One of the Mitt Romney's centerpieces in his recent presidential bid was the Massachusetts attempt to get universial health care called Coomonwealth Care. He touted it as a good model for the kind of universial health care program we would be getting soon, it was bi-partisan, paid for, and would cover everyone.
Well the jury is in and so far the program is not going to break the record of other state failures in the area like California and Michigan. Dubbed the "new Big Dig" by the local press, the program is bleeding an already financially insolvent state white. As of May 2008, the program enrolled some 350k Baystaters out of a preCommonwealth uninsured population of 650K. The parameters subsidize families making 300% of the federal poverty level ($63k for a family of four). Numbers are unknown but it is suspected that at least some previously privately insured people have dropped their own insurance for the state program which muddies the actual uninsured gain/loss.
The major problem is that not only has the program not insured everyone, it is costing a literal arm and leg. 2008 appropriation was $472 million (for 350K worth of insured, do the math) and the program administrators have asked for an additional $153 million to keep it afloat. The 2009 request was $869 with the expectation of increased participation. That number is under debate as Governor Patrick thinks it needs to be increased.
The state is now working on lowering payments to hospitals/doctors, increasing taxes on tobacco and various businesses to offset the cost of the program. Sounds very familiar.
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Comments: 34
The group: We Comment Back
Part of what costs so much in implementing a system such as this is that people who do not have insurance do not get good preventive care - so they develop more serious conditions that go untreated for longer. If you then introduce those people into the insured population, then of course the cost of their care is going to be higher than that of someone who has been getting good care for years.
Like any large-scale program, the start-up costs will be high. However, we cannot look at health care for all Americans as a short-term project, or one that can be scrapped in a year if it's "too expensive."
The fact is, the health-care costs of uninsured Americans get passed on to the insured population anyway, just not as clearly as in a plan like this. If someone who is treated for catastrophic illness cannot pay, hospitals and doctors write off those costs - but they raise the cost of procedures and consultations to cover such considerations. In turn, the insurance company passes more of that cost (at whatever percentage you pay) to you, the insured consumer, when you use those services.
Wouldn't it be a better idea to cover everyone, reduce the occurrence of catastrophic illness by improving the availability of preventive care, and in the long run reduce the cost of health-care for everybody?
There are no successes when the government runs things, other than the Armed Forces where losses are expected and the quality of personnel is very high there you can have major success. The other system is the Justice Department and I doubt you'd find many who argue that is a success on the same level of the DOD. All you should have to remember is how successful the war on poverty/drugs has been to be very doubtful government run national health care will even be moderately successful or remotely run on budget.
The gainers in this system will Mexico and non socialized neighboring countries, as Canada and Europe can testify, your medical community will bleed out to other lands. The medical flight specials will start within a year to nations where medical care is still largely for profit. Also watch how quickly Congress will increase Bethsada Naval Hospital's budget (where they get THEIR care).
The only good point will lawyers might suffer a bit until they can learn to game the system.
I don't recall objecting to the term "socialized medicine". After all, I grew up under the National Health Service in Scotland, so I know that a system like this can in fact work. It won't guarantee that the rich can automatically commandeer the best of the health care for themselves while leaving the poor with nothing, like the current American system - nor will it guarantee that all services will always be available at a moment's notice - but it will guarantee a level of care for everyone, which is what the current insurance-and-commercial-provider system in the US is explicitly designed not to do.
So those who can afford it should not get the kind of care they want or can afford. It is far better to give everyone a certain level albeit much poorer than the majority of Americans get today so all are on the same level, no matter what that is as long as all are on the same socialist plain. This nation sure has changed in the type of immigrant it gets....
The US has a problem with the closing of hospitals and clinics. Chiefly along the southern border and near larger urban areas. There are many reasons why but the chief one is by congressional fiat, no one can be turned away for care in this country. Add that to the large numbers of people already using government health programs (with low level reimbursements) and you have a drain that raping private insurers/customers CANNOT plug. The currant program is such a hybrid because of government distortion, not despite it.
