SiCKO and Healthcare

[Kaan]

health care isnt a right. so... if you dont have it and you want it... work your ass off for it. dont ask for hand outs. I personally worked in a company for two years without health insurance... then i started paying for my own... then i got a different job! now i have health insurance.

if you want something like health insurance ... maybe it will be a motivator for the "poor" (and when i didnt have it i wasnt poor!) to work a little harder, to get an education, to make progress in their lives. handing it out like candy doesnt help motivate the less fortunate.

my dear canadians... how long does it take for you to get an appointment for your child with an ear infection? well let me put it to you this way... by the time the kid gets to see the doc the kids ear infection is gone... and he/she suffered the whole time gotta love that system!

[Mike]

health care isnt a right. so... if you dont have it and you want it... work your ass off for it. dont ask for hand outs. I personally worked in a company for two years without health insurance... then i started paying for my own... then i got a different job! now i have health insurance.

if you want something like health insurance ... maybe it will be a motivator for the "poor" (and when i didnt have it i wasnt poor!) to work a little harder, to get an education, to make progress in their lives. handing it out like candy doesnt help motivate the less fortunate.

health care is for the good of everyone. if a majority of people don't receive it, we all suffer by disease and other shit. currently, health care costs are outrageous due to the way it is all set up (mainly corporations pay)... do you have any idea what it's like for a large family that is struggling to get by? or a family with someone ill? "work harder" isn't an option a lot of the time...

my dear canadians... how long does it take for you to get an appointment for your child with an ear infection? well let me put it to you this way... by the time the kid gets to see the doc the kids ear infection is gone... and he/she suffered the whole time gotta love that system!

source?

[white_2kgt]

...do you have any idea what it's like for a large family that is struggling to get by? or a family with someone ill? "work harder" isn't an option a lot of the time...

Hum. A poor, large family. Here's an idea. If you can't afford kids, don't have them. If you can afford birth control, keep your dick in your pants. WHY IN THE FUCK should I have to work my ass off, to pay the taxes, so some shit stain poor fucks can sit at home all day long, collect a check, make more poor babies and do exactly jack shit for this country? Work harder is an option, there is ALWAYS jobs out there, might not be the job you WANT, but there are jobs. Why do you think we have an immigration problem in this country? They are the ones taking the jobs 'entitled' Americans refuse to take. We need to get rid of them, let the economy take a nose dive and rebuild, all those jobs people once didn't want, well they are going to have to take them after that.

[stevegula]

You know, the only thing I can think when someone tells me the government should be in charge of my health care is -

My government has maybe done 2 things well since I've been born. I don't know what they are but I'm willing to believe they have. Why in the world would I want someone with that success rate in charge of my healthcare?

[Mike]

not everyone who is struggling to get by is in that situation because they screwed up. not everyone who is struggling to get by created their large families while they were struggling.

sure, i agree with you there are many people looking for free rides, but you also have to acknowledge that sometimes shit just sucks... generalizing how people get in to bad situations is not a very smart thing to do...

if you really need examples of how things could go from great to shit, i'll give them... i'm not talking just about poor folks in the inner-city; i'm talking about you and i.

[WRXtranceformed]

WHY IN THE FUCK should I have to work my ass off, to pay the taxes, so some shit stain poor fucks can sit at home all day long, collect a check, make more poor babies and do exactly jack shit for this country?

Ha ha ha ha, for some reason this still has me laughing :lol:

[Evan]

you guys talk as if medicare and medicaid dont exist.

the poor, old, and disabled already get subsidized healthcare.

bottom line: there is NO such thing as "Free" healthcare. Somebody has to pay for it.
Now, which do you trust more with your money, a government run monopoly, or an open competitive market?

The real issue here is how much healthcare costs, and that is not the fault of health insurance companies as I have already pointed out.

[white_2kgt]

not everyone who is struggling to get by is in that situation because they screwed up. not everyone who is struggling to get by created their large families while they were struggling.

sure, i agree with you there are many people looking for free rides, but you also have to acknowledge that sometimes shit just sucks... generalizing how people get in to bad situations is not a very smart thing to do...

if you really need examples of how things could go from great to shit, i'll give them... i'm not talking just about poor folks in the inner-city; i'm talking about you and i.

