I promise I’ll read it. I also promise that no study could convince me, or any veteran who has had something other than military or VA healthcare, that the military or VA is better or “more efficient” (an adjective that can be twisted and turned in a variety of different ways) at providing private health care.

Sorry that the link didn’t work. I’m trying it again here. It’s worth the read, and it does detail how dramatically the system’s care has improved. But you’re probably a good judge of the care you’re receiving from them now, right?

http://www.washingtonmonthly.com/features/2005/0501.longman.html

Sorry, Jack, but my long entries detailing just how efficient the VA now is have been flagged as “awaiting moderation”, though there’s nothing untoward in the language. I hope it gets listed soon and you can judge for yourself from the sources I’ve quoted just how much the VA has changed.

I promise I’ll read it. I also promise that no study could convince me, or any veteran who has had something other than military or VA healthcare, that the military or VA is better or “more efficient” (an adjective that can be twisted and turned in a variety of different ways) at providing private health care.

Once again, let’s look at the facts and go to specific references. I am quoting an article by Phillip Longman. First, it makes sense to read Longman’s opening sentence, which suggests that things have changed dramatically since you received care from the VA:

Once again, let’s look at the facts and go to specific references. I am quoting an article by Phillip Longman. First, it makes sense to read Longman’s opening sentence, which suggests that things have changed dramatically since you received care from the VA:

I’m too busy to reject each of the silly things you’ve suggested, but I’ll say that if you think the Veterans Administration is the best health care system in America, you either (a) have never received VA health care, or (b) have never received anything other than VA health care. As a veteran, and someone who has received care under Socialized medicine from both the military and the VA, I can tell you without hesitation that you don’t know what on Earth you’re talking about, and if VA health care is the bag of crap you’re trying to sell the United States of America in the name of “improved” health care, God help us all.

Once again, let’s look at the facts and go to specific references. I am quoting an article by Phillip Longman. First, it makes sense to read Longman’s opening sentence, which suggests that things have changed dramatically since you received care from the VA:

“Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they’re producing the highest quality care in the country. Their turnaround points the way toward solving America’s health-care crisis.”

Here’s just a bit more explaining how things changed at the VA (under teh Clinton administration) and how the system ranks today. It’s a very long essay, which I think you will be very interested in reading. But please do read every word before you suggest that what I’ve written here is “silly”:

“Yet here’s a curious fact that few conservatives or liberals know. Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be “significantly better.”

“Here’s another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.

“It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA’s seal of approval is the gold standard in the health-care industry. And who do you suppose this year’s winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.”

Once again, prestigious journals, the WHO, and patients say that our system needs to change, and point to a publicly run system as far superior to our current private system.

Let’s also keep in mind that the Veterans’ Administration’s health care system has been named the best health care system in America! Again, a government-run system. Let’s also keep in mind a few more facts. Today barely three in five Americans under the age of 65 receive health insurance through their employers. And that percentage has been falling relentlessly for years. Another fact: today some two in five of all Americans receive their health insurance from a government entity, either Medicare, Medicaid, the VA, active duty military, S-CHIP, or some other public entity.

I’m too busy to reject each of the silly things you’ve suggested, but I’ll say that if you think the Veterans Administration is the best health care system in America, you either (a) have never received VA health care, or (b) have never received anything other than VA health care. As a veteran, and someone who has received care under Socialized medicine from both the military and the VA, I can tell you without hesitation that you don’t know what on Earth you’re talking about, and if VA health care is the bag of crap you’re trying to sell the United States of America in the name of “improved” health care, God help us all.

“This has been the preferred solution of the right, which has argued for a move toward high-deductible care, in which individuals bear more financial risk and vulnerability. As the thinking goes, this increased exposure to the economic consequences of purchasing care will create savvier health-care consumers, and individuals will use less unnecessary care and demand better prices for what they do use.

“Problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane-but-important things like hypertension medicine, which leads to far costlier complications. Moreover, many health problems don’t lend themselves to bargain shopping. It’s a little tricky to try to negotiate prices from an ambulance gurney.

“A wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. The French have addressed this by creating what amounts to a tiered system for treatment reimbursement. As Jonathan Cohn explains in his new book, Sick:

In order to prevent cost sharing from penalizing people with serious medical problems — the way Health Savings Accounts threaten to do — the [French] government limits every individual’s out-of-pocket expenses. In addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don’t skimp on preventive care that might head off future complications.

“The French do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. It’s a wise straddle of a tricky problem, and one that other nations would do well to emulate. ”

See? Time and again the facts show us that our system of private insurance falls woefully short of public systems in other countries. It’s time for a major change.

