By Fareed Zakaria, CNN
America's health care system is really a mess. It is partly free enterprise, partly state-subsidized and overall highly inefficient in delivering quality care at a reasonable price.
I am a big fan of the free market. I think it has an almost magical ability to allocate resources and generate growth. But precisely because it is so powerful, in places where it doesn't work well, it can cause huge distortions.
The Nobel Prize-winning economist, Kenneth Arrow, outlined in the 1960s why markets don't work well when it comes to health care. He explained that people don't know when they will need health care and that when they do need it, the cost is often prohibitive. This means you need some kind of insurance or a government-run system.
Now, if we decided as a society that it is OK that when people suddenly discover they need health care, they can only get it if they can pay for it - that would work, but it would mean that the vast majority of Americans wouldn't be able to pay for a triple bypass or a hip replacement when they would need it.
Read: Tweets from @FareedZakaria on #SavingHealthCare.
The market would work, just as it works for BMW cars - people who can afford it can get it, people who can’t, won’t. But every rich country in the world - and many not so rich ones - have decided that every citizen should have access to basic health care and given that, a pure free market model simply cannot work (and remember, even if one were to have only a catastrophic insurance model, that's where all the costs are.)
Just 5% of the patients in the U.S. account for fifty percent of all health care costs - mostly the chronically ill - and taking care of these catastrophic illnesses is what drives up American costs.
A general insurance system can only work if everyone is insured. That's what the Swiss and Taiwanese found out. Otherwise, only the people who are sick will want to buy insurance and the insurance companies will spend most of their time and effort trying to kick sick people out of the system and denying coverage to those who might get sick.
That's why the Heritage Foundation, a conservative think tank, came up with the idea of an individual mandate, requiring that people buy health insurance in exactly the same way that people are required to buy car insurance.
Read: Every year, 100k Americans die from hospital-acquired infections.
That's why Mitt Romney chose this model as a market-friendly system for Massachusetts when he was governor. And that's why Newt Gingrich praised the Massachusetts model as the most important step forward in health care in years.
The Obama health care plan is not perfect by any measure. It still maintains the connection between employment and health care, which is massively inefficient and a huge burden on American business.
While businesses often talk about the need to reduce regulations to be competitive globally - a cause I support - they strangely rarely talk about their single biggest handicap against global competitors.
American companies have to pay high tens of billions of dollars to provide health care for their employees and former employees while their German, Canadian, Japanese, and British counterparts pay nothing - zero - in health care costs.
Read: Private health insurance is not efficient.
The Obama health care bill expands access to 30 million Americans. That's good economics and also the right thing to do, but it does little by way of controlling costs.
There are several experiments and pilot programs in it. There are new trends emerging, but little in the way of systemic cost controls. That's largely a failure of nerve amongst the entire political establishment.
Every expert realizes that no matter what the system of health, you will need to have some kind of board that decides that some things are covered and others are not.
This has been demagogued as “death panels” when it is really the only sensible way to make the system work. No one is saying that you can't get any procedure you want - merely that there are some that your insurance doesn't pay for.
The other unusual aspect of health care, Kenneth Arrow points out, is that the buyers really don't have much knowledge.
You can decide that you don't want a new car, or can comparison shop for a new TV, but you can't decide that you don't want a bypass.
That's why costs have come down in optional areas like LASIK surgery but not in ones where the consumer really can't walk away.
There are powerful ways to incorporate the discipline of the market to make providers lower costs, but the key, as Atul Gawande points out, is to give doctors and hospitals an incentive to make you healthy rather than the current approach where they make money if you are unhealthy and need lots of heroic procedures.
A final thought: One can reason from first principles and that's a good thing but you must also reason from facts on the ground. The fact is that all rich countries try to provide affordable health care for their citizens in some way or the other.
Watch: The GPS Road Map for Saving Health Care.
All of them - including free market havens like Taiwan - have found that they need to use an insurance or government-sponsored model. All of them provide universal health care at much, much lower costs than we do.
The United States has the most marketized system in the world and the most expensive and inefficient one with bad outcomes and low levels of customer satisfaction.
Maybe there's a theoretic model out there that would work, but right now, in the world we are living in, some kind of mixed, messy health care system is what we have and our task is not to abolish it in favor of a utopia but to improve it so that Americans can get good care at reasonable prices - like so much of the rest of the world.
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Fareed Zakaria is spot on regarding the financing side of the American Medical-Industrial Complex. The only workable solution to the financing side is to expand Medicare and Medicaid to all Americans. Medicaid for those under 26 (state regulated, federally/state financed) and Medicare for those over 26 (federally financed). The transition would have to be slow, starting with a public option. The insurance companies would eventually be selling a commodity (claims processing). This would save up to 20% of the cost of American health care, but Fareed missed or was intentially (or politically) blind to the bigger, more important target. We can't fix the crisis by hammering the insurance companies or socializing health care financing. The real problem is the flawed decision making process used by our providers. Our crisis is "just what the doctor ordered." Until we address this issue, the crisis will not be solved. Want to learn more? Read my book, "Discovering the Cause and the Cure for America's Health Care Crisis."
Robert,
I think you are off the mark here (not to mention self-promoting your book). I do not believe health care providers are to blame for the current state of "heroic" measure related expenditures as above.
I'm sure you realize it is an immensely complex problem. But, I think two issues predominate in why America spends so much of its GDP (18% or so) on healthcare, but has terrible outcomes compared to other developed contries. One, we have poor national healthcare coverage to lower socioeconomic groups, and two primary care physicians face poor patient compliance with lifestyle changes and treatment compliance. In short, even after extensive counseling, many Americans would rather be obese or would rather smoke cigarettes now, and face the consequences later.
We all need to step up to the plate on this one by improving our personal health, in order to significantly lower healthcare costs and increase the average health of our country.
Actually smoking is more prevalent in countries like France and Germany. Obesity is also an issue in Europe like it is here.
Clearly getting people to live healthier lifestyles would lead to lower costs but only in the way that getting people to give up TV's would lead to lower costs for TVs because fewer people would buy them. I think the biggest underlying problem is the cost of healthcare in the U.S. relative to Canada, Europe,etc. That is, what physician's charge, what medical schools charge to educate them, what medical suppliers charge,etc. A hidden part of this is that we seem to take on the brunt of the R&D costs for medicine. In any business, creating new products,services,etc. incurs a large R&D cost which must be recouped. Following this, the technology becomes commoditized and the price comes down. Ideally these R&D costs should be spread out over the whole world, minimizing the impact on any given group of people. However, it seems that other countries like Canada avoid most of these by having a single payer system that can negotiate better costs ending up with us Americans paying for it.
Correct. I work in an Emergency Department Observation Unit, where I routinely schedule my patients appointments with specialists, set them up with primary care, and give a two week prescription for their needs. However, I can't hold their hands and walk them through life and make sure that they go to those appointments or take their prescriptions. I'm not entirely sure why someone feels that they can continue to come to the ED instead of seeing an office physician – we need to really stress the importance of follow up, healthy life stiles and preventative medicine. I know of once patient who comes to the ED literally two-three times every week with the same complaint and has been doing so for more than a year, and has poor understanding of the difference between 'fix it now' and 'prevent it from happening later.'
@smjhunt
You're right. You should go to a clinician who didn't go to school and has no loans to pay so that you can get cheaper care.
The USCare ship is sinking and there are not enought life-boats (physicians, facilites, etc). So some are saying – let's get everyone on boats. If the boats overturn, we go down together. The others are saying, let's limit the numbers to a safe limit. They are being accused of being previliged. What would the captain of a real ship decide?
Robert: Reread Zakaria's comments about heading the facts on the ground.
The excuses you make for America's inefficient system – too much smoking, obesity, etc.. cannot be supported factually.
America is not markedly worse than the other countries with more efficient universal health care systems in those regards.
You are just running away from the fact, that America's system – which seems to be designed with a desperate attempt to adhere to free market ideology – simply doesn't work.
The big increase in health car costs happened when hospitals became profit centers, change that back to what it was and costs would drop dramatically.
In some European countries, there's the equivalence of the American FDA. Consumer organisations insist that food manufacturers and producers should reduce the amount of sugar, salt and additives, an excess of which could be a health hazard. Many believe baby food has a longterm impact on our palates as grown-ups.
I agree with you, USMD. The system is inefficient, in large part, due to the fact that Americans are poor consumers of medicine. We generally eschew preventative medicine (although that is changing generationally). We wait until we are in the throes of the fllu or other illnesses before seeking medical assistance... instead of being seen when we first become symptomatic. And we truly suck at following our doctors' orders.
In order to improve outcomes, we MUST be better stewards of our own bodies.
While it is unthinkable to have pure-market based system that would withhold treatment from those who could not pay; I don't think it's too inhumane to provide a government or insurance based system that covers everyone... until their failure to heed doctors' advice makes them a liability to the system. If you are treated for heart or lung disease, and your doctor tells you to change your diet, get more exercise, and/or stop smoking... you should have to pay for your own care if you don't comply.
This puts the onus on individuals with bad habits, instead of on everyone else who IS compliant.
You still have a choice. You can receive care, and be treated for illnesses, fully covered by the state plan; or you can choose to do with your body, whatsoever you wish. Just don't expect everyone else to pay for your by-pass, if you exercise your right to smoke.
We're all responsible for the mess in healthcare. First of all Robert, it's easy to blame the poor for not taking care of themselves, but potatoes, spaghetti and rice are a lot cheaper than foods with less carbs. Also, when people are under served and their children have no chance of the American Dream, they eat to comfort themselves and smoke to relieve their anxiety. Healthcare workers, including doctors and nurses, are guilty because they've accepted the changes that have been made lately in healthcare. There are fewer nurses at the bedside, they educate us to cover the butts of the corps while people who have been trained for 6 weeks get to spend time at the patients' bedside. We've helped keep the power by keeping the mystery in medicine and by not educating enough so that patients can make truly informed decisions. And keeping the power, keeping the mystery, keeps the corps more profitable. Besides all that, Americans are more afraid of Death than many other countries and all our ads and promises, play on the consumers' fears. So, you can't really say healthcare providers aren't responsible. We're all responsible.
As usual, Zakaria makes a compelling but flaud argument. The same argument he used to guarantee that Assad will not last 6 mo's in power – wrong. The same argument that Iran does not have a weapons nuke program – wrong, and this too is flaud. The problem is – US does not have enough physicians to provide care for all insured. There is already an acute shortage of PCP's, resulting in weeks of wait time to get to an appolintment and 3 min appointment per person. Under ObamaCare, you will wait for months to see a doctor and you will not get his in-depth review of your health issues. The result – more people will see the doctors and more people will die. Is that what you want?
It's spelled "FLAWED"
So you got yours and screw the rest. Yep that's precisely what's wrong with American society today...why it's breaking up. Too much GREED in the system. You're a symptom!
ted, Speaking from experience the month long waits to see a doctor are simply not true. As a Canadian with universal health care coverage and a shortage of doctors I can speak to the situation and I guarantee you: if I am sick today I see my doctor today, if I go to the emergency room I see a doctor within an hour or two, if I have a real emergency I see a doctor right away, and if I need an emergency procedure it is done immediately. You are correct through that if I need a non emergency procedure I may have to wait a few weeks, that however, is a price I am happy to pay.
While the most recent round of updates does put more stress on the primary care workforce, it does this by making sure that everyone has access to primary care. I agree that it will make finding enough doctors to go into primary care more difficult, but it is still the right thing to do. I recently took care of a woman in the hospital who required a week long hospitalization for a heart failure exacerbation (paid for by the taxpayers) that was caused because she could not get into a doctors office to have her meds refilled and ran out. Which one do you think it's cheaper to pay for from the taxpayers perspective? An office visit or a week long hospitalization? Realize that unless we as a society decide we're comfortable turning people away from the ER/hospital who can't pay, we're going to be left with only two options, pay for them to have cheaper, more effective health care preventatively, or pay for them to have more expensive less effective health care in the ER/hospital.
Ted, let's say I accept your premise that there are not enough health care providers and bringing on more of the uninsured is going to bottleneck the system. So what is your solution? If you have personal or job related health insurance you get care, otherwise tough luck? Do you suggest limiting care to only those currently with insurance is an acceptable way of rationing healthcare?
Ted,
I find your spelling "flaud"! /groans
So your assessment is that because we currently don't have enough doctors to treat patients, we should not expand health insurance coverage/medical coverage in whatever form. In other words, you suggest we don't cover NEW patients so that the CURRENT patients (presumably with coverage) can be treated by the current crop of doctors! My, aren't you a perfect conservative, preserving your rights and privilege to medical service by denying that same right and privilege to those less fortunate...so your lifestyle and health are bettered at the expense of others. Not particularly Christian of you! In this case, while there may not be sufficient doctors, as you claim, that doesn't mean that everyone added suddenly goes to the doctors at the same time! Also, with the passage of Obamacare and time, there can be more incentives to increase the number of doctors to help mitigate this situation. So your argument is both self-serving, not particularly patriotic, and definitely not Christian at all: let's not have more people in the system so I can get more of the care available. Sad.
I too am Canadian, and I agree with Tyson. My experience is much the same. I could also add that the admin costs are kept lower because paperwork is much less. Necessary surgeries are paid for ie heart surgery. My mother had a heart attack about 2.5 years ago, and the surgery and recovery did not cost us or cause her to lose her home or her savings. However things like elective surgery ie cosmetic etc are paid for by those who wish it.
Our system isn't perfect, however we don't fear dying and or losing our homes to pay healthcare bills. This was resolved about 70+ years ago, and in the UK this was done right after WWII and they still had food rationing. I find it unbelievable that this is something the US is still arguing about.
But we also have to wait here. A few years ago, I needed a referral to a specialist - the earliest appointment was six months out. I have noticed since the economy crashed, it is easier to get appointments with my primary care doctor - it used to be a 2-4 week wait, now it is "do you want to come in this week or next week?". And the parking lot isn't crowded. I guess with the economy down, people can't afford to go to the doctor and just wait it out at home, or if it gets bad, go to the emergency room.
I live in Massachusetts and none of those terrible things you speak of have happened here. In fact I would say we have some of the best medical teams around and many many more people insured, as opposed to a bunch of subsidized people clogging our ERs and sucking all the money out of our hospitals. I also am an entrepreneur and I can't see how any policy that would cause me to lose my insurance if I get sick can be good for my company, investments or employees.
The biggest problem with Americans is they see no reason to change things that "already works" in their minds. I consistently see those Americans arguing why a Healthcare system would not work being the same ones who have never experienced healthcare that does work. If it works in other countries, then why wouldn't it work here? We KNOW that our current system is grossly inefficient and is costing every American more than it should, yet Americans balk at an idea that totally makes sense; mostly in fear of becoming "socialists"; of which most Americans will not even know the definition. Most Americans don't know they already are "socialists" when using a public road system.
It is ignorance that is killing us. Those who stand to lose profits from our ignorance will do anything to keep it that way by continuing to promote ignorance. Obamacare is a step... and we can tweak things as we go... but for God's sake, DO SOMETHING.
I like the way it is now. Sucks that my credit score is shot, but I can get all the medical treatment I want and it costs me bupkis. nadda, zippo. I feel bad about it, but there is now way I can get a private health insurance policy. FREE RIDERS RULE....
How exactly do you come to the conclusion that under Obama's plan you will wait months to see a doctor? There is absolutely nothing that dictates who you go to, how long it takes to see a provider, or anything of the sort. If you can't spell and don't know what the heck you're talking about please spare us all your ignorance, it just doesn't add anything of value to the conversation. Please read up or shut up!
Sir,
Mr. Zakaria is correct in his assessment of our healthcare mess in the United States. See The World Healh Organization figures from 2011 and on back. Our very life expectancy is slipping and the world's most expensive and least effective healthcare system is to blame.
I have seen no evidence to back your specious argument on the long waits in Obamacare and having attended a university in Europe, I saw firsthand the superiority of their healthcare models compared to our own in many instances.
Check out the Dutch healthcare system. It was (is) even recommended by the best people in the USA who took a look at all the Health care systems in the World a few years ago and they recommended it for the the USA. The Politicians (in the pockets of the Health care insurance Companies) do not want it.
We are not very well served by people who govern us. Thank you.
Ted & Tyson – I too am Canadian and can vouch for Tyson's statements. Our healthcare system works very well, and any suggestion to the contrary by an American is simply uninformed and incorrect. Socialism ain't as bad as you Americans are brought up to believe....
It's also not the same argument.
So you are actually making a "flawed" analogy.
You need to materially demonstrate "why" Zakaria is wrong.
You did not do so.
Ted, there is a village missing its idiot somewhere. Please do desist. This is complicated stuff, way beyond your below 65 IQ. Let the adults decide what is best for the country. Lie down junior before you hurt yourself.
great article
People always affraid of socializing becuase it sounds like communism. Instead of socializing the health care, we offer one public system running parallelly with a private system. There you have a choice for private and a better public management system.
