Game Developers vs. Health Insurance (MW2 and Eric Peterson)

[jpinard]

In the latest (June) issue of PC Gamer is an article about Eric Peterson who needs a a liver transplant. He developed the Mechwarrior 2 games and is in need of funds for the transplant since he has no health insurance.

So, a few questions...

Is there no health insurance program for independant developers, something like how writers/actors etc of the tv/movie industry are covered?

I know this is a political question, but why can illegal aliens get free health care in this country, but Eric has to wait... raise funds and pay for all his health care out-of-pocket? There is something very wrong with a system that provides free health care to everyone but it's own citizens. I can't even tell you the number of times I've been in the hospital and had a roommate there with no visa, no work papers, no insurance, and the hospital just says, "well, guess we'll have to write another one off!" Meanwhile I get the 3rd degree on payment.

Here's the link http://delversdungeon.dragonsfoot.org/eric.htm - though I have no money, I still donate a little since I've always believed a little from a lot of people can help a lot. But I have to admit, it'd be better if they had a paypal fund setup for medical care.

Hope Bill D. sees this thread, as Eric said he used Tylenol for 3 weeks during the flu and that apparently killed his liver. Not sure how much he took - but if it was the recommened dosage (or slightly above), that's kind of scary. I had no idea a 3 week course of Tylenol could be so detrimental.

[Charles]

I like living in Canada.

[WarrenM]

I like living in Canada.
Yeah! Free medical care and ... uh ... and ... Wait, why?

[jpinard]

Yeah! Free medical care and ... uh ... and ... Wait, why?

Canada is a very nice place. And as global warming increases, it will be the new California! :p

[Derek French]

I was having an argument with a guy here at work who is from the States where he was adamantly stating that the US health care system is better than what we have here in Alberta/Canada. He said it was because that if he needed health care, he could just pay for it and not have to wait in line behind anyone else.

I am just horrified by the above news.

[Alan Dunkin]

Independent developers are just like any other person in a freelance job, you're a contractor. Which means you have to pay your own way for insurance, usually at prices way higher than what you'd get if you were with a company. Probably $100-$150 a month for remotely decent coverage at the minimum. I used to get mine independently through Blue Cross/Blue Shield. Though this is all deductible, like a lot of things, for self-employed folks, for tax purposes.

Writers/actors are covered becuase they are typically unionized. That changes a lot of things.

--- Alan

[BaconTastesGood]

Probably $100-$150 a month for remotely decent coverage at the minimum.

As an indie developer/contractor, health insurance is a major issue. I find it very, VERY strange that your health insurance is tied to your employment. How in the world are they related?

And I pay a cubic fuckton of cash every month since I have a family.

Canada has a very equitable system for most health care, but I've heard that the USA has the best trauma handling of most countries. But for routine shit, you're pretty screwed.

I'm a capitalist at heart, even though capitalism is the reason this country is uberfucked politically.

[SwampIrish]

cubic fuckton

I must remember this. It sounds like a very accurate system of measurement. :)

[metta]

Is there no health insurance program for independant developers, something like how writers/actors etc of the tv/movie industry are covered?

Those folks belong to very powerful unions. If you want healthcare, organize!! >.<

[Incendiary Lemon]

He said it was because that if he needed health care, he could just pay for it and not have to wait in line behind anyone else.

That makes me want to roll my eyes and scream. Its true if your independently wealthy but if you have insurance? Good luck...

[Slainte Mhath]

Insurance is VERY expensive when not subsidized by a company. During a brief stint of unemployment, I was paying $800 a month to cover my family. Basically, half my monthly unemployment checks went to cover healthcare.

Independant developers who can't get on a group insurance plan with their local small business group or chamber of commerce are pretty much screwed. The costs of subsidizing insurance for employees is astronomical.

What makes it worse is that people with no insurance but who are gainfully employed are charged 3-5 times as much for the same medical services as people who have insurance or people who are considered "indigent" (poor). In essense, you're punished for being employed and not having insurance. That's retarded.

[madkevin]

Yeah! Free medical care and ... uh ... and ... Wait, why?

You can't get arrested for smoking pot.

[BaconTastesGood]

Insurance is VERY expensive when not subsidized by a company.

Right, my point is that your _employer_ shouldn't be subsidizing that shit, the government should be. Or, more precisely, someone with a keen interest in your long term health, which is either A.) you or B.) the gummint.


Independant developers who can't get on a group insurance plan with their local small business group or chamber of commerce are pretty much screwed.

Any tips on this? The best 'in' I have is through USAA, who are a good credit union, but the last few times I've got quotes from them they were outrageous -- no better than BC/BS individual plan.


What makes it worse is that people with no insurance but who are gainfully employed are charged 3-5 times as much for the same medical services as people who have insurance or people who are considered "indigent" (poor).

Yep. Insurance companies can negotiate rates down to a ridiculous amount, so you they pay $18 for a doctor's visit, period. Individual consumers don't have that leverage, and end up paying $50 or $75 because that's the only way a doctor can profit.

It's this really fucked up unholy triangle of entities screwing each other because the system as it stands is optimized for it. Big pharma, industry, and the medical profession all work within the rules to maximize profit, and the people that get screwed are taxpayers and patients.

Unfortunately the only way a countrywide healthcare would really make sense is if you removed the really big ticket items from coverage. Cap benefits for an individual with a terminal condition, and just optimize the system for preventative and acute problems which provide a good ROI, and lock out or greatly reduce subsidization of long term terminal care where a single patient can consume more resources than 100 other patients.

[Old Man Gravy]

optimize the system for preventative and acute problems which provide a good ROI, and lock out or greatly reduce subsidization of long term terminal care where a single patient can consume more resources than 100 other patients.

Good plan, but good luck on implementing that. I'm on the finance side of the industry, and one of my macro-gripes about it is the way we spend bajillions to increase some old or extremely ill person's life by a tiny increment, while lotsa kids who would otherwise have their whole lives in front of them fall through the cracks because there's no money there for them to even get basic preventive care.

