Health care - administrative incompetence

[Garrison0fMars]

Vermont doesn't seem to be looking to be able to opt out of Medicare/Medicaid, either.
Hmmm...
I don't know what to think, I guess. I wish them luck, tho. I don't see it being a step in the wrong direction.

Well, a true single payer system would probably be impossible on a state level, since there'd still be Medicare, Medicaid (Vermont could technically drop out of that program and cover the poor through their single payer system, but they may lose needed federal funds in the process), and the VA to contend with. But a system where everyone else is covered by whatever single payer insurance system they devise will probably be a lot better than what they currently have. Vermont is an interesting place, where most are insured (around 90%), unlike other states like California which have a very large uninsured population. Because so, they actually tend to be more amendable to reforms like single payer, because while most of them do have insurance, they still have to pay through the nose with increased premiums, co pays, and deductibles, rising every year. They see it as a cost control measure, rather than an egalitarian reform. I do think though, any serious health reform will have to start on the state level, rather than the federal level, and hopefully spread through some sort of domino effect. I'm personally very excited about what's going on in Vermont.

 

[Ducky]

A freer market will reduce costs overall.

The sad fact is that MM is a niche market, if you want to use those terms. It's pretty rare and it's going to cost a lot to treat it no matter what. What would have helped Ducky (and might help him now) is the new law which says insurers can't discriminate based on pre-existing conditions. I wonder if he's applied for disability? Once you have that going, you can get Medicare. The current system is far from perfect, but there are ways to get help -very few people are totally screwed.

And you seem to be ok with them being screwed.

What's this "apply for disability" tact? Wouldn't that be the dreaded welfare you're so disdainful of?

I wouldn't get it anyway, I make too much at a job that provides private care (that is screwing me anyway) and I have full mobility thanks to my spine being rebuilt the way it was.

Side note: If you hadn't guessed, my avatar is directly taken from an MRI after the surgery.

 

[Garrison0fMars]

What's this "apply for disability" tact? Wouldn't that be the dreaded welfare you're so disdainful of?

I'd like to point out xjx388 isn't totally accurate when he says people on disability can get on Medicare. It's true that people who are permanently disabled can get on Medicare, after two years of being classified as such. In the meantime you have to contend with Medicaid, which is usually markedly inferior (though it varies between states). That's also after the two years (often takes that long) of fighting the social security administration over whether you're really "disabled" or not. So, yes, maybe in 4 years you can get on Medicare, if you're not dead by then.

 

[kellyb]

Being in a prime position as both a UK and US citizen, I think I am qualified to explain.

After WWII, the US (and the UK too for that matter) was forced to compete in the Ideological Marketplace. The Right Wing screamed and hollered about Socialism, but Keynesian economics was adopted by the more reasonable of the ruling classes.

Federal Taxes on the highest income earners (like millionaires) was roughly 90%. Taxes on unearned income, i.e. profits (which was how most of the Rich actually made their money) was much higher too. Then the Corporations, eager to show what great citizens they were offered excellent benefits packages to their workers. The Veterans Administration paid for the education of all the soldiers returning from war (the GI bill). Unions were at their peak. Thus a large percentage of the US public shifted into the middle class.

Then came Ronnie in the US and Maggie in the UK. And they weren't having any more of this "coddling" of the populace. They Smashed Unions, cut tax rates on the Wealthy, slashed public services (harder to do in the UK), Corporations cut benefits packages...Keynesian economics was on the way out.

The propaganda machine went into high gear promoting hyper-individualism, and anti-government BS (see Century of the Self, an excellent BBC production). This had all been around to some degree through most of the 20th century, but it kicked into overdrive in the 1980s. And it's been downhill ever since.

The Plutocrats had always been in charge, but, as I implied, the more reasonable wing of the Rich had been ascendant since FDR, and started declining after the assassinations of political leaders in the 1960s. But it still took a couple of decades for the Ultra Right to wrest nearly complete control of the government and to institute a new paradigm.

After Ronnie and Maggie, the fix was in. Any Democratic candidate in the US and any Labour candidate in the UK were forced to cede the ideological ground. Thus the "Third Wayers" like Clinton and Blair were able to get elected by promising progressivism to their base, but in practice continuing the Rightward trends in flattening tax-rates and underfunding public services.