You hit the nail on the head there. This is exactly what will befall us. Two health systems will arise out of the Obamanation. All the best doctors will be in demand for the private system while the public gets second rate doctors not in demand by the private system. Just as in Cuba today, the rich and politcal elite will get to take advantage of the best care, whil us slobs get just enough to help us get over a common cold.
There are a few reasons why Obama Care is not going to work: The doctors and hospitals charge extremely high prices for their services, and on the other hand, the insurance companies are paying too low, especially the Medicare & Medicaid.
I heard many times, young people who say they want to become a doctor "to get rich". Why does a doctor have to charge $600.00 or more for an appointment? My mother, who was on Medicaid, and was very ill, with dementia, diabetic, heart problem, was kicked out from the hospital, in the middle of her treatment, because the hospital don't get paid, after a certain time, so they stopped her treatment and sent her to a nursing home. In that nursing home, the doctor does not come every day, and the nurse can not give medication without him, so they refused to give her her medications, and she had to go to the emergency room again. An owner of a small business told me that he is unable to hire more employees, because since the Obama Care passed, the insurance went up like crazy, so he can not create new jobs. I have a health problem that many times, I have to be taken to the hospital, but since the law passed, I am staying home and suffer, because the insurance incread the co payment to a level that I can not pay.
John, if your friend can't hire people because the insurance premiums have gone up he's probably a) not shopping for the best plan and b) not being entirely honest. My girlfriend owns two restaurants and they provide health insurance to anyone that wants it. They've been hiring like crazy. He also might be forgetting that insurance premiums have been rising consistently for decades now. On average they've been rising at 6.1% a year. Last year was remarkable in that they went up 9% but it's not unheard of. The projected increase this year is expected to be around 5.5% which is the smallest increase in 15 years.
Something really has to be done. In 1999 the average insurance premium for a family was $5,900 in 2009 it was $13,100. That was before the law was even brought up. We can't keep going on this path- it's not sustainable. Something has to be done and the law is a good start. It's not the end of the matter but it's a good start.
Maybe we should sponser a medical student, put them through school and get discounted care afterwarrds
John, hospitals charge "high prices" because many people don't pay. If there is an individual mandate, that would solve the problem. FYI, hospital gets less than 30% what they charge from insurance companies and they use that money to subsidize people who crash emergency rooms.
Young people want to be doctors for the money? They are definitely not too bright. Do the math, they will be in school for 11 years past K-12. Take on more than $200,000 debt. They have to be the best of the best to get to med school. If they choose another profession, like Wall Street, they would make a lot more and a lot earlier. To sum it up, us MDs are doing it not for the money (most of us) but for the good of the society. BTW, you should read the Hippocratic Oath.
Your book PLUG makes you look LIKE A MORON!
Most people believe insurance companies ARE WORTH HAMMERING.
People see prescriptions for half price in Canada, AIDS drugs for 5% the cost in Africa. And see deficit spending to pay full price in the USA as well as ballooning co-premiums. They feel cheated!
People see the cost of insurance for individuals 100% more than the cost of the same product to corporations and feel angry!
People see the cost of COBRA and realize it is useless.
These issues are NOTHING MORE THAN THE US GOVERNEMENT ALLOWING MONOPOLIES TO FLEECE THE US CONSUMER!
Mr. Strube: There are multiple models out there and your thoughts are very relevant. With all humility, I would like to offer you a copy of my book 'The 44th presidency – A History of our economic future', – excerpts available on the web, which goes into multiple issues we face including jobs, healthcare, social security and how to fix them. The biggest challenges which most of us do not realize or are unwilling to accept are: Healthcare is very expensive and becomes evermore as fewer are insured, companies will stop providing it to save costs – because they can. and individuals with a median family income of 45 K a year cannot afford to pay $ 12 K for insurance. Consequently, without a reliable source of funding and a shared responsibility model we will be in dire straits.
Doctor, you and Mr. Zakaria make a lot of sense. But common sense and reality appear to be the enemy of the GOP, which is why I am pessimistic that anything will be done. If Obama can't get through a sensible public option (because the GOP disingenuously played the "socialist" card, then what hope is there? Seems as though we in America are doomed to have the GOP and insurance companies jam whatever they want down our throats. Profit before life – the GOP's motto.
love it i am totally agree with you
Every one keeps talking about all other things except the root cause of the problem because the they have no idea about the real problem ! everyone thinks insurance is expensive – yes but why – ? it is mainly due to greedy insurance companies, the capitalist mentality that free market is always good for all cases and the politicians are their puppets who work for them by creating loop holes in laws to help them milk the people, medicare, and government. Does anyone know theat the insurance companies billdifferently for the same drug if they are billing for an individual and medicare ?
Why should healthy people pay more premium for other's poor health habits ?
if you dont have money you dont get it – can you get a burger if you have only a dime ?
You dont order a steak if you have a quarter in your pocket...
It is time to go and shop online instead of going to a doctor ....
I live your idea that we just need to expand Medicare and Medicaid. Will look into your book.
I liked this statement on health care (http://www.socialism.com/drupal-6.8/?q=node/1862) and don't like the Affordable Care Act's forcing people into private, profit-making insurance companies, no matter how regulated.
Fareed Zakaria is (like always) right on with this issue. It's a huge drag on the American economy to have employers responsible for providing health care. It's a double whammy that both discourages foreign investment while forcing small business owners to either take on margin busting costs or watch their employees suffer with limited or non existent health care.
But the truth is that the system is much more insidious than most people even realize. This is how our vaunted "free market" system works; In most cases where emergency or chronic care decisions are made by physicians, doctors provide treatment before insurance companies can approve said medical care. The insurance company than comes back later and decides weather or not to pay for the procedures and treatment that has already happening. In the United States today medical insurance companies turn down payment for almost half of the medical care decisions they're billed for. In order to receive adequate compensation hospitals, clinics and doctors are forced to artificially increase the cost of the care they provide (by as much as 100% in many cases). In certain areas where health care providers know the insurance companies can't say no (ie; initial consultations, anesthesia, ect.) the pressure on costs is even higher.
In short you probably couldn't lock the most brilliant economists in the world in a room for a month and come up with a "free market" system that works more directly against consumers as much as the American health care system.
Dragoon77
Fareed Zakaria is (like always) right on with this issue. It's a huge drag on the American economy to have employers responsible for providing health care. It's a double whammy that both discourages foreign investment while forcing small business owners to either take on margin busting costs or watch their employees suffer with limited or non existent health care.
But the truth is that the system is much more insidious than most people even realize. This is how our vaunted "free market" system works; In most cases where emergency or chronic care decisions are made by physicians, doctors provide treatment before insurance companies can approve said medical care. The insurance company than comes back later and decides weather or not to pay for the procedures and treatment that has already happening. In the United States today medical insurance companies turn down payment for almost half of the medical care decisions they're billed for. In order to receive adequate compensation hospitals, clinics and doctors are forced to artificially increase the cost of the care they provide (by as much as 100% in many cases). In certain areas where health care providers know the insurance companies can't say no (ie; initial consultations, anesthesia, ect.) the pressure on costs is even higher. That process intern creates cyclical market forces that continually drive the cost of both insurance and medical care higher. The dog is always trying to catch it's own tail.
In short you probably couldn't lock the most brilliant economists in the world in a room for a month and come up with a "free market" system that works more directly against consumers as much as the American health care system.
Two books (which I did not write), 1 – The healing of america and 2 – Deadly Spin, substansiate Mr. Z's article.
Excellent article!
The Time Magazine article is even better because it includes some additional information such as the price comparison of medical services in the International Federation of Health Plans report and the health care % of GDP for Switzerland and Taiwan.
I fully support the transformation to a universal coverage version of the Medicare type health care system.
I have to suspect that the resistance to that is largely driven by the health insurance industry's love for their profits.
The issues addressed are only part of the problem. America's health system is not a health care system, it is a disease care system. Believe it or not, out bodies are programmed to be healthy. Our system does not support health, it concentrates on disease. The paradigm does not work. Chronic illness is expensive and avoidable.
Sandy,
"...our bodies are designed to be healthy."
I'm not sure what you are referring to here. Many diseases can be attributed to self-induced or controllable risk factors (e.g. smoking, obesity), such as COPD and heart disease. But many others are not – such as many cancers, and genetic diseases.
"Our system does not support health, it concentrates on disease. "
Again, I'm not sure what you are referring to here. Western medicine focuses on improving health through prevenative means, such as a healthy lifestyle, and treating disease when it is detected. Both of these improve the health of the patient.
The main deficiency in the U.S. health care system is not about treating disease, it is about access to primary care and classically poor patient compliance with lifestyle modifications.
"Western medicine focuses on improving health through prevenative means, such as a healthy lifestyle, and treating disease when it is detected. Both of these improve the health of the patient." - not true. I work within the Healthcare industry. Its is not built on preventative, but symptom treatment. Very few sicknesses are cured thru the healthcare system. Major problems such as those requiring a transplant are potential to cures, but all the pills and therapies that exist are focused on treating symptoms, not looking for a cure. Now, I am not saying the entire system is like this, but the greater majority, from the hospitals, doctors, pharma companies, on are focused on symptoms. Its the health market (magazines, health centers, etc) that focuses on preventive more than the healthcare system itself.
You are correct. Our system does not support health. Pharma companies and Doctors do not make money on healthy people. As long as our FDA promotes "cheap food" resulting in Mac & cheese out of a box, Capt'n Crunch, high-fructose corn syrup, etc. we will remain a diseased people.
Throw out these corrupt policymakers and we could see a whole new America.
Since passage of the historic healthcare lesgislation in 2010, the Republicans in congress has done everything within their means to repeal this legislation. To the privileged few to the right, making healthcare more affordable for additional 30 million Americans seems to be the least of their care or concern! And while President Obama has had to deal with the daunting tasks of trying to fix the American economy and put Americans back to work, the Tea Party calling for less government and accusing this administration of wasteful spending seems to be their only concern!
Today Dick Cheyney has gotten a second lease on life with an implanted heart and luckily for him, having full health insurance has helped to make his life saving operation a reality! But how many Americans have been turned away and denied life saving treatment or put on a long waiting list because they did not have health insurance or denied treatment because of pre-existing conditions? Each and everyday hundreds of Americans die because they don't have health insurance and can't afford to pay for an operation! So if "Obamacare" is going to give these Americans a second lease on life like Dick Cheyney, then what is wrong with that? And what is so bad with looking out for and taking care of America's most important asset, the American people? As an American, I have always felt that a healthier America is simply a stronger America! Do you share that sentiment too? Or are you a Republican or Tea partier who could care less about the welfare and well being of the American people?
I agree-my 20 year old daughter in law needs a lung transplant–she is barely insured and has cyctic fibrosis. 20 years old and she'll die before she gets lungs because she has no other choice–she's poor and her medicaid is set to expire. our son, her husband, is employed full time where no insurance is offered....sure, she's on a waiting list–but that's just a list for the have and have nots. the haves get off the list a lot sooner–as Chaney did.
Your daughter wont die. This may shock you, but get her into a good YOGA program not a calisthenics program. Meditation would help. There are free programs in every state. I have friends of mine whose kids have CF and they have good days and bad. One of my best friends sister passed away at 63 with CF. He passed away at 60. The body will rejuvenate, but you need to give it a chance. Medicine offers you a slim chance and even with a new set of lungs, there is drugs and who knows what else. I am 58 and my mother was told I would not survive as a baby, child, and even in my 20s. I do not have CF, but less than 50% lung capacity. I finished 2 marathons, teach Yoga, and 4 half marathongs. I pray that things will work for you and your daughter
Oh bull – I don't think for one minute Cheney PAID his way into a new heart!
Andy-stop the BS. CF cannot be treated with meditation. People have different types of CF (different mutations) and the ones who live past 30 don't have the normal type of CF
@Andy Rowen – What a stupid, inconsiderate thing to say. People with CF most certainly die from it (unless we find better medications fast). Yoga and meditation have nothing to do with it. It's like telling someone with cancer to do some Yoga and they will be fine. You need to leave your yoga retreat and come back down to earth.
@Annette – I'm so sorry to hear your story. It must be very difficult, frustrating, and scary.
One major problem with your argument: Americans don't WANT to be healthy. We are the fattest, smokingest, least active culture of any developed country. We choose the opposite of health. While I am all for a revamp of the health care system in this country so every American is covered for just the reasons you state, the ACA (aka Obamacare) is NOT the answer for the following reasons: 1. It will not improve healthcare access because it makes providing that access unprofitable for providers, who will choose not to participate; 2. It continues the system of encouraging treatment of existing disease and discourages promotion of disease prevention (which ultimately is the argument you make–a healthy America is a stronger America, but that comes through prevention BEFORE treatment); 3. It is financially untenable because it maintains the status quo (employer-provided health insurance) while layering over the top a secondary system of government controlled insurance that makes the system even more complex and inefficient. If the ACA is allowed to stand, it will bankrupt our country even faster than the politicians are already making happen, and a bankrupt country cannot provide anything, especially healthcare, to its citizens. The ACA is unfortunately NOT the answer because our politicians do not have the political nerve to do what is necessary: emphasize health in the populace (which the populace won't like because it requires personal responsibility, heaven forbid) by making access to covered healthcare dependent on healthy living (no smoking, no obesity, regular exercise, etc.) and preventive practices (annual physicals, regular early detection tests, etc.). We, the people, are the problem in this country. We are (and I am somewhat overgeneralizing here, I admit) unwilling to take responsibility for our own actions. We want to smoke and get treated for the diseases it causes for free. We want to over-eat and under-exercise and get treated for the disease that causes for free. We want to have our cake and eat it, too. It doesn't cost anyone more to NOT smoke, to regularly exercise, to eat normal portions and eat healthier–these are not socioeconomic conditions, they are simply life choices. It just takes effort and personal responsibility. Then when that is done, we SHOULD have access to covered health care regardless of our socioeconomic situation. But until that happens, our health care system will continue to be overburdened by the sick, specifically the 5% of people that require 50% of the resources of health care–like Dick Cheney, who in my opinion should NOT have had access to the heart transplant list. We need a health-based system where extent of coverage is earned by healthy living and practices, and where people are rewarded for positive actions. Instead, the ACA promotes unhealthy living and simply exacerbates the problem, while simultaneously worsening the underlying inefficiency and high costs of the current system. Which is typical of a system designed by politicians.
Lots of good arguments all the way up to rationing health care. Cheny waited 20 months on the list just klike everyone else. No strings were pulled. You act like those you admonish.
Take your "Tea Partier" propaganda elsewhere.
Here is the problem with Obamacare and really all recent attempts to "reform" the US healthcare system: intentionally or not, they cause harm to those of us who already have insurance and are happy with what we have. I have always had employer-provided health insurance and it's always worked fine–the premiums aren't too expesnive, the copays and deducitibles are managable, and I've never been denied coverage for anything really important. So why should I want to change this system? Especially when the Obamacare proposal threatens to force me out of my current employer-provided coverage and into the unknowns of his "exchanges" (since under Obamacare, there is a very strong financial incentive for employers to drop their coverage and send their employees into the exchanges–they will save a tremendous amount annually, even after paying a relatively small fine). And pelase do not trot out scare tactics such as suggesting my employer-provided coverage will go away anyway ... that's purely speculative. The reality is that the greatest threat to my coverage comes from Obamacare. So why should I (and millions like me) not oppose this law? There were other ways to try to expand coverage to the uninsured–this law and this approach are just poorly planned and executed.
If you aleady have insurance like many already do, you don't HAVE to change anything, you keep what you have! President Obama has stated that time and time again. IF you WANT to change you have that option.
He lied.
who lied?
about what
Please explain why ANY company in the US would continue to provide health insurance for their employees, at great expense, when they need only pay a relatively small "fine" if they stop providing it. Then their employees will simply turn to the government provided health program. This entire bill was designed to drive people to a government managed exchange. But of course, we had to "pass it in order to know what was in it" now, didn't we?
John is spot on. American's will have no choice in whether or not they get to keep their coverage. The fine imposed on an employer for not providing insurance is roughly 20% of the actual cost to provide insurance to an employee. So as a business owner, it costs you $5000 (this is the national average, not some number I am making up) per employee to provide a plan or a $1000 fine per employee to not provide a plan. If you are that business owner, you obviously take the fine, and put $4,000 an employee back in your pocket every year. Then the employee has no choice but to take the government sponsored program that will be undeniably different than their current plan. The government choice may have better or worse access, there is no way to tell since that aspect has not been detailed. But look at every government agency at the state and federal level; they are all filled with waste and overly unproductive compared to their private sector equals.
So let me get this straight John: right now businesses can stop cxoverage any time they want with NO penalty; yet somehow they will take coverage away more quickly when they DO have to pay a penalty?