While the members of the industry certainly share some blame, we gotta consider the real cost driver: the gray vote. A MASSIVE consumer base who a) always want the best of the best care, b) think they should get it for free and, indeed, have to pay either nothing or only a tiny fraction of the cost of the services they consume, c) consume the VAST majority of health care services provided in this country, and d) scare the holy living sheeyite outta Congress because of their tendency to vote as monolithic focus-issue (read: Social Security/Medicare) voters who NEVER miss a chance at the polls.
Huge consumer base + uncontrolled propensity to consume + government subsidization + no cost consideration for consumers= out-of-control price increases.

Health care facilities know that if they're to survive they have to compete for the expecting-nothing-but-the-latest-and-best and not at all cost-conscious Medicare recipients. Their management conversations go something like this:
VP: "We need a brand new CAT scan and MRI machine in radiology and a new Hemodynamics system in the cath lab. Total cost: $14 million."
CFO:"Wait! Didn't we already replace all that stuff like two years ago?"
VP:"Well, yeah, but there's this new tech now. Plus, St Peter's put in a new cath lab imaging system and all the Medicare heart patients are going there now."
CFO:"Yeah, okay, we actually COULD stand to keep that Medicare patient base, since it makes up 68% of our total reimbursement. Approved!"

Then the postscript is the imbeciles in Congress come back and point their shit-stained fingers at the industry, when they themselves were the original architects of the problem. God bless America!


And jp, re: illegal immigrants - they wouldn't be getting a liver, either. Federal laws require that hospitals stabilize a patient who's in trauma and treat a woman in labor without regard to ability to pay, but that's it. If Pedro the Illegal came in off the construction site and his liver was failing, the hospital would have to stabilize him and then would most likely either release him with a pat on the ass or just make him comfortable if it looked like he wasn't long for the world, then write off the cost.

[TheTrunkDr]

Yeah! Free medical care and ... uh ... and ... Wait, why?
Because it has significantly less suck than the US.

[Dr Fear]

Eric said he used Tylenol for 3 weeks during the flu and that apparently killed his liver. Not sure how much he took
According to that website, "I self-medicated by taking way too much Tylenol."


I had no idea a 3 week course of Tylenol could be so detrimental.
Again, according to the website, he had hemochromatosis, which means he most likely had a damaged liver in the first place. So he was taking excess amounts of a drug with known liver toxicity while likely having reduced liver function. This is completely different from taking a normal course of acetaminophen.

[Jason McCullough]

Unfortunately the only way a countrywide healthcare would really make sense is if you removed the really big ticket items from coverage. Cap benefits for an individual with a terminal condition, and just optimize the system for preventative and acute problems which provide a good ROI, and lock out or greatly reduce subsidization of long term terminal care where a single patient can consume more resources than 100 other patients.

You do realize the entire point of health insurance is covering "really big ticket items", right? What's the point of insuring yourself against treatments you can afford anyway? Same deal for auto insurance & house fires - it's spreading the risks on catastrophic losses.

This is different from "pay a million to keep some terminally ill old guy alive for another week", which no one really supports - there's plenty of enormously expensive treatments with a good life expectancy/quality of life increase.

[TheTrunkDr]

Unfortunately the only way a countrywide healthcare would really make sense is if you removed the really big ticket items from coverage. Cap benefits for an individual with a terminal condition, and just optimize the system for preventative and acute problems which provide a good ROI, and lock out or greatly reduce subsidization of long term terminal care where a single patient can consume more resources than 100 other patients.
This is the whole problem, healthcare shouldn't be about ROI at all. What's the ROI for the person who's life is being saved? Jesus fuck you can't apply economics to health care since there isn't a consumer choice in the matter. This is why for profit healthcare doesn't work and should be provided and regulated by the state. There's also little profit in keeping people healthy, which should be the end goal of any healthcare system. The state is more concerned with saving money (done by keeping people healthy) than making money off selling medications and procedures to sick people.

[BaconTastesGood]

You do realize the entire point of health insurance is covering "really big ticket items", right? What's the point of insuring yourself against treatments you can afford anyway? Same deal for auto insurance & house fires - it's spreading the risks on catastrophic losses.

There's a pretty broad range between 'you can afford' and 'millions of dollars'. For most people, broad health care coverage should cover the stuff in between and the preventative stuff. Routine physicals, things like that.

But if you pop your back and need an MRI, that is not a trivial expense. But also isn't exactly liver transplant territory either. That, to me, is the stuff health care should help subsidize, since it improves one person's quality of life and can make a huge difference on their ability to provide back to society.

And believe it or not, there are a lot of people that would adamantly refuse to make the call of 'spend a million dollars to keep someone on the edge of death indefinitely' vs. 'spend a million dollars to keep 1000 people healthy for a year'. That whole 'is one life more valuable than X others' philosophical argument.

Hell, I'm all for letting transplants go to the highest bidder and then forcing that money back into the health care system. But there's no way that most people would sign off on it because of this inculcated sense of fairness we have.

"Why should HE get the kidney just because he has a million dollars?"
"Because we then take that million dollars and use it to pay for vaccinations and medicine for thousands of underprivileged children"
"Well....it's still not right"

[BaconTastesGood]

This is the whole problem, healthcare shouldn't be about ROI at all. What's the ROI for the person who's life is being saved? Jesus fuck you can't apply economics to health care since there isn't a consumer choice in the matter.

That's an awesome philosophy to have, but the problem is that economics don't give a fuck about 'should'. Someone, in the end, has to pay, and no matter who pays, there's a finite amount of resources that are available. End of story. So while I think everyone should live forever, the practical reality is that society can't provide this.

So society DOES have to worry about ROI, because it has a limited amount of funds to devote to healthcare and maximizing that usage benefits everyone except for the few that would really like infinite spending on their particular issues.

[Squirrel Killer]

Hell, I'm all for letting transplants go to the highest bidder and then forcing that money back into the health care system. But there's no way that most people would sign off on it because of this inculcated sense of fairness we have.

"Why should HE get the kidney just because he has a million dollars?"
"Because we then take that million dollars and use it to pay for vaccinations and medicine for thousands of underprivileged children"
"Well....it's still not right"
...just imagine a kidney for little 8 year old Kaitlyn going to 76 year old Greedo McGreedy with the cool mil.

[Charles]

...just imagine a kidney for little 8 year old Kaitlyn going to 76 year old Greedo McGreedy with the cool mil.


