We Have Seen the Enemy — And Surrendered

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront – the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health “reform” plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton – why are we not surprised? – has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?

It’s not only the Democratic candidates who are capitulating. The surrender-buzz is everywhere. I heard it from a notable liberal political scientist on a panel in August: We can’t just leap to a single payer system, he said in so many words, because it would be too disruptive, given the size of the private health insurance industry. Then I heard it yesterday from a Chicago woman who leads a nonprofit agency serving the poor: How can we go to a Canadian-style system when the private industry has gotten so “big”?

Yes, it is big. Leighton Ku, at the Center for Budget and Policy Priorities, gave me the figure of $776 billion in expenditures on private health insurance for this year. It’s also a big-time employer, paying what economist Paul Krugman has estimated two to three million people just turn down claims.

This in turn generates ever more employment in doctors’ offices to battle the insurance companies. Dr. Atul Gawande, a practicing physician, wrote in The New Yorker that ''a well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That’s how a doctor makes money. It's a war with insurance, every step of the way.'' And that’s another thing your insurance premium has to pay for: the ongoing “war” between doctors and insurers.

Note: The private health insurance industry is not big because it relentlessly seeks out new customers. Unlike any other industry, this one grows by rejecting customers. No matter how shabby you look, Cartier, Lexus, or Nordstrom’s will happily take your money. Not Aetna. If you have a prior conviction – excuse me, a pre-existing condition – it doesn’t want your business. Private health insurance is only for people who aren’t likely to ever get sick. In fact, why call it “insurance,” which normally embodies the notion of risk-sharing? This is extortion.

Think of the damage. An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three-- every year. Not to mention all the people who are stuck in jobs they hate because they don’t dare lose their current insurance.

Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. Yet we faced down those “enemies” with huge patriotic bluster, vast military expenditures, and, in the case of Saddam, armed intervention. So why does the U.S. soil its pants and cower in fear when confronted with the insurance industry?

Here’s a plan: First, locate the major companies. No major intelligence effort will be required, since Google should suffice. Second, estimate their armed strength. No doubt there are legions of security guards involved in protecting the company headquarters from irate consumers, but these should be manageable with a few brigades. Next, consider an air strike, followed by an infantry assault.

And what about the two to three million insurance industry employees whose sole job it is to turn down claims? Well, I have a plan for them: It’s called unemployment. What country in its right mind would pay millions of people to deny other people health care?

I’m not mean, though. If we had the kind of universal, single-payer, health insurance Kucinich is advocating, private health insurance workers would continue to be covered even after they are laid off. As for the health insurance company executives, there should be an adequate job training program for them – perhaps as home health aides.

Fellow citizens, where is the old macho spirit that has sustained us through countless conflicts against enemies both real and imagined? In the case of health care, we have identified the enemy, and the time has come to crush it.

Comments

[roger]

why do we want the govt to provide universal health care. the govt already provides affordable housing and we see what happens in public housing projects:

http://youaintready-musingsandrantings.blogspot.com/2007/09/dunbar-village.html

dont tell me this is an isolated incident.

i might remind you that the expense for fraud alone for the katrina recovery effort was in excess of 4 billion dollars. wait until all americans are required to have purchased health insurance as a prerequisite to gaining employment which is part of the health care proposal from senator clinton who is seeking the democratic nomination. i would argue against the single payor system because the govt cannot deliver the care.

[thomasgwilliams]

a universal single payer health system does not do away with PRIVATE health care it does get rid of donations to maintain the repugnant party it does get rid of denial of care and it extends life protections without regard to wealth and political affiliation, cause when those who get health care for life at taxpayers expense support a system that denies the same to everyone else then you have to wonder why ???? and then hold your nose on the GOLF course as a health insurance company executive rides by at 10 am on his or her way to the 4 hour paid lunch before the 2pm-2:01pm blanket denial meeting of all claims then its time for the company two 1hour 59min afternoon break, then you know something is rotten in denmark and america.

[chris]

Dawn writes:

"And yes, I'm idealist enough to think that good health is one of those inalienable rights..."

People who don't smoke, don't drink and don't consume illicit drugs have fewer health problems than those who do. People who eat a healthy diet and get some regular exercise are healthier than those who eat junk and live sedentary lives.

Good health is a product of a little knowledge and a healthy lifestyle. Obviously healthful living does not prevent or cure all medical maladies. But if the entire population were living right -- which is within every person's power -- health statistics would jump far into the good zone.

