10.16.09
Lies They Told Me About Healthcare
Okay, just needed to get this off my chest. I can’t stand the idiocy on all sides of the healthcare debate. Here are a small portion of the lies I have recently read about healthcare, with my refutations. I don’t link all the facts I’ve seen to refute these lies; look them up yourself.
1. The current bill will be revenue neutral. No it won’t. The assumptions in the bill are absurd. It will increase the deficit significantly.
2. Government death panels will ration care under proposed health bills. Under the bills most likely to pass, this is not the case. The death panels will be outsourced to the private insurers, who already have death panels. Sorry, but resources are not infinite. People will always die under every health system because their treatment is not cost effective. Someone will always make that decision.
3. Preventative care saves money. No, it usually doesn’t. Consider high blood pressure. Giving blood pressure medications to everyone who has high blood pressure reduces the number of heart attacks, but because the medications are given to many people who would never have had a heart attack, money is not saved. Preventative care is still usually cost effective, though, and that is what matters, saving life-years at as small a cost as possible.
4. We need single-payer healthcare (ie, government-funded care like Canada has). No we don’t. There are many different systems used in OECD countries, and plans (such as that of Switzerland) that do not have single-payer at all but require private health insurance have similar costs and outcomes to single-payer plans. Furthermore, there are many different hybrid systems, such as in France.
5. Surveys show people in America/England/Canada like their healthcare. This is irrelevant. 90% of people are fairly healthy; for them they will likely be satisfied anywhere. I for one have had the opportunity to see radiologists in both France and the United States. In both cases the diagnosis was quick and cheap. I paid maybe $300 out of pocket for multiple wrist x-rays and a consultation with a hand surgeon in the USA (and this is with a high-deductible health plan), and I was seen three days after calling for an appointment. In France I was seen in about the same time and paid maybe 40 Euros out of pocket for a consultation with a radiologist and a back x-ray.
6. A single-payer system will keep costs down. No, not really. Single payer or hybrid systems in England and France are having cost troubles just like here. The cost problems in the American system will not be cured by single-payer. See this great article in the New Yorker.
7. It is only because of greedy profiteering companies that our healthcare costs are so high. Actually, there are a decent number of health insurance companies and hospitals that are non-profits. Look at car insurance for a comparison: a non-profit mutual insurance company like Amica competes well with for-profit companies like Geico and Allstate, but the for-profit companies are on par in cost and service with the non-profits. With hospitals, for-profit hospitals often provide more charity care than non-profit hospitals.
8. The problems with our system can be fixed by reducing government interference and regulation. I am as much of a free-market ideologue as anyone (in fact, I consider myself to be an anarcho-capitalist rather than a libertarian, and I am definitely not a conservative), but there are problems with health insurance that are structural. The main problem is that many diseases are chronic, but health insurance is renewed annually. This is the pre-existing condition problem. One legitimate way around this problem is to force everyone to hold insurance. A free-market way around this problem would be for insurance companies to offer pre-existing condition insurance, separate from health insurance, such that if a person acquired a chronic disease during a 30-year term the insurance would pay for all future costs of the disease. This is a very risky kind of insurance to offer, though, and is unlikely to come into existence on its own. What is certain is that the present system of forcing insurance companies to cover pre-existing conditions, but only under certain conditions, is quite flawed.
9. Low American life expectancy (relative to other OECD countries) is proof that our health care system is flawed. I have blogged about this before. Life expectancy is driven by all sorts of things, and the US has higher violent death rates and accidental death rates than other countries. Furthermore, the quickest way to reduce life expectancy at birth is to have plenty of babies die. The US has more pre-term babies and babies to teen mothers than other OECD countries. Despite heroic neonatal ICU expenditures, many of those babies die. Rather than look at life expectancy, it makes more sense to compare disease rates and cure rates of diseases.
10. We should keep our current system of employer-provided health insurance. Even Obama tells people that the health care bills won’t take away their insurance. No matter what system you believe in, it makes no sense to tie health insurance to employment. This makes the labor force less mobile and reduces entrepreneurship.
11. Everybody has a right to good healthcare. Nobody should die because they can’t afford healthcare. These statements sound noble but when you apply them to other situations you will realize that they are absurd outside of a socialist utopia. People die every day in Detroit and Gary and Cleveland because they cannot afford to live in the suburbs and thus avoid crime. Tens of thousands of poor people die every year because they acquire disease from a poor diet or lead poisoning from living in a poorly kept-up building. Or they die of heat stroke because they cannot afford air conditioning or they die of diabetes or a heart attack because they do not have time to exercise due to working multiple jobs. The one thing that people consider most important is their health. As long as we are not living in a socialist utopia the rich will live longer and healthier lives because they can spend money on healthcare, personal care, safety, and quality food.
12. Single-payer healthcare will at least ensure access to decent basic care for the poor. Here in Michigan we have single-payer education: almost every school district receives the same amount of money from the state per capita. The poor students still get far worse education than the rich students, and for many school districts the education is truly horrendous.
13. Obamacare will be socialized medicine. Yes, it will be slightly more socialized than our current system, but Medicare, Medicaid, SCHIP, and the VA already spend a large chunk of our health dollars. In other words, our health are system is already quite socialized.
Yngvai said,
October 17, 2009 at 12:13 am
A nice unbiased viewpoint.
