An Interesting Adventure in Government Run Health Care

It seems Steve Silberman was in England and got sick.  His experience – far from the Kafkaesque horror show described by American conservatives – was incredibly positive and incredibly cheap.  It’s worth reading his whole account, but several passages in particular struck me powerfully.

The calm, tidy waiting room presented a vivid contrast to the huge Kaiser complex on Geary Street back home, where frail seniors shuffle from waiting area to waiting area, taking numbers from machines and clutching their all-important forms to deposit in seemingly unattended baskets, before they’re herded to an examination room to wait 20 minutes for their harried physician to make a brief appearance. Though most of the Kaiser staff I’ve dealt with have been pleasant and good at their jobs, they often seem beleaguered and exhausted by the sheer workload.

The subtext of nearly every interaction with a health-care provider in the U.S. is: You’re lucky to have this coverage. Don’t push it. There are thousands of patients waiting behind you who are in even worse condition than you are. Let’s get through this as quickly as possible so the whole bloody machine doesn’t come grinding to a halt.

And:

I’m aware that my little adventure in socialized medicine is no more than a trivial anecdote — one tourist’s experience with a minor affliction that was easily dealt with. I expect that many Londoners could furnish horror stories about their ordeals in the NHS. One renowned health-care expert who grew up in England recently explained the difference between British and American medicine to me by saying that if he was very rich and had cancer, he would rather live in the U.S. But if he was poor and had cancer, he’d rather live in the U.K. and be guaranteed at least B-minus care.

That’s the sort of nuance that gets lost when the framing of public debate on health care is socialized medicine versus free-market capitalism, the feds vs. private insurers, or the GOP vs. “Obamacare” — and when we allow the tone of that crucial national debate to be set by ill-informed voters yelling Fox News talking points in staged riots at townhall meetings.

And:

Or imagine a society committed to providing access to health and wellbeing for everyone, rich and poor, rather than playing childish semantic games about “death panels” and “socialism.” The cost of calls to my insurance company to get permission to see an NHS doctor who didn’t charge me a penny will be six times what I paid for the medicine that cured my infection.

I find myself despairing at the depressingly low level of public debate in the US.  There are valid criticisms of any proposed reform of health care but hysterical cries of socialism and death panels and killing granny had no attempt at making valid criticisms and were intended to do one thing – block any rational discussion.  And succeeded in doing so – terrifying both sides in the debate, transfixing the morons in the media and scuttling any attempt to engage in rational discussion.

The second insight Silberman provides is an insight into mindset.  In the US, health care is brutally rationed but done so in hidden ways.  Everything in our system operates from position of scarcity, an assumption that creating universal health care access would bankrupt the system, destroy its ability to deliver care and leave us worse off.  Fears about individual loss of control over health care are inflated because most of us don’t recognize the ways in which we actually have no control over our health care.  Because the fear that we might be denied health care is realistic, many Americans are terrified that any changes will hurt them – most of our experiences have to do with decreasing benefits so we have experienced what happens when health insurance changes.  That these changes have been delivered almost exclusively by private companies and the operation of “free market” is glossed over.  The result is an experience scarcity.  Even people with insurance know they can be denied coverage and that having treatment paid for by their insurance company can often require a long and bloody fight. 

It’s also noteworthy that in no nation with universal health care have voters been willing to give it up.  Even the much maligned British NHS is so much a part of life that even conservatives campaign on making it better not getting rid of it.

Our degraded, coarsened public debate hurt all of us.  We could have a better system and instead we ended up with a marginal reform that tinkered around the edges.  It was political malpractice all around.

  1. #1 by Richard Warnick on July 18, 2011 - 11:24 am

    It might have helped if the Democratic Party has presented a single-payer plan — easy to understand, just like Medicare. Instead, we got the individual private health insurance mandate that everybody hates. Clearly a massive corporate giveaway, that does nothing to control skyrocketing costs.

