John McCain Works Tirelessly -- For You!

by hilzoy

The NYT has a story today about the increased costs of health care for people with insurance. It includes this:

"Shirley Giarde of Walla Walla, Wash., was not prepared when her husband, Raymond, suddenly developed congestive heart failure last year and needed a pacemaker and defibrillator. Because his job did not provide health benefits, she has covered them both through a policy for the self-employed, which she obtained as the proprietor of a bridal and formal-wear store, the Purple Parasol.

But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance."

Remember John McCain's health care speech the other day? Here's what he said about his plan to deal with people who have trouble buying insurance because of preexisting conditions:

"Even so, those without prior group coverage and those with pre-existing conditions do have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need. I will work tirelessly to address the problem. But I won't create another entitlement program that Washington will let get out of control. Nor will I saddle states with another unfunded mandate. The states have been very active in experimenting with ways to cover the "uninsurables." The State of North Carolina, for example, has an agreement with Blue Cross to act as insurer of "last resort." Over thirty states have some form of "high-risk" pool, and over twenty states have plans that limit premiums charged to people suffering an illness and who have been denied insurance.

As President, I will meet with the governors to solicit their ideas about a best practice model that states can follow -- a Guaranteed Access Plan or GAP that would reflect the best experience of the states."

So John McCain will "work tirelessly" to make sure that people with preexisting conditions get "the high-quality coverage they need." His plan? To make sure that everyone has access to state-run insurance pools for people who can't get insurance elsewhere. That's exactly the sort of coverage that would cost Shirley Giarde's husband $758 a month.

In 2006, the median income for individuals in the US over 25 with earnings was $32,140. $758 a month is $9096 a year, or 28.3% of median income. For most Americans, this is just unaffordable.

But hey: as McCain also said, "Watch your diet, walk thirty or so minutes a day, and take a few other simple precautions, and you won't have to worry about these afflictions." So it's not really such a big deal. See how easy health policy can be when you don't bother your little head with all those pesky details and facts?

Comments

[redterror]

With a trophy Sugar Momma it matters not whether St. John of the Flip-flop has good coverage, which he does courtesy of the US government. Everyone just needs to get with the program and marry into money.

[steve]

I have yet to see a true free market solution that addreses the problems of 1) Portability

2) Prior existing conditions.

3)Loss of insurance with loss of job

Steve

[KipEsquire]

Perhaps the problem isn't so much with health insurance as with Ms. Giarde's "Purple Parasol" business model. If her business can't produce enough income for her to pay her bills, then she's in the wrong business.

Debate a "right to health care" all you like, but don't claim that there is a right to run an unprofitable, sub-mediocre business and then get taxpayer-extracted health insurance on top of that.

P.S. What exactly was the back story of Mr. Giarde taking a job with no health benefits in the first place? Because I have no doubt that there was in fact a back story.

[bobbyp]

The solution to the health care crisis is simple: Simply end health care. Make medicine illegal. Doctors and all other health care workers would then have to find another line of work (unless they join the underground economy). Health insurance would obviously be no longer profitable and thus be a thing of the past.

Sick people would die. I mean, what's the big deal? We all die anyway. Think of it as collateral damage.

This would free up vast resources to address our pressing needs:

1.) Expanding the military. If present trends continue, the military budget will take up all federal spending by 2045, putting a $50 trillion hole in the budget. If discounted to infinity, the number gets larger. This is truly a crisis.

2.) More tax cuts to the wealthy. Since they whine incessantly that their taxes are too high, I say enough. Give them what they want and let the chips fall where they may. This would also have the salubrious effect of taking money out of politics, since the rich will by then have all of it. This will enable Broder's bipartisan golden age to re-emerge, and give him a good reason to retire.

Then Sidney and Grover could hold a cerimonial drowning of government in a bath tub. I mean, after paradise, history ends, right?

[bobbyp]

PS: If doctors were confined to the underground economy, and you had the cash, you might even experience a house call.

Think about it!

[Matt McIrvin]

So... I can be immortal?

[bobbyp]

Dear Kip,

You are confusing the awesome interplay of the ceaseless impersonal movements of supply and demand as they move elegantly and mathematically perfectly toward the nirvana of equilibrium(a remorseless dance akin to pre orgasmic frenzy). Perfect micro economic firms, of which, lest you forget, there are an infinite number, do come and go in this universe.

You confuse this with a sordid personal tragedy. Shame on you.

[Porlock Hussein Junior]

Yes, when health care is outlawed, only outlaws will have health care.

Come to think of it, how much of a change will that be?

[Porlock Junior]

Steve saith:

I have yet to see a true free market solution that addreses the problems of 1) Portability

2) Prior existing conditions.

3)Loss of insurance with loss of job

That's because insurance is a fundamentally wrong way of handling the costs of health care.
But you knew that already, right?