Typical Republican logic...
Employers provide coverage right now for 1 of 2 reasons:
1. They have a heart and care that their employees have good access to quality care, so as an added benefit to employment they provide an employer-sponsored program that they pay into to bring the cost down for each employee.
2. They are heartless, but with the idea of attracting the best employees to run their company at it's best they need to provide an employee-sponsored program that they pay into to bring the cost down for each employee.
There are probably a lot of people somewhere in between these two, but I use it for a point. If the heartfilled and heartless employer can now get their employees a plan comparable to their current one and save money, what do you think they will do? This is not republican rhetoric, it is simply math and fact
and you believe the liar? I sure in hell don't.
@VinUSA.....typical Democrat criticizing someone else’s plan without providing some real thought and intelligence of your own!!!
Not if all of the insurers (for instance, the one that I now pay to cover me and my family) are forced out of business by ObamaCare...
@me
Typical American, attacking each other for political affiliation instead of trying to think through areas where each party has a point and where there may be a better way...
Robert,
I see the point you raise. I also have insurance through my employer and am satisfied with my coverage and price. However, the problem we face is making sure that ALL Americans have basic healthcare coverage. This will not only benefit the uninsured, who could then see a physician regularly, it also prevents a lot of chronic disease which, as Zakaria mentions, represents the large majority of healthcare expenditure. Basic coverage for all Americans is a necessity.
If Obama's plan passes, it seems we would likely move towards a combination system such as in the UK, where you can have the basic, government provided plan or have expansive coverage through your employer or pay for it yourself.
U.S.M.D.,
The goal is universal coverage–I agree. But the question at hand is not that goal but rather the current administration's current "solution"–a solution that supposedly provides such coverage only by changing the entire system for every person.
And no, I do not believe Obama's "promises" about me keeping my healthcare coverage for one moment. Everything about his system is going to slowly or quickly erode the current employer-provided system so that we all will end up in exchanges or under a single-payer system. Given that currently I pay only a portion of my healthcare premiums (the rest, obviously are paid by my employer as part of my compensation) but I earn a decent salary that is too high to receive any government subsidy, once in the exchanges I will have to pay 100 percent of the cost of my premiums–a three- to four-fold increase. Thus, under Obamacare, I am supposed to support a plan that will directly harm my family in order to make sure that "all Americans" have coverage? Forgive me for not being that altruistic or stupid. Any plan that harms those who are doing all the right things–working hard, earning a good education, finding a decent job, etc., etc., etc.–is a poorly designed plan even if it helps someone else.
Robert, if your employer can use this law as an excuse to take benefits away from you, and there is nothing you can do about it, it means that you're underrepresented. Because of underrepresentation of the vast majority of professional workers, what you need to realize, is that most American employers are on this track already, with or without this law. The only difference is that, 25 years from now, with this law at least our kids will have health insurance.
Robert,
I think the current administration's plan does have some fundamental flaws (should have gone to a government funded single-payer system with an opt-out clause if you want to keep private insurance–I'd be willing to pay higher taxes for that). However, I prefer the administration's plans over the right's alternative of "don't have insurance, oh well, deal with it"
Due to escalating costs, the benefits of your employer provided medical coverage will slowly erode and the day is coming when your employer will drop health insurance (as many already have) or make the employees pay the whole cost. The worst case scenario is that you'll be thrown into the open market and good luck finding insurance at all if you have a pre-existing condition. The only system that makes any sense, and the one we'll eventually adopt, is a single payor system like Canada's.
I've been working under employer-provided health coverage for the past 30+ years. There has NEVER–until Obamacare's exchanges–been any existential threat to that coverage. Because if my employer dropped my coverage, it knew its best employees would simply go to another firm. But now Obamacare provides them with an "out" through the exchanges–and it is in the exchanges that i will face the full cost of my premiums. The only threat to my coverage comes from Obamacare–and I receive absolutely NOTHING in return.
This was supposed to be a reply here:
I believe that current law already requires that if you currently have coverage for any preeixsting condition–as I would have under my current employer–provided coverage–any new plan must cover ti as well. The preexisting problems are for those who do not currently have coverage. But again, the Obama plan harms those of us who already have coverage–that is a crazy, convoluted way of "solving" the ehalthcare problem.
This is a reply to Robert who fears losing his employer-provided health insurance. I don't see why your employer's decision to provide coverage is necessarily altered by Obamacare. As you say... "Because if my employer dropped my coverage, it knew its best employees would simply go to another firm". That is still true under Obamacare.
There are a lot of people commenting here who wish the US had a healthcare system like the one in Canada. Unfortunately those Canadians who tout their system and those here in the US who have no experience with it never reveal the whole truth. The Canadian system works only if you are just a little sick (cold, flu, etc.) or really sick (broken bone, acute emergency, etc.). It fails miserably if you have a major chronic illness, been diagnosed with a non-immediate but potentially life threatening illness or can be helped by a non-approved procedure. I work for a major medical center not far from the Canadian border and we treat people from Canada every day. Many of these people have conditions that are curable if treated in a timely manner, but if left untreated will cause them to deteriorate over time. In many cases they would have a good chance of dying before being treated by the Canadian system. These patients are willing to pay cash for their treatment in the US rather than wait in line for the Canadian system. The Canadian system only works because the US system is so accessible. While I agree that the US system needs some reforming, the Canadian system is not the model we should seek.
Oh, Robert. You did in fact say NEVER. How do you think things will look if you become unemployed? Hmm...there goes that insurance you once had. Hope you don't have any pre-existing conditions.
Robert,
One other thought. I have had employee covered health care as well, though only for 12 years. I have only worked for two corporations (including one of the biggest insurance companies in the country) in that time. The coverage is consistently becoming more expensive with worse coverage. Isn't that an indicator that the current system needs to be addressed?
Like you, I have always had good health care insurance through my employer...for over 40 years. But at age 60 – my job suddenly disappeared with the economic downturn – not something I had ever expected. Now I have no health care insurance – and at age 60 have found it difficult to become reemployed – with or without health care. Suddenly I am getting a good look at what many Americans face – right now I don't see an option for health insurance until I turn 65 and can get on Medicare. This is not a good system!
Employers can get rid of your healthcare coverage at any time before health care reform was introduced. His bill doesn't change that and it's not really any different then it was before.
The expansion of employer-covered health insurance came about as a result of wage controls during WWII. After the war, this type of insurance became even more popular, partially due to the fact that employer contributions to health care plans are not taxed. If employers stop providing health benefits, they will have to increase salaries to offset the loss of benefits or they will lose their best employees to employers that offer higher salaries or better benefits. With higher salaries, employees can purchase health coverage from an outside source. The increase in salaries, however, will mean employers will pay more taxes. Regardless of which path people take, with more people paying into the pool the cost per person should go down.
Robert, what happens if you lose your job and it takes over 18 months to find a new one? What insurance will you have during that period, or do you plan on paying your bills out of your own pocket? And what if the new one doesn't offer insurance and you discover that the insurance companies consider your child's acne a pre-existing condition or won't cover your child or charge a very high premium to do so.
First, I won't take a job without good health insurance–or if i am somehow forced to, I certainly won't whine and complain that everybody else should help pay for it. I do not want the government messing up the healthcare system as they have messed up so much else in this country–but I don't actually get a choice in the matter under Obamacare, now do I?
Robert,
Lets be honest here. If you have over 30 years of job related health insurance and you lose your job, you may be over-estimating your ability to quickly pick a new job that gives you health insurance. Fair or not, it is a big liability to getting a new job when you are older in America. This could lead to a window of no health care/expensive COBRA.
Now maybe you have a skill-set that will give you your pick of jobs and get past the obstacle, but at that point you should be making/saved enough money that you shouldn't need to worry too much about the impacts of Obamacare.
As others have said, there is nothing stopping an employer from dropping everyone's health care right now. Why don't companies do so today? Because they know they have to offer it in order to attract the best talent. Sure, some companies may decide they can boost the bottom line by dropping health insurance, dumping everyone onto the exchanges, and paying the fine, but they will soon find people leaving the company for others offering insurance programs. Some may offer higher pay in return for not offering an insurance program, but since that may just wipe out the difference in the bottom line, what is the benefit to the company? I just don't see this happening in large numbers.
Under current law, businesses have a large financial incentive to drop coverage for employees, (it will save them a ton of money!) Under PPACA, that incentive will be reduced because they will face a penalty for doing so... Under either setup, dropping coverage will make it harder for that business to attract and retain the most talented workers.
The bigger problem is that you and most Americans don’t see how much 17% uninsured is costing you. I can assure you that drain on our economy is on the same scale as the damage that 17% unemployment would cause. The simple fact that we’re “used to” this pain is not a sufficient reason to suffer it longer!
This article fails to point out a couple of critical, salient points of providing health care in America.
I raise the point of the importance of lifestyle changes in preventative medicine. The U.S. healthcare system is often criticized for high costs related to heroic measures. These measures – often times – could be avoided with better compliance to lifestyle related changes such as cessation of smoking, diet/weight modification, and medication compliance (e.g. anti-hypertensives, diabetes medications). It is more likely than not that if you are 40 years of age (probably younger in this day and age of obesity in America), you have been counseled by your physician to adopt one or more of the above lifestyle changes. IIf we as physicians can convince Americans to comply with these changes, then we would not have to perform nearly as many "heroic" procedures such as heart bypass (aka CABG).
Zakaria points out that physicians are not compensated for having healthier patients, but for delivering "heroic" measures. I counterpoint to him, and to all Americans, that we as a country would not have to spend as much GDP on "heroic" measures such as heart bypass, if these simple and cost effective lifestyle changes would be adopted.
The problem is you can't regulate life style. It should also be noted that eating healthy is expensive. The best we could do here is look at the food we subsidize and make it financially easier for people to pick fruit and veggies instead of some variation of corn.
I couldn't even count the number of times that I have a patient who comes to the hospital with chest pain. We evaluate for a heart attack, we decide to send them for a nuclear medicine stress test. Before the test, the patient is unable to eat. They act like going overnight without food and skipping breakfast is potentially life threatening. Then upon their return to the floor, while they are waiting for me to tell them if they have dead heart tissue due to clogged arteries or not – they sit there and munch on a Big Mac.
100% nailed it with regards to eating healthy.
I really want to smack my head against the wall when my patients tell me "I had high blood pressure before, but then I took my medicine and it came down so then I stopped taking the medicine..."
Thought-provoking article as it is intended to be. I did wonder about the requirement. How many people are unable to drive because they cannot afford car insurance? Similarly how many people will be unable to get health insurance because they cannot afford insurance? Is it given that no matter what healthcare plan may be that there will always be a segment of population that will not have healthcare plan? Minimal collateral damage? I do not envy the position politicians are in in deciding the healthcare plan for teeming masses.
Here is a bipartisan proposal called "THE INTELLIGENT HSA".
I write this as a Democrat, a physician, not a member of the AMA and a staunch supporter of Universal Care.
Patients need to be involved in controlling costs by controlling utilization. Utilization controlled internally is called conservationism. Utilization controlled externally is called rationing. Nobody wants rationing. The indemnity insurance model undermines reward for healthy lifestyle/ cost conscious behavior. People are not rewarded for conservationism in the indemnity insurance model (the insurance company is). HSA's/HDHP reward the individual who adopts healthy lifestyle/cost conscious behavior allowing them to save their own money. However, typically HSA's are not structured optimally for the individual and put additional financial burdens upon them. If the HSA's are FULLY FUNDED by the employer or government by paying the premium difference between high and low deductible accounts you are making HSA's a cash neutral event for the individual and merely shifting money away from the insurers. Your reward the individual and shun the insurers. If this adopted Universally you negate the argument of adverse selection associated with HSA's. Up to this point you have required little if any legislation!
Now that you have aligned medical dollars with the patient and empowered them, you provide a MEDICAL COACH, free of profit motive to advise the patient and to help the patient discharge their responsibility intelligently.
Finally, you put the HDHP insurance component (the catastrophic safety net) out to bid regionally. Then you treat the private insurer who wins the bid as a utility (seeing that they are only serving an actuarial function anyway!) This reduces administrative redundancy and profiteering and establishes local single payer systems that are NOT governmental so that you don’t hear the blowback about government taking over medicine. A NON GOVERNMENTAL SINGLE PAYOR.
Several prominent political candidates have endorsed portions of this plan, including California Senate candidate Tom Campbell.
“The Intelligent HSA” position paper deals with almost all of the questions or criticism that you might have to the brief description above.
Makes sense to me! I like the concept.
So you are going to punish people with juvenile onset diabetes, genetic predispositions to cancer, rheumatoid arthritis and a host of of conditions that will require expenditures not so directly related to overeating and lack of exercise? There are many physicians who would disagree with your approach. (Keep in mind that only about 15-20% of US physicians belong to the AMA.) I would stick with the idea of a general mandate as a floor for health coverage, and then continue the crucial work–as many doctors, hospitals, and other healthcare workers are currently doing–on ways to reduce costs. Handling this on a state to state basis would be extremely difficult given attempts to standardize medical practices (while maintaining reasonable flexibility), control insurance company overheads, improve utilization review and allow for the mobility of insurance recipients.
JSK: thanks for your response. I have no intention to punish anyone. I merely wish to make every patient a gatekeeper and consumer of health care allowing them to retain their money if they are savvy, healthy or cost conscious. If you are sick you merely go through your FULLY funded HSA quicker and get to your HDHP.
This method is an attempt to positively reinforce health and good cost conscious decisions while allowing the patient to use or squander their own HSA based upon personal needs and desires (rather than rationing care!)
Google "The Intelligent HSA" to read about this more fully
@bsaks: How does chronic care fit in this model? I understand that with the incentive to maintain health, you limit the ongoing care required, and you have coverage for a catastrophic event, as you do with car insurance. But what happens if a patient is given a chronic diagnosis that will require ongoing lifelong care?
Chronic care would be no different that as it would be handled now. HSA's would be funded each year (like current premiums) to save or spend.
There are basically four groups of patients:
Healthy and savvy
Sick and savvy
Healthy and non-savvy
Sick and non-savvy
The first group is definitely rewarded; the second and third groups will see lesser rewards depending upon their conditions and their degree of cost-conscious consumerism. The last group will not see any financial savings in their HSA but will certainly not be "left behind" considering the HDHP safety net. They will merely "burn through" their HSA quicker.
Hopefully this is a behavior we can change when people learn it is their own money and they are the gatekeeper of it!
This is a paradigm shift to reward good behavior and cost-conscious consumerism without leaving anybody behind and hopefully maintainin the individuals choice in how to spend their OWN HSA money rather that rationing care
Google "The Intelligent HSA" to read about it more fully
Where will you categorize people who are born with chronic condition because of some genetic disorder or mutation?
High deductible plan works well if people are healthy but with ballooning costs and ever increasing annual deductible, people with chronic conditions suffer.
Marc: good comment
the funding for the HSA helps make the difference for the high deductible. We have all gotten so use to handing our money over to the insurers with no chance of seeing any dividends if we do things right!
This plan merely shifts "first medical dollars" from the insurer to the patient to control. Insurers make money on the premiums they hold. This should be the patients money to hold.
Remember, so long as the HSA is funded (by the premium difference between high and low deductibles and by the administrative savings of a non-governmental regional single payer) even if you "burn through" your HSA to get to your HDHP this is no different that what you do currently.
However, this plan gives the individual the POTENTIAL to save their HSA if they "shop effectively" and do things right. You have no chance of saving money with the current plan.
Merely shift "first medical dollars" to the patient to fund their HSA
google "theintelligentHSA" to read about it more fully
This is a critical issue. How are US companies supposed to compete with other countries when their companies don't have to spend billions of dollars on health care? We need public healthcare so that US companies can compete globally. We don't need the individual mandate, it should be subsidized by taxes. We have the money. If we can afford an $800B war in Iraq, we can afford public healthcare. We just need to re-prioritize.
Absolutly,,to much cost on employers..lets not forget the billions they could save every year by getting the fraud under control.
The key difference between car insurance and health insurance is: I can avoid buying car insurance by choosing to not purchase a car.
Under Obamacare, I have no way to avoid buying health insurance by "choosing" to not live.
I think you missed the point Zakaria made in the article. The problem – from a medical and not financial perspective – is that people who choose to not have healthcare insurance are generally young and healthy. The problem is recognizing when you have a chronic medical condition that needs to be followed by a physician.
I will give the example of high blood pressure. Most people would not have any symptoms of a moderately high blood pressure (say, 140s/90s). The problem with this is the ongoing risk heart and blood vessel disease that occurs with chronic conditions such as high blood pressure, diabetes, high cholesterol, etc. Thus, you would end up believing you are healthy when you are in your 50s, but then all of a sudden have a large heart attack, require a heart bypass and then management of heart failure. This is so common in America, and so tragic for the patient and his/her family.
