN is doing a story about a patient whose insurance company canceled her policy once she had the diagnosis of cancer made. It's easy to find terrible examples in any system, but there must be some reason why the rest of the world has a different system than we do.

Because the rest of the world is a little bit more reasonable and rational than the U.S.?

What Kyle's article fails to mention was that the drug was an experimental drug that most country's regulatory bodies had yet to approve for breast cancer. In fact, the FDA just approved the drug for use in the U.S. last week.

Say what you want about waiting lists and the rationing of health care in countries like the U.K. and Canada, but the fact of the matter is that those countries devote significantly less resources to health care and experience marginally better health outcomes as a result. There's also the funny little fact that the root of the word rationing is related to 'rational', which is how I hope any quantitatively-minded Cornell alum would want decisions to be made.

So much of the costs of health care in this country go towards keeping extremely old, fragile, sick individuals alive for an additional couple months -- things that other countries are unwilling to have the public pay for, and rightly so, in my opinion. On the flip side, other countries are eager to spend a little bit more money on keeping children and young adults healthy -- individuals who presumably have the potential of a productive life ahead of them and who any rational society would want to keep healthy.

But nope. Not in "free market" and "pro-life" America. The tragic irony is that some sort of universal health insurance scheme would do wonders for the free market -- individuals would no longer experience job lock due to health insurance benefits and they would be free to pursue their own entrepreneurial ideas free of the economic insecurity that comes with the lack of basic health insurance benefits.

Instead, your private insurance policy premiums are skyrocketing in part due to the fact that the insurance companies are spending a lot of money figuring out who not to cover.

I'm speaking as somebody who has very recently experienced a whole host of medical problems -- to the point where I have had to change jobs and move back home with my parents. And I would probably be on disability (and without health insurance) if it wasn't for the fact that my employer is gracious enough to let me work from home on most days.

Thankfully, my disease isn't life threatening, but it is life altering, and it needs to be managed aggressively. Without health insurance I could quickly lose my job and become an unproductive member of society. And if for some reason I am laid off and lose my health insurance and my relative quality of health, I can guarantee you it will be a lot harder for me to climb my way back into the labor market.

And I speak as somebody who has a lot be thankful for; I come from a stable, middle-class family that can support me, I've worked hard in life and obtained a college education from a pretty good university, and I can still work a desk job with the proper accommodations made. But I still struggle every morning to walk my first fifteen steps to the shower. I couldn't imagine the daunting challenges facing somebody in my situation who maybe hasn't been lucky enough to obtain a college education, or somebody who has less support from their extended family and friends, or somebody who has children to care for.

Now, I've lived in both Canada and the U.K. in my 24 years. And in my time abroad, I've certainly heard complaints about the health care systems in these countries -- they certainly pale in comparison to France or Switzerland or Germany. And I think they should definitely allow more private insurance to built on top of the public base.

But I've heard a lot more complaints about the U.S. system. And not once have I ever heard a citizen of a foreign country with a public health care scheme suggest that they devolve back to a U.S. style system. The public benefits of basic safety net are too good (and too rational) to pass up.

I truly hope you regain full health and have a long, productive, and fulfilling life. I'm not sure why, but from your previous posts and because of the maturity of your writing, I would have guessed that you were in your 40s, not your 20s. It doesn't matter whether or not I agree with your take on our health-care system (I wouldn't dare offend the anti-political police on this board by offering my opinion, lest they pounce on me!), but I am proud that you are a Cornellian! Thanks for the post; you have revived my hope that this most recent group of grads will continue to do Cornell proud. Again, best wishes on your full recovery.

BillCharlton
(I wouldn't dare offend the anti-political police on this board by offering my opinion, lest they pounce on me!)

This is JSID, brother. Let 'er rip!

meta, this isn't to comment politically (I agree with most of what you said), but you may want to be aware of the 'COBRA' policies. Long story short, you can keep health insurance for 18 months after loss of a job at the company's group price (only you pay the whole of it). Hope you never have to deal with it, but if you do, I couldn't tell if you were aware.

This too is only an outcome of the government 'meddling' in the free market. Without it, the free market would drop you like yesterday's garbage.

metaezra
Because the rest of the world is a little bit more reasonable and rational than the U.S.?

That's very much a debatable proposition and fundamentally a subjective question.

I do agree that the health care market is insufficiently "free" in this country. Eliminating the tax subsidy for employer provided health care would help a lot. Eliminating some of the state required mandates for coverage would too. Then we might have a situation where people actually make rational decisions about health coverage as it relates to cost and benefit.

I've worked hard in life and obtained a college education from a pretty good university...

Nah. I hear that school in Ithaca is pretty crappy.

That's very much a debatable proposition and fundamentally a subjective question.

I certainly don't disagree.

metaezra
Because the rest of the world is a little bit more reasonable and rational than the U.S.?

Nor would I disagree with this, as it applies to health care systems. It's hard for me to imagine that "all" other developed nations have it wrong and somehow we have it right.

KeithK
I do agree that the health care market is insufficiently "free" in this country. Eliminating the tax subsidy for employer provided health care would help a lot. Eliminating some of the state required mandates for coverage would too. Then we might have a situation where people actually make rational decisions about health coverage as it relates to cost and benefit.

Not that I think your idea will ever happen here, but do you have an example of this somewhere on this globe. If so I'd like to read about it.

Personally I think most of the rest of the developed world has already made what they consider their rational decision about what kind of health coverage they want. I've not seen mass riots around the world demanding that individuals be mandated to buy their own insurance. To the contrary, all surveys that I've seen show that, as unhappy as they are with aspects of their health plan, citizens of countries with universal health care would not eliminate it.

Jim Hyla

metaezra
Because the rest of the world is a little bit more reasonable and rational than the U.S.?

