A Pig in a Blanket: The Healthcare "Choice" Debate

Choice is good, right? In the United States, everyone wants to take charge of his or her own destiny. We would all prefer to have a choice when it comes to our housing, our food, our employment, our mate, our family size---and our health care.

Well, not quite all of us. To a handful of Americans, those who are getting rich from the current, broken health care system, choice is as scary at the Jabberwock.

Republicans, many in the pay of the private health insurance industry, are attempting to frame the discussion of private versus public health insurers as one of choice. However, what they call “choice” is actually a working monopoly that sucks up health care dollars and leaves us broke while doing nothing to improve the quality of our public health----which happens to be piss poor. Our right to choose is restricted by pharmaceutical companies which extend patents on their drugs for decades, pricing many treatments out of the reach of the average American. It is limited by health insurers who attempt to play doctor (i.e. deny necessary care) in order to increase their profits. In many cases, we are denied any choice at all, because the insurance companies say that we are “too risky to insure.” No insurance means no health care, which is not a choice (though the GOP would call it one). It is more like a curse.

“But we can not afford to tamper with the greatest health care system in the world” chants the right wing chorus. In small part, they are motivated by a misguided sense of patriotism which goes something like If America tortures, then it must be ok. If the American health care system makes infants die, then infant mortality must be ok. However, their allegiance to the current system is more a matter of economics than of principle.



http://content.nejm.org/cgi/content/full/357/8/736

Why spend so much money to sell America the “best health care system in the world”? Why does anyone have a massive advertising budget? Some products are so good that they sell themselves. Others are so inferior that the dealer has to hire a team of experts to persuade folks to purchase their lemons. Or fear the Jabberwock.

Just how bad is the current U.S. health system? At the present time, we spend a combination of private and public dollars that amounts to around $5000 a person a year on health care. This is over twice as much as any other industrialized nation spends. Just our public contribution exceeds that of some western European countries. For our money, we do not get gold plated Cadillac health care. No, we get scraping-the-bottom-of-the-barrel- many-Eastern-Europeans-would-be-embarrassed-by-our-standards health care. And almost 50 million of us can not even get that. The Medical Industrial Complex---health insurers, drug companies, hospitals---like to brag about how we have the finest health care system in the world. However, the only measure in which we excel is the amount of money we pay people who work in the health care industry. American health care is a great way to get rich. If you are looking to extend your life expectancy, you should consider moving to some other country.

When something is this broken, maybe we should consider fixing it.

Today, President Obama joined other prominent Democrats who have called for a combination of both a publicly financed health plan as well as the continuation of our current system of many private insurers.



http://www.reuters.com/article/domesticNews/idUSTRE55263L20090603

Sounds good to me. Offer folks a choice. They can opt for a public payer like Medicare, which has a proven record of low overhead and relatively limited hassles. Or, they can stick with designer health insurance, Blue Cross, United Health or any of the others which promise you the sun and the moon as long as you do not want to actually make use of them. Glamor versus quality. Hmmm? I wonder what most Americans will choose?

The private health insurance industry has a pretty good idea how things will go under a system that gives people more choice. If we no longer have to pay extra to be told “You can not get the treatment your doctor ordered”, most people will opt for paying less to get more. That is why they want to kill the public health insurance option in its cradle.




Ingeniously, the health insurance industry has made its own incompetence a centerpiece in its arguments against a public system. If people are offered the public option, we are told, they will all recognize it as superior, and they will sign up for it in droves, leaving the private insurers penniless. Therefore, in order to protect the current (failing) system we must not offer people a choice.

To which I can only reply “If our current system of private insurance is so bad that people will opt out of it to get on a Medicare like system, then why the hell would we want to salvage it?”

Mind, I am not advocating the dismantling of our current system. Those who insist that we can have only public health insurance or private health insurance are wrong. Even though education is guaranteed to every American child and we all pay taxes to support the public schools, a sizable number of U.S. citizens still opt to send their kids to private schools.

http://nces.ed.gov/fastfacts/display.asp?id=65

There will always be people willing to spend a little extra money to get something different. In other words, they will pay more for increased choice. In England, some people use the private health care system, even though they also qualify for National Health. Privates are not driven out of business. They just have to offer people something that is worth the money.