Healthcare is not a commodity as easily digestible and understandable as purchasing a car. There is a reason physicians have to go through a minimum of 7 years of post-graduate education/training to be certified in their area (this can be as much as 14 or more post-graduate years).
My point still stands.
If I choose to not purchase health care services (as some religions forbid), then I have no need for health insurance. But Obamacare mandates I buy it anyway. Not right,
Or you have a heart attack and DIE and never use a penny of your overpriced health insurance.
Here's the rub, Matt. If you get cancer, get into a car accident, fall down a manhole, and you have no health insurance, unless you can cover all costs of care out of pocket, we ALL wind up paying for your medical bills.
Matt, it's like Jim Brodie says. And it's so obvious...And it's happened to a person I know, strongly against having health insurance until something (really awful) happened to him. The bill was huge, and we all had to pay. Would you rather let him die? Would you rather have me let you die when you get sick?
I support your right to not buy health insurance, as long as you agree to pay out of pocket for all medical care you may need, and further agree not to accept taxpayer Medicaid coverage when you are bankrupt due to your medical bills.
I agree! Pay for the insurance, or pay for the care when you need it. It's not like you can walk into the restaurant of your choosing, sit down, eat whatever you want and decide you'd rather not pay the bill. You can argue all you want that you have to eat to survive, but you have to be held accountable for the services rendered.
Exactly. You're going to live without the safety net, don't stick me with the financial consequences. I don't want to be charged higher premiums or medical bills so the insurer or provider can make up for the loss when you can't pay up. You can always file bankruptcy and default on your obligations, and the rest of us will get stuck with your tab one way or another. If there was a way to protect my financial interests and ensure you will pay for medical costs you incurred, I'm fine with you not having insurance.
First, religious objectors are EXEMPT from the individual mandate (look it up!)
Starting in 2016, $695 (or less) is what you pay to cover the major medical costs incurred by you and other uninsured people. Hospitals are required to treat uninsured people in critical condition, so shouldn't the bill for that be split up amongst the uninsured instead of amongst those of us who already pay for coverage?!
I believe that current law already requires that if you currently have coverage for any preeixsting condition–as I would have under my current employer–provided coverage–any new plan must cover ti as well. The preexisting problems are for those who do not currently have coverage. But again, the Obama plan harms those of us who already have coverage–that is a crazy, convoluted way of "solving" the ehalthcare problem.
Robert:
If you are refering to COBRA coverage available when leaving employment you are technically correct. But that coverage will cost far more than what you - and your current employer - pay for your current coverage. I wish you luck in being able to pay for that coverage on your own.
No, I'm reffering to The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law on August 21, 1996. HIPAA's provisions amend the Employee Retirement Income Security Act of 1974 (ERISA), as well as the Internal Revenue Code and the Public Health Service Act, and place requirements on employer-sponsored group health plans, insurance companies, and health maintenance organizations (HMOs). HIPAA includes provisions that (1) limit exclusions for preexisting conditions (conditions that were present before an individual's enrollment in that plan) and (2) prohibit discrimination against employees and dependents based on their health status.
Group health plans may not have eligibility rules based on “health status related factors.” These factors are health status, medical condition (physical or mental), claims experience, receipt of health care, medical history, genetic information, evidence of insurability, or disability. For example, a person cannot be excluded or dropped from coverage under a group health plan just because he has a particular illness.
Under HIPAA, the only preexisting conditions that may be excluded under a group health plan's preexisting condition exclusion are those for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the person's enrollment date (i.e., the look-back period). If a person had a medical condition in the past, but has not received any medical advice, diagnosis, care, or treatment for it within the six months prior to his plan enrollment date, the condition is not a “preexisting condition” to which an exclusion can be applied. The maximum length of a preexisting condition exclusion period is 12 months after the enrollment date (18 months in the case of a “late enrollee”).
A plan must reduce a person's preexisting condition exclusion period by the number of days of his prior “creditable coverage.” However, a plan is not required to take into account any days of creditable coverage that precede a break in coverage of 63 days or more (“significant break in coverage”). Most health insurance coverage is creditable coverage, such as coverage under a group health plan (including COBRA continuation coverage), HMO, individual health insurance policy, Medicaid, or Medicare.
Preexisting condition exclusions cannot be applied to pregnancy, regardless of whether the woman had previous coverage. In addition, a preexisting condition exclusion cannot be applied to a newborn, adopted child under age 18, or a child under 18 placed for adoption as long as the child became covered under the health plan within 30 days of birth, adoption, or placement for adoption, and provided the child does not incur a subsequent 63-day or longer break in coverage. Finally, genetic information may not be treated as a preexisting condition in the absence of a diagnosis.
Romney still fails to explain why the Massachusetts health care system 'cannot' work nation-wide or should not. Similarly,
no one has argued why a highly workable canadian or French or german universal health care system cannot or should not work in the U.S. The point is that Congress has not decided that universal health care is a moral imperative and that everything else flows from there. If that is the starting point, then the next step is to determine the extent of coverage and how to pay for it. Individual mandate is not an end but a means, that is, a way to spread the risk and generate money for coverage. Another way is to levy 2 or 3% tax on gross income to be solely earmarked for that purpose only. When all is said and done, as T.R.Ried has clearly pointed out in his book- the decision to have a universal health care is a moral one.
Whether you or anyone else has healthcare insurance is NOT the responsibility or purpose of the FEDERAL government. It might be a state responsibility (hence, Romneyt's defesne of what he did in Massachusetts), but it is not and shouyld not be a federal issue (as people used to say about things, don't make a federal case of it!). Our federal gvoernment is slowly but surely becoming just a social welfare agency with a big army–and there are those who would love to cut down the size of the army. This is NOT what America was supposed to be or how it is supposed to work. In Amwerica, you are supposed to have the freedom to live your life as you choose, not as the government decides to let you or decides to tell you. Now, for some people freedom is a wonderful thing because they can chieve all that they are capable of achieving–but for others it's very frightening because it includes the freedom to fail, it means that you must be an adult, that no one is there to make everything "all better" everytime you fail. The first approach–freedom–created the greatest, most prosperous, most powerful society ever known in human history ... the second approach–dependence on the government, which really means dependence on other people's money–has ruined Europe and threatens to do the same here.
The whole "state responsibility" vs "federal responsibiltiy" is a complete smoke screen. States have proven time and time again to not be any more responsible managing their books than the federal government. Many of them bankrupt their medicaid programs and then look to the feds to bail them out. There are not large enough demographic differences between the states to justify completely non-standard care and you risk worsening the already significant gap between the haves and have-nots.
Huh, so how does this explain the current economic power/success in Germany, or how poorly we compare to other rich nations in terms of health, education, the list goes on? How can we expect to improve things at home if we continue to blindly subscribe to this idea of American Exceptionalism when the data proves otherwise? Also, let's not confuse freedom with "free for all". Many rich western countries enjoy similar economic and civil freedoms we have here and manage to provide good healthcare for all their citizens.
Robert, The role of government is to potect its citizens, therefore you have a military. It also should protect its economic interests, ie its business community as well as the welfare of its citizens who are the cogs in the wheels of the economy. If you agree, then you must agree that education promotes the welfare of the country, therefore it follows that the healthcare of its citizenry should also be in its best interest. We already have laws that put this morality in place. If you get injured and an ambulance takes you to the hospital, the hospital is LEGALLY OBLIGATED to take care of you whether you can afford the care or not. This is the LAW. If you want to live in a country that does not protect its own citizens in this way, CHANGE THIS LAW. This is the law that is costing you so much in insurance premiums.
Ah, yes, because Canadians are known for their disdain of freedom and oppressive, totalitarian government. The masses labor endlessly in the maple syrup mines, lamenting their failure to foresee this outcome of universal healthcare.
@David
Hysterical. Yes the maple syrup mines here are terrible.
Leave it to Fareed Zakaria to clearly state the issue at hand. I think he is right about everything he writes about health care.
One issue that seems to baffle many of our politicians is the obvious difference between buying health insurance coverage that "is right for you and your family" and buying just about everything else. Since the difference is so obvious, the politicians who won't see it must be against basic health care for everyone for other reasons.
For the 'health care consumer' the market of health care is one that is void of the kind of information generally available or researchable for other 'products' such as price and quality.
In 2005 when I needed information on the cost of an open heart surgery procedure at a particular hospital I could not extract it from the hospital. Not even as a ballpark figure, say the average and spread for the last 12 months. This despite the fact that the same hospital had already collected and reported the same data for a study by the government. The report for 30 common procedures performed at about 6000 American hospitals is available here:
http://www.nhhealthinfo.org/docs/top30elective-inpatient-hospitalDRGs.xls
This is an MS Excel spreadsheet that is not protected, so you can add your own analysis to it if you are nifty with Excel. (There is a second spreadsheet on the website covering 11 aditional procedures.)
It can be concluded from this study that hospitals generally, i.e. as an average, charge 3 to 4 times what they are actually paid. This is explained as the discount given to insurance companies but not available to the uninsured patient.
Discounts of that magnitude grossly distorts the pricing picture for medical procedures. In my opinion it is actually meant to confuse the 'consumer'. In such an environment of deception and up against the tricky marketing gurus of hospitals and health insurance companies, are we to believe that the consumer are likely to be able to make the wise dicision about "the right choice for you and your familiy" that the politicians babble about?
I don't think so. In my opinion, the politicians are aiding and abetting the American Medical-Industrial Complex that Dr. Roger Strube is talking about above. On that background, the prospect for an honest discussion on how to provide health care to the American People as a whole seems dim.
GREAT STUFF!
http://www.Hear-The-Truth.com
You could fix health care for $3.95. Step one go to staples buy a Sharpie ,a dark one. Step two take out the medicare law and cross out where is says 65 years of age or older and replace it with the words "everyone". Yes members of congress are included in everyone (tat will insure quality.
You think medicare is adequate care? Only if you are healthy and only need to go to the doctor once a year for a check up.
Indeed, Medicare is adequate. You are well covered with Medicare Plan A, B, and D under one of the Advantage Plans (as long as they exist). My PCP doctor is easily available and admonishes me to see him more often (he, too, is in the medical business).
Didn't Obama promise I would get the same health care as Congress? Is this the same health care as Congress?
When did he say THAT??
It is if you participate in the Federal Employees Benefit program. Congress gets the same options and coverage as other Federally employees.
Good article but it does not mention that is the countries which spend less and have better outcomes, there are NO maplpractice lawsuits. Also there is better evaluation of procedures like spine fusions and they(physicians) have the guts to tell providers that the procedure does not work for certain diagnoses and is not to be used.
Totally agree! Tort reform must be a central aspect of this conversation. And I'd very much like to hear more from the doctors and less from the politicians.
saving healthcare is the same way as saving america .REMOVE THE DISGRACE OBAMA FROM OFFICE!
Dont be an idiot
Obama got rid of the DISGRACE; George Dubya Bush. WORST PRESIDENT IN US HISTORY!
That was a pointless comment with no value.
Hey look at me, I can call people names so I must be right!
I suggest you get a brain--–ct scan. Actually I am sure they will find nothing there.
All re[publican & tea party should be exposed to infection at the same time to understand & appreciate values & returns of Healthcare.
Don't be an idiot
Correction for Fareed: most countries tax personal income at a much greater rate that the US, in order to provide services such as socialized medicine. I think it's unfair to make an assertion about company provided healthcare being a grindstone around the neck of American businesses without knowing what the heck one is talking about. BTW: would you go to Italy, Saudi Arabia, Taiwan for a heart transplant if you could get it done in the US? Think you should clarify your comments about quality of care. The biggest problem we have is access to care for 15% of the population.
BTW: would you go to Italy, Saudi Arabia, Taiwan for a heart transplant if you could get it done in the US? -- regarding this, i guess the discussion is about UK, Germany or Canada. yes, why not? if i was to be denied here what choice do i have. Best doesn't necessarily mean "Affordable". It is no like buying a car, if not BMW then why not Pontiac. In healthcare it is the question of life and death. If your argument is, it can be done here, sure why not, but look at the cost. Some one will have to bear that, individual or if individual can't pay then We ALL end up paying. One way or the other that is true anyways.
No argument on sharing the burden, but I argue we can greatly improve America's health by removing big business and possibly government itself from health policy and research. Straight up: our food guidance and infrastructure are killing us. There's no place in our dies for GMO grains. We need to be on a hunter-gatherer diet - and that can include veggie diets. And we need to have industrial supported policies stop telling us otherwise. Scrap the NHLBI's ATP, scrap the food guidelines, and put the science first, the real science that shows sugar kils, not fat. Bring sanity back into our food relationships, and health care costs will plummet.
There is a fundamental contradiction when you say that we need more science and less politics, but then goes on saying that "real science" is only the one that support your borderline views of the World.
Personal hygiene is less importent than environmental hygiene. It will be good if republican are given a brief course on healthcare iby Dr.Sanjay Gupta who is MD in Neuro & Prevetive medicines on CNN..
Medical science states that if 80% people are given prophelectic care, 20% can escape from any infection.
It's a mess cause the government is involved.
And now we want to get them complete control of it?
I don't think so Tim
Matt says "My point still stands.
If I choose to not purchase health care services (as some religions forbid), then I have no need for health insurance. But Obamacare mandates I buy it anyway. Not right,"
This really is the crux of the problem. It is easy to say when young and healthy. When you DO develop serious health issues (as most people do if they live long enough), what then? Do we just say tough s*** and let you die in the street? Of course, by law, we cannot chose that option as hospitals already have to take you in. So you ultimately get a free ride while the rest of us already pay for you.
Healthcare will never be solved with legislature because is is in essence about lifestyle. How do we legislate stressful jobs, poor eating habits, lack of proper exercise, or just plain dangerous lifestyles, thrill seekers, drug abuse (legal or illegal)? How can we legislate lifestyle?
fareed, in the following sentence "That's why the Heritage Foundation, a conservative think tank, came up with the idea of an individual mandate, requiring that people buy health insurance in exactly the same way that people are required to buy car insurance." you may be correct, but the law only requires those that own a motor vehicle to buy insurance...if i dont own a car...guess what...i dont have to buy insurance....very different to what you are talking about...
Simple, then to satisfy your requirement the law could state that only those who are alive need to buy health insurance. Like health issues there are people who have cars don't drive much, are really safe drivers or for whatever reason, are not likely to have accidents ... yet to drive legally, they need to have insurance. Your argument really isn't valid and actually supports the reverse.
The biggest problem with resolving health care issues, is that it is a political football with the politicians being polarized trying to satisfy their respective special interest supporters and not concentrating on honestly and responsibly solving the problems. Sound familiar? It should as that is the problem with our politicians regarding in everything. Our government is designed to work with bipartisan cooperation and compromise ... and becomes gridlock without it. Those who demonstrate the stubborn and arrogant, self-serving and belligerent concentration on their political ambitions, at any cost to the people, should be voted out. But that is going to take a rational and objective voting population, with their emotional biases set aside. Good luck!
It's very simple - ask people who they would rather trust with their health care - the government (who is supposed to look out for citizens) or a faceless, possibly foreign health care company who makes more profit if you die. Unless you're paying cash out of your pocket for all of your health care, you're not one of those people getting the 'best health care in the world' in the US.
There are several simple truths. Our health care system costs at least twice as much annually per patient as those of for example the UK, France and Canada. Our outcomes are not across the population as favourable. Why? Firstly the profit motive, rather than providing health care is the predominant consideration. Secondly, and as a result, we do not provide preventative care to the extent that the other systems do – as Fareed indicates heroic ambitious expensive procedures are preferred. On top of that, the insurance companies spend considerable effort attempting to deny care, with the result that many health care providers have to employ people dedicated to merely dealing with the insurance companies. All of which bumps up costs and does not comport with the actual concept of health care. Finally, in the vein of enrichment, there is nothing like the practice of self referral to bump up costs. It has been established that physicians ( not radiologists ) who have their own imaging setup are approximately 2.5 times more likely to require an imaging study than when they would refer to a dedicated independent radiologist. Only way out is a kind of national health arrangement.
The population of the US is twice that of the UK, France, and Canada combined....that makes things a little more complicated.
Didn't any one ever tell you: Size ain't everything or size has nothing to do with it?? Those systems work because the government has the incentive to make it work. The US has lots of systems that do work, and there is no reason why healthcare for all couldn't work. All you have to do is decide that you WANT it to work, and you'd find a way.
How to save American health care?
Keep the government out of it.
But they have done such a good job with the post office, social security and medicare? And the department of energy has done such a good job.
You'e got it wrong. Keep the private sector out, along with profit motive. All these other countries have done something different but the government is still involved in some way. Private companies need profit. Government doesn't, it just needs to break even.
