Wednesday, April 20, 2011

Health care reform

Left: The Free Market Fairy prepares to wave her(his?) magic wand over the health insurance marketplace.

I have two choices for health insurance at work:

  1. A major national insurance company with a reputation for "losing" your claims forms and not paying doctors. If you get sick, you'll end up being tens of thousands of dollars out-of-pocket and likely have to declare bankruptcy. That's if you survive -- if you need something really expensive where doctors won't even start treatment until they've gotten pre-approval from an insurer, good luck.
  2. A major regional HMO which avoids paying for expensive treatments by simply not doing them and hoping you die before the appeals process with the state insurance commission is complete and the courts force them to provide the contracted-for treatment. They have calculated that, for example, the cost of treating leukemia (roughly $1M) is far higher than the amount of premium income they get from a typical employer group, so even if your employer threatens to move their entire company to a different insurer, they just shrug and say "Go ahead, we're still ahead of where we'd be if we paid for your employee's leukemia treatment."
These are the companies that PelosiReidCare is forcing me to have insurance with. (I call it PelosiReidCare because Obama had nothing to do with it, other than signing the final bill). Apparently the best health care plan for me is, "don't get sick." Wish me luck :(.

Soo.... why isn't the magic free market fairy (see left) not providing me with health insurance that actually, like, pays for the healthcare I need if I get sick? Two reasons:

  1. Health insurance is inherently anti-capitalist. Health insurance is to capitalism what kryptonite is to Superman. In capitalism, businesses make money by providing services. In capitalism, for example, a restaurant makes money by cooking food and serving it to you. If they didn't cook food and serve it to you, they would make no money. Health insurers, by contrast, make money by not providing service. The more health care they don't pay for, the more money they make. In short, health insurance simply is incompatible with the profit motive because it profits by not providing service.
  2. Health insurance is largely provided by employers as a benefit, rather than purchased by individuals (less than 7% of all health insurance is individual policies), and employers buy the cheapest insurance, not the best. The HMO above is not-for-profit but was formed by employers to keep their health care costs down, and still pursues that mission with a vengeance. The only way private insurers can compete with an HMO that was formed to deny as much care as possible is to, duh, deny as much care as possible.
In short, the entire system was set up to systematically deny care, not provide care, and this is what PelosiReidCare enshrined as national law. I would gladly pay to buy into Medicare and Tricare like my mother and stepdad (military retiree) receive. They get the care they need when they need it and don't have to worry about dealing with insurance companies trying to deny care. But PelosiReidCare give me no option to do so, which is why when the GOP runs against "ObamaCare", it's getting resonance amongst those who don't pay much attention (who haven't figured out yet that the GOP's health care plan is "don't get sick, and if you do, die quickly"). Forcing people to be part of a system that is inherently broken is never going to be popular, no matter how much people said they wanted "the current system, just a bit improved" back when Pelosi and Reid were doing their polling to decide what PelosiReidCare would look like...

-- Badtux the Healthcare Penguin


  1. You point out exactly what private insurance companies should not be providing primary health care insurance. Their primary purpose is to make a profit for their owners. They make money by maximizing the money they bring in with premiums and minimizing the money they pay out in health care payments.

  2. What do you suppose it will do to the long-term psychology of the American population to grow up knowing that if you get sick, you die? That there's no point in expecting to live long, because as soon as you grow old, society is going to let you die. If you don't work, you don't eat.

    Will people become fatalistic; decide they might as well just drink/drug/fuck themselves into oblivion, because what's the point of denying yourself pleasure and living temperately because there's no long-term prospects anyway? It would be nice to think if "Get sick = die" becomes the new way of thinking that people will focus on staying extra-healthy, but most human minds don't operate with long-term goal-vision like that.

    What will that do to the savings rate, which is necessary for capital formation, at least under the old rules of economics. (Do they even apply any more?) I think Americans will be more likely to say "Piss on savings. I'm just going to die anyhow. Why work hard to build up a nest egg?"

    When I was growing up, I felt like bein an American was something special. It seemed like Americans would be treated better when they fell into harm's way in other countries; like the U.S. government would try to bail its own people out of trouble. Perhaps that was the naive idealism of a kid. But now it's like "If you're an American and you're not rich, you're a dog. Go die."

    At least in Canada, Australia, the countries of Western Europe, for all the faults of their medical systems, if you're a citizen, your society will pay to keep you alive. Being a member of those "country clubs" brings with it the privilege of life. In modern America, unless you're part of the country club set, you're no better off than if you were in Somalia.

  3. Dying slowly of a treatable illness or injury is much, much easier and less painful than learning for yourself who you should vote for, then voting.

  4. I hope my bowels don't distend
    and that my arches never fail
    my cranium remains intact
    and my lungs always inhale

    I hope my joints don't get stiff
    that my knees will never buckle
    my septum never deviates
    nor arthritis in my knuckle

    I hope my prostate doesn't swell
    that my colon stays intact
    my testicles stay small and round
    my bowel movements don't turn black

    I hope my bones they never break
    my ears keep hearing sound
    my cholesterol stays nice and low
    so I keep on sticking around

    I hope my kidneys never fail
    that my liver does stay strong
    without either of these things
    you may not live that long

    If you're lucky with insurance
    these things may not be so sad
    but if you're poor and uninsured
    well that's just too fucking bad

  5. @finefroghair: but if you're poor and uninsured
    well that's just too fucking bad

    Or if you're middle-class and can't self-insure, because increasingly being insured is worthless (see my two choices above for "insurance"). You think Steve Jobs cares what his new liver cost?