Still, why is it MY job to pay for someone elses fuckup? Even if it wasn't their fault? You want to open up your wallet and help them out, please feel free to, we need those people out there to do that, I just shouldn't HAVE to. It should not be the govts job to reach into my paycheck each week, remove MY money which I work for and give it to some air head so he can get some cough syrup. If they didn't start out poor then they fucked up in their planning somewhere along the lines. I'm only 27yrs old but I have a family to support and you had damn well better believe I'm not putting myself in a position to be sitting on my ass in 6 months out in the cold wondering when the next govt handout is coming along or how I'm paying for the next round of shots for my baby girl. The problem w/ the pussys in this country is they all think they are special, or are entitled to something/everything. Fact of the matter is they/you are not special, you are entitled to absofuckingtootly nothing, you have certain rights, free health care just isn't one of them. Man up, sack up, and take care of your own business.

[Mike]

so chad, what happens if on your drive home today you accidentally run a red light a run a child over? you're then convicted of manslaughter and the child's family sues you for everything you have... you're in jail, and your wife and daughter are penniless... shit happens.

think of the government reaching in to your pocket as insurance for shit happening.

[Ginger]

so chad, what happens if on your drive home today you accidentally run a red light a run a child over? you're then convicted of manslaughter and the child's family sues you for everything you have... you're in jail, and your wife and daughter are penniless... shit happens.

think of the government reaching in to your pocket as insurance for shit happening.

That's a moral question... as for justification, well, it isn't.

[white_2kgt]

so chad, what happens if on your drive home today you accidentally run a red light a run a child over? you're then convicted of manslaughter and the child's family sues you for everything you have... you're in jail, and your wife and daughter are penniless... shit happens.

think of the government reaching in to your pocket as insurance for shit happening.

That's what insurance is for. I have enough to take care of the wife/baby for a least a year. The wife at that point will man up and take care of the kid. Yea, shit happens. If shit happens to me, I don't expect the govt to bail my ass out, and nobody else should either.

[Evan]

Watch the movie. ...Seriously, watch the movie and we can avoid these little things.

did you read all of the articles about the incredible wait times in canada and the uk? did you read about the people who have died while on waiting lists? did you read the statistics on how in debt these programs are?
bringing up moore's movie is a good launching pad into the discussion, but its by no means any source of reference.

In 2004, French Health Minister Philippe Douste-Blazy told a government commission, "Our health system has gone mad. Profound reforms are urgent." Agence France-Presse recently reported that the French health-care system is running a deficit of $2.7 billion

Britain's NHS $700 million budget deficit
<!-- m --><a class="postlink" href="http://news.bbc.co.uk/2/hi/health/5055602.stm">http://news.bbc.co.uk/2/hi/health/5055602.stm</a><!-- m -->
it. doesnt. work.

It. CAN.

why? because Jack says it can? in capital letters? every example of socialized healthcare in the free world is a failure. somehow you think one managed by the government that has mastered managerial incompetence will do better?

first take a look into the business model behind insurance companies. They arent bloodsucking profiteers like Moore paints them, the way any insurance company makes money isnt by taking your money, its by holding onto it for a while before they give it back to you (collective you)

You have got to be fucking kidding me. They hold on to it alright. I can't believe you said that. They pay... sometimes, but a broken hand shouldn't cost $1500 for a health guy (me).

well, whether you want to believe it or not, thats how insurance companies work.
but you are still getting the insurance with the cost of healthcare confused. Insurance has little to do with the cost (your $1500 broken hand), that is the cost as charged by the medical institutions. Why arent you questioning them why healthcare costs so much?

Another solution that I have been playing around with in my head, that would be centered around a free economy, would be that the government goes into the health insurance business. Not as the sole provider, but a competitor. They would have premiums and all the rest, just like a regular insurance provider, have restrictions on 'profit' (ie-none), have congressional oversight, etc.

That's a great idea. The thing is, to support such a system, taxes would take a huge hike and money would get pulled from insurance companies. It'd be very difficult to start something like that, but I think it'd be a *great* start.

well obviously the tax costs would be farrrr less than a socialized government paid healthcare, in fact barely a blip.
startup costs would be the only costs, as after that it would have to operate in the black.
but ill say it again, i dont think it would do much good unless we reform the root cause of the problem: healthcare cost.

[joshw]

Last weeks article dispeling the myth of waiting and such...

Being without health insurance is no big deal. Just ask President Bush. ''I mean, people have access to health care in America,'' he said last week. ''After all, you just go to an emergency room.''

