Why We Need a Public Health-Care Plan

[mawilson 2,133]

Why is the choice only between the miserable system we have, or a public provider? Why not a fully private marketplace with REAL competition between those private companies? To my mind, ALL the benefits Reich cites in this article could be achieved by a truly competitive private marketplace. The benefits are great, I just don't see why we need a public provider to achieve them.

It's simple. Any insurance company ultimately comes between your health care and your

tax dollars as the "middle man" who siphons off profits for their stockholders.

In theory, the most cost-efficient way to pay for your healthcare with your tax dollars is to

do so directly, bypassing that middle man. In reality, of course, the public plan option will

likely put most private insurers out of business. Not because it will be "better" or will provide

"additional choice" and "competition", but because government-run firms tend to engage in

predatory pricing (charging customers prices below the actual costs) and survive thanks to

massive taxpayer subsidies in a way a more efficient private firm couldn't.

The US Postal Service is a good example of that. They are exempt from paying state sales,

property and income taxes, while using some of the most expensive real estate in the country -

rent-free. The only reason they are unable to drive their competitors completely out of

business is their poor delivery track record and an even poorer quality of service.

For the same reasons (quality of care), I expect some private insurers will survive. Wealthy

Americans will still buy private coverage, just like they send their kids to private schools

despite having to pay taxes for public schools as well. Businesses still FedEx/Overnight their

important documents instead of using cheaper USPS overnight delivery.

As for the not-so-wealthy, there is no question that their quality of care will decline due to new

government rules and the departure of quality doctors, as well as a longer timeframe to be seen

and treated. Government is just not known for its cost effectiveness or quality.

[Mr. Big Dog 10,747]

Why is the choice only between the miserable system we have, or a public provider? Why not a fully private marketplace with REAL competition between those private companies? To my mind, ALL the benefits Reich cites in this article could be achieved by a truly competitive private marketplace. The benefits are great, I just don't see why we need a public provider to achieve them.

It's simple. Any insurance company ultimately comes between your health care and your

tax dollars as the "middle man" who siphons off profits for their stockholders.

In theory, the most cost-efficient way to pay for your healthcare with your tax dollars is to

do so directly, bypassing that middle man. In reality, of course, the public plan option will

likely put most private insurers out of business. Not because it will be "better" or will provide

"additional choice" and "competition", but because government-run firms tend to engage in

predatory pricing (charging customers prices below the actual costs) and survive thanks to

massive taxpayer subsidies in a way a more efficient private firm couldn't.

The US Postal Service is a good example of that. They are exempt from paying state sales,

property and income taxes, while using some of the most expensive real estate in the country -

rent-free. The only reason they are unable to drive their competitors completely out of

business is their poor delivery track record and an even poorer quality of service.

For the same reasons (quality of care), I expect some private insurers will survive. Wealthy

Americans will still buy private coverage, just like they send their kids to private schools

despite having to pay taxes for public schools as well. Businesses still FedEx/Overnight their

important documents instead of using cheaper USPS overnight delivery.

As for the not-so-wealthy, there is no question that their quality of care will decline due to new

government rules and the departure of quality doctors, as well as a longer timeframe to be seen

and treated. Government is just not known for its cost effectiveness or quality.

And yet, any government, anywhere in the developed world including right here in the US, is delivering more cost effective health care than the private industry in this country does. It's easy to slam the government but the numbers just don't support this statement in regards to health care where the red tape and overhead in the privately run system here consumes somewhere between $0.20 - $0.30 of every healthcare dollar while publicly run systems consume in the range of $0.02 - $0.05 on the dollar for red tape. Of course, if that red tape expense would result in better service and /or overall lower cost then one could argue that it's money well spent.

But then again, while America spends by far the most for health care per capita, it gets the least in overall return and ranks 37 in the world for health care. There isn't a country ranking better in quality or cost effectiveness that is based on a privately run health care system. Not one.

So maybe it's not the quality but the service that justifies the extra expense? Since you mentioned the USPS as an example, do you know that in terms of overall customer satisfaction the USPS stands no worse than the US health insurance industry? One of the industry giants, United Healthcare, actually scored worse than the USPS and still put together a $1.1 billion package for it's departing CEO in 2006. I'm not aware of any other CEO that has ever departed with a package that big.

