The Candy (Universality) and the Spinach (Rationing)
Posted by Peter Lawler
That’s Krauthammer’s astute characterization of Obama’s projected two stages of health care reform. Charles is perfectly right that only real alternative would have a subsidized transition to portable private insurance, and we remember that McCain and the Republicans chose not to do battle over this issue during the campaign.
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In a sense, we are already rationing private health care. It has been increasingly difficult to get health insurance, especially if you do not have some group convenient to be part of. Health insurance companies are not like car insurance companies (maybe they should be) and if everyone needs health care coverage, tough, everyone cannot get it privately.
The expectation that everyone has a right to the best health care the US can offer, which is remarkable and the best there is available, (if you live in the right cities, which I do) means that once you are accepted for treatment, just about anything goes. In my most recent experience, my 82 year-old mother collapsed in a supermarket while shopping for some incidental, esoteric addition to her breakfast menu that happened not be in her well-stocked refrigerator. She was rushed by ambulance to the hospital and confessed to doctors there that she had taken her many and various medications on an empty stomach. Six days and several pointless but expensive tests later, she was released and told not to take her medications on an empty stomach ever again. MRIs, CAT scans, EKGs, various blood tests told her doctors conclusively that she was really just fine. The real hold-up had been that for two days the neurologist was too busy to take the time to see her. If I had not vigorously complained, my mother might still be there, as if resident in a very expensive and not very good hotel. The problem for the doctor was not really the exam, which took fifteen minutes, but the requisite stack of paperwork written for satisfaction of the hospital, Medicare and the supplemental insurance company, which would take much longer. My mother wished her care had been somewhat rationed, as in handled expeditiously.
The real problem with national health care and the reason no one wants to touch the issue is that competing claims of democratic rights to all that our health care system has to offer clashes with the fact that no one wants to pay for that very thorough care.
Perhaps if the American press actually looked at the nightmarish stories about health care in those countries like Canada and Britain, they would not be pressing so hard for it here. Actually, those countries would be in terrible shape if people of means did not have the option of the American health care system to handle those things rationed.
The hospitals and insurance companies almost seem complicit in the turn to nationalized health. Big business wants it. We seemed to be doomed to it and oh, how I bet we will hate it over time.
Ramesh Ponnuru is right that universality of coverage is not in itself a winning politcal strategy. People worry that healthcare premiums are eroding their living standards or that Medicare rules are forcing tougher decisions than are neccesary, and that a bad diagnosis between jobs might financially cripple themm for life, not that someone, somewhere has opted out of the insurance system. But universal coverage does (politically) beat nothing when the existing insurance system is decomposing. One of the worst effect of conservative Reagan idolatry is that it kept them taking and thinking about the issues that have been so good to them during the Reagan administration rather than the ones were most pressing. I doubt that the principled and astute Reagan would have made that mistake.
Have you ever seen the Cleveland Clinic complex? It is like a vast and marvelous Temple of Health, with art and incredible open interior spaces like the great cathedrals of Europe have. We walked down a hallway that must have had a sequence of forty flat screen TVs hanging from the ceiling, all playing the same Clinic ad at once. The art on the walls, sculpture, fountains, are all amazing and wonderful. Wonderful, especially, because it is so much waste in terms of actual practice of medicine.
Yes, without insurance coverage, people who have had an accident or an unexpected illness are in debt, forever. It can be expensive to keep people alive. We do pour money into this system, but all of the money fuels research and innovation, not just nice hospitals. America has been full of research and innovation, because that has been profitable. Once we take the profit out, what will we have?
China and India have been sending their students for training, here, for many years past. Maybe those doctors will all go home for prosperity and profit and those countries will be the places to go to get care when our nationalized system rations us to death.
America has been full of research and innovation, because that has been profitable.
Kate - exactly how are you judging the quality of the American system? I suppose it's true that you can get great care in the U.S. - if you can afford it. The World Health Organization ranks us somewhere in the 30s, our life expectancy is lower than tons of countries, and our infant mortality rate is atrocious. We spend twice as much on health care than anyone else in the world - and we get quite a bit of mediocrity for it. But I guess if you have the cash you can get a new face.
I think it's silly to presuppose how bad a universal system would be in the United States because Britain and Canada have horror stories. Yeah - that sucks. What kind of stories do you think the uninsured or the barely insured have in this country? And how, exactly, are you "objectively" evaluating the quality of health care in the world?
As someone who spent life as a young man in hospitals--for instance I spent nearly a month and a half in a hospital for an pneumonic empyema at the age of twenty--I must say that this discussion is silly.
Yes my experience has jaded me regarding the greatness of health care. As a youth I worked in hospitals, and when I spent my time as a patient as a hospital, I knew that the so-called care sucked. They were sticking IVs in me with inches of air bubbles. They injected me in the ass with the same needle.
