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September 16, 2008

McCain’s Health Care Plan
Posted by Jim Macdonald at 09:31 AM *

“Make it more expensive, make it riskier, and for some people, make it nonexistent.”

The more you look at McCain’s health plan, the worse it gets.

Even the people who like McCain’s plan (Why McCain has the best health-care plan over at CNN Money) have noticed that:

To his credit, McCain does have a plan for relatively young, low-income Americans who can’t afford insurance. “We would increase the tax credit according to income so that poor families could buy insurance,” says Douglas Holtz-Eakin, McCain’s policy director. But McCain sorely lacks a plan for people in their 50s without corporate benefits, and Americans with pre-existing conditions, who would be brutally stripped of coverage if insurance crosses state lines. “For his plan to work, McCain has to tell us how he would deal with the old and sick,” says Jon Gruber, an MIT economist. “If McCain doesn’t tax the healthy to pay for pre-existing conditions, as happens under community rating, he has to tax the taxpayer. That means his plan will require huge subsidies he’s not talking about.”

If you’re interested in why they think McCain’s plan is better than the Democratic plan, it’s because under the Democratic plan even people who can’t afford insurance would get insured.

Let’s talk about tax credits. You know something? If you offered a $100,000 tax credit on yachts, most people still couldn’t afford a yacht. With the average family insurance plan running $12K a year, a family that’s making $26K is going to have a hard time buying health insurance, and telling them that they’ll get a $5K tax credit at the end of the year—that they can just cross off $5K from their tax bill come April—isn’t going to help.

And just try getting insurance at all if you have a pre-existing condition. Go ahead, try. I’ll wait.

Here’s a fact: People who don’t have health insurance don’t get health care. Sure, if they’re unconscious or spurting blood they can come to the Emergency Room, but that’s a cruddy way of getting basic health screening that keeps things from getting to catastrophic conditions.

I’ve seen this myself. I’ve seen a man in his mid-forties die, choked on his own vomit, unconscious from undiagnosed diabetes. Why undiagnosed? He didn’t have health insurance to cover physicals. He was working three jobs—but they were all part-time jobs with no benefits.

McCain’s health care plan is to tax job-based health insurance as income, and to remove the incentives for employers to offer health insurance. The obvious result will be for employers to drop health insurance, forcing everyone to buy insurance on the economy, or do without. The result of that won’t be healthy competition that will lower costs for everyone. It’ll be higher costs and fewer options for the poor, the old, and the sick. That is, the people who need health care. Young, healthy, rich people won’t be affected—until they get old, sick, and subsequently poor.

Several health care policy analysts said the plan could expand insurance choices for some people but has the potential to backfire by undermining employer-based coverage for many workers.

“If you’re not careful, it could lead to a substantial decrease in the number of people with coverage,” said Stuart Altman, the dean of the Heller Graduate School for Social Policy & Management at Brandeis University, who has frequently advised politicians on health care reform.

Individual health insurance plans are often more expensive - or include major exclusions - for sick and old customers, because they don’t spread out risk like group plans.

“What we’ve found is that the individual market doesn’t work very well,” Altman said.

According to the nonpartisan Kaiser Family Foundation, an average family health insurance policy cost more than $11,000 last year. McCain indicated in his speech that states might develop means to help lower-income individuals buy insurance, but critics said $5,000 would not bring many uninsured families much closer to affording coverage.

“If you think about what an average premium is right now for employer-based coverage - it’s about $12,000 per family - then a tax credit is obviously going to fall short,” said Sara Collins, an assistant vice president at the Commonwealth Fund, a foundation that sponsors research on health care policy.

The health care plans that have been offered by Democratic candidates for president have been focused on providing universal health insurance coverage, but McCain said he believes health care costs are the main barrier for many who have been pushed outside the market. Rather than government plans and mandates, he said, the government can increase coverage by lowering the costs of care and encouraging competition.

If a foreign power attempted to impose the McCain health care plan on America we would consider it an act of war.

Comments on McCain's Health Care Plan:
#1 ::: Alex Cohen ::: (view all by) ::: September 16, 2008, 09:43 AM:

A pretty good writeup at Slate on Why People Overuse the ER.

#2 ::: Fragano Ledgister ::: (view all by) ::: September 16, 2008, 09:58 AM:

Bush, you may recall, called moderately adequate employer-provided health coverage 'gold-plated'. I get the impression -- perhaps I'm paranoid -- that the Republican Party doesn't like the working class and lower-middle-class very much.

#3 ::: JJ Fozz ::: (view all by) ::: September 16, 2008, 10:01 AM:

Twenty years ago when I entered the work force, my father told me "Health care benefits will be more valuable than take home pay." At the time, I ignored him since I knew everything about everything.

Now, with two children who visit the doctor on a regular basis the old man seems pretty smart.

The fact that this country's "leaders" have not been able to solve this problem speaks volumes about the quality of our "leaders."

#4 ::: JanetM ::: (view all by) ::: September 16, 2008, 10:04 AM:

I was under the impression that the McCain (and, by extension, the Republican) health care plan was, "Don't get sick."

#5 ::: Emily H. ::: (view all by) ::: September 16, 2008, 10:17 AM:

A lot of government jobs offer comparatively good benefits in exchange for lousy pay. If teachers and librarians end up taxed on their health plans... they're going to have much less reason to be teachers or librarians.

And goodness knows their salaries aren't going to go up under McCain.

#6 ::: Larry Brennan ::: (view all by) ::: September 16, 2008, 10:24 AM:

Perhaps we should let media companies try the McCain plan first.

#7 ::: Larry Brennan ::: (view all by) ::: September 16, 2008, 10:26 AM:

I should add, by media companies, I mean newspapers and TV news organizations. Not book publishers.

#8 ::: John L ::: (view all by) ::: September 16, 2008, 10:32 AM:

It's not that the Republican Party dislikes low and middle income Americans, it's that they love corporations more.

And health insurers are big time corporations.

I know a single mother of two who hasn't got any medical coverage for herself at all. When she was pregnant with her third child (the oldest doesn't live with her), she got her pregnancy checkups at a free clinic. She worked 12 hour shifts as a waitress until her 9th month to save enough for the hospital stay and delivery (a C-section) and is still paying off the remaining charges.

Fortunately for her the children are covered under their fathers' insurance, but when she gets sick she just doses up with OTC medicine and goes on to work, or goes to the emergency room if she's feeling really bad. She worries all the time that if she got really sick for an extended period of time, everything she's worked so hard for would come apart.

There's an entire sub-economy of people in her situation all around those of us with employer provided health insurance, and unless we get to know them, we never realize how close to poverty they truly are. Basic, affordable health insurance should be made available for everyone, not just those whose employers provide it.

#9 ::: P J Evans ::: (view all by) ::: September 16, 2008, 10:33 AM:

Even with coverage, if you have to take time off from work to visit a doctor, and you don't have paid sick time or vacation available, you're out the money for that time. This is another reason why people don't get medical care: they lose money in the process.

McCain is really unfamiliar with the world we live in.

#10 ::: rm ::: (view all by) ::: September 16, 2008, 10:35 AM:

On #5 and #1:

I work for a state university for low pay and mediocre benefits (our campus negotiates its own insurance package because our state is so unhealthy that the state government's package is worse than what a 1000-employer entity can get for itself). We are already having a hard time keeping our benefits -- under McCain's plan I can see us dropping them.

Pre-existing conditions? You betcha.

Which means my part-time, evening job doing training for a Major National Corporation will become full-time, at even lower pay but with good benefits. Which will then be taxed as income. Way to encourage service, John.

And, regarding the ER, when did it become normal that the only place to get an X-ray is the ER? My kid broke a bone and couldn't be seen by any orthopedist until he went to the ER first. Then they made him wait a week; then they told us we waited too long. They can't give him an X-ray at the clinic and then decide how quickly he needs treatment?

No, because the G*&^D&^%%$ MOTHERF*&%$$##$ insurance, I guess, has to know for sure that he is injured before it pays for an X-ray, and they don't know that if he just goes to the doctor.

Every encounter I've had with Canadian health care -- several over the years -- has been really wonderful, I must say.

#11 ::: Fragano Ledgister ::: (view all by) ::: September 16, 2008, 10:37 AM:

John L. #8: That's socialised medicine which is un-American. Why this is wrong, evil, sinful, and possibly Satanic has never been clear to me, but apparently it is.

#12 ::: heresiarch ::: (view all by) ::: September 16, 2008, 10:45 AM:

McCain's healthcare plan is the medical equivalent of privatizing Social Security.

#13 ::: Larry Brennan ::: (view all by) ::: September 16, 2008, 10:45 AM:

Fragano @ 11 - Obviously because it might mean that doctors would have to play less golf. The AMA really dislikes that idea.

#14 ::: Debbie Notkin ::: (view all by) ::: September 16, 2008, 10:54 AM:

John L, #8: It's not about liking or disliking low and middle income Americans; it's about seeing us as votes rather than people. Once we've voted, we're not very important for four years, and most of the ones who die in between were probably Democrats anyway.

I currently have a friendly acquaintance, a woman I admire very much, who may not die of late-stage Lyme disease, if her friends come up with enough money. She's one reason I don't donate to Obama--I donate to her.

Thanks for spelling this out. Now, how do we get people who need to read it to read it?

#15 ::: Nancy C. Mittens ::: (view all by) ::: September 16, 2008, 10:55 AM:

It is great to see the Republicans addressing overpopulation, and so efficiently and effectively, I might add.

#16 ::: Stevey-Boy ::: (view all by) ::: September 16, 2008, 11:21 AM:

I can be a little naive sometimes when it comes to financial matters, but it occurs to me that a $5,000 tax credit is only worth $5K if you earn ~$40K a year. You can't get credit for taxes you didn't pay. So how does this help anyone?

#17 ::: Capital Dan ::: (view all by) ::: September 16, 2008, 11:25 AM:

Sweet. I'm one of those "lazy" Americans who, back in the heady Nineties, got sick in college with a chronic, incurable and god damned expensive disease, and I've pretty much been unable to work or find insurance ever since.

