From MediaMatters, Debunking The Latest Conservative Health Care Smear: “Death Book For Veterans”
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by Michael Froomkin
Laurie Silvers & Mitchell Rubenstein Distinguished Professor of Law
University of Miami School of Law
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Can you tell me which of these idiots at Faux News were in the military? None of them? All of them avoided military service. So, why should we believe anything they say about health care services for veterans?
Look, all of these scary things, whatever their connection to reality might be, should be considered with an eye toward how any government healthcare scheme would HAVE to work.
WE KNOW: there is not enough money, nor enough doctors, in the world to provide all the healthcare that 350 million people can decide they might want to use. That’s an indisputable fact.
Which means that AT SOME POINT, though maybe not the ones we are cowering in terror of now, SOMEBODY in government is going to have to say “no, you can’t have that procedure.” At that point, rationing has begun (despite claims that it won’t) and it is only logical that people who would be least likely to benefit from procedures would be the first to be cut off (i.e. a terminally ill patient will not be allowed to get a government sponsored nose-job).
So it is absolutely common sense that SOME FORM of rationing and panel decisions will be a necessity. It’s just a question of whether you want to pretend it’s not true now for political reasons, or not.
One of the few, well-reasoned and thought out articles on the subject of healthcare:
http://www.theatlantic.com/doc/200909/health-care
Until both the Dems and Reps are willing to do the kind of mental heavy-lifting this article hints at, it will all be either fantasy or a mess.
We have rationing now — by wealth. Give everyone some class of insurance, they will still be constrained — rationed if you will — by the insurance plan’s policies. Indeed, Medicare is constrained. But there won’t be panels debating if X lives or dies, there will be generic decisions about treatment, just as there are now. Having dealt with an insurance company whose answer was always no, except to unnecessary surgery, I think the bar the government has to beat is quite low.
But that is exactly the point: What is government run healthcare planning on “fixing?”
Both systems will or do have rationing. On that we at least agree. So the question becomes how will government rationing be different than private insurance rationing? (we’ll ignore the fact that much of what forces or at least encourages insurance companies to deny coverage is the result of Government mandates, not just greed.)
Well, one might argue, a government system won’t have the greed influence, so it will be able to have rational, generic policies in place, that will not be descriminatory on an individual level, thus levelling the playing field from person to person. I think, greatly simplified, this is your argument.
But there is more than simple human greed involved in such decisions. There is also the lust for power that is entailed in getting to decide for other people how they will receive benefits. Somewhere in Government there will HAVE to be someone (or small group of someones) that will be deciding the government’s policies, generic or otherwise, regarding standards of care.
So really, the argument is whether one form of greed (profit motive) is better or worse than another form of greed (lust for power), both of which have been rampant forces of evil in humanity from the first moment one of our evolutionary ancestors figured out how to make a stone knife. But why replace one flawed system by another? What is being improved? Are you really going to care when you get a denial of care based on one rationale versus another? I doubt it. But at least you will be able to sue your insurance carrier (that ability is removed as against the government according to at least some of the proposals, and likely to be in any final version, for obvious reasons). So is it better to be denied by someone against whom you have no legal recourse? I doubt you’d think so.
Look, nobody is saying the system we have now is perfect, but why does that mean that civil servants will be able to do a better job of administering it?
