US health care question

[Palisadoes]

Watching Scrubs has accurately taught me how the medical system works in the USA.

[viper37]

I don't understand it either but Yes.

You try paying 60 000$ for Chimo.

25k, actually.

[viper37]

Our healthcare system is a complete disaster and, after spending quite a bit of time mulling it over, I'm now in favor of socialized medicine... as difficult as it is for me to say so, given my libertarian leanings.

Socialized medicine and universal health care are different beasts, imho.

In socialized medicine, the State takes in charge everything.  They hire the doctors, they decide hor much of them they want to be trained in school, they manage the hospitals from A to Z, they create multiple inneificent structures in the hospital, they create multiple infrastructure outside of the hospital to wich the hospitals must refer before acquiring any resources, they negotiate 30 different contracts for the nurses, a dozen for the janitors and other "maintenance" people, and then they raise your taxes to 60% of your wage, then still manage to have you wait 48 hrs in the ER and call this an exceptionnally good year.

With universal health care coverage, people are still free to get a private insurance if they want, go where they want, and never worry about footing the bill for chemiotherapy of their hearth disease in one 60 000$ shot.  Hospitals can still be managed by the private corporations, private health insurance can still offer their services, you can still get lobster in an hospital room instead of the god awful stuff they call "food", provided your insurance pays for it.

[Caliga]

Ok, yes, I'm using the terms interchangeably and I should not be doing that.  I am in favor of universal healthcare, but not socialized medicine as you define it.  I want to be able to get private insurance, but I think all Americans need to be covered.  It seems to me that with the current system the people who most commonly get shafted are working-class/middle-class, and since those folks do most of this country's work, that's totally unacceptable.

[garbon]

I'll be pragmatic with you. I'll support socialized medicine, as long as those with means can go above and beyond.

I  private rooms.

[The Brain]

Only insane countries don't have a private market. I live in Sweden. Much of our healthcare is operated by the government but there is also a private sector. As a resident I get the government shit that sometimes works reasonably well (although horribly inefficiently), but I also have private insurance (paid by my employer) that guarantees me quick quality care wherever I happen to be in Sweden. Note: this description is simplified for our American readers.

[CountDeMoney]

Watching Scrubs has accurately taught me how the medical system works in the USA.

Having a mother as an RN for 40 years accurately taught me, too.

Like how a cancer patient, who was totally fucking terminal, had additional and painful procedures tacked on the last two days of her life by two doctors who chatted over her about her "really good insurance".

Or, how she had to come in on a Saturday morning because another patient--who was already booked for colon surgery for a Monday morning to remove an identified and located tumor--to participate in an unnecessary upper colonoscopy because the doctor "just wanted to be sure"...and because her insurance provided for additional pre-op procedures that needed to be burned up before Monday.  Cha-ching.

Yeah, I know about US healthcare.

But what really sums it up for me is how at Insert Major Fucking Medical University and Hospital here I work for, that the schedule for the first day of orientation for new House Staff members next month provides the following morning schedule:
"Malpractice Insurance" -- 90 minutes
"HMO Billing Procedures" -- 90 minutes
"Medical Ethics" -- 30 minutes


Yeah.

[MadImmortalMan]

Discounting the obvious rattle about people waiting for treatment and all the rest, I'm curious about some of this guy's ideas. Particularly the ones about making it possible to get catastrophic coverage and HSA's. Gully? Would that actually make a decent impact? Intuitively, it sounds like catastrophic plans would make the kind of coverage healthy people really need easily available and cheap. It's also a bit odd that Whole Foods' CEO is GOP. 


http://online.wsj.com/article/SB20001424052970204251404574342170072865070.html

The Whole Foods Alternative to ObamaCare

By JOHN MACKEY

"The problem with socialism is that eventually you run out
of other people's money."

—Margaret Thatcher

With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people's money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

• Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor's Business Daily. In England, the waiting list is 1.8 million.

At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an "intrinsic right to health care"? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.

Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.
—Mr. Mackey is co-founder and CEO of Whole Foods Market Inc.

[derspiess]

Our healthcare system is a complete disaster and, after spending quite a bit of time mulling it over, I'm now in favor of socialized medicine... as difficult as it is for me to say so, given my libertarian leanings.

[derspiess]

Having a mother as an RN for 40 years accurately taught me, too.

Yeah, but it also "taught" you that all doctors are greedy morons, so...

[Ed Anger]

Whole Foods

Fuck Whole Foods. I like going in there dressed poorly and basking in the snobby stares.

[Iormlund]

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

Wouldn't this just encourage all insurance companies to drop any kind of expensive treatment from the coverage? I fail to see how this would help at all. All it would do is skyrocket bankruptcies whenever someone gets cancer, MS or any other significant problem.

[garbon]

Whole Foods

Fuck Whole Foods. I like going in there dressed poorly and basking in the snobby stares.

Whole Foods.

[MadImmortalMan]

Whole Foods

Fuck Whole Foods. I like going in there dressed poorly and basking in the snobby stares.

They are GOP. 

[DGuller]

Discounting the obvious rattle about people waiting for treatment and all the rest, I'm curious about some of this guy's ideas. Particularly the ones about making it possible to get catastrophic coverage and HSA's. Gully? Would that actually make a decent impact? Intuitively, it sounds like catastrophic plans would make the kind of coverage healthy people really need easily available and cheap. It's also a bit odd that Whole Foods' CEO is GOP. 

I could tell it came from WSJ before I even saw the link.  It's a typical Cato Institute type BS that suffers from several fatal oversights.  There should be a Guller's rule for evaluating health insurance proposals:  if someone doesn't mention "adverse selection" anywhere in their proposal, it means that he has no idea what he's talking about.  Adverse selection is the propensity in a free market for bad risks to be more likely to buy insurance, and more of it, than good risks.  It's a very bad thing, and it affects health insurance to a much greater degree than any other form of insurance, for various reasons.

This flows into two other oversights.  The first one is the attack on employer health plans and their tax-exempt status.  Employer health plans in exchange for tax exemption are not allowed to discriminate based on health or age of the employees.  That limits adverse selection, because healthy and sick people alike are covered more or less involuntarily.  If you destroy that system by removing tax exemption, you will be leaving people to buy their health insurance on their own in the individual health insurance market, which is much more succeptible to adverse selection.

The second oversight is about the sick people.  How are the people with medical conditions supposed to get covered?  Health insurance companies don't like being adversely selected against, so they underwrite very vigorously to avoid insuring sick people.  They also tend to do very ethically-questionable things like canceling the coverage retroactively, if you happen to have a large medical claim after getting your insurance, and it then turns out that you didn't dot one of the i's on the application form.  That guy has no propsals for insuers of last resort or anything of that nature.

And the last thing is about letting people buy insurance across state lines.  In many ways regulation of insurance by individual states is highly inefficient.  However, letting people just shop across the state lines would make this problem even worse, because then companies would just find a state whose insurance department has the least regulations and consumer protections.  It's another idea that appeals to people who don't really know what they're talking about.  I do think that there is great merit in federal regulation of health insurance, because there does need to be one uniform regulatory system, just not the one that was a result of the race to the bottom.

In short, this guy doesn't propose anyting ground-breaking.  He's merely reiterating the Republican line on health insurance, and one that just can't survive informed scrutiny.