« Why Coulter is Better Than Malkin | Main | Super Kabuki Watch - Immigration Edition »

October 11, 2007

Comments

including how we could protect folks like the Frosts without expanding government coverage (or, if coverage must be expanded, being smarter about it).

Extend either Medicaid or the VA to cover everyone. That would be the smart thing to do.

It would be nice if conservatives could agree they will debate national health care service in the US without (a) crying up American myths about how bad health care is in other countries (b) pretending that a national health care system is something that's never been done before so it can't be discussed in terms of what everyone already know works.

Every other developed country in the world has a national health care system. They all have better health care than the US does. The health insurance companies benefit enormously by the US not having a national health care system: so do bad employers who can keep employees locked to them in poor working conditions because if they leave their job they lose their health insurance. No one else does.

"It would be nice to have a genuine discussion of health care in this country, including how we could protect folks like the Frosts without expanding government coverage (or, if coverage must be expanded, being smarter about it)."

It would be wonderful. Unfortunately, one party's starting point in any such discussion is to label any proposal made by the other party whatsoever as "socialized medicine". Which is a nice way of avoiding the merits of the debate, but a less-nice way of moving towards a solution.

Welcome back, von.

I think it's incumbent upon conservatives to offer a realistic proposal for "how we could protect folks like the Frosts without expanding government coverage" before genuine discussion of such is possible.

von: [Malkin's a] former VDare writer with a blogospheric megaphone, perfect teeth, and a persecution complex.

Is there a term for a persecution complex that engenders the desperate need to persecute others? Surely the Germans must have one.

Malkin is not ... a representative sample of a fraction of [Republican Party] membership.

I disagree. I think she is an example of a certain fraction of the Republican Party.

Malkin is not ... a representative sample of a fraction of [Republican Party] membership.

Sadly, I have to disagree. When I survey the current Republican party, Malkinites are the dominent wing of the party. they are not a minority- they are the party. It is why i am getting out. I held out hopes that it could be reformed, but when all you see is this bile from red State, Malkin, hewitt and others, and then see it repeated by prominent pundits and columnists and then again by the White House and congresscritters, it is hard to suggest they are not the dominant force left driving the GOP.

It is now, sadly, the party of Malkin and Rove. There is no decency or honor or integrity left, and I feel morally obligated to put it down like a rabid dog.

Malkin is hardly out front alone on this issue. In fact, her blogging on the Frosts' finances has been more moderate and nuanced than many of her cohorts in the righty blogosphere.

As for the Republican Party itself, apparently they were just about to issue a press release attacking the Frosts' finances before they realized that the blogs didn't have all their facts straight on this one.

There are few issues on which the right-wing blogosphere is significantly more extreme than the Republican Party itself. For the most part, they just say openly what the politicians say in code.

I'm right there with you John C, just a few years ahead on the learning curve.

Four consecutive MM posts by 3 different front pagers? That must be a record.

OT: What’s with the capcha check this morning? It just became about 5 times more unreadable…

It would be nice to have a genuine discussion of health care in this country, including how we could protect folks like the Frosts without expanding government coverage (or, if coverage must be expanded, being smarter about it).

I think it's clear at this point that the first half of your question is irrelevant. The market has spoken, and it has said that it wants nothing to do with people who have pre-existing conditions of the kind the Frost children have, or frankly, the kind most people have. The insurance industry doesn't want to insure people against loss--they want to collect premiums, invest that money and make tons back, and pay claims only when forced to by clients who have deep enough pockets to force the issue.

So there's going to be no way to keep government out of this equation, if the goal is to make sure that people in need can get health care without bankrupting themselves and destroying their lives. That's clear at this point, and that's the conversation that many on the left have been having for a while now, while many on the right respond with either "socialized medicine" or worse--in Malkin's case, far worse.

OCSteve: OT: What’s with the capcha check this morning? It just became about 5 times more unreadable…

Same here. Or are you and I just getting old?

*dodders* I had the same reaction. *blinks rheumy, ancient eyes*

That last was me trying out the Captcha system. I've turned it off for now. We shall see what happens with the spam. *shudders*

Although it's still requiring Captcha from me. I can't see any option to make it happen less.

Testing!

Still got the captcha check.

First, I am still waiting for a leader of the responsible conservative community to speak out against Malkin, or Coulter, or Limbaugh, or Savage. In the absence of any comment distancing conservatives or Republicans from the fetid, vile hatemongering of these people, I have to assume conservatives agree with them and are just being more polite.

Second, as someone said above, when we hear a rational idea about providing low-cost, high-quality health care to folks like the Frosts without expanding government coverage, I'm sure it would be a welcome addition to the discussion. At present, all I have heard are people who clearly put their "free-market" ideology above the welfare of their fellow citizens, and that is not an acceptable starting point for discussion.

Malkin is not the conservative community. Nor is she the Republican party, or even a representative sample of a fraction of its membership.

maybe not. but she did come in second (tied with Coulter, behind Limbaugh) in the latest Right Wing News survey of righty bloggers' favorites righty.

I can't post here again until the captcha is fixed.

Incertus (Brian) made the most salient point about SCHIP/healthcare:

Why hasn't the private sector already come up with policies to cover the working poor, people with pre-existing conditions, and people suffering from long-term intractible disabilities? If theprivate secvtor solutions are always the preferred ones, where the heck are they? What are they waiting for?

Are they waiting for government subsidies of some kind? Something to shore up the old profit margin, in order to make it worth their while to insure low- or no-profit populations?

If so, how is a private sector solution that requires government subsidies better than a directly subsidized healthcare system?

There's no way it's better.