Some companies charge a "tobacco fee" on those who use tobacco products to help cover their added health care costs. Why not have a federal mandate that all individuals have health insurance and the federal/state government can help subsidize the cost. Give everyone copays, even the most poor. The copay can be $5 for an office visit and $25 for urgent care/emergency room. If there is no copay, some people will take their children to the emergency room for a runny nose. That is what drives up the cost of health care. Make those who live healthy lifestyles a rebate each year to discourage poor lifestyles. Allow those who want the premium health care service to have a private company add-on policy where they or their company pay extra to have the extra service. Provide very basic coverage to everyone, but restrict it severely so that it discourages unnecessary costs and rewards healthy lifestyles. That could be handled at a national level (as Obama wants) or at a state level (as Romney wants) but it would provide insurance without highjacking healthcare. You can't continue to require private insurance companies to offer coverage for things they don't want to cover. But, you can expand federal/state benefits to cover those items the insurance companies don't want to cover. If the federal government wants to cover 25 year-olds who still live at home, let them offer basic coverage. Don't require the parents' insurance company to cover that.
I'm waiting to see what the minimum coverage provisions look like. Until recently I worked on a contract that provided the minimum coverage our goverment would allow. Basically, the insurance was a supplimental plan that have been slightly modified. It would pay (not co-pay) 100.00 of an ER visit. Several of my fellow employees found that it was cheaper for us not to use the insurance and get the cash discount from the doctor.
People seem to think that the coverage offered will be in the form of great policies that cover 80% of whatever goes wrong. I doubt that will be the case and it will look more like what my insurance was.
Drone on, dude. After the first 200 words most of us are on snooze.
do the words have too many syllables for you??
Thank you for reminding us of American's short attention span when it comes to anything important.
Another contribution from a field potato in Party Of The Illiterate And Permanently Benighted.
i am a uk citizen-we have a national health service , please note service -in the last year my wife has had both knees replaced top quality attention including doctor; hospital xrays-mri scans aftercare physio etc, at no cost as i say we have a service
I have heard from my UK friends similar reports. So the question is – why can you do it but here in the US we cannot. Perhaps we are just not capable.
You are more than capable. Unfortunately you have a component in your society that believes that patriotic crap about ability to live your life free and home of the brave etc, and not realize that maybe things are not working as well as they could be. Americans never think they can learn anything from anyone else because they know it all.
The bottom line. IF the Federal government can force a citizen to purchase a product, health insurance, then what is next. Force me to have a mortgage, force me to buy a solar panels, or force me eat only what the government provides. Get government out of health care business.
healthcare shouldn't be a business
Exactly. Private insurance companies need to make a profit. Lose the profit motive!
simple. either you sign up for it, or you can pay out of your own pocket if something happens to you. When you have chest pains and go to the ER, they tell you, this will cost $8k to run all the tests. If you need stents, that is another $12k. Do you have the insurance? No, then do you have the cash or a credit card. If not, don't expect service.
I have liberterian views, but also understand the weak law of large numbers and how it applies to all of society. If like in NH, you don't want to wear a helmet while riding your motocycle, no problem. However, if you get into an accident, and need brain surgery, your surgery should cost more than the guy who wears a helmet. Or your health insurance rates should reflect this. Don't increase MY insurance rates because of this. Pay for it yourself. If you smoke, your health insurance rates should be higher than mine.
Insurance is based on statistics, and part of that is that to have reasonable premiums, you need to have a large statistical sample. This is why my health insurance costs for the same coverage is wildly different if I work at 10 person company, or at IBM. I am still the same insurance risk. It just that IBM gets to spread my risk over 150k people.
Amen. Don't stick me with the bill and you can do whatever you want. I think that people miss the fact that their choices have an impact on others. If you don't have insurance and can't pay for your care, I am forced to indirectly cover a portion of your inability to pay. You would not want to pay for my expenses, so why should I have to pay for yours? If you were stuck with the bill and had no way of escaping your responsibility to pay for services received, then by all means, don't pay for the coverage.
"The Obama health care bill expands access to 30 million Americans." It forces and uses the full force of the IRS and punish every American for not taking part. It is a TAX!
Can you at least admit that we are paying for these uninsured either way? Our premiums are higher to cover the loss, our providers charge more to cover the loss ... or we pay your "tax".
What is striking from the arguments here and on the street is that most people who oppose the ACA, do so because they are afraid to lose what they have. Typical "boiling frog" behavior since the current state is such that everybody is slowly but definitely losing what they have on the current track. Also the lack of knowledge about other, better working systems is astounding. Having experienced 2 systems in different countries as well as the US system, I can assure you: it doesn't get worse than this. Any change and more regulation will make it better.
Actually, it can get worse. The employers who provide good insurance already could reduce their coverage to make up for higher costs associated with some aspects of this legislation.
A recent "Investor's Business Daily" article provided very
interesting statistics from a survey by the United Nations International
Health Organization.
Percentage of men and women who survived a cancer five years
after diagnosis:
U.S. 65%
England 46%
Canada 42%
Percentage of patients diagnosed with diabetes who received
treatment within six months:
U.S. 93%
England 15%
Canada 43%
Percentage of seniors needing hip replacement who received it
within six months:
U.S. 90%
England 15%
Canada 43%
Percentage referred to a medical specialist who see one within
one month:
U.S. 77%
England 40%
Canada 43%
Number of MRI scanners (a prime diagnostic tool) per million
people:
U.S. 71
England 14
Canada 18
Percentage of seniors (65+), with low income, who say they are
in "excellent health":
U.S. 12%
England 2%
Canada 6%
And now for the last statistic:
National Health Insurance?
U.S. NO
England YES
Canada YES
I think this data is fake.
Firstly, there is no 'International Health Organization' at the UN, or anywhere.
Secondly, on looking at 'Investors Business Daily' could not find any such article.
Thirdly, the data presented is in direct contradiction to WHO ( World Health Organization ) data which can be extracted from their website.
Then, the conclusions are of course incorrect as well.
Interesting numbers, but they can be interpreted differently: US over-diagnoses many conditions, and over-tests – to push billing up. The higher %% for high-cost testing is a real cash cow for most clinics and hospitals.
Where Zakaria fails..and where he ALWAYS fails with these opinion pieces about expanding government's role, is the fact that we are BROKE. We are actually beyond broke. We are trillions in the hole, and the biggest things that put us in that hole are not wars (though, they didn't help) but Medicare/Medicaid! In theory, Zakaria is correct, but its not free. Nothing is free! When you see "govt. sponsored healthcare" it does not mean "Free". The question is, how do we pay for a the single payer system he (and others) have suggested? That's the catch NOBODY is touching.
I agree with you. Countries with adequate socialized programs like Canada and Norway have small population with massive natural resources (like oil), which helps fund socialized programs. The US has a huge population, many illegals, and massive debt. I'm not sure how we will afford it.
If the US goes to universal healthcare, I'll probably move back to Canada (I have dual citizenship); not because I prefer socialized medicine, but because I don't think the US is capable of managing social programs.
This is scary. The liberal love it. Once they pass this Obama care then the liberals will really have fun. NOW, they can form boards which can be politically controlled and funded or a DEATH PANEL.", you will need to have some kind of board that decides that some things are covered and others are not.This has been demagogued as “death panels” when it is really the only sensible way to make the system work. "
Who do you think makes the decisions regarding what is covered by current insurance companies? I guarantee you it's not "life panels"
@Missouri MD: Excellent response! So tired of the "death panel" argument, since so few people realize that is what each and every insurer has today that determines what treatments you are allowed. With all the angst over "death panels", you would think one of these jokers would start to get angry at the insurance companies for doing this today. I guess that since insurance companies are businesses, rather than government, they can do nothing wrong.
Oh yes please let a profit seeking company make your healthcare decisions, there is a reason why there is Medicare for the elderly. The insurance companies don't want the very sick and elderly, they cost too much.. I'll take my Medicare when Im eligible thank you!
don't the private insurance companies routinely turn down people for all kinds of reasons?? why is a 'death panel' (to use your term) or a insurer bureaucrat making a decision about what treatment you can have?? Are they a doctor?
The comparing of having to buy auto insurance vs health insurance is not valid.
I have to buy auto insurance for the damage my vehicle may cause to others. I do not have to buy auto insurance to protect, replace or repair my vehicle if I don't want to.
Health insurance is for my protection not others. Same as my car, if I do not want to insure my health I should not have to.
Dean, you are too narrowly focused, i.e. on yourself. If you fall in the street or get hit with a latent illness you WILL get treated by the system we have even if you have no insurance. So the 'others' you are talking about WILL pay for you. Why is this so difficult to comprehend?
I really love the way the Fareed Zakaria blithly assumes that he has the one and only answer to whatever question he chooses to pontificate about in his columns. There is no area of expertise where he doesn't consider himself a godlike expert from economics to medicine to legal towhatever even though his primary training is two degrees in Political Science and being a member of the liberal establishment.
I've lived half my life in a Scandinavian country with a socialized health system. Medical coverage in America is ridiculously expensive but those with insurance certainly get better quality care. American medical professionals are competing to serve you – that's how they make money. European doctors and hospitals just can't be bothered – they'd rather not see you at all. I hope this isn't what America is headed for. As for the necessity of having panels to decide which treatments are worthy of your tax money, President Obama, in order to get those few votes at the end he needed to get the so-called "Affordable" health care plan passed, promised to make an executive order to rule out abortion being covered. This is a promise he's already breaking, forcing millions who find the killing of the unborn reprehensible to not only accept it, but to pay for it. This is my main, though not my only, objection to Obamacare.
I agree. As a Canadian living in the US, I love that medicine is part of a free market. Doctors do compete and it shows in their service. In Canada, it's like going to the post office or DMV. Their is no incentive to give you good service.
Fareed Zakaria is want a SOCIALIST STATE. He wants a government that destroys Capitalism and replaced with a Socialist State. Get the government out of health care and prices will go down and the market will provide affordable health care for all with a need.
is this the same government you want out of regulating the financial markets because they do such a good job of policing their own?? All that proved is that when left unregulated and unsupervised GREED takes over. Your Wall Street and its GREED nearly took down the world economy, and you think leaving heatlh care alone will let market forces rule??
If you were truly a Patriot, you'd want govt coming down hard on those who have cheated and lied and stolen. If you were truly a Patriot, you would want your country to be known for the absolute best ie economy and or heatlh care.
As it is all you're known for is having a financial system that almost wrecked the world and no apology or system put in place to prevent it from happening again, and health care if you're rich.
Actually, the financial market (caused primarily as a result of the housing crisis) is a result of the stupidity of Americans that don't understand interest rates or managing a budget. In Canada, stupidity is regulated (i.e. high risk loans are regulated). People in the US were free to take big risks and it was great when housing prices were rising and not so great when they fell. This is a risk you take when you 'invest' on borrowed money. People who had responsible loans or actually 'owned' their homes didn't loose them.
@mcan
you could also include commisions to loan officials which gave them incentives to give loans to NINJAs, liar loans, and selling off mortages off your books. Millions of dollars of subprime mortgages sold to other countries as Triple AAA! All this happened because of de-regulation; and this global fiasco has proved what happends when YOU DON'T REGULATE. Stupidity and greed take over, and this is a mess that drags us down too, despite the fact that our economy is roaring.
I've lived in the US for over 10 years and I never took out a risky loan. In fact I own my home here in the US in a major city (I could have never afforded to own a home in Toronto or any other major Canadian city). I LOVE the mortgage tax right off in the US and used it to my advantage. I understand the basic principal of interest rate calculations, so I wasn't sucked into a risky mortgage. The US people are much more stupid than they were a generation ago. That is why the housing crisis happened. If you are sensible, you can really have a nice life in the US where taxes are cheaper as is housing, gas, and food.
To avoid any vestige of socialism and get the government ENTIRELY out of health care, change the law that requires hospitals to care for those who can't pay and have no insurance. That is the real free market in medicine.
Any takers?
Bear in mind, if you lose your job with you oh-so-wonderful group insurance, and can't afford the COBRA (it may cost more than unemployment will pay), then YOU will be the one they turn away.
If the mandate for health care is struck down by the Supreme Court, does that mean that the mandate requiring that I buy auto insurance will also be repealed?
Interesting, most of the Republican Terrorists are complaining about the individual mandate. Everybody should have health insurance. Solution is get rid of the individual mandate, but require everybody to prove they can pay the medical costs when they go for medical help. No proof – you get a band aid. Everybody will sign up for health insurance then.
Liberals always have to be rude and call people other names when making a political statement? AS though it is a mental disorder, liberalism.
I never made this statement.
The little girl that made this statement stole my name and I have reported her to CNN.
The jerk who did this must be a eunuchoid.
I am not sure exactly what my point is but I am a Canadian who took his first visit to a U.S. hospital while on vacation a couple weeks ago. I cannot tell you how impressed I was with the level of service at the hospital in S.C. I can only speculate that the visit that took me 20-25 minutes through emerg in the U.S. (we did not even have to sit down in the waiting room) would have taken me probabaly about 3 hours in Canada, granted my childs need was not critical. What would the avg cost of insuracne run in the U.S.? what are avg wait times? Surely there must be some sort of tier 2 system that can find middle ground?
Also...it seems to me I picked up some sort of sentiment in the U.S. and on this forum as well that it is everyone for themselves down there? If you cant afford it too bad etc....shouldnt everyone in "the greatest country in the world" have access to good medical care whether you are privlidged or not?
I find it funny, that Obama and liberals, want to pretend, as thought Health care is totally out of reach. The reality is that is very affordable, accessible and the best care in the world. Obama wants to create a Socialist State. Health care is a way to move America further away from Freedom and Democracy.
I have plenty of freedom and a democracy here where I live...I ask this question serioulsy...what does very affordable mean? I have heard a family of three can cost around 7000-10 000 dollars a year in premiums is that number ballpark?
FYI in Canada, health care is a provincial responsibility. How it is delivered is up to each province, and this was mandated in Confederation (when we became a country in 1867). We all pay for healthcare with our taxes to the federal government, and they give money to each province for its healthcare needs. When you need it, you get it.
I'm a Canadian (with dual citizenship) who lives in the US and I LOVE my US private insurance and coverage. I prefer to have private insuranse vs socialized medicine anyday. There are many treatments I've received in the US at reduced costs that would have not even been available had I been living in Canada (for example: IVF treatment).
If the US goes to a universal healthcare plan and we end up losing access to private insurance, my husband (an American) and I will probably emigrate to Canada. I think with the size of the US population, illegal immigration issues, and lack of GDP growth, socialized medicine will be a mess in the US. Canada has a smaller population and is rich in oil and natrual resources (so they can better afford to run these types of programs). I just don't see the US government managing healthcare efficiently or appropriately based on what I've seen with medicare and education.
As a Canadian living in the US, I've found it's really about 'choice' and priority. I came to the US as a student (not rich at all as a student), but made sure I worked several campus jobs to pay for health insurance. Also, the extremely 'poor' have access to government medicaid.
The people I know that don't have insurance for themselves and their children are the same people that have cable tv, expensive cars or big homes. If you are struggling financially or you're younger and healthy, you should at least get 'catastrophe' insurance in the event of an accident or suprise health issue in the US.
The mandate will still require that people 'purchase' insurance. In a free society like the US, you can manage your own risk. Unfortunately, people don't realize that they have this freedom in the US, so we have to now 'mandate' coverage for the stupid.
One of the reasons why health care is cheaper in other countries is because we Americans are subsidizing their drugs. My father-in-law is taking a hep B drug Barricade. Each pill in his home country is $2, but here they charge him $20. How can our health care cost be lower if that's the case? Why do we need to subsidize other countries' drugs?
This is probalby not true. In Canada, the Candian governemnt (i.e. taxpayers) subsidize drug costs (not the US). This is why drugs are 'appear' to be cheaper in Canada. Canadians pay this out of average 15% sales tax.
There have been quite a few TV news spots on US seniors coming to Canada to get their prescriptions filled. Bus tours of seniors coming here because they can't afford it at home.
togirl: The US seniors coming to Canada to buy drugs are essentially 'stealing' from Canadian taxpayers. The US drug companies aren't selling drugs cheaper. They drugs are 'subsidized' by tax payers and pricing is negotiated by the Canadian government.
As someone who has dual citizenship, I can tell you that there are many great drugs we have access to in the US that aren't even available in Canada. This is why I love living in the US. The advancements in medicine and research starts here.
I hope everyone got to see Fareed's CNN special on health care. We pay twice as much as any other country for health care and are last in areas such as infant mortality, life expectancy and curing curable diseases. A few wealthy people come from other countries to the US for medical care, which is excellent if you have the money, but 500,000 Americans go overseas for operations to countries like Thailand and India for operations they cannot afford here. You might not like Obamacare but the GOP wants the status quo because their patrons in industry are making billions with health care as a business first and treatment of patients second. They did nothing to solve the problem when they held both houses and the presidency. They only said that the US has the best health care system in the world which may be true for members of congress but not for the population at large. By the way, those of you who don't care about health care costs because you have medical insurance through your employer should know that half the people who have gone bankrupt because of medical bills had health care insurance.