The truly elegant insanity of it all is that I've deferred my student loans to their limit since, if I get a job that makes more than $900 a month, I lose what little health care I've managed to qualify for (and subsequently lose that which makes getting a job even possible in the first freakin' place).

#18 ::: TomB ::: (view all by) ::: September 16, 2008, 11:48 AM:

Stevey-Boy at #16: It could work like the Earned Income Tax Credit. Too poor? File and get a check. It's simple and efficient.

#19 ::: Kate Salter Jackson ::: (view all by) ::: September 16, 2008, 11:58 AM:

We have good friends who were in the UK and wanted to come back to the US, (aging parents, tird of being abroa, etc). Just as they were about to start packing the shipping container to come back, One of them was diagnosed with colon cancer. Now they are resigned to never coming back to live here as they can't get health insurance in the US, even in Mass the state where it's mandatory to be able to get it.

We've always been lucky enough to have affordable health coverage through our employers. Other friends are not so lucky - like the one who just had a stroke.

#20 ::: Leva Cygnet ::: (view all by) ::: September 16, 2008, 12:03 PM:

So what's the difference between McCain's proposal for a $2500 credit to cover medical expenses, and the current option of a tax free "flexible spending account" -- which covers a good bit more than $2500 in expenses, and does it immediately?

Without health insurance, I'd be dead -- I'm another one with damned expensive and potentially lethal medical problems. My medical costs per year are greater than my wages per year.

The only question is if I'd die quickly of a sudden medical crisis, or slowly and in great and disabling pain.

#21 ::: Niall McAuley ::: (view all by) ::: September 16, 2008, 12:11 PM:

Breaking news: John McCain invented the Blackberry!

#22 ::: punkrockhockeymom ::: (view all by) ::: September 16, 2008, 12:13 PM:

I *almost* wrote about my asthma for "invisible illness week," but lost wireless for a while and gave up trying to do it here at the office.

We borrowed additional student-loan money to COBRA my ex-husband's benefits while I was in law school and he had to leave his job. Then, right before I started my current job, after graduation, we were uninsured for five months.

I knew then that I was about to start a job with a health plan that had prescription benefits and a nice salary. I knew it was temporary and I could pay it back. Otherwise, we'd have been utterly screwed. We charged five months worth of prescription drugs and I've STILL not paid it off. My drugs ran $1,000 per month then--seven years ago. Probably a lot more now.

If I lost those benefits? Well, even at the job I'm at I don't have an extra $1000 a month for my prescriptions. Currently I pay about $300 per quarter for the scripts, most of which do not have generic counterparts.

What happens without the drugs? Well, I certainly won't be a functioning member of society any longer. I might not be a member *at all*. These drugs are the culmination of years of experimentation with meds that never controlled me but only barely kept me alive. I'm controlled now, but without meds I don't make it. I'm not one of those asthma patients who can get by on a rescue inhaler. My life would become very different, very quickly, if my employer suddenly were to decide that it wasn't inclined to offer benefits. No individual plan would take me.

Suddenly, in that brave new world, I'm moving everything around, as the sole focus of my existence would be obtaining enough medication to keep working. I'm likely moving away from Michigan (which is a low-paying legal market), probably not paying for my son to go to college at all, blowing off a lot of debt, and *never* retiring (although that's probably the case anyway). No more help for mom and dad, though. I'd find a way, though, almost certainly, although our lives would suddenly become very, very unpleasant and strained.

Now, what happens to all of those people who are like me health-wise who aren't privileged enough have a high-paying job and the prospects to get a better one? I'm pretty lucky. I can probably get a job, at least for the time being, via which, if I otherwise live very, very frugally, I can spend $1000 per month on drugs.

(I always thought what you do, of course, is *not* buy enough of your meds, find yourself too ill to work--as I would be in less than 2 weeks without the drugs, mind--and then you go on SSI and Medicaid. THAT will be great for the economy, won't it, all of those folks suddenly unable to function in the marketplace because their chronic illnesses are now unmanageable?)

#23 ::: Arachne Jericho ::: (view all by) ::: September 16, 2008, 12:13 PM:

It's not just physical pre-existing conditions... though that's much harder to get insurance for. It's also pre-existing psychological conditions.

Like really nasty bipolarism compounded with post-traumatic stress disorder.

When I was a student (and then grad student), I had to go without therapy for over eight years because I couldn't afford it. And I had no idea that medication existed that would help with my condition, which worsened to the point where I couldn't put myself together most days. I'm amazed I managed to get myself hired so that I could get medical coverage (of the awful kind, but not as awful as student coverage).

It's made such a difference---it was so amazing. Now it would probably be amazing if I could get coverage for therapy, but still.

It is kind of annoying when people tell you a psychological condition is something you can "just get over". Though it is doubtless more annoying to be told "just be healthy".

Anyways. Just another reason for me to hate McCain. What happened to him?...

#24 ::: eric ::: (view all by) ::: September 16, 2008, 12:20 PM:

So yeah. Healthcare.

I'm not saying that I'm typical, but in the last couple of years, my health insurance premiums (partly paid by my employer) have been on the order of 14k a year. One of those years, I wound up paying up to the 2k out of pocket max, + deductables and other crap that wasn't covered. Total covered expenses were in the 5k range, and that's with the (trouble free, at home) birth of a kid included.

Health insurance is the second biggest expense in my life, if you factor in what the employer contributes. And it's only that because I bought a house last year. Prior to that, it was higher than the rent.

And to compare, my income tax bill (net of the rebate) is between 1 and 2 months health insurance. A 5k tax rebate would be mostly useless.

There's something wrong here, and pushing buying insurance down to individuals is not the right solution.

#25 ::: Lizzy L ::: (view all by) ::: September 16, 2008, 12:27 PM:

TomB at 18: are you sure of that? I admit, I haven't gone to the McCain website to check, but not all tax credits are "refundable" tax credits. The EIC is, but most tax credits -- like the child tax credit, foreign tax credit, residential energy credit -- are not. This means that, for example, if you are a self-employed person whose income is low and itemized deductions are high, you may pay no income taxes, so you won't get the credit, which is credited against income taxes. You do, of course, pay self-employment taxes -- which can be higher than income taxes -- on your SE income, and guess what! you pay for your own health insurance, if you are lucky enough to be able to get it and if you can actually afford the premiums. A similar situation may exist for a family with lots of kids and a low income. The credit won't apply.

If you are correct, and the credit is a refundable credit, that will help some, but $5000 won't go very far towards insurance in today's market, especially if you have a pre-existing condition. Indeed, you may not be able to even get insurance.

#26 ::: P J Evans ::: (view all by) ::: September 16, 2008, 12:29 PM:

TomB @ 18

Then they'd talk about 'welfare queens' who get more money back than they pay in taxes. See, you're supposed to do like McCain, and marry money, if you weren't born rich. The rest of us are just peasants, anyway, as far as he and his 'advisers' are concerned.

#27 ::: punkrockhockeymom ::: (view all by) ::: September 16, 2008, 12:42 PM:

PJ at 26:

There! That's it. I can marry money if my employer stops subsidizing health care benefits. *Why* didn't I think of that?

Rich man. That's what I need.

Takers? I am *so cute.* I'm high maintenance, though, particularly on the medical side of things.

#28 ::: Madeleine Robins ::: (view all by) ::: September 16, 2008, 12:57 PM:

McCain is really unfamiliar with the world we live in.

It strikes me that healthcare is to McCain what supermarket technology was to George HW Bush: the outward sign of his deep disconnect with the lives of normal people.

#29 ::: Nancy C. Mittens ::: (view all by) ::: September 16, 2008, 01:08 PM:

He has probably never paid for healthcare in his life, what with working for the federal government for most of it. If his father was an admiral, he was covered as a child by the federal government. As a Navy pilot, and later a veteran, he was covered by the government. As a Senator, he gets top-of-the-line care, courtesy of the federal government.

It's not that I begrudge anyone their coverage through the VA, etc. But why can't I have the same?

#30 ::: Dave Bell ::: (view all by) ::: September 16, 2008, 01:21 PM:

So what are the odds that somebody, directly harmed by McCain's plan, decides that they have nothing to lose? The US has a history of assassination attempts: will McCain add suicide bombers to the mix?

#31 ::: Earl Cooley III ::: (view all by) ::: September 16, 2008, 01:30 PM:

There are plenty of quotes from Dickens' A Christmas Carol that fit right in with Republican health care policy.

If they succeed in looting social programs and letting "competition" take care of America's health care needs, I'm just dead. A couple of months is all it would take, I figure. At least America's downtrodden millionaires will have subsidized boutique medical care, there's some consolation in that.

#32 ::: Lori R. Coulson ::: (view all by) ::: September 16, 2008, 01:42 PM:

Nancy C. Mittens, McCain was covered by the Military's insurance which is NOT the same as the Federal Employees Health Benefits Program.

For the duration of his and his father's military career most of his medical needs would have been taken care of by doctors at the medical facility where they were stationed.

Most Federal employees go to private facilities and physicians, rarely is there a physician available to them where they work. (Some Federal buildings may have a health center with a nurse practitioner.) We pay premiums for FEHB, and the government pays towards these as well.

FEHB is not a "free ride." We have co-pays for everything; and in some cases, may pay for the entire treatment because our insurance may not cover that particular procedure. The coverage I currently have offers minimal dental and vision coverage. I am going without some things because I simply don't have the money to have them done.

You may want what our military and Congress have -- but take a hard look at FEHB (info on the various plans should be available at OPM.GOV) -- you may not really want to be thrown in this briar patch.

#33 ::: Cat M ::: (view all by) ::: September 16, 2008, 02:04 PM:

punkrockhockymom @22:

I'm another severe asthmatic like you. And I can tell you how someone deals with it when they don't have health insurance, because I haven't had insurance for the last 9 months.

I had years of regular ER trips and a couple of hospital stays before we found the right mix of medications for me. Advair turned out to be my miracle drug, replacing two inhalers and a pill and cutting my dependence on my rescue inhaler down drastically. But the highest does Advair costs about $300 a month. So, I take it once a day instead of twice. I "forget" to take it on days when my breathing is doing particularly well. I rely on my rescue inhaler more, because those are $30 a pop instead of $300. With luck, good health and a general avoidance of strenuous activities I can stretch one month's worth into almost three.