Unless, of course, the main goal is NOT to make sure everyone has healthcare but, rather, to make sure money goes to the private sector.

Malkin is not the conservative community. Nor is she the Republican party, or even a representative sample of a fraction of its membership.

Really? Who is, then: Limbaugh? Hugh Hewitt? Powerline? Instahack? Anne Coulter?

C'mon, von: Who is a truer representative of the GOP and conzervatism than the screeching nihilists who've made political discourse such a delight over the past 15 years?

Malkin is the most linked-to Right Blogistan blog in the world (that link used to have more data, but nielsenbuzzmetrics seems to be trying to Serve You Better).

If Malkin, Limbaugh, and Coulter aren't the heart of the conservative community right now, who is? No, really, who would you nominate?

Really? Who is, then: Limbaugh? Hugh Hewitt? Powerline? Instahack? Anne Coulter?

My father in law? The average Republican voter who thinks the above are hacks and/or have never heard of them?

Von: The average Republican voter who thinks the above are hacks and/or have never heard of them?

The average Republican voter has never heard of Rush Limbaugh?

The trouble with your FiL, von, is that we don't all know him so we can't use him as a reference point. It has to be someone we can all point to, and who other conservatives *do* point to. Reagan would do except he's dead, so he's more of an icon or multi-purpose emblem than a living embodiment.

Von,


Limbaugh (and assorted imitators like O'Reilly and Hannity) has a listening audience in the millions. Thousands of radio stations carry his program and there are dozens of local imitators offering similar fare. Who do you believe comprises this demographic? If these people aren't republican, then what are they? Democrats? Unaffiliated voters?

"I think it's incumbent upon conservatives to offer a realistic proposal for "how we could protect folks like the Frosts without expanding government coverage".

Ok, I'm confused but it could be that I haven't been paying attention properly. I have a couple of understandings in my head which I'm going to list by number. If any of them are wrong please just tell me.

1. The Frosts were actually covered by the government.

2. Bush vetoed an expansion of the program, not the program itself.

3. His veto had no effect on the application of coverage to the Frosts or to other people who already had it.

I'm all for having health care debates, but I don't want to get sucked in to a frame where I'm forced to argue about how we have to change everything to get coverage for people who already have coverage.

Gary Farber: I can't post here again until the captcha is fixed.

"Ce n'est pas un commentaire de blog."

Incidentally, no CAPTCHA for me that time.

"Why hasn't the private sector already come up with policies to cover the working poor, people with pre-existing conditions, and people suffering from long-term intractible disabilities? If theprivate secvtor solutions are always the preferred ones, where the heck are they? What are they waiting for?"

That is pretty easy. Insurance regulations make it almost impossible to market the kind of catastrophic care insurance would be most useful. As for people already suffering from long term disabilities, they are already typically covered by government programs, and insurance doesn't make sense for them anyway--insurance is about paying a discount rate for the possibility of needing care. If there is a certainty you can't get a discount rate because the chance of needing the care is 100%.

Part of the reason the debate gets so muddled is that we argue about different types of people and different needs as if they were all the same. The needs of the vast majority of people are not the same as the needs of the already disabled. An argument about what to do for the latter does not automatically justify massive changes for the former.

As for CAPTCHA, does anyone know where we could get one like on A Fistful of Euros? That would be nice and easy.

Moving on.

Yes, please, let's move on.

It would be nice to have a genuine discussion of health care in this country, including how we could protect folks like the Frosts without expanding government coverage (or, if coverage must be expanded, being smarter about it).

Great, let's have it.

We already have a way to protect folks like the Frosts. It's called SCHIP.

To echo Lars' point above, if you would like to eliminate or scale back programs like SCHIP, it behooves *you* to explain what, if anything, will replace them.

To echo Jesurgilac's point above, pretty much every other developed nation has some form of national health coverage, all of them pay less than what we pay, and they pretty much all have better outcomes.

Less cost, broader availability, better health.

So, again, it behooves folks who oppose national health coverage to explain why it's bad.

The floor is yours.

Thanks -

Sorry, as others have noted, Malkin is very much a representative of the Republican Party. She's not a Goldwater conservative, sure, she's an authoritarian conservative, but that movement dominates the party and has for some time now. She's one of the most popular right-wingers on the web. Yes, I know conservatives who don't like Bush (or Malkin, etc.) too, and condemning them is to their credit, but they're not running the party. If you can reclaim your party, that'd be great, but it hasn't happened yet, and if you're watching the GOP presidential debates, you know it ain't gonna happen anytime soon. The brand has been tarnished, and for good reason. I'm not going to pretend it hasn't been.

As for the actual issues, I agree that Brian summed up many of the major points nicely. If you care to debate the issues, feel free, but come on, it's not as if many conservatives on the national stage have done much other than invoke socialism as a boogeyman. Bush hardly layed out an honest or persuasive case.

Bush vetoed an expansion of the program, not the program itself.

Yes, but I'm pretty sure it's still the case that for most people the costs of health coverage are rising faster than family incomes, so that solving the problem the program is intended to solve would require expansion.

It would be good to have serious discussion on health care. I'll just lurk, as I'd have little or nothing to contribute.

I'm not sure that serious discussions have anything to do with what happens in American politics, however. At least not for now.

I'm really just writing this to see the captcha problem.

Oh, it's gone.

Part of the reason the debate gets so muddled is that we argue about different types of people and different needs as if they were all the same.

This is a good, and interesting, point.

There's a need for basic, routine, general wellness care. Vaccinations, regular physicals and dental checkups, preventative and basic screening procedures like mammograms, PAP smears, and colonoscopies.

There's a need for critical care for traumatic injuries and severe acute illnesses.

