patrick.net

Why don't you just get it over with and say "death panels"?

Come on, you know you want to.

HousingWatcher says

Why don't you just get it over with and say "death panels"?

Exactly. Apparently these "death panels" that cause early death result in those countries having higher life expectancies. It's actually quite impressive, if you think about it.

corntrollio says

Obamacare is largely the Republican party's healthplan from the 90s.

The one thing Congress added was subsidized healthcare.

These subsidies are quite significant for poor people and phase out when you make ~$45,000!

Person aged 50 making $30,000 gets a $4500/yr subsidy. Sweet!

Age 32 with family of 4 making $45,000 gets $8000/yr subsidy! Thank you Obama!

What's weird though is age 50, make $46,021 and you get $2600. Make $46,022 and you get NOTHING, LOL.

http://healthreform.kff.org/SubsidyCalculator.aspx

corntrollio says

Please also explain how rationing does not occur in the US under the current system. I bet you can't.

"rationing" = "pay for your own damn care". Didn't some right-wing twit here say that recently?

Data for me from your link...

Premium:$13,716
on top of...

The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium) is $12,500. Whether a person or family reaches this maximum level will depend on the amount of health care services they use. Currently, about one in four people use no health care services in any given year. The minimum coverage available will have an actuarial value of 60%. This means that for all enrollees in a typical population, the plan will pay for 60% of expenses in total for covered benefits, with enrollees responsible for the rest. Specific provisions like deductibles and copyaments may vary from plan to plan, and out-of-pocket costs for any given individual or family will depend on their health care expenses. Preventive services will be covered with no cost sharing required.

That's $26,000 a year, while only covering 60% of a Cancer treatment or blood infusion.

That's 26,200 a year, I could put that in the bank for 10 years and have 260,000 dollars.

What a racket.

The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium) is $12,500.

In utter woids, on top of the hefty premiums, you'll pay for 12K of your health care for that year out of your own pocket, that will include pretty much everything a healthy family of four would pay with or with out insurance anyway. Well actually we don't get sick. But if we did, I'd expect the insurance to do its job.

FortWayne says

In olden days we had only catastrophic insurance and healthcare was much more affordable.

That would be the olden days when life expectancy was 40 and virtually none of the major health problems could be treated other than with comfort and sympathy? It was a hell of a lot more affordable in the olden days where people simply died of things like cancer, heart disease, stroke, lung disease, diabetes, etc. without having to spend any money actually treating them.

bob2356 says

FortWayne says

In olden days we had only catastrophic insurance and healthcare was much more affordable.

That would be the olden days when life expectancy was 40 and virtually none of the major health problems could be treated other than with comfort and sympathy? It was a hell of a lot more affordable in the olden days where people simply died of things like cancer, heart disease, stroke, lung disease, diabetes, etc. without having to spend any money actually treating them.

that's not true Bob. Life expectancy has Ben much higher for a long time.

There is simply too much government involvement in the system. In Capitalism market always meets the desires of their clients. But when government steps in and starts subsidies (which go all to large corporations, they aren't giving you or me cash) all it does is raise the price artificially. It always ends up "how much a month", like housing. And hence healthcare ballooned. Before subsidy it was x cost, today its x cost plus subsidy.

Just look at Obamacare. Insurance rates skyrocketed with it. And it's not like insurance companies kept them low before because they didn't want to raise prices. Simply Obamacare allowed economics to raise the prices and corporations jumped on it.

corntrollio says

Who are these fake people you invented that go to the ER for coughing?

These people aren't fake. Go work in ER in Tarzana Medical Center for a few month and see for yourself. You'd be surprise how much stupidity you'll run into. People stop by for headaches, sneezing, aches, etc... And most get sent back often with prescription for tylenol at most.

You'll see homeless who show up and by law must be treated so they stay in the hospital until sheriff kicks them out a few month later. And every day they get treated to a free bed and breakfast and lunch and dinner, etc...

You'll see illegals, a bit more rare, being dropped off by certain businesses who like to hire illegals at low wages and pass the costs onto society.

