The sooner we learn and remember that "they are us" the better off we all will be. The time of capitalism ruling the health of our citizens is over. Humanitarianism begins with taking care of all of us.

As long as it is considered 'Good Business Practice' to make money from illnesses of human beings, this will continue. As long as these 'evil' businesses can make a profit from taking money from people they will continue to do so.
As long as the medical staff are considered to be there for profit and money, this will continue.

Putting profit ahead of lives of human beings should and will be considered a crime one day soon.
How long will this evil practice continue?
I have no answer for that one Kent. I have no insurance. I am in good company, and millions of my fellow Americans are joining me, either thru job loss, on being priced right out of this system as the prices for the premiums climb ever higher.

They are us, we are them. We are all basically the same in that we are all human beings, and as such we all possess the same odds of finding ourselves in the same position as anyone else in this country, or in fact the world. People who oppose humanitarian gestures are essentially betting on non-existant guarantees, the belief that we have the same chance of becoming them as they had of becoming them, but they won't aknowledge that they have the same odds of them becoming us.

There's a fine line between priveledged and unpriveledged, and either can become the other in the blink of an eye

Great post Kent. I have often wondered about the people employed by the insurance companies whose job it is to deny claims, to deny treatments, to "screw us." How do they justify themselves, day after day. I'm sure they tell themselves that they are just doing their job, doing what they have been trained and told to do, how else can they sleep at night? It is the sort of rationalized thinking that reminds me of Germans who worked at the extermination camps.

It is white collar murder.

Ablonde, I think they don't have as hard a time these days as ordinarily becuase they probably just say “This is a horrible indignity, but one way or another I must feed my family and this is the job I can get.” The notion of changing jobs in this climate is terrifying, so what are they going to do, walk? They know better than anyone what would happen to their benefits if they did. They are in many cases as much victims as we are unless they are so brave as to be prepared to lose horribly to take a stand that will probably affect nothing and just leave their family in an awful state.

Riot in the streets, dammit. You've got a week left! Riot for single-option while you're at it. I speak from the perspective of the beneficiary of single-option, tax-paid, not-job-tied, no-insurance-companies, universal health care and CANNOT UNDERSTAND THE AMERICAN SCENE.

Coyote, indeed—capitalism has many virtues but unless we solve the problem I discussed in Medical Care and the Free-Market Catch-22, capitalism won't be up to the task of keeping us well.

Mission, it's ironic that the party that often thinks itself The Party of God somehow manages to be the champion of this “every man for himself” theory of health care. Shameful.

Placebo, exactly—it's simply gambling and with bad odds. Even those of us with health care are in a fragile situation. We need to act while we can because once we're uninsured, it's also harder to be politically active. So much more of people's existence goes to simply handling the basics ... Politics becomes almost a luxury.

Myriad, “rioting” could mean any of several things, but remember that any group action not taken in sufficient numbers is at risk of being marginalized by Patriot Act legislation. And anyway, it's an odd thing but the people talking violence are coincidentally mostly those on the Republican side; the people getting hurt the most are those on the side of compassion. What we need are voices, and that's why I'm so very disappointed in Salon for not giving us one.

Preach On! I was once a Republican, but then my mom had to quit the SEIU union to work at a new hospital, because it didn't allow unions. She got cancer, and had to put 1/2 of her chemo on credit cards. I hate the Republicans and am ashamed I was ever a member. The greed of corporate America is pure evil, cannibalistic and it preys upon our own people. We must resist it with every fibre of our being. No surrender!

RW, I generally count myself an Independent and don't think this ought to be about party at all. But the institutionalized greed and the death wish for common decency shown by the leaders of the Republican party have indeed forced the issue to fall somewhat along party lines. I'm glad to hear you've taken a stand for compassion and decency.

There is a man who frequently appears on MSNBC (with Keith Olbermann mainly)who used to work as an executive at a health insurance company. He divulges many of the discouraging realities that you allude to. We are living with a health system that in a few years --when things get better I hope, with passage of some sort of reform -- will be looked on as immoral.

Rated!
It makes perfect sense for the right wing to support the present health care system. It is plain to see that their objective is a feudal society at home and unending wars abroad. During Bush junior's terms the rich got richer the poor got poorer and many who were middle class became poor.
It is very hard to see the vision of those who signed the Declaration of Independence and gave us our Constitution be destroyed by the right wingers - the most mean spirited and the greediest among us.

Lea, yes, you're thinking of Wendell Potter, I think.

Coach/Captain, well put. And worst of all is to see it all done in the name of the founders, as if it were the original intent, when it is really the opposite. How very 1984 of them.

I want the billionaires to get even richer because they are more worthy, more intelligent, blessed by God and have worked so hard. Thinking up new ways to steal granny's food money, rape union workers of their pensions and embezzling is hard work! A rising tide lifts all boats as all RIght believers always say. Hey, if a few get drowned, what the hell. If a few suffer in pain, it must be God's will. Save the billionaires is my new cry! Health Care for common people is just not the American way, why is it so hard to believe. Work for the really oppressed- Save the billionaire---join me therichwilltakecareofyoufool.com

Hi, Kent,

I'm not in the horrible position Sandra and her husband are in, but I've been (and remain) on the verge. My feelings about health care reform slide between optimism and pessimism, usually ending in resignation. Here's an example of why:


On Wednesday, [Jason Altmire (D - PA)] met with 46 "tea party" activists from his district who boarded a chartered bus at 5:30 a.m. for a chance to confront him in a House committee room.

...

Altmire insisted that he "will not vote for a bill that adds one penny to the federal deficit."

But the conversation ran aground when he asked a fundamental question: Shouldn't the government help low-income people afford basic health insurance?

"No!" most of the visitors shouted.


I don't even know what to think about such a huge gap between what I believe is moral and decent and the views of those people.

Maybe the real real reason we have Microsoft, Dell and Facebook is b/c Bill, Michael and Mark didn't have to worry about leaving a job with good insurance in order to found their companies. Their mom's were still doing their laundry and they had nothing to lose in their gamble to start a new company - companies that changed their local, state and in some cases the national and world economies.

But imagine if they didn't, because they were worried they were uninsurable due to the benign tumor removed back in 1981.

"THEY CAME FIRST for the Communists,
and I didn't speak up because I wasn't a Communist.

THEN THEY CAME for the Jews,
and I didn't speak up because I wasn't a Jew.

THEN THEY CAME for the trade unionists,
and I didn't speak up because I wasn't a trade unionist.

THEN THEY CAME for the Catholics,
and I didn’t speak up because I was a Protestant.

THEN THEY CAME for me
and by that time no one was left to speak up."

"legally required to behave in a manner that elevates them from their already questionable status of legal people to the extreme of being what I call “legal sociopaths,”
Really, really well put, Kent. I totally concur.

Kent, I thought it was a revelation just in reading the text of this Union Worker, then actualy hearing the passion in his voice. How many thousands of earnest, dedicated workers are being victimized by the system proposed by our worst administrators?

It is heartbreaking, and I do not know if there is help coming, except through a building consensus of common sense thinkers.
Excellent post...