I keep wondering, how is there still questions out there as to whether we get our money's worth out of the privately run health care system? Seems fairly obvious to me that we do not.

Private enterprise had decades to prove that they can outperform government run systems. It has failed to provide that proof - and quite impressively so. Let's mark it as a lesson learned, cut the losses and start focusing on the implementation of a system that has proven to work in many countries across the globe where the population is much more satisfied with the health care system than we would ever be with this mess and rip-off that passes as a health care system in this nation.

[TracyTN 237]

"If you think health care is expensive now, wait until you see what it costs when it's free."

P.J. O'Rourke

I lived in Canada, healthcare was OK, not great. Not bad. I lived in Quebec and reprtedly some other Provinces are better, some worse. I know Quebec has a serious money problem with aying doctors and many in the Montreal area also have offices in Ottowa so they can collect from both Quebec and Ontario. I now live 6 miles from Canada and our local hospital parking lot is full of cars from Quebec, and they aren't just visiting. Fact is, the US has been Canada's "pressure relief valve" for years. Since about 90% of Canadians live within an easy drive to the US and have free travel to and from, border area hospitals are full of Canadians who can pay the price of admission or are sent here by the naitonal health system after a long enough wait. Canada has 1/10th the population of the US and a very responsive government. I was always amazed at how wuickly the House of Commons could act, and if Canadian politicians do not deliver...they can yank them right out! They also do not waste most of their time compaigning for the next election. They are limited to 30 days for the election cycle and Parliment is recessed during that time.

This may all seem irrelevent, but it is not. I doubt US politicians would be willing to operate in the same conditions. You simply cannot say "Well, look at Canada's system" without looking at the whole picture.

Canada also has another great "free" benefit we do not. And that is the US miltary. All day long F-16s from the Vermont Air Guard are flying around here, were our good neighbors to the north ever threatened, the F-16s would be over Montreal or Ottowa in seconds, literally, seconds. Canada has a relatively small military and can do so because of a very friendly big military on it's border a very short distance from most of the Canadian population. This is just a fact. It is in no way an insult to my good friends in Canada, having a friendly neighbor on more than 5000 miles of border is certainly worth whatever protection we provide, and I do not forget that it was Canadian military soldiers that rescued downed US pilots in the Balkans, nor the fact that nearly the entire Canadian military would be considered "special forces" in level of training. But the fact is they enjoy the benefits and dividends of a small miltary and strong neighbor, and can use that money for medical care. The medical system of Canada does not operate in a vacuum and cannot be judged that way.

I also lived in Ukraine and healthcare there can only be described as WW1 quality, literally. They could film "The English Patient" there without changing a thing. I was advised "Don't get sick!" There was a large sign in the emergency room saying "If you are vomiting and have diarreah, you probably drank water without boiling. Go Home! Always boil water before drinking" That was the Ukrainian emergency room treatment for projectile vomiting. After going to a haspital there you feel like you need immunizations! My mother in law had gall bladder surgery two years ago. They gutted her like fish. Not the neat little 2 stitch incision they make here. My wife was appalled when she went to hospital and found her dressings were not being changed...they had no dressings to offer! She went to the Aptika and bought her own! My wife changed the dressing herself and left the other supplies with the hospital in her "room" (actually a ward with many patients). Next day, all the dressings, betadine, etc was GONE! The nurses had SOLD them to other patients that would pay for it! Pocketed the money of course, because they are paid $200 per month and are 3 months or more behind in pay. So she had to buy more and bring them with her and take them away! We pay a doctor in the area a bribe every year now, since Alla is not there anymore, to answer calls for her mother and see her mother if she needs it. You do not get to see a doctor without paying a bribe or gift.

A month after arriving here, Alla had a kidney stone and I took her to the emergency room, she was diagnosed, treated and released in 3 hours. Her first medical experience here and she was pleased with the facility and treatment but almost fainted when she saw the bill! Fortunately our medical insurance paid 100%. I agree we need something here, a 3 hour visit with an x-ray and some pain medication shouldn't cost more than $2,000. But I do not think government is the answer. I also do not think the United States needs to copy what other countries do...why? I do not purport to have the answers, but I know that we are a resoureful country will lots of very brilliant people who can find a better solution than the government.