Yeah but a good system would then put half or a quarter of that money on the guy's head for a hit, and then Bill D will swoop in and take the kidney, give it to the child, and everybody wins. Health system has more money, millionaires have a sense of superiority, kid lives, and Bill D gets to write another novel.

[Jason McCullough]

And believe it or not, there are a lot of people that would adamantly refuse to make the call of 'spend a million dollars to keep someone on the edge of death indefinitely' vs. 'spend a million dollars to keep 1000 people healthy for a year'. That whole 'is one life more valuable than X others' philosophical argument.

Name one. There's probably a few libertarian cranks you can find, but you couldn't get elected dogcatcher with a platform like that. It's a non-issue.

Clearly there has to be a morality + "return on happiness and life length" calculation, but I don't see how "let's deprive poor people of organ transplants to hold up rich people for ransom to buy poor people health care" has to be the implementation. Or is even related for that matter. What, insurance pooling & taxes aren't good enough?

Going back a bit here:


While the members of the industry certainly share some blame, we gotta consider the real cost driver: the gray vote. A MASSIVE consumer base who a) always want the best of the best care, b) think they should get it for free and, indeed, have to pay either nothing or only a tiny fraction of the cost of the services they consume, c) consume the VAST majority of health care services provided in this country, and d) scare the holy living sheeyite outta Congress because of their tendency to vote as monolithic focus-issue (read: Social Security/Medicare) voters who NEVER miss a chance at the polls.

Huge consumer base + uncontrolled propensity to consume + government subsidization + no cost consideration for consumers= out-of-control price increases.

How come the US is the only first-world country with a collapsing medical system? Seriously, this is just the libertarian "people vote themselves money out of the treasury until everyone's poor" argument applied to medical care. There's no evidence for it. We should all be living on the street because oldsters voted themselves 100% of GDP from social security, right? Did I hallucinate the country electing anti-tax people any time the tax rate moves up too much?

There's plenty of evidence for cost-shifting overhead, insurance pool self-selection, and agency problems, and that's enough to basically explain it all.

[Dr Fear]

How come the US is the only first-world country with a collapsing medical system?
Because the quality of care in the US is by far the best, and the cost for significantly better care is exponentially, not linearly, related to the quality of that care.

[Alan Dunkin]

How come the US is the only first-world country with a collapsing medical system?

It's not. The UK's NHS is imploding on a daily basis.

--- Alan

[Old Man Gravy]

Seriously, this is just the libertarian "people vote themselves money out of the treasury until everyone's poor" argument applied to medical care.
No. It's not. I'm not sure about the system collapsing, but I was talking specifically about the increase in prices. It's the "there's very little downward pressure on price levels for suppliers and service providers because the vast majority of consumers consider cost last, or (in many cases) not at all, when deciding which services to purchase" argument that flows from an understanding of basic economics.

The majority of health care consumers think more in terms of co-payments, deductibles, or other out-of-pocket expenses than total cost when shopping for services. It's even more pronounced with Medicare cases, because Medicare generally pays on a fixed reimbursement system that allows the same amount for a given procedure regardless of who provides it. So the natural thing for patients to do is to seek out the best (and usually most expensive, in terms of total cost) care they can get, since their out-of-pocket will be pretty much the same no matter which provider they select. Ever wonder why there are no "Hi, I'm the low-cost alternative to unnecessarily invasive and expensive hospital care in this town!" medical outlets?
Suppliers and service providers, on the other hand, think in terms of total reimbursement, so they're just sitting out there squeezing the goose for the golden eggs as hard as they can without killing it.

CMS and the insurance industry, acting in many cases as CMS' representatives in given geographic regions, do an okay job of checking prices through contract negotiations; but there's only so much they can do against the deluge.


There's plenty of evidence for cost-shifting overhead, insurance pool self-selection, and agency problems, and that's enough to basically explain it all.
I have no idea what you're talking about here, or what's being explained by it, but I'm sure you're probably right.

[Graeme Dice]

Because the quality of care in the US is by far the best, and the cost for significantly better care is exponentially, not linearly, related to the quality of that care.

The U.S. health care isn't that amazing, as illustrated by the study discussed in U.S. health care mediocre across the board (http://www.msnbc.msn.com/id/11842861/) And then there's the fact that there are more people without health insurance in the U.S. than there are total people in Canada.

[Ben]

We should all be living on the street because oldsters voted themselves 100% of GDP from social security, right?

Don't you remember like two sentences earlier stating that the US medical system is collapsing?

[BaconTastesGood]

...just imagine a kidney for little 8 year old Kaitlyn going to 76 year old Greedo McGreedy with the cool mil.

Exactly, people would freak out, even if Greedo McGreedy's cool million bucks turned around and helped 100 other kids just like Kaitlyn but have different medical problems.

The argument isn't really 'Greedo McGreedy vs. Kaitlyn', it's 'Kaitlyn vs. 100 kids like her', but that would never, ever be how it's positioned.

[Phil_Stein]

OK, this is a topic near and dear to my heart, as I'm a game developer who's been trying to find health insurance lately.

I left PopTop/Take 2 16 months ago, and switched on to their COBRA coverage, which ran ~$850/mo (I have a family of 5). Knowing that it only lasts 18 (or 20, I forget) months, I applied this past December for insurance with two different carriers.

Long story short - one major carrier rejected us outright. The other dragged their knuckles, then denied us over a condition that my wife and kids have, then, after we presented further info, finally approved us (taking ~4 months total), for coverage at ~$650/mo, with $1000 annual deductibles per person ($3K family, I think).

We had 4 exclusions along with the policy - 1 for a condition of mine, and 3 for my wife. One of the latter is likely going to end up in a surgery this summer that I'll be $5-10K out of pocket on.

BTW, we're basically healthy, but my wife has had 3 kids in the last 7 years, and has had a few issues in connection with those pregnancies, but nothing really out of the norm for pregnant women in their 30s.

I don't blame the insurers - they are obviously in business to make a profit, and don't want to take on pre-existing conditions or sick people. But there's an enormous amount of time and money wasted in the whole processing system right now, including the rather large amount of time it takes to apply for coverage (and the corresponding time on the agent's and insurer's part in evaluating the applications), and the same thing all over again for each significant bill submitted once insured.