Who required that hospitals treat peopel regardless of whether they can afford to pay? Let's see, the law was enacted in 1986. If only I can remember who was president then. Was it St. Reagan?

Come on Patrick. I almost feel sorry for you.

I am self employed and I am my family have lived without health insurance for large portions of time for the past 15 years. Since when did health insurance become an necessity? The vast majority of human beings live without health insurance.

You are confusing health insurance with health care. You can have health care without health insurance.

Furthermore if you want health insurance you can get it for your family for under $400 per month.

Patrick - if health insurance is your highest priority in life then I'd recommend you go to work for the government. From what I hear state and federal workers have pretty good coverage.

gromitmpl says

I am self employed and I am my family have lived without health insurance for large portions of time for the past 15 years.

You're insane. Your family is inevitably doomed in America without health insurance.
Either you will be bankrupted and forced to use some kind of socialized insurance, or someone in your family will die without treatment. I feel sorry for your children.

gromitmpl says

if you want health insurance you can get it for your family for under $400 per month.

Please tell me where and what it covers.

gromitmpl says

The vast majority of human beings live without health insurance.

Almost correct! What you meant to say was "The vast majority of human beings die without health insurance."

gromitmpl says

Since when did health insurance become an necessity?

Since even the most basic visit to the doctor set you back hundreds of dollars? Since something as routine as child birth started going for $50k+?

The insurance system has caused the price of all medical services to rise to absurd levels, making obtaining health care from said system all but impossible unless you are insured.

gromitmpl says

The vast majority of human beings live without health insurance.

This is simply not true. More than half of the world's population has health insurance of some sort (government run, like China, or privatized, like the US). Of the countries that aren't insurance based, about half have national health care programs, and the rest are patient pays systems (almost universally third world countries).

Both Health-care and insurance/finance are two of the most regulated industries. Any wonder why things are thoroughly broken where the two converge?

Kevin says

government run, like China

Countries like China and Russia have government-run health-care, in theory, if you want to die in the hall ways of hospitals. If you want to get real medical service, you can either

(1) Go to a private practice in those countries (not cheap) or fly yourself out of there to seek medical service in other countries, including the US.

(2) Bribe the doctors and nurses to give you actual medical service. Heck, they'd even un-suture you right on the operating table if cash payment is not forthcoming.

In other words, medicine in those countries is cash-and-carry; what's included in those countries' free government health-care is your luck and death.

Almost correct! What you meant to say was "The vast majority of human beings die without health insurance."

Vast majority of human beings do die. Actually, ALL human beings eventually die. There is no such thing as "health insurance" except as a scam, because as desirable as "health"is it can not be insured. Insurance is for unexpected events; getting sick at some point, and especially preventive medicine, is not an unexpected event.

Insurance against getting mugged (getting hit by a huge medical bill), when the mugging is organized to induce insurance purchase . . . that's called a protection racket, aka taxation.

gromitmpl says

You can have health care without health insurance.

Without health insurance, don't expect a round of more sophisticated tests if screening tests are less than certain.

That new chest pain? That suspicious lump? Why bother an uninsured patient with expensive follow-ups? Hey, the screening tests get it wrong less than half the time.

HousingWatcher says

Who required that hospitals treat peopel regardless of whether they can afford to pay? Let's see, the law was enacted in 1986. If only I can remember who was president then. Was it St. Reagan?

Presidents do not legislate. There was no Line Item Veto in 1986. Stop the silly political game.

bob2356 says

FortWayne says

In olden days we had only catastrophic insurance and healthcare was much more affordable.

That would be the olden days when life expectancy was 40 and virtually none of the major health problems could be treated other than with comfort and sympathy? It was a hell of a lot more affordable in the olden days where people simply died of things like cancer, heart disease, stroke, lung disease, diabetes, etc. without having to spend any money actually treating them.

As opposed to now, doctors cut people's breasts off and prostates out because there is a potential for cancer. Everyone is a ticking time bomb for cancer development. DNA replication being a somewhat Markov Process, replication error is certainty if the coin toss is repeated enough times.

