America’s Health Care: Sick in the Head

Friday, January 30, 2009

Find out how America’s health care system might change during the Obama administration. Luke Mitchell, author of the article "Sick in the Head" in the February issue of Harper’s, says it’s likely that the U.S. still won’t get the health care system it needs.


Luke Mitchell

Comments [28]

LB from Montreal

For a while I had great health care in the States because of my husband's job. Before that I was single and self-employed, and getting health insurance was a nightmare. I owe a lot to a few kind doctors who helped me by giving me sample drugs and lowballing their fees. But I have a friend, a nurse, who is going deaf because her insurance won't cover an operation for her ear (they say it's a pre-existing condition).

Last year we moved to Canada, where the health care (so far) has been excellent and free. You go to a doctor's office, they swipe your health card, and that's all the paperwork you have to mess with. (Quebec has a few very minimal copays, as opposed to Ontario, which had none.) It is not easy to find a permanent family doctor, but there are ample walk-in clinics. No one gets turned away for lack of funds.

So having experienced the best of American healthcare and the worst, I would say Canada has the preferable system. Insurance companies are an unnecessary layer of bureaucracy whose goal is to keep from paying for the care their customers need. And I feel better knowing I'm living in a country in which people aren't going deaf simply because they have low incomes.

Jan. 30 2009 03:58 PM
mc from Brooklyn

jh #25,
Thank you. Too many people here in the STates are under the false impression that all European countries have single payer.

I hope you are doing OK.

Jan. 30 2009 02:22 PM
mc from Brooklyn

Sorry, but I cannot take Luke Mitchell seriously as any kind of authority on this subject when he says "mandates are debateable." They are only debateable here in the U.S. Every other country that has universal coverage requires everyone to have it. If you don't it quickly leads to adverse selection. I suppose he said that because the idea has Hillary's cooties all over it, but John Edwards espoused the same idea as do Tom Daschle and Max Baucus.

Jan. 30 2009 02:20 PM
jh from Switzerland

To robert ragaini:
The Swiss federal government requires all residents to purchase their own health insurance, defines what basic health insurance is, and clearly delineates what medical care is covered under basic health insurance. On a per procedure/visit basis, the care is cheaper here a lot of the time (except dental which is very expensive) and medication is much more expensive. Maternity care is covered in full, unless one has a complication.
What you won't hear so often is that moderate or low income families need to choose plans with a high deductible and low monthly premium in order to afford even basic health insurance. The deductibles are often prohibitively high, so that care that's not urgently needed, gets put off (sounds familiar?). My monthly premium is 213 Swiss francs or about $200 with a deductible of 3000 francs.
If you can afford it, there are all sorts of supplemental insurances one can purchase to cover private hospitals, well-person care, and maintenance dental care.

It's better than the American "system," but not ideal because there are still financial barriers to comprehensive care.

Sorry, that wasn't brief!

Jan. 30 2009 12:46 PM
jawbone from Parsippany

The seeming timidity of the Obama admin re: universal healthcare, especially single payer, is scary and depressing.

Note that when Labour brought universal healthcare to Great Britain, it was after years of devastating war (a rea war, WWII, where the nation was under direct and deadly assaults), followed by a devastated economy, with huge numbers of returning soldiers unable to find work. GB had rationing on some items into the 1950's. We're talking HARD times.

Yet, the leaders of Labour then decided to increase the social network and instituted national health care. During times at least (OK, that's a bit snarky) as daunting as our current downturn/recession/looiming depression.

Where is the courage of our politicians?? Tied to how much money they get from Big Donors (which Obama also got, don't forget)?

We can't afford to not have single payer national healthcare. Let the private insurers say they're much better and leave their monster profit-making plans on offer. Let's see what the "market" and "consumers" will do when a real choice is available to them.

As a start: Let us in, Obama, to the Federal healthcare plans!

I currently pay almost exactly $1,500 per month to Aetna for my individual insurance plan. I have a type of cancer which requires constant monitoring. I would not be covered by any other insurer. I have no choices until I reach Medicare age.

