T Nation

When Hell Freezes Over


So today MA just got themselves compulsory Health Insurance, through a BIpartisan bill.

This is a typical Social-Democratic bill -- universal health insurance, fully paid by the middle and upper classes, subsidized to the lower classes, much like in most of Northern Europe.

The real kicker here is that, in an unprecedented event, the GOP saw the light and realized what the left has always been saying: it's actually cheaper to pay for the damn thing right off the bat -- and give people an incentive to go to the doctor more often -- than to continue to spend millions in emergency healthcare.

Then again, it might just be another instance of the GOP selling their souls to the highest bidder.

Opinions or comments anyone?




So, does this mean it is time for everyone to establish residency in Massachusetts?


I've been giving this issue alot of thought lately actually. Isn't the system we have now actually a crappy version of "national" health care? I think so.

No patient can be turned away from any hospital for treatment ever; couple that with medicare, medicaid, and a prescription drug benefit, doesn't that damn near give us "national" health care? Like I said, I think so. The problem is that the system is crappy.

Some of the questions that I haven't been able to answer are related to how to keep costs down. I see alot folks who abuse the system all the time. Going to the emergency room for aspirin, calling the ambulance and the fire dept. because their knee hurts, going into the emergency room to get a damn band-aid. Even coming up with bullshit reasons to go to the hospital to use the ambulance as a taxi to where they want to go.

While nobody has a right to a job, I'm starting to think that we all have a right to quality health care. We just have to come up with a decent system of delivering it.

So, as soon as I figure this whole thing out, I'll post it :wink:



Like the dems haven't sold their souls to big unions, wacko environmentalists, etc.

This has the potential to be agreat thread. I hope it doesn't get fucked up and turn into a partisan shit toss.


I don't for a second believe that the Republicans who voted for this bill honestly think it is in-line with conservative values.

What leads you to this conclusion?


I go back and forth on the argument for national health care. As a personal right, there isn't a lot of support for it in the Constitution.

It's an economic decision the government can decide to make. Now, I'm for it, but not bc I think I deserve health care, but bc corporate health care seems to be against my rights as a consumer.

Pure unfettered capitalism is really fucking good for making cars, computers, even to an extent, making science. It's pretty fucking lousy at insurance. Here's why.

Capitialism works best when the products I can choose between have actual qualitative differences, because my informed choice will insure the success of the better product (or the best one for my niche). The price we pay for that efficiency is the overhead.

Insurance of most kinds doesn't really work that way. To an extent, my overhead is only paying for people to be more polite to me on the phone, because price is the only comparative advantage for any one company. If there were a true cost vs. quality curve within the confines of the law, I could choose between cheap or good. That doesn't really apply to insurance, because Progressive's 100K insurance policy isn't signifcantly different than Allstate's.

Insurance is essentially a hedged bet, leveraging risk by an installment plan.
This doesn't work for one person, but it works really well over groups. The only people that are absolutely essential to this operation are some clerks and some actuaries.

This is an exception to lasse faire capitalism, as the best possible government plan will beat the best possible capitalist plan every time, simply because the capitalist plan has to pay management, marketing, and has to retrun profit for shareholders.

The other main reason I don't like corporate health insurance as policy is that my return on that policy is entirely ad hoc on the part of the company. I have some rights to arbitration, after all is said and done, but I have no effective recourse to the law for bad service. It's as bad as a situation for me as a capitalist to pay into an investment that will in all likelihood not return well, and as a capitalist I should do everything I can to come up with a good investment return.

If the government is the best economic possibility for the market as a whole (reason to believe there is...for one, how about college tuition rising 8% percent a year, much of that because of health care costs), it might be indicative that the standard operating principles of capitalism don't apply as well here.

By the way, I'm not so sure I'm a big fan of the Massachutsetts bill, as its structured. As I understand it, it takes away choice for the very people I'm for giving it to. I need to read up more on it though. I'm a much bigger fan of the old Clinton plan, mostly bc it realized that the solution to affordable universal health care in this country is probably going to involve some amount of cooperation between business and the government, rather than the total veto power of either one.


Excellent post, zara.

And to add to your thoughts, I'd like to put in my two cents, being in the medical field, and perhaps having a little inside info to share about medical stuff.

Most folks may not realize just how fucked up the medical insurance game is. Zara pointed out quite eloquently how the system is NOT capitalism. I would like to also state that it isn't even real business.