There's a need for regular, ongoing, and often intensive care for folks with chronic illnesses like heart disease and severe diabetes.

There's a need for basic extra care at particular times of life, like pregnancy, infancy and old age.

Each of these things has a pretty different profile as far as likelihood, and as far as amount and duration of cost.

Some things can be prevented or curbed through lifestyle choices. Should "healthy" choices be encouraged through government-sponsored carrots and sticks? Or does that belong to the realm of personal choice and consequences?

Should each be handled differently as regards provision of care?

How, and how successfully, are these things handled in other countries?

Thanks -

As for people already suffering from long term disabilities, they are already typically covered by government programs, and insurance doesn't make sense for them anyway--insurance is about paying a discount rate for the possibility of needing care. If there is a certainty you can't get a discount rate because the chance of needing the care is 100%.


Seb,

I'm afraid I don't understand. Many people (like myself) have chronic medical conditions that:

1. qualify as pre-existing conditions and make me ineligible for private insurance, and

2. when treated appropriately, do not impair my ability to function at all, and

3. have fixed treatment costs


There's no way that I could qualify for medicare or medicade or social security disability because my condition isn't life threatening when treated. Yet, I can't get private insurance. Its not like my condition will lead to high expected catastrophic medical costs later on: I've looked at the statistics and I know it won't. And insurance companies aren't willing to offer me coverage with premiums sufficiently high to cover the fixed treatment costs.


The gap between "being so disabled that the government will pay for your medical care" and "having any tiny thing wrong with you that's large enough to justify dropping you from an individually purchased policy" is huge. Right?

my understanding was that the program as a whole was up for renewal, so the veto covers the entire program.

Since the smear of the Frosts that Von faults Malkin for *started in Mitch McConnell's office* in an email his assistant sent out to various media organizations we really don't have to reach the quesetion of whether Malkin is, or is not, the foremost representative of the Republican party and its proclivities. The *minority leader* and his staff, however, certainly occupy that position. Or is Von going to argue that McConnell, like Limbaugh, is somehow not a Republican party standard bearer. Its going to get pretty lonely out there if all the people who have "R's" after their names, who vote republican, donate republican, and bloviate republican turn out to not be real republicans. Who'se going to be the first to tell them that von's father-in-law repudiates them?

aimai

Turbulence:

Further, when O'Reilly and Hannity have Malkin and/or Coulter on their programs, what are the former up to?

When Hannity interviews Coulter, I see no sign that he believes he is on stage with a performance artist.

If he (and his viewership) doesn't get it, why should I?

If Coulter were a performance artist of any talent and guts, she'd rent a passenger jet, fill it up with young Republicans dressed in their f---ed-up idea of how radical Muslims might dress, and buzz the New York Times building, just missing it, but trailing a banner declaring: "Kidding or just bad aim? You be the judge."

If "Borat" interviewed Sarah Silverman, I'd know when to laugh.

If a rattlesnake interviewed a viper, I'd know that the discussion of the relative lethal poisonous of their respective venom would not be an Abbott and Costello routine, but rather a documentary showing all of the other snakes out there how to strike more effectively.

Re Limbaugh and this statement by Von:

"Malkin is not the conservative community. Nor is she the Republican Party, or even a representative sample of even a fraction of its membership."

Let's play with this:

Substitute Limbaugh's name for Malkin. Is the statement now more true, equally true, or less true? If one believes it is less true, then I hate today's Republican Party even more than I did yesterday.

Substitute Von's name for Malkin's. Is the statement now more true, equally true, or less true? (Insert smiley face here; he voted for John Kerry)

It makes no difference what any of us think Malkin, Coulter, and Limbaugh are, or are not, or represent. What does make a difference is what most of the Republicans elected to the House of Representatives since the Gingrich debacle or who serve on the President's staff and Cabinet, including his Vice President, think they are.

I think we all know the answer they would give.

Also, someone mentioned Abbie Hoffman in this thread or previously in comparison to Ann Coulter.

Tell you what, if Limbaugh, Coulter, Malkin, and Hannity and company show up at the Republican Convention next year and put a little money where their punk, ideological mouths are by staying in the streets to have their heads bashed in by Republican cops in a Republican city and are tried in court for expressing their radical dissatisfaction with the insufficient radicalism of their Party, rather than putting down their microphones only to snatch a quick snack at the hors d'oeuvre table inside the Convention center, I'd be better able to judge the degree of light between them and the Republican Party.

Finally, I'm trying to figure out how one could be Von's father-in-law and remain so uninformed.

;)


There's a need for basic, routine, general wellness care. Vaccinations, regular physicals and dental checkups, preventative and basic screening procedures like mammograms, PAP smears, and colonoscopies.

There's a need for critical care for traumatic injuries and severe acute illnesses.

There's a need for regular, ongoing, and often intensive care for folks with chronic illnesses like heart disease and severe diabetes.

There's a need for basic extra care at particular times of life, like pregnancy, infancy and old age.

Each of these things has a pretty different profile as far as likelihood, and as far as amount and duration of cost.

Some things can be prevented or curbed through lifestyle choices. Should "healthy" choices be encouraged through government-sponsored carrots and sticks? Or does that belong to the realm of personal choice and consequences?

Should each be handled differently as regards provision of care?

This sounds like a trick question. Of course they should be treated differently, and they certainly will be no matter what system we choose.

