Stossel Solves the Health Crisis with Capitalism

[Blue Mountain]

Yes, you can shop around for health insurance in the same manner you shop around for car insurance or house insurance, if you have the option or desire to do so.

And you can get screwed:
http://seattletimes.nwsource.com/html/health/2004247661_mega28m.html
Synopsis: Family left heavily in debt after the 11 year old son of a self-employed man ends up in hospital for appendicitis. Father did not realise the health insurance he had purchased was woefully inadequate.

That simply cannot happen in Canada or Europe. Why does it have to happen in the States?

But, at the same time, Emergency Room treatment (and mental health treatment and drug rehab and teen angst depression treatment, et al) is covered in all relevant policies - and by Congressional mandate. Or didn't you know that obvious fact?

Emergency room treatment is to healthcare as the pumpers at a burning house is to fire prevention.

 

[themusicteacher]

From what I've heard, American's spend more money and a higher %-age of their income on healthcare than any other developed country and get some of the worst healthcare. I'm inclined to agree with what oggiesnr had to say about prevention and "unsexy" long-term care. The biggest problem with the American healthcare industry is just that: it's an "industry." It's driven mainly by profits, not by what is best for patients. I am so sick of hearing how the "free Market" will solve everything as if it's a magic bullet. Modern American capitalism has created a race to the bottom and that includes healthcare. The question for these companies has become, "How can we, as a business, ensure that we make the maximum profit?" The answer, of course, is, "Charge as much as we feel like, collude with drug companies, put profits over patients and generally be a bunch of douchebags." Healthcare companies, and John Stossel, can suck it. Ideology over reality, John; keep the faith.

 

[balrog666]

Uh, we're not talking about shopping around for health insurance; we're talking about shopping around for health care.

As far as getting the best prices on the former, all things being considered, the larger the insurer and the more insured, the cheaper the prices, as insurance is all about spreading risk. Eliminating redundancy also obviously saves resources in the insurance industry. Hence, single-payer.


You're lost, bra. People already shop around for health insurance, and that obviously doesn't reduce prices.

Wrong on both counts. Again.

 

[Free Thinkr]

Wrong on both counts. Again.

Compelling argument.

 

[oggiesnr]

Hey folks, I've got some bad news for one of you. You need very complicated, life saving heart surgery. The good news is I've got a dozen quotes in, most of them about the same but there's one that's less than half the price of the others so I've booked you in with him. Not sure what his facilities or success rate are like but it's going to save you a bundle. That OK with you?

Steve

 

[Rolfe]

So are you saying that people in UHC shouldn't expect to have the best care, just so long as they have some care for the cheapest price?

And that is in the US. So if the best care in the world is here already, we just have to figure out how to make it cheaper, right?

I certainly don't expect "not to get the best care". I expect to get the care that I need, and I expect it to be of a high standard, because experience of the NHS indicates to me that this is what is on offer.

Can I show you again the press report of the little girl who had the heart transplant a year ago? Abigail's new heart. Can you really declare that this child just got "some care for the cheapest price"? What more could she have received if she'd been a US citizen?

However, if you're a mega-rich celebrity, and you want to be pampered and served 5-star food then yeah, go to the US for your treatment. It's obvious why. In the US, the healthcare "experience" you get is very much related to how much money you have. So if you've got a great deal of money, then it's the obvious place to go to be able to continue to be pampered in the manner to which you are accustomed. I don't really see that the fact mega-rich people choose to do this is evidence that the actual care on offer is significantly superior.

To go back to your car analogy, your "best care" is perhaps the equivalent of a Rolls Royce or an Aston Martin. You're rejecting the proposition that everybody can have a Ford Focus (say), and instead suggesting that the free market will somehow, magically, bring the price of the Rolls Royce and the asston Martin down to where even those on the minimum wage will be able to afford them.

I don't think it works like that.

Rolfe.

 

[Rolfe]

And that is in the US. So if the best care in the world is here already, we just have to figure out how to make it cheaper, right?

