Y’know, I’m really tired of that nonsense. I’ve dealt with insurance companies (and the Ms), and not only as a consumer but also as an employee of a Medicare-supplemental insurance outfit and the spouse of an RN working in a doctor’s office.

The notion that Medicare/Medicaid are significantly slower in making payment than private insurance doesn’t hold water. In fact, just today I got a statement from my family physician and I noticed that there was a gap of seven months between the time a service was performed and the time BC/BS finally paid. My wife had a rather large hospital bill not long ago; it took us over a year to get payment out of insurance.

It’s not that the Ms are significantly slower, it’s that whenever they are slow, you get “well, of course, it’s the government, what do you expect.” (The “red light” hypothesis in action.)

And don’t get me started on the “refusing to pay” crap as applied to private industry – or did you miss the story from last week of insurance companies using any excuse they can to cancel coverage for people who file large claims?

Finally there is the “pays too little” gripe. That one really galls me. Medicare is required by law to pay the local “prevailing rate” for procedures. But that prevailing rate is based on yearly surveys of doctors and hospitals, asking what they charge. They grumble and grouse about having to fill out “more forms” so they don’t do it – so the information Medicare has is outdated, resulting in low payments, about which the providers loudly whine. But it’s their own damn fault.

A couple of other observations:

only pay out a fraction of what the care actually costs

Umm, no. Not what it “actually costs,” but what is actually charged. The two can be quite different.

Part of the problem here is that people in the “the government is my nanny and needs to take care of me” camp insist upon putting it in terms of a “public health care option” when what they really mean is a “public health insurance option”

Sneering is only useful when done from a position of knowledge. Since no one here has talked about needing a government “nanny” and the concern that has been expressed is for others, your sneer is from ignorance and stains anything else you have to say.

As for care vs. insurance, people talk about health care because that is the goal. Insurance is merely a means.

Finally, as for me, I most definitely talk about health care because, as I said earlier, a National Health Care System is what I advocate. I think national health insurance plans are clearly inadequate to the task to which we set them and even if we get one, I’ll continue to advocate for a NHCS.

well, yeah, nobody sensible thinks any different. nobody has any horn of medical plenty, so even a fully socialized single-payer system will have to ration care.

so what? we ration access to healthcare right now, the free market doesn’t have that horn of plenty either. point of import: our current rationing scheme is badly dysfunctional, unreasonably expensive, and blows goats. there are better ones.

regarding Sweden…firstly, it’s a much smaller country, and is also very culturally homogenous, which is nothing like the U.S.

i hear Americans saying this kind of thing a lot, and every time i hear it again, it sounds more like a weak excuse to me.

yes, the Scandinavian countries — indeed, most European countries — are smaller than the USA. so what? that’s in our favor; as has been pointed out, economies of scale are our friends when setting up diluted-risk systems.

yes, the USA is far more multicultural than most European nations. again, so what? how does that make providing mass healthcare and health insurance significantly more expensive? monocultural countries are indeed far different from the USA, but what part of those differences are relevant to this topic?

bear in mind, i was born and raised in Finland, just a short hop-and-skip eastwards from Sweden, and with a quite similar national healthcare system. that’s how i know socialized healthcare works and works just fine. it’s very true my native country was and remains ethnically homogenous, but if that fact made its healthcare in any significant way cheaper, i’d like that way explained to me.

regarding Sweden…firstly, it’s a much smaller country, and is also very culturally homogenous, which is nothing like the U.S.

i hear Americans saying this kind of thing a lot, and every time i hear it again, it sounds more like a weak excuse to me.

yes, the Scandinavian countries — indeed, most European countries — are smaller than the USA. so what? that’s in our favor; as has been pointed out, economies of scale are our friends when setting up diluted-risk systems.

yes, the USA is far more multicultural than most European nations. again, so what? how does that make providing mass healthcare and health insurance significantly more expensive? monocultural countries are indeed far different from the USA, but what part of those differences are relevant to this topic?

bear in mind, i was born and raised in Finland, just a short hop-and-skip eastwards from Sweden, and with a quite similar national healthcare system. that’s how i know socialized healthcare works and works just fine. it’s very true my native country was and remains ethnically homogenous, but if that fact made its healthcare in any significant way cheaper, i’d like that way explained to me.