How about the simple solution of treating health insurance JUST LIKE WE TREAT ALL OTHER INSURANCE and allow it to universally and inexpensively available to everyone on a catastrophic basis, and take the (well) over a million dollars the average person’s employers spend on employeee health insurance, give it to people as medical savings accounts to be used for the daily drudgeries of medical care? If you paid some small amount for a catastrophic plan that would cover, say, all medical care above $15,000 – do you think you could find better use for the (based on your presumed salary as a law professor over your lifetime) $2 million or so that your past, current, and future employers will be spend on your current health plan? How about your wife’s $2 million added to that? Do you think if you added up all the non-catastrophic healthcare the average person uses in their life it amounts to anything like $2 million? $1 Million? $500,000? ($500,000 is roughly $500/month for 78 years) How do you think your family would fare, knowing catastrophies were covered, with $1000+/month, cash, that can rollover, maybe even earn interest, for incidental health expenses now covered by insurance? (I have a very similar plan now – and I can tell you it’s great)
Or would you rather wait on hold for 2 hours to finally get to speak to some low-level decision maker at a government agency to beg $500 of your own damn money back so your kids can get the eyeglasses they want, instead of the birth-control glasses mandated by a cost saving agency decision? And if your answer is you’ll just spend a little of your own money so your kids don’t look like dorks – well why involve the government at all?
Vic:
Do you cry when you think of the poor insurance companies and all the bad people who are trying to take away their hard-earned profits? Or do you just tear up a bit?
God forbid those lustful for power government workers should make decisions about what treatments will be available.
I shudder to think what we will do without our lovely insurance companies.
As for your other arguments, they are poor at best. Plus, I do love how you assume so very much about what health care will be like after the reform has been implemented.
If you have to ask what is better about a reformed system, then you are willfully ignorant or just talking junk for the fun of it.
Forty-plus million uninsured in America and you don’t know why reform is necessary.
And its dumb to say you have to beg the government for money to buy your kid glasses. Do you even know how medicare and medicade work??
All of the “experts” think that preventive care works best. The studies I’ve seen show that the majority of insurance patients refuse opportunities to take advantage of preventive care. I’ve had bilateral total hip replacement surgery and intestinal surgery. My father practiced medicine, so I am in the habit of getting regular checkups and discussing problem areas before they become big problems (colonoscopies don’t hurt that much). But, a good number of people, including those with insurance that will pay for preventive medicine, refuse to go for regular checkups. We really need to extend this health care debate, and we really need to discuss the reasons why so many of us are unhealthy. And, why do your kids get the glasses they want, instead of the glasses they NEED?
Insurance company overheads are very high, much higher than government programs.
Why is this:
* High salaries & profit-sharing/bonuses
* Advertising
* Extensive spending on claims reviews since there’s profit motive to deny claims
* Dividends for shareholders
* Utterly amazing amounts of useless paperwork that I get in the mail every month (or week, sometimes)
A government program will save on all of these, except maybe the paperwork (but even there, it might be better).
In both the case of the private and public plan it will probably be, for many things, take it or leave it from the menu. People who go private now will do the same under the Obama plan. There insurance will not change. (This is not inevitably one of the Obama plan’s virtues, but it is undeniably a feature of the plan.) The big difference though, is that with health care reform there will be nobody outside, looking in, wishing they had basic care.
Incidentally, the eyeglass frames discounted under my current plan are pretty evil-looking. And there’s no one to call about that.
I figured it out. It is all based on stupidity. Who would have thunk it.
To quote Randall Terry, noted economic scholar:
Theres no way to pay for this thing without killing granny, Terry explained.
That is what they believe. Really.
Am I right, Vic? Do you believe they will have to kill oldsters because there simply won’t be enough resources for them and for everyone else?
[Quote from http://www.stinque.com/2009/08/26/douchebag-of-the-day-26/%5D
Between you and your employer, you pay upwards of one million dollars, and for most people, it’s close to two million, over your lifetime for medical insurance, whether you need it or not. I don’t know about you, but I’m halfway through and have not even come close to using 2% of that amount.
Now imagine that health insurance plans, like every other kind of insurance you buy, was solely catastrophic care. Let’s say that you’d be paid for things costing over, say $10,000, but NOT low cost treatments and care under that amount – that would come out of your pocket. What you’d have is a very low cost insurance plan that would cost a fraction of what you pay now.
“But what about my basic care?”