I'm also bi-polar, although it took years for me to get a correct diagnosis. A circumstance which is in large part responsible for a 9 month gap in my employment history that I gloss over in job interviews as "an illness". On top of the asthma meds, my bi-polar meds cost another $300 a month. So, those too I stretch out, taking half the dose I really need and often going without for a week or so before I can afford to refill my prescription. It's dumb. I know it's dumb. And it effects my relationships and my quality of life, although it does keep me functional enough to work - if I don't mind taking jobs well below my skill or intelligence level.

When I was working as a temp I wasn't making enough to pay for all my meds on time, but I was making too much to qualify for any kind of medications assistance programs. Now that I'm unemployed, I'm finally (hopefully) getting on the free meds program from the drug company that makes all of my meds.

I'm looking for work now, and insurance benefits are a big part of my calculations, but in the present economy it's entirely possible I'll be forced to take another job that doesn't offer them. In which case, I'll at least have a year of the free meds program to cover me and I'll just have to hope I don't get sick with anything else.

John McCain's health care plan terrifies me. I'm relatively young (28), but I come with two pre-existing conditions and a long history of expensive medical care. I'm exactly the kind of person private insurance has no interest in ever covering.

#34 ::: P J Evans ::: (view all by) ::: September 16, 2008, 02:13 PM:

Lori, I think what Nancy C is getting at is that McCain has never had to buy insurance on the open market; he's always had it provided to him, at relatively little cost. He has no clue what it costs.

#35 ::: Stephen Frug ::: (view all by) ::: September 16, 2008, 02:14 PM:

So I was curious about the antecedents of the final line.

I recalled the quote that "If an unfriendly foreign power had attempted to impose on America the mediocre educational performance that exists today, we might well have viewed it as an act of war," but didn't remember its origin. Turns out it was the National Commission on Education report in 1983 (Glenn T. Seaborg, Chairman) called "A Nation at Risk" (If you follow the link, scroll down to "quote".)

And of course that in turn was (presumably) indebted to the famous line from FDR's first inaugural address, "I shall ask the Congress for the one remaining instrument to meet the crisis--broad Executive power to wage a war against the emergency, as great as the power that would be given to me if we were in fact invaded by a foreign foe."

Anything I'm missing?

#36 ::: punkrockhockeymom ::: (view all by) ::: September 16, 2008, 02:20 PM:


I had years of regular ER trips and a couple of hospital stays before we found the right mix of medications for me.

Yes, this. ER visits sometimes 2x a month, twice yearly (at least) longer hospital stays. Several instances in which sainted EMS folk had to bring me back, and a four day stint on life support when I was 17.

My miracle is largely attributable to Serevent, which is like Advair, but a little different.

Once, when I was in my early 20s, back before I was put on my current set of meds in 1999, I had a job with insurance and prescription coverage (thank gods!), but a year-long pre-existing conditions exclusion. I got bronchitis the week before it expired and was hospitalized for nine days.

The bill, in 1991, was over $8,000 *after* charitable hospital write-offs. It went to collection.

Currently I pay about $200 per month in premiums and, like I said earlier, about $300 a quarter for the drugs. And I haven't been to an ER in nine years, although I do have expensive visits to a pulmonologist and regular pulmonary functions testing twice a year. Wonder how much *that* costs? Costs me $10.00 right now.

#37 ::: Stefan Jones ::: (view all by) ::: September 16, 2008, 02:33 PM:

The local NPR station presents an international call-in show, "World Have Your Say," each morning.

Today they were in Truth or Consequences, NM.

Lots of crusty, blunt blowhards saying everyone should pull their own weight, government programs are wasteful, bleauh, bleauh, bleauh. Absolute certainty.

I suspect that in their world, everyone owns a ranch and can therefore afford a doctor, and the hands are expected to chew on a bullet and stitch their own wounds.

#38 ::: debcha ::: (view all by) ::: September 16, 2008, 02:37 PM:

Niall McAuley, #21: Breaking news: John McCain invented the Blackberry!

John McCain is Canadian?

#39 ::: Nancy C. Mittens ::: (view all by) ::: September 16, 2008, 02:37 PM:

Lori R. Coulson at 32, P J at 34 saw what I was trying to say.

Whether it was a plan like yours, or VA coverage, or Senate-related coverage, the man has never had to think about what would happen if he lost his health insurance.

#40 ::: Jkosmicki ::: (view all by) ::: September 16, 2008, 02:40 PM:

I'm here in the Great Plains, where people will vote Republican against their own best interests. I also know that to most of my fellow citizens, health care reform is code for "give all the free healthcare that you can to illegal immigrants." They do not see it as an issue to help them, they see it as a way to support illegals. Most of these people are working class and near-poverty, but they think that McCain is talking about THEM when he promises to help the middle-class. Because of Obama, when people say that a key element of this election is race, they keep thinking of Black & White - believe me people, the real racial tension around here is with the Hispanic population. Anyone who looks like they'll play tough with the illegals is going to get lots and lots of votes just for that.

#41 ::: Rosa ::: (view all by) ::: September 16, 2008, 03:00 PM:

What I don't get is why the media falls in with the "socialized medicine is bad!" line.

I used to work at a newspaper (1999-2005) and there were always posters up for fundraisers for so-and-so who went freelance and then got brain cancer, or their kid got leukemia, or they still had their union newspaper job but got hit by a car and couldn't work for 9 months so could we please donate our paid leave time to cover the time after FMLA ran out? Journalists should have a healthy awareness of how precarious insurance is.

Ditto farmers and small-business owners. Go to the diner or grocery store in any little town in Iowa and there's a 50/50 chance of fundraiser flyers for somebody's chemo. I do not understand why the specter of "Canadian-style health insurance" spooks them so badly.

#42 ::: Lois Fundis ::: (view all by) ::: September 16, 2008, 03:09 PM:

I'd like to recommend this opinion piece from yesterday's Wall Street Journal, "Why Obama's Health Plan Is Better", by David M. Cutler, J. Bradford DeLong and Ann Marie Marciarille.

I'm not sure it's better than a real nationalized health-insurance such as Canada's* or the UK's, or even than Hillary Clinton proposed during the primaries, but it certainly seems better than either the mish-mash we have now or the proposed "improvements" McCain is suggesting.

*I guess Canada's is really "provincialized" since each province runs its own, from what I can make out south of the border here, but "provincialized" has other connotations I'd just as soon not connote.

#43 ::: Lori Coulson ::: (view all by) ::: September 16, 2008, 03:13 PM:

Don't you see that the issue should be "universal health care" not universal coverage? We all know McCain is a puppet, parroting what he's told to say, and the people supporting him (i.e. pulling his strings) run the insurance companies -- they're the REAL rationers of health care.

Health Insurance companies should be banned. They are attempting to practice medicine without a license, and the Goddess alone knows how many people die every day due to their meddling and denial of care.

Universal Health Care -- NOT universal health insurance. The bloodsuckers already have enough money.

#44 ::: Nenya ::: (view all by) ::: September 16, 2008, 03:22 PM:

It's always seemed to me that a healthcare system that ignores the sick and the old is--how shall I put this delicately--not doing its job. (Immoral, counterproductive, fucking batshit evil.) Is that not what healthcare is for? To care for the sick?

Luke 5:31: And Jesus answering said unto them, They that are whole need not a physician; but they that are sick.

#45 ::: vcmw ::: (view all by) ::: September 16, 2008, 03:38 PM:

Several people mentioned government employees as having access to health care.

I work for the government and I still can't afford health care. I have a .5FTE job, and my contribution to health care payments would be about the size of my rent payment. With no preexisting conditions, I can't justify that sort of expenditure, especially since even at .5FTE I make more than my husband and we are barely squeaking by while I look for a 2nd job. I'm a librarian with a professional degree, and I haven't had health insurance since I finished library school (during school I had a full time government job, and some health care).

Even people with no children or preexisting conditions whose jobs offer insurance can't necessarily afford to take it. That's why I mock companies that talk about what percent of their workers they *offer* insurance: I want to know what percentage of their employees they insure. Both my job and my husband's job offer us the chance to purchase insurance: we can't afford either plan.

I should add that the one medication I regularly take (birth control) is not covered by many health insurance plans. When I worked in Illinois for the state, they had recently lost a class action lawsuit brought against them by their own female employees due to their longstanding refusal to cover birth control.

I think we need universal health care rather than universal health insurance.

#46 ::: Linkmeister ::: (view all by) ::: September 16, 2008, 03:49 PM:

Steve Benen over at Washington Monthly has links to many of the health care articles which have appeared over the past two days in one post. That's convenient.

#47 ::: P J Evans ::: (view all by) ::: September 16, 2008, 03:51 PM:

I worked one time at a company that did provide paid health insurance to all their employees. They just didn't pay most of said employees enough for them to afford getting sick, or taking time off to get care. One woman, who'd been there several years, still needed aid to get health care for her son. (Actually, they paid most employees slightly less than it cost to live in the area. You needed a second income just to afford to work there.)

#48 ::: Ginger ::: (view all by) ::: September 16, 2008, 04:02 PM:

I'm a government employee, and my main problem with the federal health care is I cannot put my partner on as a "spouse". F@#$ing DOMA specifically excludes same-sex partners, and the Federal Government excludes itself from anti-discrimination regulations. When she was not working, and had to pay COBRA for her health care, it really hurt the bank balance -- to the point where she dropped COBRA and went uninsured for several months, knowing that she would get coverage again as soon as the effing Federal employment rigamarole finally processed her application.

Sorry. Hot button. Please carry on.

#49 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 16, 2008, 04:25 PM:

Nancy C Mittens @ 15

Yeah, the McCain Plan is showing its debt to the fundamental principles of Social Darwinism: "Thinning the Herd".

Last year, as the Greed Crisis started becoming visible, I realized I wasn't going to get to retire this year, as I'd planned. Now I'm waiting and hoping that the economy will improve enough that I can do it next year.