The rest is recent history. Bush the II and the Cabal of so-called "neo-conservatives" (nothing "neo" about them, most of these guys have been high up on the scene since the Nixon years) deliberately ran the economy into the ground and created a Market Crash, just in time for the election of the New Clinton, Barack Obama. Thus the Economic Ideology train runs ever Rightward, even as some ground is begrudgingly ceded on social issues.

The idea of Medicare for all, or some kind of NHS like system was never on the table during the health-care debates. So Barry and his buddies started off the debate from a compromised position: the so-called public option to compete in the market with private insurers.

This was called Socialism/Fascism/Hitlerian/and Stalinism by the Right Wing Screamers, who then organized a campaign of warfare, sending out belligerent activists to disrupt health-care meetings, and Armed Thugs to intimidate Health Care Rallies. The party of NOPE and a few Right Wing Democrats, filibustered everything in the Senate until the Public Option was dead. (Along the way a Right Wing Supreme Court stripped away the remnants of constraints on Corporate election spending).

All that was left was a tentative and mild insurance "reform" package with an Individual Mandate to force people to buy Private For Profit Insurance. This was a windfall for the Insurance Companies looking for more people to fleece. Then the midterms happened. Democrats lost the House, and the Republicans promised to eviscerate any of the good parts of the Insurance Reform bill and make Barry a one term president (to be a lesson to the more Progressive wing of the Democratic Party for ever having the "Audacity to Hope."

The End (of Democracy as we know it)

GB

I'm a sad leftist, like you. I feel like I was fooled by Obama.

But isn't there an upside? Isn't there more dialogue happening now? Sure, Obama was a fraud, but that base is now strong and coherent. A MAJORITY voted for "fake Obama". That means the majority wants real UHC, for SS to be preserved if not strengthened, etc.
The Obama treason is just a battle in a longer war, I think. And I don't think over 50% of the US population is really that unreasonable.
In a nutshell, don't lose hope.
And to you in Europe, where your bankers and politicians are also screwing you, too, don't lose hope! We are all still DEMOCRACIES and we can fix this mess.

 

[Garrison0fMars]

That means the majority wants real UHC, for SS to be preserved if not strengthened, etc.

This is true.

Bloomberg National Poll
POLL: 59% Of Those In Favor Of Repeal Want Congress To Pursue The Public Option
Over half of Americans want non-profit national health insurance

Poll: Fix Social Security by Taxing Wealthy
Bloomberg National Poll

The Obama treason is just a battle in a longer war, I think. And I don't think over 50% of the US population is really that unreasonable.

Agreed. They're just apathetic. They need to be taught there's a lot more choices and possible actions than they are "offered" to take to address their grievances. Funnily enough, the only state actively designing a universal health system happens to be one with an independent progressive movement (The Vermont Progressive Party) elected to their legislature and actively pressuring the ruling party (Democrats) to adopt such a measure. Leaves some food for thought, and some hope.

 

[Fiona]

Being in a prime position as both a UK and US citizen, I think I am qualified to explain.

After WWII, the US (and the UK too for that matter) was forced to compete in the Ideological Marketplace. The Right Wing screamed and hollered about Socialism, but Keynesian economics was adopted by the more reasonable of the ruling classes.

Federal Taxes on the highest income earners (like millionaires) was roughly 90%. Taxes on unearned income, i.e. profits (which was how most of the Rich actually made their money) was much higher too. Then the Corporations, eager to show what great citizens they were offered excellent benefits packages to their workers. The Veterans Administration paid for the education of all the soldiers returning from war (the GI bill). Unions were at their peak. Thus a large percentage of the US public shifted into the middle class.

Then came Ronnie in the US and Maggie in the UK. And they weren't having any more of this "coddling" of the populace. They Smashed Unions, cut tax rates on the Wealthy, slashed public services (harder to do in the UK), Corporations cut benefits packages...Keynesian economics was on the way out.

