Can we fix it? No, we can’t

Comments (14)

1. What we do know, is that the industry will adapt to change if my fantasy that a rational health care system with single-payer is adapted. Even if they find a way to administer the plan for the government, they will retain business.

   There are a large variety of insurances that can be sold and administered beyond basic health care. Even in Canada, which uses a single-payer system and in Britain with the NHS there are robust insurance industries.

   Currently the insurance companies treat health insurance as a variation on property and casualty, and are making tons of money simply by reducing claims that in any sane system they would be paying out because they see their mission towards their stockholders as being more important than their mission towards the customers who are supplying their investment funds through premiums.

   In that sense it is a failed industry, but it is propped up by employer-based health plans and limited enrollment periods. One can’t change insurance if you are unhappy with the plan administrators unless there is a “Life event,” such as divorce, death, adoption, etc. Even then, the customer likely faces an exclusion for pre-existing conditions, or rescission when they contract a condition for which they actually need the services for which they have been paying for several years.

   Dropped. “Sorry, can’t cover your brain cancer treatments because you had a gall-bladder operation 15 years ago. Try the local emergency room.”

   If the current system weren’t failing society so badly, jonolan, there would be no hue and cry for reforms.

   As to Johns’s point on the lack of a viable political option for those of us as left-leaning as Obama is accused of being, it is truly frustrating. Here is what happened when I went to a Town Hall Forum, hosted by my own representtative and a woman from my own party:

   A Progressive Frustrated With Democrats

   Where is the American Tommy Douglas? John Edwards got caught we have had no one to take up the torch. (Never mind that he got caught doing what so many Godly Republicans were doing, and those bastards remain in their seats.)

   We are trapped in a two-party system. When I was a kid, the Canadian NDP was a rather marginal party. While it does not have the national Parliament, it now controls two provinces, and it is a truly liberal party. Unlike, of course The Liberals.

   Our Greens have not been able to gain much because too many of us liberals end up supporting the Democratic Party more to protect us from the Black Cats. Yet, they still are White Cats.

2. Well there’s also the issue that “single payer” would literally gut the health insurance / healthcare industry and this is hardly the time to destroy a $500+ billion a year industry.

3. I think it is exactly the time to destroy that industry. It will adapt, of course, and become leaner and less mean, rather than disappear, but if a rational insurance program kills that industry, it deserves to be killed.

4. Single Payer isn’t a “rational insurance program;” it’s a government takeover of the industry – possibly better for the people, possibly not. In any event, such a takeover would destroy the industry and replace it with a government system.

   This is not the time for America to destroy a half-a-trillion dollar a year industry that employs millions of people. That, on top of all else wrong right now, would be economic suicide.

5. That’s such bullshit. Everywhere else in the world it works, including my own country. Why wouldn’t it work in the US?

6. Economic suicide as opposed to what? Lots of poor people dying?

   The effects of any bill will take their time to filter through, so one could argue that this is the best time to pass the bill: the effects on the industry will only be felt when the economy is doing well (I don’t know how true this is: I would want to see some research done first. But I think the principle is OK).

7. John,

   Yes, single payer healthcare now works in many other countries. It was implemented a long time ago and in economies where the healthcare industry wasn’t nearly so vast or entrenched.

   It’s not something though that could be done now in the US. Our current economy couldn’t take the upheaval and loss of GDP. Later? Maybe.

   1. We could wait for ever, and there will be no time that is a “good time.”

8. “That’s such bullshit. Everywhere else in the world it works, including my own country. Why wouldn’t it work in the US?”

   Whether it works isn’t really the issue.

   Jonolan’s point is a sound one. Many single payer systems came into being during the height of a more socialised economic philosophy; they were a natural extension upon an infrastructure highly amenable to their implementation in the first place. For the US to implement such a system would require a tremendous amount of tearing down and reconstruction. And yes, of course job losses are relevant; it would be completely absurd to lay off an entire industry of workers in order to push a socialised agenda! Talk about robbing the poor to pay the poor (for example, the vast majority of hospital workers employed for billing departments, of which there are hundreds of thousands, are middle to low income earners who are mostly women)

   It may well be worth it in the long run (other countries are good evidence that it can work, bumps and hiccups notwithstanding), but that’s besides the point. The US cannot afford it now. It’s already up to its eyeballs in debt to a country that is beginning to lose its confidence in, and to some degree becoming actively belligerent towards, its biggest debtor.