The Fed employees monthly cost for Aetna HMO? Less than $400/month. I am being bled out financially to keep Aetna's execs living in the manner to which they have become accustomed.

Let's see: $18,000/year vs. $4,800/year. No brainer.

Jan. 30 2009 12:45 PM
Betty Anne from UES

I know this is a stretch but my argument to conservatives against single-payer-healthcare always goes to Israel.

I ask them why they support funding a nation that provides single-payer healthcare to all it's citizens. If Israel has it why can't we?

Jan. 30 2009 12:34 PM
tom from nyc

this may sound off topic but please bare with me: I had an excruciating experience with health care concerning an emergency with a beagle named "puppy." He almost died on the street when a tumor burst and a cabbie helped me get him to the great AMC hospital emergency room. By six hours into the treatment to keep him alive the bill was 1400 and going up by the half hour! The biggest stress was the money! The dog took it well, but the family who owns the dog had to make excruciating decisions-- MONEY decisions. Later aftr surgery (elsewhwere) we ran up against an emergency room franchise clinic and again MONEY was a huge problem for the family to decide. In a couple of days 3500 was spent and the 90% of the stress came from MONEY questions more than the fear of losing the dog... I will never forge it, the horror was in money ques. and pressure and rule, the beautiful and poignant thing was the life of friend. What people must go through with actual family members must be nearly unbearable.

Jan. 30 2009 12:31 PM
Howard Newhouse from Brooklyn, NY

We must reject totally any health system that permits the excessive salaries of insurance company executives. The CEO of United made one billion (with a B), helped along by backdated stock options. This is analagous to what happened on Wall Street and this greed will totally bring down the system.
As reimbursements are reduced the amount of time a physican can spend with a patient is pressured downward. Do your listeners know that GHI pays approx $40 for a visit and Medicaid less than $10. American medicine is being reduced to an assembly line.

Jan. 30 2009 12:31 PM
mc from Brooklyn

Susan from Summit,
It is more that the specialists make a lot more money so no one wants to go into primary care. So we have too many specialists, not too few, and the system rewards expensive intervention instead of prevention.

Jan. 30 2009 12:30 PM
M from New York City

Why? WHy? WHY? Indeed - Its is because our illusrious Congress is bought and payed for by the various lobbies who are merely using the premise of "ideology" as an instrumental means to justify (including negatively as with "socialism")the current system, which as the author explains, is immensely profitable in the current form. The reason there is a crisis is because a legitimate "economy" simply provides through "the market", whatever people need and want. This is not happening now as need is not being supplied in an artificial system that is "rigged" for suppliers - not the majority of potential recipients.

Jan. 30 2009 12:30 PM


Jan. 30 2009 12:29 PM
mc from Brooklyn

Rochelle #13,
The problem is, how do we control the runaway costs?

Jan. 30 2009 12:28 PM
al oof

you know, we already have socialized healthcare. it's called Sanitation. and no one complains about this. no one thinks that taxes shouldn't pay for trash, even though people create different amounts of trash. but the point of sanitation is to keep our streets clean, so that we don't get sick or get overrun with vermin.

Jan. 30 2009 12:26 PM
mc from Brooklyn

robert from Park Slope nailed it. Supply and demand rules do not work in health care. If anything supply drives demand higher. If a cardiologist owns a $1 million CT machine you can bet he keeps it booked up.

Jan. 30 2009 12:26 PM
Susan from Summit, NJ

I once heard that the availability of medical school training is purposely limited to keep costs high (supply vs. demand for doctors. Did you find that to be the case?

Jan. 30 2009 12:25 PM

Aren't many of the medical items in the recover plan that just passed the house actually the first steps towards single payer? If a great percentage of people end up unemployed and through the new unemployment benefits get medicaid or cobra help -- won't that enroll a huge population that can be converted into the beginings of a single payor system??

Jan. 30 2009 12:24 PM
mc from Brooklyn

I hear the arguments about insurance companies off loading costs, I hear the fact that our system is fragmented and terrible, I hear the fact that out of that 2.2 Trillion almost half of that is public sector.