Kimo,
We are lower in infant mortality ebcause we count every single live borth whereas many other countries only count those babies bortn who survive for a certain period first–such as 24 or 48 hours. Also, we had a large number of poor and illegal immigrants who have not had good prenatal care.
Robert, the data that is used in comparison studies for these sorts of health measures are collected by the WHO, and the exact same methods are used in all countries compared. If there are differences between certain countries in the way the statistics are calculated, appropriate adjustments are made before the results are published, or that particular comparison is thrown out.
amphiox: what is your soruce for that? It directly contradicts what I've read about the issue.
love all the "i think" scenarios but it all comes down to one thing – the price – and whether socialized or privatized it costs the same. It does. All socialized is doing is passing the buck onto someone else, and thus penalizing one group for the benefits of another while at the same time giving the government more **control** over what is and what isn't. Just decide for yourselves and deal with your own problems. We all have them.
The problem is that the individual can not make the decision (the Supreme Court) will be making the decision for you! This is the REASON, we have STATES rights. Each State should be allowed to make the decision. Allow the VOTERS to VOTE on the health care for each state.
Wrong again !
Privatized and Socialized medicine does not cost the same. It is more than just the same doctors providing the same service. Look up the health care bill and see how many new regulations and Agencies or sub agencies it created. All that costs a ton of tax payer money and a ton of administrative overhead by the healthcare industry.
Fahreed Zakaria has managed to provide a concise overview. It is clearly rational and sounds like a blueprint for something that gets the ball rolling in the right direction. The question here is why is it that we end up with elected officials that are responsible for solving problems that are anything but rational and getting paid to not solve problems?. We have a bunch of fringe, lunatic politicians that provide ridiculous temporary band-aids for any problem that they encounter. Our present attempt at healthcare management vis a vis "ObamaCare" is a good start but has a long way to go. Obama should at least be commended for trying. Instead is met with resistence from warring factions, the most devisive whack jobs of the far right. This fix is comparable to the shoddy patchwork being done on bridges to maintain them for another couple of years.........before they collapse! Are these the types of solutions that we want for our country? No! We need long term solutions for a range of problems and until someone is willing to play grown up we are going to be at the mercy of these wreckless idiots that we call "Our Representatives" It is my prayer that we all remain safe but I know that day is coming when you and one of your children is going to drive over one of those bridges that got left for another day. We will all pay the price for our ignorance by electing people that are not fit for office. Wake up America, your country is slipping into the clutches of apathy, the deep abyss of mediocrity..
Look, supreme court – you're up there in an ivory tower – and we are the homeless men women and children out on the streets dying of cancer and hunger and blood diseases as you ever so slowly deliberate from ancient sources – listen to the needs of today – listen to the people – and deliberate not from the law but from reality – we need health care to live – and yet, supreme court, you enable foreign murderous wars – so please please enable health care, my friends – it is the least you can do – you have already done so much for good and for bad
The swan song of the liberal: the poor, the elderly, the sick, and unable. American give more money and resources away than any country in the world. I believe health care in important, but let the states allow each American to vote on health care for the needs of each state.
Ofcourse, that swan song is a realistic song for the people. On the other hand, I can see a wild wild west cowboy lives with a gun, not want to pay tax, no regulation so he can shoot anyone or taking advantage of the weak ones or cheating treated ok, and going to church to cover hes evil minds of liking war and extremist on his god believe.
Reblogged this on Compare the Advantage and commented:
Fareed Zakaria's attempt to make sense of the health care debacle in this country. His perspective is very worth of your time and thought if you have a chance.
The healthcare mandate is really about regulating stupid people. We all know that at some point we can become sick or have an accident that will impact our health. Paying for healthcare should be every individual's priority (over tv, cars, i-phones etc.). Unfortuantely, people take risks and don't put this at the top of their list then complain when they don't have coverage. The solution to stupid people is one of two options: you force everyone to buy insurnace or you highly tax the population. Stupid people need to be controlled. That is what the mandate is about an demonstrates the dumbing down of America.
The problem with your argument is that it uses a bit of straw man argument. You say, stupid people need health insurance. Are all people stupid? or just some people stupid. How do you determine the stupid from just liberals? This mandate really is about creating a Socialist State and selling it as health care for all. Basically, taking away more freedoms from Americans. Most American have forgotten or can not remember, that the States Rights are very important and this Obama mandate is one more example of a central controlled Federal government over-riding the rights of States and Individual. They have been clever. They are selling the American people up the river into indentured servitude and the American people think they are getting a free ride, when really it will be ride to Centrally controlled state.
Patriot: I agree with you. Just to clarify: If a person doesn't buy health insurance then expects treatment at a hospital when they get sick or are in an accident, I would classify that person as stupid. If you are poor, you have medicaid.
Actually, auto insurance covers hospital costs and medication (and legal costs). Just because someone is unfortunate to get in an "accident" does not mean they are stupid. There are a lot of very smart people that get into accidents.
the best solution.about 40 states or so leaving the union.
while you argue i am enjoying my socialised medicine here in sweden at half the cost per capita even with chronic illneses.
What are the average income tax and sales tax rates in Sweeden?
Depends on the income, i personally pay about 28.5% in tax and the sales tax goes between 6-24% based on what goods i buy, one has to add though that what is considered american minimum/low wage jobs still give a anual 30-40k us dollar income.
If you are a high earner you pay quite alot more but for anyone in the middle/lower middle class we are actually paying quite little as you dont hit the target bounderies at the 45k usd for extra taxes.
I understand in Sweden, people pay 70% or more in taxes per person and give up a LOT of their rights.
Which "rights" exactly, Patriot? It seems to me that you conservatives like to use that word a lot without ever explaining what you mean
No no one pays 70%, as i just stated above its a sliding scale but yes High income earners are taxed harder than low income earners/medium income earners. If you make between 9-10.000 dollars per month then you pay around 58% if you live in the capital (less in the country side) and if you make something like 210.000 dollars per month you pay 62%
I pay as i said close to 29%. When you let the needs of a few who even after a high tax reduction outweigh the need of the base of the population and the middle class then its an issue. Another thing you have to understand that after taxes our overhead costs is extremly low, insurance for car/home/travel/medic aid abroad costs me less than 500 usd..per year. I have 5 weeks paid vacation, i can call of sick when i want and get paid 80%, my wife gets to stay at home for 1.8 years on paid maternity leave...
so i wonder what freedoms do i give up than you did not sign away with your patriot act ? or millenium copyright act ? the right to run around with guns ?
I'd take on that argument all day long.
What sets US health care system apart from rest of developed world? In US, health care is BUSINESS! Profits! Loot! We are the only country in developed world who pays exhorbitant prices for medications and treatments! Why do you think we have so many foreign docs here? They did not come to get poor. Hospitals, clinics, docs see their PROFIT evaporating if US population is healthy! Bottom line! ITS ALL BUSINESS! The more diseases we have, the sicker we are, the more $$$ health care industry makes!
Of course healthcare is a business. Do you want to go to medical school and then not get paid? Would you be willing to get a PhD to invent a drug for free? Healthcare isn't free. Even is socialized countries hospital administrators and doctors are well paid and it costs are reflected in higher taxes.
Healthcare is NOT a right. You can 'force' another human being to treat you for free.
There is a difference between getting paid and looting
Diane, when you need surgery why don't you go to one of those countries for care. Take Obama and his wellfare mongers with ya.
Whatever happened to the strong survive and the weak die? I'm reffering to lazy wellfare hoodies! If you want communism move to China ya idiots. Quite trying to change our country!!!!!!!!!! This is the United States not the free handout states! Obama will fix it with the help of his Hoodies.
Must be some good hooch today Joe ? But I will back your Communisim stance
A very interesting mix of beleaguered comments . In health care for 38 years professionally. Doing nothing is not an option and factionism will not change the outcome which is 5-10 years ,bankruptcy for a system which can not support the top heavy relationship between profit driven groups such as drug companies , providers , hospitals (yes they are profit driven and tax supported in many areas) , product suppliers and least we forget the myriad of insurance providers whose sole purpose is to change the rules everyday so the players stay confused. STOP calling it Obamacare. Ridiculous syntax. We must get control of ann out of control spiral of special interest or face the consequences. As a country that prides itself on caring for all we should do just that. If everyone contributes then everyone gets a share. You may identify this as any ideology you wish , but beware ,time is running out for no action at all. Oh ,and one more thing, if you need pain medication you'll have to wait . Im at lunch.
The healthacre system in the USA is broken and will never change. Insurance companies, and Healthcare providers will never let this happen. And the very sad part is, the majority of the American people are being brainwashed that they get the best healthcare in the world. Everybody is constantly repeating..."oh, the Canadians have to wait months for a procedure"...without having an idea about it.
As a Canadina living in the US for the past 10 years (I know have dual citizenship), I can honestly say that I LOVE my US private insurance coverage. I love the doctors, the service in the US. I've noticed greater access to treatments and drugs that aren't even available in Canada. Some drugs are a bit more expensive in the US, but Americans should realize that you're getting drugs that aren't even available in other countries. I work in the biotech industry in the US and am aware that these cutting edge technologies are offered to Americans first.
But not to poor Americans which do crime in streets.
absolutely true.
Zakaria actually nailed the problem but didn't expound on it. The main problem is that we throw billions at critically ill patients to extend life by only a small time, most of the time the patient lives this time in pain/suffering. We have expensive tests and expensive treatments that can do great things but don't definitely cure a lot either. People can say all they want about doctors being overpaid (total physical salaries is 8% of total health expenditure) or "poor medical decision making"; but the fact of the matter is with multiple adds for malpractice attorneys outside every hospital, as long as the family asks for it our hands are ties into throwing an infinite amount of money to help people live those few extra days.
Such a loving caring sould you are Mikey. If you really are an MD, I am so happy none of my doctors first names are Mike.
caring soul
a
When Arkansas mandated that we have liability car insurance ( which I had) the cost of my insurance quadrupled.
Crime rate can be considerably reduced if a healthcare system like that of west Europe is adopted.There must be reforms in health care. An ancient health care system must be modified.
As a healthcare provider and a small businessman I can say that the current employer healthcare system cannot sustain itself much longer. This year alone the premiums went up 20%, and that's after a big reduction on coverage. That's American healthcare, you are guaranteed to pay more for less every year for insurance. Interestingly my fees as a provider don't go up even 4% a year so where is the money going? Do the math!! Insurance companies are increasing premiums 10-30% a year, it is not going to the providers. Those of you who like your healthcare through your employer, you aren't paying enough of the premium, but you will soon!
Rich has it absolutely right. I too had a small business with several employees at one point. Between 2006 to 2008 I saw increases of 12 to 14% per year and the amount of effort and time suck to keep the increases as low as that was crazy! Yes, there is inflation and yes, the employees were getting older, but large companies clearly had the advantage with their larger risk pools. The small companies are where a significant portion of innovation takes place. Healthcare is killing that innovation. The new healthcare plan is at least a change from the status quo and from my small business perspective, thats a step in the right direction. The new plan ("Obamacare") may have problems – even huge problems – but they can be fixed.
I live on the US-Mexican border but without accessible medical coverage in the US I decided to buy a Mexican medical insurance. The cost is reasonable anywhere from $700 to $2000 dollars/year/person. Also I found out many Mexican doctors have a diploma or degree from US medical schools and because they are next to the US, they are always updated with the newest technologies and procedures. Most Mexican hospitals are not 5 stars but they are clean and nurses have many years of experience, sometimes more than doctors. I wonder if US insurance companies would consider having tele-medicine or sending patients overseas for expensive treatments.
The health care system should differentiate between looting and a charge of fee for a medical service.The medical service fee should not look like looting a patient.
The problem with healthcare is simple – it's the only thing people purchase with no price tag. If individuals were responsible for even 5% of their healthcare costs (with a cap based on income, and even not to exceed X% for anyone), costs would go down immediately. Why? Because people would start to ask questions before saying "OK, give me another test". After a move, I had a doctor suggest his office give me an MRI rather than use an MRI that was 3 weeks old from another doctor. People would also shop, as they do with other purchases, based on factors that include cost. It woudn't be the only factor, however, people would consider cost – today no patient does. Nearly everything is free, and as long as that mentality stays, costs will never go down. Like most issues that plague society, the solution relies at least in some part on individual responsibility.
greg, shopping around when you have a broken leg is difficult, shopping around for the best or cheapest broken leg doctor when you don't know you are a broken leg is even more difficult. Please realize that medical care and medecal insurance are fundamentally different from any other purchase you will make.
Would like to point out that one of the drivers of health care cost in America is the high COST OF MEDICATIONS- especially cancer drugs. In India a recent law would allow generic drug makers to make expensive medications (even while on PATENT) if the cost of the drug is prohibitively high. This forced the pharma there to lower their cost to compete with those generic makers. In other words, we as Americans pay "FULL PRICE" for those drugs to support R&D and the cost of bringing these drugs to the market and then the same pharma would sell them at a discount in India. Now one may argue that India is a developing country and cannot afford to pay. I would argue, even an average American would not be able to pay "out of pocket" costs for these drugs if there was no insurance coverage. There are many millionaires in India and the Government can subsidize these drugs. If not America should not be paying the high price just because our system " subsidizes"" these drugs under the umbrella of insurance which eventually makes cost of insurance higher for everybody. would love to know what people think about this.
This is a great point. Why should the USA fund all the development and the rest of the world get the benefit for "FREE". USA wages are being driven down by India labor, Why shouldn't India drugs drive down the price of USA Drugs?
I believe a ONE PRICE rule for medicine would greatly reduce the cost of healthcare. One price for insurance plans, if you want GM's plan, you can get it at GM's price. You need a drug? You get it at the price of India/Canada. You are in the Hospital, You pay what Medicaid pays.
healthcare should be a public service just like police and fire. In the US, it's just an insurance pyramid scheme to get insurance corporations super wealthy. The fire department doesnt refuse putting your house fire out if your house has no fire insurance. The police dont refuse to assist victims of crime because they dont have insurance. Like police and fire, healthcare is a basic service and we as a civilization cannot progress until it is considered as such.
Thanks Fareed, as usual you shed the light of truth and common sense on this subject. However, you're wasting your breath and your time trying to convince conservatives, Tea partiers, and the PRW (Paranoid Right Wing). They will fight you to the death on your common-sense health care ideas, to try and make sure that President Obama fails. Their intransigence is tragic, it's perverse, and it's nonsensical – with terrible effects, EVEN FOR THEM. It's also irrational, rabid, and unyielding. I say, let them form their OWN health care system, UNFUNDED by the object of their HATE (the US government, and its revenues), based completely on private funding in their sought-after "free market system". Simply EXCLUDE those who don't want to participate in the Affordable Care Act. Leave them on their own to form their own health care network. Those of us who wish to stay within the Affordable Care Act will do so, pay much less, and get the care we need when we need it, without fear of being excluded by one of their private enterprise "insurance" corporations. Let conservatives stay with their own insurance companies, doctors, hospitals, etc. Let THEM suffer the risks of denial of coverage, shortage of personal funds to cover big-ticket procedures or long-term medication regimens. NO hospital admission for them until they can demonstrate ability to pay from their personal funds. NO Medicare or Medicaid for THEM, because after all, they HATE the government and its attempts to allocate resources fairly, so naturally they would refuse any federal assistance or taxpayer subsidy for their subscribers. It's every man, woman, and child FOR THEMSELVES in their conception of health care, so I say, LET THEM HAVE IT. And of course, any benefit they seek from OUR ACA-based system will simply be met with their standard response to all proposals for progress in America: f/u. When people like their 71-year-old hero Dick Cheney can purchase a privileged place in line for a heart transplant that normally would not even be considered because of his age, while a younger, within-protocol transplant candidate is denied, well, they can just figure it out themselves. And they'll have no one to blame but themselves.
Great piece of reporting! Refreshing to see someone exposing the crazy set up here in America! Thank you Mr. Zakaria.
The problem in the US is that Health Care is an INDUSTRY not a SYSTEM! It is so fragmented with everyone wanting a piece of the pie that the patient gets lost along the way. Adding different levels of workers, and providing no oversight as to what they do, leads to total fragmentation of the service delivery process so that patients can easily slip through the cracks.
Why so serious? Lighten up! I suggest you all purchase my book with the companion DVD, "Minny Comes Alive". Besides great dancing and soulful tunes, I debunk the whole myth that Healthcare can't be both fun and cheap.
Hey Minny, It sounds great. Can I buy it on Amazon?