Kent, Thanks for this piece. I am so rooted in this problem. So many personal things come to mind but I have already written about them here in my posts. A few minutes ago I saw something on HuffPost about Gibbs' saying this morning on one of the programs that we will have a bill this week or by next week. Will we?

Whose voice can I believe about all of this? Who is being straight and is not spinning? Because it matters so much, I feel like a yo-yo, battered and bruised as I bounce between hope and despair.

I want the reform to come and I want it now. I have lived here before with no insurance when I came home from England and the only work I could find was paid hourly with no benefits. When I tried to buy insurance, no one wanted to know because I was diabetic. Again I have written of that here in my posts.

I understand the amnesia of worry that comes when people are insured, but is anyone listening to horror stories everywhere?

By accident I happened upon a special comment made a few weeks ago by Keith Olbermann about the night he had just spent with his father when his father asked for his help to end his pain and suffering. It made me scream with pain.

I have worked in a hospital. I was the daughter of a nurse. She didn't ask me to help her die. She was already brain dead before I knew she had fallen ill. Still, so you pull the machines? What would she want? I did at least know what she would want. We had talked about it. I didn't need to make that call. The doctor she had worked for and who loved her like a mother also knew what she wanted and told me so, told me what he would do. It was the right call. It was what she would have wanted. None of it was easy. Then she was gone.

My mother did have health insurance. I sorted through bills and paperwork, but everything was covered.

Keith Olbermann's father died last night. I feel his pain. His father had insurance. At least they didn't face that struggle.

Death. Dying. Illness. Accidents. Pain - all of it. We don't seem to like talking about any of these things. Maybe this is why clear discussions about health care and its reform are almost non-existent. Who will dare to speak without a mask of some kind as protection? I am so tired of all the posturing and deceiving and mockery about something that matters to every single one of us. All of us!!!!

Pass the bill that exists at the moment. Listen to Alan Grayson and then pass immediately a public option bill. Then speak to governors like the one I have now and mandate that they can not refuse to play!

My steam is boiling and my blood pressure is skyrocketing. I'll stop for now, but know that your words hit home for me.

Kent,

All of this brings up the old saying, “Walk a mile in my shoes.” That’s a lot of what we’re seeing; people are judging others with no foundation for their judgment. But the thing that is baffling is that there could possibly be so many who are so shortsighted.

I cannot count the times I’ve seen the “Walk a mile in my shoes” concept play out in my own life; even family members have often discounted another family member’s situation on occasion UNTIL one of them finds they are in the same predicament.

I posted something about this a day or two ago:
Republican InsuranceCare Strikes Close to Home

I live in a HEAVILY Republican part of the country, and it is interesting to watch the reactions of so many as I go through each day at work where virtually everyone I encounter regularly is a Republican. They seem to know there are serious problems, but they simply cannot suspend their beliefs that are based on partisanship. It is a truly fascinating phenomenon to watch.

RATED

Sorry, but I cannot buy into the Republicans are the only ones to blame theory of why there will be no real reform even if the sick windfall for insurance corporations manages to pass next week.

The Democratic party has a super majority in both houses. The Democrats do not want a public option or single payer or anything that would remotely hold Phrma and insurance corporations accountable. They are latched to the same corporate tits as the Republicans. Just peruse Glen Greenwald's columns last week that show the duplicity. The Democrats pretend to want a public option, but now that it could happen via reconciliation Pelosi is pulling to off the table. The same table she refused to consider single payer at and the same table she took impeachment of Bush off in 2006.

Wake up.

The Democratic Party is not bringing reform. They are working hard to stop it.

They are more to blame than the Republicans who at least are honest about their inhumanity and don't hide behind false promises of hopeful change. The Democrats could actually do the right thing, but are deliberately not.

Stop blaming the minority Republicans who chatter but signify nothing and look to the Democrats who have all the power, but yet are stabbing us in the back.

The comment Rob made describing the meeting with the rep and hte tea partiers says it - there is a core group of people dedicated to opposing anything that they think (mistakenly) will never benefit or affect them. They are (so far) louder and more media-supported than the rest of us. Until that changes, true reform will be very hard to come by. R

There is so much to say here that's it's hard to know where to start. Private insurance will never work (built on law of large numbers, adverse selection works against pre-existing conditions, and so on). The governenment will have to fund and manage health insurance; however, we simply must reign in the exhorbitant costs and fees or nothing will work.

We continue to limit the number of medical students in the country's schools (keeps demand for docs up),allow unreasonable fees, etc. The Obama proposal will of course mean raised taxes, and is full of costs that we need to address or there is simply no way to afford it.. Medicare is scheduled to run out of money in 2041.

The current sysem is truly horrific, and the insurance companies are doing horrible things to maintain their profits. Sandra's plight is testimony to how crazy this all has become. You are right on target.

The thing that continues to amaze me is how many people in this country still don't seem to get the severity of the situation for so many others.
Rated.

Lea, your country's healthcare system is already looked on as immoral and inhumane, by those of us lucky enough to have been born north of the 49th. . I've said it before, and I'll say it again- Americans deserve better.

Yes, Wendell Potter, who appeared on PBS' show Bill Moyers Journal a few days ago. You can watch it here: http://www.pbs.org/moyers/journal/03052010/profile.html.

Great work here, Kent.

"Because what we must beware of is that the insurance companies employ people whose paid, full-time profession is to find new and ever more efficient ways to screw us in order to make a buck."

I suppose that is one point of view.

Health insurance companies are currently regulated by the individual State Insurance Departments, and are forced to comply with their rules regarding premiums and underwriting.

So, just change the damn rules.

How hard is that?

It does mean that well people will subsidize sick people, but that ends up happening one way or another. Just do it through insurance instead of medicaid.

By the way, I don't care if we get rid of insurance companies entirely.

However, big chunks of what they do, including saying no, beating on doctors with respect to fees, etc will have to be done by someone.

Rated, Kent.

I've also Dugg this just in case no one else did.

The Democrats' scam becomes more transparent

"As I've noted before, the column I've written which has produced the highest level of hate mail over the past year (in terms of volume and intensity) was when I compiled the evidence back in August that the White House was working to ensure there'd be no public option in the final bill at exactly the same time Obama was publicly insisting he favored it. The very idea that the President might be saying one thing in public and doing the opposite in private was outrageous and conspiratorial; a politician (or, at least, Barack Obama) would never do such a thing. Yet all along, that's exactly what the White House was doing, and it continues to do exactly that even though there is, at least, a significant chance that there are sufficient votes to enact the public option. That's the reason their explanations and excuses make no sense: because the real reason there's no public option -- they don't want one -- is the one they can't or won't admit." -- Glen Greenwald

Okay, BBE, I'll bite. So what are your suggestions? Give up and allow the Neo-Cons, End of Timers and Tea-Baggers take back over? The Democrats may be neurotic and semi-corrupt but the Right is totally psychotic and totally corrupt. Do not try to say that ALL democrats are the same as ALL Republicans if you believe that you totally out of it. Please don't mention Nader either, please. I have read your stuff and I agree with much of it but what is the answer?