After spending all that trillions of dollars, the average life expectancy of an old person has improved by only a few months. The life expectancy improvement is mostly due to lower infant mortality, not older people living longer.

corntrollio says

HousingWatcher says

Why don't you just get it over with and say "death panels"?

Exactly. Apparently these "death panels" that cause early death result in those countries having higher life expectancies. It's actually quite impressive, if you think about it.

Life expectancy is mostly a function of three factors:

1. Infant mortality (which is very low among typical Americans but relatively high among some sections of new immigrants who are not yet integrated into our society)

2. The reporting of infant mortality (government statstics issue; in Cuba, a person is not officially born until he/she is 10 months old, as a way of keeping infant mortality statistics down)

3. Genetics and diet. Japanese have very high elderly longevity expectancy with fish and rice diet; French have relatively high elderly longevity expectancy while living on wine, cheese and butter. Don't expect a Japanese to live long if put on a diet of wine, cheese and butter.

corntrollio says

Every sane plan involves rationing. There are cost-benefit analyses that must be made in all plans. It is not cost effective to spend $1M to give a 20% chance of extending someone's life 1 day. That's how it goes. If you can afford the $1M yourself, godspeed, but please explain to me why a government plan or any other plan would sensibly pay it.

Which is why the decision should be left to the individual instead in the hands of monopolistic bureaucrats. Do you honestly think a monopolistic bureaucrat would refrain from spending $1M of your money to get a 20% chance of extending the life of his mother or his son for 1 day at your expense?

The would-be central planners still suffer from the gov=god delusion. . . aka god-delusion imagining themselves would be in charge in a new dictatorship instead of being trampled upon at the bottom of a human pyramid

How about roads? Water supply? Police? Elementary school education? Fire department? Libraries? Courts? Sanitation?
What have the Romans (government) ever done for us?

I think it's fair to say, given your original post, that the focus is in the FEDERAL government, not *ALL* or *ANY* government. Do you think that roads, water supply, police, elementary school, fire department, libraries, etc. etc., should all be federalized?

I know this to be true from painful first-hand experience with Patrick.net. It is very hard to start a small business in America unless you're already rich, because Republicans have blocked every attempt at a national health insurance option.

Sure... And discussion about increasing competition by allowing people to purchase insurance plans across state lines (i.e., someone purchase coverage from a company based in another state where that state allows further flexibilty in plans offered) is just a "talking point" that has no relevance, right?

Paralithodes says

I know this to be true from painful first-hand experience with Patrick.net. It is very hard to start a small business in America unless you're already rich, because Republicans have blocked every attempt at a national health insurance option.

Sure... And discussion about increasing competition by allowing people to purchase insurance plans across state lines (i.e., someone purchase coverage from a company based in another state where that state allows further flexibilty in plans offered) is just a "talking point" that has no relevance, right?

Yes, it is.

tatupu70 says

Yes, it is.

Awesome retort! And I guess this is because of some reason other than you (and others specifically for the position of a nationally run program) simply declare it to be so?

gromitmpl says

Furthermore if you want health insurance you can get it for your family for under $400 per month.

I demand to see a link to a quote.

I just returned from Germany after a two month stay and wanted to share my experiences there with the medical system and general attitudes to healthcare in Germany. (It goes without saying that Germany has a universal healthcare system like the rest of Europe.) I should add that I have been in Germany in 2009 for 7 months and last summer as well.

My direct experience with the German health system was in 2009. While playing soccer, I managed to smack my toe on another players ankle. I kept playing but afterwards I knew it was broken. I have Kaiser here in California, but it was really only good for emergencies (hospitalization) and this wasn't that bad. After hobbling around for a week, I decided to see a doctor.

I had no idea how much it would cost out of pocket and no one could tell me - they were all covered! So I took out 500 Euros, brought along my credit card and hoped for the best. I was sweating the price - I mean, consultation, x-rays, this could really add up! I was also thinking, long waits (you know like they say in Canada) and bad service..etc.