This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it's not as if those kids really need insurance -- they can just go to emergency rooms, right?


O.K., it's not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that ''the poorest Americans are getting far better service'' than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

A recent article in Business Week put it bluntly: ''In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.''

A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures -- and I suspect that France, which wasn't included in the study, matches Germany's performance.

Besides, not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they're often caused by insurance companies trying to save money.

This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. ''It was only later,'' writes Mr. Kleiman on his blog, ''that I discovered why the insurance company was stalling; I had an option, which I didn't know I had, to avoid all the approvals by going to 'Tier II,' which would have meant higher co-payments.''

He adds, ''I don't know how many people my insurance company waited to death that year, but I'm certain the number wasn't zero.''

To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs. But there's no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their ''medical losses'' -- the industry term for actually having to pay for care.

On the other hand, it's true that Americans get hip replacements faster than Canadians. But there's a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That's right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that's what they call their system) because it has more lavish funding -- end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

You guys are funny

[ScottyB]

what is the source for that article?

[joshw]

what is the source for that article?

Paul Krugman.

One article he cites is in Business Week

here is another of his peices on healthcare from July 9th

These days terrorism is the first refuge of scoundrels. So when British authorities announced that a ring of Muslim doctors working for the National Health Service was behind the recent failed bomb plot, we should have known what was coming.

''National healthcare: Breeding ground for terror?'' read the on-screen headline, as the Fox News host Neil Cavuto and the commentator Jerry Bowyer solemnly discussed how universal health care promotes terrorism.


While this was crass even by the standards of Bush-era political discourse, Fox was following in a long tradition. For more than 60 years, the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens.

I say conscience, because the health care issue is, most of all, about morality.

That's what we learn from the overwhelming response to Michael Moore's ''Sicko.'' Health care reformers should, by all means, address the anxieties of middle-class Americans, their growing and justified fear of finding themselves uninsured or having their insurers deny coverage when they need it most. But reformers shouldn't focus only on self-interest. They should also appeal to Americans' sense of decency and humanity.

What outrages people who see ''Sicko'' is the sheer cruelty and injustice of the American health care system -- sick people who can't pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn't a participant in her mother's health plan won't treat her, hard-working Americans driven into humiliating poverty by medical bills.

''Sicko'' is a powerful call to action -- but don't count the defenders of the status quo out. History shows that they're very good at fending off reform by finding new ways to scare us.

These scare tactics have often included over-the-top claims about the dangers of government insurance. ''Sicko'' plays part of a recording Ronald Reagan once made for the American Medical Association, warning that a proposed program of health insurance for the elderly -- the program now known as Medicare -- would lead to totalitarianism.

Right now, by the way, Medicare -- which did enormous good, without leading to a dictatorship -- is being undermined by privatization.

Mainly, though, the big-money interests with a stake in the present system want you to believe that universal health care would lead to a crushing tax burden and lousy medical care.

Now, every wealthy country except the United States already has some form of universal care. Citizens of these countries pay extra taxes as a result -- but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care in countries with universal coverage is much lower than it is here.

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries -- even Britain, which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian's access to health care is as good as that of the average insured American -- and much better than that of uninsured Americans, many of whom never receive needed care at all.

And the French manage to provide arguably the best health care in the world, without significant waiting lists of any kind. There's a scene in ''Sicko'' in which expatriate Americans in Paris praise the French system. According to the hard data they're not romanticizing. It really is that good.

All of which raises the question Mr. Moore asks at the beginning of ''Sicko'': who are we?

''We have always known that heedless self-interest was bad morals; we know now that it is bad economics.'' So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn't one of those cases where we face painful tradeoffs -- here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.

So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can't overcome those forces here, there's not much hope for America's future.

[joshw]

and another peice that is indirectly related to healthcare...

Traveling through Europe recently, IÔÇÖve been able to confirm through personal experience what statistical surveys tell us: the perceived stature of Americans is not what it was. Europeans used to look up to us; now, many of them look down on us instead.

No, IÔÇÖm not talking metaphorically about our loss of moral authority in the wake of Guant├ínamo and Abu Ghraib. IÔÇÖm literally talking about feet and inches.

To the casual observer, Europeans ÔÇö who often seemed short, even to me (IÔÇÖm 5-foot-7), when I first began traveling a lot in the 1970s ÔÇö now often seem tall by American standards. And that casual observation matches what careful researchers have found.