  2. #2 by brewski on July 18, 2011 - 11:50 am

    I am waiting for Bernie Sanders to go to the annual AMA convention and tell all the doctors that they will all have to take a 36.4% pay cut, since it is their patriotic duty.

    [UK doctors make 36.4% less than US doctors]

    Then I want Bernie Sanders to go to the annual convention of pharmaceutical companies and tell them that they need to accept price controls, since it is their patriotic duty.

    [countries like the UK all have price controls]

    Then I want Bernie Sanders to go to the annual convention of Alzheimers specialists and tell them that the US will not be cover some of their newest drugs, since it is their patriotic duty.

    [the UK and other countries have determined that helping some Alzheimers patients just isn't worth it].

    Then Bernie Sanders can go to the national convention of Arthritis specialists and tell them that some of their newest drugs won’t be covered, since it is their patriotic duty.

    [in Canada their single payer plan doesn't cover some of the newest Arthritis drugs].

    Richard, and you call my reform ideas impossible to get passed?

  3. #3 by brewski on July 18, 2011 - 11:50 am

    I am in moderation

  4. #4 by Richard Warnick on July 18, 2011 - 12:35 pm

    Back in the 1970s, I went to a speech by Senator Ted Kennedy at the Georgetown University Medical School that went over like the proverbial lead balloon. At the time, Kennedy was proposing that government provide full or partial medical school scholarships in exchange for just two years of public service.

    We’ve been over this, but it’s worth remembering that our so-called health care “system” rations care already. Under a single-payer system, people will still be able to purchase supplemental insurance if they want. The point is that nobody gets left out, or has to hold a car wash to pay for catastrophic medical expenses.

    I’d rather see the Dems make the case for the best solution to the health care crisis, even if they lose. After it went through the congressional meat grinder, the ACA was worse than nothing. Look at what the right does — they plug away at their issues year after year until what once seemed radical becomes part of the accepted political discourse.

  5. #5 by brewski on July 18, 2011 - 12:46 pm

    Maybe it was because the Georgetown University medical students didn’t like listening to a convicted Harvard cheater.

  6. #6 by Richard Warnick on July 18, 2011 - 1:00 pm

    Or because those students refused to consider working for less — even for two years, and even if their education expenses were subsidized.

    Ted Kennedy was expelled from Harvard for cheating on tests (in 1951, before I was born), then re-admitted after serving two years in the U.S. Army. You say “convicted” as if he had been sentenced in a court of law.

    That’s nothing compared to confessed torture conspirators, like former President George W. Bush and VP Dick Cheney. Torture is a federal crime punishable by 20 years in prison.

  7. #7 by jjohnsen on July 18, 2011 - 1:08 pm

    Of course you’ll hear the occasional horror story about medicine in the U.K., but I have friends in both Canada and various European countries that love their system.

    As for brewski’s point, you’re nuts if you think we all have access to the latest and greatest under our system. Somebody is still deciding whether you are worth it. When my grandfather was dying they were pretty quick to decide what kind of medicine and care he should be allowed, no matter what his HMO’s plan said.

  8. #8 by brewski on July 18, 2011 - 1:18 pm

    I am serious when I say that Sanders should run for President. It would be one clean way to see what percent of the country truly wants the regressive agenda. It would also be a clean way to get out there and put on the table all the plans regressives have; single payer health care, 90% tax rates, etc. According to regressives, there is this huge silent majority that wants all that and it is just the racist GOP and the corporate sell-out Dems who won’t let it happen. So let’s get it all out there and vote on it.

  9. #9 by Richard Warnick on July 18, 2011 - 1:25 pm

    The majority is not silent. Take a look at the polls.

    Two-thirds of Americans support Medicare-for-all
    65 Percent favor millionaires tax

  10. #10 by Ronald D. Hunt on July 18, 2011 - 1:33 pm

    Ahh guaranteed universal health care, retirement at age 60, 35 hour work week, 5 weeks of paid vacation every year, free college education for every person without regard for income(either high or low).

