A Tale of Three Injuries
Greg Sargent reports that Organizing for America, the Obama campaign successor organization, is planning to compile a vast database of health care anecdotes. I thought I might offer a few of my own:
During a short-lived stint as a summer camp counselor, I was playing basketball on one of those short hoops—this one must have been 6′6″—that they have for kids. I was playing defense in the low post, and didn’t realize that I’d actually positioned myself directly below the rim. I jumped, smacked my head into the rim, and the little loops of metal that hold the net in place cut my scalp. It didn’t hurt too badly, but I was bleeding like crazy. Someone drove me to the emergency room in Augusta, ME and I was holding a towel on top of my head to try to minimize bleeding. We got to the ER, and fortunately someone was available to see my almost immediately, but first I had to fill out some insurance forms. So I was standing there at a counter, bleeding from my head, struggling to fill out the forms without the ability to use my left hand to stabilize the sheet of paper. I used the left elbow instead, then kind of contorted my head and neck somewhat so as to be able to hold the towel in place. Naturally, with my head tilted there was blood dripping onto the counter and the forms wound up being filled out with a less-than-ideal degree of eligibility. But, damnit, this is America where we have our priorities in place. First you fill out forms, second you get treated.
If the Queen needed a band-aid, she would call it an elastoplast.
Conversely, one time I was in the UK and sort of randomly cut my leg. It wasn’t especially bad, but it’s the kind of thing you want to clean properly and put a band-aid on. But I was far from my hotel and didn’t have any of the relevant equipment on me. I hopped around a bit, hoping to find a pharmacy, but I actually saw an NHS clinic first. So I limped in there, a nurse saw the problem and quickly and politely dealt with it with no fee or forms or anything. The only problem was a minor miscommunication around the fact that I had no idea what an “elastoplast” is.
Back to the US, where about three years ago I stepped on something in bare feet and cut myself. It didn’t seem like a problem at the time, but it got infected which created a painful “I can’t walk on my left foot” kind of situation. Naturally, I called my doctor to see if he could help me out with that. And because this is America where we don’t have waiting times to see doctors, was told that he could see me in two days. Fortunately, the very next day somebody canceled his appointment and I got a call and was able to cab it over to the doctors office and get the situation treated relatively swiftly. And since I’d been to this doctor before, the forms and such had already been filled out. It was practically an NHS level of service, except since this is the United States of America an extremely minor problem was dealt with by an expensive MD rather than a cheap nurse.
Now as I said yesterday we have hundreds of millions of people in the developed world and thus tens of billions of anecdotes about health care. Under the circumstances, a dueling battle of anecdotes is not going to reach any definitive conclusions. But people think about the world in terms of stories, so these kind of things matter.
91 Responses to “A Tale of Three Injuries”
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June 23rd, 2009 at 11:35 am
I think the word you were going for was “legibility,” not “eligibility.”
June 23rd, 2009 at 11:37 am
Sure, you got prompt and competent care, but you still must have noticed the omnipresent, stifling lack of freedom, dampening spirits in the NHS clinic.
June 23rd, 2009 at 11:38 am
Maybe the doctor would have let the nurse treat you if he wasn’t so damn scared of getting sued if she screwed up.
June 23rd, 2009 at 11:41 am
Maybe the doctor would have let the nurse treat you if he wasn’t so damn scared of getting sued if she screwed up.
That’s a good point. Which might be why Obama offered to include malpractice reform to help with this situation as part of a health care compromise. Of course, Republicans aren’t actually interested in any kind of compromise, which is why when asked they couldn’t think of a single think they would be willing to give up in return for malpractice reform.
June 23rd, 2009 at 11:47 am
Which might be why Obama offered to include malpractice reform to help with this situation as part of a health care compromise.
So he is in favor of a cap now?
June 23rd, 2009 at 11:49 am
What Matt doesn’t say is that after filling the form or waiting one day, he got the best health care in the world.
June 23rd, 2009 at 11:52 am
I had a similar situation to MY’s in the UK, but mine was in Canada.
I cut my hand badly in Parry Sound, Ontario and went into town to the storefront clinic. They stitched me up immediately and sent me on my way. No forms, no charge, nothing – they didn’t even ask for an ID.
June 23rd, 2009 at 11:59 am
NO! NO! NO! Anything but our present system is TOO EXPENSIVE!!!!! AND SOCIALIST!!!! It will COST TOO MUCH!!! EVERY WHITE TAXPAYER WILL HAVE TO PAY A MILLION DOLLARS A YEAR AND BE FORCED TO WAIT IN LINE AT A DIRTY PUBLIC CLINIC WITH LAZY N***ERS WHO DON’T DESERVE HEALTHCARE ANYWAY!
To convey the proper tone of the debate, I should properly copy and paste the foregoing twenty or thirty times in every thread on the topic, but I won’t.
June 23rd, 2009 at 12:12 pm
When I was living in Chicago I got a pretty bad fever. I hadn’t felt too bad in the morning but by around noon I realized I was quite sick. While waiting on the platform for my El train home, I passed out and hit my head on the concrete. The paramedics were called by the transit employees and I was sent to the hospital. I wasn’t that badly hurt, a moderate concussion and a chipped tooth. But it was a head injury, requiring a CAT scan, an overnight hospital stay, etc. Just the ride in the ambulance was $800. All told I owed about $12,000. I didn’t have health insurance.