For an individual/family, being uninsured is pretty unattractive. Not only is there the risk of a catastrophic event beyond the capacity of most people to pay, but there's the whole thing that people paying non-negotiated rates (i.e. 'list prices'), pay at GREATLY inflated rates. And nothings tax deductible unless you have really high medical costs in a given year (as opposed to employer-provided health coverage, which never even shows up on your income statement, much less do you have to worry about if you can deduct it or not).

So, because of tax breaks and negotiated rates, it is effectively MUCH cheaper to pay for equivalent medical care through employer-issued insurance than through employee paid, straight out of pocket pay as you go.

If you're self-employed, you can have your company (i.e. yourself), buy insurance, and yes, then you'll get the tax break, but, as mentioned above, it's much harder to actually GET the insurance, and basically, you'll only be insured for the treatment of conditions that you don't yet have. If you've got any kind of chronic conditions, or even if you've received any treatment for anything significant in the last 5 years, it's almost certainly not going to be covered. When you're a 25 year old male, this is rarely an issue. But as you get older, get married, and have kids, suddenly the list of 'prior medical conditions' gets a lot longer (we had to attach extra pages to our form).

[Squirrel Killer]

Exactly, people would freak out, even if Greedo McGreedy's cool million bucks turned around and helped 100 other kids just like Kaitlyn but have different medical problems.
So what's your plan to deal with the lynchings of Greedo McGreedy and every legislator who passed this wonderful system? I'm not sure "Step #1: Instigate class warfare" is a good plan.

[Ben]

I'm not sure "Step #1: Instigate class warfare" is a good plan.

Kulak traitor!

[Dr Fear]

The U.S. health care isn't that amazing, as illustrated by the study discussed in U.S. health care mediocre across the board (http://www.msnbc.msn.com/id/11842861/)
This is typical bad epidemiology, worse reporting of epidemiology, and doesn't even refute my point. The NEJM article referenced was in one of last month's issues. Looking at the actual article, it has all sorts of problems, including everything involved in retrospective studies, the fact that the chosen categories are some kind of RAND panel that is some theoretical and transitory standard for health care that doesn't necessarily correlate to clinical practice, is limited to "30 medical conditions," and tries to use this to evaluate treatment in categories that an intelligent physician would tell you can't be statistically separated. Just looking at the categories you can practically guess where the differences arise: I would bet money that the differences between women and men in the "screening" category arises almost solely from the fact that there is a protocol of screening procedures in women (Pap/ASCUS/HPV/colposcopy) that has no male analog, and is done so routinely that it has to raise the percentage of female screening procedures done properly without reflecting any "quality of care." The AP article itself makes all kinds of mistakes just in reporting the data, such as reporting differences between categories when upon examination, statistically there are none. Lastly, the survey makes no mention of the availability of specialized technical therapies in the US that are not available elsewhere which are the real cause of skyrocketing per capita medical costs, and the quality of these therapies. And as a bonus last point, the standard of care in the US could still be substantially better than anywhere else, even if every data point in that article were true, because there is no correlation to the standard of care in other countries. The word "mediocre" in the headline appears for no apparent reason because mediocrity can only be assessed relative to a population, and there is no population of health care systems against which that study is made. I guess the Associated Press embraces the 7-9 scoring system.

But nice job typing "US health care quality" into Google and thus making yourself an expert on health care evaluation.


And then there's the fact that there are more people without health insurance in the U.S. than there are total people in Canada.
This is one of those meaningless factoids that sounds great while you're typing it but means nothing. So what that there are? Google an answer, quick!

This should all be in P&R. Somebody should move it since it has clearly tanked the shark or gone into the shark tank or whatever.

[Graeme Dice]

But nice job typing "US health care quality" into Google and thus making yourself an expert on health care evaluation.

No, it's called being able to remember an article that you read about a month ago.


This is one of those meaningless factoids that sounds great while you're typing it but means nothing. So what that there are?

That should be obvious. The quality of health care available to the average person is the only factor that matters in any way, shape, or form, simply because every person has an equal right to access to health care under any ethically sound system. People who claim that the U.S. system is great because you can get good health care if you can afford it are both idiots and heartless bastards.


This should all be in P&R. Somebody should move it since it has clearly tanked the shark or gone into the shark tank or whatever.

What do you expect when people defend the absolute failure that is the U.S. health care system?

[Alan Dunkin]

If it was an absolute failure I wouldn't be able to get health care. I can, therefore you're being a little overdramatic don't you think?

--- Alan

[BaconTastesGood]

So what's your plan to deal with the lynchings of Greedo McGreedy and every legislator who passed this wonderful system? I'm not sure "Step #1: Instigate class warfare" is a good plan.

Maybe you missed the part where I said "people would freak out" and specifically pointed out why such a plan would never work.

[Squirrel Killer]

Maybe you missed the part where I said "people would freak out" and specifically pointed out why such a plan would never work.
Which is why I didn't miss "I'm all for letting transplants go to the highest bidder..." either.

[jpinard]

Phil,
I wish I had more comforting words to say outside of, "I feel your pain". So cliche'd, but can't think of anything more approrpriate. People who are healthy or have career medical coverage have no idea how terrifying it is to have to be worried about how you're going to get/stay covered - and not go broke.
What's ironic is if a person had no money, no job, they'd have a more comfortable healthcare solution than a person who's working hard but has no employer healthcare plan.

I wish most of our politicians weren't independantly wealthy, didn't receive lifetime healthcare, and had to worry like mad about the cost and availability of medicine.

[Desslock]

I was paying $800 a month to cover my family. Basically, half my monthly unemployment checks went to cover healthcare.

Man, I wish I only paid $800/month for my Canadian health care, but I do like that everyone has at least basic (and pretty good) medical insurance care available in Canada when they need it, regardless of their financial condition. I don't really understand why basic medical insurance isn't similarly automatically made available to U.S. residents.

[Lunch of Kong]

So, Desslock, can we move-in with you for a little while and get treated in Canada for free?

[Elton]

It's the "there's very little downward pressure on price levels for suppliers and service providers because the vast majority of consumers consider cost last, or (in many cases) not at all, when deciding which services to purchase" argument that flows from an understanding of basic economics.