What I mean is that the prices for our services have nothing to do with production cost, overhead, or anything else which determines price a la supply and demand. Our prices are determined by what kind of insurance you have, and this also determines the level of care you will receive. Different insurance = different prices. This doesn't sound so bad until you realize that two patients with the exact same medical problem to resolve will be paying two different prices for the exact same service or product. Is this like haggling? No, not really... it's like going to a Burger King and being charged ten dollars for a cheeseburger because you're wearing a green shirt, while the folks wearing red shirts pay a dollar.

A hospital will charge as much as they possibly can, dependent upon what is expected from an insurance company, which is determined from a "diagnosis code" for some ailment you have. Nothing to do with what resources you have consumed during your treatment. Oh, those resources are tracked and billed for, make no mistake there: it's just that you may be paying a hundred more dollars for the same lab testing that the patient in the next room is paying.

So what ends up happening is that everything in your care is pre-determined according to actuarial calculations made by your insurance company. The lab tests your doctor orders, the medicine you are offered, the surgery you are offered... everything is dependent upon something we call "the standard of care".

I would say that most of the lab testing I perform, over fifty percent at least, is medically unnecessary. And that is me being very generous here... it's probably closer to eighty percent. This is lawsuit protection for the physicians who are legally responsible for your health and charged with providing the standard of care.

And "cover my own ass" medical waste/fraud is just the beginning of this mess. Many many many patients I see in the ER do not belong there. Some nights, half of the patients sleeping in beds in the ER are homeless drunks being "treated" for their medical problems which amounts to hunger and not having a place to stay the night besides a gutter somewhere.

If you are ever homeless, and you need to eat something, here is the magical phrase which will give you a temporary fix:

"I have chest pain."

Maybe it's chest pain from not having had any kind of solid calories in a week(whiskey only stops hunger pains for so long), but that doesn't matter. Because we MUST provide the standard of care, this bum gets the full workup, including lab testing, free meal, medical evaluation, maybe (if you are sly enough) some pain medication for your possible heart attack. IV fluids will also lessen the effects of the hangover from a week-long cheap whiskey bender. Bonus! We will even call you a free cab in the morning when you wake up.

Will that guy be paying his bill?

So do I have anything to say here besides some bitching? Yes. There is a solution to this, but nobody wants to hear it. This idea is so weird to most of us that I know the only way it might ever come to pass is for something in our system to seriously break, and the next few decades with our baby boomer patient population just might do it.

All we have to do is eliminate the legal responsibility the doctors have for your health. If we make each of us responsible for our own health, and doctors become more like "health consultants", then all the burden on our system starts to wash away. That's right, no more millions and millions of dollars in medical malpractice insurance premiums. No more rabid ambulance chasing lawyers, and the "cover my ass" needless expenditures. Maybe we can start with putting a major cap on malpractice awards? I don't know. But something is gonna have to change... take my word for it.


I wonder if there is an affordable way to do it without hurting physicians.


The physician is getting the shaft now.

They aren't paid to be "doctors" anymore. They are highly-trained technicians who perform procedures according to a predetermined formula. Free thought and innovation are discouraged. More and more I see the physician moving away from a philosophy of being a healer to being a disinterested mediator between a patient and the delivery of medical products and services.

Example: A doctor has prescription power. Quite simply, you cannot get powerful and effective medicine without a doctor saying you can have it.

Drug companies know this, and they market separately to us and to the physicians, sometimes going quite far in their quest for "encouraging" doctors to try out their latest formulation of pseudo-poisonous and questionable medications. Case in point: have there been any major recalls/lawsuits for any heavily-marketed "wonder drugs" lately? vioxx zyprexa celebrex

Whew, that was just me having a little fit there, huh? Why don't I take a lozenge and provide a link?


And that's just for 2006 so far. There's more. Much more. Check the last few years out.

Doctors are people too. They succumb to advertising and marketing ploys just like anybody else. Many times they might find themselves throwing drugs at a problem instead of getting to know their patients and try to heal them as a person... the patient becomes a set of symptoms and clinical risk factors who might try to sue at the drop of a hat, instead of a person with feelings and a life.

A very wise doctor from the old school I worked with in an ER down in south florida once told me:

"Dave, I have the easiest job in the world. Look at these huge bags of medications that these people bring in with them. All I do is tell them to stop taking all but one or two of their prescriptions, and they magically start to feel better."

This is why I vehemently oppose the increased medicare support of many prescription drugs. VEHEMENTLY. What these people is NOT more drugs, but less. Everybody thinks that another pill is going to make them stop feeling old or some shit. The only people helped by increased medicare support of prescriptions are the people who sell medicine.