    Ohhh yea that sounds terrible Brewski.

    “90% tax rates”

    Well progressive curve maxing at 90%, I really don’t see what the issue with paying for our government is.

  11. #11 by brewski on July 18, 2011 - 1:46 pm

    Then run on it.

  12. #12 by Richard Warnick on July 18, 2011 - 2:08 pm

    Problem– President Obama is expected to raise $1 billion in special interest money for his re-election. There is no progressive candidate who can even come close to that.

  13. #13 by brewski on July 18, 2011 - 2:15 pm

    You mean the virtue of the ideas wouldn’t propel Sanders to the White House?

  14. #14 by Richard Warnick on July 18, 2011 - 2:18 pm

    It was your idea for Bernie to run for President, you can figure out how he can win. ;-)

  15. #15 by brewski on July 18, 2011 - 2:35 pm

    OK, then Michael Moore. He has the money.

  16. #16 by Larry Bergan on July 18, 2011 - 3:22 pm

    The conversation at OneUtah is on fire lately!

    I love it!

    The closer we are to – noisy, but truthful – democracy, the further we are from violence.

  17. #17 by cav on July 18, 2011 - 4:46 pm

    Sanders / Hunt versus Bachmann / Beck

  18. #18 by Larry Bergan on July 18, 2011 - 6:11 pm

    Michael Moore must have thousands of millions!

    Not. :(

  19. #19 by Cliff Lyon on July 18, 2011 - 8:18 pm

    Brewski, The “virtue of ideals” DID propel Sanders (S-VT) into the Senate and the “virtue of ideals” DID propel A HOOP HUCKING BLACK AFRICAN into the White House.

    What was you question again?

  20. #20 by brewski on July 18, 2011 - 9:49 pm

    Yes, Sanders did become senator of Vermont. Keep in mind that Vermont has fewer residents than Columbus, OH.

    As for Obama, since Richard strongly disapproves of Obama, his winning does not prove your point.

    I am thrilled that Obama is a hoop hucking black African, but I don’t seem to share your fetish for the topic. What is your obsession with this whole African thing? Did growing up in such a lily white world of prep school and UVA do a number on your head? Those of us who actually grew up in the diverse world that you could only imagine got over that thing about 30 years ago. Please catch up with the rest of us, you’e lagging behind the pack.

  21. #21 by brewski on July 19, 2011 - 1:10 pm

    Wow, Vermont has 1% black people, according to the US Census. I assume that back in your day it was even less. No wonder you have this fetish for hoop hucking black Africans; you’ve never met one. It sounds as though I had more black people in my kidergarten class in my LAUSD school than you’ve ever known in your entire life. Explains a lot.

  22. #22 by james farmer on July 19, 2011 - 5:22 pm

    brew: Good on you for conceding in #20 that diversity is a good thing and worthy goal. There may be hope for your sorry ass yet.

  23. #23 by cav on July 19, 2011 - 6:03 pm

    I came for the politics but stayed for the interpersonal sniping. Not.

  24. #24 by cav on July 19, 2011 - 6:25 pm

    The biggest problem facing the country was the rich did not have enough money and ordinary working people have too much. The deficit reduction plan is a big step forward toward addressing this imbalance.

  25. #25 by brewski on July 19, 2011 - 7:32 pm

    I actually did not say that. I said that I have lived in the diverse world that Cliff can only imagine. I do not support your state-sponsored discrimination against Asians.

  26. #26 by brewski on July 19, 2011 - 8:02 pm

    Richard, as for your “Medicare for all” support. Apparently this has a few sticky problems:

    Currently, Medicare pays the most to ten states that often provide poorer
    outcomes, safety, and service at higher cost, and much less to most of the country where providers demonstrate
    generally better outcomes, safety and service at lower cost. As healthcare providers, we believe that insertion of a
    measurement of value into the payment system is a critical step to change provider behavior throughout the
    country and “bend the cost curve” in U.S. health spending without compromising health…..