The GOP made a mistake calling the Affordable Care Act "Obamacare"...because like it or not, the care act is saving lives and if it gets taken away, it will be the GOP who took away someones right to life. Odd..that the party that presents itself as caring about the unborn fetus, also takes away health care from those who actually get born.
Bull pucky ! Obamacare has yet to save one life. It hasn't even been implemented yet. The only pieces that have are pretty basic.
Republicans think everyone is America is white, and middle or upper middle class. They can afford private health care! And they want their votes.
The only people I trust less than the Government, are the companies on corporate welfare. It would only take 2 or 3 simple things to correct the US Healthcare problem.
1) ONE PRICE model. For healthcare products (services, drugs, insurance, etc), the is ONE PRICE and that price is published. No more charging the insurance one price and the consumer another. Everyone gets the Government price on Medicare. USA pays the same as Canada/India/Africa for drugs.
2) Selling ACCESS. Doctors and Hospitals are allowed to sell premium ACCESS. Think "extra leg room" or "priority boarding" for a percentage of their time. Those who want to pay get to the front of the line. Those who can't, back of the line. This encourages excellent service and lets good Doctors and Hospitals continue to make a premium.
3) BREAK UP MONOPOLIES. micro monopolies (hospitals, healthcare conglomerates) and Drug companies should face anti-trust lawsuits and should be divided into multiple companies.
The fact that we are importing poverty (11 million plus illegals) deserves some mention here. They add more than a little to the cost that every paying citizen incurs.
As usual, Fareed writes a cogent article and includes all the technical details necessary for the discussion. Good job! However, I think the main problem with the american healthcare system is the enormous costs associated with the actual health care delivery; R&D costs, doctors' pay, and all the admin costs that are visible/invisible. On top of these costs we have for-profit insurance companies. Their existence helps in many ways, but it has other difficult to handle side effects. Like hospitals manipulating price of care, or the additional costs to help maintain these companies (not to mention their shareholders). Per my understanding, government after government has tried to fix the whole mess by looking at the insurance thing in isolation. Just by including a public option, overall health care costs for everyone don't come down. Its just that the government or someone else will have to cough it up. I believe this is where the problem is getting politicized: Who should pay these costs? A part of the political spectrum wants the government to help pay, while the other part wants no government interference at all. But the bottom line is, we have to fix our health care providers as well as the insurance companies. Health care is not exactly a business in the normal sense (as Kenneth Arrow has suggested). We need new rules of engagement here.
The only solution is a National Health Care System that applies to all including elected officals. Make the insurance, health care and pharmacy compaies bid for the services while keeping a cap on how much they can charge. Take the greed factor out. Compaines do have to make a profit , just not a killing at the expence of the public. No National Health care to illegals.
Do you think a national healthcare bid would not be corrupt? (Think Haliburton and Iraq) Some Company would hire an ex-President or Senator and they would BUY the bid and fleece America
isn't Haliburton a private company? Sort of like the private incurance companies?
@togirl, You are correct. Haliburton is a "private" company that paid Dick Cheney a ton of money. Then Dick gave them possibly the biggest government contract in the history of the world (no bids taken). I suspect something like that would happen with the outsourcing of Medicare/Medicaid
@ortidefan
That's why I think the government needs to be involved. I've heard about fraud ie calling hammers something else and charging 30X what they cost in a store, or other such nonsense. If you farm this out to private companies, good luck in auditing their books.
And how will you prevent the new wave of Cash Only private hospitals and clinics that pop up eveywhere ? Nothing says a Hospital or Doctor has to honor your insurance. Soon it will be only the affluent and political elites getting top notch care.
I don't think there are enough "elites" around to completely fund a Hospital. Doctors/Hospitals/Drug companies need the VOLUME created to cover costs and they make 90% of the profit on the uninsured.
A few things about Germany. It's not paradise, but they run it cheaper. Employers do pay 50% of health care cost, and the employee pays the other half via a deduction (about 8% of salary). Contributions are capped at ~EUR 300 monthly. Insurance carriers are run as non-profits. There is a mandate. Most people are in the public healthcare system which relies on government price caps for services. I would claim there is less reliance on prescription drugs and high-tech equipment (who has not seen "The Meaning of Life"?) than in US medicine.
Here's my take I am a person who is not an expert but I can see through smoke. Its not the delivery,the cost, the need or where we are as a democratic society who embraces free enterprise. Its politics. The President wanted the best system money can buy to cover each and every American. Republicans realized that if this was achieved they could lose their base with the American people. Especially after the disappointing administration of George Bush. We have a government system full of egos and agendas on both sides of the isle. They then scare the average American who is so vunerable to these programs and are probably leary of change. The politicians seize on this and put the fear of God in us while holding out and banning together in the legislature to make the healthcare system not work to its potential.
Shame on Us and God help our Nation
I guess you can't see through the smoke up you bottom. The Demo's got you drinking koolaid.
easy answer then. make sure Republicans aren't elected, and maybe you'll see a change in your politicians. BTW, I'm Canadian and no vested interested in your election.
As Zakaria states, the US is the ONLY developed country that doesn't have some form of universal health care for its citizens. Could it be that every one else is wrong and the US is right? No, obviously the US is wrong and EVERYONE else is right.
Wrong again. I have seen drug addicts with not a penny go into an Emergency room and walk out after being treated, admitted, and walk out with a purse full of meds.
I am really impressed by, for the most part, the intelligent discussion taking place on healthcare.....in this article's comment section. Really good points are made on both sides. This is the type of discussion we should have had before the bill passed, but instead, the throngs of opponents of any change at all read articles like this one over at Foxnews.com (note that it is in the "Opinions" category, for all that is worth) and accept it as fact with no dissenting opinions allowed:
http://www.foxnews.com/opinion/2012/03/23/top-5-freedoms-at-stake-if-obamacare-is-upheld/
Rationale thought is going to be lost in the noise on this issue.
Fareed Zakaria is the Deepak Chopra of CNN. Phoney.
But YOU, the all-knowing "MoChuck", are credible. Okay then. Knucklehead.
first ajournalist should try to give some facts which really werent presented in the article. but forget that and lets make assumptions and try to think out of the box a little. The socialized healthcare systems in other countries aren't terrible but neither are they better than the US. Indogent people do get health care in the US. When i think about the issues with U/S healthcare i think of several things.
A. My employer owns my healthcare not good
B. Private healthcare providers charge more for the elderly than they do employed people (which is why we have medicaid)
C. The young just getting started often can't afford it and dont really see the need (they think they are healthy)
So why not , change it so employers pay a healthcare benefit in dollars that can only go to yout healthcare provider (and maybe it goes through the federal governement for payment to healthcare providers or to a private clearing house.
enact a regulation so health insurers cant charge more for any group of people (especially the elderly) and we do need our young people prodded to get their health insurance in place and maybe that is a mandate if the insurer doesnt provide it maybe thats a tax on only those who dont have it (as in an option) plus incent all employers to contribute some (any level) and the individual pays the rest like they do today . The key is to get more people covered which will drive the cost down and have the healthy subsidize the unhealthy. I'm not worried about healthy lifestyles as insurers could charge more for lifestyle choices (they do smoking today). This way we don't get the government beauracracy which is always full of fraud and not efficient. This way liberal thinkers get what they want coverage for all and conservatives dont get stuck with another government bearuacracy which we cant afford.
The "federal government aqs a clearing house" will cost you n70% of your healthcare. That is why we need the federal government out of healthcare.
I agree, the above mentioned contributes to complicating health care resulting in indecent costs. I lived in France 15 years, everyone is insured, and yes, everyone contributes so that everyone benefits - they are proud of this. france: healthcare gdp, around 7.5% and very efficient. US: 18% inefficient, too many left out in the cold. .... yes, i will go back
First, get rid of all the low-life's that are illegal aliens, chronically unemployed or generational welfare recipients. Put them under the Democrat's Eugenics mission. That will lower costs.
Make all health insurance companies not-for-profit.
Keep the government out of controlling standards, pricing or wages.
And why pray tell is this a good idea?
what is the point of holding both ends of the rope while falling?
Look, if the Supreme Court invalidates the Affordable Care Act, the only option left will be the public option. That is what would work best.
The young must pay for the old and the healthy for the sick. You never know when you will need health care and that is why everyone has to be insured. The Affordable Care Act was a messy compromise.
I would insure everyone by raising taxes to pay for health care. Raising taxes is not a bad solution because the average payment is likely to be less than those Americans not on Medicare pay for insurance.
The public option is, moreover, the only solution to this mess. What is the Republican's solution? Vouchers? Vouchers will just mean more uninsured with the burden thrown back on those with insurance to pay for the uninsured. The Republicans really have no solution.
The GOP doesn't have a realistic solution. Any "free market" solution would require a massive anti-trust effort to eliminate unfair pricing to consumers by the entire industry.
ObamaCare is a failure because he was unwilling to hammer the healthcare lobby (and reduce their profits).
I can't imagine ANY US politician taking the necessary steps to reduce the overall cost of healthcare.
Make it unprofitable to practice medicine or be in medical research. That will drive all the best doctors out for sure and we will be stuck with a health care system like Cuba. Only the elite will be able to afford private hospitals and doctors and the rest of us slobs will not get treated for more than a cold or infection.
Currently, Healthcare providers charge uninsured people 3-4 times what they charge Government/Private insurance companies. Private Insurers charge individuals 3-4 times what they charge large corporations for the SAME product.
The reason they get away with this is that THEY ALL DO IT. Which means they are implementing a "price leadership" or monopolist market. Throwing more money into a monopolist market only benefits the monopolist not the consumer.
If you believe in FREE MARKETS you would be screaming for anti-trust actions.
Your solution is why SS and Medicare are in red ink now. Why do you need to burden others so ?
Your health, you but your insurance, enough said.
"This was resolved about 70+ years ago, and in the UK this was done right after WWII and they still had food rationing. I find it unbelievable that this is something the US is still arguing about."........................................................The business of America is business. That's why one third of our health dollars are soaked up by the insurance industry. We need to get away from the business model in health care.
My point exactly.
It isn't the "business model". Free markets work when they aren't dominated by monopolist and usury pricing. The problem with the healthcare (and most US industries) is that the Lawyers at the Justice Department never read the Sheman Anti-trust act!
"That's why the Heritage Foundation, a conservative think tank, came up with the idea of an individual mandate, requiring that people buy health insurance in exactly the same way that people are required to buy car insurance."
This is a great idea, now mandate and get the government paws out ! No subsidies, no government reimbersement.
individuals running the show will just aggravate the current state of health care. health care must be a right for everyone.
"Just 5% of the patients in the U.S. account for fifty percent of all health care costs – mostly the chronically ill" – this points me to a different solution. Outsource treatments of chronically ill patients to a country where medical treatment is much cheaper. China/India/Thailand could do their job under supervision and that would save both man-hours and cost for Americans. However, I feel outsourcing is a "bad word" these days and some people might just prefer bankruptcy over outsourcing.
Nice! Ship all the Sick people over seas!
People object to "socializing" medicine. Socialism is government control of the means of production. I am certainly not for that. But is health care a "means of production?" Certainly producing medical equipment, building hospitals, manufacturing drugs, etc are forms of production => we should keep government out. But is the application production? What is produced when you care for a sick person? Well care for a healthy person? IMO, health care has both production and non-production aspects. We should IMO separate where free markets work well (producing) and where they don't (application to real people).
you are not marx and this is not stallinist russia. calm down and drink your tea
Hey rollo, have you ever read any of Marx or Stalin?
That’s sound like educated person
Here is my solution to this: Rather than having the state pay for health insurance for those older than 65 (medicare), have the state pay for insurance for those UNDER 65, and those older pay for their own. The amount of money people spend on private health insurance for the first 65 years should cover the last 12 (mean life expectancy 77 years). More importantly, this will ensure that every citizen is able to get free preventative health care, that can significantly reduce the amount of money spent later in life on health care. It will also help individuals become financially secure earlier in life (rather than having to worry about paying for insurance as well as college loans). Sort of a crazy idea, but something worth throwing out there.
Once again, FZ is over-reaching his knowledge and skill set. He seems to be the only news media commentator who is allowed to comment on any topic, both US domestic and international. His CNN editors are exploiting him. Every day, sometimes twice a day, he posts a commentary on various topics. I read the headlines, but I refuse to read any of his posts, even though I may agree with the article suggested by the headline.
cant see my comments?? I tried posting again but I get a message of duplicate comments??? whats the matter?
It is clear that this is not an easy question. But it is absolutely clear that an only goal of this article is to save Obama’s face. Is not it, Farid?
Lots of good ideas and some bad ones too. But we must all accept anytime the government gets involved, inefficiencies, fraud and abuse go into overdrive.
Government has no incentive to save money but only to spend and spend more than before.
America had best figure out how to get the job done without public worker intervention. The government does not have your best interest at heart.
A common statement in this conversation is "the government makes you buy car insurance".
There are several fundamental flaws in that argument.
1) You don't have to drive.
2) Car insurance only covers accidents. Not maintenance. Car maintenance plans are considered the biggest rip off in business. In a "free market" Why would health insurance plans be any different?
The reality is, we don't have a free market. Break up the monopolies, simplify/publish pricing, enforce US company patents overseas to force other countries to pay THEIR FAIR SHARE!
re the car simile: you can always buy another car, and if you don't take care of it, it's your problem. But you only have one body, one life. Good luck trying to get another one if you don't take care of it. You do need preventative healthcare to look after the one body you've got.
Don't bother trying to reason with these tea-party loons, they are some of the most ignorant people on earth
I lived in Taiwan for more than 9 years. If that is what Obama wants, we all have a problem. Medical care isn't very good. The doctors are not that well trained. A doctor sees 6 people an hour. Yes, the coverage is cheap and you get what you pay for. My mother-in-law died from back surgery from this clamp that they put on her spine. It took her a year to die from blood poison. I was told my heart was fine, but to find out I had a bad heart valve. I knew there was something wrong when I was short of breath. You can keep government health care and Obama care. Neither will be worth lives.
why are comments being censored??
the US has a lot of 'public' already in it: public parks, schools, libraries and transportation. The public library is your invention. I do not understand what or why anything 'public' suddenly threatens your noble Freedom or hallowed Democracy?
am i mandated to go to a public park or library
Until lawyaers are out of the healthcare equation, nothing good will happen. It's the lawyers and their malpractice suits that have caused our health care costs to rise. If Mr Obama REALLY wanted to fix health care in America, he would have fought for tort (Malpractice) reform.
The real problem is the power of the medical industry where they can extort whatever cost they want from people, and those people have no other choices. To even get trated at a hospital, you have to sign a waiver that says – we will do what we want and you will pay for it. We cannot fix a system that has no possible cost control.
OK, so health insurance should be required like car insurance. Then price premiums according to location and risk, just like car insurance. If someone wants to live an unhealthy lifestyle (overweight, smoke, etc), then they should pay more. Yes, healthy people should be in the pool and share risk, but when 5 % of the users of health care, make up 50 % of the costs, why should healthy people want to pay for such irresponsible people?
"How to save American Health care?"
Population control.
What is wrong with our healthcare system is that we do not let supply and demand determine pricing levels. Suppliers of medical services (doctors and hospitals) are free to charge what the market will bear but users of healthcare (demand) do not care bout price due to the nature of our system. We as patients have no "skin in the game" and therefore do not behave rationally when it comes to our use of healthcare. Change this and people would be much differently when it comes to preventative care and general behavior about there health. One cannot control a great deal about health issues included accidents and serious disease or illness but much of our healthcare costs are driven by the lifestyle choices that people make. If those choices and consequences were managed economically overall healthcare costs would go down. The more the government decides should be provided "free" as healthcare the less control we will take over our own healthcare. Healthcare should be available to everyone but the consequences of lifestyle choices have to be part of the process if we are ever to change the cost structure of health care in this country.
The idea that health care can be provided by private companies and that would be fair is at odds with its noble intentions.
The jacked up pricing that lot of news coverage have highlighted time and again will show how much mark up goes into a typical ER visit or some form of surgery.
Having to pay anyone who touches your body ridiculous amount of pay starting from doctors (who are at the top) is unbelievable.
Professionally a doctor is no different in terms of (effort) that he puts in than a PHD in other discipline so how can you justify 5 to 10 times the pay.
Some may say medical malpractice insurance well it is a contributing factor and can be worked out for one but it is not it !
Second in the list is the cost of medicines, prosthesis and such that Americans have to pay the HEAVILY marked up prices and this is the PHARMA lobby.
And last but not the least the hospitals (for profit orgs) do have to make something for themselves.
So all in all in the name of 'better' care and 'safety' of patients we do get to see 'hotel' like hospitals more often than not but the outcome is still not that great. The amount of mis-diagnosis, wrong medications, hospital infections are not encouraging if you look at the costs !