Taxing the lower end of the income spectrum may make you feel better, but it doesn’t really accomplish very much. According to the Heritage Foundation, the bottom 40% of Americans earn barely over 11% of the total income. For the bottom 20%, it’s just 3.5% of total income. The latest stats I can find (2004) show that the total (individual) income was about $6.85 trillion, so the bottom 40% had $753 billion in income, and the bottom $240 billion in income. You could take every penny the bottom quintile makes and still not even cover 50% of the DOD budget (for example). Take every penny the bottom 40%, and you’ve just barely covered the DOD and interest on the national debt.

Now, I’m all in favor of some VERY small tax on EVERYONE, just so that everybody has skin in the game, but the real money’s going to have to come from the people who have it. Which, generally speaking, ain’t the poor.

That’s actually not a bad job of summarizing some of the problems we face. Now, if you could take it a step further and offer up some solutions, apart from “leave bad enough alone,” we’d really be getting somewhere. I won’t hold my breath.

For the record, as I mentioned above, I’d prefer a system in which any government-subsidized health coverage paid the providers directly, rather than wasting money on the middlemen in the insurance industry. Want to reduce costs? Eliminate health insurance entirely.

gatt:
Even ignoring the matter of taxes, if the “public option” is in no way required to actually make ends meet, it has what we call a “major advantage” over competitors that have to actually pay for the services they provide.

I still fail to see how the presence or lack of a public option significantly changes this equation. Are the private insurers going to be able to dictate what the government pays them? Or are they going to have to make do with what the government gives them? If the former, then you’ve done nothing to keep costs under control. If the latter, it’s no different than with a public option.

It’s a strong disincentive toward efficiency

Yes, because more than anything, the private insurance industry we have today is famous for its efficiency…

it seems rather unlikely that the “public option” would be limited to those who can’t afford health care otherwise

I don’t believe anyone has ever argued that the public option would be so limited, but so what? Government bureaucracies are inefficient (we’re told), and the red tape is far too much (we’re told), and the services they provide are subpar (we’re told). If those things are actually true, then a large number of people would actually willingly pay a little more for the superior service provided by the private entity. So even with those caveats, it doesn’t address my initial argument: if the private sector is inherently better, and provides better service, it shouldn’t fear competition from the government, even when the government is substantially cheaper.

The introduction of low-cost overnight shipping by the USPS hasn’t exactly killed FedEx, as Uncle was quick to point out, despite all of the postal service’s “unfair advantages.” Private schools thrive, despite the existence of free (to the parents, anyway) public schools! Why should health care be any different?

Health insurance providers are not health care providers. In order for health insurance to mean anything, there has to be enough providers of the service to cover everyone who needs covered.

There aren’t enough health care providers in this country now…what makes you think there will somehow magically be enough to provide care with another 50 million or so customers…who’s “insurance” will only pay out a fraction of what the care actually costs? (in addition to the millions already on Medicare and Medicaid which are notorious for late payment, refusing to pay and paying too little when they do finally pony up).

One of my best friends is married to a doctor who is considering pursing a different career because of these factors. My personal doctor is in the process of building and opening a shooting range and gun shop in the local area as a “fall back position” in the event that he feels compelled to leave medical practice.

These are not uncommon considerations in the medical community.

Now combine that with the rapidly rising cost of higher education. How many new doctors will we be making when it reaches the point that they will not be able to, in their entire career as a doctor, pay back the massive debt they incur during 8 years of higher education and four years of internship and residency?

How many RNs and LPNs will have to be laid off because private insurance companies, in “competition” with government subsidized plans, have to reduce the amounts they’ll pay out?

Medical care is commodity that is just as subject to the rules of scarcity as any other commodity. Pretending that there is a neverending source of “health care” to tap in order to provide this commodity to anyone and everyone who wants or needs it, and at a uniformly low cost, is a utopian pipe dream.

There Aint No Such Thing As A Free Lunch.