I am going to check-out more of your writing. I like the way you mix the anecdotal with the rhetorical in this posting.

Dr Spudman, I hear what you are saying to BBE, but I really do ask who can I believe? Who is daring to speak the truth? The two Democratic leaders seem more worried about their individual powers than in helping their president who was voted in on a thunderous drumbeat for change. Are they envious or were they of his charisma? He outshines them and so many others in so many ways and yet no one is making this happen. Teddy is gone and where is someone else to fill that void? Anywhere?

Thursday morning I read a piece in The Guardian, probably my very favorite paper. Next to The Boston Globe. Can't help it. Was born there! Love the Red Sox! Back to The Guardian. Michael Tomasky wrote a piece on Thursday that struck me as the clearest observation on the Democratic failure to have already passed health care reform which would have really covered everyone. I truly believe that was what Teddy and Obama and so many of us originally hoped would happen now. I would give you a link but that is beyond me. Go to the Guardian at guardian.co.uk. Look for Tomasky on March 11th and you should be able to find it.

I don't feel that I am hearing honesty from anyone. Maybe from Alan Grayson but why should he have to cary the party and is Medicare the best buy in?

I lived under single payer in England. It was not perfect but I was covered. Not only was I covered but, because I was diabetic, I didn't pay anything. Let me repeat that. BECAUSE I WAS DIABETIC, I DID NOT PAY ANYTHING. I was under the care of one of the best consultants in the country. She did not have much of a bedside manner, but she had the respect of other consultants in London and was feared by ALL the staff in the hospital where I recovered from having the flu. How many of us need to go to the hospital for having flu? I was newly married and in my early 30s. What would I do here? now? What do any of us do here, now if we do not have the right card?

So much more but perhaps I will write another piece about that. Don't suppose many will read that either. My soul is screaming and I can't make anyone hear!

I don't care who is at fault. There are far too many to be bothered counting. I am screaming at MONEY that gets in the way and may they all burn in a place set aside for them in Dante's Inferno!

I am so terrified and so enraged that the country I chose to come home to can not see what is happening and does not seem to care enough to make something real happen. Democrats are as much to blame as anyone. And Obama, I feel, is letting me down. I applaud all he has tried to do. But it is not happening. Surely someone can corral the opponents who are simply stalling and blocking and keeping the votes away.

They should be stripped of government funded health care. I would vote for that. Stop the eternal posturing nonsense. Think of your constituents and just so the right thing!

Fight about other things, but, for God's sake, make sure that all your constituents are covered for health care.

I am sick and tired of comments thrown out even today about the fear that people will ask for more health care than they need, will ask for tests not needed. THAT IS A DIFFERENT ARGUMENT.

I don't want tests I do not need. I simply want not to be afraid that I should fall sick and can not seek treatment. Who is listening to the likes of me who has paid for insurance when I have been able to have it?

I have no calm about this. I am long past calm. My soul is screaming. Why is no one listening?

My answers are (1) primarying obstructionist democrats to remove them from power which includes Obama, Pelosi, Reid, Lincoln, Stupak, etc; (2) supporting the minority of Democrats who are right thinking like Kucinich, Grayson, Feingold, Massa - Kucinich is being targeted hard at the moment. (Massa was taken down by a tempest in a teapot scandal. Tickling male staffers is nothing when compared to Senator "I wear diapers with prositutes" Vitter or Senator "Toe Tappin' with a Wide Stance" Craig, both of whom are still voting happily. Massa is gone because he opposed the windfall for insurance bill and would have voted no along with Kucinich.); (3) supporting third party candidates like Nader so that the democratic party is forced to move from right of center to perhaps center sometime before I die. The democrats won't stop the wars, eliminate the insurance industry, or do any of the other things they should be doing unless they know they will be tossed out of office. Several organizations are working to make primaries happen. Firedoglake and the Accountability Now PAC are examples. Even ten bucks a month sustaining the third party of your choice can make a difference.

Blaming the Republicans for the failures of the Democratic super majorities and then voting the same obstructionist Democrats back into office again is not the answer. Accepting a bullshit reform bill that doesn't really fix anything and further cements big insurance into the healthcare paradigm doesn't help either.

Anna1-- Most are listening. I have no healthcare and will probably end up filing bankruptcy here soon over old medical bills for my son. It is the way the system works. I went blind in my left eye. Totally blind and I don't have the money to get it fixed. This is a corrupt system and there are millions of stories each day. Your rants are the same as millions of others. But the insurance companies are fighting with all they have to prevent any changes. They have evidently won the battle because of five Democratic Senators who act like Republicans.

The idea of insurance [the system around us] is unconstitutional. They make money off of their clients dying. It's both ironic and criminal.

Great post. Rated.

BBE--I compliment you on a good answer. The radical part of me agrees with almost all of it. The pragmatic part of me calls bullshit. Now, I need to explain. I have been in social work and education for forty years. When Democrats are in power my causes have funds. My people have services. When Republicans are in power my causes funds are always cut and my people lose services. So, it is simple to me. All of my clients live on SS payments of around seven hundred a month. A fifty buck cut is devastating to them. Republicans have shown over and over when in power that people like my clients do not matter as they have the Ayn Rand philosophy of life. We had a great Democrat as governor in Idaho, Cecil Andrus who was a near miracle worker. Now, we have this idiot Republican who is going to fill the prisons while cutting social programs. That is what happens. It is not theory.

On the national level, I hate Lincoln, Nelson, Stupak and that traitor Lieberman. They are the ones who ruined everything. The House under Pelosi passed many good bills that are over in the Senate rotting because of Lincoln, Nelson and Lieberman. If everything that the House had passed had been passed in the Senate many changes would have already occurred. I am not convinced that all politicians are the same; I just do not believe it the evidence is to the contrary. Going third party and all that is fine theory but will take years to change things. Me and my clients don't have years. I saw what happened in the 80's when the Republicans ran everything and they would be considered moderate by today's standards. If you and your followers splinter off you will hand the Neo-Cons power and control and they will never allow anything to happen to benefit society. They are the living breathing embodiment of the Military/Industrial complex. If they do assume power again this country will be done. I think they are after the National Parks and National Forest lands next as their plum cherries. You are playing a dangerous game here. They are cowards and wuzzies, the Democrats and others who do not value life. Ayn Rand's philosophy is terrifying and one that is gaining more and more momentum. End of Timers, like Imhoff, are waiting with glee for the world to erupt in nuclear war. Millions think the Rapture is around the corner. This a psychotic group ,a mob, that will embrace Fascism and happily put the nooses around their own necks. I agree in theory; I can't join you. It is too dangerous.

Kent, BBE and Dr Spudman,
Thanks for your listening. Why are we represented by cowards? Why do people speak as though they have courage only to make way for people who only know how to play safe and guard their own financial interests?

Does the White House ever look at OS? They should. Someone who can make a difference should.

