Teddy and Me

[Dick K]

Today's mail brought a plaintive plea from Senator Edward M. Kennedy (D-MA) that I join with him in contributing to the Democratic Senatorial Election Campaign Fund (or somesuch) and thereby help thwart the nefarious right-wing agenda of George W. Bush (Boo! Hiss!).

Senator Kennedy even enclosed a postpaid, addressed envelope for whatever I would care to offer.

Alas, I could not see my way to making a financial contribution, but I figured Senator Kennedy and the faceless toilers in his money-grubbing vineyard might be in need of some reading material offering a bit more variety than the Senator's own turgid prose.

Fortunately, the same mail delivery which brough me Senator Kennedy's heart-wrenching appeal also contained a wide variety of jun^H^H^H bulk rate advertising material. I asked myself, as I am wont to do on such occasions, WWMMD? (What would Michael Moore do?)

So,...I crammed somewhere between eight ounces and a pound of assorted reading materials (AARP insurance offers, great deals from GEICO, miscellanous magazine subscription offers, etc., etc.) in the envelope so thoughtfully furnished by the Senator and heaved it into one of the boxes provided by the US Postal Service to receive outgoing mail.

Sure; the postage may cost the Democratic Senatorial etc. a few bucks which will now be unavailable to fund their efforts to unseat the Devil's spawn currently occupying the Republican seats in the Senate, but I hope they will consider it a small price to pay for the wonderful variety of reading material that will soon be in their hands.

It is always satisfying to know one is performing good works.

[Judy G. Russell]

...AARP insurance offers...
WHAT????????? You didn't instantly buy all the AARP insurance you could get? Why... why... whatsamatta with you? You unAmerican or something??? I mean, gee... you could insure your trailer! Your motorcycle! Even (gasp) your teeth!

[Dick K]

WHAT????????? You didn't instantly buy all the AARP insurance you could get?Judy -

No; I guess my loss is Teddy's gain. But I did save the 1-800 number to call for an automobile insurance quote so I cvan score the desk calculator they will give me if they cannot beat my current insurer (which they cannot do--it is USAA). Between AARP and GEICO, I have a steady supply of cheap desk calculators....

(Actually, for those who need Medigap insurance, the AARP program is a good deal. The premiums are low, the claims handling is speedy, and the filing procedures are extremely simple. My mother had AARP Medigap, and we were very pleased with it.)

[Judy G. Russell]

Actually, for those who need Medigap insurance, the AARP program is a good deal. The premiums are low, the claims handling is speedy, and the filing procedures are extremely simple. My mother had AARP Medigap, and we were very pleased with it.
Believe me... I will be headed in that direction the MINUTE I qualify for Medicare. I would prefer never to need insurance at all, but given my history (sigh...), I better be prepared with everything I can get. Medigap insurance is waaaaaaaay up there at the top of my "gimme!" list.

[Jeff]

Believe me... I will be headed in that direction the MINUTE I qualify for Medicare. I would prefer never to need insurance at all, but given my history (sigh...), I better be prepared with everything I can get. Medigap insurance is waaaaaaaay up there at the top of my "gimme!" list.

Yeah I probably will too. But that's about 3 1/2 years away, and my present health insurance is $680 a month with a $3,000 per calendar year deductible. That premium will increase until the witching year of 65 when coverage stops whether I want to continue it or not. You don't wanna know how much I didn't pay for how much I did get in Holland; everything was the reverse of here.

- Jeff

[Judy G. Russell]

Yeah I probably will too. But that's about 3 1/2 years away, and my present health insurance is $680 a month with a $3,000 per calendar year deductible. That premium will increase until the witching year of 65 when coverage stops whether I want to continue it or not.
The cost is one of the reasons why I can't even dream about retiring before I'm Medicare-eligible. I'm technically eligible to convert my group policy to an individual policy for a period of 18 months if I were to retire earlier than 65, but it'd be a very big expense.

You don't wanna know how much I didn't pay for how much I did get in Holland; everything was the reverse of here.
The whole issue of the cost of insurance and healthcare is going to have to be addressed seriously one of these days.

[Lindsey]

The whole issue of the cost of insurance and healthcare is going to have to be addressed seriously one of these days.
First we need to get beyond the knee-jerk response of "Socialized medicine!!" every time somebody tries to float a single-payer system idea, as well as this myth that the health care system in the US is the best in the world. It isn't. We pay more for less than any other industrialized country. Hillary may have gotten the politics wrong, but she was absolutely right on the issue itself.