The propaganda machine went into high gear promoting hyper-individualism, and anti-government BS (see Century of the Self, an excellent BBC production). This had all been around to some degree through most of the 20th century, but it kicked into overdrive in the 1980s. And it's been downhill ever since.

The Plutocrats had always been in charge, but, as I implied, the more reasonable wing of the Rich had been ascendant since FDR, and started declining after the assassinations of political leaders in the 1960s. But it still took a couple of decades for the Ultra Right to wrest nearly complete control of the government and to institute a new paradigm.

After Ronnie and Maggie, the fix was in. Any Democratic candidate in the US and any Labour candidate in the UK were forced to cede the ideological ground. Thus the "Third Wayers" like Clinton and Blair were able to get elected by promising progressivism to their base, but in practice continuing the Rightward trends in flattening tax-rates and underfunding public services.

The rest is recent history. Bush the II and the Cabal of so-called "neo-conservatives" (nothing "neo" about them, most of these guys have been high up on the scene since the Nixon years) deliberately ran the economy into the ground and created a Market Crash, just in time for the election of the New Clinton, Barack Obama. Thus the Economic Ideology train runs ever Rightward, even as some ground is begrudgingly ceded on social issues.

The idea of Medicare for all, or some kind of NHS like system was never on the table during the health-care debates. So Barry and his buddies started off the debate from a compromised position: the so-called public option to compete in the market with private insurers.

This was called Socialism/Fascism/Hitlerian/and Stalinism by the Right Wing Screamers, who then organized a campaign of warfare, sending out belligerent activists to disrupt health-care meetings, and Armed Thugs to intimidate Health Care Rallies. The party of NOPE and a few Right Wing Democrats, filibustered everything in the Senate until the Public Option was dead. (Along the way a Right Wing Supreme Court stripped away the remnants of constraints on Corporate election spending).

All that was left was a tentative and mild insurance "reform" package with an Individual Mandate to force people to buy Private For Profit Insurance. This was a windfall for the Insurance Companies looking for more people to fleece. Then the midterms happened. Democrats lost the House, and the Republicans promised to eviscerate any of the good parts of the Insurance Reform bill and make Barry a one term president (to be a lesson to the more Progressive wing of the Democratic Party for ever having the "Audacity to Hope."

The End (of Democracy as we know it)

GB

Your analysis is much like my own and I agree with most of what you say. However I am not comfortable with the description of what happened after the war as competition in a market of ideologies (though I can see why that is an attractive shorthand).

For me the roots of the right wing retreat were in the outcomes of that ideology in the 1930's. The peoples of europe and america paid that price and they did not forget after they came back from the war: they decided they did not wish to pay again. In face of that the right made concessions and we had a post war concensus during which a compromise system was established under which the super rich maintained a very privileged position but the inequalities were somewhat reduced in order to achieve a better standard for all. The aim of reducing inequality was open and most people understood that it produced better outcomes for most.

That persisted for a couple of generations: but as ever, people take for granted the gains they enjoy and they come to forget how and why those gains were achieved. Naturally enough they stop being grateful for what they have and they start to focus on the imperfections and seek ways to improve their situation. Nothing wrong with that so long as you understand the situation as it was before the changes were made and remember that that situation can re-emerge: people have not changed and their interests have not changed. But people do not remember that, because if you have always had a reasonable life style it is easy to persuade you that this is natural.

It seems to me that this is a cycle: the right retreat when they must and advance when they can: and the rhetoric which underpins the advance changes at each cycle: but the ideology remains the same. In short those who are very rich and powerful genuinely do not have the same interests as most of us.

I agree that the right became resurgent in the Reagan/Thatcher years and that the move towards the current situation has been ruthlessly pursued since that time. This is not surprising. With much greater control of information; and with the ability to exploit cosmetic discontent and to characterise it as evidence of a fundamental flaw in the way things are organised, they can persuade many to misunderstand where their own interests lie. Thatcher was quite open in what she wished to achieve: Victorian values. I do not know if Reagan was so open but in any case they were both mouthpieces for the plutocratic interest and they were personally irrelevant (though I will still dance on her grave). It is no accident that both were rather stupid and rather one dimensional figures. Cometh the hour, cometh the selfish moron.