Does anybody here have a grandma who takes fifteen different drugs depending on the day of the week and what time it is? Do they have complicated boxes to try to keep all their different drugs they need to take all separated right? I have an idea. Go visit your grandma and make her some tea. Sit down and spend a few hours talking, and I want her to smile and laugh. She will feel better than she has in a long time. It always worked for me, but I can't do that anymore because both of my grandmas died last year.

You'd be surprised at the true healing power of a single phone call. All you have to do is care, and you become a healer instead of a technician. This is what is being discouraged these days in my field. Terrible idea.


A concern:

Underwriting moral hazard: I think the first step in reforming our broken health care system is fixing the demand side first, or at least addressing it. Before I could get to how the health care is provided and repairing all the moving parts there - like tort reform or universal insurance - I would want to take the time to try make some noise about that first step in quality health care: self-responsibility for your own health.

Universal health care ignores this issue, and I think that is a problem. Insurance should be insurance against unforeseen calamity, not healthy people paying for the choices made by unhealthy people.

The trends are not pointed in a favorable direction. Rising obesity, sedentary lifestyles, the manic belief that pharmaceuticals are the solution to every physical/mental/emotional problem you have, etc. - what will correct these problems, ones that add up to a frightening drain on health care resources? Universal health insurance, I suspect, will do little to reverse the trends, and I fear it may actually make them worse.

Until we address the demand side of health care, no supply side reform will amount to much. Even a well-intentioned and reasonably financed universal health care system would wind up bankrupting itself, because it does nothing to encourage taking responsibility for one's own health.


I don't know all the details of the bill. What I heard on a news report is the following:

  1. Requires employers to provide insurance to all employees.

  2. Unemployed and indigant covered by state.

Again don't know the details but is this the type of universal health insurance we are talking about.


Of which cinclusion are you refering to?

That nobody has a right to a job?, Or that folkas have a right to quality health care?


Your posts on this issue have been incredible. There is nothing I disagree with. Our current health care system forces doctors to be "Mc Donald's care givers". Until the general public realizes that the current system is NOT in their best interest other than possibly financially depending on the insurance company, there will be little expected change. If a doctor spends 6 hours treating one case but gets paid the same as he would a 25 min work up, I'll leave that up to the reader how that affects the mood of that physician.


Given the topic of the thread, I'd go with the health care part.


I agree with this.

I'm sure you know that I agree with a universal healthcare system, but what Thunder says is both true and worrisome.

Although, I don't think that there is any way to change this without having the government step in, which Republicans would hate, and even I would not be comfortable with.

Are you going to ban McDonald's? Or smoking? Or drinking? Can you really try to control an American's caloric intake?

In a government that is run by big business and special interest as ours is, you will never find the government looking out for regular people - ever.

They would rather see people die from eating like shit than to see their special interests groups like the sugar cane industry get pissed off.


So someone who has a better insurance plan will have to pay more for the same treatment than someone who has a lesser insurance plan, is that what you're saying? And someone who has a lesser insurance plan doesn't get the same "standard of care?"

And say we do remove all legal responsibility from the doctors, then what are we supposed to do when something does occur? Not trying to criticize or anything, I just find it very interesting that everything is so...formulaic.


Thanks smartass. Given that the post you responded to had two seperate ascertations, I felt the need for clarification. My bad.

I'm just wondering if people think that quality health care is a right for everybody, or if it is a right for those with good insurance. I'd be a hypodrite if I said that the private sector is better for providing ALL services. I think I do a pretty damn good job as a fireman working for a government fire department with no profit motive.

It's not a matter of socialism vs capitolism. It's a matter of what's the right fix for the situation. IMHO, a strong profit motive for health care might not be extremely healthy.


That's not what he wrote as far as "standard of care". All patients receieve the same standard of care. The reason is, the doc has to cover his ass. You may not actually need a full x-ray series, but because you are likely to sue if he misses anything at all including anything unrelated to what you came in for, he checks for EVERYTHING. Some is just the basic act of being thourough, while some is simply the act of protecting himself from potential lawsuit considering patients try to sue for any and everything.

No one is saying remove legal responsibilty from doctors. However, if you all think that the massive avalanche of lawsuits that require massive malpractice insurance payments from the doctor are helping you, you are living in the dark. This society is sue happy. That has a snowball effect that eventually effects YOU.


Quality health care should be a right for everyone. I would hope there aren't many docs who are providing "poor quality health care". However, here is a basic concept, if your doc sees that your insurance only pays for the cheapest material, you will receive whatever material is supplied by the lowest bidder. That is what health insurance does for you. Sounds great, right?