Now imagine that your employer, INSTEAD of giving you a lower salary (which they do) and ALSO taking money directly from your check to pay into that million dollar plus pile-o-cash, took that substantial amount of money and put it into a medical savings account for you. One that could accumulate (roll-over) and was (as such accounts are) pre-tax money.
Now lets add to that the idea that you don’t NEED to keep adding to a medical fund above a certain amount, since your catastrophic care is insured, and there’s only so much non-catastrophic care that anyone is likely to need. So as you accumulate in that account, if it gets above X amount, you will receive that money as income (or perhaps be given various retirement options for its use). You could also pass it along to your heirs.
Additionally, since the account is cumulative, you might be short early on, or from time to time if more major medical expensis (not covered under you catastrophic care plan) arise. The medical savings account would be creditable against your future input. Pretty much anyone who works regularly will accumulate apparently vast sums over the course of a lifetime – even min wage workers, so a credit should be no problem. (you just don’t really realize how much you spend, and what’s being spent every month on your behalf – even your paycheck is only part of the story).
So now you’d have:
-Catastrophic care for you real medical emergencies.
-A medical savings account for your daily care (to spend any way you’d want, not how someone behind a desk allows you to spend it).
-The ability to have credit against future earnings for more expensive medical care.
-Your employer would not have to maintain employer-based insurance for you – lessening his costs.
-You’d receive the benefits of the money you RIGHT NOW spend on insurance AND the benefits of the money you don’t have to spend in insurance – and it would be tax free.
-You might even get more salary from your employer (above and beyond the current health insurance costs) simply because the overhead of managing your healthplan would no longer be in place. (or jobs would be created)
-Your children/loved ones would receive money that would otherwise be long gone, if you used less than you received into your medical savings account (the vast majority of people would use far less).
Unless you think that every wage-earner in America uses $1-2+ million in health care over their lifetime, this is the best deal you’ll ever see in EXACTLY the health care you want (almost nobody uses anything like 1 million dollars in healthcare over their life – but they pay for it as if they do). Your current health insurance is effectively a bet that you won’t use anywhere near the amount of money your are directly and indirectly paying in. And guess what? You are losing that bet big time. Having Government take over won’t change that bet – only who gets the benefit of it.
My current healthcare plan is about as close to the above idea as possible under current law and it works GREAT. A lot if people use this type of plan.
All this type of plan requires is that you take some interest in your own health and finances – just like you somehow manage when it comes to your car, your house, your groceries, your back-to-school needs, your job, etc.
Leave government plans and programs for the few that would be left (effectively, the perenial non-wage-earners – a far lower number than 40 million – by the measure of continuing poverty (not temporary as most is in the context of a lifetime), less than 4% remain in the poverty quintile for more than one decade of their lifetime).
Unless you don’t WANT all that money ($2-4 million in a two wage earner family), and don’t think your kids have any need for it – in which case keep throwing it away and make insurance companies richer on your back. Or just give it all to government – I mean they need that money more than YOU do, right?
Now, maybe this idea is not perfect – and no plan will satisfy everybody – but wouldn’t you like to see our government ACTUALLY debating these kinds of ideas, instead of just saying things like “Medicare isn’t broken, it just needs more [of your] money” as Barney Frank helpfully pointed out recently? But that’s the problem in a nutshell: Government wants a chunk of that big pile-o-money that you are currently giving away to insurance companies – it’s lost revenue, in their eyes. So they won’t recommend anything more radical than changing who gets rich. Is that what you want? Are you really so pliable in your morality that so long as government throws a bone to someone who you believe to be screwed by the current system, you are perfectly willing to keep happily eating your scraps – when you AND THEY could be eating steak. I think if you really want to help people, you need to start thinking further than what politicians claim to be true.
Vic:
Sorry. You lost me in your first few sentences. Indeed, you (initially) seem to be making the argument that insurance companies provide zero additional value, although that clearly isn’t your intention.
Why would you even consider the fees charged by insurance companies at present as a benchmark? Do you realize how much waste is contained in their costs? Your assumptions are flawed, to put it bluntly.