[Porlock Hussein Junior]

Since I'm comfortably retired and have adequate coverage for (hypothetical major health costs, it follows that I'm totally out of touch with the interests of ordinary people, unlike Senators McCain and Clinton. Still, it burns my ass, and has since 1960, the way the comfy people smugly blame other people's health problems on the victim.

1960 was when the Republican in the dorm (among, say 23 Democrats and social democrats and socialists, plus one anarcho-syndicalist) (*) held forth on the evils of Socialized Medicine -- nothing new here -- because in his Daddy's practice he saw all these stupid poor people living wrong and not deserving to have decent people pay for it. Did I mention he was a pre-Med, or did you just know it? No doubt he did run into too many obese chain-smoking patients, but, shit, the self-satisfaction of the highly prosperous could take my breath away then, and still does. Walk 30 minutes a day, vote Republican and nothing bad will happen to you! Unless you deserve it!

[felix culpa]

Oh yes I do indeed love that deserving thing. Granted I have a skewed view, because I’m not clear I deserved any of the really good things I’ve enjoyed.
Three wonderful kids. A supportive family. A chance to work with some really admirable artists and take part in some extraordinary works of theatrical art.
I certainly didn’t deserve the first two, and the last I’d call luck.
The friends, I’d call that luck too.

Of course we have public health care in Canada.

rai posted this over on ‘Oil and War’.
“Distinguished law scholar Elizabeth Warren teaches contract law, bankruptcy, and commercial law at Harvard Law School. She is an outspoken critic of America's credit economy, which she has linked to the continuing rise in bankruptcy among the middle-class.” (YouTube)
Her analysis is pretty appalling, particularly with respect to housing, education, and medical costs.

No wonder that the quality of American life falls so low relative to other developed nations. What is it, twenty third out of twenty-four?

[Winghunter]

I can't believe what I'm seeing here!

Are you all suffering from memory loss or is it merely because you have a selective memory??

Just who do you people think picks up the tab for outrageous medical malpractice suits once the insurance company shells out millions?? WE DO.

Who dumps out $340 Billion a year to have 15+ Million illegal aliens who have shut more hospitals down by merely using the emergency rooms as their primary care?? WE DO!

Who has pushed to allow illegals to come and stay for the votes those ignorant provide?

Liberal elected officials and rogue republican presidents.

In the current day working model of socialist health care, what does it tell us about Clinton's old AND new socialist plan??

Romney Quiet On Health Care Because His Plan Is A Dismal Failure
http://www.sltrib.com:80/opinion/ci_8111338

Subsidized care plan's cost to double 2/3/08
http://www.boston.com/news/local/articles/2008/02/03/subsidized_care_plans_cost_to_double/

Wake up and start figuring out how you're own ignorance and denial are being used to play you for fools.

[Davis X. Machina]

Just who do you people think picks up the tab for outrageous medical malpractice suits once the insurance company shells out millions?? WE DO.

...including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending.

That's based on 2005 figures. Let's double it to be safe.

It's one per cent of health-care spending.

Yep, that's the problem right there....

[Davis X. Machina]

Wait, maybe it's the illegal immigrants...

A report released on 25 July found that immigrants are not swamping the U.S. health care system and use it far less than native-born Americans. The study, published in the American Journal of Public Health, found that immigrants accounted for 10.4 percent of the U.S. population but only 7.9 percent of total health spending and 8 percent of government health spending.

[Ramza]

I have yet to see a true free market solution that addreses the problems of 1) Portability

2) Prior existing conditions.

