People need health care, not health care insurance

Fareed Zakaria:

Curbing the cost of health care

Many liberals believe that the Affordable Care Act — Obamacare — is unpopular only because most Americans don’t understand it. There is some truth to this: Studies show that the core provisions of the bill are more popular than the bill itself. But there’s also a reason, rooted in reality, why many Americans worry about Obamacare — its cost.

Most Americans have health care. What they worry about is the cost of insuring 20 million to 30 million more people. Unless the meteoric rise of health-care costs is slowed, a big expansion of coverage might well remain unpopular, no matter how it is explained.

Republican alternatives to Obamacare, such as Rep. Paul Ryan’s plan, don’t bother with expanding coverage, which is a mistake because they leave in place a broken insurance model in which people can freeload. But most do have a strategy to control costs — get consumers to pay for more of their health care. The basic idea is intuitively appealing. Markets produce efficiencies; they presumably would do the same thing in health care.

People aren’t “freeloading”, they are opting out. If you are young and healthy and only see the doctor for annual check-ups and occasional minor injuries and illnesses, paying $1000 month for health insurance is a bad bet. Whether we privatize or socialize the cost of health care we still need to control it.

We spend twice as much (or more) per capita on health care as other industrialized nations. ObamacareTax does nothing to address that disparity. The problem isn’t that health care is inaccessible, it’s that it’s unaffordable.

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45 Responses to People need health care, not health care insurance

  1. Oswald says:

    Eliminating for-profit health insurance companies would save about 15-20% off the top.

  2. yttik says:

    What I don’t understand, we have medical insurance hidden in our car insurance policies, to pay for somebody elses injuries. We have medical insurance hidden in our L&I benefits, to pay for medical if we get hurt at work. We have medical insurance hidden in our homeowners insurance in case somebody falls through our deck and breaks their leg. We have business liability insurance to cover any customers we might punch in the face. In my state, these are all mandatory policies. We’re poor, but still, all together we have over 3 million dollars in insurance coverage.

    We don’t have medical insurance. Can’t afford it.

  3. DeniseVB says:

    Wouldn’t tort reform help? Most md’s practice to their malpractice insurance and I don’t think Obamacare is going to cover those tests that would protect them from, well, malpractice.

    Our insurance, co-pay and deductible has already gone up, now waiting on Obama’s demand to raise military insurance 400% more.

    Of course there’s misunderstanding, and I blame that on the Dems (have to read it before we know what’s in it) and the Repubs (Repeal ! But replace with what…..?).

    • WMCB says:

      The costs associated with lack of tort reform are not primarily for the malpractice insurance itself. The biggest hidden cost is the defensive medicine practiced every day. Probably at least 25% of the tests, drugs, etc that are used are not because the doc thinks it’s really needed. He may be 99.9% sure it’s pointless. But the first question that is going to be asked on the witness stand is “WHY did you not do a CT scan?!” The patient may have been really sick, and whether or not he got this or that test may not have made a lick of difference in his bad outcome. But that doc is going to cover his/her ass six ways from Sunday even MORE on the pointless hopeless patient than on a healthier patient. Because when they inevitably go downhill, family often starts looking for someone to blame.

      Want to bring costs down? Prevent docs from being sued for anything other than deliberate and gross negligence. Make the Medicare guidlines the standard of care, and disallow suits so long as the doc followed that standard. It is completely unfair to tell a doc ” We have decided that X test is unneccessary in situation Y, so we won’t pay you for it.”, then turn around and have following those guidelines be ZERO defense in a court of law. Outlaw “shotgun” and “lottery” lawsuits as well. (Where a plaintiff basically sues every doc and nurse who ever laid a hand on or is mentioned in the chart, regardless of their level of involvement, in hopes of getting a few to pay off just to avoid the hassle.)

      • DeniseVB says:

        Was hoping you’d respond to me wmcb, thanks. All I’ve learned about tort reform is from John Edwards’ book Four Trials. Not much about healthcare reform as it was about really, really stupid doctors. He was destroyed for a reason 😦

      • mcnorman says:

        The patient may have been really sick, and whether or not he got this or that test may not have made a lick of difference in his bad outcome. But that doc is going to cover his/her ass six ways from Sunday even MORE on the pointless hopeless patient than on a healthier patient. Because when they inevitably go downhill, family often starts looking for someone to blame.