    Nangleator: yeppers. The majority of Americans simply don't care. And that's what's come back to bite them this past thirty years.

    Bukko: The likely response is what we're seeing with regard to the Great Recession and unemployment insurance: If the available insurance will not sustain life, you attempt to self-insure by accumulating as much savings as possible. This is what happens in China, where there is no real health insurance. The problem is that this sends consumption and thus employment down into the dumper (see: paradox of thrift). Regarding investment capital, flow of funds data from the Fed shows that banks already have more money available to lend than they can find viable businesses or people to lend it to. Having more money available to lend is not going to help one bit there.

    Critter: For all other insurance products, if the insurer fails to meet his legal obligations, you sue and four or five years later win and get your legal fees plus the payment plus interest plus, if they were being especially evil, punitive damages. Health insurance is the only insurance where you can't do that, because if you don't get the care you need when you need it, you're dead. Sorta hard to sue your insurer to force them to live up to their contractual obligations if you're dead, eh?

    MandT: The private insurers are terrified that someday ordinary people might be allowed to buy into Medicare as their health insurer at *any* price. Likely it would cost more than private insurance, but Medicare has no profit incentive to kill you, which is why it is the second most popular government program in the USA (the most popular being of course Social Security).

    - Badtux the Healthcare Penguin

  6. BadTux,

    You're a smart guy and I luv ya, but I feel a bit irritated when you pin this on Pelosi/Reed. I had to deal with health insurance companies in 1986 because it was my job. I sometimes wonder if you understand just how tight the stranglehold that the insurance companies have on "healthcare" and how long it has been going on?

    Wendell Potter knows, he was the PR guy for the company that gave the doctors I worked for then the most headaches. Creative coding was necessary then to get those buttheads to pay anything.

    The difference now are the mandates to buy the insurance AND the fact that more people are using the sick care ("healthcare") because the boomers need more care and the nurses in hospitals have unions that protect their wages. The healthcare companies are now mostly huge corporations that squeeze the nurses to absolute exhaustion in order to please shareholders. Also, the large corporations have offshored workers so they don't get the discounts on insurance for the workers that are left, and they pay less taxes (which covers boomers on SS and Medicare, further squeeezing the hospitals) than they did even in the 80's. The boomers are a much larger group of people than kids my kid's age who are having a hard time even getting into the job market, even at the crap wages offered to them.

    And then there are the congresswhores who suck up to insurance companies for campaign contributions and then deliver the laws that benefit them.

    Here is Potter's latest article
    Ryan's Medicare Plan would be a windfall for insurance companies

  7. ps, my friend is a small business owner and her personal coverage cost three times a month what we pay for a family of 3 for the whole year. My eyes almost popped out of my head when my friend told me that :(

  8. Tux - -
    Been asking for years just exactly what the "healthcare insurance industry" contributes to either healthcare (or industry).
    There's also the argument that employers are scared to death of single-payer since once instituted, many employees would say "take this job and shove it."

  9. This comment has been removed by the author.

  10. I look forward to your campaign for Senate.

  11. Dear BT, I swear that is the ugliest fairy ever I did see. Are you sure it ain't a troll?

  12. Can't disagree so far as it goes, but the un-capitalist part of the insurance industry is their anti-trust exemption. If they actually had to compete w/each other, perhaps things might be different. Though they'd probably just compete to see who can provide the least service.

  13. Can somebody please explain to me in detail as to how health insurance companies managed to get an "anti-trust" exemption in terms of the way that they have set themselves up?

  14. Dah Sab, insurers *do* compete with each other -- to be the cheapest option for employers. That is, they compete to deny as much care as possible. That is why I state that health care is inherently anti-capitalist.

    Davis X, I ain't pretty 'nuff for politics, and am neither independently wealthy nor pliable enough for someone who is independently wealthy to back. As long as the majority of Americans insist upon electing the prettiest face with the glossiest campaign ads, I'm afraid you're going to have to be satisfied with the assorted losers, creeps, and morons who are our current political class.

    MandT, the Free Market Fairy is insulted at your impertinence. Watch out, or she's going to ram her Magic Wand of Free Market Fairy Dust up your rear and do to you what she did to all those poor sods who are now underwater on their mortgages, yo!

    Neurovore, the anti-trust exemption dates from the time the Blue Cross / Blue Shield mutuals started up. They were member owned and agreed to go after different enrollment classes in order to assure that each had sufficient people enrolled in order to sufficiently spread risk amongst the enrollees. I am of the opinion that the anti-trust opinion should *only* apply to mutuals, *not* to for-profit insurers. But even in that case, it makes no (zero) difference to the fundamental observation that health insurers are motivated to deny care, not provide care, by their very structure...

    BTW, sorry about my late responses on this thread. I was quite ill for a few days and then very tired after that.

    - Badtux the Healthcare Penguin


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