It is no use saying that the plutocracy has done this to the people: we are complicit, in that we have allowed the limits of debate to be set very narrow; and we have indeed voted for this. The current economic debacle is not an accident: it is an inevitable outcome of these policies. Some of the right do not understand this: but some do, I think. They are exploiting it to further the agenda as well, so the "solution" is more of the same stuff which got us into the mess in the first place.

There is nothing new about the neo-cons, as you rightly say. They are old fashioned laissez faire capitalists: we saw them in the 19th century and we saw them in the 1920's. We see them again in their new emperors clothes, but we do not have the little boy yet.

We better get one soon: because this road leads to war, I fear

 

[jimbob]

How? How is "a more free market" going to significantly bring down the cost of Ducky's surgery/treatment without turning that sort of high-tech treatment into a niche market product?

PLEASE explain this to me.

A freer market will reduce costs overall.

The sad fact is that MM is a niche market, if you want to use those terms. It's pretty rare and it's going to cost a lot to treat it no matter what. What would have helped Ducky (and might help him now) is the new law which says insurers can't discriminate based on pre-existing conditions. I wonder if he's applied for disability? Once you have that going, you can get Medicare. The current system is far from perfect, but there are ways to get help -very few people are totally screwed.

Ducky's specific treatment might be niche, but there are lots of other high-tech treatments that are also needed.

The biggest costs will be the cost of the highly-skilled labour, the amortisation of capital equipment and the cost of courses of new non-generic drugs.

You want doctors to be paid more, which doesn't square with your stated desire for a free market.

Medical equipment is a global market, and such equipment is expensive because it required a lot of investment to research and make, and it (rightly) also has to meet stringent governmental and non-governmental quality standards. Altering the US system could only have a marginal effect on this. The hospital infrastructure will also be expensive to build, and this is not going to reduce under a free market for healthcare.

There might be some scope for reduction in the price of drugs.

There is scope to reduce what my calculations did not include - the 30%-35% administrative overhead.

However that still leaves high tech treatment unavailable to all except the rich under your unclearly-espoused model.

I don't think you are aware how much richer you are compared to large numbers of US citizens. Multiple times I have posted data showing that the median net worth of renting households in 2004 was $4k. How useful is that going to be to pay for a course of treatment?

I have also posted data that shows that 75% of medical bankruptcies in the US had medical insurance at the start of the illness. Insurance often doesn't work.

I have posted examples where insurance companies refused treatment on spurious grounds, because it reduced their costs. Insurance often doesn't work.

 

[kellyb]

And you seem to be ok with them being screwed.

What's this "apply for disability" tact? Wouldn't that be the dreaded welfare you're so disdainful of?

I wouldn't get it anyway, I make too much at a job that provides private care (that is screwing me anyway) and I have full mobility thanks to my spine being rebuilt the way it was.

Side note: If you hadn't guessed, my avatar is directly taken from an MRI after the surgery.

You're really the most horrible kind of Moocher, Ducky; unwilling to become part of the permanent underclass we as a collective nation now need to scorn since we got rid of "old welfare".

Full mobility and good employment at a price of a f***ing MILLION dollars to the rest of us? Who, exactly, do you think you are? And the only thing you have to suffer now (besides the whole "excruciating pain" thing, and "fear of imminent death" thing, but you plebs deal with that well, so it doesn't really count) is ungodly debt and a PITA insurance company?

How do you even sleep at night, knowing what you've done to us?

 

[Ducky]

I'd like to point out xjx388 isn't totally accurate when he says people on disability can get on Medicare. It's true that people who are permanently disabled can get on Medicare, after two years of being classified as such. In the meantime you have to contend with Medicaid, which is usually markedly inferior (though it varies between states). That's also after the two years (often takes that long) of fighting the social security administration over whether you're really "disabled" or not. So, yes, maybe in 4 years you can get on Medicare, if you're not dead by then.

I would also point out the social relief healthcare program I dealt with (MinnCare) screwed me heartily based on me having to have an income of less than 500 a month. That's a very small fraction of my paychecks and doesn't cover rent, let alone food or other bills. It also was not a program designed for long term use, as they passed people off after 6 months to a private insurer (which, again, dropped coverage for spurious reasons.)