You fantasized:

"...along with free education..."

Let me know when all those teachers who staff the classrooms offer to work for free, with no healthcare benefits and no pension benefits. The same for those janitors, lunchroom workers, principals and other administrators.

Let me know when you find a builder to construct those school buildings for free, and let me know when you find a source of free energy to heat and cool them. Are there any textbook makers willing to supply all students in the US with books for free?

You rolled on:

"...and rights to privacy...

Oh. And you believe that it's possible to maintain personal privacy even though you want Government Healthcare. A nationwide healthcare plan requires a database including EVERY person in the country. You are out of your mind if you think the government can protect a database like that.

You freely spoke:

"...and free speech..."

You have free speech. Do you even know what the expression means?

You gabbled:

"...and equality."

Human beings are not equal. Smarter, dumber; Stronger, weaker; Taller, shorter.

What you really mean is that you want the capable people to support the less capable people. It's a one-way street, though you won't admit it.

You went off the deep end:

"Not to mention clean air and water and..."

If all the developing nations of the world enjoyed air and water as clean as ours, we'd have minor pollution problems on this planet.

And in a final flash of communistic dreaming and wishing:

"Right now I also think affordable housing should be an inalienable right..."

A right? We tried it. It was called Public Housing. For the most part, it was a total disaster.

If you want more abudand housing, the solution is simple: remove the ridiculous impediments to building. Builders build. That's what they do. Meanwhile, housing is expensive because construction is mired in regulations.

However, if you are looking for a cheap house, check Iowa and all the states around it. There are plenty of spacious homes in that region that are prices well below $100,000. You can find excellent homes for $25,000. What are you waiting for?

[roger]

no it doesnt eliminate private insurance. in its present form it would require you to purchase either private insurance or govt coverage.

http://ezraklein.typepad.com/blog/2007/09/the-hillary-pla.html

[chris]

thomasgwilliams, you blathered:

"a universal single payer health system does not do away with PRIVATE health care it does get rid of donations to maintain the repugnant party..."

You are hallucinating.

Further hallucinating:

"...it does get rid of denial of care and it extends life protections without regard to wealth and political affiliation..."

There is NO government program in the history of government that has met the needs of everyone. Every bureaucracy falls short of serving its entire market. Healthcare, because it is more complex than any other need, falls shorter when administered on a large scale.

As always, the best practitioners will enter private practice. Government Healthcare will not match the pay of Private Enterprise. Thus, Government Healthcare, as Medicaid proves, will never match private care.

Your hallucination extended:

"...cause when those who get health care for life at taxpayers expense support a system that denies the same to everyone else then you have to wonder why ????"

Wonder "why" what? Now you are hallucinating and rambling.

And more hallucinating:

"...and then hold your nose on the GOLF course as a health insurance company executive rides by at 10 am on his or her way to the 4 hour paid lunch before the 2pm-2:01pm blanket denial meeting of all claims then its time for the company two 1hour 59min afternoon break, then you know something is rotten in denmark and america."

Who are these executives playing golf on weekday afternoons? You have been duped by urban mythmakers. And how would you know what is discussed among the members of a foursome?

Lots of people play weekday golf. When it's business, it's the salesguys who tee it up.

[Fran]

chris attempts to save face here.

chris apparently thinks they can tell what sex a person is via telekinesis or something.

Let me reiterate that I have no problem with capitalism.

There are no communist nations. They don't exist. What most people call communism is really just violent repression. China is in fact a much more capitalistic country than we are. If you don't believe me, ask the companies that are all moving there. Why would capitalist companies move to a communist nation? Put away your straw man.

Are you saying that you pay for your cops and firemen? Did you pay your police bill last year? Oh, no, they take it out of your taxes. Even if the firemen are volunteers, the equipment, fuel, etc. are not volunteeered, you paid for it. You don't get to choose to not have police protection. What a communist country this is!

All those rapists and murderers that the police dealt with last year, and that idiot who burned down his house with a candle, and it's all coming out of your tax bill!!! This communist police and fire state is costing you real money!!! Isn't it outrageous! People who get robbed more often should be denied police coverage, because it's really costing us.

My point is that as a society, we create mechanisms to solve our problems. Some of them involve communist ideals, like the fire and police departments, and some involve capitalistic ideals, like the grocery store and the car dealer. Some things fit better into one system than the other. We don't buy police protection, and we don't all get cars for free.