I'll take the easiest one first. Or at least it is easy for me. Lifestyle choices. The government (at least from a hard healthcare push) shouldn't get involved in any lifestyle choices that it won't also allow insurance companies to consider. Lots of people have been super-sensitive about what insurance companies are allowed to consider. The rule, whatever that is, should be the same for both. One of the biggest parts of my problem with the popular health care debate is how people offer hugely different treatments for the government and insurance companies. "Insurance companies won't cover 'X'" isn't a particularly good argument unless you have a good reason to believe that a government program would. Similarly, if you don't think insurance companies have any business trying to save money by trying to influence behaviour, your shouldn't be suggesting the same from the government.

Basic wellness can be easily covered as an adjunct to medical insurance. But since it is a routine cost, you typically won't get it at lower than its actual cost. For people who clearly can't afford this routine cost, there should almost certainly be a government program. And typically, right now, there is.

Traumatic injuries and acute illness. This is a classic insurance case.

Ongoing chronic care. If we set up a situation where people can join a pool early and maintain it for long periods, this can be an insurable cost. The problem with these types of costs NOW is that with the employment-insurance linkage the pools get broken up and reformed all the time. What was a statistical chance may have become an actual certainty between one job and another, and it is stupid to have a system where that makes a difference.

Same issue with the 'basic times of life' care you talk about.

That stings, Thullen.

"There's no way that I could qualify for medicare or medicade or social security disability because my condition isn't life threatening when treated. Yet, I can't get private insurance. Its not like my condition will lead to high expected catastrophic medical costs later on: I've looked at the statistics and I know it won't. And insurance companies aren't willing to offer me coverage with premiums sufficiently high to cover the fixed treatment costs."

Aren't willing? Or are not permitted to? My understanding (but this is a general understanding, so I am VERY open to the idea that I'm wrong) is that they are not allowed to make the kind of carve out that you are talking about. Essentially you and they would want a situation where they could offer you general coverage, but either make an exception for your know chronic condition, or increase your premium enough to cover that known cost.

My understanding is that states make this kind of 'discrimination' illegal in individual policies except for very limited exceptions. That is a government created problem, NOT a market failure.

Seb,

Do you have a cite for your belief that insurance regulations prohibit these deals?

Since the smear of the Frosts that Von faults Malkin for *started in Mitch McConnell's office* in an email his assistant sent out to various media organizations we really don't have to reach the quesetion of whether Malkin is, or is not, the foremost representative of the Republican party and its proclivities.

Having read the Think Progress piece, I don't think it's accurate to say the smear started in McConnell's office. Rather, it sounded like a McConnell staffer read a bunch of blogs, most likely including Malkin, and sent an email to the press to say "look what the blogs are saying."

They adopted the smear, but I have yet to see evidence that they were the ones driving it in the blogosphere. They were trying to drive it in the MSM.

I agree with steve, it looks I think the freeper started it and McConnell's office helped propogate it.

Turbulence, if the questions are too personal, just say so.

I tried to find a list of states and their requirements. I saw lots of statements indicating high levels of variability based on state regulations. Lots of People cite the annual Blue Cross report entitled "State Legislative Health Care and Insurance Issues: XXXX (Survey of Plans)" [XXXX is any given year of the report" It sounds really useful, but I haven't found a copy.

Looking around it seems that exclusionary riders and rate increases are common in states that allow them, but that many states have restrictions on which ones are allowed and some states flatly don't allow them. Of course they don't bother to list them, they seem to assume that the audience already knows.

What state are you in? I could target my look there.

Have you applied to more than one carrier? This report suggests that people with chronic conditions can often get exclusionary waivers or riders, but that they sometimes have to apply to multiple carriers.

Seb,

I was living in MA. This was back in 2004, so my memory might be fuzzy, but I think I asked 2 or 3 different companies.

Ahh, MA is one of the ones that came up in the different articles (I saw them on Cato and Heritage if you want to look around on the topic) today as being one of the most restrictive in terms of what they allow (the other typical example was Minnesota). In CA for example, you would be able to get insurance with a waiver.

Turbulence,

My understanding of MA law (before some recent changes) is that companies were required to offer insurance to all residents without regard for pre-existing conditions, and set rates based only on age and (maybe) zip code.

When I moved here, in the mid-nineties, I needed an individual policy and was astonished that the application form essentially asked nothing but name, address, age, and "Are you a permanent resident of the state?" It is true that the cost of insurance has risen sharply since then, but it is available.

Perhaps I missed something.

Sebastian, my experience is that what people decry from insurance companies isn't "trying to influence behavior" but rather discrimination on the basis of preexisting conditions or genetic predispositions that people have no control over.

In any case, I want a system where everyone has insurance and the insurance can't go away. Any system that lacks that ends up leaving millions of people with inadequate healthcare. I can't see how that goal is possible without massive government intervention, since it doesn't make sense from a business standpoint for any company to offer insurance under those terms.

Any system that links payment to healthcare usage (as personal or small pool insurance schemes do) is going to end up penalising the poor. Why? Because the poor are always likely to be sicker than average (lower quality food, poorer housing etc) and the sick are always likely to be poorer than average (less able to hold down jobs). The supporters of such schemes need to explain why they think the rich and healthy should have further advantages via healthcare then they already have.

I don't have to worry about buying any health insurance, but my recent dealings with that industry as I've sought to buy home insurance make me very skeptical that it is bursting with firms just itching to sharpen their pencils to craft policies designed to meet their customers wants and needs.
Home insurance is only available as a bundle that includes not only replacing the structure and its contents but also a lot of other froo-fraws that I neither want nor want to pay for (e.g. outbuilding replacement, tree replanting costs etc.). Oddly enough, it is impossible to have any extras removed from the package but those pencils are very sharp indeed when it comes to adding yet more froo-fraws.
Further, the standard industry program calculates that replacing my house will cost $370,000, and that the contents need a further $260,000 in coverage. I disagree on both counts (having just built the house with my own hands and tracked every dime, including my own time I know what I'm talking about). I ask for a policy with limits of $250,000 on the house and $100,000 on the contents with the premium adjusted accordingly. "Oh no sir we cannot do that." What happens if my house burns down and it turns out that $250,000 is enough to replace it? "Then we'll pay out the $250,000 sir." But you're forcing me to pay for $370,000 in coverage!?!
And so on and so forth.
I just want to cover myself against catastrophic loss (with a clearly defined upper bound of a payout!) without a lot of extras and some how this is not possible. I shudder to think of what it must be like trying to buy health insurance.