    Under the current Medicare system, a majority of doctors and hospitals that care for Medicare patients are paid
    substantially less than it costs to treat them. Many providers are therefore already approaching a point where they
    can not afford to see Medicare patients. Expansion of a Medicare-type plan without a method to define, measure,
    and pay for healthy outcomes for patients will move many doctors and hospitals across this threshold, and ultimately
    hurt the patients who seek our care. We should not put more Americans into the current unsustainable
    system.

    http://www.mayoclinic.org/healthpolicycenter/pdfs/open-letter-to-congress-7-22-09.pdf

  27. #27 by Ronald D. Hunt on July 19, 2011 - 10:02 pm

    Most people advocating Medicare for all also support payment reforms, their was infact a good sized group of progressives who supported the “weak” public option on the bases of creating this payment model to transition the system towards the single payer medicare for all style system.

    Even the Medicare based “strong” public option would have been setup to pay Medicare rates plus 5 or 10 percentage points, which would have set the stage for overall payment reform.

    “Under the current Medicare system, a majority of doctors and hospitals that care for Medicare Patients are paid substantially less than it costs to treat them”

    Only when using studies that ignore the difference in payment models, Of course AHIP and the AHA, and large clients are going to say we need to pay them more, and their more then willing to manipulate statistics to make the numbers look favorable to their position.

    Either way it is manipulative to say that Medicare for all would just create a larger “unsustainable” as Medicare for all would by the nature being the only payer would have to have a different method for negotiating rates, delivering payments, and financing the overall system.

  28. #28 by Richard Warnick on July 19, 2011 - 11:01 pm

    brewski–

    I don’t simply support Medicare For All, I believe it’s inevitable. It’s the for-profit health insurance industry that is unsustainable. There is no other effective way to control costs other than single-payer. My previous employer is dropping health insurance because it has gotten too expensive.

  29. #29 by brewski on July 20, 2011 - 9:57 am

    The point theses experts are making is that to simply say we need single payer ignores how that single payer system is designed. As they point out, Mecicare rewards inefficiency, poor quality and bad outcomes and punishes efficiency and quality. The fake healthcare “reform” bill didn’t address any of that, and “Medicare for all” doesn’t address it either.

  30. #30 by cav on July 20, 2011 - 10:14 am

    Well, if saying such things as ‘America has the best health care system in the world’ is ever to have any heft, we’re going to have to figure out how to bridge that divide.

    It can’t always be theft – hidden by smoke and mirrors.

  31. #31 by Dwight Sheldon Adams on July 20, 2011 - 10:54 am

    Brewski–

    “Since when was ‘it just makes sense’ a useful predictor of what will actually happen?”

    “I am serious when I say that Sanders should run for President. It would be one clean way to see what percent of the country truly wants the regressive agenda.”

    and

    “You mean the virtue of the ideas wouldn’t propel Sanders to the White House?”

    You know—as you have stated above—that the quality of the ideas has very little to do with their acceptance. That’s part of the point of this article. So I have to ask: what’s your point? If your point is to challenge ideas solely on the basis of their acceptability to the average American, I’d say you’re arguing on the wrong thread. To me, this is about what’s a good idea and what’s not, not about whether the average American has the IQ to see through the media fog.

    Clearly “Medicare for all” isn’t a solution. What you fail to acknowledge is that it isn’t supposed to be a solution—it’s a slogan. Amongst a certain group of people (i.e. those people who are only interested in results, not policy) it’s a solution, because people like that always think of slogans as solutions. “Eat great, even late” is a description of service to them, or a set of instructions, not an advertisement.

    I don’t know about you, but I’m not particularly interested in having those people—or those who refuse to talk to anyone but those people—be a part of the discussion. It tends to lead to nothing but political mania.