The data show that Americans, who in the words of a recent paper by the economic historian John Komlos and Benjamin Lauderdale in Social Science Quarterly, were ÔÇ£tallest in the world between colonial times and the middle of the 20th century,ÔÇØ have now ÔÇ£become shorter (and fatter) than Western and Northern Europeans. In fact, the U.S. population is currently at the bottom end of the height distribution in advanced industrial countries.ÔÇØ

This is not a trivial matter. As the paper says, ÔÇ£height is indicative of how well the human organism thrives in its socioeconomic environment.ÔÇØ ThereÔÇÖs a whole discipline of ÔÇ£anthropometric historyÔÇØ that uses evidence on heights to assess changes in social conditions.

For example, nothing demonstrates the harsh class distinctions of Britain in the age of Dickens better than the 9-inch height gap between 15-year-old students at Sandhurst, the elite military academy, and their counterparts at the working-class Marine School. The dismal working and living conditions of urban Americans during the Gilded Age were reflected in a 1- 1/2 inch decline in the average height of men born in 1890, compared with those born in 1830. Americans born after 1920 were the first industrial generation to regain preindustrial stature.

So what is AmericaÔÇÖs modern height lag telling us?

There is normally a strong association between per capita income and a countryÔÇÖs average height. By that standard, Americans should be taller than Europeans: U.S. per capita G.D.P. is higher than that of any other major economy. But since the middle of the 20th century, something has caused Americans to grow richer without growing significantly taller.

ItÔÇÖs not the populationÔÇÖs changing ethnic mix due to immigration: the stagnation of American heights is clear even if you restrict the comparison to non-Hispanic, native-born whites.

And although the Komlos-Lauderdale paper suggests that growing income and social inequality in America might be one culprit, the remarkable thing is that, as the authors themselves point out, even high-status Americans are falling short: ÔÇ£rich Americans are shorter than rich Western Europeans and poor white Americans are shorter than poor Western Europeans.ÔÇØ

We seem to be left with two main possible explanations of the height gap.

One is that America really has turned into ÔÇ£Fast Food Nation.ÔÇØ

ÔÇ£U.S. children,ÔÇØ write Mr. Komlos and Mr. Lauderdale, ÔÇ£consume more meals prepared outside the home, more fast food rich in fat, high in energy density and low in essential micronutrients, than do European children.ÔÇØ Our reliance on fast food, in turn, may reflect lack of family time because we work too much: U.S. G.D.P. per capita is high partly because employed Americans work many more hours than their European counterparts.

A broader explanation would be that contemporary America is a society that, in a variety of ways, doesnÔÇÖt take very good care of its children. Recently, Unicef issued a report comparing a number of measures of child well-being in 21 rich countries, including health and safety, family and peer relationships and such things as whether children eat fruit and are physically active. The report put the Netherlands at the top; sure enough, the Dutch are now the worldÔÇÖs tallest people, almost 3 inches taller, on average, than non-Hispanic American whites. The U.S. ended up in 20th place, below Poland, Portugal and Hungary, but ahead of Britain.

Whatever the full explanation for AmericaÔÇÖs stature deficit, our relative shortness, like our low life expectancy, suggests that something is amiss with our way of life. A critical European might say that America is a land of harried parents and neglected children, of expensive health care that misses those who need it most, a society that for all its wealth somehow manages to be nasty, brutish ÔÇö and short.

[joshw]

and one more about medicare from april 20th

The plot against Social Security failed: President Bush's attempt to privatize the system crashed and burned when the public realized what he was up to. But the plot against Medicare is faring better: the stealth privatization embedded in the Medicare Modernization Act, which Congress literally passed in the dead of night back in 2003, is proceeding apace.

Worse yet, the forces behind privatization not only continue to have the G.O.P. in their pocket, but they have also been finding useful idiots within the newly powerful Democratic coalition. And it's not just politicians with an eye on campaign contributions. There's no nice way to say it: the NAACP and the League of United Latin American Citizens have become patsies for the insurance industry.

To appreciate what's going on, you need to know what has been happening to Medicare in the last few years.

The 2003 Medicare legislation created Part D, the drug benefit for seniors -- but unlike the rest of Medicare, Part D isn't provided directly by the government. Instead, you can get it only through a private drug plan, provided by an insurance company. At the same time, the bill sharply increased payments to Medicare Advantage plans, which also funnel Medicare funds through insurance companies.