--Lindsey

[Judy G. Russell]

There's no "may have" about it: Hillary did get the politics wrong, but she was right that the whole system needs to be shaken up and something done about it. I'm not sure what the fix is, but there is something terribly terribly wrong when the average breast cancer treatment runs between a quarter and a half million dollars.

[Lindsey]

There's no "may have" about it:
I wasn't using "may have" in the sense of "maybe yes, maybe no," but in the sense of something like, "George Bush may have graduated from Yale, but he still doesn't know diddly."

As for the solution: I am even more convinced now than I was in 1993 that health care is just not something that lends itself to free market solutions. You know that something is wrong when the leading cause of bankruptcy in this country is debt incurred for medical expenses at the same time that the health care industry is raking in the bucks. (The top 17 US health insurance companies, for example, enjoyed profit growth of 114% over the space of the 4 year period 2000-2004.)

--Lindsey

[Judy G. Russell]

You know that something is wrong when the leading cause of bankruptcy in this country is debt incurred for medical expenses
Correction: the leading cause of bankruptcy in this country was debt incurred for medical expenses. Thanks to the new bankruptcy bill passed by our compassionate-conservative Republican Congress and signed into law by our compassionate-conservative Republican President, medical debts are no longer dischargeable in bankruptcy. If you do end up having to spend that half-million for treatment for breast cancer, for example, you now can get the assistance of the courts in establishing a plan to pay off that debt. You can't get it discharged.

[Lindsey]

Correction: the leading cause of bankruptcy in this country was debt incurred for medical expenses. Thanks to the new bankruptcy bill passed by our compassionate-conservative Republican Congress and signed into law by our compassionate-conservative Republican President, medical debts are no longer dischargeable in bankruptcy.
That bankruptcy bill was an absolute travesty, and the banking industry that I work for bears a lot of the responsibility for it. And the Democrats should not be let off scott free. There were LOTS of Democratic votes for that thing. Disgraceful.

--Lindsey

[Judy G. Russell]

I don't have a basic disagreement with the notion that the eligibility for personal wipe-the-slate-clean bankruptcy protection needed to be tightened. But the way it was tightened and the things that were excluded from being included... "travesty" is a very good word.

[Jeff]

I'm not sure what the fix is, but there is something terribly terribly wrong when the average breast cancer treatment runs between a quarter and a half million dollars.

About the only thing that can be done for me is LVRS; lung volume reduction surgery. It can help for a few years, but it is most definitely not a cure. 3/4's to a full million, if there are NO complications and not including the cost of six or so months of recovery during which you're mostly helpless.
A few hours on the table and a few days in the hospital for a million dollars?
In Holland it would have cost maybe a quarter of that, of which I would have paid nothing, but the surgeon said don't do it now; it's too soon and don't waste your only chance before you really need it. So here I am, staring into the headlights of the US medical 'system'.

- Jeff

[Judy G. Russell]

So here I am, staring into the headlights of the US medical 'system'.
Believe me, I understand how terrifying that can be. And the worst part is, you're most likely to be caught in the clutches of that system at a time when you're least able to cope, either physically or emotionally (or both!).

Case in point: I had to try for almost five full months to resolve a $2300 bill for anesthesia from my last surgery. The insurance company denied the claim because, it said, it wanted the anesthesia notes and the anesthesia people wouldn't send them. The anesthesia billing people said the insurance company didn't really want the notes, it wanted the time units. The insurance denied the claim again, and said no, it didn't want the time units; it really wanted the notes. So we went back and forth and back and forth with the anesthesia people sending me more and more strident "pay this NOW!" bills and the insurance company denying the claim every time I sent them whatever the anesthesia people sent me.

Finally, I did 10 minutes worth of legal research about NY State law on patients' rights to their medical records and sent the anesthesia people MY demand for the anesthesia notes, with a copy to the state consumer affairs people and the patient advocate at Columbia Presbyterian. It took about 24 hours for the notes to be produced to the insurance company and the insurance company to pay the claim in full.

Now, I ask you, why was that all necessary? And what would a patient who wasn't a lawyer do to get that resolved?

[Lindsey]

I don't have a basic disagreement with the notion that the eligibility for personal wipe-the-slate-clean bankruptcy protection needed to be tightened.
The only tightening that I can see that was needed was to prevent abuse by the extremely wealthy, who were able to take advantage of unlimited homestead exemptions in states like Florida (and Texas, I think?), and who also could set up trusts to shield their assets from bankruptcy proceedings.