Dr. Spudman, I am listening and I hear you. I so hope you do not have to declare bankruptcy and I can only hope that your son is well now. I am so sorry about your eye. Why could I live in England and at least know that illness did not make me a pariah? Why do I find at home, at least the home of my birth, that I have become a person no grata because diabetes runs in my family?

So I wonder, is there someone somewhere who could start an insurance that doesn't prohibit anyone from being covered? Is there a celebrity or wealthy person somewhere who could start such a company? I bet there is. Who is it and where are they? I am sure there is someone who could help us if government fails. People should not be afraid to be sick and should not be penalized because they are. Nor should their children or spouses, gay or straight for that matter.

Done for the moment, but thank you for caring enough to respond.

You can work all three prongs simultaneously. They are not mutually exclusive. You can support third parties while at the same time contributing to Kucinich and Halter, the guy who is challenging Lincoln for her senate seat in the May AR primary this year. If you don't support more progressive third party efforts, the Democrats will see no incentive in moving away from the right and more to the center.

Your point about your governor is valid, but that is state. I'm talking federal. Here is a good litmus test: any Democrat who continues to vote for war funding needs to go. Check the roll call for those votes and you will understand how messed up most Democrats are. I understand the value of fifty bucks a month, but have you ever considered that the only difference between the democrats and republicans is that today's democrats toss you a little bread and circuses while bending you over. Yes, you have that fifty bucks a month, but in the end you are still screwed. Wars are still funded while healthcare is sold out.

"hands off" approach...pfft
They need to take their "hands off" their hips and on to some reform.

Kent, the odd thing about these anecdotes of insurance companies always trying to avoid paying: If they are so good at avoiding paying, then how is it also true that we spend the most on healthcare in the world?

I just published a post that paints a different picture of of what we may have to fear.

Financial Collapse as Preview of Healthcare Collapse

Kent, I'm finding more and more on this topic, that words fail me. Not for lack of things to say, but for lack of a suitable place to start, and for lack of words strong enough.

The health insurance companies are the robber barons of the 21st century. I sure hope only the early part. But that doesn't begin to capture it.

The underpinnings of it all, is the systematic undermining of our democracy. There are two dimensions to that -- the political partisanship aspect (I urge everyone to read George Washington's farewell address on the topic), and the corporate personhood aspect. These two aspects combine to form our political economy; each serves to SYSTEMATICALLY dilute and divert our voices, inputs, and ultimately, to rob and misdirect our tax dollars.

It's not that they're stealing our tax dollars, per se. All these services do cost money, after all. But by federalizing everything, or by moving school funding from local to state control, etc. -- our local and individual voices in priorities is diluted.

So this is what's happening with healthcare: We already have a system that, through tax incentives and legal protections, insulates insurance companies from any effects from their direct consumers -- because we're not the customers. And because it's private, politicians can wash their hands of responsibility, even though they maintain the structure of the system.

So we have the Republicans, on the one side, who want to federally mandate that we throw the door open to the state with the weakest regulations, and the Democrats, on the other, who want to federalize it, and regulate a bit, keep people from being thrown off and pay scarce dollars to get people on who aren't now.

But basically, keeping the same employer/insurance firewalls in place, and rewarding the insurance companies with a subsidized boost in customer base.

Mind you, I'm willing to pay tax dollars where needed to get universal coverage. What I'm NOT happy about is not fixing the problems, where there is no real control over how it's run.

At least with a public option, we can point at Congress. This scheme means that Congress can say, "it's the insurance companies", and the insurance companies can say "look at our profits, aren't you proud of us!", because they only have to talk to their shareholders, not to us.

In the meantime, 30% or so of our healthcare dollars go into these whirlpools, and big chunks of that are broken off to fund political campaigns and lobbyists to maintain the status quo.

It's really not that the Republicans are blocking everything. They're simply in competition with the Democrats to milk the issue without changing anything much.

Meanwhile, roughly 30% of our healthcare expenditure goes to these companies in exchange for pooling money hand creating the most byzantine payment system this side of the Federal income tax!

The crowning irony is that at one time, some of these companies were non-profits, existing for the common good.

Very good post and excellent discussion.

I don't have much to add, except this: In the same way that single payor would reduce the overhead cost of medical insurance, treating medical care itself as a single system would reduce the cost of medical care.

When people talk about reducing the cost of medical care, this is often stated as a problem of overutilization -- too many people seeing the doctor for head colds, too many people demanding unnecessary diagnostic tests, and so on. But I don't think that's really the main problem.

In my years working in the financial side of health care, onc thing I noticed is that every hospital and health system wants to have the latest and greatest. Everyone wants to have the latest MRI, CAT scan, PET scan, state of the art this-and-that, their own cancer center, their own transplant programs, etc., etc. And on top of that standalone facilities spring up -- imaging centers, labs, and so on. And then all of these places have to "market" their services and fight for patients and physician referrals. And sometimes physicians even have a financial interest in these facilities.

Many of these things involve huge capital and staff expenses. And in such an uncontrolled environment, it's easy to end up with too many hospital beds, too many clinics, to many labs, too many imaging centers, etc. And all of this overhead has to be paid for.

A more systematic approach would involve regulating purchase of equipment and construction of new facilities. Hospitals and clinics would have to get approval on this stuff and prove that it was actually needed.

Of course the conservatives would call this "socialized medicine." But it really is necessary if we are truly interested in controlling costs, and it is something that could be implemented at the state and local levels.

The question is really quite simple -- are we going to become a civilized society or are we going to continue to allow ourselves to be ruled and ruined by jungle ethicists?

Mishima, I always like your straighforward comments... even when I disagree.

In this case, I know that I do not want the government involved in deciding how many of what type of machines should be available. There is a zero chance that they will get it right.

If your theory that there are too many machines chasing too few patients were true, then prices would be going down (supply > demand). Given that prices are not going down, then it likely means the cost increases are unrelated to the number of machines.

There's not much to add to these fine comments.
The Dem plan has a few nuggets of value, such as supposedly ending rescission, but fails to control costs. The mandate invites popular anger, and I am inclined to believe the true costs of the sop to Big Useless Insurance will generate deficits.
Politically, the mandate to feed Big Useless Insurance will give the Repubs a solid hammer to use on the Dem's thick heads. The fact that the Repubs could only do worse - if they were actually inclined to do something to benefit America - won't sway voters.

All things considered, the plan would do better if it kept the popular changes, and dropped the mandate. Feeding what has already proven to be unworkable isn't good politics or a wise business decision.