I don't have to worry about buying any health insurance, but my recent dealings with that industry as I've sought to buy home insurance make me very skeptical that it is bursting with firms just itching to sharpen their pencils to craft policies designed to meet their customers wants and needs.
Home insurance is only available as a bundle that includes not only replacing the structure and its contents but also a lot of other froo-fraws that I neither want nor want to pay for (e.g. outbuilding replacement, tree replanting costs etc.). Oddly enough, it is impossible to have any extras removed from the package but those pencils are very sharp indeed when it comes to adding yet more froo-fraws.
Further, the standard industry program calculates that replacing my house will cost $370,000, and that the contents need a further $260,000 in coverage. I disagree on both counts (having just built the house with my own hands and tracked every dime, including my own time I know what I'm talking about). I ask for a policy with limits of $250,000 on the house and $100,000 on the contents with the premium adjusted accordingly. "Oh no sir we cannot do that." What happens if my house burns down and it turns out that $250,000 is enough to replace it? "Then we'll pay out the $250,000 sir." But you're forcing me to pay for $370,000 in coverage!?!
And so on and so forth.
I just want to cover myself against catastrophic loss (with a clearly defined upper bound of a payout!) without a lot of extras and some how this is not possible. I shudder to think of what it must be like trying to buy health insurance.

Sebastian: If we set up a situation where people can join a pool early and maintain it for long periods, this can be an insurable cost.

We have that system in the UK, Sebastian. We call it "the NHS". Works very well. Pleased you've come round to the idea of adopting it for the US.

Funny, even Americans on the left typically don't want the NHS.

Funny, even Americans on the left typically don't want the NHS.

Typically conservative, Sebastian: reminded that the US has the worst and most expensive healthcare system in all the developed countries of the world, you respond with a silly jibe at one considerably better - which resembles, in principle, exactly what you suggested: an insurance system where we all stay in long term, we all pay, and we all benefit. (And we even treat visiting foreigners.)

I think lots of us would take it over what we've got now, just not over other, superior alternatives.

LizardBreath: I think lots of us would take it over what we've got now, just not over other, superior alternatives.

Sure, there are better healthcare systems than the NHS.

But a lot of Americans, I think, take their impression of the NHS from listening to Brits grumbling about it, rather than from any detailed and thorough study of its real shortcomings. (A lot of the real problems the NHS has are sourced to it being starved of funds by a conservative government for 18 years: it's still recovering from that.)

A lot of the grumblings are precisely about what we fear about a government system, so there you are. And the socially directive policies it has implemented recently are precisely the kind of things that states disallow from insurance companies.

"A lot of the real problems the NHS has are sourced to it being starved of funds by a conservative government for 18 years: it's still recovering from that."

That seems unlikely, as the last conservative government in the UK was ten years ago.

"I think lots of us would take it over what we've got now, just not over other, superior alternatives."

Would you personally, Lizardbreath, give up your current insurance for NHS-level care?

Sebastian,
What is NHS-level care? Is it supposed to be terrible in some way?
If it is analagous to the care I and my family receive here in Canada then it's just fine.

If Lizardbreath thinks the answer is "no difference" so be it. It is just a question of her perception or her own care.

As to the NHS question, could someone provide a link to a reasonably complete description of what it does/covers.

I left MA two years ago and it was true that there were no pre-existing conditionalities on buying direct insurance... when I moved to New York, my hypertention was not covered for a year... on the other hand, the premium in NY (a program for self-employed people) was less than half what buying it in MA cost. ($260.00 v $540.00)

How, and how successfully, are these things handled in other countries?

this links to OECD country profiles and comparisons. Though the info on the Netherlands is outdated: we changed system almost two years ago. This is a short description of our current system.

Everybody has the same basic package (no insurer can refuse someone for the basic package). The individual pays for it, so it is not work related (I obtained ours through a consumer-group and thus got a 10% discount, which worked better than the discount my husband could get via his work). Kids till 18 are all insured for free (and in some area's, dental care for instance, more extensive).

The insurance companies compete through additional packages they offer. We have an additional package for dental care and one for additional healthcare options (fysio, psychology, ortodonthy, etc.). For us two and our three boys (5, 7 & 9) we pay approximately 225 euro per month but have free choice of docters/hospitals.

My thyroid medication doesn't cost any extra, nor do my specialist sessions. I have to pay for the hearing aid for my middle son because he only needs it in one ear, I have to pay 5 euro/hour for the psychology treatment that helps my oldest aquiring better social skills but the full price for the ergotherapy we think helps him too.

When the kids were ill, or my spouse broke his wrists, or my youngest had pain in his operated ear, we were all seen an helped within 4 hours by respectively the GP, the emergency room and the specialist. When my oldes was bothered by a wart or my youngest needed a general checkup we had to wait before we could get an appointment.

Last week my teammate had a sudden heavy blatterinfection during training. She called her husband at 9.15 (being in a sportshall makes sorting out address harder). He made an appointment with the GP-centre in the emergency room for 10.30. They checked, prescribed antibiotics that had to be fetched by the central pharmacy that is open all night, but she was home with her pills at 11.15 and didn't have to pay anything anywhere.

