Obamacare Wins (Maybe)
The House of Representatives has just approved Obama’s healthcare bill 220 -215. The bill will now go to the Senate where the Democrats may have the numbers to pass the bill – assuming all Democrats and the two independents vote for it. Obama needs to get everything passed before the mid-term elections. It is highly likely that the Democrats will either lose control of one or both houses or, at least seriously erode their margin. Obama can then kiss his healthcare bill goodbye. Effectively, he probably needs to have it enshrined in law by the end of the year as Congressmen and Senators become increasingly nervous as the mid-terms approach and don’t like being asked to vote on controversial issues.
Of course, if he gets it passed, there is no way that the Republicans will be able to do anything about it. History shows that engineering a perceived reduction in health care is a fine way of getting yourself voted out of office. Once Obamacare is in, it will be impossible to move and it will be practically impossible to prevent the inevitable socialisation of US healthcare.
This is how it will go down. Medicare will be greatly expanded and costs will be tightly constrained in order to price the policy as low as possible. In order to maintain some semblance of a profit margin, healthcare providers will attempt to charge private insurers higher fees. Only the larger insurance companies will have the size and clout to resist this. Private insurance fees will go up, forcing more and more companies (who are now being forced to provide insurance cover) to plump for the cheaper Medicare option, despite the benefits being a limited, one-size-fits-no-one, standardised plan.
- Job losses are almost inevitable as companies struggle to cope with either new taxes or new healthcare costs.
- Smaller insurance companies will go to the wall, reducing competition (the exact opposite of Obama’s claim to increase competition)
- Larger insurance companies will haemorrhage clients, increasing costs
Eventually the system will stabilise with Medicare taking a sizable chunk of the market. This chunk will be too big for the providers to absorb, forcing many into liquidation. The crisis in health care created by this will force the government to buy out major hospital groups (bailouts, anyone?), effectively forming the hub of a new state health care system. Some bright spark in government will point out that owning the insurer and the provider is daft and Medicare will then probably implode, forming a true state health system. This last may not happen, as there may be some incentive for private insurers to buy healthcare from the government providers, if it is cheaper. Moderately well-off people will still be able to insure themselves and access private health care. The wealthy will pay for private health care directly. The poor and the elderly will by then be getting used to the rationing system the state will inevitably put in place.
I hope they don’t mind waiting for their healthcare. A long, long time.
We in New Zealand can tell them how that feels…
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Nov 8 09 2:47 pm
Is it your contention, MD, that a state-run health care system is on balance worse than a privately run one, or just not obviously better?
Albeit that if the President and Congress want a state-run system, they are, if your predictions prove correct, going about it in about the most costly and inefficient way imaginable. Which doesn't bode well, at all.
Nov 8 09 6:35 pm
Furthermore MacDoctor, the US biotech sector already undergoing a massive reshuffle, will suddenly lose not just its Tier 3 companies that are presently doomed to fail, but also its Tier 2 companies that venture capital was willing to fund until future discoveries made good. The Tier 1 companies with ongoing cash in hand and near term products will suddenly find themselves with limited access to market because of costs – Pharmac anyone? This will have huge implications for peripheral activites like R&D, patient trials and so forth and drive a lot more of this offshore. The VC community in the USA is already extremely angry with Obama – this could be his Waterloo for them. The Senate needs to be very careful what they wish for.
Nov 9 09 8:25 am
Apteryx: You really need 50 — 100k in an insurance account or private health insurance to be comfortably assured of getting your health needs met.
Comfortable would be 100K + six months salary AND an income protection policy that kicks in at six months…
Nov 9 09 2:41 am
Do you know the US pay the most per capita for healthcare in the world but yet have some of the worst statistics for health care.
Wonder why that is?
Wouldnt be anything to do with ridicolous profits been made by some.
Which in turn wouldn't have anything to do with the strong resistance by such lobby groups to change.
Nov 9 09 8:21 am
Jeff R Do you know the US pay the most per capita for healthcare in the world but yet have some of the worst statistics for health care.
Ah. The "worst statistics for health care" myth. The US has, in fact, the best access stats for healthcare in the world. You can check this for yourself at WHO. They have poor infant mortality stats which gives rise to reduced longevity stats, but their infant mortality stats are poor because the US counts all stillbirths in these stats. Most countries do not.
I see you also cite the "ridiculous profit" myth for health insurers as well. I suggest you take a look at the annual reports of insurers and providers. The only thing ridiculous about their profit margin is how small it is. Which, in turn, is why their lobby groups strongly resist the government muscling in on their already thin profit margin.
But you don't have to take my word for it. Chances are Obama will get his healthcare bill through and you can observe the effects for yourself.
Nov 9 09 9:51 am
Mac, do Canada and the UK count stillbirths? If so, you're off target. Experts from The Urban Institute analysed various studies that compared national health care systems in developed nations. The conclusion was, it's a
They found no support for the common claim that American health care is the best in the world, and no hard evidence of any particular area in which American health care is truly exceptional.