So the premise is that every one in this business has this notion that whatever they charge has a justification and will therefore be high. One way or the other either by charging the government which includes bogus claims to insurance companies they make that money. The insurance companies end up jacking up their costs on people and government increases the national debt !
With such a powerful lobby, ignorant public at large and political mouth pieces who are ready to 'scare' and paint real life death squad scenarios how the hell there is something substantial going to happen !
If health care is a business than it is not going to be fair like most of us would like to see however unregulated business will even bring it down to its knees if you leave it to the 'private enterprises' solely.
People who really cannot afford these days do not get it. There are lot of people neglecting or over looking their ailments or going without medicines when it comes down putting food on the table v/s their health.
So for 1 in six americans who are poor they are living a life of 'third world'. This class is expanding as we speak and than it will not seem that difficult to make these difficult decisions !! Really sad....
Look, let us face a single over riding fact within the health care system that forces it out of the free market system and ensures that free market laws will never trully apply towards health care. The free market works when you have choices to offer and to make, however with health care there is no choice. You need a treatement for cointinued survival, why should i as a provider lower the cost? Why? Is there some magnanimous reason that permeates health care providers to lower costs? If there is i havent seen it yet. If i want to charge a million dollars for something that costs me twenty dollars, as long as you need it to survive you will damn well pay it. Welcome to the free market system as it applies to health care.
our health care system is working just fine. ask any congress person who has great coverage and they see no need to change.
HI Fareed, Hope all is well. You are missing a vital, centrist, market-oriented third option here. Think outside the box of private vs. public insurance, individual vs government payers.
The missing option is to finance health care for the poor and uninsured by giving doctors and health care providers (including drug companies) tax deductions for treating pro bono those who cannot pay. Essentially, we are talking charitable deductions, on steroids, for medical services to the needy. To accommodate all the needy (20% – 25% of the population), tax deductions should be set so that medical providers would be able to zero out their taxes by taking 20% – 25% of their patients pro bono. If properly designed, after tax income for medical providers should rise slightly as a result of pro bono health reform, which would give medical providers a simple incentive to take care of the needy.
No individual mandate is needed. No new bureaucracy would be needed. The IRS would be sufficient to certify financial need and process tax returns. No death panels would be needed. Doctors would make their own triage decisions and would have no incentive to over-treat any one patient, versus treating all the needy to the proper standard of care. PCPs would see more patients, emergency rooms less. Medical costs would drop across the system.
To read more about this original idea, look here: http://www.21stcentrist.com/2009/09/super-pro-bono-best-new-idea-in-health.html
Mr. Zakaria,
It seems to me that when I talk about government involvement (in any sector of the economy) I am constantly being rebutted by comments about freedom and personal choice. To me the debate is not even so much about the Free Market and Capitalism but about freedom in general; freedom from the government running our lives. Regardless of whether Obamacare saves Capitalism and allows the Free Market to work, people object to it because of the deep-seated fear on the far-right (and even among some moderate Republicans) of the government.
Now I personally believe that in order to be truly free we must also seek equality, and that every person needs to have the opportunity to succeed or fail on their own abilities (or lack thereof). When we as a nation keep the lowest and poorest from obtaining those benefits like healthcare and good education we are no longer a free society. Whether intentional or not we have done this. I don't think that anyone can disagree with me that healthcare is expensive, and even if you can afford healthcare you may not have enough coverage. Obamacare seeks to be largely a private-sector solution to get everyone covered and healthcare affordable. I tend to prefer Britain's system because it does not rely on insurance being affordable or obtainable, but is provided to everyone (though you do note in your GPS special that not everything is treated). But Britain (and others) is an example of how nationalized healthcare can work, and do it even better than private health insurance (compare Britain to the U.S.).
“Irrespective of what the nature of their immediate business may be, in reality there is only one business – the business of human wellbeing. That's everybody's business and that is my business too.” – Sadhguru
From "The Business of the Business" with Sadhguru and Kamath, chairman of Infosys Limited (India)
http://inconversations.com/sadhguru/in-conversation/k-v-kamath/live/?utm_source=MailingList&utm_medium=email&utm_campaign=In+Conversations-+KV+Kamath
great articel
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Hell, at the moment,health care threatens to grow to consume the entire economy of not just the United States, but most of the developed world. If you want to use your go to example of Europe, they too face rising health care costs. Check our~'Penny_Health'~to read articles on how to save money on health insurance.
I am reposting this comment after it was removed from this blog. Also the other posts from people who are Swiss have been removed and I can't understand why they were removed since they add legitimate specific detail to the debate.
Although I have always admire Fareed, I disagree with the assessment that we can do what Switzerland has done. After living in CH for 7 years and living with the healthcare system (which was fantastic) I think Fareed has missed several important points.
1. Switzerland has a solvent government and can afford this coverage. The CH tax rates are almost 30% lower than in the US which causes many business to move into CH over other countries, which in turn creates jobs and massive tax income which can offset healthcare costs.
2. Swiss people are very healthy. You can spend weeks in any canton in CH and would be lucky to find one overweight person, which lessens the burden of compounding cost on society.
3. Everyone pays into the basic insurance in CH, not just couples who make over 350K per year like the health care bill passed in the US.
4. They have a virtually non-existent unemployment rate and salaries that for me and my husband were almost 40% higher than the same jobs in the US. So, the rate you put in is insignificant to the amount of money you take home.
5. Government doesen't pay for everything. After the birth of our child, under basic insurance, we owed 17K. We had additional private insurance that paid 17K not paid by the basic CH insurance.
6. Government isn't as big as in the US. We paid a 12% total tax rate in our canton so again the health care cost was less burdensom than it is in the US where we pay a much higher rate (40% between federal and state taxes).
7. Although I am no expert on it... CH uses some sort of bidding system for insurance which theoretically lowers rates for basic insurance.
8. People in Switzerland pay for health insurance forever. There is on such program as we call Medicare to support people in old age without also continuing to pay into the system.
Although, the system is still controversial in CH, in my opinion it works. The problem is that we are not Switzerland. Our government is too big and indebted to consider feasibly affording this right now. We should consider what CH has done first by making a much smaller and efficient government and inviting businesses and workers in with extremenly low tax rates. Then people could have high paying jobs and afford to provide more coverage for people who need medicine here in the US.
Ahahahaha! The Obamacare is going to be shot down as I write this. It was a "train wreck" today at the Supreme Court according to CNN. I told you all. You Leftists lose again, your flawed thinking is on the wrong side again.
This is AMERICA. Land of the free. You can go move to Europe now, you are not reconstructing this place.
And now Obama will go on the defense and say to get Obamacare, reflect him. What a deserved tradgety for the Left. The socialists lose again here.
Come Novemeber the quiet majority is going to take it all back.
And guess what? Romney's past liberal positions on healthcare will just be nullified with Obama and it all becomes a NON ISSUE for everyone to decide who to vote for.
The right is right again! God Blass America.
I am a family doc, having practised fo 40 years...in Northern B.C. I was born and raised in So. Cal. My first year after I qualified was in Escondido, California. During this time I paid several tens of thousands of dollars for malpractice insurance, and constantly was looking back over my shoulder, fearful of being sued. I then came to Canada, where malpractice cost me $50. There ar around 200 docs on the local medical staff, and in my time here, not has been sued.
So, one cost of American health care is driven by litigation lawyers.
what about this Fareed: Those who don't' want to buy health insurance, they need to have some financial guarantee (showing savings, property, retirement fund or just life insurance etc.) to show that they wont' burden the system when they fall sick.
And then govt stops caring for those who chose to opt out of Individual mandate.
And then the field is level set: premium are calculated for those who are in the market, to be paid by the same people.
50 TRUCKS A DAY CROSSING FROM SYRIA TO HIZBOALLAH ECEVRY DAY SINCE MARCH 1 , ALL THE WEAPONS . CASH COME FROM IRAN AND SHIIA IRAQI GOVERNEMENT, AND THE HEAVY WEAPONS FROM RUSSIA SALE TO SYRIA , SYRIAN SENDING THE WEAPONS TO HIZBOALLAH AS A BACK UP PLAN TO BASHAR AL ASAD RUN, WHERE IS USA , UN AND NATO FROM THIS, THOSE WAR CRIMINALS KILLED MORE THAN 14,000 CIVILIANS TO DATE, WHY IS THE SILENT ....SYRIANS ARE STILL KILLING CIVILIANS DAILY, WHY THEY SEND WEAPONS TO HIZBOALLAH ALONG WITH CHEMICAL WEPAONS WE SEE IT ON THE GROUND EYES WITNESS SEE THAT THE TRUCKS GO AL BEQAA VALY AND SOUTH LEBANON , AND ANY BODY STOP THOSE TRUCKS WILL BE SHOT DEAD....SOME OF THE WEAPONS INCLUDE KATIOSHA ROCKETS, K47, HEAVY GUNS. ANTIAIRCRAFT WEAPONS, ANTI TANKS, MINES, LAND MINES , POISON GAS, AND SMALL UNMAN AIRCRAFTS. SCUDS ETC.....SYRIA MUST BE STOPED AND HIZBOALLAH MUST BE DEALT WITH , IRAN PREPARING THEM JUST INCASE THEY GET ATTACKED.
Zakaria, please address the insane amount of debt acquired by American Medical Graduates, American PA's, American NP's... The result of dirt-cheap medicine and sky-high medical education will result in an entire generation of providers forever in dept! Many of us are tired of being called "greedy" while $200K in debt and struggling to make ends-meat.
Healthcare must adapt to two important realities. Health insurance doesn't create healthy people. Sick people cost money one way or another. We are so instant gradification oriented here in the US – but Health has it's own natural time table. If you smoke tobacco for years – massive intervention when you develop lung cancer is only (expensive and invasive)crisis control at best. Eating "food" so far removed from being real it makes twinkies look good doesn't rob you of your health in a month, but if not corrected over time, it likely will.
And as for arguing that the government should not be interferring with the free market, have you heard of medicare, medicaid, social security, unemployment insurance, food stamps, licensing, taxes, laws, and fiat money?
(1) try practicing, and adequately reimbursing , PREVENTATIVE medicine, not the American reactive type:
(2) try the practice of health care, NOT THE BUSINESS OF HEALTH CARE;
(3)prohibit deceptive and misleading advertising practices by pharmaceutical and medical instrument companies
(4)single payor health insurance( cut down on useless insurance administration costs)
(5) tort reform ( including the old joke about the 1000 lawyers, chained and the ocean) (6)societal changes in personal responsibility for self destructive behavior
I have practiced medicine in the US and Canada. For years the average Canadian thought they had the BEST health care system in the world with no directly visible charges....hmmmm taxes? Quality of acute care outcomes is similar between US/Canada. Major difference was wait time for non-urgent procedures, including access to newest "black boox " technology. Both systems have problems. Americans are too easily mislead and DEMAND the BEST, whatever the computer tells them . I demand to see a cardiologist for this chest discomfort( initial meet and greet $300, plethora of medical-legally motivated, not medically indicated , tests $5000. Or visit family doc for assessment( no direct charge $75 charge to government) and a logical, progressive testing regime that seals the diagnosis with H2 blockers and dietary adjustment.
You compare the costs.
Single Payer. Just like Canada. Free market health care delivery with single payer insurance. It's inevitable. There is no stopping it. There is only all the shouting, screaming, lobbying, and insanity to be suffered between now and it's ultimate implementation.
Vermont has already cleared the way to start implementing it. Many other blue states are close to laying the ground work. This is precisely how Canada ended up with Single Payer - province by province until the federal level finally decided it was a done deal. The program is so successful and popular in Canada that no politician would suggest to eliminate it. Single Payer was inadvertently implemented by a coalitions of doctors in Grand Junction, Colorado with the result that health care costs in Grand Junction are the lowest in the country and HALF what they are in many other areas - with nothing unique about the demographics.
After blue states start implementing it, and citizens of red states continue to see their health care costs skyrocket relative to the Single Payer blue states, the citizens of the red states will be clammoring for their state to go Single Payer. That's precisely the how the dominoes will fall, and there will be no stopping it for the simple reason that it is overwhelmingly the right thing, and BY FAR the most cost effective thing, to do.
BTW... with Single Payer, businesses are no longer bothered with overhead headaches and expenses for things like shopping new health insurance constantly and there is no need for workers compensation. Auto insurance no longer needs to cover the medical expenses of accident victims. That coverage is a big part of auto insurance premiums that remains high regardless of the value of the vehicle you're driving. Single Payer makes those things simply disappear.
A few years ago I was bit by a brown recluse. It cost me several thousand dollars at the local public hospital to wait 8 hours in urgent care and eventually be seen by an NP who went at my leg with a scalpel five minutes after handing me a percocet and sent me off with a bandaged ankle and a few percos for the road. This experience lead me to realize that most medicine isn't all that complicated. Have necrotic flesh? All they're gonna do is hack it out with a blade so you might as well do it yourself. Get an Xacto knife and some vodka, sterilize the blade, cut it out, and get properly wasted to kill the pain. Best case scenario, get a friend to wield the knife after you've had a shot or three.
This experience has lead me to support black market medicine. Google offers vast amounts of information for most cuts, burns, bites etc., it can make going to the hospital totally avoidable in many instances. Pretty much anything short of a properly broken bone can be solved with Google and a decent supply of internet-procured pain killers.
I practice family medicine as a salaried hospital employee in an area where most patients have Medicaid or are private pay (no pay) so I am acutely aware of the cost of what I order. The 2 major problems escalating healthcare costs with little to no change in patient outcomes are defensive medicine and end of life care. The practice of defensive medicine isn't just ordering more tests so you don't miss anything and get nailed with a failure to diagnose lawsuit. It includes hospital observations and specialist consultations to CYA. I would hate to see the bill for all the people I have had to admit to the hospital because the ER doctor was worried about the liability of letting them go home. End of life care is also very expensive. I have seen so many patients kept alive for weeks longer with no chance of recovery only because they had no living will and their distraught families do not know what to do.
Health Care is a privilege, not a right. Just like police and fire protection, K-12 education, highways, and national defense. You should take personal responsibility and pay as you go and stop looking for handouts.
you're dead wrong on this! Education, healthcare, personal security and freedom are the innate rights of every citizen. Or should be at least in this country.
Why not tax people for Health Insurance or increase Medicare taxes and make health care available to everyone (people with job/s, jobless, homeless,..). If you earn more, you should pay more for health care tax and make it less burden for middle class and poor people. Unfortunately, that seems more communist to America.
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No family, company, and/or business can survive a 20% increase in costs per year while at the same time only receiving 4%
in profits per year. AND that is the healthcare picture in America. At a rapid rate, Americans are dropping their health insurance and joining the freeby emegency room lines. Taxes in the form of medicare, medicaid, State and Federal grants PLUS increasing insurance premiums is the only thing keeping hospital and doctor offices open. BUT this is shrinking fast.
I'll give this thing two years at the most before the whole thing collapses.
I think it also "spreads the love." The sicker these people are, the more they cause a negative factor on society as a whole, and the sicker they are to make others sick as well. One thing spirals onto another and wages high costs in lost productivity and effort for inability to do what needs to be done. I realize the GOP solution is to kill anyone who can't work due to illness or need of surgery, and that includes kids, but really?
I kissed my way up to VP at a health insurance company. Now I take over $500,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $106,800 level. Now I only pay 1.3% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.
Let's get back to basics..We are not talking about health care..We are talking about "sick"care. We start with a doctor and a patient and try to not add any unnecessary additional players. As we add we are careful to remove scavengers such as lawyers and businesses that serve as middle men..Would you give your neighbor money each year and ask him to pay for your care and keep the rest?? Do we need to pay big bucks to administrators, lobbyists,drug executives,politicians ,lawyers who get to play on both sides..A system that works efficiently can repay the money to the doctors for research and training and to the patient for health and "sick"care..
The health care system is made up of payers,hospitals and the ppos who own the network of hospitals and doctors.All three sign no audit agreements and have PAY AS CHARGED contracts......
Maybe we should just say "Healthcare isn't a Right" and let the 5% of the people that are creating 50% of the expenses either pay their own way, or die off. After several short years of this we would be massively healthier, massively more efficient, and massively better prepared to totally rock on economically for decades to come. Short term pain, but very long term gain, and we would eliminate most of the "theft" of robbing healthy folks to pay for the unhealthy (esp. since many of the unhealthy are only that way because of lifestyle choices THEY made ... and now they are making the rest of us suffer for THEIR bad choices)
Reblogged this on nealstotts.
Fareed
On your TV shown you asked "what if everyone had to pay out of pocket to see the doctor and their insurance only covered major care?" You then made the argument that there are many of those (and you gave examples) who abuse their employer paid health insurance by seeing the doctor for every minor injury or illness, because they know they don't have to pay for it, which drives up the cost for everyone else. Why didn't you mention this in your post? Is it because they don't make up the 5% that drive 50% of the cost? Just curious. Thank you.
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