I believe the new law does tighten up somewhat on the homstead exemption abuses, but it didn't touch the asset trusts.

Beyond those, there was no evidence that I am aware of that there was rampant abuse of the bankruptcy laws. In fact, that Harvard study showed quite the opposite.

--Lindsey

[rlohmann]

It is always satisfying to know one is performing good works.Love it!

[rlohmann]

The whole issue of the cost of insurance and healthcare is going to have to be addressed seriously one of these days.Yes, but I hope it's addressed responsibly. There's so much misinformation floating around about the allegedly marvelous European health-insurance schemes that I sometimes wonder how wishful wishful thinking can get.

[Judy G. Russell]

The whole issue of the cost of insurance and healthcare is going to have to be addressed seriously one of these days.Yes, but I hope it's addressed responsibly. There's so much misinformation floating around about the allegedly marvelous European health-insurance schemes that I sometimes wonder how wishful wishful thinking can get.
I don't think there can be anything less than a responsible review and overhauling -- this is so fraught with political peril that either it won't be done at all or it'll be done in a way that is either good for everyone or at least equally perilous for everyone.

[rlohmann]

First we need to get beyond the knee-jerk response of "Socialized medicine!!" every time somebody tries to float a single-payer system idea, as well as this myth that the health care system in the US is the best in the world. It isn't. We pay more for less than any other industrialized country. Hillary may have gotten the politics wrong, but she was absolutely right on the issue itself."Gotten the politics wrong...."

That's an interesting assessment.

Like many Americans who swoon over socialized medicine, you may be unaware of the realities. Take a look at

http://tinyurl.com/8a8cu

[rlohmann]

I don't think there can be anything less than a responsible review and overhauling -- this is so fraught with political peril that either it won't be done at all or it'll be done in a way that is either good for everyone or at least equally perilous for everyone.See my note to Lindsey and read the CBC piece I referenced.

The fundamental difficulty with socialized medicine is that it fails to take human nature into account. In the first place, people don't value what's given to them for nothing and tend to overuse it. In the second place, government administration of any disbursement system--I speak here from 41 years of experience--is inept and tends to bog down in bureaucratic sludge. In the third place, such a system does not pay physicians what they believe their years of study and experience entitle them to, which gives them a strong incentive to avoid participating in it.

Proponents of socialized medicine are looking for a free lunch, blissfully aware that there's no such thing.

[Judy G. Russell]

I'm not interested in socialized medicine as that term is commonly used (and mostly by corporate medicine folks trying to avoid having anything happen that could possibly eat into their profits). What I think might work is a better big-pool insurance system. It doesn't have to be run by the government; it could be done by contracted insurers. But the bottom line is spreading the risks.

[Dick K]

Love it!
Thank you. Oddly enough, yours was the first message in this thread to address the substance of the seeder post.

[Judy G. Russell]

You're complaining about thread drift? Here?

[Lindsey]

In the first place, people don't value what's given to them for nothing and tend to overuse it.
It's not for nothing--people pay taxes for it. What is your evidence that such systems are overused?

In the second place, government administration of any disbursement system--I speak here from 41 years of experience--is inept and tends to bog down in bureaucratic sludge.
If you don't think private insurers are inept and bogged down in bureaucratic sludge, talk to Judy.

In the third place, such a system does not pay physicians what they believe their years of study and experience entitle them to, which gives them a strong incentive to avoid participating in it.
My employer doesn't pay me what I believe my years of study and experience entitle me to, either. I suspect that's true of most people. What's your point?

--Lindsey

[Dick K]

You're complaining about thread drift? Here?
Nope. No complaints; just an observation.

[Judy G. Russell]

And this surprises you exactly how?

[Dick K]

And this surprises you exactly how?
No real surprise, but even here, the drift does not usually start with the second message in a thread!

[Judy G. Russell]

No real surprise, but even here, the drift does not usually start with the second message in a thread!
That's true. It usually starts only by the third message!

[Wayne Scott]

Dick: I agree with your opinion of the AARP gap insurance. We had it for a while, but the AMA came up with a plan that had NO limitations figuring physicians would be good to physicians. After about 2 years they stopped accepting new enrolees, but I still have mine.
They have made profit on about 90% of my premiums, but my dear Marion used up that and more.