Here is what I don't hear. Out of the 2.2 trillion pie publised by CMS only 7% accounts for insurance overhead and profits. 2%!! That means we pay too much for redundant and unnecessary treatments. WE HAVE TO TALK ABOUT THIS. Insurance companies hold back 15% of what they take in and that figure has remained flat for almost 6 years.

Jan. 30 2009 12:22 PM
robert ragaini from new york city

Luke Mitchell's description of proposed insurance-based health care systems sounds identical to the Swiss system. The few Swiss I've asked, like the insurance plans they've chosen, and the fact that those who can't afford it are subsidized by the government. Are you familiar with it?

Jan. 30 2009 12:22 PM
Susan from Summit, NJ

How much of the problem is related to the fact that insurance companies are "for profit" and must please their shareholders.

Jan. 30 2009 12:21 PM
Charles Loughhead

Interesting article by Gladwell includes some relevant history on the UAW and health care benefits:

Jan. 30 2009 12:21 PM
Shoshanna Sofaer from Manhattan

Mitchell is absolutely correct that people who are on the receiving end of our health care expenditures want to keep the money coming their way, and will oppose any plan that stops the flow. The "stakeholders" have too much to lose. The public has much to gain. Obama, Daschle and all of us who care deeply about this issue need to mobilize and demand meaningful change. We need an organizing effort similar to that of the Obama campaign. At the same time, while we need a lot of things to change, we should NOT get hung up on ideological minutiae.

Jan. 30 2009 12:21 PM
robert from park slope

It's ridiculous to talk about "market solutions" regarding health care. First, there is no direct patient-provider interface but instead a menage à trois arrangement between patient, provider and insurer. Second, normal market solutions depend on demand shrinkage in response to higher prices (price elasticity of demand). However, there is no such elasticity when it comes to treating cancer or removing an appendix. People will pay as long as they have money in the bank and without consideration of long-term financial consequences.

Jan. 30 2009 12:20 PM
Terry from Inwood, Manhattan from inwood, manhattan

Fewer doctors are accepting medicare because of the low rates and slow payments. I am in favor on single payer, universal health care.
How will we insure that we have good to excellent doctors participating in medicare as it is now or universal healthcare, and smart people going into the field.

(Of course, the decline in financial sectors compensation will help.)

Jan. 30 2009 12:19 PM

What's to stop the insurance industry from destroying health care with a flood of "Harry and Louise" commercials, as it did last time?

Jan. 30 2009 12:17 PM

I have a very good health care plan, but I call them once a month and say, "OK, who do I owe, and what do I owe them? I can't make heads nor tails of all the things I'm being sent by hospitals, doctors, and you."

The person on the phone is usually very good, tells me what's in process, what they have or haven't received, what checks they sent to me to tear up, etc.

What a complex, screwy system!

Jan. 30 2009 12:15 PM
John from manhattan

Having used both the Canadian and American Health Care System I would prefer the socialized system as opposed to our system. There are some definite kinks and myths about it but overall it was less complicated to use and I never had sub-par treatment. (I think the problem with the Canadian system is in the rural areas where there aren't enough family doctors. Part of that problem is that there was a trend, which has since reversed, for Canadian doctors to come to the US.)

Jan. 30 2009 12:14 PM
Frustrated from Brooklyn

The U.S. could be the country it claims to be if it would step up and not try to fix it but completely change our healthcare system. Our current system is holding the nation back.

Jan. 30 2009 12:14 PM
Steven B. from New York, NY

One problem I discovered with a multi-payer system is this: it is in the interest of your current payer (i.e., your insurance company) to put off approval of treatment. If they put it off long enough, you might change jobs and the burden will be placed on a new, different insurance company. If you are 60, when you may need the health care most, the goal is to put off treatment until medicare pays. With a single payer system, it is in the interest of the payer to restore your health quickly, before the cost escalates due to delayed care.

Jan. 30 2009 12:14 PM

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