The problem isn't income; I've got enough in my 401K and IRAs to have a modest income for both of us into our 90s. The problem is health care. My current benefits are quite good; necessarily so. Our combined bill for prescriptions alone, before insurance, is more than US $600 per month. The copay it costs us instead is $60. And I spent a year and a half on COBRA after the dotbust; I know just how much that costs, even with a really good safety-net system like the one here in Oregon. On top of which I'll be scheduling 2 surgeries before the end of the year, and the cheapest will cost about $6K before insurance, so I really can't afford not to have insurance, and I can't afford to have to pay the full premium myself right now.

OK, now I have a good salary, and have been saving, and investing at reasonable returns for a long time. I'm not the average camper here. What's going to happen to someone who makes the average per-family income and is headed for retirement, when health insurance becomes an undesirable and unnecessary expense for employers?

#50 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 16, 2008, 04:35 PM:

Ginger @ 48

No, please, it's a very important point. Given the Republicans' deep homophobia, what makes us believe that part of "Thinning the Herd" won't include unspoken rules about who actually gets any of these (meager) benefits without the standard "fill out the form and submit it to be lost 3 times before we even consider it, and with any luck you'll die before the court forces us to give it to you" attitude of the current set of health insurers, the VA, and all the other organizations whose bosses have told them to cut costs using the techniques of malign neglect.

Pisses me off just thinking about it, and it makes me want to dine on Republican nominee's liver, with fava beans and a nice chianti.

#51 ::: Terry Karney ::: (view all by) ::: September 16, 2008, 05:17 PM:

Nancy C Mittens: Coverage at the VA isn't what it used to be (and before Clinton it wasn't all that much... but he hated the services, and scorned veterans... I've heard that, and I believe it).

I am deathly afraid I'll end up a health care refugee. Between the Reiter's Syndrome (not bad now, but who knows? I can get away, at this moment, with not declaring it; because the Army tells me it was a temporary thing. After my physical tomorrow... probably not), and whatever PTSD I've got, private health care is a pipe dream.

So I may end up an ex-pat, not because I hate the gov't, but because I don't want to be a cripple.

#52 ::: David DeLaney ::: (view all by) ::: September 16, 2008, 06:11 PM:

As another person who hasn't been able to afford health insurance for a few years now - self-employment has wonderful hours and a great dress code, but sadly lacks some other benefits - I agree that what we Really Want is "universal health CARE", not "universal health INSURANCE". (I do get regular checkups, and am able to afford, barely, lancets and the cheap diabetes medication I take intermittently, mainly because the doctor I had when I _did_ have health insurance let me stay on afterwards, and doesn't force expensive tests for various things on me...)

Also - given that actually implementing the Republicans' plans for health insurance would seem to lead directly to the deaths of possibly hundreds of thousands of Americans ... is there any possibility we can get the people pushing these plans classified as terrorists, maybe? Just a thought...

--Dave "I know, I know, it's okay because they're Not Our Kind Dear. ptui." DeLaney

#53 ::: Nix ::: (view all by) ::: September 16, 2008, 06:27 PM:

This thread has assured me of one thing: despite its legendary sloth (I'm in the middle of waiting four months for a colononscopy to figure out why my digestion is stalling every other day), there's no damn way I'm ever going to move anywhere that doesn't have the NHS or some similar freeish health service. Anything else is inequitable and outright dangerous.

(I too have personal reasons to dislike this sort of thing. My mother was not rich when I was born months early and nearly died at once. The NHS spent, I understand, well over a million quid on then-experimental procedures over a three month period to keep me alive: I don't know the exact figure, but it was between one and two million, in 1976. Had she had to pay for that, she'd still be paying it off now: given that she and my father had had a serious car crash three years before, it's much more likely that the decision would have been made to not spend much effort on me and, like my twin, to let me die. (There was no point trying to save Stephen: after twenty minutes without oxygen you're a vegetable at best.)

Thus, I strongly suspect a US-style healthcare system would have killed me.)

I was thinking how strange it was that so many people speaking up in this thread had serious health problems... but, of course, it's not strange at all: *everyone* has serious health problems at some point. If they have them when they're young enough and avoid dying, they're going to be in favour of equitable, humane (-> socialized) health care forevermore, and so will all their loved ones, if they have any heart at all. (Even selfish bastards will see their premiums go insane and decide that perhaps socialized health care is a good idea.)

What amazes me is that *everyone* isn't in favour of it. Are there so many people out there who are either assured of eternal riches or assured that they'll never fall ill? Or are they just extremely stupid? I can't see a charitable alternative here, I'm afraid.

#54 ::: Max Kaehn ::: (view all by) ::: September 16, 2008, 06:56 PM:

An analysis of the McCain health plan states:

Senator McCain's health plan has three central features: withdrawing the current tax exclusion of employer payments for employer-sponsored coverage (in other words, taxing premiums paid by employers), introducing a refundable individual health insurance tax credit, and deregulating nongroup insurance by permitting the purchase of policies across state lines.


Eliminating the tax exclusion would greatly reduce the number of people who obtain health insurance through their employers. This decline would be driven by three factors: the effective price of employer-sponsored coverage would increase, the nondiscrimination rules would no longer apply, and low-risk employees would have less incentive to remain in employer-sponsored groups.


For our analysis, we took a middle-range estimate from these studies and assumed that the elimination of the income tax preference for employer-sponsored insurance would cause twenty million Americans to lose such coverage. We note, however, that the effect could be much larger.

Or, to put it in more personal terms: John McCain wants my wife to die in agony.

Senator McCain, do you remember that promise you made to follow Osama bin Laden to the gates of Hell? Just to make sure, why don’t you carry him in?

#55 ::: Lynn ::: (view all by) ::: September 16, 2008, 07:51 PM:

This a really sore issue for me, because a friend of mine has bones that are permanently misaligned (and painful) because she was one of the ones that had to wait for it to stop hurting while popping extra strength Tylenol.

She's a teacher for a non-profit preschool/daycare that specializes in caring for low income and handicapped children. Given the circumstances, there isn't any program money to spare. Thanks to recent legislation (Ohio or national I'm really not sure) that subsidized insurance for teachers, she and her coworkers were able to get coverage for the first time this year.

Like I said, I wish I was more up on the specifics of the legislation, but she said it was passed precisely because the lack of health care is leading to a lack of new teachers.

#56 ::: Allan Beatty ::: (view all by) ::: September 16, 2008, 09:23 PM:

Nix @ 53: "I was thinking how strange it was that so many people speaking up in this thread had serious health problems..."

Time for me to speak up then. I am (to date) one of those disgustingly healthy people with no chronic conditions or regular prescriptions. I've never had to choose between medical care and food/rent/transportation. Yet this McCain plan scares even me, because I can see what it means to people around me, and I hope I have a sense of how fleeting good health can be.

This McCain plan is what I have been dreading ever since health care reform became a major topic in political discourse: that someone would float a "reform" proposal that would actually be *worse* than what we have now. For all its faults, the current setup does have the advantage that a fraction of people (those whose employers sponsor plans) can get group coverage through groups that are formed for other reasons than a desire to purchase health care insurance. You have a more-or-less random risk pool and can afford to include some pre-existing conditions. McCain would take that away.

#57 ::: Allan Beatty ::: (view all by) ::: September 16, 2008, 09:34 PM:

BTW I fear this thread is overdue for a social darwinism drive-by.

#58 ::: Lila ::: (view all by) ::: September 16, 2008, 09:40 PM:

Nix @ #53: I have no health problems that require prescription meds, cause significant pain or impair my function in activities of daily living. (At least not yet. I've had over 110 deer tick bites in the past 48 hours, and my tongue and lips are tingling a bit, but that might be the benadryl).

However, I am a physical therapist assistant. Every day--EVERY DAY--I see people who are in pain, unable to work, or unable to care for themselves because they don't have access to adequate health care (particularly preventative care). I know there are 80,000 amputations due to diabetes in the US every year. I've met many people who became lifelong dependents for lack of rehabilitative or other medical services. I work with disabled children who will require care their whole lives, and with stroke patients whose coverage for physical and speech therapy combined is $1810 per year--so they can work on learning to walk again, or learning to talk again, but not both.

I am furious and terrified by the health care system in the US.

#59 ::: Ginger ::: (view all by) ::: September 16, 2008, 09:46 PM:

Bruce Cohen STM @ 50: I've got a decent chianti around here, if you'll bring the fava beans, or a reasonable substitute.

We've been lucky in terms of our health, and we both come from families with long-lived ancestors. Still, living the life of the uninsured (which I did as a resident) is not conducive to a good night's sleep, plus we have a just-about teen-aged son who is not exactly known for his thoughtful approach to life.

Somewhere around the internets there was a really good explanation of the Canadian health care system. It made a lot of sense, and really made me want to move there.

I guess I'd better lay in a large supply of chianti, for all the people who want to stop by for dinner.

#60 ::: Meg Thornton ::: (view all by) ::: September 16, 2008, 10:00 PM:

I'm not going to say anything about the US health care system (at least, not until the hair on the back of my neck lies down again). What I *will* point out is my home state (Western Australia) is still short of folks to work in places like shops. We have Medicare, and it covers psychological treatment (I know this because I'm seeing a psychologist at the moment - I pay her $165 for a session, and get about $112 and small change back from Medicare).

How much does it cost to emigrate?

#61 ::: Caroline ::: (view all by) ::: September 16, 2008, 10:18 PM:


I've tried to write this comment about five times now and it always comes out sounding too aches-and-pains complaining, but let's just say that I worry about health care and I actually have halfway decent insurance right now. It's the "right now" that's key to the worries.

I also love McCain's statement about how under Obama's health care plan, "a bureaucrat stands between you and your doctor." He's never tried to get approval for tests and treatment from an insurance company, has he? Let's discuss the number of bureaucrats who stand between everyone and their doctors right now.

#62 ::: Kathryn from Sunnyvale ::: (view all by) ::: September 17, 2008, 12:07 AM:

I'm in a week of minimal writing, but I figure I can quote myself* from a few months ago:

James Nicoll--Canadian--had noted to self

"Do not get involved in discussions of universal health care systems with Americans."
Evidently that discussion is a sinkhole of vacuum, because being best in the world requires the very best in defensive answers.

