Universal Healthcare

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 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.

Ezra Klein:

As Sarah Arnquist has written, aside from his awful internment in a Vietnamese prison camp, it is hard to find a day in McCain's life when he was not sheltered by the government-run health care he now claims to loathe. Born the son of a Navy admiral, he was cared for by Navy physicians during his childhood. After graduating from high school, he enrolled in the United States Naval Academy, and the military's care continued until he retired from the service in 1981. In 1982, he won a seat in Congress, ushering him into the Federal Employee Health Benefits Program, and in 2001, he qualified for Medicare. When he says, "we have the highest quality of health care in the world in America," he is speaking as a man who has enjoyed a lifetime of government-run care.

But now John McCain is seeking the presidency as a Republican, and a healthy distaste for government-run health care is de rigueur. "I am convinced," said John McCain at Miami Children's Hospital, "that the wrong way to go is to turn over your lives to the government and hope it will all be fine. It won't." Spoken like a 71-year-old whose government health coverage has kept him healthy enough to run for the presidency.

"Consumer-driven" health plans are favored by many Utah legislators & other conservatives as a market-based solution to rising healthcare costs. These plans typically combine high deductibles with a tax-advantaged health account that can be used to pay deductible and medical/dental expenses that are not covered.

The latest survey by the non-partisan Employee Benefit Research Institute found that

Here are two of Dr. Joseph Jarvis's six suggestions for bringing about true health-care reform in Utah (Salt Lake Tribune):

Perverse incentives: From the Wall Street Journal on April 5: "Research at Dartmouth Medical School suggests that if everyone in America went to the Mayo Clinic, our annual health-care bill would be 25 percent lower (more than $500 billion) and the average quality of care would improve. ... Of course, not everyone can get treatment at Mayo. ... But why [is] this example of efficient, high-quality care not being replicated all across the country? The answer is that high-quality, low-cost care is not financially rewarding. Indeed, the opposite is true. Hospitals and doctors can make more money providing inefficient, mediocre care."

Market-based health policy: If we are to eliminate the perverse incentives that lead to inefficient, mediocre care, we have to give up the cherished notion that health care is a commodity efficiently distributed by market forces. We do not principally fund health care through the private sector — 60 percent of revenues paying for health services come from taxpayers, making our citizens more taxed for health care than any people in the world. Beyond that, health care is not subject to market forces, such as a lowered price increasing demand. No one ever had an appendectomy because the price was right. The occurrence of illness and injury primarily determine demand for health services.

Paul Krugman says that "the power of competition" does not drive down healthcare costs:

For one thing, even if you buy the premise that competition would reduce health care costs, the idea that it could cut costs enough to make insurance affordable for Americans with a history of cancer or other major diseases is sheer fantasy.

Beyond that, there's no reason to believe in these alleged cost reductions. Insurance companies do try to hold down "medical losses" — the industry's term for what happens when an insurer actually ends up having to honor its promises by paying a client's medical bills. But they don't do this by promoting cost-effective medical care.

Instead, they hold down costs by only covering healthy people, screening out those who need coverage the most [...]. They also deny as many claims as possible, forcing doctors and hospitals to spend large sums fighting to get paid.

And the international evidence on health care costs is overwhelming: the United States has the most privatized system, with the most market competition — and it also has by far the highest health care costs in the world.

• How government lowers healthcare costs (Jacob Hacker in the Washington Post)

• How to debunk a mischaracterization of what your candidate said (Charles Krauthammer in the Washington Post, demonstrating that he can think rationally when defending Republicans)
  
• Small currency outlets in Amsterdam refuse to take U.S. dollars (Reuters)
  
• After a brief dip last week, Obama takes an 8-point lead over Clinton nationally (Gallup)