Yes -- A great example is laser eye surgery, which is not often covered by insurance. The effectiveness of the procedure has improved considerably over the last few years while the price has dropped dramatically because providers compete on price. Usually the first happens with covered procedures but there is little pressure for prices to go down. There is lots of innovation for new techniques and not as much to make existing techniques cheaper.

Everyone's got a plan to fix health insurance ... the most sensible thing I've seen was proposed by (I think) Tim Harford (the guy who wrote "The Undercover Economist"), and has been implemented in someplace small like Singapore. The basic idea is that health insurance should be more like car insurance -- as mentioned above, it should protect against catastrophic expensive stuff, and people should pay out of pocket for routine and preventative care. To make it work, you need to:

1) Make catastrophic insurance obligatory. Healthy people who might otherwise forego it will help subsidize the less healthy. Government covers the costs for the poor. Should be much less expensive than current insurance plans.

2) Everyone gets a medical savings account and are obligated to contribute at least $1500 a year pre-tax to the account; they use that money for routine & preventative care. The government tops up the account for the poor; the money can be carried over from year to year indefinitely to help save up for the expensive gray years. Consumer pressure will drive down the costs & improve the service of routine medical treatment.

Even more off-topic: The NY Times editorialized about a similar proposed plan (flexible medical accounts attached to health insurance with a high deductible) and decided they were bad because (in their view) people aren't capable of determining what level of care and prevention they need. That's about the purest example I've seen of why the NYT is a paternalistic left-wing rag (although I still read it online every day).

[Phil_Stein]

JP - I'm fortunate - I sold my company a few years back, and so I can endure high medical bills and insurance. But for a more typical worker with a family and an imperfect medical history, trying to get insurance and pay uninsured costs is a huge expense, outside of a large employer-paid program. I suspect, among other things, it's a major factor in limiting entrepreneurship among those supporting a family.

To give another example - my brother's wife was diagnosed with cancer about 9 years ago. It was treated and went into remission, although it everntually returned and my sister-in-law passed away two years ago. The medical bills, fortunately covered by my brother's big-company insurance, were certainly in the $hundreds of thousands. From the time she was diagnosed until she died, it was obviously impossible for my brother to consider any employment options other than big companies with big group health plans.

Medical insurance is different, in a number of ways, from other staples like auto and fire insurance. Namely:

1) Auto/fire insurance mainly cover against single 'events', which neither the insurer nor the insured can predict with particular certainty. The event (car crash/fire), occurs in a single day, and then the claim is resolved. Health insurance covers conditions that often last for a lifetime. This causes all sorts of self-selection issues and other problems.

2) The typical per-capita spending for medical issues is VASTLY higher than per-capita annualized losses to fire or auto accidents. This of course makes medical insurance much more expensive. Moreover, medical issues (and attendent costs) occur to people regardless of their income - poor people get cancer just as much as rich people. So, if you assign each person the full burden of their per-capita medical costs ($5,267 in 2002), that may only be 10% of the income of a single professional, but it would be half or more of the income of a lower-paid person supporting even a small family.

3) Medical spending is further distorted in two ways that make 'flying solo' much more expensive than obtaining comparable medical care through an employer plan. First, employer plans have no tax impact, whereas 'flying solo', you'll likely be paying a significant chunk with after-tax dollars. Second, insurance carriers often have access to greatly discounted rates unavailable to individuals.

I'm generally pretty libertarian in my economic views, but medical coverage is an area where, as things now stand, there are some fairly serious problems with a private-sector insurance system. I'm not sure exactly what the right answer is, but I suspect it's somewhat different from what we currently have.

[Charles]

Man, I wish I only paid $800/month for my Canadian health care, but I do like that everyone has at least basic (and pretty good) medical insurance care available in Canada when they need it, regardless of their financial condition. I don't really understand why basic medical insurance isn't similarly automatically made available to U.S. residents.

So you think that well over half your taxes go to healthcare in Canada? That's an... interesting assertion.

[WarrenM]

Because it has significantly less suck than the US.
I was born there and lived there until I was 20. Don't even try that with me.

[Veinless]

Here's a good summary:

"
My father has been waiting for almost a year now to complete a round of testing to find out if he has angina. He's very fit, runs and rock climbs - but has burning in his throat.

He's been on nitro patch and been told he can't do anything other than light walking. His condition is not "serious" enough to warrant moving through the system any faster. It's been very difficult for him.

While he's frustrated and angry, he'd also be the first to tell anyone that he'd rather have it this way than have a private for-profit system.

He was a hospital executive for more than 30 years at the very hospital where the specialist he's waiting to see is a resident...

It's not easy to say what the solution is, obviously.

Approximately 40% of Americans don't have health insurance - at all. Nothing.

While Americans generally have a lower average tax rate than us, medical insurance ranks as their second largest expense - behind mortgage - even with employee plans.

And despite that private system, the American government spends MORE per capita on health care (HMO) than Canada's public system. So much for the big government theory.

A recent study found wait times for most medical procedures was virtually the same in Canada and the US. The US does have significantly less wait time for things like hip replacement and elective surgery, but that's not what this discussion is about.

Get your head around paying $600 a month for the most basic of no-frills private health plan with a $1000 deductible and 1/10 claim rejection rate and then decide what model you'd rather have.

My aunt and uncle are very wealthy farmers in Minnesota. This past summer my cousin broke his arm playing high-school football. Despite their top-of-the-range family medical insurance ($1100 per month if I remember correctly) they ended up paying $2500 out of pocket for deductible and other treatment options that would have raised their insurance rate had they opted for the insurance to cover it.

Where do I sign up for that?

I always find discussion like this the greatest indicator of how well off we all are. We can afford to be ignorant and reactionary. We can afford to whine about gas prices while we fill up our boats and sleds and SUVS to go up to the cottage and complain about health care while we light up another dart and mix another rye and coke.

Yup we live with our heads up our asses and the worst thing we can find to complain about is the smell.
"
From http://looneybeaver.com/forum/viewtopic.php?t=6427

[Phil_Stein]

Approximately 40% of Americans don't have health insurance - at all. Nothing.

As of 2002, 15.2% of Americans lacked health insurance (http://www.cbpp.org/9-30-03health.htm). I doubt it's changed much since then. You're probably confusing your stat with the absolute number who lack insurance, which was 43.6 million in 2002.