Well, think about it. You just have to figure out how to make a quadruple bypass, or removal of a brain tumour, or chemotherapy for Hodgkins disease, or a heart transplant, "cheaper". And not just a little bit cheaper, but cheap enough so that even someone on the minimum wage, or who is retired, or who is unable to work because of illness/disability, can afford it. Realistically, that is while still being able to eat and keep a roof over their head, and keep paying for the follow-up care and treatments that they need.

I honestly can't see how you can even begin to imagine that this is possible. This isn't cans of beans. Hospitals cost money. Equipment costs money. Staff cost money. Highly trained and educated staff cost a lot of money. Seriously ill patients need a lot of staff time expended on them. And there are corners that you cannot cut and should not be allowed to cut, for reasons of safety. And indeed, you yourself have assumed that corners will not be cut, because you want everyone to get "the best care in the world".

Just how are you going to make that heart surgery affordable by the woman who has just enough in her budget to make sure her children don't go hungry?

Rolfe.

 

[volatile]

Just how are you going to make that heart surgery affordable by the woman who has just enough in her budget to make sure her children don't go hungry?

Rolfe.

Which is, lest I remind him (though he says he has me on ignore), somewhere between 12 and 17% or the US population at any one time (and over half of Americans will be in that group for at least one year of their lives). 10% of the population apparently are so poor for at least one month a year that they can't even afford food:

"Eighty-nine percent of American households were food secure throughout the entire year 2002, meaning that they had access, at all times, to enough food for an active, healthy life for all household members. The remaining households were food insecure at least some time during that year."

(http://en.wikipedia.org/wiki/Poverty_in_the_United_States)

 

[Toke]

Which is, lest I remind him (though he says he has me on ignore), somewhere between 12 and 17% or the US population at any one time (and over half of Americans will be in that group for at least one year of their lives). 10% of the population apparently are so poor for at least one month a year that they can't even afford food:

"Eighty-nine percent of American households were food secure throughout the entire year 2002, meaning that they had access, at all times, to enough food for an active, healthy life for all household members. The remaining households were food insecure at least some time during that year."

(http://en.wikipedia.org/wiki/Poverty..._United_States)

You should not ignore this.

 

[Rolfe]

I'm trying to watch this TV show that has impressed Dan so much. So far I've watched the first segment. It's an exploration of the flaws in the idea of having health insurance tied to your job. Why should you access healthcare through your job? How much does this tie people to jobs they'd rather move on from? Why does General Motors spend more on healthcare insurance than it does on steel?

It goes on to show one woman's plight in detail. She gave up a job with good health insurance because she wanted to take the opportunity of diong better with a change in career. She bought "temporary" insurance to cover her while she shopped around for the best deal on a permanent policy. During that period, she contracted breast cancer.

The temporary insurance was for a fixed period only. When that period came to an end she was unable to find a policy she could afford, because she now had the pre-existing condition of breast cancer. The segment ends with her in tears, contemplating a bleak future. My heart goes out to her. It's difficult to call it without knowing the exact oncological diagnosis, but I think it's likely she'll die fairly soon because she's skimping on follow-up care.

Now single anecdotes do not make general principles. However they can illustrate them, and this seems to be a good illustration of a serious flaw in the present system. So far, I'm not disagreeing with the sentiments expressed. Any system that has the potential to do that to a citizen, is broken.

On to the next segment.

Rolfe.

 

[Darat]

KellyB, what was really scary for me was seeing a Canadian man who was having a heart attack waiting for an available bed.
...snip...

So this never happens in the USA system?

It was also pretty scary for the woman on the show who's doctors told here she had to wait months for "elective" surgery that ended up almost killing her. Luckily she made it to the doctors in the US who were able to treat her and BTW said if she would have waited any longer she'd be dead. She wasn't upset at the cost though. She was just fine with being alive.

And what would have happened if she was a USA citizen who simply didn't have the money to pay for the treatment?

 

[Darat]

So if our healthcare is so bad, why did the people from other countries (famous Italian singer, Jordans pres, etc) choose to come here instead of their current system?

...snip...

Because they have a lot of money? How many people in the US could have afforded those treatments?

