Eccentric Flower:200912/Cromwell Says
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«December 2009 «Eccentric Flower
Cromwell Says
If you were hoping for health care improvements in your stocking, forget it. As far as health care goes, Christmas is cancelled.
This is independent of any voting which can be finagled. Even if the Democrats get their bill through, you still lose.
It's really not a comfortable position for me to be out here on a limb, especially when people on the opposite side of the tree are basically sane, thoughtful humans like Nate Silver. I don't ever want to bet against Nate Silver, and I don't like being out here with often-froths-more-than-he-thinks Markos Moulitsas. But I can't help that. I think Kos is right:
Silver is trying as hard as he can to convince people that, even flawed as it is, we should all get on board behind trying to get the Senate bill to pass. He's trying so hard that he's crossed his usual lines of dignity and grace (using language like "batshit crazy" is not going to do you any good at all, Nate). When you use language like that people are going to retort in kind. Here are two of the politer responses in that thread, both of which I happen to agree with:
Demonizing justifiably, I would add.
Look, there are two problems with the system we have now:
1) Costs are far too high. Apart from a couple of obvious cases of gouging (we'll do the drug company rant some other day), I do not fully understand why they're so high. It mystifies me. I am a simple soul and greatly naive, and so I don't understand why a night in a hospital room, which doesn't even have the same service quality (and therefore expense) of a second-tier hotel, costs far more than some first-tier hotels. Give me a dedicated nurse at my beck and call 24/7 while I'm there and you can argue in favor of those costs, but you know and I know that these days hospitals are lucky if they have three nurses for the entire floor, so can someone explain what the deal is here? Why do some processes and procedures that involve expensive machines still continue to cost a fortune even once the expensive machine's purchase costs have been recouped? Why don't we have more and cheaper doctors? Is it that hard to convince people to be doctors these days? I don't see any downturn of people trying to enter medical school. Am I missing something?
2) The system is in the hands of insurance companies, who are not in the business of providing health care. Insurance companies are in the business of not providing health care. For an insurance company, if they pay off, they're doing it wrong. With health insurers, denying coverage as soon as anything goes wrong or threatens to go wrong isn't sleazy - it's correct business policy. They'd be stupid to do it any other way. Health insurers make their money by taking payments from people who, on a significantly-better-than-average basis, will never get any return value for what they pay in.
Insurance has its place. Health care is not it. There will not be any meaningful health care reform in this country until we crush the insurers like bugs.
Unfortunately, if we take insurance out of it, that means the government has to pay for it. That means you. And you don't want to pay this bill. Trust me; you don't. (Sure, your employer could pay for it, but the cost is crushing them too, and by concealing the true costs for so many years, employer-subsidies are a large part of what got us into this mess.)
Which brings us back to point 1. Health care has got to be cheaper. If it doesn't get cheaper it will be a burden someone is justifiably reluctant to pay, and the finger-pointing and cost-shifting and fun and games will continue. If health care doesn't get cheaper, it will be a disastrous problem for someone. There is no way around it. If there is an unbearable cost - and right now it is coming dangerously close to an unbearable cost - then there can be no solution which is ultimately stable.
Silver argues that this bill is not great but it would be even worse not to pass it - that it is, in effect, a better first step than doing nothing. I'm not sure I agree with that. I'm worried it is a first step in the wrong direction. It strikes me that the mindset needed to think this is a step in the right direction is the mindset which has already accepted that we will never be able to beat down the insurance companies, will never be able to beat back costs, that we must work with full acceptance of the two issues above because we'll never be able to change those factors. That may very well be true, but I maintain that any solution which does not change the two factors above is not a real solution; it is merely a stay of execution.
Joy:
I'm so disgusted with this whole thing that I'm just trying not to think about it too much. Yes, head in the sand, that's me.
I think it is absolutely, in this case, not better to do something rather than nothing. Because I fear that if something is done, then people (in govt mainly) will say they can move on to something else, that this got done and it is enough.
-- 18:12, 17 December 2009 (GMT)
See, and here is another part of the problem. Company focused on profit. Will force its product on health organizations, who then either have to eat (as overhead) the cost of any supplies that don't get used up, or coerce their patients into getting treatments they otherwise wouldn't have gotten (presumably because they don't need them).
-- 18:45, 17 December 2009 (GMT)
The idea that the cost-setting part is mostly in the hands of the people who don't, you know, actually give the health care is, to my mind, just another argument in favor of my point #2.
Which is not a disagreement.
-- 19:41, 17 December 2009 (GMT)
Andy:
The health care bill won't fix a lot of the things that are broken in the current system. But it's my understanding (unless this has changed; the bills change so much it's hard to keep track) will fix something that I think is very important; people will no longer be denied coverage on the basis of pre-existing conditions.
A good friend of mine spent the last 15 years of her life trapped in a miserable job, because her son had a brain tumor, and if she didn't keep that job, and the insurance that went with it, no-one else would insure her son (or her, during the last 5 of those years when she had breast cancer). And you can't blame the insurance companies for this: If one insurance company decided they would ignore pre-existing conditions, all the sick people would by insurance from them, and they could only survive by hiking rates to the point where no-one could afford the insurance. But if the governmnent requires *all* the insurance companies to insure regardless of pre-existing conditions, the adverse selection process goes away, and people are no longer trapped with the insurance they don't like and the jobs they don't like that go with it. Massachusetts has done things this way for years (this is not the recent MA mandated health-care law, but a much older one) and it's worked great. Unfortunately for Helen, she lived in NJ, not MA.
I think that fixing this is important enough that I haven't seen enough bad things in the health care bill to outweigh it. And it effects enough people that I think that if this passes, people will see that the sky-is-falling anti-health-care forces will lose credibility and get voted out of office, and something good can get enacted.
-- 21:05, 17 December 2009 (GMT)
Joy:
You know, that's true Andy. That is a huge problem with the current system, and fixing that alone is worth something.
-- 03:03, 18 December 2009 (GMT)
Jweader:
The whole "why are costs so high" question has such a complex answer that I really think it is un-answerable in whole. Medical service providers (i.e. doctors, hospitals) aren't the only ones who set rates. In fact, they're pretty far down on the list (right above patients). Insurance companies and the government are #1 and #2. Both can decide, seemingly on a whim, to change the entire basis of their pay structure. See this HHS release for some info.
Doctors, for the most part, have nothing to do with setting rates, since doctors are part of {1..n} practices / physician groups / etc. Those have relationships with hospitals, offices, etc. to give the docs somewhere to do their work.
I really have no idea how capital equipment gets purchased at each facility, and who all is involved in those decisions. I'm sure that there's a $400 hammer type of thing going on to spread out some of the capital costs, which is what leads to seemingly outrageous prices for what should be cheap(er) visits or procedures.
I have no doubt that much of the cost is in the complexity itself. And I think that's where the nationalized (or heavily regulated on a national scale) programs do much better, since the government can enforce a clearer relationship between the parties involved (or even limit the number of parties). Not gonna happen here, though. Any change will just make the system more complex, which in the end will make it more expensive overall.
-- 18:11, 17 December 2009 (GMT)