Wayne

[Wayne Scott]

Believe me... I will be headed in that direction the MINUTE I qualify for Medicare. I would prefer never to need insurance at all, but given my history (sigh...), I better be prepared with everything I can get. Medigap insurance is waaaaaaaay up there at the top of my "gimme!" list.
Just follow Dick's advice on the AARP stuff. Their politics are totally lousy and self-serving, but their medigap is great.

Wayne

[Wayne Scott]

First we need to get beyond the knee-jerk response of "Socialized medicine!!" every time somebody tries to float a single-payer system idea, as well as this myth that the health care system in the US is the best in the world. It isn't. We pay more for less than any other industrialized country. Hillary may have gotten the politics wrong, but she was absolutely right on the issue itself.

--Lindsey
Actually, the health care system is probably the best in the world. However, the health care delivery system stinks. I don't think your heroine's plan was much good back when she made that arrogant attempt to jam it down America's throat. As I'm sure you agree, I'm one of the smartest people on earth (?) but even I, great as I am have no solution that satisfies me. I AM pretty sure that the 535 members of COTUS do not have much of a chance of figuring out a good solution.
I don't think you are demonstrating that YOU are better able to solve it than I.

So there, Curm

[Wayne Scott]

I don't think there can be anything less than a responsible review and overhauling -- this is so fraught with political peril that either it won't be done at all or it'll be done in a way that is either good for everyone or at least equally perilous for everyone.
Yeah, what you said.

Curm

[Wayne Scott]

It's not for nothing--people pay taxes for it. What is your evidence that such systems are overused?


If you don't think private insurers are inept and bogged down in bureaucratic sludge, talk to Judy.


My employer doesn't pay me what I believe my years of study and experience entitle me to, either. I suspect that's true of most people. What's your point?

--Lindsey
Ralph doesn't need to produce specific written proof that what he says about overuse is correct. If you would spend some time in physician's waiting rooms in the UK or Germany you might change your mind. I interned in a hospital owned by the brotherhoods of the Santa Fe Railway System. Some machinist would drop into the out patient clinic when he got off shift and had had a few drinks, demand to see a doctor, and tell me, after I had been awakened from a brief nap, "Hi, doc, I just thought I'd drop in and let you check my blood pressure."

[Wayne Scott]

That's true. It usually starts only by the third message!
Do you think your exchanges prove that 2 snow tires are as good as 4 snow tires?

Just asking both of you.

Curm

[Judy G. Russell]

Do you think your exchanges prove that 2 snow tires are as good as 4 snow tires? Just asking both of you.
ROFL!!!!!!!!!!!!!!!!

[Jeff]

Now, I ask you, why was that all necessary? And what would a patient who wasn't a lawyer do to get that resolved?

I just had something similar happen. It went back and forth for three months, and finally I simply paid the $20. That's what a non-lawyer caught in the system does, unless you want an impact to your credit rating.

- Jeff

[Judy G. Russell]

Frankly, if it had been just $20, or even perhaps $200, I'd have paid it just to get it off my back. But $2280 is just a tad on the high side to walk away from.

[chm]

(My surgery alone cost $24K for a partial mascetomy, and we're not talking any reconstruction.)

Don't even get me started about the U.S. health care system.

Aren't we the only industrialized country in the world which doesn't have a health care system?

What is the matter with us?!

I don't get it, don't get it at all.

BTW, I have no health insurance, can't afford it at all, can't afford to go to the doctor, can't afford tests and screening I should be having, can't afford my prescriptions (but somehow struggle to pay for them, though often delayed).

My husband finally has just received his health insurance after a year's employment. I'll get mine next year as his spouse. Prescriptions? Way down the road. Dental and Vision?? Good question, but not anywhere on the near horizon, if at all.

I'm really too old and unhealthy for all this...

Two cents from a self-employed cancer survivor,

chm

[chm]

Proponents of socialized medicine are looking for a free lunch, blissfully aware that there's no such thing.

I'd like to get any lunch.

As it is I'm not getting the health care I need at all, plus am struggling to pay for my meds (Do you know just Advair costs nearly $200?).

Nope, the U.S. health care delivery system plain sucks. To be blunt, but to the point.

The doctors, etc. are good, some of the best. If you're lucky enough to have access to them, that is.

Very many of us don't. Too many of us don't. That's wrong, very wrong.

chm

[Judy G. Russell]

As it is I'm not getting the health care I need at all, plus am struggling to pay for my meds (Do you know just Advair costs nearly $200?).
That's the other thing that terrifies me about ever being able to retire. I have one drug I have to take daily. There's no option -- not taking it will send my entire muscle system into tetany (severe spasms) and acute tetany, consisting of severe muscular contractions, tremors, and cramps, can result in death. The prescription -- sans insurance -- is something on the order of $250 a month in the generic form.