As a result, Medicare -- originally a system in which the government paid people's medical bills -- is becoming, instead, a system in which the government pays the insurance industry to provide coverage. And a lot of the money never makes it to the people Medicare is supposed to help.

In the case of the drug benefit, the private drug plans add an extra, costly layer of bureaucracy. Worse yet, they have much less ability to bargain for lower drug prices than government programs like Medicaid and the Veterans Health Administration. Reasonable estimates suggest that if Congress had eliminated the middlemen, it could have created a much better drug plan -- one without the notorious ''doughnut hole,'' the gap in coverage once your annual expenses exceed $2,400 per year -- at no higher cost.

Meanwhile, those Medicare Advantage plans cost taxpayers 12 percent more per recipient than standard Medicare. In the next five years that subsidy will cost more than $50 billion -- about what it would cost to provide all children in America with health insurance. Some of that $50 billion will be passed on to seniors in extra benefits, but a lot of it will go to overhead, marketing expenses and profits.

With the Democratic victory last fall, you might have expected these things to change. But the political news over the last few days has been grim.

First, the Senate failed to end debate on a bill -- in effect, killing it -- that would have allowed Medicare to negotiate over drug prices. The bill was too weak to have allowed Medicare to get large discounts. Still, it would at least have established the principle of using government bargaining power to get a better deal. But in spite of overwhelming public support for price negotiation, 42 senators, all Republicans, voted no on allowing the bill to go forward.

If we can't even establish the principle of negotiation, a true repair of the damage done in 2003 -- which would require having Medicare offer seniors the option of getting their drug coverage directly, without involving the insurance companies -- seems politically far out of reach.

At the same time, attempts to rein in those Medicare Advantage payments seem to be running aground. Everyone knew that reducing payments would be politically tough. What comes as a bitter surprise is the fact that minority advocacy groups are now part of the problem, with both the NAACP and the League of United Latin American Citizens sending letters to Congressional leaders opposing plans to scale back the subsidy.

What seems to have happened is that both groups have been taken in by insurance industry disinformation, which falsely claims that minorities benefit disproportionately from this subsidy. It's a claim that has been thoroughly debunked in a study by the Center on Budget and Policy Priorities -- but apparently the truth isn't getting through.

Public opinion is strongly in favor of universal health care, and for good reason: fear of losing health insurance has become a constant anxiety of the middle class. Yet even as we talk about guaranteeing insurance to all, privatization is undermining Medicare -- and people who should know better are aiding and abetting the process.

[joshw]

And another about insuring children.....

Consider the choice between two government programs.

Program A would provide essential health care to the eight million uninsured children in this country.

Program B would subsidize insurance companies, who would in turn spend much of the money on marketing and paperwork, and also siphon off a substantial fraction of the money as profits. With what's left, the insurers would provide additional benefits, over and above basic Medicare coverage, to some older Americans.

Which program would you choose? If money is no object, you might go for both. But if you can only have one, it's hard to see how anyone could, in good conscience, fail to choose Program A. I mean, even conservatives claim to believe in equal opportunity -- and it's hard to say that our society offers equal opportunity to children whose education may be disrupted, who may even find their lives cut short, because their families can't afford proper medical care.

And here's the thing: The question isn't hypothetical. Universal health care may happen one of these years, but the choice between A and B is playing out right now.

Program A is the proposal by Senator Hillary Clinton and Representative John Dingell to cover all children by expanding the highly successful State Children's Health Insurance Program. To pay for that expansion, Democrats are talking about saving money by shutting down Program B, the huge subsidy to private insurance plans for Medicare recipients -- so-called Medicare Advantage plans -- created by the 2003 Medicare Modernization Act.

The numbers for that trade-off add up, with a little room to spare. Covering all children would cost about $50 billion over the next five years, while the Congressional Budget Office estimates that eliminating the Medicare Advantage subsidy would save $65 billion over the same period (and $160 billion over the next decade.)

Now, nobody is proposing that Medicare ban private plans -- all that's on the table is requiring that they compete with traditional Medicare, run directly by the government, on a fair basis. And that's not what's happening now. According to Medpac, the official nonpartisan commission that assesses Medicare payments, Medicare Advantage plans now cost taxpayers an average of 12 percent more per enrollee than traditional Medicare. Private fee-for-service plans, the fastest-growing type, cost 19 percent extra.