 

[Rolfe]

The second segment starts with another horror story relating to a person with insurance. The man took out a health insurance policy, and two weeks later noticed a swelling on his leg. He was diagnosed with a liposarcoma. The insurance company paid for some initial treatment, but then sent him a letter cancelling his insurance. They alleged that he had known or suspected he had the cancer at the time he took out the policy, and had therefore lied in the parts of the application document when he said he didn't have any pre-existing conditions. He's facing bankruptcy, having been left with bills of over $200,000.

The film goes on to discuss the incentive the insurance companies have to deny insured people treatment in order to keep their outgoings down (and thus presumably their premiums competitive and/or their corporate profits healthy). The presenter goes to interview the insurance industry about that.

The insurance executive interviewed is pretty complacent. Most people have their claims paid just fine. Only 3% of claims are denied. She then goes on to explain sweetly how her company can't possibly take on the woman with the breast cancer because it would cause the premiums for everyine else to go up. Perfectly rational business decision. There is also evidence presented that the man with the liposarcoma might indeed have lied on his insurance application form, but this isn't pursued further.

Next, evidence of presented of the high cost of insurance management to the healthcare system. One doctor is reported as employing FOUR people just to do the paperwork to keep track of insurance claims. It is also stated that on average it costs doctors 14% of their income plus a lot of time (that could otherwise be spent on patients) to administer insurance claims.

So far, I'm totally with the broadcast. It's describing a system I find completely horrendous, extremely wasteful and fundamentally uncaring.

But then, the presenter goes completely off at a tangent. He shows a doctor saying how patients demand procedures that are not indicated just because the insurance company is paying for it. This segment takes a few seconds, and is not explored at all.

Now this is where I would challenge the presentation. One doctor is claiming this. ONE doctor. Unchallenged. So far, there has been no return to the insurance company to ask how come the company is prepared to pay for procedures the doctor thinks are unnecessary. This is completely at variance not only with everything I've ever heard about the US health insurance system, but with everything I know from the pet health insurance system. Where is the exploration of the far more prevalent abuse, that of the doctor (OK, the vet) who recommends procedures that are not exactly essential, because he'll make money out of it?? Or even the incentive for the doctor to order unnecessary procedures because he's afraid the patient might come back and sue him if he doesn't cover even the most remote and unlikely possibilities?

These are the inflationary pressures that really make the difference in healthcare insurance costs. But they didn't even get a mention. Instead, we're simply told that it's all down to patients who want to buy everything that's on offer, because they're not picking up the bill.

What??? Which planet is this guy on?

He now proceeds to use this extremely shaky and entirely unresearched position as the jumping off point for his next concept, that of food insurance. Oh, if an insurance company was paying, we'd all just buy the smoked salmon and the caviare and not budget for what we could afford. And the supermarkets could put their prices up as high as they liked. If our car insurance paid for the petrol and the serivces, we'd have mechanics charging $100 for an oil change, and everyone would drive with no thought for fuel economy.

False analogies, anyone? This is a leap of complete nonsense. There is nothing in this ridiculous concept of "food insurance" that is at all comparable to health insurance, and the analogy is not illuminating in any way that I can see. He's simply using his very questionable assertion that insured patients demand (and get) procedures that they don't need to build one of the most astonishing straw men I've seen in a long time.

Well, maybe it will make more sense if I watch a bit more of it.

Rolfe.

 

[Darat]

Want to bet?

 

[Francesca R]

And that is in the US. So if the best care in the world is here already, we just have to figure out how to make it cheaper, right?

So the best cars in the world are already made in Italy; we just have to figure out how to make Ferraris cheap enough so that everyone can buy one.

 

[Darat]

DaN K. StAnLeY - I've watched the video and saw nothing that changed my mind. One thing I did wonder about is why do you put up with a system in which your employer pretty much dictates what health care you get? What's it got to do with them!?

 

[Porkpie Hat]

I just re-watched a couple of the segments from Stossel’s show and can’t help but be totally blown away by the ignorance of SOME Americans when it comes to healthcare. He’s advocating a capitalist approach to making healthcare affordable to all citizens by simply shopping around the same way we do for chicken wings and big screen TV’s.