Nor would I disagree with this, as it applies to health care systems. It's hard for me to imagine that "all" other developed nations have it wrong and somehow we have it right.

I don't have a hard time imagining it. Popular governments seem inclined to head along the road towards socialism and government giveaways in general, a tendency that I'm pretty convinced (based on instinct and economic theory) leads to bad results.

Plus, I just have more faith in America than the rest of the world. Reagan's "shining city upon a hill" and all that.

Jim Hyla

KeithK
I do agree that the health care market is insufficiently "free" in this country. Eliminating the tax subsidy for employer provided health care would help a lot. Eliminating some of the state required mandates for coverage would too. Then we might have a situation where people actually make rational decisions about health coverage as it relates to cost and benefit.

Not that I think your idea will ever happen here, but do you have an example of this somewhere on this globe. If so I'd like to read about it.

The fact that it has not been implemented doesn't prove that it wouldn't work. At best it's one part of an argument. I do think it's clear that what I've suggested would "solve" some of the problems people mention like people sticking with lousy jobs for the sake of health insurance. Whether they would raise other problems (and what they would be, how severe, etc.) is a subject for debate.

Jim Hyla
To the contrary, all surveys that I've seen show that, as unhappy as they are with aspects of their health plan, citizens of countries with universal health care would not eliminate it.

That's the frustrating thing about government programs for us small government types. It's very hard to get rid of them once they are instituted even if you can demonstrate clearly that there is a better way. It's hard to convince people to give up things they think are "free" (e.g. single payer health care) even though rationally they are paying for it anyway via taxation. Direct costs have more of an emotional impact than indirect costs. It's not rational.

KeithK

Jim Hyla

metaezra
Because the rest of the world is a little bit more reasonable and rational than the U.S.?

Nor would I disagree with this, as it applies to health care systems. It's hard for me to imagine that "all" other developed nations have it wrong and somehow we have it right.

I don't have a hard time imagining it. Popular governments seem inclined to head along the road towards socialism and government giveaways in general, a tendency that I'm pretty convinced (based on instinct and economic theory) leads to bad results.

Plus, I just have more faith in America than the rest of the world. Reagan's "shining city upon a hill" and all that.[/q]

But of course Reagan was not a small government, balanced budget guy. He just had different priorities for his spending.

[q]

Jim Hyla

KeithK
I do agree that the health care market is insufficiently "free" in this country. Eliminating the tax subsidy for employer provided health care would help a lot. Eliminating some of the state required mandates for coverage would too. Then we might have a situation where people actually make rational decisions about health coverage as it relates to cost and benefit.

Not that I think your idea will ever happen here, but do you have an example of this somewhere on this globe. If so I'd like to read about it.

The fact that it has not been implemented doesn't prove that it wouldn't work. At best it's one part of an argument. I do think it's clear that what I've suggested would "solve" some of the problems people mention like people sticking with lousy jobs for the sake of health insurance. Whether they would raise other problems (and what they would be, how severe, etc.) is a subject for debate.[/q]

True, it's possible, but before we go jumping off a cliff, hoping there is a safety net below (how's that for bringing in a liberal phrase in), I'd like to see it successful somewhere. After all, my idea of universal health has numerous successful examples all over the world.[/q]

[q]

Jim Hyla
To the contrary, all surveys that I've seen show that, as unhappy as they are with aspects of their health plan, citizens of countries with universal health care would not eliminate it.

That's the frustrating thing about government programs for us small government types. It's very hard to get rid of them once they are instituted even if you can demonstrate clearly that there is a better way. It's hard to convince people to give up things they think are "free" (e.g. single payer health care) even though rationally they are paying for it anyway via taxation. Direct costs have more of an emotional impact than indirect costs. It's not rational.

But you still cannot come up with one example of your system, and I'd rather be as happy as all those other "irrational thinking citizens".

KeithK
It's hard to convince people to give up things they think are "free" (e.g. single payer health care) even though rationally they are paying for it anyway via taxation.

I think the calculus is even simpler than this, Keith: it's hard to convince people to give up things that other people are paying for. That is the case with all entitlements in this country: most of the voters are paying for but a small portion of what they use, and the rest is paid for by people richer than they are. (It's like the class envy joke: "Who are the super rich? Anyone making more than twice what I am."

This is precisely the problem with democracy when it is used to justify taking from one person to subsidize another.

Kyle

I don't think people in single-payer systems think their healthcare is free. They're smart enough to understand the concept of taxation, and to suggest otherwise is a strawman. I think what you'd be hard-pressed to get them to give up is the peace of mind of knowing that if they lose their job, or just don't have a decent salary to begin with, they'll still have health insurance. And I'd venture a guess (though I don't have anything to back it up and I'm too lazy to look it up) that even many of the relatively well-off in those countries wouldn't want to get rid of the system, because they don't want to screw their less fortunate co-citizens.

FWIW, Humans are a naturally societal species, and the concept of government-organized welfare isn't actually some crazy idea the liberals invented... even chimps have it. There was a very interesting segment on this on NPR's science Friday a year or two ago, where basically the experimenters dropped a bunch of bananas into a pen, a couple of chimps fought over it, and then the alpha male walked over, took the bananas, distributed them evenly among all the chimps, and everyone was happy.

Basically, if you're against universal healthcare, it means you're against acting like a chimp, and that means you shouldn't masturbate. Or, to put it slightly differently: Every time you masturbate, God kills a kitten keeps a homeless man from dying of pneumonia.

ftyuv
I don't think people in single-payer systems think their healthcare is free. They're smart enough to understand the concept of taxation, and to suggest otherwise is a strawman.

Oh come on, don't you know, the whole rest of the free, and some not-so-free, world are just stupid pawns, being lead down the yellow brick road by their governments.