 

[Garrison0fMars]

I would also point out the social relief healthcare program I dealt with (MinnCare) screwed me heartily based on me having to have an income of less than 500 a month. That's a very small fraction of my paychecks and doesn't cover rent, let alone food or other bills. It also was not a program designed for long term use, as they passed people off after 6 months to a private insurer (which, again, dropped coverage for spurious reasons.)

I hear you, I've had to deal with similar crap. Just 4 months ago I was insured by my state's medicaid program, yet with no change in income they still kicked me off, because I turned the magical age of *21*. Sucks for me since I still have a serious health issue to deal with, and now trying to navigate my county's "safety net" health program to get the treatment I need.

 

[kellyb]

Your analysis is much like my own and I agree with most of what you say. However I am not comfortable with the description of what happened after the war as competition in a market of ideologies (though I can see why that is an attractive shorthand).

For me the roots of the right wing retreat were in the outcomes of that ideology in the 1930's. The peoples of europe and america paid that price and they did not forget after they came back from the war: they decided they did not wish to pay again. In face of that the right made concessions and we had a post war concensus during which a compromise system was established under which the super rich maintained a very privileged position but the inequalities were somewhat reduced in order to achieve a better standard for all. The aim of reducing inequality was open and most people understood that it produced better outcomes for most.

That persisted for a couple of generations: but as ever, people take for granted the gains they enjoy and they come to forget how and why those gains were achieved. Naturally enough they stop being grateful for what they have and they start to focus on the imperfections and seek ways to improve their situation. Nothing wrong with that so long as you understand the situation as it was before the changes were made and remember that that situation can re-emerge: people have not changed and their interests have not changed. But people do not remember that, because if you have always had a reasonable life style it is easy to persuade you that this is natural.

It seems to me that this is a cycle: the right retreat when they must and advance when they can: and the rhetoric which underpins the advance changes at each cycle: but the ideology remains the same. In short those who are very rich and powerful genuinely do not have the same interests as most of us.

I agree that the right became resurgent in the Reagan/Thatcher years and that the move towards the current situation has been ruthlessly pursued since that time. This is not surprising. With much greater control of information; and with the ability to exploit cosmetic discontent and to characterise it as evidence of a fundamental flaw in the way things are organised, they can persuade many to misunderstand where their own interests lie. Thatcher was quite open in what she wished to achieve: Victorian values. I do not know if Reagan was so open but in any case they were both mouthpieces for the plutocratic interest and they were personally irrelevant (though I will still dance on her grave). It is no accident that both were rather stupid and rather one dimensional figures. Cometh the hour, cometh the selfish moron.

It is no use saying that the plutocracy has done this to the people: we are complicit, in that we have allowed the limits of debate to be set very narrow; and we have indeed voted for this. The current economic debacle is not an accident: it is an inevitable outcome of these policies. Some of the right do not understand this: but some do, I think. They are exploiting it to further the agenda as well, so the "solution" is more of the same stuff which got us into the mess in the first place.

There is nothing new about the neo-cons, as you rightly say. They are old fashioned laissez faire capitalists: we saw them in the 19th century and we saw them in the 1920's. We see them again in their new emperors clothes, but we do not have the little boy yet.

We better get one soon: because this road leads to war, I fear

Yes.

A LOT of us here in the US are with you.

 

[kellyb]

I hear you, I've had to deal with similar crap. Just 4 months ago I was insured by my state's medicaid program, yet with no change in income they still kicked me off, because I turned the magical age of *21*. Sucks for me since I still have a serious health issue to deal with, and now trying to navigate my county's "safety net" health program to get the treatment I need.

I am so sorry.
I think you might be caught in the poverty trap I talked with Agatha about earlier in the thread.

 

[Garrison0fMars]

I am so sorry.
I think you might be caught in the poverty trap I talked with Agatha about earlier in the thread.

I might be. I mean, my condition isn't terminal (well, yet at least), but if I could get it treated, I could go on with my life, and go to school (which I was planning, but had to post pone it because of what I'm physically going through). If I could get past it, I could well, escape poverty, or at least have a fighting chance of doing so...