Mishima and Steve, at the hospital I go to, I've been by the rooms that have the fancy machines. They're often idle. This is a consequence of competition. Presumably half of the machine time at one hospital is not used, and half at another. But if profit were removed from the system, they could just send everyone to the one hospital and wouldn't have to buy two machines. I'm sure there is a lot of ego and one-upping each other that is involved in this, and in some cases the “best” hospitals probably pass through whatever cost to whoever's paying. To me, the true cost of the machines is not known because it isn't divided across the number of patients. For a few dollars an hour to have an operator on more hours, not millions of dollars more investment, a lot more people could be seen. So the cost we speak of is entirely artificial and until we change it to just be the cost of getting the machine and not the cost of marketing, the cost of lesser capacity because of competition, the cost of not caring because it's about profit rather than wellness, etc. we won't have any idea how much we've been wasting. Once we see we're all in it together, we may reconceptualize how we use our resources. The notion that a cut in money must result in a lowering of service seems very controversial to me, and requires a lot more support than the things I've been hearing lately which are all of the form “we're used to spending $X so if you give us 3/4 of $X, you'll get 3/4 of the care.” When they talk about cutting welfare they assume that cutting will lead to better efficiency. Are they saying that's because there is waste and abuse in welfare but none in medical care?

Although I'm pretty conservative in most areas, I do think the time for socialized medicine in the United States cas arrived. This does not mean people still can't go to private doctors, any more than socialized education means that people can't choose to attend private schools. It does mean that no one should ever be denied needed health care because they cannot get health insurance or because they cannot afford their medical bills.

Spudman, what can I say—you make a compelling case and I'm swayed. Let's save the billionaires.

Rob, thanks for bringing me back to reality. Spudman almost had me there. Yes, you're right. It really is a moral chasm. That it comes from the party so used to claiming the moral high ground is stunning. It leaves one almost speechless. Well, almost. I always have a good speech in me somewhere.

Sandra, great point about those people. I often mention that I think health care is holding back fluid motion of employees. The Republicans talk about the need for a healthy free market, but they mean a market of retail people. The market of employees is in fact stagnant because employees are in many cases very afraid of leaving on employ for another. Oh, and regarding the poem—I have a graphic of that I almost used here. I totally agree it's appropriate.

Walter, thanks. I really appreciate your support.

Gary, yes, hearing that guy call in was quite something. A lot packed into the voice. And I transcribed him as closely as I could, flaws and all, in part because I think it underscores that he was not just reading from a script. I heard that on C-SPAN and made a mental note that it was an important bit. I was so glad I could dig it out when I decided to do this post. I think it really adds to things.

Anna, thanks for your thoughts. Yes, death is a hard topic.

Rick, thanks for the support. Regarding the Republicans you see having a hard time with it—it's true that a lot of the problem is cognitive dissonance. I think most of those people would love to support the reform if only some leader would help them find the way to not lose face and to feel it was consistent. We who are not Republicans can make suggestions, but the present wall of isolation that has been built makes it hard, as Obama has observed in his sessions with Republican leaders, for anyone to go along. How very sad.

BBE, many of us are not blind to the notion that the Democrats are not moving as fast as they promised. But Spudman in a later comment has it right—what would you have us do? I am not of either party. But with all due respect to Rumsfeld, sometimes you go to the ballot box with the candidates you have, not the candidates you wish you had. Absent preference-order voting, I have to vote based on who will actually be elected. It might be that Obama is in many ways like Bush. But he's still better than Bush. That you're quibbling about how much doesn't change that. Better candidates, at least right now, haven't a snowball's chance in hell. I have on other occasions written things critical of the Democrats. But at the end of the day, the choices are not perfect.

Blue, yes, the Dems (and others opposing the Party of No) need to be more organized.

Grif, it's a good point about medical students. I think it woud help a lot if the government would plan for an appropriate number of medical students and fund scholarships in areas we're short of.

Bonnie, I agree, and to this extent I agree with BBE. If any sitting Democrat is blocking this legislation, they should not feel comfortable in their seat. That said, though, if a Republican offering worse is all that's running against them, I don't think voters should be stupid.

peppermint, thanks for the perspective from up north.

Leslie, thanks for the link. :)

Nick, I think it's not only acceptable but desirable that people who are well should pay for those who are sick. That is naturally done by taking it out of taxes. Also, to your other point (or one of them), it isn't that someone in a revised system won't still have to “say no” as you suggest. It's that the present system is about pushing a bubble under the rug, pretending that if you just push off a problem on someone else, you've saved money or made things better. But really that's not true. So it might be someone gets said no to, but the ponit is that all of it has to tally on the same sheet so we can see really how we're doing and not hide it.

Late, thanks for the digg.

BBE, the President should be held to his “promise” to insist on the public option. I'm not in disagreement there.

Adam, thanks for the compliment. I'm glad you enjoyed the piece.

Anna, thanks for stopping back by with more comments.

BBE, I'm with you on (1) and (2), but I disagree with (3).

Evil, yep, it's really that bad.

Spudman, I took BBE's idea of primarying as the safe thing because as long as someone else emerges from the same party, you haven't given things away to the Republican. If no same-party candidate comes, though, I agree with you we can't just give it over to the Republicans.

Anna, if the white house ever looked at OS, someone would probably have them impeached for the content we have here. It's really NSFW. It makes me sad there is no alternate cover for political topics.

Amanda—any suggestions about how to get them to do it? :)

Bob, I agree with you on the robber baron analogy, and certainly agree that at least the public option would help. I hope we get it, but you're right there's a lot of corruption.

Tom, nicely put.

Paul, I think the mandate may be politically unpopular but is the absolutely right thing. People must save while they are well for times they are sick. People who think they can put this off are deceiving themselves. Even if they have the best of intentions to do it later, if they are in an accident later, they may find they are unable and have missed their chance to contribute. In short, there is no way for them to fairly guarantee they will really do it other than to do it now, not later. The system needs to be paid for by the healthy, all of them. That will be maximally fair.

Cindy, thanks for the support.

David, great to see you here. I think it's odd this is painted as “not conservative.” Maybe on another day I'll write a piece explaining why I think health care reform, even single payer, is still “conservative.”

Kent, I didn't intend my comment to argue for a Public Option, though I agree it would likely help that issue a bit.

The approach I'd advocate is to kick the props out from under the insurance companies..

I'd cap profits and overhead. There's simply no excuse for charging that much money to move money around. Given how inefficient they are, I'd cap it at a level that they'd lose money unless the become more efficient.

That's pretty radical and non-market, but I regard it as a penalty for their past non-market operations.

And I'd blow up group plans. Your employer can pay, you can pay, or some combination, through your paycheck, or directly as you will, but all plans are individual, and individually chosen, and it's yours even if you leave the company. Perhaps some portion of unemployment insurance could be hardwired to go to it as well, unless you're also covered by another plan.

(I'm not sure dual coverage makes sense in such a world. The reasons it makes sense now are mostly due to the current twisted situation).

Employers would be required to continue their current contributions initially, ultimately transitioning it to regular salary/wages.

Insurers could compete on price, service, auxiliary services, or any combination, but they have to satisfy the employee.

Absolute ban on recisssion, with MAJOR penalties. Some of the practices we've seen should result in the corporate death penalty: a ban on their doing business in the field.

I think the Democrats are missing a great chance to steal Republican thunder (which the Republicans aren't using anyway), and restoring marketplace competition to a currently government-mangled non-market situation.

McGarrett50 writes: "If your theory that there are too many machines chasing too few patients were true, then prices would be going down (supply > demand). Given that prices are not going down, then it likely means the cost increases are unrelated to the number of machines."

