Daily Archives: July 26, 2009

Why “free market” health insurance doesn’t work

healthinsThe U.S. healthcare “system” works only for insurance companies. The rest of us are being crushed by premiums, deductibles, denial of coverage, expulsion from plans, and bankruptcy. The only people who think it works, are those who haven’t been seriously ill. Meanwhile our tax money goes to support Dick Cheney’s paranoid fantasy of world domination. This has to change.Paul Krugman:

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there’s a widespread sense that our fellow citizens should get the care we need — not everyone agrees, but most do — this means that private insurance basically spends a lot of money on socially destructive activities.

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (”I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.

Between those two factors, health care just doesn’t work as a standard market story.

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Bush kept evidence of climate change secret

Hi res images show loss of polar ice from 2006 to 2007

Hi res images show loss of polar ice from 2006 to 2007

The damage done by Bush in so many areas can never be totally undone. Thousands have died in the US, a million or more in Iraq, while he play-acted at being actor Ronald Reagan. His worst malfeasance may turn out to be obfuscating global warming/climate change.
Guardian:

Graphic images that reveal the devastating impact of global warming in the Arctic have been released by the US military. The photographs, taken by spy satellites over the past decade, confirm that in recent years vast areas in high latitudes have lost their ice cover in summer months.

The pictures, kept secret by Washington during the presidency of George W Bush, were declassified by the White House last week. President Barack Obama is currently trying to galvanise Congress and the American public to take action to halt catastrophic climate change caused by rising levels of carbon dioxide in the atmosphere.

One particularly striking set of images – selected from the 1,000 photographs released – includes views of the Alaskan port of Barrow. One, taken in July 2006, shows sea ice still nestling close to the shore. A second image shows that by the following July the coastal waters were entirely ice-free.

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