April 30, 2008
Following up on my previous post.... go read Ezra.
It's 3 a.m. and your child is awake. She's been up coughing all night, fever resting between 101 degrees and, for a few scary minutes, 103. You and your husband spent hours trying to decide whether to take her to the emergency room. A couple times, you even started toward the car. But you know you can't afford a trip to the hospital. You don't have health insurance.
It's 3 p.m. and your child is finally asleep, her forehead still hot to the touch. Somewhere in the house, a phone is ringing. It's your old insurance company, the one you had before your employer decided to make you a contractor rather than a full-time employee. Sorry, they say, but your family just doesn't fit their risk profile. They've got nothing in your price range. What if we pay a little more, you ask, rapidly weighing the consequences of taking out another mortgage or shifting more purchases to credit. Sorry, the even-voiced representative says, this time more firmly, they really don't have anything for you at all.
It is a call -- or, sometimes, merely a letter -- that millions of Americans have received, particularly those not covered by large employers or the federal government. These Americans are rejected for health insurance because they were sick once, or because they're too old now, or for no apparent reason at all. They are rejected because insurers make money by not paying for care. To get an idea of how insurers think about care provision, it's worth knowing that they routinely speak of "medical-loss ratios" -- the amount of money they "lose" paying for the medical treatment of their customers. But you can't blame them, really: Insurers seek to make a profit, and some of us are simply not profitable.
It is not a call that John McCain has ever received.
I realize that conservatives think markets are the answer to everything, but even accounting for that, McCain's new health care proposal is really, really dumb. The typical cost of health care coverage for a family in the US today is around $12,000. McCain's plan would cover $5000 of that with a tax credit, and then leave you to cover the rest. And the best part? By smashing the link between health care coverage and employment, he would remove the subsidy that many Americans receive when their employer covers half the cost of their premiums. In other words, for most people their out of pocket cost would go up. Brilliant, no?
Jonathan Cohn, a health care policy wonk's wonk, responds:
In just the last few weeks, this issue has started to become a political liability for McCain, thanks mostly to Elizabeth Edwards, who--in addition to being a well-known cancer patient--is also a well-known policy wonk. Edwards has given a series of speeches in which she has pointed out that neither she nor McCain himself, who is a three-time melanoma survivor, could buy individual insurance under his plan, since insurers would disqualify both of them for pre-existing conditions.
McCain bristled at this suggestion, vowing recently to ABC's George Stephanopoulos that "we're not leaving anybody behind." His advisers echoed that sentiment, saying Edwards didn't fully understand the proposal--and that, in short order, they'd have more to say on the subject.
Apparently that's what McCain was doing earlier today. In a speech at a Florida cancer hospital, McCain acknowledged that people with pre-existing conditions can't always buy insurance on their own. But, he says, that doesn't mean these people will be left to twist in the wind.
Instead, McCain is offering people like Edwards what he calls a "Guaranteed Access Plan." But unlike all those awful big-government entitlements the Democrats are promising--you know, the ones that (supposedly) make you wait in long lines and cut off access to high-technology treatments--McCain says his plan will let the states handle the problem by working hand-in-hand with private insurers to offer insurance for people with pre-existing conditions.
It will be the best of both worlds, McCain promises: Affordable, available insurance, but through private carriers and without the heavy hand of Washington.
It all sounds very lovely--unless you know something about health care policy, in which case it sounds absolutely preposterous.
Read on for all of the details.
The rest of the world has already largely solved this problem, but for some reason we continue to insist that we can't look to them for our solutions. At bottom, its quite simple: for a whole host of reasons too long to list, the magical power of markets cannot solve our problems. Why? Because in most cases, it is the magical power of markets that are actually creating our problems. Virtually everyone who has studied this issue already understands this. Except, apparently, the people advising Republicans.
Expect Elizabeth Edwards to stay front and center on this between now and November. In fact, if I had to make a prediction, I'd guess that it will be she, even more than Obama and Clinton, who will define the terms of debate this fall. And if that doesn't terrify McCain and his people, it should.
UPDATE: Much more from Hilzoy here.
April 25, 2008
When we have gotten to the point where even the blogs at Glamour Magazine are analyzing health care policy and concluding on entirely reasonable and appropriate policy analysis ground that McCain's proposals make no sense, we really have gotten somewhere in our political debate, haven't we?
Know hope!
April 13, 2008
Frontline's report this week is a look at the US health care system in comparative perspective:
If you look at the World Health Organization's rankings of national health care systems, you'll find the United States sandwiched, uncomfortably, between Costa Rica and Slovenia -- 37th overall.
In this Tuesday night's FRONTLINE broadcast, "Sick Around the World," veteran Washington Post foreign correspondent T.R. Reid asks: What can we learn from some of the thirty-six countries listed above us? With health care reform at the top of the agenda this election year, the answers couldn't be more timely.