Talk about bureaucracy! How big are the insurance companies? Apparently too big to get rid of. And what do they do? They take our money and turn it around to the health care providers. What is the value added? What do they contribute? How much do they skim off in the process? Billions and billions! And what do we get in return? Arbitrary decisions about life and death. If you don't think the govenment could do a better job, why don't you...

Ask George W. Bush and the members of Congress about THEIR health insurance. Single-payer, government-run, govenment-paid. Why can't the rest of us have that, too? The government already manages health care for a lot of people, and it already does it more efficiently than our greed-mongering insurance companies. If you don't agree with that, then you should call the president and tell him to stop freeloading and go out and get his own health insurance.

[roger]

"There are no communist nations."

http://en.wikipedia.org/wiki/Communist_state

that would be news to solzenitzen.

[normanx]

One very big problem is that HUGE pension funds (like CALPERS) are invested in these insurance businesses. Until they divest, there will be no reason for the insurance business to change. I think we need the approach that was taken with South Africa and divest of businesses that are associated with the health apartheid against the citizens of the United States.

[Fran]

Indeed, there is no more Soviet Union. Thanks for proving my point. Communism doesn't work. Neither does Capitalism, by itself.

My point is, which social institutions should be based on the capitalist model, and which should be based on the socialist model. Clearly we Americans have decided on the socialist model for our police, fire, and many other public services. We have decided on the capitalist model for distributing food amd other material goods.

Up until this point we have used the capitalist model for health care. The rest of the world has been wrestling with this problem, too, and they seem to have much better results with the communist model. These other countries already have our Coca Cola and our Television, they could have our insurance, too, if they wanted it, but they don't.

Economists tell us that capitalism works best where there is a free market. Health care is not a free market. It operates under the Hippocratic Oath, which really messes up the free market, to the point where no tinkering can make it right. If you have to tinker with a market to make it free, it isn't free.

When you have a system that won't conform to a free market, what do you do? You manage it in a socialist manner by having the government run it. Just like all the other social services we have today.

[Fran]

Mr. Solzhenitsyn used to live in Vermont, but now that there is no more Soviet Union, he has moved back home. It is indeed great news to him!

[Fran]

I know I've said a lot, but I'd like to add that normanx's idea is a very good one.

[Larry In Lethbridge]

I think one reason why Osama Bin Laden hates the USA and despises America is that he thinks many are made in the same mold as our Chris. Loud, opinionated, narrowminded, quick to maliciously criticize people with differing opinions etc..

I mean here we are a blog designed to evoke discussion and this little runt jumps in like a juvenile in need of attention and carries on like a complete idiot. Unable to secure a position in politics due to these inadequacies , he uses this forum to fulfil his political aspirations.

Chris, you are giving your fellow Americans a bad rap buddy. No need to be a BMOC here, as your grandstanding seems to only be benefiting you. Your behaviour is giving Bin Laden more ammunition everyday.

[chris]

fran wrote:

"chris apparently thinks they can tell what sex a person is via telekinesis or something."

Fran, it wasn't your name that led me to think you were female. It was the nature of your whining.

In your best The-Earth-is-Flat tones, you said:

"There are no communist nations."

Yeah. Sure. Okey dokey.

Like those people who claim we never landed on the Moon, you said:

"They don't exist."

And:

"What most people call communism is really just violent repression."

So if you take away the violent repression, does the state still own the means of production in Cuba, North Korea and a few others places, soon to include Venezuela? Or not?

Here's a whopper for the Dumb Statements by Economist's Hall of Fame:

"China is in fact a much more capitalistic country than we are."

While I agree the Chinese economy is evolving from communism to capitalism, the government is in charge and there are literally billions of problems unsolved by the all-embracing Central Planners.

Next the Amazing Fran attempts to perform magic never before seen on Earth when he says:

"If you don't believe me, ask the companies that are all moving there."

Name ONE company that has "moved to China." One.

If you think building a manufacturing facility in China means "the company has moved to China" you are out of your mind. You obviously don't know a thing about the financing arrangements of factory deals in China or the guarantees the Chinese government gives large multinational companies willing to manufacture goods in China.

Anyway, GM is still headquartered in Detroit. If the idiots in the UAW want to keep their jobs, they will recognize they are competing with the Chinese government, not GM management. The amount of labor moved to other countries is in the hands of the union workers. No one else.

And going further into your delusional world:

"Why would capitalist companies move to a communist nation?"