People who speak of health care have never been in a patient in a hospital.
Hospitals--for good or ill--are places where people go to die.
Yes children need health care, but if they spend their lives like me taking drugs for asthma that only make you jittery like a speed freak, then I wonder the utility.
I stopped having asthma attacks after I started smoking cigarettes. My inhaler only made me tweek like I was on crystal meth.
Modern medicine is a sham. We can live forever. Yea.
Is life better without death?
Just for effects--my empyema reqired a thorochotomy where six inches of my left fith rib had to be sawed off in order to extract the grapefruit sized cheezy pus ball from my chest. Since then I have been smoking cigarettes like a "melon farmer."
So called heath care is a joke.
Prior to my illness, I considered going to med school. I worked in a vivisection lab testing the effects of various drugs regarding smoke inhalation on sheep.
At eighteen years of age I worked as surgery tech on sheep placing catheters in the aorta, as well as sticking Swan Gans catheters into the sheeps' jugular arteries. Unfortunately several sheep were killed for medical reasons. I got to put the sheep into plastic bags, and drag them to the cooler where they were later taken to the incinerator.
I suppose I later deserved my hospital suffering. I participated in sheep thorochotomies--so why not me later?
Either way, cigarettes did better for my asthma than any sadistic medical man ever did.
Modern medicine is a joke.
Having read halfway through G. Edward Griffin's book The Creature from Jekyll Island (so far) I finally understand how something like this is possible. The people can't understand the deficit and how debt turns into to money meaning that they just don't understand that inflation is a very real tax. The people seem destined to never connect the dots between government free wheeling of the checkbook and inflation causing their savings to decrease in value. Why stop at healthcare though, lets buy everyone a home and two cars and be done with it. A year from that date it would cost a million dollars for an apple but so be it in the name of gradual international socialism. By "borrowing" (printing cash although even worse because that gets multiplied through the system) from the federal reserve (niether federal nor a reserve) the limits of government spending are infinite.
John the smoker giving us tips on the modern health care system. His medical advice: take up smoking to help your asthma! His post is like a bad skit on the Colbert report.
If you eat one you will grow fat and need a dentist, if you eat the other you will be svelte and have enormous forearms like Popeye.
Brutus, my Subway costs $5, and once I buy a gun I can go to Detroit and speculate on homes that are selling for the exorbitant price of two such subs, only so long as health care covers gun shots. Plus if Apples cost a million(how happy will Steve Jobs be?)...but if you mean the fruit costing a million...well then I say to be honest to the thread the Wendy's value meal fries hit a million before the apple hits a million.
Matt, yes, you are quite right, that you can get great care in America if you can afford it, or if you are an interesting case. My daughter-in-law falls in that latter category and since she has been sick since shortly after her birth, she has seen quite a lot of medical care. She is alive and approaching her thirtieth birthday. I might accept the idea that this is a miracle, as she has almost died several times, but good medicine and capable care-givers might have something to do with it, too. I have to give them credit.
Perhaps John is correct and the other problem with medical care is human error, but I don't see the how to get away from having humans implement health care. The other problem you, Matt, cite is how to pay for health care. My son and his wife carry a frightening amount of debt, all medical, because insurance does not pay for everything and they only recently have it, and because, even when they get Medicare to pick up some of the bill, there are always hundred of dollars left over. We say that it, the debt, builds their character. Interestingly, this is not preventing their being able to buy a house. It is not ruination, just a considerable weight. I wish they did not have it, but while it is not my daughter-in-law's fault that she gets so sick, neither it is the fault of anyone else, especially not the American taxpayer, who has been helping her stay alive and to pay part of the tens of thousands of dollars it has cost to keep her alive. Thank you, very much.
Why is our infant mortality rate so high? That daughter-in-law, who weighs 78 lbs. on a good day and was never supposed to be able to have children, did. I found it amazing how doctors could keep her going - although a surprise and a half, as well as a known threat to her health, she wanted to try to keep the baby - and the infant, born prematurely, was kept alive and is in excellent health and not only has all of her wits, but perhaps some extra ones, too.
Matt, medicine can keep amazingly undeveloped preemies alive, so why is our infant mortality rate high? What tons of countries have higher life expectancy? Is this a medical issue or a matter of American life-styles. Look at John, practically begging for an early death by his behavior. It seems to me that of all of us, he is putting the most faith into our health care system.
If you were on the fence here comes the new pandemic threat to show the need for universal healthcare and a rigorus vaccine regiment. I used the examples of inflation in a non literal sense. History is filled with central banks, government using them to create money out of nothing, then failed currencies where the people loose everything.