So I get to the office and wait about 30 minutes (I didn't have an appointment). The doctor comes to see me and we discuss my injury. He orders an Xray (total takes about 30 minutes). They I get a second consultation with the Xray in hand (crap, this is starting to add up). Indeed, I have a broken toe - a hairline fracture that, luckily, needs no surgery and I can just walk around with tight shoes.

Feeling better, but now dreading the bill, I limp over to the counter to pay, hoping I have enough. Guess how much? 50 Euros. Total. Are you kidding me? No insurance?

I celebrated by limping over to my favorite beer shop and buying a Jever Pils for 80 cents. To dull the pain of course. That was my interaction with the German healthcare system.

My other anecdote from the Italian healthcare system. My brother and sister in law took their baby to Italy for a vacation. We came along with our little son (2 years). Before we got there, apparently, their kid started to hyperventilate! They freaked out. Was it an allergy? Was he going to die? My brother in law is a surgeon so you think he would be able to diagnose something, but he may be more of a worry-wort because he is a physician. At any rate, they call the ambulance and go to the emergency room. It turns out that the baby was probably just upset at the brand new travel crib they brought along and felt claustrophobic.

Wow, emergency room, ambulance ride...how much would that cost in the US uninsured? AND they have a doctor in the ambulance, not just the EMTs! This is going to cost THOUSANDS OF DOLLARS (Euros)! What a insurance nightmare with the reimbursement.

The total cost: "No problem sir. Don't worry about it." 0 Euros. Although my brother in law is pretty conservative and a surgeon ($$$) this really changed his tune about universal healthcare. He was a straight Republican voter, even signed up as a reservist after 2001. But after this experience, he was really impressed with the care and really thinks our system is crap, despite his $400K/year salary.

I also note that my father in law is English, has almost no money and works in a pub. But he gets free dental care and free checkups with the doctor. Otherwise, WE would be stuck with the bill...

Now, here is my indirect experience with the European system:

Number of German friends complaining about their healthcare system: 0
Number of people I talked to who even mention healthcare or dentistry (also covered) in daily conversation: 0
Number of friends there with no health insurance (incl. students, kids, coffee shop workers): 0

And on a broader scale, the costs are lower for healthcare in Germany (and everywhere else per capita), they live longer even though everyone smokes and eats pork all the time, and the number of bankruptcies due to medical bills: 0.

I hear and read all sorts of comments by Americans about other systems, how we have it better, how "socialized" medicine is so bad..etc. So I figured I'd give my personal perspective as an American in Europe. BTW, making sure my son can speak German so he has a few more opportunities elsewhere....with health insurance!

Paralithodes says

tatupu70 says

Yes, it is.

Awesome retort! And I guess this is because of some reason other than you (and others specifically for the position of a nationally run program) simply declare it to be so?

Hey, you asked.

OK--here's what I think. Insurers can sell health care plans in any state they want right now. There is no restriction against a health care company operating in all 50 states. They do have to follow the laws governing each state, however.

So what you are proposing is a way to circumvent state laws that some insurance companies find objectionable. And as such, you would not reduce health care costs per service but rather simply reduce services.

It wouldn't be more efficient--it would just be crappier coverage. That's not the direction I'd like to go in...

skully says

Feeling better, but now dreading the bill, I limp over to the counter to pay, hoping I have enough. Guess how much? 50 Euros. Total. Are you kidding me? No insurance?

Well you feel ashamed of your self, not paying over 500 euros, I mean how can all of the 401K pensioners make their nest egg for wall street to skim from?

skully says

The total cost: "No problem sir. Don't worry about it." 0 Euros. Although my brother in law is pretty conservative and a surgeon ($$$) this really changed his tune about universal healthcare. He was a straight Republican voter, even signed up as a reservist after 2001. But after this experience, he was really impressed with the care and really thinks our system is crap, despite his $400K/year salary.

So how much does Doctor like his counterpart in Germany get paid? Where's the money coming from? obviously not from the patients paying 0 Euro.