Answer. They don't. Some US companies have established operations in China -- because China has finally offered the security needed before capitalists are willing to invest.

Are there any US companies with operations in Cuba or North Korea? How about South Korea, Europe, South America, former Soviet republics, former Eastern European states?

What about US operations in Africa? Any there?

And now into your fantasy land of municipal financing:

"Are you saying that you pay for your cops and firemen?"

Absolutely. Via state and city taxes. And the bill is increasing because its contract time for the cops.

You rattled:

"Did you pay your police
bill last year?"

Yes.

Did those who were caught and convicted of committing violent crimes repay their victims and cover the medical bills of the people they injured? Did they compensate the families of people they murdered?

Has OJ Simpson paid the judgment against him for murdering his ex-wife and Ron Goldman? No.

That's getting away from the point, which is this: government services, with the possible exception of fire departments, ALWAYS fall short of meeting their goals.

You wrongly stated:

"Even if the firemen are volunteers, the equipment, fuel, etc. are not volunteeered, you paid for it."

Many volunteer fire departments depend on donations. I am not sure of the amount of federal, state, and city funds that are awarded to volunteer fire departments, but local residents are well aware of the value of donations to the firehouse. These days, with money flowing to municipalities under the banner of Homeland Security, the local volunteer firehouse is likely to receive a slice.

You blathered again:

"You don't get to choose to not have police protection."

Really? Go visit rural Montana and other sparsely populated regions and tell me how often you see a cop car on patrol.

You then illogically connected dots:

"What a communist country this is!"

You are one of those nitwits who doesn't know the difference between "compare" and "contrast".

Public safety is a concept common to both capitalists and communists. However, given the dilapidation and ricketiness of most structures in communist nations, the lack of restraints against smoking and the absence of sound building codes, you can be sure the destruction due to fires is far greater in communist countries than capitalist counterparts.

In bug-eyed amazement you say:

"All those rapists and murderers that the police dealt with last year, and that idiot who burned down his house with a candle, and it's all coming out of your tax bill!!!"

The local, city, state and federal police forces of the US solve many crimes. However, a huge percentage of crimes are never solved. Murders, rapes, arson, fraud, extortion, drug-dealing and on and on and on and on. Never solved.

However, it appears the success-rate of today's police is high enough to satisfy your expectations for a Government Healthcare plan.

You ranted:

"This communist police and fire state is costing you real money!!!"

Without fire protection, homeowners could net get fire insurance. Without fire insurance, banks would charge much higher rates for mortgage loans and expect much higher downpayments. Otherwise the bank would take the hit if a fire burned down the house.

Insurance companies to not offer flood insurance. But the federal government does. And it limits the maximum payout to $250,000.

Meanwhile, most residents of the flooded New Orleans areas did not have federal flood insurance. Should people who willingly live below sea-level in a flood zone receive free money from tax-payers for their obliviousness to the painfully obvious risks?

Crazily, you zip into orbit:

"People who get robbed more often should be denied police coverage, because it's really costing us."

Who said that? I said that it is a simple fact that poorer neighborhoods are the sites of far more crime than more prosperous neighborhoods.

You claim to have a point, but don't, when you state:

"My point is that as a society, we create mechanisms to solve our problems."

Solve our problems? Very few problems are "solved" except in math class. But we tackle them. Fire departments to not "solve" the fire problem. Fire departments simply limit the damage.

Meanwhile, strict building codes and strict fire safety codes PREVENT fires and minimize their danger.

You whizzed around:

"Some of them involve communist ideals, like the fire and police departments"

You really know nothing about communism and capitalism. You've got to look at the role of government in each setting. The differences are many.

You spun on a little more:

"...and some involve capitalistic ideals, like the grocery store and the car dealer."

As yet the US government has not gotten into the grocery business or the car dealership business. However, the government does operate programs that supply free food to anyone who needs it.

You got fictional when saying:

"Some things fit better into one system than the other. We don't buy police protection, and we don't all get cars for free."

We absolutely pay for cops and cars, and cop-cars.

More lunacy:

"Talk about bureaucracy! How big are the insurance companies?"

All sizes. What of it?

More madness:

"Apparently too big to get rid of."

Insurance companies take every possible step to improve their efficiency. Here again, it's clear you know nothing about how insurance works and why you need it.

You wondered:

"And what do they do?"

They protect you from loss and make it possible for people to obtain goods with borrowed money.

