Rationing Health Care - it's a lie!

[ddt]

As to jimbob's last quote, there's a remark I had wanted to make earlier. Ziggurat has mentioned before that there's COBRA - a law that says that health insurers have to offer the ex-employee the same insurance for some time.

However, when I look at the wiki page there are two disadvantages to COBRA. First of all, this does not apply to all employees. In fact, it says that employees of a firm under 20 employees are out of luck - that's a hell of a lot employees, as there are lots of small companies around.

Secondly, it says that only 10% of those entitled to COBRA, actually use it. When your employer has paid the premiums, and now you suddenly have to pay a couple of thousands a month, I can see a problem.

 

[Matthew Best]

Some more comments from the piece linked by jimbob

In defence of the NHS: I'm glad I didn't break my leg in the US

Our system makes it very hard to raise a family. My wife and I are about to have our second child, but my employer doesn't cover spouses or kids. Insurance for my wife and the kids will cost $350/mo at minimum and that's for a catastrophic plan that will result in high out-of-pocket co-payments, etc. We cannot afford that.

I am generally in great health. Eat well, exercise regularly, no dependence on prescription meds to keep me ticking along, but contraception costs me $70 a month, and when I found a breast lump I just read WebMd, and kept an eye on it for 9 months, hoping I could trust the internet and my own gut instincts that it wasn't cancer. A friend in a comparable position to mine got a mammogram and a sonogram and it cost over $800. That's more than I earn, before taxes, in a month!

I pay insurance of $1850 a month in the US. Once I fainted in the heat one day. I fell to the floor. I was out about a few seconds. Someone called emergency - and I am grateful for their kindness.
Later I got a bill from the fire and ambulance; emergency care with blood tests, chest x-ray two ECGs. None covered by insurance.

And finally,

Most Brits love to moan about the NHS - the waiting lists, the postcode lottery, the rationing of health care - but these ludicrous attacks have reminded many of us of how lucky we are. By forcing us to compare our creaking health system with the brutal reality of American profit-based medicine, those (mainly tories) who would like to copy the US system have been set back a decade.

 

[Ziggurat]

And if the emergency isn't immediately obviously life threatening, how are cases assessed as to whether they are life threatening?

Whether or not the emergency is life threatening is irrelevant: if it's an emergency, you cannot be denied care. Furthermore, the question of whether or not you consider such access sufficient is irrelevant: access to healthcare exists for all Americans regardless of ability to pay.

It was obvious that this comment was referring to no direct cost to the patient.

Regardless of what he meant, that is not what he said. What he said was that it was free, which is false.

There are a few other contributions in the guardian by Americans with experience of the NHS.

American healthcare is in truth already rationed

I am healthy now, yet my background means that US insurance companies can refuse to cover anything related to events that happened over 20 years ago.

This is false. If you have group insurance (ie, through your job), the insurance company can only exclude coverage for pre-existing coverage for the first 12 months, and even then, it only applies to conditions for which you sought treatment in the last 6 months, not for something that happened 20 years ago. Furthermore, if you're transferring from a group plan to an individual plan, you cannot be denied coverage for pre-existing conditions if you've maintained coverage for at least 18 months. And even if none of that applies, state laws in most states also limit the time period of exclusion of coverage for pre-existing conditions.

Medical bills are a leading cause of bankruptcy.

This too is a lie, though she probably does not know it. The studies which have claimed this are deeply flawed, and cannot show a causative link. Again, it's ironic to complain about lies being spread about the NHS when you're spreading lies about the US system.

 

[Ziggurat]

However, when I look at the wiki page there are two disadvantages to COBRA. First of all, this does not apply to all employees. In fact, it says that employees of a firm under 20 employees are out of luck - that's a hell of a lot employees, as there are lots of small companies around.

And many companies that small don't offer employee health plans in the first place. Yes, I know this.

Secondly, it says that only 10% of those entitled to COBRA, actually use it.

So? If you're jumping straight from one job with coverage to another with coverage, there's no reason to use it. A low usage rate alone tells us nothing about its disadvantages.

 

[Ziggurat]

Some more comments from the piece linked by jimbob

I am generally in great health. Eat well, exercise regularly, no dependence on prescription meds to keep me ticking along, but contraception costs me $70 a month, and when I found a breast lump I just read WebMd, and kept an eye on it for 9 months, hoping I could trust the internet and my own gut instincts that it wasn't cancer. A friend in a comparable position to mine got a mammogram and a sonogram and it cost over $800. That's more than I earn, before taxes, in a month!

This one stuck out for me. First off, contraception is a purely elective cost. One can keep from getting pregnant for free: don't have sex. And if you do have sex, well, you can get condoms for a lot less than that. So complaining about the cost of contraceptives is, well, not exactly making my heart bleed.

