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August 14, 2008

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Laura

Great post, Isaac. Now can you parlay some of this to your great buddy Barack? Mandating coverage isn't mean and bothersome. It's making sure people get health care. Our current system has turned decent medical care into a luxury of the wealthy. How sick is that (both literally and figuratively)?

RLewis

A Rational Decision is the last thing a person makes if s/he thinks they are going to die. That's why healthcare has to be regulated. I would empty every bank account and max out every charge card, if I thought that would buy something that keeps me from kickin'. who wouldn't?

I can tell you that before I had to go full-time for the man (insurance included), I was a temp for a decade. The best thing I ever did was sign-up at Ryan/Chelsea-Clinton Community Health Center. It's kinda on the dole, I guess, but I never paid more than $29 per visit. And everything there is brand new. When I needed a procedure they refered me to a nearby hospital, and after 3 visits there at $5 per visit, I'd never felt better. I learned about Ryan/Chelsea at the Actors Fund, and I can't recommend either higher.

malachy walsh

One way or another, healthcare is going to cost all of us a lot of money.

Whether it's through taxes or our employers, we pay for it.

Regardless, is there anyone who really believes that people could make rational decisions about healthcare considering the complexity involved?

Ken

To leave people's health (literally a "life and death" issue) up to the whims of the marketplace is the final indication that the conservative "free market" ideology is wicked, cruel, and inhumane. The idea that the government shouldn't oversee coverage for everyone (and the myth that such coverage would automatically be some evil Soviet-style bureaucracy determined to crush the souls of all who live under it) is one that could only have been hatched by a bunch of rich, well-connected, solipsistic individuals living in a protected bubble of privilege.

malachy walsh

A recent ad for an insurance company reads:

Your arm is broken. Your back's wrenched. And all you can think is, "Getting my car fixed is gonna be painful."

Will OHare

Whatever the cost of the procedure, you got the procedure right away. Go for the same treatment in Canada and you could be walking around with that same ingrown toenail for weeks or maybe months at a time.

You bought health insurance you knew was crappy and then you complain about getting crappy service. It's like buying a lemon at a used car lot and then saying that the government should be in the car manufacturing business because you got ripped off.

Also, New York is a terrible example of looking at free market healthcare. It's one of only a few states that makes it illegal for health insurance companies to base your eligibility for coverage and premiums based on your health. The advantage is that you can't be turned down based on age or health. The big downside is that premiums are expensive. In my experience it seems that a lot of young people don't even get coverage because they cannot afford it. If the premiums were based on health, then when you're young and healthy, you can get into the system without paying prohibitive premiums. In a lot of other states, you can get a basic plan or an emergency plan for a tiny fraction of what you pay per month to GHI.

To me, the biggest problem with the healthcare system is that we view healthcare as something someone else should pay for (either the government or your employer). So, in a sense we've created a corporate welfare. Why would Bluecross be interested in my business as an individual, when it's much more lucrative to develop contracts with large employers. It's like the individual's been so removed from the process. Costs have been allowed to inflate because it's not like purchasing anything else in the free market. The consumer rarely deals with the true cost. It's as if we walk around with the attitude of "my company covers me, so all I want to deal with is the $20 co-pay and it doesn't matter if the procedure is $500 or $5000." We scrutinize what we pay for a liter of milk more than we do our healthcare.

Now, the problem with government sponsored care isn't that it's evil or anti-American. It's that the government is faced with the same problem of how to distribute the resources. Decisions to deny and delay care would still occur on a daily basis. Believe me, when it comes down to making a decision about who to distribute care to, your ingrown toenail is going to be far down the list. You could end up dealing with someone just as incompetent as the person you dealt with at GHI, but if the government is your only source for the care, then you have no alternatives. As you noted in your post, you are now in the process of switching to a new carrier for your health insurance. Such a luxury would not be an option if private care were eliminated.

I think there a number of problems with our current healthcare system, and I think I would be interested in exploring the idea of the government playing a role in everyday, preventative care. Something that would encourage people to see a doctor regularly, and in the long run, keep down health costs by helping people stay healthier longer. But I think it's so easy to throw around words like cruel and inhuman when talking about our system. Without being able to have a second or third opinion and choose the doctors she wanted, my mom would've probably died of cancer a decade ago. As we've seen with public education, the government doling out resources doesn't automatically make things fair or humane.