Or, the other explanation is that health care doesn't follow the standard model of supply and demand. Let me give you a concrete example using an imaginary situation to illustrate what happens in the real world.

Gotham City has two hospitals, Riverside and Central. The region around Gotham City requires around 50 kidney transplants per year. Central Hospital has a kidney transplant program that performs all the kidney transplants.

But Riverside Hospital doesn't like that. They want the prestige of having their own transplant program so as to attract more paying patients and renowned medical staff. And the nephrologists practicing in Riverside don't like the fact that their patients with renal disease end up leaving them after their transplants to be cared for by the doctors at Central who specialize in post-transplant care. And when that happens, Riverside Hospital also loses revenue. Since kidney transplants are covered by Medicare, all of those patients have insurance. So Riverside is losing surgical revenue from not doing transplants, and also losing all of the post-transplant revenue, which is significant.

So Riverside starts their own transplant program. That means that they have to hire a transplant program director, social workers, and other medical staff who specialize in transplants and post-transplant care. And a hospital has to have all of that in order to have a transplant program. It's kind of like having a restaurant -- whether you serve 10 or 100 dinners every night, you have to have a manager, hostess, bartender, cook, servers, and so on.

After Riverside starts their own kidney transplant program the patients are split between the two hospitals, 25 per year at each. So you now have twice the overhead distributed over the same number of patients. And instead of having one strong program at Central Hospital, you now have two weak programs. This is because medicine is indeed a "practice" -- as a transplant program staff cares for patients they get better at what they are doing. Their outcomes are better, and patients require less hospitalization. This translates into lower-cost care. So you end up with higher overall cost, because of additional overhead and more costly care.

This is a consequence of profit-driven health care rather than managing health care resources systematically. As Eliyahu Goldratt notes in his Theory of Constraints, the system optimum does not equal the sum of the individual optima. Stated in ordinary language, the above example shows how two hospitals doing the best they can with two programs creates a worse situation than a single hospital doing its best with one program.

The best first step is to take away the anti trust exemption from health insurers

During the 1990s my mother lived with me for the last 4 1/2 years of her life. I am the eldest of 5 siblings. Not one of them thought to help me with caring for her. She had suffered a massive stroke which effectively removed her ability to function as an autonomous adult. Everyone interacted with her as if she was unchanged and got angry when she didn't act as they wished for her to act.

Before she came to live with me, while she was in recovery my uncle and her husband at the time went through her household possession and had a yard sale. Neither of them knew the value of my mother's hard won possessions or which things were heirlooms. They were just trying to come up with some money to deal with the situation, but they were as ill-suited to the task at hand as many of the folks who are making the decisions at insurance companies. The difference being that my family wasn't acting out of greed, but out of necessity.

Eventually, because of their failure to understand her medical condition her husband divorced her, and my uncle's wife was incapable of learning how to get the kind of help my mother needed and so she came to live with me because I couldn't bear the unintended cruelty of her situation.

During the time that I cared for her I was unable to work in a full time job. The financial cost of replicating the level of care I gave her made it silly for me to work. There were no tax deductions for people in my position. No recompense for the fact that I was paying back student loans for a career I wasn't free to pursue. Had I chosen to find a convalescent home to take care of her they would have had to accept her on the basis of public benefits she was entitled to in California where she had lived most of her life. But since I was providing her a home, there was nothing because our culture does not value taking care of our elders or the people who do it. This is, and has been for sometime, how we deal with aging and health related issues. We push these problems off on whomever is compassionate enough to accept the burden. We allow old folks like my mother, who worked hard physically all her life and was literally retired by a massive stroke, to fend for themselves when they are no longer capable.

This isn't just the Republican plan by the way. Clinton was President when I first started taking care of my mother. Plenty of families get sandwiched between their family's young who still need help, and the aging, like my mother, who needed our help.

A month before my mother died I took her to a doctor because she had radiating pain in her arms that she said made them shake. It was the best description of the symptoms she was experiencing she could come up with before she died of a massive heart attack. It was a mistake made by a perfectly honorable doctor who was probably overwhelmed by the volume of work she confronted. Mom had to go to a public health practice facility for care. If she had the insurance that I have now and the private practice doctors would have done more, and perhaps she would have gotten to know Aidan, who is turning ten years old next week.

My feelings about the healthcare debate are marked by this painful experience. It all makes me so angry. This was no way for my mother, who was room mother many times at our elementary schools, even though she had a full-time job throughout our childhoods, and she did this for each of five children. She was the one who would cater a community event that no one could afford. She contributed. She didn't deserve what happened to her and every time I hear these selfish bastards justifying their political positions I think that if it was their mother they probably wouldn't want to be such selfish ass-hats. But probably they would.

I appreciate your analysis Kent. But in the end, I think we should just remember we are taking care of our folks, and they are all our folks.

Bob, yes, I agree with a number of those ideas. See my article on health care reform from a few years ago before I started blogging.

Mishima, thanks for the concrete example—this was exactly the kind of thing I was predicting in a more theoretical way in my remarks to Steve above.

OE, I pretty much agree about anti-trust, although I have heard discussions which have pointed out that it might not do as much as you think (even though I still think it couldn't hurt) because the real game is in large pools, and competition from a small operation won't be serious. This is a system where fewer operations should be better.

Well, then, some say, let's open up competition across state lines, some say. And again I'm not strictly fearful of competition, but there is concern expressed that all insurance companies would suddenly home in some state like Delaware or South Dakota, committed to to attracting business by adjusting their state laws to make it favorable for one or another business purpose. So heavy federal regulation might be needed to make sure the effect of cross-state-line competition was fair.

All of these factors really say that competition on a per se basis like it happens in other industries is not necessarily the way. Until the goal is saving people on a large scale and not making a profit on a large scale, we're going to have problems.

I am quite fearful of incremental solutions to fix what is really a systematic problem. To use a kind of goofy analogy, it's like replacing the heart of a human being with something that runs on gasoline rather than blood. You can't just replace the heart or just replace the fuel lines. It kind of has to happen as a system all at once or it could be worse than what you have.

Susanne, I agree we should care that it's our folks, but again I think the problem is that (sadly), for some of our population, their folks are gone, and that allows at least some people the luxury of thinking that it's something they can ethically ignore. Other people's folks may not seem to matter. And it also ignores that some problems are curable problems not of old people, but young ones, who if you got them back into the work force would be cost-effectively caring for themselves and paying back to society that investment. So I don't at all discount the hardship you're describing; rather, I think it all has to build together into a larger whole. It's not just any of these things like the one you raise, it's also these things.

The structure of the Health Insurance industry is what makes it the way it is. Americans change jobs ever 4-5 years. They change insurance every 3-4 years. That means investing in their customers' health is a short-term proposition. Take the example of a 6 month intensive effort helping someone learn to better manage diabetes. It might have a substantial pay-off in both customer health and lower claims.

But, the insurance company only profits if the pay-off is within a few years. Further, if they develop a good reputation with diabetics, they might end up with a sicker customer base and higher fees, driving the healthier customers to cheaper policies.