As I said, it's hard to see how anyone can, in good conscience, think that preserving subsidies to insurance companies is more important than providing health care for children. But that is, of course, exactly the position taken by the Bush administration, which is adamantly opposed both to any attempt to expand the children's health insurance program -- in fact, the administration wants to cut its reach -- and to any attempt to reduce Medicare Advantage payments.

The official reasons given for this position are evasive and dishonest.

Explaining the administration's opposition to expanding the children's program, Michael Leavitt, the secretary of health and human services, said the program ''should not be the vehicle by which we insure every adult and every child in America.'' But that isn't what the Democrats are proposing.

As for why the administration wants to keep subsidizing insurance companies, Mr. Leavitt says, ''The president and I are for competition.'' But nobody is against competition -- it's subsidized competition that's the problem. Mr. Leavitt added that ''the marketplace beats the government at controlling costs and delivering value'' -- but he's not willing to put that assertion to the test by requiring that private insurers compete on a level playing field.

Lately, both the insurance lobby and the administration have also started playing the race card, claiming that Medicare Advantage offers special benefits to the poor and to minority groups. (Remember how Social Security was supposed to be bad for black people?) But a new report from the Center on Budget and Policy Priorities thoroughly debunks these claims: low-income and minority seniors are less likely than the average Medicare recipient to be enrolled in a Medicare Advantage plan.

Clearly, the real reasons for the administration's position have nothing to do with any of these supposed justifications. They are, instead, political, having to do with the long-term battle over the future of the welfare state.

But that's a subject for another day. For now, the choice is between A and B -- health care for children, or subsidies for insurance companies. Which will it be?

[joshw]

and more healthcare related stuff from March 5th

When Salon, the online magazine, reported on mistreatment of veterans at the Walter Reed Army Medical Center two years ago, officials simply denied that there were any problems. And they initially tried to brush off last month's expos├® in The Washington Post.

But this time, with President Bush's approval at 29 percent, Democrats in control of Congress, and Donald Rumsfeld no longer defense secretary -- Robert Gates, his successor, appears genuinely distressed at the situation -- the whitewash didn't stick.

Yet even now it's not clear whether the public will be told the full story, which is that the horrors of Walter Reed's outpatient unit are no aberration. For all its cries of ''support the troops,'' the Bush administration has treated veterans' medical care the same way it treats everything else: nickel-and-diming the needy, protecting the incompetent and privatizing everything it can.

What makes this a particular shame is that in the Clinton years, veterans' health care -- like the Federal Emergency Management Agency -- became a shining example of how good leadership can revitalize a troubled government program. By the early years of this decade the Veterans Health Administration was, by many measures, providing the highest-quality health care in America. (It probably still is: Walter Reed is a military facility, not run by the V.H.A.)

But as with FEMA, the Bush administration has done all it can to undermine that achievement. And the Walter Reed scandal is another Hurricane Katrina: the moment when the administration's misgovernment became obvious to everyone.

The problem starts with money. The administration uses carefully cooked numbers to pretend that it has been generous to veterans, but the historical data contained in its own budget for fiscal 2008 tell the true story. The quagmire in Iraq has vastly increased the demands on the Veterans Administration, yet since 2001 federal outlays for veterans' medical care have actually lagged behind overall national health spending.

To save money, the administration has been charging veterans for many formerly free services. For example, in 2005 Salon reported that some Walter Reed patients were forced to pay hundreds of dollars each month for their meals.

More important, the administration has broken longstanding promises of lifetime health care to those who defend our nation. Two months before the invasion of Iraq the V.H.A., which previously offered care to all veterans, introduced severe new restrictions on who is entitled to enroll in its health care system. As the agency's Web site helpfully explains, veterans whose income exceeds as little as $27,790 a year, and who lack ''special eligibilities such as a compensable service connected condition or recent combat service,'' will be turned away.

So when you hear stories of veterans who spend months or years fighting to get the care they deserve, trying to prove that their injuries are service-related, remember this: all this red tape was created not by the inherent inefficiency of government bureaucracy, but by the Bush administration's penny-pinching.

But money is only part of the problem.

We know from Hurricane Katrina postmortems that one of the factors degrading FEMA's effectiveness was the Bush administration's relentless push to outsource and privatize disaster management, which demoralized government employees and drove away many of the agency's most experienced professionals. It appears that the same thing has been happening to veterans' care.