You raved:

"They take our money and turn it around to the health care providers."

Yes, doctors and other healthcare providers are paid from insurance proceeds. That's part of the plan.

YOu wondered:

"What is the value added?"

Well, try living with no insurance and see how things go when calamity strikes.

You wondered:

"What do they contribute?"

I gather you are relatively penniless.

You wondered:

"How much do they skim off in the process? Billions and billions!"

Skim off? The financial statements of many many insurance companies are freely available. Of course they won't mean anything to you because obviously you lack the knowledge to read an income statement, balance sheet or cash flow statement. But that's your problem.

You wondered:

"And what do we get in return?"

Pay-outs according to the terms of your policy.

You claimed:

"Arbitrary decisions about life and death. If you don't think the govenment could do a better job, why don't you..."

The government do a better job? Who is the government? We have Medicaid to serve the poor. It's a fact that some of the worst doctors in the country serve the Medicaid patients.

Do you have any real experience with government agencies? Or are you just floating along in your communist euphoria?

You said:

"Ask George W. Bush and the members of Congress about THEIR health insurance. Single-payer, government-run, govenment-paid. Why can't the rest of us have that, too?"

I have no idea of the quality of the healthcare plan enjoyed by Congress. But I did notice that a few members of Congress recently died of diseases recently. Meanwhile, the president of the US will get the best care available because his health is more important to the nation than yours or mine.

YOu muddled along:

"The government already manages health care for a lot of people, and it already does it more efficiently than our greed-mongering insurance companies."

Is it news to you that Medicare and Medicaid exist and that people have many many complaints about the extent and quality of their benefits?

About 100 million Americans are covered by the combination of Medicare and Medicaid. The total bill for covering one-third of the US population is $565 BILLION. Therefore, to cover the entire population would cost 3 times that amount, or about $1.7 TRILLION. But those programs would never approach the quality of care given to the president or Congress simply because there are not enough top-notch doctors and top-notch facilities to match the care received by our top dogs.

You finally ended with:

"If you don't agree with that, then you should call the president and tell him to stop freeloading and go out and get his own health insurance."

All former presidents get free healthcare for life.

However, if you want to know how much it would cost the nation to provide everyone with the level of healthcare given to the president, it should be easy to calculate the number.

After you get the figure for his healthcare, multiply it by 300 million (the US population) to determine the cost for the entire country. The number will go well into the TRILLIONS of Dollars. I don't think the nation can afford it.

[chris]

Fran, you wrote:

"These other countries already have our Coca Cola and our Television, they could have our insurance, too, if they wanted it, but they don't."

Fran, you really don't know anything. In fact, US insurance companies are global operations. AFLAC, with its quacking ducks, is huge in Japan.

[buena]

Barbara, your blog piece is brilliant. I'll forward it widely.

[Fran]

Here I go again...

To stretch an analogy, think of our society as a living being. Money is its blood. It moves the value from one place to another. When there is a problem with the flow, the money starts to pool in one spot. In living beings, this is a REALLY BAD sign, when the blood starts to pool. The last time this country had so much pooled-up money (in the hands of the rich) was just before the Great Depression, and I think it's fair to say that the patient lost some blood in that incident.

Right now in the health care business we have a constriction of the flow because our health care professionals are sworn to protect their patients, not to worship the dollar. So the money pools upstream, in the insurance companies.

If we get rid of the insurance companies, alas, we will not be able to hire them all as claims processors in the new system, because it will be so much more efficient (no arguing about payments).

[roger]

your analogy fails entirely.

[Fran]

chris,

put away your bad attitude and hair splitting nonsense.

Yes, I look at how much money the insurance companies make, and how much they pay their leaders. I think they are very good business people, they make a lot of money and they pay themselves handsomely. Your profits are my skimming. It just depends on whether you're on the giving or the receiving end.

Personally I would not invest my money in an insurance company unless they were the stingiest, most arrogant bastards around. Anything less would be a waste of my money and a breach of their fiduciary responsibility to their shareholders.

I work in the health care IT field, I know where the money is going, my software moves it around.

How can you calculate how much it would cost to insure everyone based on how much it cost us to treat Nixon's phebitis? Come on, mr. capitalist, pull out your spreadsheet. Insurance actuarials are some of the most gifted mathematicians, don't pretend that their work is child's play.

Now suppose we actually did have single payer health care. How would that be different than what we have? You would go to the doctor, just as you do now.