The problem with comparing other countries is that our government was never designed to do anything and is terribly inefficient. When we have socialist healthcare, the Canadian system will be further strained and they will have serious issues and wiull no longer be the "model" healthcare system that everyone points to.

Imagine if our health care is run like USCIS!!!!!!!!!

Your post is the best I have read on this quite complex subject. The last line is particularly telling but it was all right on point.

[Niels Bohr 72]

Everyone here knows about the failure of Canada healthcare system. For those who think we're blinded, think again.

The post from Rebbecajo (who is aware of the Canada health care system) shows why the private enterprise has such profiteering endeavors that it created reduce coverage for more profits.

Lets not use public insurance and opt for private. If we opt for private, lets have more competition. Get rid of the headway. Regulate the insurance providers to not increase fees and give less coverage. Or do something about these behemoth. Get rid of the pre-existing verbage!

Who says the sheeps are blinded?

Edited June 25, 2009 by Niels Bohr

[Mr. Big Dog 10,747]

But the fact is they [the Canadians] enjoy the benefits and dividends of a small miltary and strong neighbor, and can use that money for medical care. The medical system of Canada does not operate in a vacuum and cannot be judged that way.

The fact you're overlooking is that Canada doesn't use money it presumably doesn't have to spend on defense or whathaveyou and spends it on health care. Canada - and every other developed country - spends significantly less per capita on health care compared to the US and has a greater and better overall return on that expenditure. Your argument doesn't make any sense.

Edited June 25, 2009 by Mr. Big Dog

[thetreble 19]

Can I just point out one thing about Canada's healthcare system? I'm not sure if it was mentioned already in this thread but I wasn't going to read through the whole 10 pages...

Most Canadians also have SUPPLEMENTAL health insurance on top of their provincially funded healthcare. The healthcare you receive from the government is basic services for the most part. Glasses, physical therapy, medications, dentistry...you need supplemental insurance from a private provider that your place of work hopefully provides to you, or that you pay out of your own pocket for, in order to receive those things at a low cost.

Many people think that Canadians just get their healthcare from the province, where up until the day I left Canada, I had OHIP (Ontario insurance) as well as Sunlife (private insurance) to cover me completely from all angles. There seems to be a bit of a misconception from a lot of people I talk to that have heard about social healthcare that the country pays for 100% of everything for you.

Edited June 25, 2009 by thetreble

[rebeccajo 14]

Can I just point out one thing about Canada's healthcare system? I'm not sure if it was mentioned already in this thread but I wasn't going to read through the whole 10 pages...

Most Canadians also have SUPPLEMENTAL health insurance on top of their provincially funded healthcare. The healthcare you receive from the government is basic services for the most part. Glasses, physical therapy, medications, dentistry...you need supplemental insurance from a private provider that your place of work hopefully provides to you, or that you pay out of your own pocket for, in order to receive those things at a low cost.

Many people think that Canadians just get their healthcare from the province, where up until the day I left Canada, I had OHIP (Ontario insurance) as well as Sunlife (private insurance) to cover me completely from all angles. There seems to be a bit of a misconception from a lot of people I talk to that have heard about social healthcare that the country pays for 100% of everything for you.

How much do people pay for supplemental coverage?

[thetreble 19]

It all depends on your work place, how many dependents you have and what your workplace has negotiated with the insurance company.

[scandal 951]

It all depends on your work place, how many dependents you have and what your workplace has negotiated with the insurance company.

I haven't lived in Canada since 1997, things may have changed in the past 12 years.

When I did live there, I had OHIP (the provincial health plan).

And I had through my employer, supplemental insurance for dental, and for vision care (eyeglasses, contacts), and short and long term disability plans. I don't remember paying any premiums for these, I seem to recall that they were 100% paid by my employer (Nortel). I could be wrong, and paid a small amount out of my paycheck.