That happened over four years ago. I’ve paid off less than half; as a full-time grad student, it’s tough to put away that kind of money. At least I’m a fairly employable, young and healthy adult who will one day have the capacity to pay it all off and someday get a job with insurance. There hasn’t been a month where I didn’t write out a check and wonder how the hell this country got to be in this current mess, or how so many people can be so certain we need to stay right in it.
June 23rd, 2009 at 12:13 pm
That’s not the reason. If a fee-for-service doctor sees a chance to bill, he does. Kaiser, with salaried doctors, maintains facilities for patients to see nurses for minor emergencies. Kaiser doesn’t want to get sued either, but they also don’t want to pay doctors to do nurses work.
June 23rd, 2009 at 12:18 pm
A few years ago, beginning a vacation in Amsterdam, I found a that my eyesight had changed noticeably (I’m very nearsighted). Fearing for my vision or worse (brain tumor?) I went to an eye doctor recommended by my hotel.
(My vision had indeed changed dramatically – I realized it likely had come from getting away from nonstop contact use.)
Anyway, I got into see the doctor immediately. The cost of the visit, examination and diagnosis?
Nothing. Zero.
All I had to pay for was a new contact presciption. Cheaper than in the US.
Yes, please spare us from European socialized medicine.
June 23rd, 2009 at 12:21 pm
That’s not the reason.
Maybe, maybe not.
But on your broader point about Kaiser. They’re great. I don’t have employee based health insurance and I pay $230/month for me and my two boys at Kaiser. They are pretty efficient, cheap and good care. And not government run.
June 23rd, 2009 at 12:27 pm
I don’t have employee based health insurance and I pay $230/month for me and my two boys at Kaiser. They are pretty efficient, cheap and good care. And not government run.
Good for you. I have no idea what the details of your policy are, or what special circumstances qualify you for such an amazingly low rate, but I will venture to say from personal experience that such deals are simply not available to the vast majority of uninsured Americans.
June 23rd, 2009 at 12:27 pm
But people think about the world in terms of stories, so these kind of things matter.
As long as they support your position. You go to great lengths to refute or dismiss anecdotes from other blogs or news sources that refute the efficacy of government health care.
June 23rd, 2009 at 12:29 pm
“a cheap nurse.”
Hey, man, nurses are not “cheap”. That’s pretty demeaning. They’re “inexpensive”.
June 23rd, 2009 at 12:30 pm
but I will venture to say from personal experience that such deals are simply not available to the vast majority of uninsured Americans.
You’d be wrong.
June 23rd, 2009 at 12:31 pm
This is an interesting idea, which is why these comments will likely soon be full of hackneyed comments from people like Judd.
Here’s my example of the excesses of American healthcare. About three years ago, I developed a boil on my leg. I did the usual hot compress to treat at home, but to no avail. My GP was out of town, and none of his MD colleagues would see me. I mentioned the possibility of a nurse practitioner, but was waved away by the practice. Indeed, they said that I should just go to an emergency room for treatment. Given no alternative, that’s what I did: to a certain teaching hospital in DC. Upon checking in, I waited six hours after the initial assessment. Ultimately, I was seen by the attending ER MD, who thought my boil was a fantastic teaching opportunity. With an entire class of students on their ER rotation, he spent an hour lancing my boil, asking the students about the relevant issues: what type of antibiotic I should be put on; should they send a sample to the lab to make sure it wasn’t MRSA (which they did); etc. I was required to return one week later to have the packing removed, which was also done by the same attending MD (after about a three-hour wait). I asked him whether such treatment could be administered by someone without his level of training to save on time and expense. He just responded that I was lucky that that I had such wonderful insurance and that it happened to be a quiet day in the ER.
For lancing a boil, my insurance company was billed about $1,500.
June 23rd, 2009 at 12:31 pm
You go to great lengths to refute or dismiss anecdotes from other blogs or news sources that refute the efficacy of government health care.
So it’s time to go back to hard data, showing that the US doesn’t have a better health care system than most Western countries (if anything, it is worse), but it costs 50% more?
June 23rd, 2009 at 12:36 pm
No, simply trade-offs and fighting fire with fire.
June 23rd, 2009 at 12:36 pm
Matt,
Next time do what I used to do: wait until the main offices closed, then go to the urgent care/emergency room to get same day attention. Well, that’s what I used to do until 2007 when I took a buyout from Ford. I couldn’t find another job and my benefits expired less than a year later. Now, I just pray I don’t ever get sick.
I think this is where I’m supposed to pump my fist and scream “America! F@#& Yeah!”
June 23rd, 2009 at 12:37 pm
The myth that malpractice costs is driving healthcare costs is perhaps the greatest fraud perpetrated on the American public, and I say this as a defense attorney.
And insurance companies, who perpetrate this fraud, have done such a good job that they have the medical community paying them premiums of two to three times what they should and blaming someone else for it.
Doctors don’t get sued over minor incidents despite this or that anecdote that some advocacy group might dig up. It simply costs too much money to bring a malpractice suit to justify it over minor injuries with no damages.
If Matt’s infected foot were a misdiagnosed staph infection and he lost his foot, leg or died over, than a law suit might result, but short of that such a suit would never happen. States like FL and IN that have enacted the tort reform demanded by these insurance companies have been rewarded with explanations from the Ins companies as to why rates must continue to rise. (pdf)
June 23rd, 2009 at 12:48 pm
Before Jay Leno left the Tonight Show, he told an anecdote about a friend who had broken an arm in a motorcycle accident and went to an ER for treatment.