If you say that the waiting lists are longer in other countries, go ahead and try to get an appointment with an allergist in Boston. You'll be sneezing for months before you see the doctor.

Okay, so after you see the doctor, you won't get a bill. The bill will be sent to the government, where some underpaid slob will open it and punch it into the computer. Except instead of pressing the 'deny' button, they press the 'pay' button, the government cuts a check for the doctor, and that's the end of it.

Up to this point with insurance, it's the same thing, but we're just getting started. They send you a rejection letter or pay for only part of it, you protest, you get your doctor involved with all the paperwork, your heath suffers, etc. Of course the insurance company loves the flurry of paperwork because it's more clerical work which means more overhead which means more profits. The insurance companies love car accidents because there are multiple insurance companies involved and they can spend months arguing about who pays for what, and guess who pays the bill for all their shuffling? You do.

And all of those poor people you sneer at who can't pay their medical bills, who pays for it? You already do! When the hospital can't collect a bill, it just raises everyone else's bill. I don't know about you, but I would rather pay for people to get an appointment and go to the doctor ahead of time instead of 'going to the emergency room', as our president so charitably suggested they do.

[Fran]

roger, you startle me with the width and breadth of your intellect. What don't you share some of it with us instead of just sniping?

[chris]

fran, you wrote:

"I work in the health care IT field, I know where the money is going, my software moves it around."

That's another way of saying you have no idea what all those numbers on the income statement, balance sheet and cash flow statements mean.

You wrote:

"Insurance actuarials are some of the most gifted mathematicians, don't pretend that their work is child's play."

Actuarial science is the statistics side of math. Big deal. Actuaries are intelligent people who studied a rather dry subject. I am not overwhelmed. Actuarial studies are no more difficult, actually, less difficult than engineering, which I studied as an undergrad.

That aside, you seem to suggest that mortality and disease would lessen if the federal government controlled healthcare.

The sillier part of your argument is the part that depends on your complete and willful ignorance of every bureaucracy that overweights every government agency.

An even sillier aspect of your paean to Government Healthcare is you willful ignorance of our national experience with Medicare and Medicaid.

Medicare is pretty good. But miles from meeting every demand from every beneficiary.

Medicaid is, by any and every account, lacking. Moreover, Medicaid doctors lose medical malpractice lawsuits as fast as they're filed.

Medicaid costs over $300 Billion a year to serve about 60 million people, or 20% of the population.

The doctors lose the suits because they commit medical errors. And juries just love giving money to people in medical malpractice suits, especially when a big bad insurnace company has to fork over the dough, or the GOVERNMENT has to pay.

If we expand Medicaid to cover 100% of the population, what will medical malpractice lawsuits add to the cost of service?

Then, what will it take to improve the inferior Medicaid service to the levels you dreamers have in mind?

Do you understand that every government -- town, city, state, federal -- creates paper-shuffling positions to keep people employed?

Those government jobs may offer paychecks that are somewhat less than non-government jobs, but they generally include vastly more comprehensive healthcare benefits. Thus, your goofy suggestion of efficiency goes out the window when the expenditures for so many unneeded employees are totaled.

Anyway, you've made many claims here about many matters. But you have provided ZERO support for any of them. I know facts are inconvenient, but it's the absolute absence of fact that keeps your fantasies from advancing beyond the dream stage.

As long as we can sue the pants off doctors, we will never have Government Healthcare in the US.

Take notice that in the countries offering what you think you want, you cannot sue if the doctor leaves a sponge in your belly after removing your appendix.

Lawyers like John Edwards would never go for a society in which doctors were untouchable.

Meanwhile, as for waiting times, they vary. If you need immediate care, you will get it. If not, you may wait. So what?

[Fran]

I think there is some sort of conception out there that people who want a single-payer health system are communists in every sense of the word.

Get it straight: I don't want free groceries, free insurance, free Brittany Spears music, or any of that. I think that everyone who is able should be making some sort of a contribution, either working at a job or at making a family. I'm a happy consumer and I have no problem taking part in our capitalist society. It's just that the health care situation is a total mess and more of the same is not going to make it any better.

My employer pays much of my and my wife's health insurance, but not all, and I pay the rest. The total is shocking, it's as much as the all the taxes combined (nb I live in New Hampshire). My wife and I have both had significant health issues costing many thousands, but the total cost to the insurance company has not come close to the amount I have paid in premiums. You can't tell me that a single payer health system will be as big as the rest of government combined.