In Japan, for example, Reid finds that people go to the doctor three times as often as Americans, have more than twice as many MRIs, use more prescription drugs, and spend more days in the hospital, yet Japan spends about half as much per capita as the United States thanks to strict price controls -- a ten-dollar a night hospital stay, a ninety-eight dollar MRI.
In Taiwan, every citizen is issued a "smart card" containing a person's entire medical history and a code to get bills paid automatically, cutting administrative costs to less than 2% -- a fraction of the 12-30% of American health care dollars that are estimated to be eaten up by all of the paperwork burdening doctors and hospitals.
To be sure, many of the countries Reid visits still have their problems: doctors protesting low pay in Germany, hospitals struggling to stay in business in Japan and Taiwan, patients complaining about long lines and limited choices in the United Kingdom. But, in these countries, Reid also finds a few bottom-line rules of successfully providing universal health care that none of the U.S. presidential candidates has yet dared to suggest: Doctors and hospitals have to accept a set of fixed prices for all services, and private insurance companies can't make a profit when delivering basic care. Not a dime.
I know a good bit about the system in Europe, but next to nothing about what goes on in Asia. Should be quite interesting...
April 9, 2008
If you care at all about health care reform, please go read this. If you were in my comparative public policy class last semester, please go read this.
Today's lesson: health care supply creates demand that does not in any way improve outcomes.
April 4, 2008
Is there nothing these fools will not do? Wired:
A U.S. government-funded medical information site that bills itself as the world's largest database on reproductive health has quietly begun to block searches on the word "abortion," concealing nearly 25,000 search results.
Called Popline, the search site is run by the Johns Hopkins Bloomberg School of Public Health in Maryland. It's funded by the U.S. Agency for International Development, or USAID, the federal office in charge of providing foreign aid, including health care funding, to developing nations.
The massive database indexes a broad range of reproductive health literature, including titles like "Previous abortion and the risk of low birth weight and preterm births," and "Abortion in the United States: Incidence and access to services, 2005."
But on Thursday, a search on "abortion" was producing only the message "No records found by latest query."
Stephen Goldstein, a spokesman for Johns Hopkins, said he wasn't aware of the censorship, and couldn't immediately comment.
Under a Reagan-era policy revived by President Bush in 2001, USAID denies funding to non-governmental organizations that perform abortions, or that "actively promote abortion as a method of family planning in other nations."
A librarian at the University of California at San Francisco noticed the new censorship on Monday, while carrying out a routine research request on behalf of academics and researchers at the university. The search term had functioned properly as of January.
Puzzled, she contacted the manager of the database, Johns Hopkins' Debbie Dickson, who replied in an April 1st e-mail that the university had recently begun blocking the search term because the database received federal funding.
"We recently made all abortion terms stop words," Dickson wrote in a note to Gloria Won, the UCSF medical center librarian making the inquiry. "As a federally funded project, we decided this was best for now."
More:
University administrators of the world's largest scientific database on reproductive health blocked the word "abortion" as a search term after receiving a complaint from the Bush administration over two abortion-related articles listed in the database.
"The items in question had to do with abortion advocacy -- the two items dealing with abortion were removed following this inquiry, and the administrators made a decision to restrict abortion as a search term," said Tim Parsons, a spokesman for the Johns Hopkins Bloomberg School of Public Health in Maryland.
The blocking of the keyword "is a decision that the dean does not support in any way," he added, and the administrators are unblocking the search for the term right now.
"I could not disagree more strongly with this decision, and I have directed that the Popline administrators restore 'abortion' as a search term immediately," said Michael J. Klag, the school's dean in a statement issued on Friday. "I will also launch an inquiry to determine why this change occurred. The Johns Hopkins Bloomberg School of Public Health is dedicated to the advancement and dissemination of knowledge and not its restriction."
The Popline search site is funded by the U.S. Agency for International Development, or USAID, the federal office in charge of providing foreign aid, including health care funding, to developing nations.
Good to see JHU decided not to play along with this nonsense.
April 1, 2008
I know its still early, but I'm already calling it. Nobody is going to beat this from Ezra:
Elizabeth Edwards says she and John McCain have one thing in common: "Neither one of us would be covered by his health policy." True enough. McCain's health care plan would let insurers continue to discriminate against preexisting conditions, and melanoma, which McCain has had, and breast cancer, which Edwards has, would be more than reason enough to deny coverage. Sure is lucky for John McCain then that he has government health insurance, where his premiums are community rated and insurers can't turn him down. Watching him tout "the best health care system in the world" and then propose reforms that have nothing to do with the government health care he's aways known is like watching a fat man eat a cake, praise the cake, loudly proclaim that everybody should try his cake, and then offer you some celery.
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