Asking Congress to force us to pay extra for less is ---well, it is just plain backwards. Like something out of Alice in Wonderland





If someone wraps a pig in a blanket and tells you that it is a baby, you are not obligated to make it your heir. If the medical industrial complex says that choice is not choice and that denying us choice is choice, we do not have to buy their crazy rhetoric.

One of the reasons Single Payer is so damn good at containing costs? It's SINGLE payer. It doesn't have a bunch of profit driven private insurance agencies skimming all the low risk higher profitability members of the risk pool out of the equation and leaving it having to deal with a larger percentage of the higher risk higher cost patients... and complicating all the health care providers administrative processes with their individual accounting and claims systems... and generally just fucking up the whole system.

Medicare in the U.S. would be WAY less expensive than it currently is if it didn't have private insurance injecting itself into the equation and screwing the deal.

It's better than nothing, and if you can get any expansion of public insurance coverage then hey, great... but if you want to do it right you need to kill the private health insurance industry dead and have one and only one source of health insurance coverage and screw this "choice of systems" crap. It is not a good thing.

Good post

all the money that would NOT be pissed away on advertising.

or charge them higher rates. So they won't be able to skim out the low risk people for themselves.

...without any loopholes those agencies will wiggle though to do it anyway, and good luck with that with how many lawyers they'll have working on doing exactly that... that hardly addresses the rest of the problem. The presence of those private insurance agencies unnecessarily complicates administration for the care providers and lowers efficiency for the entire system, thus raising everyone's costs.

Can we dunk Baucus?

I do not do this normally, but this is a great thread.

Is it true that Obama's plan forces insurance companies to take high-risk customers at no difference in price? This is the first I have heard of it.

How many more will have to die so the profit machines will meet their greedy goals ? Health care is a fraud gone the way of Wall St. http://www.wisecountyissues.com/?p=62 Affordable health care won't do much good until we demand a higher standard of quality health care than what is deemed, defended and supported in East Tennessee and southwest Virginia.

since Dems have the majority, who gives a rats ass what GOP does?

It is DEMS who obstruct real reform that is the right reform!

We all know it, you just say it very, very well.

"choice" = rich people get designer care, poor people get minimal shit for care.

Universal = everyone gets decent care, & rich people can pop some extra for designer care if they like.

#2 I never knew the meaning behind "pig in a blanket".

I was familiar with all of those food references already.
I always assumed the pig in a blanket or, pig in a pancake was an uncircumcised penis.

nothing to do with it, the poster's invention in the sense he's using it in - pig in a blanket to be synonymous with pig in a poke.

Everyone uses the NHS. Everyone. Those who have private health insurance, like BUPA, just use it as a "Top-up". Say, they could have elective surgery they needed at a private (more luxurious) hospital, or skip the queue for a test they are on a waiting list for by having it done privately (usually by the same doctor, at the same medical centre - they just pay to go to one of the doctor's "private clinics". Any emergency care etc would always be NHS. Insured care here is just a "top-up" option.

Like once, my baby needed a procedure done (not life threatening) and they told us it was going to be 6 weeks (less than the wait many in the US with insurance would have for the same procedure). When I enquired about it being done privately they said it would cost me £250 (about $375) if I wanted to have it that week (still hardly was going to put me in a financial hole). If I had had private cover that would have been covered.

I love the NHS, it is wonderful. I wish that the US could have a similar system. Sadly I think that they are so far in the pocket of the "industy" (people laugh here that healthcare is called an "industry" in the US) that it would take a miracle to pull it off.

Most people will opt in. However, a small number will demand something different (this is the U.S. land of rugged individualism) and an industry will spring up to serve them. In addition, there will be "nonmedical" demands for cosmetic surgery etc which will be met by nonpublic health care.

The privates simply need to get their act together and provide quality service for the dollar. The folks that are best at serving people' needs will stay in business.

Right now, the U.S. government is rewarding health industry incompetence and greed.

The reason we need to make it clear that the private option will never disappear is because some Americans are afraid that they will not be able to get "elective" services in the new climate. This is not true. If they want them and can pay for them someone will provide them.

Oh no, the majority of the Democrats are beholden to them too.

Other than that, good post.

survive competition- To Bad! "Ingeniously, the health insurance industry has made its own incompetence a centerpiece in its arguments against a public system. If people are offered the public option, we are told, they will all recognize it as superior, and they will sign up for it in droves, leaving the private insurers penniless. Therefore, in order to protect the current (failing) system we must not offer people a choice." This is the whole argument and nothing else.