The cost – $27,000!!
June 23rd, 2009 at 12:55 pm
I play on an amateur full-contact sports team, so my teammates and I on occasion get injured. It’s been quite eye-opening to see how they deal with it. One teammate was afraid that she’d broken a bone, but she didn’t have insurance. She owns her own small business and she didn’t want to pay out of pocket for X-rays unless she was sure it was broken. Someone told her that if you get a tuning fork, and press it near the bone while the fork is vibrating, that it will be extremely painful if the bone is broken. It didn’t hurt, so she assumed it wasn’t broken and went about her business. I remember wondering how our medical system got to be so messed up that people are relying on this type of self-diagnosis to avoid staggering debt.
June 23rd, 2009 at 12:57 pm
Back in 1991 my dad was in France, hiking in the Alps with a your group. He twisted his ankle really badly.
They called in the medical helicopter that flew him down to an ambulance that rushed him to the hospital. He received the red-carpet treatment – that is until they found out he was American. Since there is no single-payer system in the US, the French Gov’t had no equivalent US entity to request reimbursement.
The doctors apologized profusely and said, ‘give us your Visa card and we’ll make this as inexpensive as possible for you.’
If my dad had been from any other nation on the planet, everything would have been fine, but no, we are from America and therefore we are screwed.
June 23rd, 2009 at 1:15 pm
Are you going to produce the anecdotes from the UK which talk about a cancer patient croaking from a case which is much more likely to be survived in the U.S.? Are you going to tell non-poor American retirees about the anecdotes of similarly aged Canadians who wait substantially longer for identical procedures? Oh, and here’s a clue: electorally it doesn’t matter a good goddamn whether you or other non-retirees consider the procedures not time-critical, because the segment whose votes are most sought after isn’t interested in experiencing longer waits than they currently do, no matter your opinion.
Yes, I could make posts of a similar tone regarding many people who defend the current regime. The number of people who are willing to be honest when discussing this topic is very small.
June 23rd, 2009 at 1:18 pm
Comrade,
Wow, so your Dad actually had to pay for a service that was provided to him. The horror!
June 23rd, 2009 at 1:18 pm
Doctors afraid of being sued because of his or her nurse?
Most “family” doctors now have PAs (physician’s assistants). A PA only needs a a bachelor’s degree, the same as a RN. However, a PA may prescribe medications in most states, order tests and assist with surgeries. My mother quit her oncologist because she never saw him, she only saw his PA which had NOT trained in oncology, but had trained in orthopedics.
I know many people who tell me that their doctor is “Dr. So-and-So”, but they haven’t seen him or her for years because they are rerouted to the PA.
Of course, none of this addresses the perks of being a doctor: free takeout meals at the better restaurants if the doctor is willing to listen to a pharma rep give an “educational talk” while waiting for that meal to be boxed, entire sets of golf clubs at medical association meetings, Christmas parties paid for jointly by pharma and for-profit hospitals, “consulting fees” for sending a patient to a certain lab for unnecessary tests, etc. ….. How do I know this? We had a doctor in my immediate family for ten years and this stuff is expected.
June 23rd, 2009 at 1:21 pm
It’s even worse. Insurance companies have doctors believing that “pain and suffering” damages are the cause of increasing malpractice payouts. They are not. It is economic damages that are increasing most rapidly*. A big part of why economic damages are increasing is that they have to cover the injured party’s medical costs, which are increasing at a truly ridiculous rate.
The real story behind the “caps” is that insurance companies don’t really care about them. They are a PR stunt to get doctors to accept inordinately high premiums to make up for bad investment strategy by the insurers. If non-economic damages were capped at $250,000 nationally, malpractice insurance rates would barely change at all. They would, however, screw some people who are suffering.
(*At least in states where such data are not kept secret. In most states, the critical data is held only by insurers, who never allow it to be used in any arguments on the topic. Instead, they cherry pick supporting snippets of data, and hide the rest.)
June 23rd, 2009 at 1:29 pm
No Will, we won’t. That’s the point. Those stories are already being told, in overwhelmingly disproportionate levels of anecdote relating. You are implying that it is somehow wrong for our side to fight back without inflicting equal amounts of damage to ourselves as we inflinct on our political opponents.
When someone kicks you in the balls, you do not respond by kicking one of their balls and one of your own – just to be fair.
June 23rd, 2009 at 1:32 pm
Are you willing to tell me what someone who is incapable of getting health care coverage should do, Will Allen? Judd? Anyone who is here defending the status quo has to admit that there are millions of people in this country who are unable to get necessary health care. So if you oppose government intervention to change that fact, I ask you: what should they do? What should an individual do, if they need health care, and can’t afford it?
June 23rd, 2009 at 1:42 pm
What should an individual do, if they need health care, and can’t afford it?
We already know the conservative answer. Pull yourself up by your bootstraps. I guess in this case it means taking a second job at Taco Bell for 10 years to pay for the massive bills from one uninsured hospital stay.
Or, you know, rely on charity to pay your medical bills. I hear there are a lot of charities out there that take care of that for all 47 million people who need it, so the government really shouldn’t do anything at all. The free market always provides for the best general welfare, right?
June 23rd, 2009 at 1:44 pm
We had a doctor in my immediate family for ten years and this stuff is expected.