[Desslock]

So you think that well over half your taxes go to healthcare in Canada? That's an... interesting assertion.

How did you reach that nutty extrapolation from what I actually said?

[Charles]

Man, I wish I only paid $800/month for my Canadian health care

I pay about 1600 bucks a month in taxes. I'm in a high tax bracket. With that in mind, you are wishing you "only" paid 800 bucks a month, meaning you probably feel you pay more than that.

Perhaps you meant only 800$ a year?

[MikeJ]

I pay about 1600 bucks a month in taxes. I'm in a high tax bracket. With that in mind, you are wishing you "only" paid 800 bucks a month, meaning you probably feel you pay more than that.

Perhaps you meant only 800$ a year?

I think Desslock pays more than $4000/month in taxes.

[Desslock]

I think Desslock pays more than $4000/month in taxes.

Uh, yeah. It is Canada, after all.

[Charles]

Okay. Well, regardless of whether or not Desslock makes six figures and I don't, his assertion would still mean that *I* pay more than half my taxes directly to healthcare.

[Old Man Gravy]

This little snit aside, it's fairly clear to most who aren't just looking for a reason to hate on one system or the other that there are clear advantages and just as quantifiable drawbacks to both.

I've never understood what criteria the "health care is a basic right" attitude is based on (is me having to pay for someone else's doctor visit in the Bible or Magna Carta or Talmud or something?), but I'll admit that it would be nice to live in a society where at-risk kids who needed them could get braces or whatever, and where people with serious and/or chronic conditions didn't have medical bankruptcy to worry about in addition to all their other challenges. On the other hand, it's also good to be in a system with an abundance of the world's best practitioners and most advanced facilities and where you can get diagnosis and treatment in under a year if you can pay for it.

[MikeJ]

Okay. Well, regardless of whether or not Desslock makes six figures and I don't, his assertion would still mean that *I* pay more than half my taxes directly to healthcare.

Still does not compute. He said he wished *he* paid only $800/month for healthcare. I don't think he said anything about what others pay, or what the average Canadian pays or whatever.

I mean, as a student, $800/month would be like 250% of my taxes.

[Jason McCullough]

I'd vote for that contrarybear/undercover economist plan in a heartbeat. The liberals aren't asking for much, here.


I've never understood what criteria the "health care is a basic right" attitude is based on....

Well, the short version for me is that it's just morally appalling to have some people have long happy lives, and others short lives of disease-ridden misery - based solely on the amount of money they make, and then on top of it the amount of money made is often only tangentially related to how hard they work, how good of people they are, or whatever. We're not there yet, but that's the direction we're heading, and the level we have right now is just unsettling. Yes yes, you shouldn't spend a billion dollars to keep an alcoholic hobo alive for another 24 hours, but that's not what anyone is asking for - all I want is "mainstream high ROI procedures for everyone who needs them for reasonable prices."

This applies to third world african countries vs. the US too, but that seems to be a much more intractable problem. Health care for the moment, by contrast, looks like an easy technical fix.

[Desslock]

Okay. Well, regardless of whether or not Desslock makes six figures and I don't, his assertion would still mean that *I* pay more than half my taxes directly to healthcare.

No, I was just stating that I wished I didn't pay a hell of a lot more than $800/month for healthcare, exactly like I stated. We don't pay anything directly to healthcare, well, unless you live in Ontario and therefore have to pay an additional $1800/year new tax imposed last year (an amount which, in itself, could provide decent medical insurance in the U.S., and it's only a tiny fraction of what we pay for healthcare). We pay a ton in taxes in Canada, and that indirectly pays for our healthcare. The fact that you're in the high income tax bracket, despite the other assertions you've made about your income, are pretty indicative of how heavily taxed we are.

The point is a decent medical system is expensive. The downsides of the Canadian system is that we get considerably worse medical services delivered on worse equipment, with long waiting lists for even essential surgeries, and yet we pay a hell of a lot more for our health care than we would for a medical insurance policy in the U.S.

But on the positive side, if you're poor and can't afford insurance, like a small minority in the U.S., or you object on principle to paying more because you have a bad health history and think it's fairer for people who make more to subsidize the system (an argument I don't disagree with, since no one chooses to become sick), the Canadian system is better.

[Desslock]

Well, the short version for me is that it's just morally appalling to have some people have long happy lives, and others short lives of disease-ridden misery - based solely on the amount of money they make

We certainly agree on this one.

[Charles]

Oh, I know how much we're taxed. I love knowing that if I make any bonuses I lose an immediate 40%.

But I don't hold it against the health system. And from the experience of those around me with major illnesses (cancer, ALS, etc), all the scare talk of waiting lists and problems are overblown. My girlfriend's mother was diagnosed with uterian cancer and in for surgery within two weeks of being diagnosed. Someone I know with ALS had access to specialists within two weeks after diagnosis as well.

For all the talk I hear of people having to wait for major stuff, I know more people who've never had a problem. Not saying those problems don't exist, but it's absolutely not an across-the-board problem.

[MikeJ]

we pay a hell of a lot more for our health care than we would for a medical insurance policy in the U.S.


Yet in aggregate, Americans spend far more per person on healthcare.

A medical insurance policy isn't the whole cost of healthcare in the US. Isn't Medicaid/Medicare funded from taxes? You'd have to consider insurance costs plus fraction of taxes directed to health care, plus out-of-pocket fees.

Clearly, you specifically are paying more for your healthcare in Canada than you would in the US. But that's not true for the population as a whole and I suspect it's especially not true if you are supporting a family, working independently and not making piles of cash.

[TheTrunkDr]

I was born there and lived there until I was 20. Don't even try that with me.
I was also born there and I lived there till I was 27 and I stand by my statement. There is significantly less suck in Canada than there is here in the US. End of story as far as I'm concerned.

I haven't a clue what Desslock is getting at. While it's quite possible that he's paying more than $800 in taxes a month that is most definitely not all going to healthcare. Maybe he's got an optional health plan that costs him additional money, but he can always drop that and still get basic coverage for him and his family.

Either way, getting taxed at 20%-25% and having to pay $800 is far worse than just getting taxed at 30%-35% and never having to worry about getting a bill from a hospital or doctor's office.