Once you’ve realized that public health care is a far worse option than private health care, I hope you also realize that there’s no way to pay for this, too.

You write that a public health care option is far worse than private health care. I suggest that you take a look at this summary of the French system before you dismiss public health insurance”

France

“It’s a common lament among health-policy wonks that the world’s best health-care system resides in a country Americans are particularly loath to learn from. Yet France’s system is hard to beat. Where Canada’s system has a high floor and a low ceiling, France’s has a high floor and no ceiling. The government provides basic insurance for all citizens, albeit with relatively robust co-pays, and then encourages the population to also purchase supplementary insurance — which 86 percent do, most of them through employers, with the poor being subsidized by the state. This allows for as high a level of care as an individual is willing to pay for, and may help explain why waiting lines are nearly unknown in France.

“France’s system is further prized for its high level of choice and responsiveness — attributes that led the World Health Organization to rank it the finest in the world (America’s system came in at No. 37, between Costa Rica and Slovenia). The French can see any doctor or specialist they want, at any time they want, as many times as they want, no referrals or permissions needed. The French hospital system is similarly open. About 65 percent of the nation’s hospital beds are public, but individuals can seek care at any hospital they want, public or private, and receive the same reimbursement rate no matter its status. Given all this, the French utilize more care than Americans do, averaging six physician visits a year to our 2.8, and they spend more time in the hospital as well. Yet they still manage to spend half per capita than we do, largely due to lower prices and a focus on preventive care.

“That focus is abetted by the French system’s innovative response to one of the trickier problems bedeviling health-policy experts: an economic concept called “moral hazard.” Moral hazard describes people’s tendency to overuse goods or services that offer more marginal benefit without a proportionate marginal cost. Translated into English, you eat more at a buffet because the refills are free, and you use more health care because insurers generally make you pay up front in premiums, rather than at the point of care. The obvious solution is to shift more of the cost away from premiums and into co-pays or deductibles, thus increasing the sensitivity of consumers to the real cost of each unit of care they purchase.”

How are private health care plans destroying “both doctors and Americans’ health”? Again, use facts, not Howard Dean’s screeching and moaning. It sounds like you’re just making this up.

OK, let’s look at facts. A study by the Institute of Medicine found that in 2000 18,000 Americans had died due to complications resulting from a lack of health insurance. The study also found that “uninsured adults are 25 percent more likely to die prematurely than adults with private health insurance.” Furthermore, the Urban Institute “reported that at least 22,000 adults died in 2006 due to a lack of health insurance.”

Here’s another fact for you, which helps debunk the notion that government-run health insurance can’t work. A 2006 study published in The Journal of the American Medical Association found that, on average, English people are much healthier than Americans are; they suffer from lower rates of diabetes, hypertension, heart disease, heart attack, stroke, lung disease, and cancer. According to the study’s press release, the differences are vast enough that “those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in Great Britain.” See how our current system is harming Americans, not helping Americans? Keep in mind that Britain’s is a system of socialized medicine. They cover 100% of all citizens, and do it for half of what we spend as a percentage of GDP.

Now those are just a few facts, not “screeching and moaning”. And you can check those studies to see that I’m not “just making this up.” Please do check the sources. Again, if we look at the facts, this country will embrace a public health insurance option made available to all Americans.

What, exactly, and with specific references, gives you faith that the federal government can run a health care system?

OK! Let’s look at the facts. Nearly every country in the developed world utilizes some form of government health insurance, covers every single one of its citizens, and does it for far less than we are paying to cover just 85% of our citizens. WHO rates the French health care system as the best in the world, and every single person there is covered under the state’s social security system of state-provided health insurance. A quarter of France’s health care expenditures come from health insurance plans from the “private sector” that give extras to those enrolled. But half of those “private plans” are in fact non-profit companies. Canada covers every single Canadian for 10% of GDP, while we provide coverage for only 85% at over 17% of GDP.

And let me point out that every single American at the age of 65 and over is covered by- wait for it!- government-provided single-payer health insurance- Medicare! Every single American! Indeed, when Taiwan went scouring the world for the best system of health care, they adopted America’s Medicare system. But they adopted the original medicare system, not the perverted system that George Bush created, which pays private companies a 15% subsidy to siphon off the healthiest seniors from the system, leaving the sickest in the government-run Medicare system, thereby diverting premiums to private companies (and profits), while sticking the government with declining revenues and increasing costs. That is going to stop under Obama.

Let’s also keep in mind that the Veterans’ Administration’s health care system has been named the best health care system in America! Again, a government-run system. Let’s also keep in mind a few more facts. Today barely three in five Americans under the age of 65 receive health insurance through their employers. And that percentage has been falling relentlessly for years. Another fact: today some two in five of all Americans receive their health insurance from a government entity, either Medicare, Medicaid, the VA, active duty military, S-CHIP, or some other public entity.