And secondly, if this person is making less than $800/month before taxes, then they aren't working full time. Even at McDonalds, you'll make more than that if you're full time. But even at whatever part-time sallary she's got, she could pay for most of that mammogram from the $70/month contraceptives that she didn't need to be spending for the past 9 months she was worrying about that lump.

 

[Matthew Best]

Whether or not the emergency is life threatening is irrelevant: if it's an emergency, you cannot be denied care.

What if it's not an emergency? What if you have a lump in your breast, say, and you don't know what it is? Does that count as an emergency?

 

[ddt]

And many companies that small don't offer employee health plans in the first place. Yes, I know this.



So? If you're jumping straight from one job with coverage to another with coverage, there's no reason to use it. A low usage rate alone tells us nothing about its disadvantages.

That's right, but it also mentions that "many were unable to afford the full premiums". Neither the wiki article, nor its references, mentions hard numbers, though.

For a meaningful evaluation of this all, we'd need more numbers. But COBRA is definitely not the perfect solution. (and I acknowledge we agree on the fact that tying health insurance to the job is a bad idea).

 

[Ziggurat]

What if it's not an emergency?

Like I said many posts ago, whether or not the access all Americans have is enough is a different question than whether or not all Americans have access. The claim made in that paper was that many Americans have no access. And that claim is wrong. Since the author of that claim should know it's wrong, I consider it a lie.

 

[Matthew Best]

There may be delays, frustrations and bureaucracy with the NHS, but the system delivers outstanding healthcare at no cost to the patient

This too is a lie, and a transparent one at that. There's no cost at the point of service, but there sure as hell is a cost.

No, it's not a lie. There is no cost to the patient, which is what he said. There is a cost to the taxpayer, but that's not the same thing. Calling it a lie is a stretch.

 

[DavidJames]

No, it's not a lie. There is no cost to the patient, which is what he said. There is a cost to the taxpayer, but that's not the same thing. Calling it a lie is a stretch.

The semantic nature of your argument is consistent with the semantic nature of Ziggurat's claim that everyone in the U.S. has access to health care.

I doubt he'll see it that way, however.

 

[thaiboxerken]

I think Rachel Maddow illustrates it best with this little skit, as goofy as it is.

http://www.msnbc.msn.com/id/26315908/#32469091

Republicans say they want health-care reform........but....

 

[GreyICE]

You have completely missed my argument. A drug whose price was lowered through negotiations would not be less available. But in order to get price breaks on that drug, one needs leverage, or the drug companies will not drop prices. After all, why should they, unless you have leverage against them? And the only way to get a large amount of leverage, which is what you need if you want large price cuts, is to have a credible threat of walking away from purchases. And the only way to make a credible threat is to actually, you know, walk away from some purchases. Which means some drugs will go unpurchased. But those will, rather logically, be different drugs than the ones you got a price break on. What does manufacturing costs have to do with this argument? Nothing. They appear nowhere within my argument at all.

Nonsense. They have exclusive rights on the manufacture of that drug for 20 years. You evaluate their profit level and set the price of the drug.

They will sell as many units of the drug as they can, because they want to make money. People will buy as many units of the drug as they need, because they need it.

Made up problem solved.

Why did you decide it was necessary to poison the well of this discussion with this absurd mischaracterization of my views? Why isn't such behavior beneath you?

Because you're making stuff up! Your problems are fantasy, they're based on nothing like UHC works in other countries. There's 168 countries in this world. Many, many of them have UHC. You can look at any of them to see how they actually operate! This isn't some hypothetical new system, this is a system that works in dozens of countries. None of them have these made up problem where drug manufacturers won't sell them drugs.

And instead of looking at these countries, you've decided to create made up problems that don't happen anywhere.

I'd ask if these fantasies were beneath you, but I think we know the answer to that question. My characterization, on the other hand, is looking spot on.

 

[Rolfe]

According to this logic, I couldn't possibly have got £2,000 off the price of my new Golf GTi! I was determined to buy it, and I'd made up my mind that only the Golf would do. I'd rejected the Focus ST and various other rivals, and I knew the Golf was for me. Funny, I still got £2,000 off list price over and above the scrappage deal of £2,000 I was also entitled to.

How on earth did I manage it? Remember, I was determined to have exactly that make and model of car!

Rolfe.

 

[Ziggurat]

Because you're making stuff up!

No, I am not. I am discussing what I think will happen if you try to negotiate a lower price for a drug, which was the proposed tactic for lowering drug costs in the US. Am I wrong? Possibly. Am I making things up? No, though you seem to be having a difficult time understanding what is under discussion. Even others who disagree with me seem to be able to understand what you apparently cannot. And most importantly, did anything I say even resemble the hateful things you attributed to me? No, they did not.

My characterization, on the other hand, is looking spot on.

What with me yelling "Nazi!" all the time. Sure, GreyICE, sure.

 

[Rolfe]

Ziggurat, there's no point in pontificating in a bubble about "what you think will happen if", when out there in the real actual world, it's all happening, and it isn't happening as you theorise.