[Jason McCullough]

I think what Desslock is getting at is that he pays a shitload of taxes. Some of that goes to medical care, but it's kind of besides the point - you could get close to funding a single-payer system with a flat % tax of income if you really wanted.

[Qenan]

Think of it as the self-employment tax. If we had National Health care, we would pay the tax directly, but there would be less incentive to be a wage-slave rather than self-employed.

[jpinard]

I'd vote for that contrarybear/undercover economist plan in a heartbeat. The liberals aren't asking for much, here.



Well, the short version for me is that it's just morally appalling to have some people have long happy lives, and others short lives of disease-ridden misery - based solely on the amount of money they make, and then on top of it the amount of money made is often only tangentially related to how hard they work, how good of people they are, or whatever. We're not there yet, but that's the direction we're heading, and the level we have right now is just unsettling. Yes yes, you shouldn't spend a billion dollars to keep an alcoholic hobo alive for another 24 hours, but that's not what anyone is asking for - all I want is "mainstream high ROI procedures for everyone who needs them for reasonable prices."


Jason, that is a very eloquent post. If only we had people in charge with that kind of moderate outlook. But as long as the ultra-wealthy control all facets of the government and our lives - I don't see this changing as it would diminish their own perceived value. We have a President right now, who feels all Presidents need twenty-three $110 million dollar helicopters! Spending $6.1 billion on the upgrades. Some of the essentials? A Galley kitchen and a folding ramp so they don't need to duck. <sigh>

[WarrenM]

There is significantly less suck in Canada than there is here in the US. End of story as far as I'm concerned.
Great. I'm still disagreeing with you. Thanks!

[Graeme Dice]

The downsides of the Canadian system is that we get considerably worse medical services delivered on worse equipment, with long waiting lists for even essential surgeries, and yet we pay a hell of a lot more for our health care than we would for a medical insurance policy in the U.S.

Really, where'd you get that information, since the actual statistics from the WHO would tell us that Canada outperforms the U.S. in nearly every category.

http://www.who.int/whr/2000/en/annex01_en.pdf

[Dr Fear]

Really, where'd you get that information, since the actual statistics from the WHO would tell us that Canada outperforms the U.S. in nearly every category.
Seriously, that's your evidence? A statistical appendix from some WHO report with categories like "overall goal attainment?" Do you have any idea of how those rankings were compiled, and the validity of the supporting data? Do you really think the fourth- and fifth-best health systems in the world are Andorra's and Malta's? How many tertiary care facilities do you think there are in Andorra? Your inability to locate relevant information is exceeded only by your inability to critically evaluate it.

[Graeme Dice]

Seriously, that's your evidence?

Well, that's part of it. You see, I like to actually provide evidence when asked for it, unlike people like Desslock and yourself who make unsupported claims. I could, of course, have just linked you to the report itself (http://www.who.int/whr/2000/en/), but that would be less useful in most cases, since you'd have to dig through more information to find the useful statistics.


A statistical appendix from some WHO report with categories like "overall goal attainment?" Do you have any idea of how those rankings were compiled, and the validity of the supporting data? Do you really think the fourth- and fifth-best health systems in the world are Andorra's and Malta's? How many tertiary care facilities do you think there are in Andorra?

Do you have any evidence to suggest that the report is incorrect, or are you just going to claim that it's wrong because it doesn't match up with your preconceived notions? Removing all the European countries with very small, healthy populations isn't going to change the relative position of the U.S. worldwide.


Your inability to locate relevant information is exceeded only by your inability to critically evaluate it.

You are remarkably good at throwing up a smokescreen to hide the fact that the U.S. system is a failure when compared on a cost basis, or just about any other basis to the Canadian system. It looks even worse if you compare other nations, so I'm not sure what you are trying to defend.

[Dr Fear]

I could, of course, have just linked you to the report itself (http://www.who.int/whr/2000/en/), but that would be less useful in most cases, since you'd have to dig through more information to find the useful statistics.
I could dig through that report all day and not find any useful statistics, because there aren't any. Did you read that report, or did you not have enough time between the Googling and the posting to actually see what it says? But if you want to play this game, fine. The report is composed for the most part not of evaluating actual health care, but the "potential" for the world's health care systems to be as good as they can be, which has to be one of the most unmeasurable things they could have possibly chosen to do. It's an amazing report, with so many confounding factors that it could only have been generated by WHO.

The closest thing I could find in the report that actually measured anything I could identify as "health care" was the section on "responsiveness" which purports to measure seven separate factors, which are "dignity, autonomy, confidentiality, prompt attention, quality of basic amenities, access to social support networks during care, and choice of care provider." And which country is first? The United States. Of America.

In fact, the US health care system is apparently so responsive and dignified that the difference between it and the second-placed country (Switzerland) is 10-20 times larger than the average difference between any two adjacent countries on the table.

But only the super-rich get that level of care, right? Not according to WHO, which had such a hard time evaluating the level of distribution of responsiveness that there were only two countries in the top 38 that stood out. And they were the UAE and Bulgaria. Make of that what you will. Everybody else (meaning the US and Canada) gets to be "3rd through 38th." So in distribution of the quality of health care, the US and Canada are tied. Who had the demonstrably best level of responsiveness, though? Right.

Then there is a table that rates all the countries based on the "fairness of financial contribution," where 100% is Grame Dice Utopia and 0% is Nazi Germany. The United States scores 95.2, which sounds pretty good to me, at least on a 7-9 scale. Canada scores 97.2, making it an incredible 2% fairer than the United States. Either way, they both sound pretty darn fair. But because the people at WHO who were compiling this report had heard about statistics but didn't actually have any firsthand experience with them, they found it relevant to report uncertainty ranges without actually adjusting the rankings for them. So while Canada's 97% fairness score makes it the 17th- to 19th-fairest system on the planet, the uncertainty level in that measurement makes it statistically indistinguishable from the 81st-fairest. The United States, exactly 2% fairness lower, is knocked down to 53rd-54th. But given the uncertainty ranges, these two rankings are statistically the same.


You are remarkably good at throwing up a smokescreen to hide the fact that the U.S. system is a failure when compared on a cost basis, or just about any other basis to the Canadian system.
By the report you just provided to me, the US health care system is 95% as fair as it possibly could be, and is statistically indistinguishably as fair or fairer than the Canadian system, while having the highest quality of actually measurable "health care", and distributes this quality of care exactly as well as Canada does.