One more thing to consider: Are the people of any other country in the world with government-run health care clamoring for their government to adopt America’s private-sector system? Absolutely not. People in other countries cannot understand why we insist on maintaining our current system, and are horrified at the thought of being thrown into a system like ours.

One more point: Medicare spends barely 2% of its total expenditures on overhead. The figure for the private sector is estimated between 23% and 31%. Wouldn’t you want to a system that directs 98 cents of every dollar of premiums to actual health care, rather than admin and profits? Isn’t that common sense?

No. That’s not true. You are dead wrong if you think that government health care adds choice. It takes away choice, which is exactly what happened in Hawaii. The system was overwhelmed by people who thought, “free health care!” and left the plans they could afford. The state’s plan went bankrupt, and it was dumped.

Wait a minute! You just wrote that the people of Hawaii “chose” the public plan over the private plan! They exercised “choice”. Now I’m not sure what happened with Hawaii’s plan, or how it was financed. But if the people of that state opted for a public plan, isn’t that what “choice” is all about?

On healthcare, I am suggesting higher copays whether it be in prescription copays and or doctor visit copays. For example, state employees were paying $3 for generic drugs and $6 for brand name. That is going up to $5 & $10. What do you pay?

Hah! My LOWEST copay on prescriptions for generic is $10. For regular prescriptions it’s $25. For the top tier meds it’s $40. Recently I started ordering from the mail order place (recommended by my insurer) where you get a three month supply for a two month copay, in order to save money. The problem then is that the schmuck UPS delivery guy delivered my daughter’s 3 month supply of insulin and just plonked it by the front door without bothering to ring the doorbell, so it sat on the front step in the heat for several hours even though I was home working all that time. But the time I went out later that afternoon, all the ice packs had melted. So now I have to worry if three months worth of insulin is denatured.

So if you figure this on top of the $20/$30 visit copays and over $2,000 per month premium for one woman and two kids, do you understand why I miss the good old National Health Service?

Republicans have opposed national health insurance because they allege that it takes away choice from health care consumers. So the Democrats have called Republicans’ bluff: they’ve proposed giving Americans even more choice\- private sector and public sector insurance plans.

No. That’s not true. You are dead wrong if you think that government health care adds choice. It takes away choice, which is exactly what happened in Hawaii. The system was overwhelmed by people who thought, “free health care!” and left the plans they could afford. The state’s plan went bankrupt, and it was dumped.

http://www.foxnews.com/story/0,2933,440561,00.html

This will happen on a national scale, and Americans will lose choice in their health care plans.

Furthermore, they’ve also called the Republicans’ bluff on the charge that a government plan would result in inefficiencies and bad medical service. So the Democrats are proposing a competition between public and private. If the public plan is inefficient and results in bad service, Americans can go to the private insurance plans.

Wrong again, for the reasons above, and take a look at Massachusetts, too.

http://www.boston.com/news/local/massachusetts/articles/2009/05/28/more_mass_residents_report_trouble_paying_medical_bills/

“The survey of roughly 4,000 adults found that, after seeing initial gains in affordability, an increasing percentage of residents are now reporting problems paying medical bills. It also found that a rising number of residents, especially those with lower incomes, are reporting that they did not get needed care because of costs, which are rising faster than inflation.”

But Republicans know darn well that the government plan will turn out to be cheaper, offer as much choice of doctors, if not more, and match health care outcomes.

What, exactly, and with specific references, gives you faith that the federal government can run a health care system?

That’s why they’re up in arms. A competition will result in the driving out of the private plans that are destroying both doctors and Americans’ health.

How are private health care plans destroying “both doctors and Americans’ health”? Again, use facts, not Howard Dean’s screeching and moaning. It sounds like you’re just making this up.

Once you’ve realized that public health care is a far worse option than private health care, I hope you also realize that there’s no way to pay for this, too.

1.As long as somebody else pays for your insurance the price of healthcare will not go down. ex. A few sniffles and a run to the Doctor because what the hell, I have insurance. Maybe if I had to pay the first $25 out of pocket I would make sure I really needed to go.

Wait, doesn’t that happen already? I wouldn’t know since I pay (through the fricking NOSE) for my insurance already. AND I pay anywhere from $20 – $40 per visit depending on if the doctor is in network or out of network on top of my exorbitant monthly premium. So yeah, I put off going to the doctor unless I think it’s really necessary. But don’t people who get their insurance through their jobs have to do that too?