Maybe on a small scale like Scotland it works but to judge by the overall record of the British Isles, it has been a rather spectacular failure. Trying to improve the time to be seen to a minimum of several hours (similar attempts have done nothing to improve service) for emergency service, never mind the waiting times for surgery does not make those of us skeptical about the efficiency/timeliness of most government services very assured of the kind of vast improvements you laud.
Although costs are high, results have been worthwhile. Some cost cuts have helped to keep the system soluble. Recent changes have excluded immigrants who can't prove they are legally here.
I feel if it is done right. A national plan like this could help our country in the long run. A healthy & educated populace makes a country strong.
We have trillions of dollars missing going God knows where and we can afford a war in Iraq that seems to have no payoff and only liabilities and costs.
So ... talk about biases, and ignorance?
Sarah's a good little American, she just has to "hear" to know all she needs to know.
Just a small exmple. Earlier this year I went to Costa Rica on vacation. I met three groups of Canadians. Two families, and a couple. As I usually do when I meet people from countries with socialized medicine, I asked them about it. As usual also, I got not one bad remark about their system.
The relief of the health care burden is just what the doctor ordered for US corporations who say they cannot afford to give people health care anymore. Why should health care be only for people who work for certain companies, or why should it be tied to employment at all?
Sorry ... I;m asking a question that requires a bit of thought, don't mean to throw you?
I understand since I'm someone you obviously disagree with, you assume I'm unable to think as clearly as you. No problem, one thing about being here on gather is that if you are outside the progressive/leftie/liberal (pick your nomenclature) pack, your intelligence is obviously that of a lower kind. No one on this site can disagree with whatever is the PC norm and still be considered capable of debate.
When I say the state is insolvent, I'm talking about debt load and the sheer inability to pay it off anytime soon. If Massachusetts or the US government for example were private citizens, they would be bankrupt. Their creditors would be screaming for whatever they could get of their loans. Of course neither are taxpayers/citizens so they just keep printing/borrowing/spending money, no problem right? The US has been a fabulously wealthy cow but too many parasites are milking her and she is being bled dry. Whatever comes out of the eventual collapse will not be anything either of us will like I'm sure.
Wars are expensive, just or unjust. That money being spent there would still have been spent here by politicians buying votes. The only difference is that money spent on war at least is Constitutionally mandated while some 85% of what is spent domestically is not. Do you honestly believe Washington, controlled by either party can suddenly become both honest and efficient?
To to answer your question about if health care should be portable, I agree with you in saying it should be yours and not tied to a job. Congress (or at least some of them) have tried that for years and its been shot down as often as not by one party or another. Relieving corporations/the private sector of medical costs is one of those nice sounding plans but it will do nothing but shift the up front costs to the government who will in turn ship it back to the private sector/taxpayers. No matter how you cut it, taxpayers and the private sector will have to pay a lot more to get the envisioned type of health care you want, far more than what they are paying nowadays too.
The end game is government control of health care. That has been a gradual process and I honestly think its too far done that road to be reversed. You will have your Canadian style system but without the escape valve it has of it's southern neighbor. For those with more disposable income, Mexico and the Islands will provide medical tourism but for the rest of us, it will end up the nightmare of Medicare writ large. That system already is threatening to be the bank buster that will make social security problems look like a lemonade stand failure.
Your anecdotal story about how people up north love the Canadian health system ignores the court challenges to it there and the tens of thousands of Canadians a year who have to come south for medical care beyond the most basic. It also ignores the financial nightmare it is to both the provinces and federal government. Of course some are happy with it, here in the US many people are happy with their private insurers and I notice that makes no difference to your view we have to have a national system which makes all equal.
> outside the progressive/leftie/liberal (pick your nomenclature)
> pack, your intelligence is obviously that of a lower kind.
Oh come on, don't waste my time with this "stuff". Where
did I impugn your intelligence personally Charles?
Money is an instrument of politics, that is, power. Supposedly
in this country the people have the power, ie. we are supposed
to be a democracy. Sharp people will retort that we are a
"representative" democracy, a Republic.