BTW, a "0" fee system is probably not sustainable with highly mobile population like in the US. I'm sure you have heard of the racist anti-immigrant politics in Germany; it's only a prelude to accusations of "free-loading" between the regions like the north-south difference in Italy. When something is free of charge, people would cross regional borders to get it.

Patrick... I love your site, but let's keep the political op eds out of housing... We are BROKE as a country and cannot afford European style WELFARE! LOOK how good it is working for them!

Healthcare prices really went nuts when the government got into the business with Medicare/Medicaid. We need to go back to fee for service, but it will never happen. All these politicians (esp. Liberals) want is MORE CONTROL!! Get the government OUT OF MY LIFE! They only care about keeping their jobs and making their friends rich (Nancy Pelosi).

Also, ALL the USELESS regulations and EPA requirements also squash small business and keep them from forming (ala Obama)!

guruoracle says

Patrick... I love your site, but let's keep the political op eds out of housing... We are BROKE as a country and cannot afford European style WELFARE! LOOK how good it is working for them!

Actually, we can't afford not to go to a European style system. It's much, much cheaper than ours...

Maybe health services fall into the same category as food. Food is an absolute necessity. We largely let the free market regulate prices and supply. We also have food stamp programs to ensure no one goes hungry. We have the FDA to make sure the food is safe. Could heath services follow a similar model?

I know the analogy isn't perfect, but i figure it's food for thought (no pun intended).

wthrfrk80 says

Maybe health services fall into the same category as food. Food is an absolute necessity. We largely let the free market regulate prices and supply.

No, health services are nothing like food:

1. You cannot shop for critical health care, and you cannot walk away. You MUST have treatment for your heart attack NOW. If you shop or walk away, you die. Even for long-term critical care like cancer treatment, it's very hard to shop and you still can't walk away.

2. Food is cheap. If you had to, you could be perfectly well nourished in America on $5/day. And it is at least possible to grow your own food, but try to treat your own heart attack or cancer and you'll die.

3. Medical care is insanely expensive in the US compared to "socialized" countries like Germany described above. And they have a longer life expectancy, even with all that beer and sausage. And they smoke like fiends. I lived in Germany for 2 years, and they definitely have a better medical system than we do, and cheaper.

A government health insurance OPTION could do wonders to bring down the cost of medical care in the US. If you're worried about over-use, just have a 10% co-pay on everything. That small cost will stop most of the frivolous usage.

Paralithodes says

Sure... And discussion about increasing competition by allowing people to purchase insurance plans across state lines (i.e., someone purchase coverage from a company based in another state where that state allows further flexibilty in plans offered) is just a "talking point" that has no relevance, right?

Insurance has to have a network in the state, these rates are negotiated pet network basis, otherwise no one will accept the insurance.

Patrick,

It's hard to argue against your actual experience. I didn't realize you lived in Germany for 2 years. I've never actually lived in a country with "socialized" medicine so I don't know if it's better or not. Obviously "free" healthcare is very attractive, but aren't the taxes in Germany a lot higher to pay for it?

I'm open to any ideas to make things better. Obviously the current system here in the USA sucks and seems like a huge racket involving both "big government" and "big business."

A government health insurance OPTION could do wonders to bring down the cost of medical care in the US.

Isn't it amazing that the supposedly left wing media wasn't able to help us have this debate? This is something that is a popular idea, and would have only been more popular had we been able to hear a good debate on it.

I wish people could fathom what happened with this issue.

tatupu70 says

Actually, we can't afford not to go to a European style system. It's much, much cheaper than ours...

True. It's sort of like balancing the budget. You have to do that in good times not when you're in the all time worst recession. Health care is what, 1/6th of our GDP?

A government health insurance OPTION could do wonders to bring down the cost of medical care in the US. If you're worried about over-use, just have a 10% co-pay on everything. That small cost will stop most of the frivolous usage.

Like medicare co-pays that do not exist that are the primary driver for the constant increase in medicare costs?

Patrick, I have a bridge to sell you. Interested? It's got granite. Interested? It's got stainless steel appliances too.

Washington can't even pass a bill with co-pays for Medicare. "co-pay" in washington is "killing grandma" in campaign advertisements.