Do you realize how little social utility they provide?
I will not start with current fees as any kind of benchmark. Fees and coverage are completely out of control already.
If you are coming to the conclusion that the insurance companies are worthless, and must be constrained in order to establish a stable risk market, then we can talk.
Otherwise, to be honest, you would just be an insurance company shill. Regardless of intention on your part.
Why would you start with insurance company-dictated premiums as a baseline?
They have nothing to do with costs, and everything to do with market power…
Sorry, I thought the first of these most recent two comments was eaten by Froomkin’s cheapo server 😉
“Why would you even consider the fees charged by insurance companies at present as a benchmark? Do you realize how much waste is contained in their costs? Your assumptions are flawed, to put it bluntly.”
I don’t know why I continue to assume people using the Internet in English actually can UNDERSTAND English, but I do. More fool me.
THAT’S ENTIRELY MY POINT!!!!
You lose tons of money, well over a million if you have anything like a professional salary, in current health care costs. It doesn’t matter what the basis of those costs are. If they are artificially high, then that just makes my argument better. My argument, in plain English, is: You are spending NOW, waaaaaayyyy more than what you need to spend on health care – largely because it’s a third party payer system, which are always more expensive than first party payer systems. So how about, my argument goes, getting rid of that third party, except for catastrophic emergencies, and allow YOU, the first party, to decide what care you want to pay for? It is guaranteed for all but maybe a handful of people in the whole country, that you will spend far less for healthcare than you do now involuntarily, and you will be able to pocket the difference in some manner – while still getting all the care you need.
Moving it to the government, even if we assume it will reduce costs (which is arguable), STILL involves a third party payer and STILL will involve you paying for far more healthcare than you use – unless you happen to be attached to a heart-lung machine.
RZ, I’m starting to wonder if you actually have anything meaningful to add, of if you are just like that argument office in the Monty Python sketch.
Participants are kindly requested to be civil, especially to each other.
–The Management
Let’s look at Vic’s comments in this thread alone:
WE KNOW: there is not enough money, nor enough doctors, in the world to provide all the healthcare that 350 million people can decide they might want to use.
Now, this looks like an incorrect statement, (one beloved by the economic ignaramouses on the right like Randall Terry) but Vic has added “can decide they might want to use”, which simply makes the statement irrelevant. No one is arguing that everyone would be able to use as much health care as “they want”. Hence it is remarkably un-useful.
Which means that AT SOME POINT, … SOMEBODY in government is going to have to say “no, you can’t have that procedure.” At that point, rationing has begun (despite claims that it won’t).
Here we have another incorrect statement. ‘Rationing’ exists right now in the private insurance market and with medicare. ‘Rationing’ will not start once the government reform is implemented. It exists right now. Nor would any terminally ill patient receive less coverage under the new plan.
Not one, if my understanding of the plan is correct.
So that is strike two.
So it is absolutely common sense that SOME FORM of rationing and panel decisions will be a necessity. It’s just a question of whether you want to pretend it’s not true now for political reasons, or not.
Oh, I am going to call that a foul tip. Just for the heck of it.
Now let’s go to the second comment from Vic.
Both systems will or do have rationing. On that we at least agree. So the question becomes how will government rationing be different than private insurance rationing?
Uhh, ok that is obviously a re-formulated argument. Now Vic is admitting that the entire rationing argument makes no sense (although I would wager he will allow this bogus argument to creep in later), even though this was his entire point in the first comment.
And, this argument is that a government reform will not be better even though both systems have rationing. Interestingly, Vic asks why we should make any change, which of course indicates pretty clearly that he easily dismisses the 45 million uninsured Americans. To him, they are not a sufficient reason for reform.
So, and it should be understood that Vic is arguing against reform consistently, what is the problem with reform, now?
Somewhere in Government there will HAVE to be someone (or small group of someones) that will be deciding the government’s policies, generic or otherwise, regarding standards of care.