The point is that the country has been taken over by monied
interests that rationalize their absurd expenditures in war
while dismissing the needs of the citizens, the infrastructure.
The "representatives" of the people are not doing their job.
The costs of health care are already on the people, and they
are being ripped off. Companies take up the cost of health
care for their employees, less and less as time goes by, but
they are given a tax credit to do that, against their compensation
to employees. This accountant talk is useful only if you do not
use it to handwave and confuse the issue.
Read Robert Reich's book "SuperCapitalism" for an explanation
of how this works. The pattern of colrruption and greed is so
almost universal it is a wonder that citizens still believe anything
that the government says, or have any faith at all in this system.
Another good one, not specifically about health care is Kevin
Phillips book "Bad Money" and the financial industry and how it
has gamed almost everything else to suck the life -and money -p
out of the country and then disappear.
You do not get the point about Canadians going south for health
care - are you being deliberately dense of just propagandizing.
If I had a severe enough illness and the money I would fly to
Johns Hopkin or England, France of India for a medical procedure
if it was indicated.
The fact that some Candians do that is fine. That is not the point.
The point is that those who cannot afford to jump past the system
can at least get care. Why is this an argument for you?
Your side of the argument always talk about financial nightmare,
like Republicans and conservative philosophy is somehow responsible
world leaders in finacial thought? Ahhh ... maybe you are also not
paying attention or bringing that super-intellect to bear on this
issue, but America and American industry and finacial institutions
are not only being revealed to be totally corrupt, but they have been
for a long time. The idea that anyone is left that can say government
is the problem still, and that private enterprise is always the solution
is just a child's doll with a string to pull to get repeated meaningless
statements.
GM is going broke, and all the American industries have been foundering
for decades. Government is the problem and does not work in direct
proportion to its being controlled by business, and in inverse relation
to the alientation and uninvolvement of the people in the business of
running the country.
Things have been happening like it is illegal to label foods that have
genetically modified components ... this is not regulation whereas
the real regulation like looking at cattle and American beef is so bad
people are dying in Korea demonstrating to keep our mad cow beef
out of their country.
Also Charles, you profess to be so smart, but try parsing a goddamned
sentence correctly for a change ... because American citizens have
national health care would not make us all equal, it just gives people
who need health care what they need to be productive citizens ...
it is a good investment.
Maybe not as profitable as investing in slave labor in China, but much
better for the country and more inline with what our country's
supposed values are.
"Sorry ... I;m asking a question that requires a bit of thought, don't mean to throw you?" and "Ahhh ... maybe you are also not paying attention or bringing that super-intellect to bear on this issue"...your words Bruce, call it patronizing but it is the attitude common here when some disagree, no one of course would have seen that in your comment.
There is no debate here, you made your statements and downplayed my responses. You use your hyperbole (Koreans dying to keep American mad cow beef out...) ignoring the the local meat business influences there at the same time you loudly decry your perceived threats here. I must be dense as you say or propagandizing to have missed your point about Canadian health care. You met and questioned some Canadians who gave you positive remarks about their system, this is anecdotal...please inform me of what I missed? Money enables the largest number of people to work for their dreams, the inverse of course is that those with more tend to gain more political power. Nothing the redistributionists can do will ever reverse that and I still can't believe that so many people out there can trust government with even more power while bemoaning what the current level of government has been doing for so long. You honestly believe a change of parties will change that given the record of the last 80 odd years?
An argument made by a progressive some time ago about what nationalized health care was bad was pretty interesting. He said it was wrong because of how it drained other countries of their doctors, ie African/Indian/Pakistani doctors going to England and Canada while their doctors/medical people fled to the US. An interesting argument but not one anyone seems to even note.