Canada: Canadians receive better care with better results and longer survival periods: renal dialysis, kidney transplants, childhood leukemia, colorectal cancer. Canadians overall enjoy over three years longer life expectancy than Americans, and the Canadian infant mortality rate is far below the US. And percapita health spending in Canada is about half what US citizens pay.
U.K.: with true socialized medicine — no one is proposing that in the US — British citizens generally live longer than Americans, and fewer U.K. infants per capita die before the age of one than do American infants. U.K. citizens spends less than half what their US counterparts do on health care.
Even The Economist — no commie rag, that — admitted that the British system is superior to the US.
Nov 9 09 10:53 am
Harpoon: Mac, do Canada and the UK count stillbirths? If so, you’re off target.
There are a number of factors involved besides stillbirth. There is also reduced immunisation rates, large illegal immigrant populations, areas of poverty and the like. Canada and the UK do count still births but their definition is different from the US.
Note that life expectancy is not related to healthcare. Poland has a better life expectancy than the US but you wouldn't want to be hospitalised there.
If you want a good measure of health care there life expectancy from age 80 is a better one (the very elderly rely massively on healthcare to survive). The US beats every other country hands down here. From memory I think the nearest rival is Canada at 30% lower.
Nov 9 09 11:00 am
But for the elderly in the US, Medicare is already in place. I read recently (can't find the ref) that a a study found that when uninsured people turn 65 and start receiving decent medical treatment under Medicare, they see a dramatic improvement in their health. Funny, that.
Nov 9 09 11:11 am
Harpoon: when uninsured people turn 65 and start receiving decent medical treatment under Medicare, they see a dramatic improvement in their health. Funny, that.
Hardly. No-one is arguing that being uninsured is not bad for your health. Of course it is. But there are much better ways for the US to help uninsured people than setting up another giant taxpayer-backed insurance scheme. I outline a far better scheme right here.
Nov 9 09 2:44 am
An interesting comparision.
http://en.wikipedia.org/wiki/Comparison_of_Canadi...
Nov 9 09 8:23 am
Jeff R : An interesting comparision.
Yes, I particularly like the section on waiting times – where they deliberately compare the long Canadian waiting times to the long waiting times on Medicaid, the crappy public-funded insurance. And avoid comparing it to the vastly shorter times on private insurances.
Even the much-maligned HMOs have shorter waiting times…
Nov 9 09 9:53 am
But US citizens spend twice as much per capita on healthcare than Canadians, for results that are — to put it lightl — nothing to brag about.
Nov 9 09 10:35 am
Harpoon: But US citizens spend twice as much per capita on healthcare than Canadians, for results that are — to put it lightl — nothing to brag about
All that money goes on two things – better access and legal fees.
Nov 9 09 10:45 am
Better access for those who have [employers who have] the money. And legal fees for those who have the money, time and inclination to bother suing. Socialised health policy isn't all bad.
Nov 9 09 5:08 am
Um, for the foreigners… NZ has been running in effect a state funded system with pseudo competition since the 1930s.
If you have something go wrong fast — you are in a road crash or similar — care is good.
If something is going wrong less than fast there are delays in the system. Delays to see specailists. Delays for treatments such as radiotherapy or surgery.
If you have something painful you need enough "points" to get help.
Consequences? my dad waited 4 years for a quadruple coronary bypass. We do more complicated total hips because people do not get them done in time.
Except in private. You really need 50 — 100k in an insurance account or private health insurance to be comfortably assured of getting your health needs met.
Nov 9 09 9:57 am
In the US, insurance companies employ thousands of people specifically to find ways to deny people's claims. And hospitals refuse to treat until they see a credit card or evidence of ability to pay. Don't you think that delays treatment too?
Nov 9 09 10:41 am
Harpoon: Don’t you think that delays treatment too?
Not appreciably. Emergency treatment cannot be denied on the basis of inability to pay, so urgent treatment is never delayed. Elective procedures require approval which usually delays treatment only by a day or two. Denial of treatment is a separate issue – it is not delaying treatment, it is just saying you aren't insured for it. This usually means that you have a "cheap" policy.
Don't confuse denial of claims with rationing of treatment, they are two very different things.
Nov 9 09 10:49 am
They may be different beasts, but the results are both unpleasant.
Also, Emergency treatment isn't denied here either. And here' once she's off the critical list, your relative will still get treated even if she doesn't have the cash. Is that a bad thing for society?
Nov 9 09 11:00 am
Harpoon: And here’ once she’s off the critical list, your relative will still get treated even if she doesn’t have the cash. Is that a bad thing for society?
You left out the important word – Eventually. Your relative will eventually get treated. In some forms of socialised medicine – notably europe and the UK – this changes to NEVER if you are old. Ageist denial of treatment is the commonest problem in socialised medicine. And that is a very bad thing for society.
Nov 9 09 11:06 am
Mah … the old 'death panel' smear. Are you serious?
http://mediamatters.org/research/200910300018
Don't forget, in the US, medical care for the aged is already socialised — Medicare.