While watching this I was thinking about my step-brother-in-law in west Texas who has 4 kids under the age of 10. He’s always been a hard worker but most of the jobs he’s had didn’t offer decent healthcare benefits. His family has no healthcare right now because his back is screwed due to years of hard labour. Stossel’s approach would work if one of the kids had a skinned knee or bloody lip but what about childhood lymphoma? Should this guy move his family to Abilene and find a low paying job with benefits? Would a low paying job offer the benefits necessary to cover things like cancer or organ replacement if one of his kids got really sick? How does the average American who is against UHC view people like my step-BIL? Is he just not ambitious enough?

I was also thinking back to when my wife and I got together. We met on vacation; fell in lust which eventually led to love. She was living in Colorado at the time and had a good job with great benefits. The company she worked for was bought up by some corporation and she was layed off. At first she wasn’t worried but as time went by I remember her telling me that her Cobra was about to run out leaving her uninsured. This was a totally foreign concept to me. How can you live in such a rich country and be without health insurance?

At the time I had already proposed and she had accepted. The only question was logistical. Where were we going to live? Healthcare determined we would live in Canada. She put her belongings in storage, got on a plane to Calgary and a week later we were married (a week after that I had her covered by Alberta Healthcare). Now we’re thinking of moving to the US but every conversation leads to the same brick wall...healthcare.

 

[Rolfe]

Third segment. He now moves on to critique universal healthcare systems. Free is good, right?

We start with footage of free giveaways of ice cream, petrol and beef. Hey, people are queueing! Nobody is just walking up to an empty table and getting the freebie. Well, duh. The fact that the lines seem to be moving pretty fast and the people are cheerful and happy to be getting the freebie and soon walk off with what they wanted isn't remarked on. No, how awful, there was a bit of a queue (which in this case inconvenienced nobody).

Making it free increases demand.

No kidding, Sherlock!

Now we have the first example from my own experience, and I KNOW the presenter is either deliberately lying, or so desperate to make his point that he hasn't bothered to find out what he's actually showing. (Reminds me of the pro-gun film in the USA which showed the Countryside Alliance protesting about the ban on fox hunting, and claimed it was a protest against a firearms ban. In fact it was quite the opposite - the protestors were objecting to being told that they must shoot the foxes with guns instead of chasing them with dogs, because the gun was more humane.)

This present example is very similar, as has been touched on by others already. The queues shown are not for a dentist's appointment. The presenter is either lying or woefully misinformed. The queues (which only happened in a few places) were the result of the government getting a healthcare calculation wrong. They set the remuneration system for NHS dentists too low, with the result that many dentists simply left the NHS and set up in private practice. If you had the money, there were dentists and to spare, ready to see you tomorrow.

But people didn't want to pay the dentists to treat them privately - many couldn't afford the fees at all. They wanted access to NHS dentistry. They were queuing to register with one of the few dentists in the area who was still prepared to take NHS patients, and who was overwhelmed.

As I said, it was a miscalculation by the government. And a nice example of how the free market still operates even where there is a universal healthcare system. But it has nothing whatsoever to do with the point the presenter is trying to make. It merely shows that even where there is ample availability of privately-paid-for treatment, people are still prepared to queue up to register to access the universal system.

This blatant misrepresentation by the programme makes me very wary indeed of the entire thing.

He now goes on to show protests by doctors in mainland Europe complaining that they aren't being paid enough. I'm struggling to see how this is relevant to the eventual aim, which seems to be to suggest ways to bring down US healthcare costs. So he's going to do that while still allowing the doctors to set their own remuneration?

And now he's back on the wait times. One case is presented of a woman expecting quadruplets in Canada who went to the US to give birth because of a shortage of neonatal cots. But there's simply not enough detail given to know how compelled she really was to do that. He's got hold of one Canadian doctor who thinks Canadian wait times are excessive. One guy. No exploration of how the wait times are managed, of whether the really urgent cases get put to the front while the less urgent ones wait a bit longer, no exploration of whether it might be better to wait a few weeks and get the treatment "free as the air" or to be in the position of the woman at the beginning with the breast cancer....