Did that doctor write out the occasional prescription for you? Or empty out his samples drawer? This is something that I’m currently very interested in — the whole grey market system of friends-and-family doctoring.
the segment whose votes are most sought after isn’t interested in experiencing longer waits than they currently do, no matter your opinion.
Well, that’s nice. Of course, the way to address this is generational: Medicare is a binge of costs because retirees have had to deal with the famine of private insurance their working lives. Put an actual healthcare system in place before people retire, and you can change the basis of what happens afterwards.
June 23rd, 2009 at 1:45 pm
Freddie, what is it about forums such as this which destroys reading comprehension? When I wrote this….
“Yes, I could make posts of a similar tone regarding many people who defend the current regime. The number of people who are willing to be honest when discussing this topic is very small.”
……what do you think I am saying?
Frankly, the reason I infrequently post on this topic is that the overwhelming precentage of people who do are stunningly dishonest. Until a person is willing to specifically identify who they are willing to let die or suffer greatly, in order to enact their preferred form of rationing, they aren’t worth listening to, which means there is hardly anybody worth listening to on the topic.
June 23rd, 2009 at 1:46 pm
Are you going to produce the anecdotes from the UK which talk about a cancer patient croaking from a case which is much more likely to be survived in the U.S.?
Bring ‘em on, Will. Make sure you start with “I know this person who…” Or STFU.
June 23rd, 2009 at 1:48 pm
Lest someone write that there is nothing wrong with doctors getting a free meal, these free meals count toward continuing medical education requirements since there is some sort of “lecture” or “seminar” involved. These programs are presented by doctors on pharma’s payroll.
In addition, pharma sales reps, the one standing in the lobby of the restaurant giving a sales pitch to the doctor, usually make calls on each doctor within the rep’s territory once a month. These pharma sales reps are almost always business majors with either a BA or MBA. A few have a a BA in physical education and have at least taken an anatomy course. But, the main purpose is to convince the doctor that a drug is absolutely needed so that the doctor will prescribe it. As part of the sales pitch, pharma hires computer programers to write software programs which in turn are given to doctors so that the doctor has “evidence” that the drug is absolutely necessary.
Once a patent on a drug runs out, the drug is no longer absolutely necessary because something new has been developed or the binding agent for the drug is changed so that a new patent can be obtained for an old drug which is marketed as a new drug. Either way, the patient is not prescribed something that is generic, but is billed for a new drug.
June 23rd, 2009 at 1:52 pm
This set a.c. doesn’t include you.
Q.E.D.
June 23rd, 2009 at 1:54 pm
Well, scythia, I prefer data to anecdotes, and let it be noted that this is a far better measure of health care delivery than life expectancy at birth, which is the statistic so fatuously and frequnetly put forth by thos who advocate cahnges in the U.S. system.
http://www.webmd.com/cancer/news/20080716/cancer-survival-rates-vary-by-country
http://www.medscape.com/viewarticle/561737
June 23rd, 2009 at 1:59 pm
Until a person is willing to specifically identify who they are willing to let die or suffer greatly, in order to enact their preferred form of rationing, they aren’t worth listening to, which means there is hardly anybody worth listening to on the topic.
I’m going to let die anyone who is, without a shadow of a doubt, going to die within a matter of weeks, and upon whom hundreds of thousands of dollars is spent so they can stay alive a week or two longer. I think that should go a good ways towards cutting massive amounts of cost from the system.
And of course, you didn’t mention your form of rationing, which is that the only people who can get care are those who can afford it. Who are you willing to let die or suffer greatly so that doctors and insurance companies can make huge profits?
June 23rd, 2009 at 2:00 pm
Until a person is willing to specifically identify who they are willing to let die or suffer greatly, in order to enact their preferred form of rationing, they aren’t worth listening to, which means there is hardly anybody worth listening to on the topic.
The poor and the uninsured, obviously. ¡Viva America!
June 23rd, 2009 at 2:03 pm
Actually, Savage, if you are interested, I have my preferences. I’d prefer that coverage be mandatory at age 18, with some sort of Medicaid program for that small slice of the percentage of the population which is uninsurable at that age. I’d have a lifetime, inflation-adjusted benefit cap for each individual. After their benefits were exhausted, they would either pay out of pocket, or die. Yeah this is arbitrary, but no more so than some government body denying cutting edge technology because it is deemd too expensive. Finally, I’d like to explore ways to greatly greatly increase the supply of doctors while reducing the debt doctors have upon leaving school.
June 23rd, 2009 at 2:04 pm
Personally, I think Matt should have let some of his blood drip on the insurance form. Let whoever is looking at the form see the blood, and maybe think about how it got there.
In some ways, blood on the insurance paperwork is a perfect metaphor for the American health care system.
As for the third injury, you don’t mention this, but with a little public awareness education, better cleaning of the wound and an OTC disinfectant product might have prevented the infection before it happened, saving your lost work productivity as well as the medical efforts of everyone in the system (that was involved). Less business for the cabbie, though.
Fortunately, you not only had health insurance that allowed you to get help for this problem, but also the kind of job where you aren’t in danger of losing your job because an infected wound kept you away from work for a couple of days.