OHIP covered all prescription medications. All hospitalizations. All doctor visits.

I had two children born in Canada - all prenatal care, postnatal care, immuniziations - covered by OHIP.

Caesarian sections, epidurals, covered by OHIP.

Usage of the hospital's birthing center and semi-private room - covered by a supplemental plan through Nortel, if I recall correctly.

My kids had routine ear infections, late night fevers.... all emergency room visits, scrips for antibiotics - covered by OHIP.

My wife at the time (now the EX) had a baffling condition over many months involving intense headaches, bright flashing light in her eyes, and other symptoms. She contracted Bells Palsy and lost the hearing in one ear. We never figured out exactly what happened and what caused all the symptoms, but she went through various diagnostic tests including MRIs and was seen by about 5 or 6 different doctors. All covered by OHIP.

She was unable to work for those months - covered by the short term disability at work, including an attending nursing aide who came to our home.

[mawilson 2,133]

Government is just not known for its cost effectiveness or quality.

And yet, any government, anywhere in the developed world including right here in the US, is delivering more cost effective health care than the private industry in this country does. It's easy to slam the government but the numbers just don't support this statement in regards to health care where the red tape and overhead in the privately run system here consumes somewhere between $0.20 - $0.30 of every healthcare dollar while publicly run systems consume in the range of $0.02 - $0.05 on the dollar for red tape. Of course, if that red tape expense would result in better service and /or overall lower cost then one could argue that it's money well spent.

Sorry, I just don't buy it. Health care doesn't cost more in the US because of "red tape".

Health care costs more in the US because it's better (yes, only for those who are insured -

please don't bring the uninsured into this). It's more expensive because the doctors run

more tests - more expensive tests.

If the insurance companies are so damn greedy, don't you think they would have eliminated

the inefficiencies by now to maximize their profits?

As for the government delivering more cost effective health care... Medicare is bankrupt!

Adding young people to the pool would certainly help, but not if the government has to pay

for them anyway.

[Peikko 1,575]

Running tests or performing proceedures does not = good health. Most Dr's will tell you that they perform more tests than is necessary because they fear litigation. They will also tell you that the red tape costs are down to having to ask the insurance for permission at every turn. That is a very, very costly exercise. If Doctors had the freedom to perform tests when they were deemed medically necessary without having to ask permission and people had the good sense not to sue except when something was egregious then the system might be cheaper. Until then, it's extremely wasteful and expensive, whether you 'buy' the arguments or not.

[Mr. Big Dog 10,747]

I had two children born in Canada - all prenatal care, postnatal care, immuniziations - covered by OHIP.

Caesarian sections, epidurals, covered by OHIP.

Usage of the hospital's birthing center and semi-private room - covered by a supplemental plan through Nortel, if I recall correctly.

My kids had routine ear infections, late night fevers.... all emergency room visits, scrips for antibiotics - covered by OHIP.

Contrast this with our experience here in the US:

Had insurance through my employer when my wife became pregnant - monthly cost for premiums to me roughly $ 250.00 - not sure about the employer contribution but probably in the range of $500.00 - $600.00 / month at the time based on a roughly 1/3 - 2/3 split which is quite common.

Every pre-natal care visit was $15.00 out of pocket. Pre-natal vitamins were out-of-pocket. At month 6 of the pregnancy, I took on a new job in a different company and different state. Insurance provided by new employer at roughly the same premiums.

Now you need to find a new doctor which was some adventure as no OB/GYN was going to accept a patient that was 6 months pregnant regardless of the fact that the patient has been under continuous care during the pregnancy, that patient charts were available and that there were no complications in the pregnancy. It took me two days and two dozen phone calls to find a doctor who would see my wife and take care of the pregnancy and delivery.

Again, every visit was $15.00 out of pocket. When the time for delivery came (scheduled C-section due to breach position), we were $500.00 out of pocket for the hospital stay. The day after the delivery, my wife requested pain treatment - not surprisingly since she was cut open the day before.

Every post-natal care visit for my wife and every infant care visit for our daughter, $15.00 out of pocket each. Any medication required always had a co-pay of $5.00 - $50.00 attached to it - depending on the medication.