        “Defensive medicine” is a huge problem in this country as well. The amount of throw away $$$ never ends either. I sent out a pre auth for a procedure. Included were tests that were conducted two years ago. Nothing has changed and according to specialty, nothing will change. I got a call from the pre auth dept wanting a current more expensive test (just for funsies, right?).

      • Lizzy says:

        Another source of unnecessary tests is doctors referring patients for tests in facilities where they have a financial stake. These tests can be extremely expensive. Also I have blood tests every three months; I was told the bill for those tests was $800. What can they do to blood that costs that much?

        • mcnorman says:

          Maintaining these facilities and having them approved is very costly. That’s why they run like a factory. You are correct. When someone has a stake in the diagnostics, sometimes the more expensive tests will be ordered. Not always, but there is incentive.

    • votermom says:

      One of the good side-effects of an actual universal healthcare system (as opposed to Obamatax) is that there would be no reason for juries to award huge settlements for future healthcare costs.
      (I do think there should be caps on “pain & suffering” awards)

  4. Lola-at-Large says:

    The new freeloading talking point (the progressive equivalent of a “welfare queen” argument, ftr) will be addressed in my post tomorrow. It’s a bunk claim, but one which is easily argued either through compassion, logical cost-effectiveness, or by meeting the offensive rhetoric by flipping it and using equally offensive rhetoric. In the latter case, the real freeloaders are those with pre-existing or expensive medical conditions as a result of their lifestyle choices. We’re all being taken for a ride so those folks can have access to healthcare that we’ll end up paying for.

    • votermom says:

      Speaking of lifestyle choices – has anyone every looked into how much healthcare elite athletes use up? All the risky behavior, injuries, etc.

      Yet it’s only the couch potatoes that MO picks on.

  5. HELENK says:

    stops in diner. tells patrons ” just pretend I am not here” then interrupts card game and talks to everybody.
    I would like the story better if he said ” just pretend I am not here” and they did

  6. Lola-at-Large says:

    You’re all set to go with my post tomorrow scheduled for 8:00 AM EDT (5:00 AM your time). Sleep in, clown. 🙂

  7. HELENK says:

    I remember this from awhile ago. Maybe the msm did not make it public the it was on the internet

  8. Lola-at-Large says:

    GOP sets fundraising record, but Obama once earned more in 2008:

  9. Lulu says:

    The full weight of the Roberts switcheroo is becoming clearer. Althouse has it up from Michael Tanner at Cato. It further shows just how dim Kagan and Breyer really are.

    “[I]f a state doesn’t expand its Medicaid program, most of those who would’ve been eligible for Medicaid will now become eligible for subsidies through ObamaCare’s health-insurance exchanges. And those subsidies are paid in full by the feds.” ……

    “ObamaCare gives the feds the authority to step in, setting up and operating an exchange in any state that doesn’t set up its own… [But f]ederal subsidies are available only through exchanges that the states set up. The feds can’t offer subsidies through a federally run exchange.”

    “Thus, if states neither expanded Medicaid nor set up exchanges, that would effectively block most of ObamaCare’s new entitlement spending.”

    Althouse quote:”The original legislation had the states locked in, because they’d lose all their Medicaid funding if they didn’t participate. That was held to be coercive, and thus not supportable by the spending power, which requires that states be given a choice whether to run federal programs and accept various related conditions. Under the Court’s ruling, the states only lose the funding for the expansion of Medicaid, which makes it possible for them to say no, as many seem to be doing.”

    LOL. Roberts checkmate.

  10. HELENK says:

    he started a war with the Catholic church over birth control.
    now battling the Black church over gay marriage.

    not really good moves

  11. DM says:

    Most Americans… worry about is the cost of insuring 20 million to 30 million more people. Unless the meteoric rise of health-care costs is slowed, a big expansion of coverage might well remain unpopular, no matter how it is explained

    The problem with Obamacare is that it’s too expensive for what it accomplishes. There’s no cost containment.