June 23rd, 2009 at 2:06 pm
But I’m still asking you, Will, and you aren’t answering. What’s your advice to them? If someone said to you “Hey, Will Allen, I’m suffering, I need medical care but I can’t afford it,” what would you tell them? What realistic path can you offer them that gives them appropriate care and doesn’t leave them destitute? Or can you simply not answer the question?
June 23rd, 2009 at 2:08 pm
Wow, Will “I support mass murder so long to promote my lifestyle” Allen, posting a dishonest screed about how horrible it will be when health care is no longer controlled by soulless insurance company bureaucrats bucking for a bonus, complains about dishonesty. Hey Will, why don’t you tell your story about how the war on the Iraqi people prevented a nuclear holocaust? Or the one about how George McGovern was secretly Pol Pot? Or perhaps you could explain how there is no such thing as Social Security taxation because there’s no way to differentiate between pots of government money? I know I always love that one.
The fact is, Will, you define dishonest argumentation.
June 23rd, 2009 at 2:11 pm
Ah, look at Will’s plan – he wants the government to force individuals at the point of a gun to give their money to insurance companies. All in the name of “freedom” of course.
What a fucking half-wit.
June 23rd, 2009 at 2:13 pm
Adam, my opinion of President Obama would increase greatly if he would put forth your proposal. Of course, he is a professionally deceitful person, given that he is President, so we won’t be hearing that from him. By the way, everytime I put forth the idea in this forum that non-poor old people in this country are going to have to expereince getting less of what they currently get, the usual invective ensues. When Gingrich put forth that notion in the mid ’90s, it was used as a cudgel by Democrats against Republicans. I suspect Republicans will try to do the same against Democrats now. given.
June 23rd, 2009 at 2:13 pm
Adam, my opinion of President Obama would increase greatly if he would put forth your proposal. Of course, he is a professionally deceitful person, given that he is President, so we won’t be hearing that from him. By the way, everytime I put forth the idea in this forum that non-poor old people in this country are going to have to expereince getting less of what they currently get, the usual invective ensues. When Gingrich put forth that notion in the mid ’90s, it was used as a cudgel by Democrats against Republicans. I suspect Republicans will try to do the same against Democrats now. given.
June 23rd, 2009 at 2:15 pm
Actually, Stupis, I’d be fine with not forcing people to not buy health insurance, as long as they signed a release saying they refused all medical care that they could not pay for.
June 23rd, 2009 at 2:18 pm
In the case of Stupid, I support limitless subsidies of lithium.
June 23rd, 2009 at 2:20 pm
My daughter began having a serious heart irregularity (extremely fast heart rate) the day I brought her back from college (a month ago or so). I took her to the local ER immediately for treatment. A few interesting (to me, anyway) points about her treatment and the costs:
- There were no questions about her insurance initially. They got her into a treatment room, started care, and then asked me if she had insurance (which she did, my employer-based insurance).
- She had attention from the head of the cardiology group at the hospital, and an overnight stay in the cardiac care unit, and was released the next day.
- The base price for her treatment was about $25k, but my insurer (Aetna) has agreements with the hospital that reduced the bill to $4k.
- From a combination of copay and deductible, she owes $600 towards the $4k bill.
How can people without insurance even begin to deal with a $25k bill? It’s not like anyone with insurance ever has to pay close to that for most procedures. The billed amounts are pure fantasy.
My family (luckily) isn’t hurting financially right now, so we can pay the $600 easily enough, but even that would probably seriously hurt a lot of families, and this is after my company has paid a lot of money to an insurance company to cover our costs, and I pay $300/month as well through payroll deductions.
-John
June 23rd, 2009 at 2:22 pm
Freddie, why on earth would you suppose such a person would need my advice? Or yours?
June 23rd, 2009 at 2:22 pm
Adam, my opinion of President Obama would increase greatly if he would put forth your proposal.
As would my opinion of any politician that did so, because it’s something that apparently nobody can say without getting pilloried.
By the way, everytime I put forth the idea in this forum that non-poor old people in this country are going to have to expereince getting less of what they currently get, the usual invective ensues. When Gingrich put forth that notion in the mid ’90s, it was used as a cudgel by Democrats against Republicans. I suspect Republicans will try to do the same against Democrats now. given.
Yes, this is pretty spot-on, which is why nobody can say what should be said (that terminal old people need to get their benefits cut). But you’re mistaken that Democrats will give up that opening. After all, we’re not the fiscally conservative party. May as well just let the old people keep their benefits, enact universal health care, and deal with the deficit/spending complaints, since we’re going to get nothing but deficit/spending complaints anyway.
Also, you might want to reconsider the details of your proposal. Some of it’s good, but the “lifetime cap” basically means that anybody who’s not rich and gets cancer is just going to, well, die. If a cap were large enough to cover the millions of dollars in treatment a cancer patient goes through, it wouldn’t really reduce spending over what we have now. So you’d have to set the cap low enough to not fully cover that. Which might put a damper on those US cancer survival rates you love to cite so much.
June 23rd, 2009 at 2:25 pm
Freddie, why on earth would you suppose such a person would need my advice? Or yours?
Because you’re the one claiming that it’s not a big problem that the poor and uninsured can’t get healthcare, that rationing is a bigger problem than 47 million not having health care, etc. Freddie is suggesting that you some one of them in the eye and tell them what they’re supposed to do in their situation, because right now they have no answer.
And if your response, as based on your responses it should be, is to tell them that cancer patients having a 5% higher chance of survival is worth having them and millions like them uninsured, then I’d love to see how they react to being told that. Because it sure as hell isn’t going to be voting Republican ever again in their lives, and will probably include punching you in the face.