Countries with universal healthcare systems pay significantly lower prices for their drugs, and they still get the drugs.

Rolfe.

 

[Ziggurat]

According to this logic, I couldn't possibly have got £2,000 off the price of my new Golf GTi! I was determined to buy it, and I'd made up my mind that only the Golf would do. I'd rejected the Focus ST and various other rivals, and I knew the Golf was for me. Funny, I still got £2,000 off list price over and above the scrappage deal of £2,000 I was also entitled to.

How on earth did I manage it? Remember, I was determined to have exactly that make and model of car!

Rolfe.

Did the dealer know this? If so, then you've worked a miracle (or there are interactions you aren't telling us about). If not, then I'm sorry, but you're simply not dealing with an equivalent situation. The dealer cannot track your individual buying history (which is probably too infrequent and variable to be of much use anyways), and so cannot distinguish between you and a potential buyer who will walk away from a purchase without a discount. So no, Rolfe, you haven't demonstrated any problems with the logic at all. Rather, you have tried to apply it blindly to an inequivalent scenario.

 

[Ziggurat]

Ziggurat, there's no point in pontificating in a bubble about "what you think will happen if", when out there in the real actual world, it's all happening, and it isn't happening as you theorise.

Countries with universal healthcare systems pay significantly lower prices for their drugs, and they still get the drugs.

Rolfe.

First off, you're wrong: those UHC systems are indeed forgoing purchases of some drugs. We've been over this already, and you even conceeded that you were wrong about the example I gave.

Secondly, do you know why DVD's have region codes on them? The reason may give you a hint about one of the big reasons for drug price differences.

 

[Rolfe]

This too is a lie, and a transparent one at that. There's no cost at the point of service, but there sure as hell is a cost.

By the way.

Can we just take it as read that British citizens know that the NHS is paid for from taxes, not the healthcare fairy godmother, and that when the word "free" is used, it means "free at point of delivery", that is at no additional cost over and above these taxes?

We don't want to go down the road of the conversation I summarised in this post here
http://www.internationalskeptics.com/forums/showthread.php?postid=4996205#post4996205
where a remark that not only do we like our healthcare in Britain, we like the fact that we pay only half of what the USA pays, was met with the assertion (from the Painter) that he only pays $60 a month for "top shelf" coverage for himself and his wife, and he couldn't believe that we paid as little as $15 each.

Some way down the road, after we'd pointed out that he pays taxes to fund Medicare and Medicaid, and his employer pays a premium that otherwise might go in his pay packet, and that he aso has co-pays and deductibles to cover, he asked us if we were retarded?? Of course he knew that, but it was irrelevant, and he only actually pays $60 a month.

After being informed that if he wanted to do the sums like that, then we in fact pay NOTHING AT ALL, he sort of went away.

Remember also, that the amount of tax we pay to fund the NHS is actually a little less that you pay just to fund Medicare and Medicaid, which you can't access. So if our taxes are more than yours, it's not because of healthcare costs.

From your point of view, yes, we do pretty much get it for free.

Rolfe.

 

[Ziggurat]

Can we just take it as read that British citizens know that the NHS is paid for from taxes

You can assume whatever you like about what British citizens know, but you still have to say what is the truth. Which is why I didn't defend your criticism of that other poster for claiming he only paid $60/month - that too was wrong.

Remember also, that the amount of tax we pay to fund the NHS is actually a little less that you pay just to fund Medicare and Medicaid, which you can't access. So if our taxes are more than yours, it's not because of healthcare costs.

I've never made that argument.

From your point of view, yes, we do pretty much get it for free.

No. You get it at relatively low cost, but you sure as hell don't get it for free.

 

[GreyICE]

No, I am not. I am discussing what I think will happen if you try to negotiate a lower price for a drug, which was the proposed tactic for lowering drug costs in the US. Am I wrong? Possibly. Am I making things up? No, though you seem to be having a difficult time understanding what is under discussion. Even others who disagree with me seem to be able to understand what you apparently cannot. And most importantly, did anything I say even resemble the hateful things you attributed to me? No, they did not.

Are you wrong? Possibly. You did have to leave out more than 3/4s of my post because you had no coherent response to the fact that what you hypothesized doesn't happen in countries with UHC, and in fact would probably work how I described, because that's what it's currently doing.

But hey, after all that, you've moved all the way to 'possibly wrong.'

What with me yelling "Nazi!" all the time. Sure, GreyICE, sure.

You don't like her? Stop sounding like her. Stop making up dystopian fantasies of how UHC might work, start looking at how UHC does work, in the UK, in France, in all those European countries, in Canada for pete's sake.

If you're going to ignore facts and refuse to think like the rest of that bleating rabble, I'm going to lump you in with them. You don't have to agree with me. But pretending people will get turned away from life-saving drugs under Obama's system just throws you in with the rest of the Death Panel crowd.