The redoubtable Henry Waxman, chairman of the House Committee on Oversight and Government Reform, points out that IAP Worldwide Services, a company run by two former Halliburton executives, received a large contract to run Walter Reed under suspicious circumstances: the Army reversed the results of an audit concluding that government employees could do the job more cheaply.

And Mr. Waxman, who will be holding a hearing on the issue today, appears to have solid evidence, including an internal Walter Reed memo from last year, that the prospect of privatization led to a FEMA-type exodus of skilled personnel.

What comes next? Francis J. Harvey, who as far as I can tell was the first defense contractor appointed secretary of the Army, has been forced out. But the parallels between what happened at Walter Reed and what happened to New Orleans -- not to mention parallels with the mother of all scandals, the failed reconstruction of Iraq -- tell us that the roots of the scandal run far deeper than the actions of a few bad men.

[joshw]

AND....... From way back in February (16th)

Is the health insurance business a racket? Yes, literally -- or so say two New York hospitals, which have filed a racketeering lawsuit against UnitedHealth Group and several of its affiliates.

I don't know how the case will turn out. But whatever happens in court, the lawsuit illustrates perfectly the dysfunctional nature of our health insurance system, a system in which resources that could have been used to pay for medical care are instead wasted in a zero-sum struggle over who ends up with the bill.

The two hospitals accuse UnitedHealth of operating a ''rogue business plan'' designed to avoid paying clients' medical bills. For example, the suit alleges that patients were falsely told that Flushing Hospital was ''not a network provider'' so UnitedHealth did not pay the full network rate. UnitedHealth has already settled charges of misleading clients about providers' status brought by New York's attorney general: the company paid restitution to plan members, while attributing the problem to computer errors.

The legal outcome will presumably turn on whether there was deception as well as denial -- on whether it can be proved that UnitedHealth deliberately misled plan members. But it's a fact that insurers spend a lot of money looking for ways to reject insurance claims. And health care providers, in turn, spend billions on ''denial management,'' employing specialist firms -- including Ingenix, a subsidiary of, yes, UnitedHealth -- to fight the insurers.

So it's an arms race between insurers, who deploy software and manpower trying to find claims they can reject, and doctors and hospitals, who deploy their own forces in an effort to outsmart or challenge the insurers. And the cost of this arms race ends up being borne by the public, in the form of higher health care prices and higher insurance premiums.

Of course, rejecting claims is a clumsy way to deny coverage. The best way for an insurer to avoid paying medical bills is to avoid selling insurance to people who really need it. An insurance company can accomplish this in two ways, through marketing that targets the healthy, and through underwriting: rejecting the sick or charging them higher premiums.

Like denial management, however, marketing and underwriting cost a lot of money. McKinsey & Company, the consulting firm, recently released an important report dissecting the reasons America spends so much more on health care than other wealthy nations. One major factor is that we spend $98 billion a year in excess administrative costs, with more than half of the total accounted for by marketing and underwriting -- costs that don't exist in single-payer systems.

And this is just part of the story. McKinsey's estimate of excess administrative costs counts only the costs of insurers. It doesn't, as the report concedes, include other ''important consequences of the multipayor system,'' like the extra costs imposed on providers. The sums doctors pay to denial management specialists are just one example.

Incidentally, while insurers are very good at saying no to doctors, hospitals and patients, they're not very good at saying no to more powerful players. Drug companies, in particular, charge much higher prices in the United States than they do in countries like Canada, where the government health care system does the bargaining. McKinsey estimates that the United States pays $66 billion a year in excess drug costs, and overpays for medical devices like knee and hip implants, too.

To put these numbers in perspective: McKinsey estimates the cost of providing full medical care to all of America's uninsured at $77 billion a year. Either eliminating the excess administrative costs of private health insurers, or paying what the rest of the world pays for drugs and medical devices, would by itself more or less pay the cost of covering all the uninsured. And that doesn't count the many other costs imposed by the fragmentation of our health care system.

Which brings us back to the racketeering lawsuit. If UnitedHealth can be shown to have broken the law -- and let's just say that this company, which is America's second-largest health insurer, has a reputation for playing even rougher than its competitors -- by all means, let's see justice done. But the larger problem isn't the behavior of any individual company. It's the ugly incentives provided by a system in which giving care is punished, while denying it is rewarded.