June 23rd, 2009 at 2:27 pm
Sorry, “that you look some of them”. Word replacement fail.
June 23rd, 2009 at 2:27 pm
But I’m still asking you, Will, and you aren’t answering. What’s your advice to them? If someone said to you “Hey, Will Allen, I’m suffering, I need medical care but I can’t afford it,” what would you tell them? What realistic path can you offer them that gives them appropriate care and doesn’t leave them destitute? Or can you simply not answer the question?
Just reposting Fred’s question until he gets an answer….
June 23rd, 2009 at 2:27 pm
Or to put it another way, Freddie, what would be your advice to a person in the UK who can’t get the cancer treatment which will greatly improve his chances of survival?
Rationing is inevitable, and it is inevitable that some will die as a result of rationing. What’s your advice, Freddie?
June 23rd, 2009 at 2:31 pm
Adam, I never claimed that it’s not a big problem that the poor and uninsured can’t get healthcare. You imagined that.
June 23rd, 2009 at 2:34 pm
A friend of mine is chief of ER at a major teaching medical school.
He has a side job wherein he gives a 5 minute spiel on certain medications to other ER docs in the city (a big city).
The sessions start with a very fancy dinner at one of the best restaurants in town (roughly $100/person). He talks over dessert.
There are usually 6-10 docs in attendance and one or two pharma reps. Whenever there are a couple cancellations he invites me and my significant other (on big pharma’s tab, of course).
He says he makes $2,000/dinner.
June 23rd, 2009 at 2:46 pm
Defending the low post from underneath the rim? I’m disappointed, Matt. Somebody got backed down and backed down good.
And not to add insult to injury, but hitting the rim with your head is goaltending. I hope you explained that to the kids, before they carted you to the hospital.
June 23rd, 2009 at 2:50 pm
Also, Adam, you may wish to read the new stories regarding the recent Treasury auctions. Cheney’s assertion tha deficits don’t matter is about to be examined in detail. A Democratic Congress and President may decide that they don’t care about deficits, but they damned sure are going to care about 12% unemployment brought about by credit markets.
June 23rd, 2009 at 2:55 pm
Will “I support mass murder using taxpayer monies” Allen cannot possibly imagine that his idiotic arguments could be opposed by someone sane. Will, I’m not the one who wants to force people to pay for insurance company profits. That’s fucking insane. I’m not the one who wants to use the government to murder people and then call that “freedom”, that’s insane. I’m not the one suggesting a lifetime cap on how much money can be spent on someone’s health – determined one supposes by the same rich bastards you want to force everyone to pay – that’s insane.
Perhaps you should look inwards when making accusations of insanity.
June 23rd, 2009 at 2:56 pm
Will is so fucking insane that he thinks that a few people not getting massively expensive treatments is worse than 47 million who are getting little to no care at all under his sociopathic system.
June 23rd, 2009 at 2:58 pm
Until a person is willing to specifically identify who they are willing to let die or suffer greatly … they aren’t worth listening to
Curious to know whether this was also your standard when it came to the Iraq War. Or whether indiscriminate, arbitrary death inflicted by politicians was OK by you in that case.
June 23rd, 2009 at 3:07 pm
Hmmmm, maybe lithium delivery by firehose is needed.
June 23rd, 2009 at 3:07 pm
what would be your advice to a person in the UK who can’t get the cancer treatment which will greatly improve his chances of survival?
Who is this person? Because the advice certainly isn’t going to be “move to the US, where you’d likely have already been fucked over by your insurance company.”
And you’re behind the times on this: there are now structures to allow patients to pay for cancer drugs out of pocket while keeping their NHS care. Along with a residual exceptional circumstances fund that local trusts maintain to cover treatment that isn’t approved for general use by NICE, if there’s medical justification for its use.
June 23rd, 2009 at 3:23 pm
Yes, psyd in NC, everyone in the U.S. is likely to get fucked over by their insurance company, which is why cancer patients in the U.S. have a better chance of survival.
Why are people so committed to pretending that trade-offs don’t exist? Is remaining in a child-like state so comforting?
June 23rd, 2009 at 3:47 pm
Matt, if you are going make up anecdotes, at least make them plausible. Nobody is going to believe you have more than a six inch verticle.
June 23rd, 2009 at 3:49 pm
Will,
You are forgetting that a very large portion of our medical spending is done in order to provide worse, but more expensive, care. We can save hundreds of billions of dollars by “settling” for better care.
June 23rd, 2009 at 3:52 pm
What Will “I’m a fucking moron willing to let 47 million go without care” Allen means by “patients” is “people who already have insurance which means that I don’t have to count all those poor souls who aren’t getting any treatment”.
Which is a nice trick, but only works if you hate humanity. But then I guess someone who cheers on mass murder isn’t really going for an award in humanitarianism.
June 23rd, 2009 at 3:54 pm
which is why cancer patients in the U.S. have a better chance of survival.
Those stats are distorted to some degree by hyper-aggressive screening and treatment, which is driven by fee-for-service billing. Slow-growing prostate cancers, for instance, are often only identified after death from other causes.
You’re also cherry-picking your example, and doing a good job of dancing around the point: the NHS, with an idiosyncratic model that is irrelevant to the US healthcare debate, gets marginally worse cancer outcomes while spending a fraction of the money and distributing care more equitably. France spends more money than the UK, but still much less than the US, and has similar outcomes to the US, with care distributed much more equitably.