I never professed to be "so god damn smart" Bruce, I just don't happen to agree with you. You offered nothing but the line of the government is the answer types like Reich (I've read some of his articles, never this book however and I'm not impressed). As I said, your side has won this debate and I really don't think you'll like the end result any more than me but it will not be reversed.
you do not even know what my side is because i have no political constituency, no group that i agree with. i know that what we are doing now throws away people, even as we have been squandering oil and resources.
as far as health care, why is it then that all other developed countries have national health care if my comments about its effectiveness are so anecdotal and wrong. explain to me what is not anecdotal ... listen to any right wing radio broadcast and anecdotal is all you hear, about how candians complain ... as you said as well. they go to other countries to get health care. i explained what that is and what it means ... you ignored it.
it would be nice if we could drive government and business with some kind of logic or reason, but it does not happen. that is not to most American's benefit, but what do they do?
you did too profess to be so god-damned smart. my first post had none of the elements that you reacted to. i just pointed out that the reality that the US is broke is awfully funny when the wealth collected by the top 1% is the highest it is ever been.
the argument is that this one percent, when enabled by capital is able to bring jobs to the rest of us. never mind the trickle down theory, but the theory is that capital amassed in the hands of the wealthy helps the rest of us. this appears to be either a lie or no longer true. the basic tenets of the country are not longer active, and it tickles me to see you and some others here make these same arguments like just sticking to your guns and repeating them makes them true.
not to mention when confronted by contradiction "your side" has no response but call people Liberals, and then step it up to socialists, pointing to the failure of the soviet union, which despite its name was never socialist, as the historic lesson that socialism supposedly does not work.
of course you ignore the ever-faltering and about to go brioke European democracies, and canada and australia - their lack of collapse, and the imminent collapse of our own country - you just keep saying the same thing ... that is not even anecdotal, it is just repetition.
I have tried to respond to your arguments and you simply say I ignore what you call facts. We'll just have to agree to disagree Bruce, I'd have to agree with everything you say before this would become anything then what it has become, a squabble.
I just seem to bump into wall of your comments about government ... in other words the only thing that matters to you is to attack government. I do not see any way to avoid government even if your theory was correct.
What most seek in this country is not actually socialized medicine but rather socialized insurance. The plan in Michigan in no way removed the insurance companies from the profitable role they feel is their entitlement. Were we to go to a national Medicare type of program, that would accomplish the needed task.
Those who feel that government is the cause of all ills are hopelessly misinformed and reflecting personal bias from this misinformation. How could the government that fails at everything else be proficient in the production of a military? It's pretty obvious if you look at it, the military is adequately funded and the funding for other programs is miserable. We have a real commitment to prevent failure in the military but won't make that same commitment in other important areas. Not only is funding inadequate for most government programs, the same people who condemn government are the first to want additional tax cuts! Go figure!
That is OK but it logically follows that you shouldn't be blaming the government for the failure of it's citizens to adequately fund.
I am for the expansion of Medicare to cover everyone ... The bill is
called HR 767.
You can go to Michael Moore's web site and sign a petititon to
pass this bill.
And ... if the government is bad or incompetant its every
actions has been controlled, bought, paid for, and influenced
by the profit making of some corporation or personal interest.
That is what is making the government not work.
In order for there to be "another failure" it would require that there be a case of "socialized medicine" and this has certainly not occurred in Michigan.
Then look at the licit drug propaganda everywhere, and the suppression of basic very important health information and legislation. Diabetes on the rise? BIG profits for pharmaceutical corporations and the insurance companies with which they're entangled...entwined...When all we need is a really excellent public health education / legislation program to rid us of the white sugar/white flour / high fructose corn syrup / wrong-fats [i.e. margarine etc] diet that is soooooooooo diabetes-inciting. Instead that info is suppressed and we have spiralling diabetes with its associated syndromes.
A good health care awareness system ( we DO have national health in terms of public health departments - but many of them are in the pockets of the pharmaceutical / insurance leeches) - a good health care system would regulate appropriately, recommend appropriately, work in appropriate ways with physicians' and other health practitioners' schools and professional organizations, and truly serve the entire populace.
Right now this military-chemical/pharmaceutical/insurance tarpit has conventionally-health-educated legislators in a sticky icky stranglehold. The honest ones have their legislative hands tied, and the crooked ones are in on the profiteering.
Then there's malpractice gambling. Do any of you readers have any idea of the damage caused by malpractice law profiteering to the basic medical service ethic in this country?