Our national institute has more figures about health care & costs.

In all fairness: we pay slightly more for our healthcare. Everybody with an income also pays a tax for healthcare, which is 0-150 euro per month (depending on your income). Most employers pay it for their employees, which is why I forgot to count it.

If you are self-employed you pay 0-120 euro per month in health tax, depending on your income.

Sebastian:

Have you or a family member actually dealt with the US medical/insurance system recently? Frankly, I would *eagerly* give up my current doctor in exchange for never having to fight a company for a benefit for which I have paid premiums, but which they are refusing to pay as a matter of policy.

Not to mention that at the end of the year I'm going to be faced with the choice between my doctor of 20 years and my insurance company anyway, because the practice is so ticked at the company's policy of never paying anything before you nag that they're not going to renew their contract.

Right now the US medical/insurance system gives us all the headaches of NHS without any of the advantages.

I'm with DS on this one Seb.

Each year for the last 4 years, I've heard one of my coworkers talk about how our insurance company has once again refused to pay for her annual exam. Same doctor, same insurance company, same exam, same procedures.

Each year, she has to call and challenge them, and each year they agree (after hours on hold and being "accidentally" disconnected a few times) that yes, her exam is covered under our insurance contract, and yes, they have to pay for it. And the next year it repeats all over again.

I have yet to hear a good argument as to why most US insurance companies shouldn't be hauled up on criminal fraud charges.

Actually I've personally just been through some medical problems with my back and had surprisingly little trouble. And my roommate went through about a 10 minute procedure getting a therapist authorized.

Where to go first.

von, in regards to Malkin not representing a faction of the Republican Party. Sorry, disagree. She may not represent a sizable faction of those who consider themselves Republican, but she is very much representative of the Republican Party, particulalry its leadership in Congress.

And unfortunately, that is what the party has come to in this era. I don't know what will change it, but my guess is if the faction of those who consider themselves Republican that she doesn't represent started their own party we could see things improve drastically.

Seb:

"1. The Frosts were actually covered by the government.

2. Bush vetoed an expansion of the program, not the program itself.

3. His veto had no effect on the application of coverage to the Frosts or to other people who already had it."

1. Nobody disputes that.

2. True, but an expansion in terms of increased funding was necessary just to maintain the status quo.

3. Not true as without increased funding states would have to reduce the number of people under their respective plans. Additionally, there are several million kids whose family meet the criteria for coverage but who can't be covered due to lack of funds at the state level.

I have worked in the health insurance industry for over 20 years and some clarification needs to be done.

In genneral, rules regarding coverage are determined at the state, not national level. There are a few exceptions and most of those are through HIPAA.

Two of the biggest benefits of HIPAA were increased portability and a semi mental health parity. The portability negated the pre-existing condition preovision if a person changed from one job to another and had insurance through his/her previous employer. The mental health parity rule negated dollar caps that were lower than medical caps, although visit/day limitations were allowed.

Companies can work around some of the rules by being self-funded, but this is slowly changing.

BTW, I am in favor of single-payor coverage.

The biggest problem in getting insurance is for individuals and small businesses. Since the risk is higher, the cost of insurance is greater, even when the person applying has a history of excellent health.

It is true that some insurance companies work very hard to limit their liability, but unfortunately, the government doesn't do enough to limit its liability. Medicaid and Medicare both tend to be somehwat negligent in checking into the need for treatments. However, most of the state SCHIP programs are very careful about avoiding payment for unnecessary care.

I don't see anyway, if the end result is to make sure that everybody has access to decent healthcare to avoid an expansion of government involvement, but I agree with von that it is necessary to do it in an intelligent manner.

However, the gap between the two sides is very broad at this point, and people such as Malkin tend to make sure the gap stays that way. (And yes, there are people on the left who are almost as bad.)

If you are looking for information about the systems in different countries and other information, you could do a lot worse than Ezra Klein's index page of his 'Health of Nations' blog posts. The 5 country posts are towards the bottom. I can't vouch for all of them, but the Japan post is pretty good, though some developments in the care of seniors have changed the landscape a bit.

Anyone wonder why Malkin might be afraid to debate Klein on this?/snark

Seb H.: "Would you personally, Lizardbreath, give up your current insurance for NHS-level care?"

Can't speak for Lizardbreath, but I would in a heartbeat. Unless you have a great group program or a very high net worth, you would be an idiot to say "no".

What part of the significant risk or expectation of penury is it that you do not understand?

"What part of the significant risk or expectation of penury is it that you do not understand?"

I understand my medical insurance just fine. I'll revisit in a post this weekend.

Seb H.: "Would you personally, Lizardbreath, give up your current insurance for NHS-level care?"

Can't speak for Lizardbreath, but I would in a heartbeat. Unless you have a great group program or a very high net worth, you would be an idiot to say "no".

What part of the significant risk or expectation of penury is it that you do not understand?

If I, personally, had to choose between my present insurance and the NHS, and I were restricted to thinking about my own personal needs, I'd have to do some research and think about it. I've been generally satisfied with the actual care I have received (since leaving Kaiser Permanente, about which the less said the better) (I particularly liked their refusing to give me a tetanus shot after I stepped on a rusty nail twelve years after my last tet. shot, but close rivals are their refusal to vaccinate me for measles on the grounds that measles, while endemic to the area I was travelling to but not quite common enough comes close, as does their refusal to cover any rehab after I shredded my knee and had to get 36 stitches in it, and couldn't bend it at all b/c of scar tissue ...)