It's stated that Canadians like their system, but then there seems to be a big search for stressed doctors and people waiting. The heart attack guy who is getting treatment, but who hasn't yet been transferred to intensive care. People unable to get on to GPs' lists. What I'm not seeing is an acknowledgement that these people are actually being treated.

The rest of the segment concentrates on finding problems in Canada. I recognise that Canada's system does have particular problems. So how about asking how long patients in France have to wait? Oops, no, don't ask that. Because France is well-known for not having waiting lists. Or even in Britain. Yes, there are waiting lists, but they're less than they used to be because pressure was put n the government to do something. And examination of overall times is misleading anyway, because it's routine to bump those with the urgent need to the top of the queue. But I see no balanced assessment of how severe the wait problem generally is in a range of universal healthcare sytems, or any discussion of whether people might prefer to wait a few weeks for a non-urgent procedure when they know they will get it done and they won't have to pay for it, rather than go down the US route.

This programme has an agenda, maybe it will become clearer later what that actually is.

Rolfe.

 

[Porkpie Hat]

So this never happens in the USA system?

I still don't see whats so scary about waiting for a bed!

The man was treated then was waiting for a permanent bed...not left in a hallway to die from a heart attack.

 

[Rolfe]

Hmmmm. Part 4. Serious conflation of two issues. He starts by remarking on the criticism of the profit motive in healthcare. At this point my hackles tend to go up a little, because hey, nobody spends five years in medical school and then however many more years in speciality training to earn the minimum wage. If you pay peanuts for your doctors, you'll get monkeys. Something most universal healthcare systems understand, and it was noted on another thread that British GPs earn slightly more than US doctors doing the equivalent job.

But no, the profits being criticised are those of the insurance companies. Yes, I think there's mileage there.... Oh no, we're back to doctors' profits, and the profit incentive to innovate and bring down prices.

Innovative doctors will be denied the incentive to innovate if they can't profit from it. [Is there a hair-tearing-out smilie?] The better a doctor you are in a universal system, the better a job you will get, and the higher a salary you will command. (Also, the better a private practice you will be able to run, by the way.) Research projects don't just dry up in a universal system, but he's just implied that they do! What's he smoking?

And we're back on the completely inappropriate analogies. Private enterprise made cars cheaper and better. And mobile phones. This is relevant how, exactly? By this analogy, the USA should be so far ahead of any other first-world country that we'd all be clamouring to know how they were doing it. After all, doctors there have the profit motive all free and clear right now. But really, there's no clear lead in US healthcare as far as innovations go, not beyond what you'd expect of the biggest and richest country in the world. Maybe we need to mention Abigail's Berlin Heart again - surely, two countries with universal healthcare systems can't innovate in the way this case seems to demonstrate - but hey, they did.

Oh, hey, another invalid leap of subject. He's moved on to pharmaceutical innovation. We need these companies to be able to make profits in order to motivate them to produce new drugs. Er, yes. And did anyone suggest stopping that? Did anyone suggest nationalising drug companies? Not that I noticed. How it works, Mr. Stossel, is that drug companies innovate for profit, and then the universal healthcare systems buy the drugs from them. Kinda simple when you think about it. And you know why drug companies just LOVE universal healthcare systems and lobby to have their products approved by them? Because in a universal system all the patients who can benefit from the drug will get it.

Maybe he's going to point that out?

No.

We just moved on to the non-sequitur that people who are very rich and very privileged and very pampered like to come to the USA to pay to be pampered when they are sick. Which does precisely zero to help the US citizens who don't have access to that Rolls-Royce treatment.

And finished by again observing that private companies have produced a lot of healthcare innovation - without the slightest acknowledgement that these private companies operate in countries with universal systems in just the same way as they do in the USA. Nobody nationalises drug companies.

Sigh. This is dishonest, cherrypicking junk journalism.

Rolfe.