AND it's interesting, isn't it, that the international volunteer medical service organization, Doctors Without Borders, sends physicians to the United States to care for some of our uncared-for poor? Yup. Bedford-Stuyvesant, last I heard, was visited by Doctors Without Borders.
What's wrong with this picture?
I must remind you that sugar/white flour / high fructose corn syrup / wrong-fats/ margarine are not any of them poisons. It is the misuse of these and the excessive consumption which causes the problems. My dad used them all, of course, he only lived to ninety one!
I do agree with you that prevention and good eating habits would help a lot. As would getting some exercise on a regular basis. Our children are raised indoors today, you don't see the number of kids out playing that would be traditional for a given subdivision density of children.
I also agree strongly that the pharmaceutical companies seem to have our current government in their hip pockets! The laws are run as entitlements for the drub lords!
On the malpractice thing, it has been used consistently as a very good argument and explanation for increased rates, even though the actual costs of malpractice awards is only a minute fraction of our health care costs. Whether it is the providers, the insurance companies or whoever, they always say "Gee, with these tremendous malpractice settlements, we simply can't afford not to raise our rates!"
Your last paragraph, is interesting. However, if you look at the uninsured, the infant mortality rate and the general rate of success with our health care system, it is no wonder that they do come here!
I do agree that we can't avoid government, I just wish I could run into a bit less. I by no means am what I'd call a rightist and more than once in the past I agreed with you on issues or points, I just find the whole right/left mess to be different flavors of the same ol drek.
I use the economic argument because it uses facts/history rather than emotion or in declaring what things should be. Government is too slow/clumsy to be effective in such efforts despite the often earnest desire to do so. Rather than me breaking things down into the government/business spectrum, I think more along the line of government/private sector (you and I for instance) spectrum. Businesses just tend to be factor we were discussing compared to government.
James C,
Both Michigan and California's plans have failed to do much in subtracting any significant numbers from the uninsured numbers. You can say there are increased numbers of people insured under the state plans which I also noted happened in Massachusetts' plan. The problem was the number who dropped out of private plans to get the subsidized state plans. The actual number of uninsured did not change that dramatically and the cost to the state taxpayers is considerable. With Michigan for instance looking at another shortfall in its tax revenue (despite the new tax increases), these state medical insurance plans are draining state coffers. You can say they aren't failures but then your measurement of success must be pretty limited.
If you wish, I'll readily agree that what they did in Michigan was a joke and for political purposes. It was never intended to help the people but to perpetuate the monopoly of insurance companies on our health care! It was a failure before it came off the drawing boards. Something cannot "fail" until it is tried! Socialized medicine has never been tried.
Frankly I am not in favor of socialize medicine, just socialized health insurance. No additional involvement in health care delivery is warranted than that which already exists. And, I believe it could be trimmed back some. The HIPPA thing needs to be re-written. It costs much more than the benefits, some of which are very desirable, warrant.
California is a slightly different matter. I believe it was initiate with good intentions and I also believe it is far too soon to say it is a failure, although it faces the same problems as Michigan, it perpetuates the insurance monopoly. And some would call it "socialized medicine?" Perpetuating huge corporation's monopolies is scarcely socialism, therefore, socialized medicine could not have failed in either of these states until it is tried. Frankly, I believe it must be tried on a national basis as there are too many factors to go against any state.
I don't want you to have to agree to anything. Though I often disagree with you, I've found you try and frame things in debate form rather than name calling and ignorance of what others say. That is a pleasant change from much of what I get on gather for disagreeing with someone.
That said, corporate socialism is as evil as any form of socialism. Making artificial monopolies is dead wrong and its one thing that our government has gotten increasingly good at as you mentioned in your home state. Distortion by government is the key to the problems in medical care/insurance and its apparent seeing how the distortion virtually follows the creation of Federal and state programs in the 1960s to "help" out. Good intentions have an alarmingly tendency to harm and this area is no different.