But I haven't been happy with things like wait times, coordination of care, etc.

More importantly, I'm in about the best position it's possible to be in. I have a job I can't lose short of what they call "moral turpitude". I get group insurance that doesn't care about my preexisting conditions (e.g., epilepsy.) It's good coverage, because universities do that. Etc., etc., etc. And I'm still not sure I wouldn't take the NHS.

The choice becomes easy if I have to choose either knowing that a lot of people don't have my luck, or (alternately) as if I were in the original position, and knew I'd turn out to be someone in the US, but not who. Then, the NHS in a heartbeat.

Though I'd choose the French system over the NHS just as quickly.

I guess I should admit that my willingness to throw my current insurance, doctor, whatever over the side is in no small measure due to getting my insurance via a 3-person business, so I have no insulation from the hideous, draining cost. And that's not even counting the cost in time & emotional energy we spend arguing with the insurance company, trying to decide if we should switch insurance companies, etc.

I can say from personal experience that the medical insurance specter is one of the largest barriers faced by anyone who wants to start or maintain a small business in the US.

If you & your roommate haven't had any bad experiences, Sebastian, that doesn't make you ordinary or smart, it makes you *lucky*.

First, thanks to Sebastian for his response to my questions upthread. I appreciate your thoughts.

Second:

Would you personally, Lizardbreath, give up your current insurance for NHS-level care?

I'm with hilzoy. I work in an industry that treats its employees well, so I have exemplary coverage. Lucky me. So, probably not for the NHS, probably yes for the French system.

Although, if trading what I have for the NHS would get NHS level coverage for everyone in this country, I might just go for it. That's just the kind of guy I am.

Finally:

Here's what I want, and what I think is reasonable to expect in the richest nation in the history of the world.

I want everyone to have access to basic health care. By "basic health care" I mean vaccinations for kids, regular checkups for everyone, regular tests wherever they are available for preventable illnesses. This is a basic public health issue. Access to this level of health care should be no more remarkable than access to electricity or potable water.

I want everyone to have access to treatment for acute illnesses and traumatic injury without worry that they will be reduced to penury.

I want everyone to have access to a reasonable and adequate level of extra care during the predictable times in life when a rudimentary level of coverage is not enough. Pregnancy, infancy, early childhood, old age.

I don't give a rat's behind whether this comes directly from government, from industry, or from Mars. I really don't. I just think it really, really ought to be available. Look at what we spend money on in this country. The money is there.

That said, I do, however, note that government programs such as Medicare have lower overhead rates than most private providers.

People in this country die, unnecessarily, because they simply don't have access to routine health care. In purely utilitarian terms, that is a waste of an irreplaceable resource. In non-utilitarian terms, it is a crime.

We pay more than any other nation similar to ourselves, and get less in return. People fall ill and die unnecessarily.

What we have now isn't working.

Other countries similar to us take a more "socialistic", if you will, approach, pay less, and get a better result.

If you oppose socialized medicine, by which I mean that the access to the stuff I mention above is guaranteed, in some form, by the government, you need to explain to me why whatever other idea you have is better.

Thanks -

I can say from personal experience that the medical insurance specter is one of the largest barriers faced by anyone who wants to start or maintain a small business in the US.

To follow up on this:

My wife is self-employed. I am not. I could be, but I never, ever, ever, ever, ever will be, because the value of the health insurance I get (which covers my wife as well) far outweighs whatever benefit I might get from hanging out my own shingle.

Want to support an economy based on innovative, self-directed, industrious entrepreneurs?

Decouple health insurance from employment.

Thanks -

Getting around to actually reading the links that I provided, I see that Ezra's individual country posts were collected and expanded into an American Prospect article.

Yes indeed, Russell.

One of the most bizarre aspects of this whole swift-boating episode was the argument by some righty bloggers that since Mr. Frost had his own business, he should have just provided insurance for his family. They claimed that he "denied" them insurance. Seriously, it's like they believe it's magically free or something, if you happen to be an employer.

My job is gradually going away, and I've thought about doing consulting on my own (it would be the logical step after working for companies with 900, 70, and 3 employees), but one reason I haven't is that as far as I can determine individual health insurance is (1) an unbelievable hassle that can eat up more time than I on my own without an HR department can handle and (2) far too likely to end up being a scam, in which the company won't pay until months of calls and letters, or won't pay at all, or will suddenly raise my premiums to unaffordable levels, or will cancel my insurance altogether.

Sebastian- Shouldn't the NHS question be worded "would you choose access to the NHS under all circumstances you ever find yourself and your family in over your current coverage, factoring in the chance of losing your current coverage if you change jobs or are laid off or lose benefits due to a cut in hours or being classified as part-time or having to do temporary work, no matter how many part-time or temporary jobs you have to work in order to make ends meet?"

Shorter version -- see Herodotus 1.32 on Solon and Croesus.

I don't know if I'd trade mine for NHS (the WGA's is pretty good), but I'd sure as hell trade my housekeeper's for it -- which she doesn't like, but is all I can really afford for her.

Russel,
Your list of things you want in the richest country in the world seems quite reasonable and unremarkable to me. But there was one rather large missing area; treatment for chronic illnesses. Is that a deliberate omission?

And the mind-bendingly high cost of health insurance for the self-employed (let alone all the administative time and headaches) in the USA has had me gobsmacked ever since it entered my conciousness about 5 years ago via a commenter at Calpundit. Talk about disincentives.

Malkin is not the conservative community. Nor is she the Republican party, or even a representative sample of a fraction of its membership. She's an former VDare writer with a blogospheric megaphone, perfect teeth, and a persecution complex. She also doesn't realize that the first rule of scandals -- and she's in one -- is to change the subject.

