Healthcare

So you might remember Palin's powerful closing statement from last night (via Ezra Klein):

It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don't pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we're going to find ourselves spending our sunset years telling our children and our children's children about a time in America, back in the day, when men and women were free.

Inspiring, huh? Well, it turns out that quote was from — I am not making this up — a recording Reagan did in 1961 to convince doctors' wives to oppose Medicare.

The doctor begins to lose freedom. ... First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then doctors aren’t equally divided geographically. So a doctor decides he wants to practice in one town and the government has to say to him, you can't live in that town. They already have enough doctors. You have to go someplace else. And from here it's only a short step to dictating where he will go. [...]

You and I can do this. The only way we can do it is by writing to our congressman even if we believe he's on our side to begin with. Write to strengthen his hand. Give him the ability to stand before his colleagues in Congress and say, I heard from my constituents and this is what they want. And if you don't do this and if I don't do it, one of these days you and I are going to spend our sunset years telling our children, and our children's children, what it once was like in America when men were free.

Freedom according to Ronald Reagan means the freedom to be denied coverage by your health insurance company.

Ezra Klein:

[A]s a 72-year-old who's healthy enough to run for president, there's no evidence that McCain has ever experienced a day of dissatisfaction with his health care coverage. Indeed, as the husband of an heiress, McCain could easily have stepped out into the private market — the very market he wants all Americans to use — and bought another plan for him and his wife, so he wouldn't have to deal with the government system any longer. There's no evidence he did that, either.

McCain's problem is not simply that he's been on government health insurance his whole life. It's that, by all accounts and appearance, he's been quite satisfied with his coverage. His complaints are all of a general nature. "I've always been a free enterprise person" or "my opponent wants to create a health care bureaucracy." Never "I've been on Medicare for years now, and it's a house of horrors."

Ezra Klein:

The Kennedy tribute was touching, but it was Kennedy who was powerful. Walking out to chants of "Teddy, Teddy," Kennedy sounded strong and sharp. He's old now, and sick. He walks slowly and the mane has thinned. But he's still got that voice, that rumbling bass — as Harold said to me this morning, "the last voice in American politics." The words, as they've always been, were clear, and the message was simple. Broadly, it was this: Health care. Before he even mentioned Obama's name. Health care. After he spoke of the hope Obama brings. Health care.

In the last few weeks, I've spoken to a couple Kennedy aides who all told me the same thing: Health care. Kennedy has told them that this is his final crusade. Aides who work in other legislative areas have been told that their issue areas are going to almost dissolve, and they'll become something like support staff for the health team. Kennedy means to pass a bill. He means to muster the full force of his legislative talents, his sprawling staff, his longstanding relationships, and even the poignancy of his condition. It will be his legacy. It is his dream. Health care.

nyceve at Daily Kos:

The medical loss ratio refers to the percentage of dollars actually spent on medical care versus administrative costs or profit. The higher the ratio, the more money is being spent on actual delivery of care. Components of the medical loss ratio include payments to physicians, hospitals, pharmacists and other providers of health care.

For example, an unheard of medical loss ratio of 91 percent means that 91 cents out of every dollar goes to practitioners and providers. This never happens, of course. Most medical loss ratios are in the neighborhood of 80–81 percent.

The mission of the U.S. insurance industry is to keep this ratio as low as possible. The way they do this is with ruthless companies like TC3 Total Claims Capture and Control which I'm going to introduce you to today. When the medical loss ratio creeps up, which means too much money is being spent on our healthcare needs, the for-profit insurer turns to TC3 to bring costs (losses) down.

Kos:

As Ford posts yet another crazy-ass quarterly loss ($8.7 billion), it makes one wonder how much better the US auto industry (and its unions) would be doing if they had let the government raise CAFE standards, huh? The government could've bailed them out of this mess.

And it makes one wonder how much better that industry would be doing if they hadn't so viciously opposed Bill and Hillary Clinton's 1993 health care initiative. In 2004, GM spent over $5 billion in health care costs — a number that is likely significantly larger today. That's billions that would be off its balance sheet had they not opposed universal healthcare.

Lots of industries may shoot themselves in the foot, but none more so than the auto industry. It truly deserves the comeuppance it is getting (and it has gotten a healthy assist from its unions). The people who don't deserve it — of course — are its workers, who are getting screwed.