I used the term socialized medicine because it's state sponsored, subsidized, and ignores (except as an end provider) the private sector. Any veteran will tell you that government run health care is much more clumsy than a private sector equivilent. I was amazed how quick I could see a doctor about non emergency things once I got a private insurer rather than just TriCare, conversely my wife was horrified how long it took to get appointments with it.
Any national plan will be the one we are stuck with. No way the government/Congress will ever stop it no matter how much of a failure it is. That is why I'm afraid of it. If we had a responsive, representative government I'd chance it because its not hard to predict the failure. Since we don't, I hope that it will not happen anytime soon.
While we disagree on the best route to follow, I think we can agree on some of the problems with the health delivery system. I agree that true socialized medicine, where government takes over the delivery of that care, is fraught with problems. At this time I see no reason to go there. Our delivery systems are working pretty well and the Government may well do more harm than good.
On the other hand, the insurance industry has failed miserably as stewards of the American health payment system. I'll admit that there have been many advances in technology simply because the insurance industry made it possible for the result of that advance, to be paid for and profitable.
Still, it should not be a matter of chance of whom some one is employed by whether they get to take advantage of these advances or not. I speak with some experience in the area of failure to get health care because of finances. I've been there! Later in my life I was employed where insurance was provided and frankly, I loved it. I quit having teeth pulled because that was all I could afford. I could get care for my family without having to decide whether the illness was sufficiently grave to warrant taking food off the table and I mean that literally.
But our industries must compete with foreign ones who are not saddled with the expense of health care. There is virtually no portability in the coverage process. All insurance companies are in a position of working against what they are supposed to do because to deny coverage builds the bottom line while covering illness lowers it. A true conflict of interest!
Right now, the insurance company owns your health care unless you are wealthy. They know it and abuse it. I've had good insurance for many years now but the errors made by the insurance company, and there have been many, are always in favor of the insurance company. When I contact them, they are helpful and always correct the errors but why are they always that direction? Because that is the direction that builds profits.
What I am contending is that we need a collective group insurance, which covers everyone and insures that the young and relatively healthy are part of it as well as us old codgers! Medicare, with which I have been very pleased for a number of years, is stuck with paying for the needs of all of us older, and often sicker, clientèle, making the expense far greater than would a uniform system covering all.
In the five years I've been on Medicare, there has been no instance of my having to correct their errors. If Medicare can do this, so can private enterprise, were they willing.
If one chooses to call what I envision, socialized medicine, then so be it. I have no problem with that. To me it qualifies as socialized insurance with the delivery of care left to private enterprise.
The problem with implementing any of this is that the companies, with lobbying money to burn, will fight it with tooth, claw and fang, every step of the way, and they are capable of buying much more favors from the congress than I! Corporate socialism is very powerful in this country. The industry has a major entitlement in their view. With the lobbying funds they have, it will remain an entitlement of these companies. The drug companies fit in the exact same category, with the government trying to curb any competition from any other country and punishing seniors for purchasing from Canada.
Charles, I too enjoy debating a view without having my ancestry impugned, or being told I am stupid. I've tried hard to keep that fact a secret! I don't necessarily seek agreement as I know people come from differing places in life and see things differently. Besides, if everyone agreed with me this would be too boring for me, so I appreciate your excellent writing and your comments!
Thanks!
I hear you. No one can say the system works even remotely close to perfect. There are also too many horror stories. I've never been without insurance due to the Army and making sure I had it after I retired. The problem is going to be financial. You mention other countries pay for their people's health care instead of the employer. That's correct in that Company A for example does not actually pay the health costs DIRECTLY but indirectly via taxes. Those countries offset the taxes collectively for much higher income taxes. For people like me, European tax levels would be grounds for revolt. The shifting of taxes from poorer people to those of us who work or invest is doing a good job of securing votes for any such medical plan, regardless of cost.
Anyway, we can see the problems and to some extent solutions but we are on the losing side. Economics and constitutional issues aren't driving this train anymore, good intentions are and thats what will win out, damned the consequences. We will have a national health care system and the results will not be pretty for either the country or most people.
Good babbling at you James C, even disagreeing with a gentleman isn't that bad!
Didn't think so.