Yes, well, I've also noted to myself

"Don't try to explain the American system to Canadians."
Don't try to explain a system of job-linked and job-dependent insurance, Cobra, 'pre-existing conditions exclusions,' high-risk pools, or a personal-pay HMO that can get canceled in an instant were I ever late just once in paying them. Don't try, not to my Canadian relatives and friends who aren't already familiar with the US system.

Because by the middle of that explanation, somewhere around

"Well of course our insurance shall be linked to the particular field in which we toil, and the generosity of the liege and the number of subjects he has, if he has over 50. And if he has under 50, should we not be dependent on the liege of our spouse? And to leave for a different pasture could mean the permanent loss of coverage, if you have ever partaken in the coverage much beyond your annual exam. It is only generous if you do not use it! How else could it be?"
that Look shows up, confusion turning to pity, a pity that grows the more they understand what I'm saying. Both the 18 year olds and the 80 year olds, giving that Look.
And that's before I get to
"Fear not, if one is uninsurable and needing to buy in the marketplace there is the charity plan that will only cost half of your pre-tax wages if you make 12 Thalers per hour, and then one-fifth of all expenses thereafter, and the burden is lessened by being tax-deductible, this for an elderly woman of 34--of course she should not expect better: she has had illness! A grand-elder of 40 or 50 would pay much more, as is fitting."
I might as well say "...then I bow before the liege, pay out a goat and two carrots, pass between the archers, and get my donkey for the ride back to the hut where I've recently introduced running water" for what that Look means.

* w/ a few edits

#63 ::: Marilee ::: (view all by) ::: September 17, 2008, 12:24 AM:

Tom B, #18, if that were true, I would have gotten a check from the IRS for my negative tax owed last year. It's mostly from my medical stuff, but some from my mortgage. And yes, if Social Security/Medicare died, I probably would, too. I wouldn't have nearly enough money to see doctors, even if I could get someone to take me with all of what's wrong.

#64 ::: geekosaur ::: (view all by) ::: September 17, 2008, 01:34 AM:

Nenya @44:
Actually, health care for the healthy makes sense: preventative medicine. Which US health care is notoriously bad at, instead preferring to wait until something expensive results from its lack. No, this doesn't make any sense even from the standpoint of a moneygrubber.

Bruce Cohen (SpeakerToManagers) @50:
It's worse than you think: for a while, Michigan had a law on the books permitting doctors to refuse care to homosexuals. (I think it got tossed after a challenge, but I wouldn't want to bet on it.)

I wouldn't die without the care I get (medium Advair for allergy to cigarette smoke; short-cycle dysphoric bipolar syndrome with generalized anxiety and social anxiety), but my life would be a lot less pleasant and I would (this is an all too demonstrated fact) not be able to go to work very often. And I am well above the poverty line. McCain's plan benefits who exactly?

#65 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 17, 2008, 01:47 AM:

Ginger @ 59

We've been lucky in terms of our health, and we both come from families with long-lived ancestors.

Not always a lucky thing. My own family tends to live a long time; one of my grandmothers and three of my aunts lived into their nineties, most of the males in my family lived to their late eighties (my father died at 75, but that's because he smoked 2 packs of cigarettes a day for almost 60 years). But Eva and I just got done watching her father die at 87, over a long period of time, acutely senile for the last 6 months, but able to pay for the medical treatments to keep him sort of alive. I'm not at all sure it was a kindness.

This leaves me wondering what happens to me in 20 years or so, with that much more medical science to use (it's an exponential increase over time). Even if I can afford it, will I want to?

#66 ::: Matthew Brown ::: (view all by) ::: September 17, 2008, 02:13 AM:

It always strikes me that the American health "system" is so inimical to the very kind of people Republicans claim to be on the side of: the self-reliant, the independent, the entrepreneur, the small businessman, the self-made man.

Because of the American healthcare system, only people in the absolute best of health can *afford* to strike out on their own and start their own business - where 'best of health' means absolutely NO medical conditions whatsoever, even those which are wholly or largely mitigated by medication and which do not prevent working at full capacity.

Quite apart from the other things it damages, it effectively turns the nation into one dependent on big organizations, because only working for one gets you decent healthcare, whether it's big business or big government.

A fact which absolutely torpedoes any claim the Republican party has on being the party of small business and the can-do American spirit, and exposes them as the tool for big business that they are.

However, they successfully encourage small business owners to fight universal healthcare, by making them terrified of higher taxes. Despite the fact that small businesses would be, in reality, beneficiaries of universal healthcare - because then they'd be able to compete equally with big business for employees. There are an awfully large number of people who'd enthusiastically work for small companies and do wonders there - if they didn't have the healthcare worries.

#67 ::: TomB ::: (view all by) ::: September 17, 2008, 02:13 AM:

Hi Marilee. The government really does have an Earned Income Tax Credit. I'm sorry you don't qualify for it. Well, actually, I'm really glad you don't qualify. I'm sorry it is so stingy.

#68 ::: Epacris ::: (view all by) ::: September 17, 2008, 04:10 AM:

Quick typo note: Start of the 10th par says "McCain’s heath care plan".

(I'd be interested to see if there was one for that ecosystem, actually. It would probably involve strip-mining or building over them, since heaths are usually characteristic of non-arable areas.)

From Australia, "the average family insurance plan running $12K a year" is a horrifying datum. I assume you'd also have what we call 'gap' payments and I think you call 'co-payments' on top of that.

#69 ::: Kathryn from Sunnyvale ::: (view all by) ::: September 17, 2008, 04:25 AM:

To amplify Michael Brown's #66 and my own #62, I'll give numbers for myself and a good friend.

I have my own consulting business so my insurance is individual pay (not from an employer or spouse's employer). I started it years ago and protect it as if my health depended on it...*

Because my health was good when I started it** I'm paying about $4200/year (baseline)***. Note how that's very close to McCain's proposed line between ordinary and 'gold plated' insurance. It is my HMO's best individual plan and I'm glad I got it when I did.

Other than in emergencies, I must go to this HMO's facilities and hospitals, and if traveling in the US, I must get their approval ahead of time for non-HMO visits. It doesn't cover foreign trips. If I move to a region (state, county) without branches of the HMO, I will lose my coverage. I can see my regular doctor within a day, but specialists can take up to 2 months.

Still, with this metal-plated goodness, I could and did go out on my own, because I could pay it even in years when I went well below the US median income.

In constrast, a good friend of mine. She's younger than me, she's a creative entrepreneur, and she has a chronic health condition for which she takes (effective) medication. No California insurance company will insure her, so she qualifies for the state's "high risk" pool.

It would cost $12,000/year (baseline), iirc, plus a 20% co-pay (which can be 3x or more of my co-pays) and it doesn't cover prescriptions. A year that might cost me $5,000 would cost her $15,000.

She's in her 30's. $12000. She can't stop working, ever. She can't change to a small startup: small companies face the same prices as individuals. If I had to go 2 months in the hospital my finances would be stressed. For her it would likely mean bankruptcy ($2400 to keep up her insurance, perhaps $30k-$40k for the hospital (assuming a few pricey meds)

It just gets worse for those in their 40's or 50's. If McCain was in his 50's, given his health record I doubt he'd find anything that's much under the median income for the US.

* If it came to a choice, I'd skip a car, rent, or credit card payment before skipping the insurance bill.

** It goes up by 10% a year. My health is still fine, but a series of small visits can add up and push you into scary-riskyland. I've had allergies treated: bad. Sinus infections: bad. Stress from taking care of a dying relative: bad.

** plus co-pays. $25:routine visit, $10: lab test, $100:ER, $100:ambulance trip, $10: up to 30 days of a prescription. $200/day for the hospital.

#70 ::: Terry Karney ::: (view all by) ::: September 17, 2008, 05:06 AM:

Kathryn from Sunnyvale: Should she have an exotic hospital stay... yeesh.

I am allergic to sulfa. Badly. So badly I was the subject of 16 doctors' attentions, as well as not less than one monograph (dermatology). I joked (black humor) that I was lucky it was the Army which had damaged me, because without them footing the bill I'd've been filing for bankruptcy on Tues (I was admitted on a Monday).

Between Monday and Thurs. the billable procedures probably tipped $250,000. I was there for another week.

In other circumstances they might have forgone some things (the spinal tap, some of the follow-on sonograms... having one's liver looked at for for thirty minutes is no fun.. even if she did show me my pancreas). They might just have decided it was a drug reaction and treated for it.

And, if it wasn't a drug reaction (which the narrowing of problems down to is what cost the cool 1/4 million dollars) that course of treatment would have killed me.

If I'd taken a little longer to respond to the meds, I'd have manifested Steven's Johnsons, and that would have been a lot more money (and OT, and PT).

And there's no way I could ever have paid that off, absent winning a lottery.

Hell, a kidney stone, absent insurance, was $8,000, for five hours of care.

#71 ::: Marna Nightingale ::: (view all by) ::: September 17, 2008, 06:10 AM:

Kathryn @ 62:

I understand how it all (fails to) work fairly well; mind you, two of the uninsured USians in this thread are partners of mine ... I did not used to understand it quite so well.

But as far as trying to explain to Canadians "what it's like"...

Well, as far as I can tell it's like being a cat is, in Canada, only with more paperwork and euthanasia is not yet quite considered a reasonable response to a situation where you don't have some entity with money available to call on that is willing to pay for your treatment.

#72 ::: Mez ::: (view all by) ::: September 17, 2008, 07:32 AM:

There was a good Non Sequitur cartoon, published in 2007 on "8.10" (10th August in US-speak) related to this. In case you can't find it — the title is The HMO Medical Procedure (whatever that means over there) — it's described below. One of my all-time favourites of this strip, which is also one I like a lot (thank you, Wiley Miller).

It shows a hospital-gowned guy kneeling on a gurney in the prep-room (whatever that bit just outside the actual operating room is called). By the theatre door there's a card-swipe unit with instructions saying: "1) swipe card; 2) select surgery required; 3) hit enter for credit approval". He's just tried, and one of the scrubbed-up staff ready to push him in is saying "Maybe if you tried another card?"

#73 ::: Emily H. ::: (view all by) ::: September 17, 2008, 07:50 AM:

I was having dinner with my aunt from Canada and my sister, who freelances (conveniently, she gets regular paychecks and can be required to work overtime, but if they call her a freelancer they don't have to give her any benefits.)