I would disagree with #3, but only to a point. It depends on how preventive care is defined. Putting people on high blood pressure medications certainly would be expensive and not cost saving. But there are forms of preventive care that can be cost saving. For example, there is evidence that obesity treatment can help employers save on health-care costs, which is why some employers like Microsoft will cover weight management programs. Such programs can also reduce absenteeism and presenteeism, which also are cost-saving for the employer.
Tastylunch said,
October 21, 2009 at 7:58 am
I think we have a solution here.
Give people with terminal illnesses insurance but force them to live in inner city Detroit. It will prop up housing prices there and serve as a death panel instead of having the gov’t or private insurance do it!
I kid I kid.
Something does have to be done though, what I don’t claim to know.
my health insurance has gone up 17% per annum since I started and I’ve had no claims. That is clearly not sustainable.
Joe Shareholder said,
October 24, 2009 at 1:18 pm
The debacle will be forcing people to pay for health insurance that don’t need it………until they do. For example, healthy young people will most likely opt out of the program and pay (because there will be no pre-existing limitations), and they opt out of the program the very next year. Any idea who will pay for this surgery? That’s right, others on the plan. Anyway, these kinds of issues will increase everyone else’s premiums. It will be much more expensive as you pointed out in bullet number one.
Joe Shareholder said,
October 24, 2009 at 1:22 pm
Whoa, half my comment above was erased somehow. My point was healthy people will pay the fee and opt out of the program until something major happens. Since pre-existing conditions will no longer prevent coverage, they’ll simply sign up when they need health insurance. This will increase the premiums everybody else pays since they’ll likely opt out again the very next year. The benefit for them will be a major surgery for a small price, and the cost will be passed on to others still in the program.
Mark said,
November 12, 2009 at 5:19 am
“Single-payer healthcare will at least ensure access to decent basic care for the poor. Here in Michigan we have single-payer education: almost every school district receives the same amount of money from the state per capita. The poor students still get far worse education than the rich students, and for many school districts the education is truly horrendous.”
-but they atleast get access to education which is more than you can say to the millions of Americans who cannot afford/get healthcare access.
I don’t get the insurance example comparing it to other types of insurance. I missed the point in that part. But I think comparing health insurance to any other insurance doesn’t make sense bc they do entirely different things. Car insurance or home insurance work fine but they only pay our for big catastrophes and one time things. Where healthcare is an ongoing yearly thing for many people especially women. It requires many payments frequently. Thus private healthcare is flawed just from that aspect.
Mark said,
November 12, 2009 at 5:26 am
I agree tying it to employment is stupid.
Yeah, the cost may end up being the killer of single payer it especially with the medicare payments we have due as baby boomers are approaching retirement. hehe I guess it would just be another ponzie scheme along with social security at this point. Going to be hard to payoff all this national debt and keep things going at the rate they print money.
Michael Goode said,
November 12, 2009 at 8:20 am
Mark — Actually, there are very few people who don’t get access to healthcare. Keep in mind that we have Medicaid for the poor and Medicare for the old. Also, one of the problems with health insurance is that it is not treated like insurance. Health insurance covers all sorts of standard things it shouldn’t cover, so of course premiums are high! What is wrong with people paying for basic care out of pocket? People do that for their cars and that works fine. They also do that for housing and for food. By having insurers pay for everything there is an extra layer of bureaucracy and cost. If healthcare is so basic as to necessitate that the government provide it to everyone, why is the same not true of food and housing?
Mark said,
November 13, 2009 at 12:04 am
housing, food and cars are affordable. I don’t know if you know how much a hospital bill for one day is? If you get an illness that requires recurring treatment that cost is extremely high relative to food and housing. It’s not just poor people that can’t afford health costs. From my understanding it disrupts the middle class just as much as the poor.
This is pretty much the story around the country.
At least 62 percent of all U.S. family bankruptcies result from medical expenses, reports a study released yesterday in The American Journal of Medicine
http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=are-medical-costs-the-leading-cause-2009-06-05
http://www.washingtonpost.com/wp-dyn/articles/A9447-2005Feb8.html
Nobody’s safe. That’s the warning from the first large-scale study of medical bankruptcy.
Health insurance? That didn’t protect 1 million Americans who were financially ruined by illness or medical bills last year.
A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs — until illness struck.
As part of a research study at Harvard University, our researchers interviewed 1,771 Americans in bankruptcy courts across the country. To our surprise, half said that illness or medical bills drove them to bankruptcy. So each year, 2 million Americans — those who file and their dependents — face the double disaster of illness and bankruptcy.
But the bigger surprise was that three-quarters of the medically bankrupt had health insurance.
Michael Goode said,
November 13, 2009 at 6:35 am
Mark — that is why I differentiate between health care and health insurance. I have had catastrophic-only health insurance for a few years. And I have had no problem paying for x-rays, doctor visits, and medications. For hospital stays and other expensive things it is quite necessary to have insurance to cover it.
Everything you state ignores my point: people’s focus on having health ‘insurance’ cover everything makes no sense! If anything, the focus on having it cover everything draws attention away from how well it insures against catastrophic risk. Do you know how much your insurance plan will cover in a year or in a lifetime? I do ($5 million, with my out of pocket limit at $10,000). Most people don’t. I can assure you that 99% of those bankrupted by medical bills either had no insurance or their insurance had a very low coverage limit. Yet I am sure that they know what their copay is for a routine doctors visit.
So I am not arguing that our current system works. I am arguing that if we fix some of the problems in the healthcare insurance market it could work quite well.