And nobody outside the US seems eager to adopt the non-system that Americans have to deal with. Sorry about that.
June 23rd, 2009 at 3:54 pm
Maybe a lithium ocean…..
June 23rd, 2009 at 3:56 pm
Yes, Njorl, that is your assertion.
June 23rd, 2009 at 4:06 pm
Or to put it another way, Freddie, what would be your advice to a person in the UK who can’t get the cancer treatment which will greatly improve his chances of survival?
Your question proceeds from false assumptions. If the treatment would *greatly* improve his chances of survival, the NHS would approve it. That’s the whole point of the QALY metric. The treatments rejected under it are the ones that only *slightly* improve chances of survival at great expense. It’s still rationing; we all agree that’s inevitable. But it’s rational rationing (at least unless the doctors running it screw it up).
In any case, “In the U.S. you wouldn’t be able to afford that treatment anyway”, while rather tactless to say to the patient’s face, is nevertheless true, so it’s not really a weakness of the English system that it would have denied the same treatment. Anyone who can pay for that kind of treatment out of pocket can also become a medical tourist, since the cost of travel is trivial compared to that kind of medical care.
June 23rd, 2009 at 4:32 pm
It is neither mine, nor merely an assertion. It is backed by a study of fee-for-service care compared to salary compensated care. While I doubt the most extreme interpretation ($700 billion in savings) is true, it would take increedible naivete to think there would not be significant savings.
It is irrational to believe we could not reap savings along these lines. It is obvious that people routinely inflict small harms on others for their own profit. To expect doctors to act otherwise when our system so strongly encougages them to act selfishly is bizarre.
My “assertion” is backed by data, by logic, and, less meaningfully, by personal experience. What is your justification for not believing it?
June 23rd, 2009 at 5:56 pm
judd – enlighten us about where to find cheap individual coverage – I don’t live in Kaiser’s area.
My mom had a pacemaker installed, and her medicare had a similar discount to #49’s Aetna discount – about 85-90%.
My GP offers a 20% discount for cash payments just so they can get paid promptly.
June 23rd, 2009 at 6:13 pm
chris, the perception of “greatly” varies quite a bit, based upon whether you are the person who just received a cancer diagnosis. Perhaps you think it is just random chance which has produced the UK’s cancer survival rate.
Yes, yeas, the history of cnetrally planned rationing is a story of the triumph of rationality.
June 23rd, 2009 at 6:21 pm
psin in NC, I wasn’t the person who raised the example of UK health care.
June 23rd, 2009 at 6:24 pm
Norl, I think perverse incentives exist in all systems, and they are very hard to quantify, so I think it is incredibly naive to be confident of future outcomes.
June 23rd, 2009 at 6:43 pm
Poor Will, being reminded of your cheerful support of mass murder really bothers you doesn’t it? But really, your “murder for freedom” in Iraq is not all that different from your “force people to provide profits for corporations for freedom” plan here.
Sure they both sound stupid when put bluntly, but that’s what I’m here for, to remind people just how monumentally, monstrously, and moronically stupid you really are.
June 23rd, 2009 at 6:43 pm
Will, of course, has no answer for how he cherry picks those who are being treated with insurance against an entire population, none of whom are denied treatment. But that’s because he’s a fucking moron. Well, that and a dishonest fuckwit.
June 23rd, 2009 at 6:43 pm
Re: It was practically an NHS level of service, except since this is the United States of America an extremely minor problem was dealt with by an expensive MD rather than a cheap nurse.
We do have clinics nowadays where you will be seen and treated by a nurse practitioner rather than a MD for minor illness and injury.
Re: have no idea what the details of your policy are, or what special circumstances qualify you for such an amazingly low rate, but I will venture to say from personal experience that such deals are simply not available to the vast majority of uninsured Americans.
If you are fairly young (under 40) and healthy you can generally find individual health inusrnace at low rates. Presumably the poster was in this group.
Re: Are you going to produce the anecdotes from the UK which talk about a cancer patient croaking from a case which is much more likely to be survived in the U.S.?
By “Survived” do you mean cured? Or do you just mean that the American survives longer between diagnosis and death, either because they get an earlier (but still hopeless) disagnosis, or because their final days are more prolonged in the US? Everytime I hear rightwingers trot out these “cancer survival “statsitics I note that they never say “cured”, so I suspect the latter is really the case.
Re: what would be your advice to a person in the UK who can’t get the cancer treatment which will greatly improve his chances of survival?
What would you tell a 70 year old with multiple myeloma who is refused a bone marrow transplant in the US? (I think 55 is the cut-off age). Life-saving treatments are rationed in the US too, even if you are unaware of it. It does however make tons more sense to ration for valid medical reasons (the 70 year old has poor prospects of surviving the bone marrow transplant) and makes no sense whatsoever (besides being morally odious) to ration healthcare by income.
Re: they damned sure are going to care about 12% unemployment brought about by credit markets.
Um, credit markets are improving, TED spread is back where it was before Lehmann went under. Yes, we are certainly not out of the woods, but every indication is that the financial system at least is convalescing. That won’t translate into general prosperity any time soon, but I see no indication that the credit markets are going tank again the way they did last year.