Sister: So I looked into getting health insurance for myself, but the cheapest I could find it was $600...
Aunt: Well, that doesn't sound too bad for a year.
Sister: ...A month.
Aunt: My god! What do people do for health care?
Me: You know how the U.S. has more religious fundamentalists? It's because people have to pray they don't get sick.

#74 ::: punkrockhockeymom ::: (view all by) ::: September 17, 2008, 08:01 AM:

Kathryn @ 69:

You know, given the cost of that coverage, and given that it doesn't cover prescriptions, so I'd still be paying upwards of $1,000 a month for those, well, I likely wouldn't buy that coverage.

My meds have controlled me well enough since 1999 that I would pay for the meds and take my chances with the inevitable rest of it. Which would not be smart; eventually I'm sure to have another bad spell again, I'd have to forego the twice annually testing and maintenance appointments, and, sometimes, in addition to the asthma, I have other health problems. I would just have to risk that they would occur infrequently enough and be manageable enough that their costs would not top out the at least $24K per year it would cost for both the coverage AND the scripts.

But I couldn't afford *both* that coverage and the meds, and there isn't really a choice for me to *not* take the meds. So.

Oh. My. You know, this thread is really starting to freak me out. And I have a really good job. And mobility. And I'm still freaked out.

#75 ::: Mark ::: (view all by) ::: September 17, 2008, 08:16 AM:

I explained the US situation to a dear friend in the UK some while back.

She's been begging me to emigrate ever since.

#76 ::: abi ::: (view all by) ::: September 17, 2008, 08:16 AM:

This is the conversation to have with McCain supporters, people.

Leave aside your anger at the lies and the smears, ignore the Palin squee, bite your tongue at Iraq. Arguing these matters will not persuade the unpersuaded.

Talk about the loss of employer-funded health care and how it will affect specific people. Describe how it will affect you, your friends and your colleagues, and your audience will think of people they know who are similarly situated.

Talk about the costs for chronic conditions like diabetes and asthma. Talk about cancer and its costs, talk about accidents, talk about care for the elderly such as hip replacements. Everyone knows people who have these conditions, or are at risk for them.

This is a conversation we must have not only with one another here, but with the people who think McCain won't damage their lives and the life of the nation.

#77 ::: Alex ::: (view all by) ::: September 17, 2008, 08:26 AM:

If someone proposed this "plan" in the UK, I'd take hostages.

#78 ::: Alex ::: (view all by) ::: September 17, 2008, 08:27 AM:

That is, of course, meant to be funny, but not too funny.

#79 ::: Paula Lieberman ::: (view all by) ::: September 17, 2008, 09:00 AM:

The McCain health plan favors corporations hiring young healthy workers, or high-priced executives. Everyone else gets to be a "contractor" having to pay their own expenses and "benefits."

For the most particularly nasty case--see "Marianas" and "sweatshops." Products made t here have "Made in USA" tags. (The region is US terrritory, but does not have statehood status.) Until recently when Democrats got a razor-thin majority in Congress under two years ago, mainland USA labor laws did not apply. Because of that, corporations, particularly ones that Jack Abramoff was a lobbyist for, set up factories staffed with mainland Chinese citizens lured to work for them, who were treated no better than slaves; some of them were even forced into prostitution and forced to have abortions.

Sen McCain did nothing to deter such abuses. It was Democratic members of the House of Representatives who fought for years to have the situation investigated and the laws changes to prohibit/end such abuses.

#80 ::: Nix ::: (view all by) ::: September 17, 2008, 09:05 AM:

abi, I've participated in attempts to argue as you suggest with libertarians (well, they *say* they're not libertarians and then engage in all the usual libertarian 'taxation is theft, privatize everything other than the army' stuff, so they might as well be libertarians).

Several of us noted (trying to get into their uber-selfish shoes) that privatizing medical care is not especially wise from a selfish perspective when you consider that this would tend to lead to a lot of damaged babies, who become damaged adults, who are statistically more likely than undamaged ones to be unemployed, and thus more likely than otherwise to become criminals and invade *your* yes *your* property.

The response: 'I don't care' about the extra damaged babies: 'if they invade my property I'll just shoot them'. This despite being out at work or asleep some of the time and thus unavailable to stand guard 24 hours a day 365 days a year.

When several of us pointed out that we/our children/our loved ones would be dead on their planet, the libertarians universally changed the subject. They had a similar response when asked what they'd do if they lost their job and then fell ill, or grew old and then fell ill (as they were also against anti-discrimination legislation as government interference and thus bad).

Libertarianism: selfishness, lack of foresight, and inability to face consequences/victims, all in one neat vile package. Thank goodness it's too wacky even for the US voting population.

#81 ::: Charlie Dodgson ::: (view all by) ::: September 17, 2008, 09:11 AM:

Mark@75 --- does your friend have any references on visa requirements?

#82 ::: Scott Taylor ::: (view all by) ::: September 17, 2008, 09:40 AM:

Abi @ 76 -
This is the conversation to have with McCain supporters, people.

Yes. Framed properly, this is powerful.

Leave aside your anger at the lies and the smears, ignore the Palin squee, bite your tongue at Iraq. Arguing these matters will not persuade the unpersuaded.

And, for god's sakes, avoid comparisons to Otherplacian health care systems. Don't open that rabbit hole - not only do you invite exposition on every single failure (or perceived failure) of those systems,* you get into all sort of other minefields (perceived liberal euro-fetishism, pseudo-patriotism of the "We do it better than anyone!" variety, etc. etc.) that are best avoided if you're (generic you, not abi-you) interested in actually convincing people to your point of view, instead of just scoring points.**

*Yes, I know we pay more per-capita for health care than anyone else in the developed world, have worse coverage, blah blah blah. Those are great talking points to bandy about internally - they do not convince someone who has spent time standing in a DMV line that a governmental agency is going to work better than what they have now.

**Too often, it seems that people who claim they want to discuss a topic are, in fact, looking for arguments (which is down the hall, next to insults), rather than actually discussing. If any of your proposed statements can be appended with "...and your little dog Toto, too!" you should probably re-think your approach.

#83 ::: Christopher Davis ::: (view all by) ::: September 17, 2008, 09:55 AM:

abi (#76): There's even another argument to be made here, that goes straight to a major GOP talking point.

"You're worried about terrorism? What would happen if a biological weapon were released in the US, among people who don't have health care? Do you think it'd get detected early enough to be treated and stopped, or would it already be too widespread to do anything about by the time it was noticed? Is making it harder for people to get preventative care going to make America less safe? I think so."

(You could even point them at the Pandemic game/ML thread.)

#84 ::: guthrie ::: (view all by) ::: September 17, 2008, 10:19 AM:

I am aghast at people having to pay as much as my mortgage was, in order to have healthcare. Sure, here in the UK the gvt takes a fair chunk off me in taxes, but not that much.

(For context, I earn quite a bit under the {alleged but only by numbers not by actual people recieving it} average wage)

#85 ::: Stevey-Boy ::: (view all by) ::: September 17, 2008, 11:55 AM:

I'm a Brit living in the US, so I've seen both systems. They both have great faults. I think McCain's plan is suicide for at least 30% of the US population.

I believe there are several healthcare professionals and some economics/business gurus that visit here. Does anyone have a hybrid solution? No pressure.

#86 ::: Raphael ::: (view all by) ::: September 17, 2008, 12:15 PM:

Stevey-Boy @ 85, as far as I know, most industrialized countries aside from the US and the UK have one or another form of hybrid health care.

#87 ::: Allison ::: (view all by) ::: September 17, 2008, 02:28 PM:

McCain and Obama both answered a questionnaire on their views on health research, which is an important component of health care plans in this election. You can see their answers and compare at

#88 ::: Earl Cooley III ::: (view all by) ::: September 17, 2008, 03:17 PM:

About the McCain health plan killing lots of people, is there such a crime as conspiracy to commit negligent homicide? I would have liked to fit the phrase "depraved indifference" in there somewhere, but it's not an official term in all jurisdictions, as far as I know.

#89 ::: Paula Lieberman ::: (view all by) ::: September 17, 2008, 03:35 PM:

#88 Earl
Criminal negligence and malfeasance are crimes.

#90 ::: Linkmeister ::: (view all by) ::: September 17, 2008, 03:41 PM:

Here's another bit of personal data to go with Kathryn's above:

I've been self-employed since 1998 and luckily found a plan with Kaiser. When I first started paying premiums it cost me ~$140/month for a bare-bones, 50% co-pay for every lab procedure and surgery, mandatory minimum for medication policy.

That same less-than-ideal plan is now costing me $328/month. While my health plan premium has gone up 100%-plus in those ten years, my income has emphatically not.

#91 ::: Kathryn from Sunnyvale ::: (view all by) ::: September 17, 2008, 06:03 PM:

I should note that I'm giving the example of myself and friend to show

1. a real-life example of insurance for non-US readers. All states vary, so this only shows you something about Californians who find themselves uninsurable. Then again, this means what 12% of the US's population faces if they don't get insurance through an employer.
2. how much health care costs skyrocket if you have a pre-existing condition
3. how individuals can be paying well over $5k/year for non-gold-plated insurance.

I'll also note that I could pay less for a "deductible" plan--pay full price up for services until I've reached the deductible, and then a set price for the rest of the year. I chose against this originally because I preferred predictable-but-higher monthly bills to the possibility of having a $1500+ bill in one month. I keep it because it has the lowest costs in case of a major event--a week in the hospital, say. I'm risk adverse.

#92 ::: Lizzy L ::: (view all by) ::: September 18, 2008, 12:15 AM:

Here's what Brad DeLong thinks of McCain's health plan.

#93 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 18, 2008, 01:15 AM:

Scott Taylor @82

they do not convince someone who has spent time standing in a DMV line that a governmental agency is going to work better than what they have now.

Oddly, DMV here in Oregon is quite well organized. I've got to go in get my car emission-tested to renew the registration; there's a webcam that lets me see what the line's like right now. And most other stuff is doable by mail (I haven't had go to the office to renew my license in almost 10 years, and that was just because they changed the form of the license, and mine was almost 15 years old at that point). DMV here is considerably better organized and efficient than most HMOs. And the people there are really rather pleasant to talk to.