-Will

isaac

Hey Will,

Interestingly enough, in conversations about health insurance, car insurance (or car dealership) metaphors and analogies pop up a lot, and they're consistently misleading. You don't have to have a car-- or for that matter car insurance-- but you do need your health, and if you don't want those costs to bankrupt you, you in general do need health insurance. I bought a plan that I knew wouldn't cover that much, but I trusted that when they said something would be covered, or a doctor would be in network it would be, similarly I trusted my doctor's office when they said my insurance covered the procedure. At no point in making health care decisions should one be thinking the same way they do when buying a used car-- that's what government regulations are supposed to protect you from.

Furthermore, most countries that have government health care also allow individuals to purchase supplementary assistance if they choose to. So the idea that it wouldn't be option under a government run system depends which government you're talking about.

Finally, I will simply say that if I expect the government to cover health expenses, I'm not saying that "someone else" should. I'm a tax payer, I'm one of the people paying for and supporting that system. Government isn't separate from me.

I agree with you that the government doling out resources won't *necessarily lead* to successful outcomes. But I do know that for-profit health care is a debacle. We need a good plan for socialized medicine, there are plenty of countries that have them, and some that don't. I'm not well-versed enough in Canada's systems to argue the merits of it, but I will say that Canada spends less as a nation on health care than we do, has a lower infant mortality rate (http://www.phac-aspc.gc.ca/publicat/meas-haut/mu_c_e.html), a longer life expectancy and a lower death rate (http://www.unitednorthamerica.org/simdiff.htm).

(I totally agree with you about preventative care, btw... but given the rigamarole one must go through to get a doctor's appointment covered, it's hard under our current system to encourage such things, and it is worth noting that many socialized medicine systems save money by placing heavy emphasis on preventative medicine)

Johnson

I think the point that you bought a lemon and now complain about the lemoniness of it is appropo - even if it is a car analogy.

Still, something should be done. If the cost doesn't change, how it's paid for should - or only the rich will live the healthy life.

isaac

Well, yet another reason why that analogy doesn't work is that if you go to a used car salesman and get a lemon, you can invoke your state's lemon laws and do something about it. (http://www.carlemon.com/lemon/NY_law.html) So it's not like

I would also note that my true appreciation for GHI's crappiness did not happen until this incident and the only reason why I am able to switch health insurers is that my new HMO dropped their rates by over a hundred dollars. They were able to do this because I am a healthy 29 year old non-smoker. If I were diabetic or whatever, I'd be totally screwed.

Johnson

You certainly shouldn't be liable for the bill from the Dr. whose office told you that they took your insurance.

That's a verbal agreement to take what you got.

If you had the wherewithal to pay legal counsel...

At the very least the Dr. should reported to the Better Biz Bureau and whatever other governing body might need to know. He could be running a scam.

On the lemon matter, you miss the point. You knew you had catastrophic insurance with limited options. Then you complain. That's what's being said. That's all.

Not that it's fair.

Toronto life insurance broker

"by people whose economic views tend towards the free marked capitalist is the idea of rational actors" Rational actor is not a "must" for free market idea, of course many economists noticed non-perfect information. But is government more rational? And is not freedom to choose, even to choose "wrong" option, more important?
Lorne

Will O'Hare

From http://www.healthplanone.com/healthinsurance/newyork/:

"In New York, medical underwriting is not allowed. This means that insurance companies are not permitted to review the medical history of prospective members. As a result, they are required to charge the same rate (or premium) to members regardless of their health status. This leads to extremely high premiums.

In New York, all health insurance companies must offer insurance coverage to all individuals, even those with serious medical conditions. "

Obviously, there are pros and cons to medical underwriting, but it's important to note that individuals in New York have less choice than in most places in the country.

I'm glad you've been able to switch plans, though. And keep giving GHI hell. It seems to me that you could report them to the Better Business Bureau.

Check out Working Today and the Freelancers Union. I found it to be an arduous task to get enrolled, but they're able to offer freelancers group insurance rates.

Will

resume writing service

Idea of Rational Consumer does suck. Actually this is one of the reason of world crisis. And your example is quite vivid one, that's valuable life experience.

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