Given that, unless you have some amazing secret Hail Mary Report from Doctors Without Borders, I think I'm done here. As, in a different meaning of the phrase, are you.

EDIT: I missed one of the responsiveness categories, "quality of basic amenities." Please forgive me.

[Desslock]

Dice owned

(as usual)

[Erik]

http://myspace-367.vo.llnwd.net/00698/76/38/698028367_m.jpg

Down, down! Stay down, Dice!

[Graeme Dice]

Dice owned

You planning to ever supply your own evidence Desslock, or are you just going to continue to parrot your Libertartian masters on every single political topic that ever comes out?

[Graeme Dice]

Given that, unless you have some amazing secret Hail Mary Report from Doctors Without Borders, I think I'm done here. As, in a different meaning of the phrase, are you.

Are you planning to actually debate the real point under contention, or are you going to spend the rest of eternity throwing up your smokescreen. Desslock claimed that "The downsides of the Canadian system is that we get considerably worse medical services delivered on worse equipment, with long waiting lists for even essential surgeries, and yet we pay a hell of a lot more for our health care than we would for a medical insurance policy in the U.S." Now, unless you, or he, can provide evidence that this was correct, then I'm just going to have to call you the liars that you are. Note that any comparison, like yours, that shows that Canada and the U.S. are similar, is still not evidence that Canadians get "considerably worse medical services delivered on worse equipment."

[Dr Fear]

Are you planning to actually debate the real point under contention
I've debated the specifics of every point you have had the bad judgment to actually try to make, with predictably severe consequences for you. In case this trauma has caused you some retrograde amnesia, here is a recap.


The U.S. health care isn't that amazing, as illustrated by the study discussed in U.S. health care mediocre across the board
I then explained (http://www.quartertothree.com/game-talk/showpost.php?p=624409&postcount=33) exactly why this was false.


the actual statistics from the WHO would tell us that Canada outperforms the U.S. in nearly every category.
I then showed you (http://www.quartertothree.com/game-talk/showpost.php?p=625895&postcount=67) how the report you cited tells us nothing of the sort.


Note that any comparison, like yours, that shows that Canada and the U.S. are similar, is still not evidence that Canadians get "considerably worse medical services delivered on worse equipment."
In the post I was responding to, you made the bold assertion that "Canada outperforms the US in nearly every category." Now you're claiming that "Canada and the US are similar," which is actually not what my analysis showed, (it was pretty clear that the US was better) but whatever. Way to run away from an untenable position without even acknowledging you ever held the position in the first place.

It's impossible for you to debate this via Google, because to have a meaningful debate, you actually have to know something. For example, an OECD study on stroke outcomes (http://www.oecd.org/dataoecd/9/15/2957939.pdf) has a lot of data in it. Which data is important? Since you don't know, I'll suggest that to get at actual treatment efficacy, you need to look at long hospital stays, because differences in therapy are most demonstrable on severe presentation, and these are likely to result in prolonged hospitalization. If you scroll through that study, you will find that the 30-day hospital fatality rate in stroke patients in Canada runs at about 20%, and this rate hasn't changed since 1990. By comparison, the US fatality rate in the same category runs around 8%, and has been steadily and sharply trending downward during that same period. Furthermore, these are Medicare patients, so you can't even argue that this is rich old people in the US paying for a standard of care that is unattainable for "the average person" as you stated in one of your many previous ill-considered posts.

Since you still probably have no idea what to make of this except for a vague feeling that you're going to get proven wrong again, I submit that this can reasonably be attributed to faster care and better equipment in the US, because stroke outcomes are strongly correlated with speed of intervention, and severe stroke patients are managed in NICU, which is very equipment-intensive. The down-trend in US stroke presentation is likely in part due to huge improvements in neuroimaging (equipment-based), which you would be familiar with if you actually had any idea of what you were talking about.

Is this analysis a perfect indicator of care quality? Of course not. Is it in itself more compelling evidence than the sum total of everything you've managed to post in this thread up to this point? Most likely, yes.

I'm going to do you a favor and leave it at this, because arguing with someone on a messageboard is even more pointless than usual when the person you're arguing with has absolutely no expertise in or even inkling of what he's talking about. You seem to be very emotionally invested in showing that the US health care system is a failure. It must be very frustrating to not be able to do it. As someone who "only posts when someone is wrong," I offer you the free advice that when you do so, you limit yourself to topics that you actually know something about. This might limit your posting further, but based on what you've managed to come up with in this thread, I don't think that would be so bad.

[Desslock]

You planning to ever supply your own evidence Desslock,

Is that a joke? Are you really as ignorant as you sound, or are you a fake alias for someone having a laugh?

There's tons of available material on Canada's dreadfull waiting lists - here's a recent survey, if anyone's interested: http://www.fraserinstitute.ca/admin/books/chapterfiles/WYT2005pt1.pdf#. The average waiting time for many surgeries is greater than 4 months.

The U.S. invests far more in technology in its health care system - access to services and equipment unavailable in Canada is the primary reason Canadians cross into the U.S. for medical treatment.

I prefer the Canadian system to the American health care system, but only because I prefer its compromises over those the Americans are willing to make - "pretty good" universal care is more important to me than "very good" care which excludes a small portion of the population on the basis of wealth.

But the Canadian system certainly doesn't compare well to other universal systems (http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=782 for more info), and we pay a lot for it, both in terms of taxpayer $$ on the federal, provincial and municipal level (the latter 2 for some reason are often excluded from estimates, even though the average Canadian family pays thousands in health care in just provincial taxes, aside from the 10% of the thousands it pays federally) and, in particular, political resources and focus. It's almost a singular obsession in Canadian politics - if we just had a simple universal insurance system, instead of having the government run everything, we'd pay a lot less (as Americans do, for medical insurance) and the government could actually focus on something else, for a change.

[BaconTastesGood]

Whoa, Dr. Fear just did a:
http://www.stageleft.info/blog-images/kelso_burn.gif

[Jason McCullough]

By the way, "let's use Canada's system instead" isn't the only option for the US; France & Germany's (http://ezraklein.typepad.com/blog/health_of_nations/index.html) are better on an outcome per dollar basis.