June 23rd, 2009 at 7:03 pm
I know, Will, that you think that somehow by providing a “fuck you, you don’t get coverage” option, that what you are proposing isn’t the use of the power of the government to force everyone into paying insurance company profits, but only someone remarkably stupid would believe that this constituted “choice.”
Guess whose name is in the “remarkably stupid” envelope?
June 23rd, 2009 at 7:10 pm
Without the poor guinea pigs, most “cutting edge treatments” wouldn’t happen.
June 23rd, 2009 at 11:09 pm
About cancer survival rates: they are damn hard to compare, because of differences in detection. You detect earlier, people survive longer. You detect non-cancers as cancer: people survive even better.
Morever, I read that with all that, US is doing better in treating cancer than UK, but not so much for heart disease. Thus overall mortality may be a better measure.
And then there is quality of life. The shock an American traveler suffers when, in a foreign country, he is writhing in pain and bleeding, and YET! THE BARBARIANS! nobody asks to fill any forms! could be too much for some. I guess, warning brochures of videos should be distributed.
The other issue is that some forms of medical practice amount to a robbery. Someone describe an experience of getting a concussion, and then getting 12,000 bill. An insurance company would probably be billed half of that, or perhaps less, because they would have someone to reject unnecessary treatments and tests, and they would get 50% discount for what they deem necessary. But an individual gets no discount, plus, how an unconscious person can reject a service, or shop for a more reasonable rate?
Suppose that someone passes out from surfeit of alcohol, and to prevent dangers like mugging or exposure, he is placed in an expensive hotel, gets room service (without asking), and gets 400 bill. If the person did not ask for the hotel, this would be regarded as ridiculous.
June 24th, 2009 at 12:34 am
And, again, if you exclude large portions of the population from screening and then don’t count their deaths as failures of the medical system, then you get to crow about how “well” it all works.
This is stupid, but then look at what morons are defending the status quo.
June 24th, 2009 at 12:34 am
Ok, here are 2 medical anecdotes:
My wife was diagnosed with agressive, stage 3 breast cancer in January ‘05. The treatment was 6 months of chemo via a port in her chest wall to be followed by surgery. A few weeks before surgery the surgeon’s office called and said they no longer accepted our insurer, the largest in the state. They pried an extra grand out of us, and tried to bill us another grand extra after the surgery. Plus, the lab she used did not accept our insurer. It should be pointed out that the only reason we survived financially was the entirety of care happened in one calendar year. (And yes, my wife is now fine: the quality of care was excellent.)
A sadder story: a long time friend lost his job and insurance when his employer closed. He went to work with another company that had a 3 month wait for insurance. In that time he was diagnosed with metastatic cancer of the small intestine. He briefly was covered under SSI (Medicaid) for surgery and some chemo, but lost eligibility for SSI when his RSDI disability checks started coming. RSDI has a two year wait for Medicare eligibility. So he was high and dry with no way to get additional chemo, and was dead within the year.
June 24th, 2009 at 2:16 am
judd (12) said:
But on your broader point about Kaiser. They’re great. I don’t have employee based health insurance and I pay $230/month for me and my two boys at Kaiser. They are pretty efficient, cheap and good care. And not government run.
I don’t have employee-based health insurance either, but I pay nothing. I have VA health care, which is very efficient, although I do have to wait at times for certain non-critical care. It is, of course, run by the government.
I doubt it would cover younger children or spouses for free, but I have neither, so I can’t say for sure.
June 24th, 2009 at 4:53 am
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June 24th, 2009 at 12:54 pm
One more US healthcare story, this one with an insurance bent.
My wife gets very serious, very debilitating migraines (not the, oh I have to take excedrin once in a while kind). She’s been to dozens of doctors over the years, tried, literally one or two dozen different medications, had all the tests and whatnot, many times over.
She recently changed jobs, so changed insurance. They sent her a form saying her doctor had requested a prescription for the (now finally generic!) medication she’s used for acute treatment for 15 years, but she hadn’t undergone enough tests and they didn’t know how many other kinds of treatments she’d tried, so they weren’t going to cover it without a shitload of information from her doctor within 20 business days of when the letter was sent. Of course the letter was dated two weeks before we got it.
Incredibly, they in fact already have covered a very slightly different, NOT off patent version of this same medicine. So one department’s fraudulently trying to screw her out of a treatment with a generic drug that’s been prescribed by maybe 20-30 doctors over the years, while another is for some reason willing to pay, what, 20-100 times more per pill for an almost identical treatment still on patent.
We need some reeducation camps complete with stress positions and water-boarding for some folks in this country…
June 24th, 2009 at 1:06 pm
We have rationing here already. Will seems to be making the argument that some other form of rationing would be so much worse.
June 24th, 2009 at 1:41 pm
No, Rick, I simply prefer it when people who engage in advocacy on this issue will plainly identify who will be first to die in their preferred rationing scheme.
June 24th, 2009 at 3:46 pm
The largest perverse incentives in our healthcare are quite easy to detect. While exact quantification isn’t easy, determining that they are enormous is not hard.
Providers profit from provision of unnecessary care.
Insurerers benefit from industry-wide high medical costs which make having insurance intrinsically more valuable.
Tasks that “are very hard” get done when trillions of dollars are in the balance. The reactions of providers and insurers reinforce my confidence that, while we certainly are not going to establish a system of optimal efficiency, a public option with a strong bargaining unit will be a vast improvement.