In short, an insurance industry working for their customers' health is not going to happen without structural change.

The same is true for financing of hospitals, as per Mishima's post. We need radical change, not a few tweaks making the current system a bit better and last a bit longer.

Malusinka, I agree with your analysis. Thanks.

I didn't mean that they are our folks, i.e., parents, but that all people are our folks. My grandson had two holes in his heart when he was born. His mother was only 23 at the time. What was she supposed to do? At one time I was taking care of him while I cared for my mother because who could afford a nurse? How could we leave him with someone that didn't understand his heart problems?

I think we are overly intellectual about this and remove ourselves from the reality of what it means to be responsible for sick people.

My entire point is that everyone belongs to everyone else and if we intellectualize ourselves out or realizing that we are treating people this way, then we have reached moral and ethical bankruptcy as a nation. We can't fix every health problem, but, some are worth fixing, and I believe that people like my mother could have been saved for a whole lot less money than is recognized. Her life meant a lot in the productivity of our family. My grandson is 15 now. Fixing the holes in his heart was very expensive and was very challenging for him having surgery at 13 months and another when he was six. I get the feeling that some of these folks would, metaphorically, simply have dropped him into the river and left him to float by simply leaving his heart untreated. Really, we've been arguing about this my entire lifetime, since the Truman administration. All the politics and intellectualizing hasn't changed a thing.

I agree with what you say, and can't phrase that agreement any better than CoyoteOldStyle's comment above. Good work, and a good reminder.

Yes, Kent, "They are us." That is a profound observation. It is essential that we do not forget it in the waning days of this debate. There are many websites containing verbatim stories of families and lives destroyed by lack of access to health care. Each story, one would hope, would carry enough weight to help cut through the curtain of denial that has descended over the issue. And it is right to be outraged that all of these stories, taken together, do not yet have sufficient collective weight to advance this cause against the entrenched financial interests that thrive when legitimate claims are denied.

Susanne, thanks for clarifying. Although, even as I agree with you, something in what you write reminds me of something I left out: This issue also gets tangled slightly with the immigration issue, since the urge not to help people also extends to that. I think that's a pity, the moreso because many poor countries take in our people willingly and often offer them better care than our own country would, without that bitter/xenophobic notion of treating only citizens.

Saturn, thanks for the support.

Steve, your support is appreciated as well. And yes, the outrage is what's amazingly absent... I think mostly because people just don't know what to do. BBE urges various actions to get better representatives in place, but that's almost glacially slow. And short of that, I think people are so stunned. Also, this preys on the weakest, the ones least likely to march on Washington or anything dramatic like that. Most people caught up by it are lucky if they can afford anything once their lives are spiraling down the drain. And this busy silence is mistaken for complacence by many.

Yep. It's repulsive. As someone who is with Anthem "We're huge evil greedy fuckers who should all get a terminal disease and die" Blue Cross, I can tell you, the interesting mail and robotron phone calls I've gotten from the company about their rate hike ... priceless. Their main interest seems to be fishing to find out if I'm going to dump them if they raise my rates too high. The answer to this one is YES. But will I be able to find other insurance? Not so clear.

Excellent Kent. I don't have much hope that Republicans will see the 'us as them them as us' analogy. I don't think it is in their make up. My Republican friends believe, truly believe, that capitalism is the great equalizer, and, that the states can manage to govern, no need for the feds, no need for regulation or any more provisions aimed at the public good. They really, truly believe that is what the Constitution demands. And, they feel fine with that position. By and large, these people are self proclaimed Christians, and all of their us v. them ravings seem counter to what Jesus/God - whatever - would advocate. I find it confounding. I will try to find time to go back and read your past posts linked here. xxa

Great post, as usual, and terrific discussion.

I got that sinking feeling, again, watching Real Time on Friday night, when the former (Republican) governor of New Mexico said, of health care reform, "We just can't afford it."

Yes, we can afford several immoral and illegal wars, and hand out billions in no-bid contracts to mercenary armies and contractors who do substandard work, but we "can't afford" to give our citizens access to basic healthcare that will alleviate suffering and prevent needless death.

This is where we are, and it's a really depressing and ugly place to be.

Odette, I don't think the market is functioning—they'll just use it as a way to exclude things. Be careful switching.

Akopsa, it's just perplexing and maddening the way many people who call themselves Christians behave politically. I don't think they can realistically answer the somewhat cliche yet still apt question, “What would Jesus do?” with “He'd say ‘Every man for himself,’ and ‘If they didn't provide for themselves, I'm damned sure not doing it.’ ” I have long since given up religion myself, but I certainly have not forgotten my basic Sunday School teachings of how to be kind and caring to one's fellow man. A pity they can't do the same.

Jeanette—Indeed, without a healthy population, there's little we can afford. A correctly functioning economy requires workers capable of doing the work, not home sick or taking care of others who are sick because no one else will.

Kent, you always explain things very well. Although I didn't support Kucinich, his position on the government single-payer health care system is closest to my own. But I don't expect to see that, or anything very close to it, in my lifetime. Which reminds me of that old joke, adapted to current circumstances.

God decides to answer the questions of three world leaders. First he appears to Wen Jiaboa, the Prime Minister of the world's most populous country. "Is there a question I can answer Mr. Wen?" "Yes God, will China become the most powerful country on earth?". God replied "yes, but not during your term in office."

Then, He visits President Calderon of Mexico. "God, will Mexico ever rid itself of the narco-traffickers?" "Yes," God replied, "but not during your term in office".

Finally, He visits Obama. "God, will the U.S. ever have a health system that provides the same type of care to the poorest of our citizens as it does to the President of the United States?" "Yes," God replied, "but not during my term in office".

Abrawang, I see the joke you're going for, but I can't really believe any god worth praying to would have such an attitude. I'm not religious, but I am troubled by the number of alleged religious adherents willing to promote the “every man for himself&rdqu0; theory. It shouldn't require me to say this, but that just isn't a Christian theory (not that Christianity is the only religion, but if you listen to certain Republicans you'd never notice that). Christians are called on to treat the poor with compassion and that's not what present health care is about. They are admonished that they should expect to be judged by how they have treated the weakest among us, and especially given how soon they think the End Times are arriving, I just don't know why they think they'll be getting through any gate into Heaven with the political positions they're pushing.

Kent/Mishima, I am late in coming back. I think Mishima's example helps make my point. The hospitals with the same machines in the same town are in fact competing with each other and normally that would be good for consumers. Unfortunately, because the consumer is not the empowered individual, then the competitive effects do not work. Having the government take over more of healthcare and become the primary payer will only further divorce the consumer from their transaction. The end result is that people will not care who they pay or what they pay because they don't pay. That is how demand exceeds the supply, the market distorts, and costs balloon.

Also, anecdotes about supposedly unused machines is not a good basis for a major policy change. I could just as easily argue from anecdote that in a major incident in that town that two machines would not be enough to treat patients quick enough and some would die.

I don't think anyone answered my original bigger question which was how costs are so high if insurance companies are so successful at denying claims? Also, insurance profit margins are not above average.