[MollyM/CA]

A few years ago I had a LEEP procedure, to remove a bit of precancerous tissue from the cervix.

The insurance company held up the payment to the doctor for almost two years, while sending me form after form that insisted it must have been an occupational condition (for which they wouldn't have paid).

I finally started returning the forms with nasty, nastier, and nastiest letters along the lines of "This is an operation which (da te da) from the cervix. Just what line of occupation are you thinking I'm in?"

Finally, someone caught on, I guess --they shut up and paid. The gynecologist thought it was funny.

I also didn't appreciate the insurance company being charged $36,000 (that's right, 36k) for "narcotics" by Manteca Doctors' Hospital when the sum total of the medication I received while there with the pulmonary embolism was an aspirin and lots of oxygen, both appropriately billed for. Manteca's bill for part of two days and one night was close to $800,000 --almost the same as the bill for the week in the hospital that actually dissolved the clots and put in the filter. Something's gotta be wrong somewhere.

[Judy G. Russell]

The insurance company held up the payment to the doctor for almost two years, while sending me form after form that insisted it must have been an occupational condition (for which they wouldn't have paid). I finally started returning the forms with nasty, nastier, and nastiest letters along the lines of "This is an operation which (da te da) from the cervix. Just what line of occupation are you thinking I'm in?"
ROFL!!!!!!!!!!!!!!!!!!!!!!!!!!

[MollyM/CA]

Prescriptions? Way down the road.

Downer than you think, maybe. Our version of Blue Cross/Blue Shield just decreed that "maintenance" drugs --anything you have renewed three times (in a year?) -- now have a $1000 deductible. The premium is now about $700 a month, the general deductible goes up every year --- a couple K now, I think-- and Medicare is by their fiat my primary insuror, which means that all but the very dregs of the local doctors (who are for the most part the very dregs themselves) laugh when you walk in their doors to attempt to become a patient.

Meanwhile, the amount (proportion of billed fee) they actually pay the doctors is going down every year.

One wonders.

I like the proposal that we all by law get the same medical/dental/vision coverage our lawmakers get.

[Judy G. Russell]

I like the proposal that we all by law get the same medical/dental/vision coverage our lawmakers get.
Wouldn't that be nice...

[Judy G. Russell]

(My surgery alone cost $24K for a partial mascetomy, and we're not talking any reconstruction.)
I was looking at my costs this year just the other day and think they've totaled more than $75K since January. And bankruptcy protection, if I had had the great misfortunate to be self-employed, would only be available until October. Geez louise...

[Wayne Scott]

I'd like to get any lunch.

As it is I'm not getting the health care I need at all, plus am struggling to pay for my meds (Do you know just Advair costs nearly $200?).

Nope, the U.S. health care delivery system plain sucks. To be blunt, but to the point.

The doctors, etc. are good, some of the best. If you're lucky enough to have access to them, that is.

Very many of us don't. Too many of us don't. That's wrong, very wrong.

chm
I absolutely agree with you, Carolyn. The big, nasty quesion is, "How do we fix it?" We don't follow the UK, German, Canadian, Hillarian systems or we'll be in a terrible mess. We "fixed" the problem a while back with HMO's. The only people that were helped were the tycoons who own and run the HMO's. They have gotten rich, the physicians' incomes have been cut, the costs have gone up, the patients are not getting good care, but are jammed into crowded waiting rooms, told the lay people who make the decisions that they can't get any expensive tests or treatments.
I have no idea how to solve the problem. I guess I've been part of it, tho I never got rich. My maximum net income from practicing medicine was $62,000. one year.

[Wayne Scott]

However, all joking aside, it's a terrible problem and your pessimistic statement that the solution will be lousy is, I'm sure, true.

Weeping in Wyoming

[Dick K]

I like the proposal that we all by law get the same medical/dental/vision coverage our lawmakers get.
Sounds good to me. Of course, we all by law will get the same salary cap, gift acceptance restrictions, financial reporting requorements, and outside income limitations that our lawmakers get, right?

(No; I am not a lawmaker, but I am a retired military officer and retired federal employee with--thank God--some excellent healthcare insurance and benefits. Every now and then, some yo-yo kvetches, "Why don't I get the same retirement benefits as those featherbedding military and Civil Service retirees? Either give those benefits to the rest of us, or take them away from them!" and my buttons get pushed.)

