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« Blogging, then | Main | Help Geoff »

Jun 29, 2009


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I'm a retired fed, so I have that much-ballyhooed federal health insurance. Not that it's the same thing that members of Congress get. It's BCBSNC.

So, speaking of choice... Once a year open season comes around when I can change insurance companies. Years ago, I remember several dozen health insurers in that list. Last year, it was just about half a dozen.

I've had two surgeries since I retired, one major and one a minor out-patient thing. In both cases, I was theoretically free to choose my surgeon and my hospital. However, because the costs of going out-of-network was prohibitively high, my choice was severely constrained. The same applies to choosing a general practitioner, a dentist, or any other care provider. Staying in network constrains choice and going out of network carries a price, a prohibitive price for big-ticket items. So, it's an illusory choice.

My mother suffered a lengthy, debilitating illness late in her life. At a critical juncture in one of many hospital stays, she was discharged against her doctors' expressed will (I was in the room) because her insurance company declined to pay for any additional hospital days. Phone calls from myself, the doctors, and hospital staff change nothing. My mother had the choice to remain at the hospital, receiving the care her doctors said she needed and that could only be provided in hosptial, if we were willing to pay the $10,000-per-day bill. We could not, as most cannot. so, again, the choice was illusory. The insurance company prevented my mother from receiving the care she needed.

More people have had similar experiences than have not. The dominance of a handful of giant health care insurers has reduced, not expanded, choice. Time to focus on the health of Americans, not the health of American insurance companies and HBO's.


just: the personal and painful situation you described is a fiefdom, not a market. The participants are serfs, not consumers. Changing feudal lords sounds promising, however. I'll read more about the model and get back to you. Until then, to your good health.

greensboro transplant

i don't think anyone over the age of 45 would disagree that the current system is broken. i didn't contribute a penny towards my health care until the early 90's. now i pay ~ $300/month. the quality of care has not gotten that much better in the past 20 years.

but obama's ideas are not new, bold ways of thinking. they're socialized medicine for the 21st century.

how are his plans going to:

a) increase competition
b) improve availability of care
c) improve quality of care
d) increase personal responsibility for health issues

his plans will do just the opposite.


Beezle: I agree that it it is a fiefdom, not am market. But I dodn't believe that the market can deliver effective helath care for all. The market is driven by profit. If something is perceived as unprofitable, the market will not supply it. Health care for all cannot be both profitable and effective.

Greensboro Transplant: Almost everyone in Canada and most of Europe cannot fathom why we Americans put up with such an inadequate and unfair health care system. They have good reason. I don't care if you want to call it socialized medicine. So what? We have socialized power companies, socialized police and fire departments, and socialized military. No problem there. No one is keeping score. It's only the whackjobs who are more interested in pushing their ideology than they are in keeping people healthy.

greensboro transplant


i respectfully disagree. i think your characterization of "Almost everyone in Canada and most of Europe..." is just plain wrong. no self respecting Brit participates in their social medicine system. and the survey reports i read about canada (google for them) are mixed at best.

competition reduces costs and improves quality. the current system limits competition and encourages consumption for those that have coverage. that drives up cost. but the answer is not a system that will eliminate competition, ration care, and reduce quality.

as beezle so eloquently put it, you seem to be satisfied with "Changing feudal lords". don't you want more?


GT: I don't believe the market can provide appropriate health care for all because it is impossible to make a profit on every aspect of that care. If we have a health system that provides the kind of "choice" you and Beezle seem to prefer, the only choice available to tens of millions of Americans will be the choice of no health care.

I also believe that it is the natual tendency of sellers in the market to merge and coalesce into a few very large and dominate entities. Hence, the point of Ed's post. In other words, left to its own devices, the market eventually destroys competition.

I've lived in the UK and strongly disagree with your assetion that "no self respecting Brit participates in their social medicine system". Every Brit I knew used NHS, and was simply amazed that I and my employer paid several hundred dollars each month for my health insurance. When the occasional jerky visiting American pointed to their alleged huge tax burden, they rightly pointed to the amount of money American workers and their employers pay on premiums and asked: What's The Difference?

Frankly, I think those who espouse a market-based approach to this problem are more invested in sustaining the health of our corporate-dominated market than they are in sustaining the health of all Americans.

If I could trade a functioning single-payer system open to all Americans for the bankruptcy of every health insurance corporation, I would. The health of our people trumps the health of our corporations, in every instance.

Ed Cone

The numbers I've seen seem pretty convincing that countries with national health plans tend to pay less than we do for healthcare, and to get better outcomes.

Which is why I favor a public option in the US.

I don't see this as an ideological fight.

We have a system that costs too much and doesn't work that well, we see other models that seem to work somewhat better, so we move to improve our system in ways that have been shown to work well elsewhere.


GT - what do you mean by "eliminating third party payer systems" that you mentioned in a prior thread?

Competition in medicine, as things work today , does not work like other industries. Consider going to an experienced ER doc vs. a fresh out of residency. Complaint - bad headache. Which will be more likely to order a CT? Which will produce a better outcome? It is the same as what medicare pays the Mayo clinic vs. the guys in McAllen. You are paying more for an inferior product. GT, of the things mentioned none will address this fundamental problem.

Obama's main current goal is increasing primary availability for those that currently don't have it. It also aims to reduce costs, mostly by eliminating inefficiencies and possibly by fixing the McAllen problem.

The biggest part for me to the public option is just giving some people any real option at all. The market for individual insurance if you've had any medical problem at all is atrocious. The whole point of insurance is to spread the risk. The risk is best spread with large groups, the larger the better.


>>The whole point of insurance is to spread the risk. The risk is best spread with large groups, the larger the better.


Inevitably, for-profit private health insurers shrink the pool because they have an incentive to deny coverage. Their profits increase, but more people enter the uninsured ranks and costs go up across the board.

Ed: I agree that this is not, or should not be, an ideological fight. But, when people continue to defend a market approach to health care that has obviously failed, we need to consider their motivation.

The Canadian and European systems work. Do people gumble about them? Sure. People grumble about everything. We ought to notice, however, that none of their legislatures is facing a contentious fight about health care reform. They're gonna keep what they have.


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