    –Dwight Sheldon Adams

  32. #32 by Ronald D. Hunt on July 20, 2011 - 12:28 pm

    “As they point out, Mecicare rewards inefficiency, poor quality and bad outcomes and punishes efficiency and quality.”

    ALL fee per service systems do that public, private, Medicare, Medicaid, BCBS, whatever. Isn’t their a single study comparing Medicare to a typical private insurance plan?, All these studies on Medicare seem to neglect that most of the problems with Medicare that they site are problems for the ENTIRE INDUSTRY.

    Medicare has some great advantages on the administrative end of things, but at the end of the day are delivery isn’t very different from any other model. Medicare for all, as a single payer system would allow the use of bulk payments, and global budgeting which in of themselves provide incentives for better performance, but when payments are made this way can be tied to any number of metrics for bonus’s for performance.

    And Dwight is right, Medicare for all is a slogan, a means of advertising an ideal, as the policy to create that ideal would be very different from what we currently know as medicare.

  33. #33 by brewski on July 20, 2011 - 1:54 pm

    My point is, that we went through a painful and ugly process to pass something which was called “health care reform” when it was not. We had the opportunity to stop, take a breath, stand back, and look at where we wanted to go, but we didn’t.

    Health care delivery is a topic that has been looked at and evaluated by experts, none of whom were consulted during the process. Some of them, like the CEO of the Mayo Clinic, even stood up and screamed “stop, you’re fucking this whole thing up” to no avail.

    In addition, there are other systems and models used throuout the world, from Canada, Costa Rica, Switzerland, etc., from which we could have borrowed best practices, but we didn’t.

    If any of this was done Obama would be riding 80% approval ratings and they’d be renaming Alabama after him. But what do you expect from someone whose first pick is James Johnson.

  34. #34 by Richard Warnick on July 20, 2011 - 4:45 pm

    It might have been less painful and ugly if the Republicans hadn’t abandoned all their own health care ideas from years past. The outcome might not have been better, but the process would have been smoother.

    Remember the “death panels” as well as the individual mandate were first proposed by Republicans.

    Progressives tried to stand up and advocate for single-payer, but they were dragged out of the congressional hearings in handcuffs. Nothing like that happened to any CEOs, so forgive my lack of sympathy.

  35. #35 by brewski on July 20, 2011 - 5:25 pm

    I just remember the process beginning by the “end of democracy as we know it”:
    http://www.huffingtonpost.com/robert-reich/how-the-white-houses-deal_b_257094.html

    Oh that’s right, I forgot. Everyone who didn’t support Obama is a racist.

  36. #36 by Larry Bergan on July 20, 2011 - 8:01 pm

    brewski:

    Thanks for pointing out that democrats harshly criticize their own president when he deserves it. That never happens on your side.

    Richard said:

    Progressives tried to stand up and advocate for single-payer, but they were dragged out of the congressional hearings in handcuffs.

    I ran across that video a little while ago. What a sad spectacle Max Baucus made of himself.

  37. #37 by Richard Warnick on July 20, 2011 - 9:11 pm

    Larry–

    Did you see this? After throwing the single-payer advocates out of his hearing room, Senator Baucus brought Medicare for All to Libby, Montana. Strange but true. If you want to enroll in Medicare before age 65, all you have to do is move there!

  38. #38 by brewski on July 20, 2011 - 10:25 pm

    This is what I was talking about. If regressive ideas are so popular and if there is some vast majority of people who want a single-payer system, then where were all of them 2 summers ago? Where was the million-person march on the Capitol? A small group at a senate panel hearing doesn’t cut it. If the Tea-Partiers, which you dismiss as the lunatic fringe, can lay siege on the Capitol, then where is the huge groundswell of the single-payer majority?

    Also, you need to tell your friends at MSNBC to bone-up a little on the economics of healthcare. Chris “I have no fucking idea what I’m talking about but I talk loud” Matthews said tonight that “there are only 2 ways to reduce Medicare costs; 1. increase copays, and 2 increase the eligibility age”. I guess he knows nothing about lowering drug prices or more efficient delivery models such as used by the Mayo Clinic.