3)Loss of insurance with loss of job

Steve

1) Everyone is mandated to have insurance
2) Government offers a Medicare type plan, which competes with normal private insurance programs, you "buy into" the Government plan for X d ollars
3) Government gives a rebate that has to be spent in its entirety on medical care. Can be spent on private or public plan. Government requires all plans to have minimum standards of what type of medical practices are covered to qualify for the rebate. Also requires certain maximum caps for the individual on payment in the event of catastrophic care
4) Rebate amount is equal to the amount needed to spend for the Medicare plan (or you can adjust it that only the poor get the rebate while the rich do not on a sliding scale, depends on your philosophy on income redistribution.)
5) If the private insurance plan is cheaper than the rebate (severely doubtful), any additional "savings" serves as a retirement vessel which you can't access till the age of 65. You have control over this investment within limits (most risky thing being mutual funds).
6) If the private insurance plan is more expensive than the rebate, than the individual pays the difference. Usually these type of plans offer some greater services to warrant the extra cost. This money is tax deductible.
7) Companies can not offer specific plans, instead they can agree to give additional dollars to their employees in addition to the rebate. Like the individual extra amount to pay for insurance this expense is also tax deductible since it isn't income and it is an expense.
8) To qualify for the rebate insurance companies must use universal government forms, paperwork and definitions to save billing and other paperwork costs. If you don't use these forms your insurance doesn't qualify for the rebate. Can't have any additional forms than the government dictates, and the government chooses which are the possible relevant information/criteria for the insurance company.
9) You can not be denied for insurance. You can not pay a higher premium for factors related to risk you do not control. Mostly insurance costs will be related to age, sex, where you live, and lifestyle choices. Genetics, family history, and similar things you can not control can not be an issue on cost.
10) You can not pay higher costs for pre-existing conditions that you don't have control over.
11) You can change insurances freely. Though their may be a delay where you make an announcement before the new insurance can cover you (up to six months or a year). Your old insurance will cover you till you the waiting period is ended (thus you don't change insurances for plan X has better benefits for disease Y).
12) Non profit information gathers will rate various insurance plans and compare benefits in a matter similar to consumer reports.
13) Standardized costs will be done for medical procedures, if a doctor charges more you have to pay the difference. Customers will have to be told the standard cost as well as what their doctor is charging.
14) No competing on tv with advertisements and 30 second soundbites.

-----

Note this plan is not completely free market for it relies on taxes for the rebate and thus is redistrubitionary of wealth, how so is dependent on how the tax code is written. It may not be necessary progressive or regressive, or flat, regardless taxes are redistrubitionary for they pick winners and losers.

Also it isn't completely free market for their are government regulations on what you insurances needs to do to get the rebate.

The last part can make or break how efficient the system is.

-----

I may be forgetting a few important matters. I am by no means an expert on health care, just a concerned citizen who cares very much about the issue.

The above system I outlined will combine the universality and much of the cost savings of a government run health care. While at the same time allowing the free market to compete and create innovation. There is some waste due to insurance competing against each other, I see this as a benefit though for this competition while wasteful in the short term also creates greater innovation in the long term by forcing insurances to do something they currently do not, the key magic word INNOVATE.

Insurance as it currently is, is the opposite of innovation.

[Sniffnoy]

9 and 10 seem a bit silly to apply to insurance companies; certainly you would expect it of a government health care plan, but insurance companies, are, well, insurance companies. That's how they make money.

[dutchmarbel]

We have something quite similar to what Ramza proposes, including 9 and 10.

Most of my care-givers send the bill directly to my insurance company, the others are paid by me and I send the bill on to the insurance company who will repay me within a month (they claim 2 weeks).

Insurance is taken by individuals, in their own name - but if they do it via their work they often get a discount (10 % or so). I take it via a consumer group that I allready participate in for discounts in fuel, but there are more groups (unions, parties) that have contracts with other firms and give more or less the same discount.

For a family of two adults and 3 kids we pay (not counting the discount, I save that up) 266 euro per month. No co-pay for hospitals, doctors visits, prescribed medicine or basic dental kiddy-care. Completely free choice in care-givers. The only contact I've had with my insurance companies (I've changed a few times) in the last 20 years is sending them the bills and receiving the rebates.

We have general practitioners as gate-keepers though. Last week monday I was almost out of my thyroid medication. I called the GP, but got the answerphone because they were moving office. I called the backup number, got the backup GP practise and explained. The assistant looked me up in their computers and agreed to send a new prescription to my pharmacy. In the afternoon I biked past the pharmacy and my medication was ready for me. Less bureaucracy saves enormous amounts of money.

I think mandates are essential for the system to work. I also think that the US will get a problem in getting enough doctors. Quite a large proportion of the current US doctors is foreign trained; you need less lawyers and more doctors if you want more people to recieve medical care.

[Noumenon]

In 2006, the median income for individuals in the US over 25 with earnings was $32,140. $758 a month is $9096 a year, or 28.3% of median income. For most Americans, this is just unaffordable.

If I had congestive heart failure, I think I would find a way to afford it. The average American spends 32% after tax on housing and 14% on food, that means you only have to cut half of your "other" spending to find 28%. For a necessity like insurance, you could find room (probably trimming some fat in housing and food too).

And, he's only got to buy it for a year and then he's on Medicaid -- it actually sounds like a pretty good safety net to me. I didn't even think we had a program to pick up people who were deemed "uninsurable."

[Incertus]

If I had congestive heart failure, I think I would find a way to afford it. The average American spends 32% after tax on housing and 14% on food, that means you only have to cut half of your "other" spending to find 28%. For a necessity like insurance, you could find room (probably trimming some fat in housing and food too).

Hmm. How much of what you so blithely call "other" includes such frivolities as electricity, water, telephone service, gasoline, home and auto insurance and the like? You're saying "other" like it's all Twinkies and trips to the amusement park money we're talking about here.