#94 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 18, 2008, 01:33 AM:

I got some news today that may make my relationship with health care somewhat more dire than I expected. As part of deciding whether to have a particular form of spinal surgery* I went to see a neurologist, who reviewed my recent lumbar spine MRI, and ran some nerve conduction tests. She agrees from looking at the MRI that I have a congenital stenosis that's compressing the nerves to my legs, and other places as well, ao the operation is almost certainly worthwhile. But she's also very suspicious from the nerve tests that I have neuropathy as well, and if so, it's probably not reversible, and it's unclear what the long-term prognosis is. More tests are indicated. Just when I was starting to hope that the only serious chronic problem I have was at least going to allieviated for a few years. This almost certainly means I'm going to have to adjust my retirement budget projections to reflect higher medical costs from now on. And if McCain is elected, I may have to consider emigration too.

It just occurred to me to wonder what the Republican position is on using transplantable organs as payment for or collateral on loads for medical procedures when you don't have insurance coverage. Maybe they're planning on making sure of a good supply of hearts and lungs and kidneys when theirs start to give out.

* It involves putting a titanium spreader called an X-stop between 2 vertebrae, to keep that part of the spine in flexion and allow me to stand and walk without the pain of nerve compression. It's a very simple and close to risk-free surgery, whose only drawback is aeveral weeks recuperation and therapy time, and, it goes without saying, a pricetag that would be extremely difficult for me to pay without health insurance here in the US. I'd have to take the money out of retirement savings, which is a hell of a choice to have to make.

#95 ::: John L ::: (view all by) ::: September 18, 2008, 07:30 AM:

My brother had a car accident some years ago that did muscle damage to his back and neck. Over the years, he's developed some vertebra problems from those injuries, so he's now considered having a "pre-existing condition" that would not be covered if he changed (or lost) his insurance. He recently asked me advice on whether he should have surgery to correct the problem, or defer it for now.

I told him that if his surgeon is experienced in the procedure, to go ahead and get it done, since he's going to get in more and more pain, and depending on who becomes President, he could find himself without ANY health insurance in the future.

It's a wonder that anyone will vote for McCain given the crap that's coming out on him and his VP candidate, but no doubt at least 48% will do so.

#96 ::: Paula Lieberman ::: (view all by) ::: September 18, 2008, 09:10 AM:

#93 Bruce
Massachusetts revised things a few years back, and allows renewals by mail, by phone I think, by Web, and in person. There's a reception point that gives out alphanumeriics (obviously not numbers, A11 is not a number unless counting in e.g hexadecimal)and one waits in the waiting area, which has generally quite a bit more seating than there are waiting people, to get called to a counter.

That means, no more lines.

The waiting at HMOs and such is definitely longer...

#97 ::: Seth ::: (view all by) ::: September 18, 2008, 10:29 AM:

I think I've spent about as much time waiting in MN DMV as in my Mpls HMO. That's two visits to the DMV and around 20 to the HMO.

#98 ::: Earl Cooley III ::: (view all by) ::: September 18, 2008, 11:22 AM:

Bruce Cohen (SpeakerToManagers) #94: But she's also very suspicious from the nerve tests that I have neuropathy as well, and if so, it's probably not reversible, and it's unclear what the long-term prognosis is.

One key element of your health strategy should probably be to attempt to survive long enough for stem cell based treatment for that kind of condition to become practical. It's one of the things I'm waiting on.

#99 ::: Lucy Kemnitzer ::: (view all by) ::: September 18, 2008, 12:58 PM:

I'm in the midst of composing a letter to the Office of the President of the University of California, appealing their decision not to honor twenty-nine of my nice fellow's thirty-four years of service (he worked for outside contractors, in the same job, until the University took over his department five years ago. He died eight working days before his "five-year anniversary," and they decided he didn't therefore earn retirement benefits for his survivors). The decision leaves me without any medical coverage in the nearish future.

I did a little research before this. The health plans I looked at said: they may, depending on pre-existing conditions, charge me more for the plans they're advertising, offer me a different (presumably worse) plan, or refuse to cover me.

But Arnold Schwarzenegger has a plan, even better than McCain's: he wants to make it mandatory for every person to carry health insurance the way it's mandatory to carry car insurance.(per Kathryn @62: $12000 a year is almost half my income, and I'm nowhere near a healthy 20 year-old).

Lori @43L: you're absolutely right: health insurance doesn't do the trick: it's health care we need to be guaranteeing.

#100 ::: caffeine ::: (view all by) ::: September 18, 2008, 03:29 PM:

People who think they'll never need major medical procedures because they're young and healthy are fooling themselves. Just to contribute another data point: my husband was one of those people who never got sick, never had to go to the doctor, and so on. Disgustingly healthy, never even got colds. Three years ago we had both just graduated from college. I had found a job; he was still hunting. Completely out of the blue he began having seizures. Suddenly we were $15,000 in debt from a two-day hospital stay. TWO DAYS. He was in his mid-20s at the time.

While he was working with doctors to get a diagnosis, he found a job with insurance. Thank God, because his medication is very expensive, and he's about to go into the hospital again for a week because a scan found a brain tumor and they want to see if it's malignant. No living right or eating well or exercising or fiscal conservatism could have prevented him from developing a brain tumor. I almost feel sorry for people who are convinced it couldn't happen to them.

Oh, and on the preventative care thing? I was without insurance for nearly ten years before and during college. Couldn't afford to have regular checkups and dental cleanings, and I have very thin tooth enamel, so I have probably $20K worth of work ahead of me to have functional teeth again. I have good insurance and the last appointment, to fix TWO teeth, cost me $2,000. On the credit card, because where am I going to get that kind of money? Oh, and dentists don't do payment plans like hospitals.

(Regular reader, normally lurking. Hi!)

#101 ::: Earl Cooley III ::: (view all by) ::: September 18, 2008, 03:44 PM:

caffeine #100: I have very thin tooth enamel

That rings a bell, because I just saw that symptom on a diagnosis investigation TV show, but calcium deficiency can have multiple serious ramifications; I am not a medical professional, but I think this medical issue should be brought to the attention of someone who is.

Oh, and thanks for delurking.

#102 ::: caffeine ::: (view all by) ::: September 18, 2008, 04:11 PM:

Earl, thanks for the welcome! I've actually had tooth issues since I was little (and had excellent dental care and insurance), and several other family members have the issue, so I think it's more likely to be genetic. I think I'll look into calcium supplements nonetheless.

#103 ::: Paula Lieberman ::: (view all by) ::: September 18, 2008, 05:52 PM:

Tooth enamel.... tetracline while the permanent teeth are forming Does Bad Things... which is part of the reason why I have a most of a mouthful of crowns (18 of them...)

#104 ::: Ginger ::: (view all by) ::: September 18, 2008, 10:08 PM:

101, 102: Some people just do have thin enamel. One of my college friends married a man with almost no enamel (if I recall correctly) on some teeth and thin enamel on the rest; he had major dental work while he was in the academy to correct the worst of it.

#105 ::: Marilee ::: (view all by) ::: September 18, 2008, 10:35 PM:

Bruce, #94, so sorry to hear about the possible neuropathy. I hope things go well with the surgery.

caffeine, #100, I hope your husband's tumor is benign and removable.

#106 ::: P J Evans ::: (view all by) ::: September 19, 2008, 12:02 AM:

[grump] Politicians who think that the answer to health care access and affordability is mandatory health insurance (aka health care coverage), should be told that if it isn't affordable and available to everyone, including the unemployed, those in minimum-wage jobs, and those with pre-existing conditions, then they shouldn't even bother suggesting it. Of course, making insurance available and affordable like that would require actually doing regulation of insurance.[/grump]

#107 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 19, 2008, 01:23 AM:

Early Cooley @ 98

One key element of your health strategy should probably be to attempt to survive long enough

I think you said it all right there :-). The other thing I'm hoping for is robotic spinal microsurgery. I have congenital spinal stenosis, meaning the openings ("foramen") for the nerve bundles leaving the spine are too narrow, and are compressing the nerves. This condition will get worse as I get older. I had a fascinating discussion with my surgeon about the possibility of micro-surgery to enlarge the foramen; he said a surgeon won't do it because of the high risk of damage to the spinal cord, but that my idea of a robot like the atherosclerosis reamers the Japanese are working on was a distinct possibility in 10 or 20 years.

OK, everyone, it's time for a chorus of "Hold on, it's coming!"

#108 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 19, 2008, 01:40 AM:

caffeine @ 100

I recommend finding, if you haven't already, a dentist who's really into preventive dentistry and has a wizard hygienist on staff, then get checkups as frequently as your insurance will pay for. For the last few years I've been on a quarterly checkup schedule, and one tooth that the oral surgeon who worked on it 10 years ago said might last 5 years is still hanging in there because of it.

#109 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 19, 2008, 01:41 AM:

Thank you, Marilee, I appreciate the thought.

#110 ::: Praisegod Barebones ::: (view all by) ::: September 19, 2008, 07:18 AM:

Abi 76, Scott 82

Here's a line you might want to borrow, though perhaps not if you're Joe Biden...

'If (John McCain) is elected,I warn you not to be ordinary, I warn you not to be young, I warn you not to fall ill, and I warn you not to grow old.'

#111 ::: JESR ::: (view all by) ::: September 19, 2008, 02:40 PM:

Tooth enamel:

I was dosed prenatally with a drug known to interfere with tooth formation; the fact that I erupted deciduous teeth at all was sort of a surprise to my mother's doctor. I had my first three-surface amalgum filling in a two-year molar before I was three. My entire malar dental arch is crowned; the maxillary molars and three premolars are crowned. I spent Wednesday getting a crown taken off and replaced; my dentist has a fascinating new CAD/CAM machine that mills porcelein crowns while you wait.

Most of my personal consumer debt is dental work.

The old-style tooth extraction and denture process is cheap; it is also one of the things correlated with reduced life expectancy, especially in people with diabetes, but dental insurance is still granted as if dentistry is primarily a cosmetic procedure.