There is the boogyman of that day. A government functionary is going to make rules about what you can get and what you can’t!
Surprisingly, that doesn’t seem to scare anyone except Vic.
This comment’ argument is somewhat less cohesive, but he seems to argue for the health savings accounts that Bush used to talk about. Anyway, let’s move on.
Now imagine that health insurance plans, like every other kind of insurance you buy, was solely catastrophic care. Let’s say that you’d be paid for things costing over, say $10,000, but NOT low cost treatments and care under that amount – that would come out of your pocket. What you’d have is a very low cost insurance plan that would cost a fraction of what you pay now.
“But what about my basic care?”
Now imagine that your employer, INSTEAD of giving you a lower salary (which they do) and ALSO taking money directly from your check to pay into that million dollar plus pile-o-cash, took that substantial amount of money and put it into a medical savings account for you.
So, now, Vic argues that insurance companies should be limited to providing only catastrophic care, and everything else comes from the employers, and he throws in these personal health savings accounts to boot.
Now, why the insurance companies won’t refuse coverage and cancel these catastrophic policies just like they do now is unexplained. And why employer paid insurance is a good idea when we have it now and we still have 45 million uninsured is also unexplained (and presumably unexplainable).
Then, finally, with irony rising in the east, Vic takes the cake. Watch this one, folks, its a classic:
You are spending NOW, waaaaaayyyy more than what you need to spend on health care – largely because it’s a third party payer system, which are always more expensive…Moving it to the government, even if we assume it will reduce costs (which is arguable), STILL involves a third party payer and STILL will involve you paying for far more healthcare
Remember all those insurance company profits? Remember all the overhead of dealing with them, the denied claims, the reviews requested? Somehow, in the mind of Vic, the goverment system will necessarily be just as wasteful. Reform can’t reduce costs or waste, in his estimation.
Just because.
Vic, show some basic respect. I am trying to understand your argument to the extent possible. If it isn’t worth your time or if I am not worthy to argue with you, then just go away. There is no need to make punk comments like the above.
Insurers have far less incentive to cancel catastrophic policies – as this is in line with the basic practical way that insurance is designed to work – UNLIKE the current way health insurance works. Under a catastrophic system, costs can be better predicted, controlled, and spread among policy holders in ways that are considerably more difficult when care is based on desire, as current healthcare largely is. Insurance companies and insureds prefer catastrophic style policies, which is why that’s how insurance works generally. Only health care is currently non-catastrophic.
I don’t ever argue for employer paid healthcare as you claim. Read my post again. I argue that your employer should pay YOU the money you earn that is currently paid into healthcare systems so that YOU can pay your OWN healthcare (excepting catastrophic care). The reasoning here, repeated yet again, is that you lose far more money paying for unneeded benefits that you will ever use in your lifetime for needed healthcare. Government run care, even if we presume better efficiency (which is arguable) will STILL involve you paying for more than you use. If you’ve ever worked in insurance you’d know exactly why, but in a nutshell, government forces insurers, against their desires and former practices, to charge everyone for care that only a few will ever need. Since the source of the problem is government in this regard, it is hard to fathom why this problem will change when government is in charge.
So in the end, your employer will pay nothing for your health insurance but will give all that lost salary to YOU. You will then have the choice of how to use it and assuredly will gain far more cash and get better healthcare than you get now.
It’d be nice if someone actually enganged the argument, rather than gleefully pouncing on apparent logical inconsistancies. As I said, I don’t expect the idea is perfect, but I think it makes some good points and I, for one, would like to see our politicians making such arguments, rather than just doing the same sort of silly pouncing and endzone dances. To me, the intellectual excersize in healthcare involves coming up with ideas to bang around, not purety of rhetoric. Clearly the prefernce here is leaving everything the same, but handing over one segment of the population to the government for payment. The lazy way out, I’d say.