True story: the hospital screwed up and billed us for something that they should have billed the insurance company for. We got the bill in the mail. We made a mighty stink and the hospital 'fessed up and billed the insurance company. The insurance company paid 75% of the bill and the hospital called it even. We have the paperwork to prove it. Next time you get a bill, offer to pay 75% of it and see how you get treated. Don't even start to tell me that the insurance companies play fair.

The true capitalist does the thing that costs the least and has the highest rate of return. Our current system sucks at this, unless you're an insurance company.

Yes, I live in New Hampshire and I'm a Live Free Or Die kind of guy. I shook Meldrim Thompson's hand once. Insurance companies, stop taking my hard-earned money away from me.

[Fran]

Chris,

You gotta get me some of you're taking. The visual effects must be very interesting, you're seeing things that aren't there.

[Larry in Lethbridge]

Do you all sense Chris is near a meltdown ? I see telltale signs. I feel he fears Osama is gonna get him. I'll bet Bin Laden can get his Internet address easily and finding him will take 3 minutes.

[Fran]

So I can't sue the doctor that leaves a sponge in me. You are saying that the appropriate response to a medical error is to have a lawsuit, and lavish lots of money on lawyers for a legal procedure that does nothing to alleviate the problem? Lawsuits do not undo the thing that they were brought for. In the end a lot of money changes hands but the sponge is still there.

There are other ways to get people to do a good job than to threaten them with a lawsuit if they screw up. Doctors in particular have a strict code of ethics and any doctor who did this sort of thing would not be a doctor for long in any reasonable society.

This situation is like a perverse lottery: if you are the unlucky bloke with the sponge, you just might spend the rest of your life on easy street if you win that lawsuit and collect punitive damages, or it might kill you.

Why not just patch the poor bloke up and see to it that he has a comfortable existence? You don't need a lawsuit to figure out that it's the right thing to do.

If it were a really free market I could pick a doctor based on their performance, like I pick a car dealer or a grocery store. But it's not a free market, the insurance companies control it, and they tell me what doctors I can go to. Stop pretending that this is a free market.

For all of you who say that you can't do this or you can't do that in a single-payer system, sit down and think if it makes any sense anyway. Look. We don't have a single-payer system. If we get one, we're going to make it ourselves. We don't have to slavishly copy other countries, we can learn from them, we can use our own experiences, and we can forge something that works. We've been solving problems like this as a country all along. We overcame our civil war, we beat the Nazis, we beat the Russians, we went to the moon. Last time the rich people f*cked us this bad was in the '20's and we recovered from that. We can figure out health care.

I think it's patently unpatriotic to say that we are too stupid or too lazy to do anything about this.

[chris]

Fran, you wrote:

"My employer pays much of my and my wife's health insurance, but not all, and I pay the rest. The total is shocking, it's as much as the all the taxes combined..."

Many people suffer from chronic problems. Thus, you should have no difficulty extrapolating the high costs you and others incur and how those costs pump up the bill you want to share with every other taxpayer.

You wrote:

"My wife and I have both had significant health issues costing many thousands, but the total cost to the insurance company has not come close to the amount I have paid in premiums."

If your statement is true, and I doubt that it is, why do you carry health insurance? By your estimates you would spend less by making direct payments to your healthcare providers.

Meanwhile, if your bills are as high as you say they are, you should qualify for the tax deduction for medical expenses, which would lower your net cost.

You declared:

"You can't tell me that a single payer health system will be as big as the rest of government combined."

I can tell you anything, but you will probably ignore the reality.

You can easily estimate the number of healthcare professionals working in the US now and add the number of employees working for healthcare insurers.

The combined figure will fall far short of the number of people who would populate healthcare if we were to enact Government Healthcare.

You show ZERO willingness to compare government bureaucracies with private competitors.

The Post Office versus FedEx or UPS.

Public School versus Private School.

Amtrak versus Commercial Bus Service.

Medical marijuana versus illegal weed.

Government housing versus private housing.

The government is a lousy operator compared with the private alternative, if it exists.

Meanwhile, your Government Healthcare system would suffer tremendous abuse from fraudsters.

We in New York City have lots of experience with Medicaid Mills and the opportunity to submit phony bills. If you think you can minimize fraud, you must know you will need lots of investigators.

Government programs are always ripped off in every direction.

Like you said, your underpaid government bureaucrat will push the "paid" button without thinking twice. After all, it won't affect his job if the bill is phony.