This makes me cranky. Crankier. We have what is probably one of the best health-care plans in the US, provided by the State of Washington to my husband as an employee; still, copays on prescriptions and office visits are a burden in a single income household with two middle aged people with chronic health conditions. Having to pay taxes on the employer contribution would pretty much push us to the point of having to give up what few small indulgences we currently afford ourselves.

#112 ::: Julia Jones ::: (view all by) ::: September 19, 2008, 02:49 PM:

Another tetracycline kid here -- I'm glad that my husband had a job with good dental insurance while we were in the US, and that I had a dentist who took clinical dentistry seriously. (The dentist I've found now I'm back in the UK commented on how good my root canal work was.) My entirely non-cosmetic dentistry was still expensive, but it was at least affordable on our income.

#113 ::: ethan ::: (view all by) ::: September 19, 2008, 02:58 PM:

On the discussion of teeth:

Barf. Barf barf barf barf. Barf barf.

Sorry. My personal thing. Carry on.

#114 ::: Lori Coulson ::: (view all by) ::: September 19, 2008, 03:45 PM:

Ethan @113:

Don't DO that! Don't you know acids from vomiting also damage tooth enamel?!

JESR @111:

A goodly portion of my consumer debt is either dental or medical, sigh...and if I weren't covered by my partner's dental plan, I'd be even deeper in debt.

#115 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 20, 2008, 01:03 AM:

To return to the title of this thread, McCain's health is bad, and my plan is not to care as long as he doesn't get elected.

#116 ::: lightning ::: (view all by) ::: September 20, 2008, 01:47 AM:

Another "disgustingly healthy" one here who's appalled by McCain (and Republican in general) attitudes toward health care. In their neat little universe, everybody gets health care one way or another. If they don't, they're just stupid. (Urge to kill ...)

And yes, we need health CARE, not health INSURANCE. Far too many of the so-called "insurance" plans out there are marginal (if not outright) scams. Paperwork that requires an MD degree to fill out, "lost" paperwork, payments that take months to process ...

#117 ::: lightning ::: (view all by) ::: September 20, 2008, 01:55 AM:

I have gum problems. A few years ago, I started going to a dentist who recommended a "standard" dental cleaning four times a year instead of the "normal" two. It made a *drastic* difference -- most of my problems simply went away.

I don't have dental insurance and my dentist doesn't deal with insurance anyway. It's worth the extra money.

BTW, good dentists are a dime a dozen. Good hygienists are jewels beyond price.

#118 ::: Rosa ::: (view all by) ::: September 20, 2008, 01:58 AM:

Remember, even if McCain wins, he can't pass any of this junk unless Congress lets him. You can still put a lot of pressure on your Senator and Representative, and of course raise hell when your state tries to cut low-income care or pass a bad statewide bill.

Even if you live in a blood-red state, your vote at the state and local level makes a difference, and the closer to home you get the more power you have, proportionately.

#119 ::: ethan ::: (view all by) ::: September 20, 2008, 02:38 AM:

Lori, you are cruel.

#120 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: September 21, 2008, 01:46 AM:

lightning @ 117

BTW, good dentists are a dime a dozen. Good hygienists are jewels beyond price.

And the combination of a really good dentist* and a really good hygienist? Priceless.

* We inherited our dentist from our previous dentist (they were partners), who had to quit to talk care of a chronically ill husband and a new child. The old one and the new one are the two most careful dentists I've ever had for making sure they don't cause pain, and for being conscientious about the quality of their work. That is uncommon.

#121 ::: Stephen Sample ::: (view all by) ::: September 23, 2008, 07:32 PM:

Ok, now I've got What Did you Learn in School Today going through my head:

What did you learn in school today
Dear little boy of mine?

I learned the Republicans have a plan
For health care for every woman and man
And the reason why the cost's not high
Is when you get sick, you DIE, DIE, DIE!

And that's what I learned in school today.
That's what I learned in school.

#122 ::: Howard ::: (view all by) ::: September 29, 2008, 03:42 PM:

There are some serious problems with Senator John McCain's Health Insurance plan. As a health care provider, I will mention one that seems to be overlooked. Moving away from an employer based system, allowing people to purchase their own coverage in any state, will make it impossible for providers to participate with your health plan. You will have to pay cash, and then be reimbursed. Possibly this is not considered a problem, because his plan pushes high deductibles and medical savings accounts. I think one needs to be aware of the impact this will have.

We are a small office in a non affluent area. As a courtesy to our patients, we accept what most health insurance plans pay. We “participate” with insurers. Most patient's can not afford to pay for care out of pocket . If people are allowed to buy coverage in other states, we won't be able to accept their plans for several reasons.

If a health insurance plan has enough members, a reduction in fees is offset by the number of patients you have access to. There is no incentive to participate with plans from which you see a handful of patients. Plans with many members come from local employers. By moving the choice to the individual, allowing them to purchase insurance in any state, Mr. McCain's plan will break up these large groups insured under one plan. This will eliminate the incentive for providers to participate with these plans.

It is difficult to keep track of all the different plans in our state and area. We don't have the resources to keep track of plans all over the country. You have to sign participating agreements, know what they cover, keep track of what their deductibles and co payments are, know when to get prior authorization for treatment, keep specialized forms, etc. It's impossible to keep track of all these things with additional plans in other states, so we won't.

The state we practice in has a good insurance department that enforces it's rules when carriers fail to play by them. Many a time when a carrier has denied payment for the excuse of the day, all that was needed was the threat "if we do not receive payment in 10 days, we will file a complaint with the NY State Insurance Department." This will not work in states who's insurance departments have less tenacious enforcement. Where do you think less expensive policy's will come from? Senator McCain says he will make states work together for enforcement issues. With what, a magic wand? This is another reason my office will not participate with carriers in other states. We won't have recourse if we are not paid for services we should be.

Mr. McCain's plan may give you a choice of less expensive insurance. Our office and many others won't be able to accept your plan or help you get reimbursed. You will have to pay out of pocket and good luck getting reimbursed.

#123 ::: Lily ::: (view all by) ::: October 06, 2008, 04:50 PM:

Healthcare is getting rediculas and large corporations are covering less and less. Take Lockeed Martin for instance. My husband makes the low end of the payscale for the job he does. We just found out that we are going to have to pay $100 per week for family health care. On top of that they have a $300 per person deductible/10% coinsurance and $20/$40 Copays. They also don't fully cover maternity needs as other plans do.

When you factor all of that into having a baby it means you are going to pay for most of it. I had an induced but otherwise uncomplicated delivery and we ended up paying for over $3000 which was about half of our overall bill. The sick thing is that before the sub prime lending crash I had an assistant in my real estate business and for $500 per month I bought her insurance. She had no deductible, no coinsurance and $10/$20 copay. So why is it that the largest government contractor can't provide something better?

No reason at all except that they are probably getting a kick back from the insurance company to force employees to have no other option than to make Aetna a fat cat!

#124 ::: John ::: (view all by) ::: February 24, 2009, 12:33 PM:

Well now that Obama is elected we will see if he follows through with his promises! While I believe that universal healthcare will help millions I still don't totally believe that it is the government's responsibility to provide it. Why don't people take care of themselves but eating real food and drinking water again?...then we wouldn't have so many people that are sick and need care. Take some responsibility!

#125 ::: Mara ::: (view all by) ::: March 17, 2009, 08:34 AM:

is it our fault people are bums?

#126 ::: Fragano Ledgister ::: (view all by) ::: March 17, 2009, 10:17 AM:

Mara #125 has all of the characteristics of a drive-by.

#127 ::: abi ::: (view all by) ::: March 17, 2009, 05:19 PM:

Fragano @126:

I'm leaving them there in case anyone believed that there was universal consensus on this matter.

Me, having lived in places where universal access to medical care is a given, I can't see the logic.

But I'm sure there were people defending the idea of leaving the elderly and weak behind for the wolves to eat when the tribe moved on, too. Useful to know the mindset still exists, so we don't get complacent about this here civilization thing.

#128 ::: albatross ::: (view all by) ::: March 17, 2009, 05:34 PM:

abi: You mean we're not supposed to leave the old and sick out to be eaten by wolves? But...but who will think of the poor, hungry wolves? What will they eat, in this brave new socialist paradise of yours?

#129 ::: abi ::: (view all by) ::: March 17, 2009, 05:45 PM:

I was going to throw the AIG executives to them. Also, whoever stops clapping first after I'm done speaking.

#130 ::: Dave Bell ::: (view all by) ::: March 17, 2009, 05:47 PM:

The other thing about healthcare is that nobody knows what's going to happen. 40 years ago, the medical professionals didn't expect me to live until I was 50. Last December, I didn't expect to be high on morphine, for pain control, with three fractured vertabrae (I recall missing some wild fannish parties).

The American system might very well have killed me, because I'm a walking insurance loss.

#131 ::: David Harmon ::: (view all by) ::: March 17, 2009, 05:56 PM:

Albatross #128: Bankers, of course!

#132 ::: Stephan Brun ::: (view all by) ::: March 18, 2009, 01:06 PM:

(claps furiously, but shows signs of tiring...)

#133 ::: abi ::: (view all by) ::: March 18, 2009, 01:48 PM:

(wolves howl outside)

#134 ::: Stephan Brun ::: (view all by) ::: March 18, 2009, 02:21 PM:

(Shivers in fear and redoubles effort (precisely the wrong thing to do.).)

Thank you, most Evil One, for giving us the chance to prove ourselves!

(falls down.)

#135 ::: abi ::: (view all by) ::: March 18, 2009, 03:22 PM:

(trips over a cord, unplugging the tape player with the continuous loop of wolf howling)

Well, I guess you can stop clapping, then.

#136 ::: P J Evans ::: (view all by) ::: March 18, 2009, 03:38 PM:

Brava! Bravo! (whistling and applause))

#137 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: March 18, 2009, 09:12 PM:

Wolves like the taste of deregulators too. And they dry nicely for storage.

#138 ::: Stephan Brun ::: (view all by) ::: March 19, 2009, 01:02 AM:

(Gets up, puts sheepish grin on face)

I wasn't fooled, no ma'am. I knew all along you were trying to fool me. I wasn't had at all!

(Looks at audience)

Thank you, thank you. You are most kind. We shall be here all week. Do try the... Well, I don't know what they are, but do try them.

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