Oh please. Malkin is very prominent among what passes for the right-wing intelligentsia, and she's practically the embodiment of what it's descended to. I'll bet she's been on TeeVee a helluva lot more than, say, Andrew Bacevich -- whom she'd probably gleefully describe as a traitor and coward.

I want to highlight one sentence (one among many spot-on sentences) from Russell's 10:19 pm comment:

"Look at what we spend money on in this country. The money is there."

I have two words for anyone who disagrees with that sentence: Crap and ola.

Whenever I hear anyone say we must do more with less, I'm thinking someone's hired an Enron accountant to avoid paying taxes by having the Chinese Central Bank purchase U.S. Treasury bonds.

For example, Larry Kudlow, recently featured in a Kevin Drum post, reveals that supply side economics means that government repeatedly cuts taxes and thus increases its revenues.

Result, according to him: We must cut spending because we must do more with less, even though we have more revenues, which means we have less, apparently, because, abracadabra, fact is, Kudlow hates paying taxes, because he might be disincentivized and shut the hell up and give up his talk show and become a low-wage garbage man, which is an incentive for all of us to raise taxes. To call his bluff.

Which means less than it seems but is given more credibility than it deserves, more or less, but I can't tell because I don't have a napkin handy.

We have a choice.

Do you want maximum freedom, or do you like lentils? If YOU want maximum freedom, then someone else must find 12 ways to cook lentils without cable access to Emeril Lagasse, who could use two months on a lentil diet, but won't because he doesn't care how high his deductible is, though he used to because he was poorer and skinnier and healthier, but couldn't afford the monthly premium..

Or, do you want a little less freedom with the possibility that you may have to eat lentils every other Thursday with some whole-grain bread?

Speaking of lentils, why is it that the disadvantaged are advised to keep a hearty supply of the sturdy pea on hand when the wolf is at the door (Odd that wolves only visit those who have no meat on hand. Vegetarians, are they?), but they don't seem to get a discount on their health insurance premiums for having a healthy, low-fat, preexisting, lentil diet, despite their kid's traumatic brain injuries.

That's doing hardly anything with more than any one body can handle.


Sebastian: And the socially directive policies it has implemented recently are precisely the kind of things that states disallow from insurance companies.

...what socially directive policies?

I'm familiar with most of the American myths about the NHS, but this is a new one. (For all I know, it may be based on a substratum of fact: I'm just not sure what you're talking about.)

A family member recently studied in the UK for a quarter. She explains that the NHS system there is the basic care, with supplemental insurance available.

Sebastian, I certainly would perfer having a basic level of care exempt from the weaseling of insurance companies to avoid paying for justified care. It seems from the little I have read on the subject that the net expense would be the same or a little less than I have paid for the insurance plans chosen by small US companies. Then you add the non-covered expenses here...

Sebastian, one aspect of the NHS which you will not, I think, have considered: No woman pays anything, ever, for contraceptives. Whichever contraceptive a woman prefers, she gets a prescription for it, and the prescription is filled for free. NHS maternity services could be better (WHO health statistics tell me that in that regard, the UK is almost as bad as the US) - but that, too, is one area in which the Labour government has been working to improve, and maternity services are covered from first week of pregnancy to last month of the infant's first year. Which is, I gather, not automatic for many insurance plans in the US - and especially not the cost of contraception.

Actually, I have two words for TWO sentences.

Can I help it if Russell has an equal number of sentences to my words?

What a refreshingly well-informed and courteous thread on a controversial subject!

"Look at what we spend money on in this country. The money is there." I have two words for anyone who disagrees with that sentence: Crap and ola.

I dunno, JT. I mean, think about how whenever we consider the possibility of military action, we spend so much time agonizing over how much it will cost, wondering where we will ever find the money. Ya know?

"Would you personally, Lizardbreath, give up your current insurance for NHS-level care?"

I sure would. Since, you know, Sebastian, Colorado offers me none.

Having settled this question, what? Should I be opposed to some sort of NHS in America, because my alternative is the emergency room?

Or am I supposed to not exist, or what? What reason do you suggest I might have for opposing a British-type service?

I'd surely like to know, since it seems extremely unlikely.

"Shorter version -- see Herodotus 1.32 on Solon and Croesus."

Is that "Here is the truth of each man's life: we must wait and see his end, scrutinize his dying day, and refuse to call him happy till he has crossed the border of his life without pain"?

Maybe I'm the only one who finds it slightly irritating to be asked to look stuff up, rather than have it directly linked to. Linking would seem politer.

Gary- Sorry. I figured my offhand reference to Herodotus would be at least as polite as your referring to Samuel L. Delany as 'Chip' with no explanation for those who have never met the man in person. [/deadpan]

Sorry, I wasn't around and missed the question. Yes, I'd make the change in a heartbeat. That's based mostly on the fact that I really, really, really hate arguing with my insurance company about whether care I've received is covered, and they deny claims for routine stuff about half the time. This leaves me on the phone with someone at the insurance company who doesn't have any information about why the claim was denied, and won't tell me what they need to know to change that denial, but says they'll look into and nothing changes.

I really want to never spend another hour on the phone with my insurance company ever again.

"I really want to never spend another hour on the phone with my insurance company ever again."

Or talking to your doctor or hospital about why your insurance is claiming they're not in-network because they've failed to register for some exceptional circumstance or telling their lab that your child is covered for test x and send the bill to so-and-so at your insurance so it'll get taken care of correctly or ...

I am belatedly curious about what aspects of Senator Clinton's style remind Von so much of Michelle Malkin.

The comments to this entry are closed.

Blog powered by Typepad