    He also proclaimed that current retirees have paid into it so they deserve “full health care”. So Richard, the model you suggest of only basic coverage being provided and then everything above that would be part of private plans people would have to buy does not seem to be in Matthews’ vision. He doesn’t want to be the one to tell them that they aren’t going to get the drugs they want for Alzheimer’s, arthritis or heart disease. Matthews also doesn’t mention that current retirees will receive three time in medical benefits what the cost they ever paid into Medicare.

    So under the status quo Chris Matthews model, everyone gets as much health care as they want, they only have to pay for 1/3 of it and the rest is paid for by the Medicare fairy, and we should never change the delivery model to save costs. This is why we refer to the intellectual weakness of the left.

  39. #39 by cav on July 20, 2011 - 11:51 pm

    “This is why we refer to the intellectual weakness of the left”.

    This is why we refer to the intellectual weakness of the right(wrong):

    http://mediamatters.org/mmtv/201107200019

  40. #40 by Richard Warnick on July 21, 2011 - 6:12 am

    There was no march on Washington in favor of single-payer, because Medicare for All was taken off the table already during the 2008 Democratic Presidential Primaries. All we were offered was the weak public option, and that wasn’t worth marching for. The final bill was worse than doing nothing.

  41. #41 by brewski on July 21, 2011 - 9:26 am

    Cav,
    I don’t listen to Rush, so I will take your word for it. But if you want to put Rush and Matthews in the same intellectual category, then I agree.

    Richard,
    If there is some majority who wants single-payer, and it was not offered, then that is all the more reason to have a million person march for it. Demand that it be part of the offer.

    I agree that the final bill was worse than doing nothing. We both must be racists.

  42. #42 by Larry Bergan on July 21, 2011 - 5:02 pm

    brewski:

    I have been trying to tell you that Chris Matthews is no liberal for some time. It’s good to see that you finally agree.

    Maybe you can tell how people who have to rely on their jobs to get any healthcare can take off to Washington to protest. By now they know the “liberal media” wouldn’t give them a fraction of the time they give the teabaggers anyway.

    The teabaggers, (when they become a registered party, I’ll call them the Tea Party – I swear), didn’t have to worry because they were already covered no matter how long they took off work. They were either covered by medicare or had enough millions to open some kind of comprehensive medical savings account.

    It’s amazing to me that anybody could say “medical savings account” in this country with a straight face when even a millionaire with a little string of bad luck could end up in the gutter.

  43. #43 by cav on July 21, 2011 - 5:10 pm

    Msnbc, Tweety Mathews’ paylord scrapped Cenk Unger because he was a little tough on the insane repugs they scheduled for interview. Not only was the nonsense they spewed about austerity too much for him personally, but in the sense of fair and balanced, they couldn’t have him bashing the corporate puppet machine…so Cenk’s out.

  44. #44 by Larry Bergan on July 21, 2011 - 5:18 pm

    cav:

    Speaking of heat waves:

    I think it’s time for the governor of Texas to take a stand on whether he’s going to secede from the union or accept federal assistance. Can’t have both, sparky!

  45. #45 by Larry Bergan on July 21, 2011 - 5:28 pm

    Obviously time to replace MSNBC with Current TV on cable outfits that care about people of little means.

    Oh…

    Sorry, typewriter moving faster then brain.

  46. #46 by Larry Bergan on July 22, 2011 - 3:07 pm

    Cenk Uygur explains why he got canned from highly visible cable channel MSNBC.

    I greatly respect Olbermann and Cenk for standing by their principals enough to get banned from a cable news station which has been much better then the rest, but which is slipping into the “access” trap:

    Seems like the videos on Current TV are running better then when Keiths show first started. I’m going to be tuning in on his web page a lot more!

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