Then I get a bill for $380.00 for the pain treatment my wife sought because it wasn't "pre-approved". Her physician ordered it but it wasn't pre-approved and hence the insurance company (Aetna) felt that they don't need to pay for it. Took me several phone calls and a couple of weeks to get that straigthened out.

You think that's bad? Man, I didn't know how good I had it.

Fast forward to the end of last year when the plan I used to have became unavailable for the coming year (2009). Now I have a plan that costs me 350.00/month ($700.00 for my employer on top of that), carries a $1,000.00 annual family deductible (90/10 thereafter). So, I set-up a HCSA to have the deductible covered tax-free.

We took our child to day care in Feb. She got sick - a few times. As did my wife. The HCSA was wiped out by mid March meaning we've exceeded the $1,000.00 out-of pocket and then some (on meds) 2.5 months into the year. This is the insurance that you pay $12,000.00+/year for in the good ole' USofA.

I'd take what you described above any day over the pizz-poor excuse for a health care system that we have available any day of the week and twice on Sundays.

[Niels Bohr 72]

One thing is the fukcing pre-existing clause! That needs to be changed!

[thetreble 19]

It all depends on your work place, how many dependents you have and what your workplace has negotiated with the insurance company.

I haven't lived in Canada since 1997, things may have changed in the past 12 years.

When I did live there, I had OHIP (the provincial health plan).

And I had through my employer, supplemental insurance for dental, and for vision care (eyeglasses, contacts), and short and long term disability plans. I don't remember paying any premiums for these, I seem to recall that they were 100% paid by my employer (Nortel). I could be wrong, and paid a small amount out of my paycheck.

OHIP covered all prescription medications. All hospitalizations. All doctor visits.

I had two children born in Canada - all prenatal care, postnatal care, immuniziations - covered by OHIP.

Caesarian sections, epidurals, covered by OHIP.

Usage of the hospital's birthing center and semi-private room - covered by a supplemental plan through Nortel, if I recall correctly.

My kids had routine ear infections, late night fevers.... all emergency room visits, scrips for antibiotics - covered by OHIP.

My wife at the time (now the EX) had a baffling condition over many months involving intense headaches, bright flashing light in her eyes, and other symptoms. She contracted Bells Palsy and lost the hearing in one ear. We never figured out exactly what happened and what caused all the symptoms, but she went through various diagnostic tests including MRIs and was seen by about 5 or 6 different doctors. All covered by OHIP.

She was unable to work for those months - covered by the short term disability at work, including an attending nursing aide who came to our home.

Okay, Weird. I wrote quite a massive response to this and...it disappeared after I posted it.

So here we go again.

I have never been 100% covered by OHIP, and I lived in Canada all my life until I moved to the US.

My dad had Sunlife and still does. They still don't pay 100% of anything. I always had to have supplemental insurance. I believe when we were growing my dad paid $400 to $600/month for a family of five.

My mum has gotten extensive dental work done and they have had to pay out of pocket many times for parts of it. This is also not cosmetic, it's stuff like crowns, bridges, and other dental repairs.

Before I left for the US I quit my job and had no supplemental insurance. I got strep throat and had to pay $17.00 for my medication, even though I still had OHIP.

So I'm guessing you got lucky with Nortel where they pad for 100% of everything for you. Not all insurance companies in Canada do that. It depends on what kind of plan is negotiated through your place of work and you usually pay out of your pay check per dependent.

[mawilson 2,133]

Running tests or performing proceedures does not = good health. Most Dr's will tell you that they perform more tests than is necessary because they fear litigation. They will also tell you that the red tape costs are down to having to ask the insurance for permission at every turn. That is a very, very costly exercise. If Doctors had the freedom to perform tests when they were deemed medically necessary without having to ask permission and people had the good sense not to sue except when something was egregious then the system might be cheaper. Until then, it's extremely wasteful and expensive, whether you 'buy' the arguments or not.

There are many degrees of "medically necessary" and well, somebody ought to control how

many tests doctors perform because tests costs money.

If not the insurance company, then it will be the government, but somebody WILL do it, you

better believe it.