I still have ambitions for the future, but...I can't really pursue them right now

 

[Architect]

Emigrate.

No, seriously.

Emigrate.

 

[Garrison0fMars]

Emigrate.

No, seriously.

Emigrate.

Are you addressing me?

 

[Architect]

Are you addressing me?

Where I come from that's usually the invitation to a fight, but setting that aside then yup, I was addressing you.

 

[Delscottio]

Emigrate.

No, seriously.

Emigrate.

What he said. I'll even chip in for the airfare if you promise to become a higher rate tax payer down the line!

 

[kellyb]

Are you addressing me?

We're all relatively healthy over here, and Obama the fake leftist has me really , really freaked out.

I'd be doing everything in my power to move elsewhere if a member of my family needed health care.

 

[Garrison0fMars]

Where I come from that's usually the invitation to a fight, but setting that aside then yup, I was addressing you.

Oh no, I'm not looking for a fight, just wondering if you were addressing me.

Ok, but where to? I don't think that's a possibility for me. I don't have any money (none whatsoever, I'm just above going homeless, which may happen in the near future), and what nation is going to take in a sick adult youth? From what I understand, health screenings are standard procedure to emigration to filter out the "costly" emigrants, though I could be wrong. If I could emigrate somewhere with a decent universal healthcare system, I'd do so in a heartbeat...

 

[bookitty]

Your analysis is much like my own and I agree with most of what you say. However I am not comfortable with the description of what happened after the war as competition in a market of ideologies (though I can see why that is an attractive shorthand).

For me the roots of the right wing retreat were in the outcomes of that ideology in the 1930's. The peoples of europe and america paid that price and they did not forget after they came back from the war: they decided they did not wish to pay again. In face of that the right made concessions and we had a post war concensus during which a compromise system was established under which the super rich maintained a very privileged position but the inequalities were somewhat reduced in order to achieve a better standard for all. The aim of reducing inequality was open and most people understood that it produced better outcomes for most.

That persisted for a couple of generations: but as ever, people take for granted the gains they enjoy and they come to forget how and why those gains were achieved. Naturally enough they stop being grateful for what they have and they start to focus on the imperfections and seek ways to improve their situation. Nothing wrong with that so long as you understand the situation as it was before the changes were made and remember that that situation can re-emerge: people have not changed and their interests have not changed. But people do not remember that, because if you have always had a reasonable life style it is easy to persuade you that this is natural.

It seems to me that this is a cycle: the right retreat when they must and advance when they can: and the rhetoric which underpins the advance changes at each cycle: but the ideology remains the same. In short those who are very rich and powerful genuinely do not have the same interests as most of us.

I agree that the right became resurgent in the Reagan/Thatcher years and that the move towards the current situation has been ruthlessly pursued since that time. This is not surprising. With much greater control of information; and with the ability to exploit cosmetic discontent and to characterise it as evidence of a fundamental flaw in the way things are organised, they can persuade many to misunderstand where their own interests lie. Thatcher was quite open in what she wished to achieve: Victorian values. I do not know if Reagan was so open but in any case they were both mouthpieces for the plutocratic interest and they were personally irrelevant (though I will still dance on her grave). It is no accident that both were rather stupid and rather one dimensional figures. Cometh the hour, cometh the selfish moron.

It is no use saying that the plutocracy has done this to the people: we are complicit, in that we have allowed the limits of debate to be set very narrow; and we have indeed voted for this. The current economic debacle is not an accident: it is an inevitable outcome of these policies. Some of the right do not understand this: but some do, I think. They are exploiting it to further the agenda as well, so the "solution" is more of the same stuff which got us into the mess in the first place.

There is nothing new about the neo-cons, as you rightly say. They are old fashioned laissez faire capitalists: we saw them in the 19th century and we saw them in the 1920's. We see them again in their new emperors clothes, but we do not have the little boy yet.

We better get one soon: because this road leads to war, I fear

Both of you have manage to sum this up so succinctly. Thank you. Now if we could only get people to listen.