   Obama handing over a trillion bucks to the financial sector probably wasn’t the smartest thing to do in terms of laying the groundwork for a more socialised health care system. There’s simply no money left, even to the most imaginative of government accountants.

   It’s ironic really, but there’s a certain conservative “bootstraps” mentality that countries with single payer systems in place tend to adopt when addressing American health care. “If we can do it, then why can’t you?!”

   1. Fair comment, but there’s an answer: implement it in stages, and make sure that costs are lowered as you do it. You can’t pay more than you presently do. One thing that would save a lot of money is to penalise unnecessary tests and to block unnecessary litigation. These are things under the control of the federal governments and the states at the legislative level. I don’t think anyone is expecting it to happen in two months.

      As Mike said, there is no good time, but it will save you money in the longer term. Or, to put it another way, the best time to fix things is now.

9. The various industrialized nations have a variety of approaches to universal health care, some frankly socialistic, others largely or entirely private. If America doesn’t have a viable system, and lord knows we don’t, the explanation goes beyond a distaste for “socialism” however defined. The real problem is political, not economic: America is deeply and disastrously corrupt, rotten at heart. It is by no means clear that the country as currently configured can deal with serious problems like health care. John, who is not an American, might be unwilling to point out this fact; but I am an American and I’ve learned to accept it.

   Americans believe that they are special or at least know that they must always claim to believe they are special; but while there have certainly been plenty of admirable Americans and we’ve contributed many things to the world, it’s obvious that our dominance over the last century owes a lot more to our huge size, geographic isolation, and sheer luck than some postulated national virtue. These unearned advantages and the remarkably strong prohibition on self-criticism in these parts have blinded us to the fact that in many ways we are a mess. Our official constitution vests an inordinate amount of power in states with small populations, in effect partially disenfranchising those of us that live in large states and, not incidentally, giving disproportionate influence to the most backward, racist, and anti-democratic regions of the country. Our real constitution—the effective organization of government—gives decisive power to the corporations and the military that routinely—and legally—make punks of our elected political leaders by simply buying them outright. The problem actually goes beyond that: elites run things everywhere. In America, however, the elite is a remarkably cynical and short-sighted group whose vanity and indeed brutality is more often encouraged than curbed by superstitions whose absurdity would make a witch doctor shake his head. Meanwhile, everything takes place in a society whose conversation is dominated by a public relations, propaganda, and advertizing apparatus operating under the name of journalism that puts out gossip and calls it news. In sum, one hardly knows whether to call this poor country of mine the White Trash Republic or simply the Great North American Whorehouse. The health care fiasco is merely a symptom. Any cure would have to address the underlying disease. I’m not personally optimistic. The rest of you better watch out for us.

10. Single-payer wouldn’t require the destruction of the insurance industry; many single-payer nations still have insurance companies, because single-payer insurance is never inexhaustible — it always insures only up to a particular point. But there are always people who want more, so there is still a market for private insurance, as long as the government doesn’t initiate an insurance monopoly. Moreover, in the US the government already pays 47% of all medical bills, as compared to the 35% taken care of by private insurance. We’re getting there already, in a system that’s badly suited for doing it.

    I do think there are legitimate worries. The US is more massive, with a more complicated political structure, than most nations with successful single-payer systems; that guarantees that any single-payer system for the US, with fourteen times the population of Australia, will be harder to implement, and less efficient once implemented ,than most of what’s been done before. And that means that there are plenty of stretches for government to mess up.

    And that’s the rub. It’s not that Americans are particularly afraid of socialism, although some are. It’s that they don’t trust their governments to make massive changes in a competent and noncorrupt way — and, unfortunately, they are right to be suspicious, because we have become a society ruled by sophists. And so we are frozen into a degenerating system until the winds change.

11. There is one recurring flaw in the arguments in favor of Single Payer at this time in the US – it’s a lot more than just health insurance that would be affect.

    Who do you think owns most of the hospitals in America? Sickeningly enough it’s the insurance companies. Hurt the parent company and you hurt subsidiaries too.

    Could a shift to Single Payer be done in stages? Possibly. Hybrid systems that are in flux are normally grossly inefficient though.

    In any event, my point was originally limited to just the problems of implementing Single Payer in the US right now.

12. And as Taibbi points out, it could actually lower federal spending on health if the single payer option were adopted. But it won’t happen because health insurance lobby groups fund too many Republicans and Blue Dog Democrats.

    You could just as well argue what a wonderful world it would be if evolution hadn’t created those awful predators and parasites, and just left the herbivores alone. But you’re just not seeing the big picture! (and neither am I…)

Comments are closed.