If not, maybe I should just give up this writing gig and go back to Wall Street, even though I hated it. Oh wait, but there probably aren’t any jobs. Damn.

Furthermore, in opposing the Democrats’ plan to open up the state’s health insurance system to small businesses, Republican minority leader John McKinney dredged up what he called horror stories about the terrible health care system in Canada. His stories appear to have been bunk. Read this post that debunks the myths about Canada’s health care system. They operate with just 1% overhead, compared with over 30% for private insurance plans in the U.S. And though McKinney came up with a story about a cancer patient who couldn’t get treated for eight months, in fact cancer treatment and survival appears better in Canada than in America.

It is important that we look at the facts and that we not rely on myths in this debate.

So how do you fix it without some sort of govt regulation? I have health insurance horror stories that would curl your hair. Like when I was on the “losers plan” and didn’t have a prescription plan, so I’d have to pay for the prescriptions at the pharmacy and then send in the claim to get reimbursed.. At one point, United Frickin Healthcare owed me over $10,000 in prescription reimbursements. They kept “losing” my claims. Not kidding, there there some claims I had to send them FOUR times. It wasn’t until I wrote to the Chairman of UHC with copies to my Congressman and Senator that mysteriously I started getting checks back from these shysters.

Sara, if I had the simple solution to healthcare, I would be the Republican nominee for President and you would probably be working for my campaign. Some obvious issues that run up the cost of healthcare imho:

1.As long as somebody else pays for your insurance the price of healthcare will not go down. ex. A few sniffles and a run to the Doctor because what the hell, I have insurance. Maybe if I had to pay the first $25 out of pocket I would make sure I really needed to go.

2. Trail lawyers run up the cost and force Doc’s to practice defensive medicine. For example, mom takes little Johnnie to the Doc and says he has a tummy ache. The Doc sends little Johnnie for some expensive testing procedure because they can’t risk the 1 in a billion chance the kid has a more serious problem and some trial lawyer will be ready to pull the Docs pants down and spank um in a court of law.

Again, as long as somebody else pays, rates will go out of sight for the rest of us.

Are there extreme cases in which doesn’t work for every single person ? Sure, but it would go a long way in bringing down the cost for most of us.

Forgive me ACR, but I lived in the UK for 15 years and your one story about rats in one hospital is not going to persuade me that the care I received there is FAR superior to the system I have to fight here.

I’m not saying that your story doesn’t suck. It does.

I am saying that the United States Government cannot do health care better than United Health Care, and the Democrats who suggest otherwise are only setting up the general public for failure (as usual).

Chris Dodd and his buddies printed $10 trillion for the banks. He should now do that for the healthcare industry.

It seems simple to me.

Am I missing something? Or maybe we’re just not supposed to talk about Dodd and his bankster buddies?

Sara, you and I are in 100% agreement on private insurance jacking up their rates. 18% increases is absurd and unsustainable. How to fix it is another issue.

So how do you fix it without some sort of govt regulation? I have health insurance horror stories that would curl your hair. Like when I was on the “losers plan” and didn’t have a prescription plan, so I’d have to pay for the prescriptions at the pharmacy and then send in the claim to get reimbursed.. At one point, United Frickin Healthcare owed me over $10,000 in prescription reimbursements. They kept “losing” my claims. Not kidding, there there some claims I had to send them FOUR times. It wasn’t until I wrote to the Chairman of UHC with copies to my Congressman and Senator that mysteriously I started getting checks back from these shysters.

Oh yeah, and then there was the time when in their infinite wisdom they decided that my son with Aspergers, who had already shown signs of major depression and was coping with being seriously bullied at school and his parents going through a 3 1/2 year divorce NO LONGER REQUIRED THERAPY.

Forgive me ACR, but I lived in the UK for 15 years and your one story about rats in one hospital is not going to persuade me that the care I received there is FAR superior to the system I have to fight here.

When it comes to healthcare, I don’t think that has anything to do with it. Those charming private health insurance companies are just reaming successful self-employed people. My boyfriend – a successful self-employed entrepreneur – the kind of guy I’d think you GOPers would be courting – he just got his health insurance premium renewal today – up 18%. It’s a matter of who do you want to be more successful? The private health insurance companies or individuals and small businesses.

Sara, you and I are in 100% agreement on private insurance jacking up their rates. 18% increases is absurd and unsustainable. How to fix it is another issue.

I am pleased to hear that your boyfriend is a successful entrepreneur. GOPers like hearing success stories and want everyone to be able to reach their dreams and when they do, they don’t like when government steals their hard earned money.

So Sara, perhaps your boyfriend will change your mind and you can come back home to the GOP? When you’re ready, I will have a big hug and a smile waiting for you