    • WMCB says:

      They also have to deal with the issue that a big chunk of those 30 million are uninsured by choice. The number of people who want and need insurance but CANNOT get it is really small, comparatively. There were a lot of ways to get them covered without creating this leviathan. And of course, getting everyone insured still does not make it affordable.

      • yttik says:

        “..a big chunk of those 30 million are uninsured by choice.”

        Well, I think we should take a deeper look at this, because how do you define “choice?” Many people I know “choose” to not have employer provided insurance because their share would be 40% of their wages. They “choose” to pay rent instead.

        • Lola-at-Large says:

          Yeah, I don’t think that many people are uninsured by choice. Most people who can afford it, get it. Especially as they get older. It might be true that a lot of young people who can afford it don’t buy it, but that’s not blanket statement that resonates with what I’ve seen across age groups. I think Obama’s own numbers on this are, like, 1.5% of the population, and that would include young people.

        • WMCB says:

          The CBO did a study in 2009 that showed that roughly half of the uninsured had enough income to afford insurance. Many also already qualified for Medicaid, but didn’t sign up.

          Even if you think they estimated high as far as how many “can afford”, and it’s not half, it’s still a big chunk. The CBO is not usually off by THAT far. So yeah, there are a lot of the uninsured who choose to be so. There are also a lot who don’t, and would get insurance if they could afford it. Not disputing that some need help, just pointing out that when they say “30 million uninsured”, it’s likely closer to 15 or 20 who actually CAN’T get insurance.

        • yttik says:

          “Many also already qualified for Medicaid, but didn’t sign up.”

          A lot of them are probably worried about medicaid recapture. The Gov never gives anything away for free and once you go on medicaid, they have the right to take any future assets you may have. If you sell your house, manage to save money in a bank, anything, the state can go after if.

          I remember what the CBO said, but I think they seriously miscalculate what is “affordable.” Heck, the gov hasn’t even increased the poverty levels for years. Most people are just way out of touch about what people can afford.

        • T says:

          Yeah, I agree. Choice? Hooey. The CBO says all kinds of things that lack truth. Look at their pre-estimates of the cost of the health insurance bill…

        • Oswald says:

          The CBO did a study in 2009 that showed that roughly half of the uninsured had enough income to afford insurance.

          Define “afford.”

          Half your net pay? 25%?

    • votermom says:

      There’s no cost containment.

      That’s a feature, not a bug.
      The purpose of Obamataxcare is to funnel money to the health insurance industry.

      • DM says:

        Obamacare forces Americans pay tribute to the health care insurance industry and pharma because they own the politicians in Washington as evidenced by Medicare Part D passed by the GOP and then Obamacare by the Democrats.


        A tribute… is wealth, often in kind, that one party gives to another as a sign of respect or, as was often the case in historical contexts, of submission or allegiance.

  12. HELENK says:

    off topic
    something old is new again. Does this sound familiar

  13. DeniseVB says:

    I worked as an Office Manager for a Veterinary Hospital for 10 years, I think I’ll recuse myself from the conversation now since we could give a golden retriever hip replacement surgery for $1800, but my husband’s cost $168,000 ? I think if I break my hip, I’m going to a vet!

  14. Lola-at-Large says:

    OT: Posting this here, because not only will you die laughing, you will immediately feel the need to endlessly share. How you do that dead, I do not know.

  15. Lola-at-Large says:

    Best tweet on the latest Conservative hashtag wargame:

  16. HELENK says:

    these are the people teaching our kids. teachers convention becomes backtrack love fest. no other views allowed. this is scary

  17. mcnorman says:

    Most people are unaware that administrative costs are sky high for physician visits. Ex: Medicare administrative costs are in the vicinity of $70 for a new patient visit. A physician ten years ago was being reimbursed .26 on the dollar. Now, they are reimbursed .17 on the dollar. The VA reimburses docs .10 on the dollar. More regulation means more money used for administrative costs, not better healthcare.

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