Ezra Klein: You Don't Know The Shape I'm In

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February 28, 2007

You Don't Know The Shape I'm In

I'm unconvinced by the mortality data in here, at least as it relates to the present day, but there's no doubt that a primary role of programs like Medicare is to simply insulate individuals from financial ruin. Indeed, I've never thought the health benefits are the most important reason to extend coverage to the uninsured -- though there will be health benefits, and they are important. In any large population, particularly one that trends young, as the uninsured do, only a small number in any given year will see real health improvement from easier access to care. But the economic security and freedom offered by medical coverage will aid every member of the community, freeing them to search for better jobs and see doctors without anxiety and treat nagging-but-not-mortal conditions that harmed their quality of life.

That said, for the small number who do need the care and currently forego it, insurance is crucial, and its absence is catastrophic. Indeed, I don't even know what to say about this...

February 28, 2007 in Insurance | Permalink

Comments

Yeah, I don't know why anyone would think health insurance was about health care either. Are you serious? If you are, your youth is showing in this post.

Posted by: nolo | Feb 28, 2007 11:24:02 AM

If you want to see the state of "compassionate conservatism", check out the reader comments for the WaPo's article about the 12-year-old's death. Maybe it's just me, but lots of people seem to have a barely hidden glee about bashing the old welfare queen demon yet again. Never mind that the article says that the mother was working. Never mind that a few dozen or hundred dollars in treatment might have forestalled a very horrible death, and a quarter-million dollars in heroic but fruitless treatment. Nope, to a certain kind of mentality, this is all about the shiftless darkies.

Posted by: sglover | Feb 28, 2007 11:28:12 AM

The simple fact is that administrative costs skyrocket and administration in the sense of verifying eligibility etc damn near becomes impossible when the population is very poor. Poor people don't always read their mail. They often move without having the wherewithal to leave forwarding addresses. They get homeless and have no mailing address. They are depressed and can't make the effort to engage agencies that would exhaust even the sunniest, most tenacious person.

The solution of pouring more money into better verification and assignment procedures will not solve the problem. The only soulution is to cover people who show up, when they show up. Lord only knows what this might cost and some people won't be able to utilize even the easiest system, but spending money trying to deny care to children who may not qualify hardly seems like a good response to the problem.

Posted by: Neil Paul | Feb 28, 2007 11:43:20 AM

It probably won't cost all that much, Neil. The Canadians do it. The Europeans do it. But you're right-- getting rid of the whole verification thing and just treating those who need treatment will be a lot cheaper than it is today.

And it is NOT just poor people. Once you've been sick, you can't get new insurance with that condition covered, and often you can't get new insurance at all. My son went to the hospital once to be tested for appendicitis. He didn't have it, and the dr. prescribed acid reducer. Next time we tried to get insurance, every single abdomen-based condition was excluded from coverage for him. Everything. So if he does get appendicitis, or stomach cancer, or an ulcer, he's not covered. That's on top of asthma not being covered because he used to get it when he mowed the lawn (grass allergy). My chronic condition is also not covered, and when I tried to get a new insurance policy, the entire family was turned down (and this was group coverage, believe it or not) because of it.

I'd pay $1000 a month for family coverage... but no one is letting me.

Posted by: petra | Feb 28, 2007 12:10:14 PM

Hardly the first kid to die of a toothache.

Greatest medical system in the world, y'all.

Posted by: anonymous | Feb 28, 2007 12:18:50 PM

I would like to agree with Ezra and others here that the healthcare system is not all it could be. That being said, I don't champion the same ol' tired suggestions that focus on robbing taxpayers to pay for insurance for the poor. The real solutions will involve the root cause and that is the cost of healthcare itself and what can be done about it. Ezra and his crowd hardly ever address this issue.

I'm not sure what form it will take, but I'd like to introduce you to
Dr. Devi Shetty, a cardiologist in India who, with the help of investors, set up private insurance for the poor. Rates are about 11 cents per month. Dr. Shetty has streamlined heart surgery and encouraged other disciplines to do the same. He currenly does bypasses with a 99% survival rate, does about thirty a day, and the total cost for the treatment is roughly $2,000.