As a note, I would favor something more like Singapore where everyone gets high deductible insurance and the consumer pays for most day to day healthcare and tests. With the consumer in charge of most intiial payments, competition would work.

Steve, even ignoring the argument that the Republicans had a long time during which it was clear they got their way on everything and they made no attempt to get this going so it's 100% clear that there is no on who's going to cause your fantasy competition to happen, the fact is that the insurance companies are not going to compete over care because they aren't required to. They're competing over what money they can make. It is insufficient for you to say “I can describe a system in which the money flows a certain way and it's good for people and good for companies.” What you have to show is that the system you are talking about will actually produce that outcome. Even just right now we see that insurance companies are raising rates in a “free market way” because they know they can make more money off of a few easy actions for people with a lot of money than off of a lot of detailed things on a lot of people with middle or no money. There is simply no reason to suppose the outcome you describe will happen. Could it? Sure, it might. But it's equally plausible—even more plausible, given recent behavior—that the companies will just both have surplus capability, will both raise their rates, and will both just say “that's the cost of doing business.” You don't get the kind of market that works out all the kinks except where you have really a lot of market players and a lot of options. Health care is not like that. The market there will only optimize what in computer science we call the “high order bit,” or “most significant bit.” There isn't enough precision in the engine of capitalism to worry about details like the ones under discussion. Markets crank out interesting products and low-cost products but they don't guarantee to find “best” products. That's why, for example, Facebook (even for all the competition it has) still attracts so many people even given how pathetic its user interface is... It doesn't have to care about the user interface because it can efficiently compete just on the people it has attracted. As soon as the hospitals found something they could compete on, they would become complacent, too, because really struggling for best effect is hard work—and occasionally expensive, and if profit is their motive, they're not going to be interested. They won't be content to get close to a good profit and then throw it all away just because there are a few more people who could be saved.

Kent,

I agree that we should all be past the idea of market perfectionism. The market does not necessarily reward the best-functioning product at the lowest price. In addition, as you suggest, healthcare is inappropriate for a marketplace of any kind. Markets deny goods to those who cannot afford them. If you believe in a competitive market for health insurance and/or health care, you believe that the rich have a right to superior screenings, preventive care, tests, physicians, medications, etc. In the marketplace, the rich can have bigger, safer cars, larger homes, more durable clothing, etc. A market for healthcare assumes the same divergent outcomes. This is obviously okay for Republicans. It is not okay for me. I find it morally reprehensible. But then again, I feel the same about torture.

This is a simple moral question. Is healthcare like a car? Do rich people get, in every aspect, a superior product?

I read Sandras' post a few days ago. And as I commented to her, I am in the same boat as here husband. I had insurance for most of my life. Then when I was forced to retire, I had to seek "private" insurance. The very first time I saw a doctor with my new insurance. I was told they would not pay, because of a pre-existing condition. I still do not know what it was. They never told me. It had something to do with my bloodwork, that I know.
I never expected to be dropped. I had a $7000 deductible and was paying over three hundred dollars a month in premiums. I got dropped over a $90 dollar office visit. Like you said, if it can happen to one of us, it can happen to all of us.
The insurance companies are in business to make money, not to dole it out. They should never have been allowed to be in charge of Healthcare!

Kent, you are mis-identifying who will compete. When consumers pay most of the day to day bills then doctors and other providers will compete for consumers and consumers will price shop. This is exactly how eye doctors, car mechanics, plastic surgeons, home repair, etc work now. Insurance only comes into play when there is a catastrophe. Based on the mail I get and the amount of TV advertising, insurance companies compete for my home and car insurance like crazy. Given a true insurance market instead of the employer based market we have now would result in the same for high deductible health insurance. I accept that some regulation of this insurance would be reasonable to minimize abuses by companies and also expect that some small gaps in the market might necessitate some subsidies to cetain individuals. I do not believe that the gaps justify a complete centralization of all healthcare payers.

As to your theory that medical providers are complacent, I would argue that the last 40 years of huge surgical and drug innovation occurred precisely because providers were competing to come up with new and better ways to deliver products and services. Once there is no competition and profit, they will almost certainly stop... just like the phone company monopoly in the 60's and 70's where everyone got the same plain jane phone.

As to who should have to produce evidence of improved results, I think it is the people who seek to mandate changes and take away freedoms who should have to provide evidence.

And, just because I notice these things, my question of how costs are so high if insurers spend all their time denying claims remains unanswered. Methinks the problem is not the insurance companies but they are an easier target than the real culprits. Pay no attention to that man behind the curtain...

Steve, you'll need to do more than passively accept that regulation of the market is needed, you'll need to advocate it. Because when your loyal opposition does it, it's seen as a socialist plot. If you and a lot more people aren't willing to stand up and say that this needs to be done, other parts of your plan can't work.

I wouldn't say that all that innovation happened due to competition, for example. Rather, I think a lot happened because insurance companies had not yet figured out that this was the inefficiency they needed to work out of the process because it was hurting profits. I would say also some of this was gone after defensively, to avoid lawsuits, the lawsuits they'd like to avoid in tort reform.

In this one, I think the burden is on you to convince me (to convince me that a completely new course is not needed) because you people were in for too long and ran it into the ground. Arguing that the status quo is okay isn't convincing me. I doubt it's convincing many these days.

Also, by the way, if we had a single uniform standard of what people were entitled to, rather than myriad systems, the paperwork would be way less. Substantial paperwork would be eliminated, but there would be other subtleties. Huge amounts of time are wasted by sick people who could be trying to recuperate or by friends/family who should be working simply chasing down their benefits. That lost productivity would save money, too. The present system of racing between schemes has very high costs. Every company wouldn't have to have an expert explaining their plan. That would save money. Let medical businesses compete on price of service (I can give 1000 shots for the least money, I can take out 100 appendixes the most safely, etc.) but as far as banking money to be made available for care, a single large pool can do that way more efficiently than a zillion little ones. All the payments would be done by taxes, which we're already set up for, and which already makes sure people really pay throughout their lives. Why have competing services just to do the same commodity job.

But I appreciate your engaging the debate.

Leonce, sadly, I think there are really people who will make the unabashed claim that health care has always been and should be about rich people getting better care than poor people. And while I can imagine this might even be realistic when you touch high-cost issues where a rich person wants to pay to try every last thing, I think it's really (as my title says) beyond the pale to think that ordinary care on a broad range of issues should be that way. Among other things, a modest investment by society in bringing a person back to health will quite often yield financial returns to the society as a whole. Apparently, some people's notion of “pro-life” stops at birth.

Kenny, thanks for adding your story. I'm sorry to know it happened to you but happy to see you able to tell the tale.

Karin, it's worse. The employees are in most cases obliged to be sociopathic and could be fired for not being so. (Principals of the company could be personally sued as well, I think.) Employees are pretty much obliged to act in the best interest of the company, which must in turn act in the best interest of the stockholders. They are not permitted to use other issues as a consideration as long as they're within the law, which is why laws are so important in this area in the US.