Kos tells the story of a woman he met in Austin who was convinced that elected officials can't do anything about problems like health care or the mortgage crisis:

[...] Well, I responded, what about health care, are you happy with your health care? She lit up, "I know no one who is happy with their health care!" and then segued into a rant about the disgraceful state of the health care system. Well, I responded, Democrats are working for universal healthcare, but Republicans have gotten in the way. But we'll be able to do it next year.

"Ain't no one who can fix that stuff," she sighed, slumping. That brief expression of fire and brimstone snuffed out in an instant. She was adamant that it was all hopeless. [...]

I had one last argument up my sleeve. Look, I get it, I told her, government hasn't given us many reasons to be confident of late. I can certainly empathize. But can we make a deal? If Democrats push through universal health care in the next four years, will you vote for Barack Obama in 2012?

She looked initially uncomfortable at the thought, but after a pause and a brief internal struggle, she softened and said, "Yeah, I will."

That, in a nutshell, is what Kristol and Ponnuru and Lowry and every conservative in this country fears the most.

Congressional Quarterly looks at Taiwan's system of single-payer healthcare, which was put into place in 1995:

"In Taiwan, we have no waiting lists," says Hou [Sheng-Mou]. "In Taiwan, the doctor works on Saturday. They operate on Saturday afternoon." Moreover, the government does not tell its citizens where they must go for care, he said. Sophisticated information technology is a part of the health system. Each resident of the country carries a "smart card" to entitles them to health care.

"With the smart card you can go to any clinic at any time without an appointment," Hou said. And there is no "gatekeeper" denying access to specialists, a frequent complaint among Americans about U.S. managed care companies. [...]

The smart card also contributes to the quality and efficiency of the system by giving doctors a medical profile of the patient and by automating payment. When a provider swipes the card, the patient's medical history and medications show up on the computer screen and the government is billed for the provider's services.

Taiwan's single-payer system isn't perfect; for example, its expenditures are slightly above its revenues, and there is less money available for R&D than in the U.S. On the plus side, Taiwan's system has far lower administrative costs: 1.6% of healthcare spending vs. 15% (as a low estimate) in the U.S. Also, Taiwan insures all its citizens while spending only 6% of its GDP on healthcare, while we spend 16% of our GDP on healthcare and still have 47 million Americans without coverage.

Unless healthcare is universal, we'll continue to get egregious instances of cherrypicking by insurance companies. Who knew a Caesarian birth could render a mom un-insurable or forced to pay more for insurance (NYTimes)?

When the Golden Rule Insurance Co. rejected her application for health coverage last year, Peggy Robertson was mystified....said Mrs. Robertson, "I'm in perfect health." She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it... With individual insurance, unlike the group coverage sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person's medical history. Sometimes, a past Caesarean means higher premiums.

As more and more people are self-employed or take jobs that offer no health insurance, millions more Americans will seek individual health coverage...where cherry-picking the healthiest and gouging or refusing the others is rampant.

Thousands of low-income people in our capitol city are suffering because of medical debt. What can our elected officials do about this problem? Come to the SLC Main Library on Wednesday, May 28, at 6:30 pm to be informed about this. For more info, email Bill Tibbitts at bill@crossroads-u-c.org. The event is sponsored by the Anti-Hunger Action Committee, an organization for food pantry clients that works to get low-income folks involved in the political process.

I can't stop giggling about this comment from Sen. Mitch McConnell (DailyKos):

"It's pretty clear to me that the Democratic agenda is to turn us into France," the Kentucky Republican told The Washington Times in an unusually blunt interview at his office in the Capitol. "Americans may want change, but the question is, what kind of change?"

Well, let's see. France's healthcare system has been rated the best in the world (the U.S. ranked 37th). They have the 11th-highest life expectancy (the U.S. is 45th) and the 6th-lowest infant mortality rate (the U.S. is 43rd). French employees get 5 guaranteed weeks of vacation every year. (In the U.S., that number is zero.) And yet, despite having all that vacation and the burden of "socialized medicine" and only one-fifth the population of the U.S., France is the world's 6th-largest economy.

So, yeah, Democrats want to make the U.S. more like France. It wouldn't exactly be a bad thing.