And what proportion of the very old can still afford premiums for comprehensive health insurance? Pull the other one.
Nov 9 09 6:33 am
It is widely held that the reason for Detroit's demise has been that their health benefits make American auto workers the most expensive in the world. Since the average Democrat voter almost certainly expects that Obamacare will be at least as generous (unrationed)as the union deals which ruinied Ford and General Motors, any guesses where what is left of the US economy is headed?
Nov 9 09 6:37 am
Some states all ready have mandatory healthcare , so the predictions are the usual GOP scare stories.
The things to remember are that the hospitals ( 70%) are mostly not for profit, but there is enormous waste as a city the size of Hamilton would have at least two full service tertiary hospitals, especially if there was a university in town.
Nov 9 09 8:31 am
Mediatart: Some states all ready have mandatory healthcare
Not to my knowledge. Which states are these?
there is enormous waste
There is no evidence that resources are wasted. US access is much, much better than NZ. By only having one hospital in Hamilton, we guarantee that we will wait six months for a hip replacement, six weeks for a bypass. IF WE ARE LUCKY!
Nov 9 09 10:00 am
States … I'm not fully up with it all, but how about Maryland?
Nov 9 09 10:13 am
One more thing … waiting time for hip replacements: can't find a number for Hamilton, but in Counties Manukau it's probably still 12 weeks. Hardly six months!
Nov 9 09 11:05 am
Harpoon:but in Counties Manukau it’s probably still 12 weeks. Hardly six months!
12 Weeks! I know of an old lady who waited three years! Of course, that was before the waiting list was "cleaned up" by bumping all the elderly off the hip replacement list unless they were virtually housebound by their disability.
Socialised medicine = cardboard compassion (MacDoctor expression based on those smiling cardboard cutouts you see in front of shops)
Nov 9 09 11:09 am
Hmmm … sorry for the dud link. Here's the proof … in that known commie rag, Granny Herald: http://www.nzherald.co.nz/counties-manukau-dhb/ne...
Nov 9 09 11:21 am
That is 12 weeks on the waiting list assuming you have enough "points" to make it on to the list. ANd that doesn't include the wait for the specialist appointment (often another 12 weeks). So that's 24 weeks, assuming I make the "grade"
Compared to 1-2 weeks in the US. Assuming I have insurance.
Nov 9 09 11:35 pm
Harpoon, get real ! For god's sake, don't you have any idea just how hard it is to even get on the waiting list. This is exactly how NZ and most public systems manage to make themselves look good, redefine the meanings of words ! So, in NZ waiting list is NOT a list of those waiting to get the procedure, it is a "managed" list of those deemed worthy by the "system" to be suitable to be placed on the list.
Thus, the REAL waiting list in Manukau is probably many months plus 12 weeks.And this isn't true for just hips of course, it's across the whole spectrum.
Nov 10 09 7:43 am
Ed, get real! Don't you have any idea just how hard it is for US citizens to even get insurance if they're old enough to need hip replacement, let alone afford the premiums?
In private medicine polities, waiting lists may be small, but they are NOT list of those waiting to get the procedure, it is a "managed" list of those who have been able to afford the premiums, deemed worthy by the private insurance system to be suitable to be a low enough risk to be insurable.
Thus, the REAL waiting list in the USA is probably many months (years even) more than 12 weeks. And this isn't true for just hips of course, it's across the whole spectrum.
Ed, do some reading.
Nov 9 09 6:41 am
The % of Heathcare of the OECD numbers for 2009 are out now. One thing that is curious is that for NZ the Health budget includes the disability sector which is roughly 20% of the budget. Do other countries include this in their health budget. NZ of course used to cover this in the Social Budget until Ruth Richardson pulled a switch to make the welfare 'look' as though they had made big changes, but had put more money into health.
Nov 9 09 11:12 am
Link to show 12 weeks counties Manukau wait:
http://www.nzherald.co.nz/counties-manukau-dhb/ne...
Nov 10 09 9:56 pm
Harpoon: Mah … the old ‘death panel’ smear. Are you serious?
Mah… the old exaggeration smear.
I merely said that rationing in a state healthcare system is ageist – this is undeniably true. ANd insurance is not a problem for the elderly in the US. As you have already pointed out, if they can’t continue their previous policy, they can always access Medicare.
However you swing it, the stats show that there are very few old folk in the US who wait more than 4 weeks for a hip replacement. And they don’t have to be crippled to qualify.
Nov 11 09 8:50 am
Harpoon, I’m being realistic, you were trying to claim that waiting lists in NZ were short, which is, as you know, a artifact of language. Access to the waiting list is managed to give the impression of short waits. Quite why you want to buy into this deception I can’t guess, unless you have some political motivation ?
And, you obviously don’t know how hard it is to get insurance, it’s just that you been told that it must be hard. Next you’ll be claiming that 47 million of them don’t have insurance !