[Anarch]

The average American spends 32% after tax on housing and 14% on food, that means you only have to cut half of your "other" spending to find 28%.

To amplify on what Incertus said above, if you go by what Elizabeth Warren says in The Coming Collapse of the Middle Class -- and she's probably right, though of course I don't know the statistics well enough to check -- then the level of "immutable" spending is actually around 70%, not 50%. Things get a little wonky in the absence of health insurance (which is entirely the point of this post, I realize) but I don't think it's at all reasonable to assume that one can penny-pinch in the way that you're describing.

[cleek]

... and in any case, $32K is the median; there are plenty of people below that level who simply can't scrimp their way into an out-of-pocket plan.

[trilobite]

15+ Million illegal aliens who have shut more hospitals down by merely using the emergency rooms as their primary care

Apart from the factual errors noted by Davis X, Winghunter appears not to grasp that one of the biggest reasons to improve the health care insurance system is so that we DON'T pay for people's primary care at publicly-subsidized emergency room rates.

[Slartibartfast]

John McCain Works Tirelessly -- For You!

So. You're saying that the tires have already come off the McCain campaign?

[Wayne]

Interesting, such a serious problem; so much sarcasm. Is that the best you can do?

[Anarch]

Actually, I thought that was pretty good...

[ral]

So, Slart, are you on the bus or off the bus?

[a vaguely connected reference in honor of the passing of Albert Hofmann]

[Bernard Yomtov]

Perhaps the problem isn't so much with health insurance as with Ms. Giarde's "Purple Parasol" business model. If her business can't produce enough income for her to pay her bills, then she's in the wrong business.

Debate a "right to health care" all you like, but don't claim that there is a right to run an unprofitable, sub-mediocre business and then get taxpayer-extracted health insurance on top of that.

That's the way to encourage entrepreneurs. If a recession hits and your business struggles for a while you end up at risk of losing health care.

[gwangung]

That's the way to encourage entrepreneurs.

Or small businesses (who employ most Americans) in general.

The person you were replying to hasn't been paying attention. Health care for smaller businesses has been a major concern for the last several years, crippling expansion and putting the strongarm on profits.

[felix culpa]

a vaguely connected reference in honor of the passing of Albert Hofmann

Wow. 102! Has anyone suggested acid extends life expectancy?
Maybe the health-care system should look into it.
A sudden surge in people walking around with blissful grins.

Although longer life-spans would cripple said health-care systems.

Requiescat in pace, et in lux aeterna...

[Incertus(Brian)]

cleek, you're exactly right. And those are the ones most likely to use an ER as a primary care outlet. McCain's plan ignores them completely.

[Hogan]

a Guaranteed Access Plan or GAP

Wow--talk about hiding the truth in plain sight.

[SamChevre]

Well, $758 a month isn't that much more than the amount it would cost for any of the universal mandate plans ($500/month/person). I'm thinking that UHC is not the right solution here.

[cleek]

Well, $758 a month isn't that much more than the amount it would cost for any of the universal mandate plans ($500/month/person)

50% more, actually.

[Hartmut]

I currently pay 134€ per month all inclusive (I guess that's about 200 US$ but the way the greenback goes it will be more soon*) just for comparision.

*Soon the dollar will be convertible to Pound and Euro: 1 pound of dollars buys one Euro ;-)

[Noumenon]

How much of what you so blithely call "other" includes such frivolities as electricity, water, telephone service, gasoline, home and auto insurance and the like? You're saying "other" like it's all Twinkies and trips to the amusement park money we're talking about here.

My basic argument for "it can be done" is that there are lots of people who make ($32140 - $9096) = $23,000 a year. Somehow they survive without the electricity, gasoline and home insurance and other 70% of immutable expenses.
You can't adjust in a day, but when you get stricken with congestive heart failure you're going to have to adjust to a long-term decline in your standard of living.

If it costs $30,000 a year to keep healthy then if society doesn't help you it's basically leaving you to die, but if society helps enough to bring it down to $9,000 a year I don't think society has to feel guilty about not doing more.

I'm sure it will be almost impossible for us to agree on this because the world looks so different to a person like me who actually makes $30,000 and saves $10,000 of it every year, and a more normal person who has a family and would have to think hard to save 10%.

[Hartmut]

Well, there are so many people in the world that can survive on less than 1 US$ a day, so 88$ per day should be luxurious beyond imagination. Stop complaining you ungrateful money-wasters [/sarcasm eating through keyboard]

[Noumenon]

I don't see the sarcasm in that. If you can imagine not sympathizing with someone who makes $200,000 and says they can't make ends meet, then you can imagine someone who makes $1,000 not sympathizing with you.

The only thing is, even people who make $1 a day could survive on less, so I guess by my logic charging them 30 cents a day for healthcare would be reasonable.