I understand that there are some differences that must be taken into account, but my point is that Ezra and the cry-babies that wish to redistribute wealth in the name of Healthcare should take a look at solutions around the world that don't invove worshiping Europe or Canada. Solutions that are working not only to provide affordable healthcare to all, but also attacks the core problem instead of the symptom.

Posted by: Fred Jones | Feb 28, 2007 12:37:50 PM

Fred,

why so harsh? What I have mostly seen Ezra do is show that moving to a Canadian style system would not require huge additional outlays by the wealthy. Basically you cut admin costs, shift rescources to providing care and the total cost is perhaps less than what we pay in the states to get more people care than we presently do. Its not a whole lot more communist than the dysfunctional quasi-public/private hybrid we now tolerate and it just might work better.

Posted by: Neil Paul | Feb 28, 2007 12:43:00 PM

For a Dr. Shetty-style solution to occur in this country, you'd first have to persuade the U.S. health care industry to accept a very different business model (like one in which a provider will accept $2000 to do bypass surgery, as opposed to the $60,000 to $80,000 that apparently is the going rate these days).

Posted by: nolo | Feb 28, 2007 12:55:07 PM

...you'd first have to persuade the U.S. health care industry to accept a very different business model...

Did you not read the part about how Dr. Shetty streamlined his process and the processes of those in the program? At Thirty a day, it amounts to 60K revenue per day.
I guess it's just easier to fuck the taxpayer.

Posted by: Fred Jones | Feb 28, 2007 1:51:28 PM

At Thirty a day, it amounts to 60K revenue per day.
I guess it's just easier to fuck the taxpayer.

Try getting a U.S. cardiovascular surgeon to give up his Wednesday tee-time, let alone performe thirty procedures a day.

Posted by: nolo | Feb 28, 2007 2:30:06 PM

I certainly don't see why we can't "outsource" some of these procedures to qualified foreign providers. We do this now with labor (China), call centers (India), engineering and wasn't it you that wanted to be able to import drugs from foreign nations?

Why not? Qualified, as good or better survival rates, and a fraction of the cost.

Naaaa.....it's just easier to focus on the symptom of insurance issues and fuck the taxpayer and it's a great reason to scream for wealth redistribution.

Posted by: Fred Jones | Feb 28, 2007 4:33:50 PM

wasn't it you that wanted to be able to import drugs from foreign nations?

If that was addressed to me, you've got me confused with someone else. I've never addressed the subject anywhere, anytime.

Posted by: nolo | Feb 28, 2007 4:54:11 PM

Tha's right. You're the one that was having the party...

Posted by: Fred Jones | Feb 28, 2007 5:08:18 PM

I knew it was a mistake to treat you with any resspect, Fred.

Posted by: nolo | Feb 28, 2007 5:21:12 PM

Oh, C'mon there, nolo. Just having a little fun with ya'. Have a sense of humor. I have a great sense of humor. I have to here among the true believers of Marx.

I still love ya'

Posted by: Fred Jones | Feb 28, 2007 10:23:15 PM

I have a great sense of humor.

After all, 'Fred', you have to deal with your reflection in the mirror.

Posted by: pseudonymous in nc | Mar 1, 2007 12:28:06 AM

First off I didnt know cardiologists were allowed to do CABG surgeries in India. WTF is that? You dont need to be a trained surgeon to do surgery? Hopefully thats a typo and he's actually a cardiothoracic surgeon and not a cardiologist. Cardiologists are not trained in surgery.

SEcond, there's absolutely no fucking way he's doing 30 CABGs every day. Now maybe his GROUP of multiple CT surgeons does it, but its impossible for one surgeon to do that many procedures in one day. Or else the good Indian surgeon is lying to us and he has his "assistants" do all the surgeries. Either way, something is wrong there.

As for general outsourcing to other nations I think its a good idea, but this would only apply to surgeries, not to routine medical care. Also, going overseas for surgery means its virtually impossible to sue for medical malpractice. I bet the lawyers love that.

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