[rlohmann]

It's not for nothing--people pay taxes for it. What is your evidence that such systems are overused?Thank you for walking right smack into my parlor, sneered the spider (wearing a spiked helmet and a broader-than-usual sneer) to the fly. :D

About 18 months ago, the (Socialist) German government enacted the lyrically named Gesetz zur Modernisierung der gesetzlichen Krankenversicherung (GKV), which imposed a nominal charge (currently about $12) for visits to doctors' offices and prescriptions. The reason--surprising to no one but those who believe that free medical care isn't overused--was that the system was being overused to the extent that it was in danger of total collapse.

If you don't think private insurers are inept and bogged down in bureaucratic sludge, talk to Judy. Private insurers are relatively inept and considerably bogged down in bureaucratic sludge. Wait until you get old enough to deal with the Social Security Administration. <sneering anticipatorily>

My employer doesn't pay me what I believe my years of study and experience entitle me to, either. I suspect that's true of most people. What's your point?Your analogy is flawed. Your employment situation isn't analogous to that of a doctor in a socialized medical-care system. Did you read that CBC feature I posted? Like the Harley-Street physicians in London, Canadian doctors are trying to get out from under the socialized system.

(I was in Canada about a month ago, but since my sneering muscles are in magnificant shape, I didn't need any medical care.) :)

[rlohmann]

Ralph doesn't need to produce specific written proof that what he says about overuse is correct.The German Parliament did it for me. :)

[rlohmann]

There are some in this group who would rather not think ill of the senior Senator from Massachusetts, and would rather seize upon something--anything--else in preference to doing so.

(I, of course, have no difficulty thinking ill of the senior Senator from Massachusetts.) :)

[Judy G. Russell]

Sounds good to me. Of course, we all by law will get the same salary cap, gift acceptance restrictions, financial reporting requorements, and outside income limitations that our lawmakers get, right?
Let's see... "As of January 2004, Senators and Representatives receive $158,100 per year. Certain positions have higher rates of pay. The Majority and Minority Leaders in both the House and Senate and the President pro tempore of the Senate earn $175,700. The Speaker of the House earns $203,000."

SOLD!!!

[Judy G. Russell]

However, all joking aside, it's a terrible problem and your pessimistic statement that the solution will be lousy is, I'm sure, true.
Weeping in Wyoming
Dear Weeping,

I wish I could offer you ever the slightest hint that things will get better with this. I can't.

[Lindsey]

Actually, the health care system is probably the best in the world. However, the health care delivery system stinks.
I will agree with you there: it's actually the health care delivery system that is the problem.

--Lindsey

[Lindsey]

Ralph doesn't need to produce specific written proof that what he says about overuse is correct.
Fine; in that case, I am free to doubt his assertion.

I can't speak for Germany, but the UK has tried to implement their health care system on the cheap; when you do that, it's no wonder that demand outstrips supply. I don't believe there is that same problem in France, but they still pay far less there for better overall outcomes than we do.

--Lindsey

[rlohmann]

Fine; in that case, I am free to doubt his assertion.You do that anyway. :)

I can't speak for Germany You might want to try. Germany was the real-world example I offered in response to your demand for documentation of the assertion that freebie services are overused to the point of collapse. If you have rebuttal evidence, I'd like to hear it.

but the UK has tried to implement their health care system on the cheap; when you do that, it's no wonder that demand outstrips supply.Nonsense. You're trying to deny a fundamental aspect of human nature. Regardless of how much money goes into buying goods or services that are handed out at no cost, demand will always outstrip supply.

I don't believe there is that same problem in France, but they still pay far less there for better overall outcomes than we do.Now that is an allegation I'd like to see documented in a source more reliable than L'Humanite. In fact, I'd be surprised to learn that even they believe it. :)

[Judy G. Russell]

You're trying to deny a fundamental aspect of human nature. Regardless of how much money goes into buying goods or services that are handed out at no cost, demand will always outstrip supply.
Why does it have to be "at no cost"? Why can't there be some basic level of insurance provided to everyone, with people paying or not paying for that insurance depending on their income/need/some combination and with some payment required beyond that (most insurance only covers a percentage anyway) for every service? We don't have to choose between 100% government service on one side and the disaster we have now on the other! It's not black-or-white, either-or.

[chm]

The big, nasty quesion is, "How do we fix it?"

Unfortunately I started my morning with the L.A. Times which smack all over its front page had a huge, excellent, and horrifying article about health insurance (disability insurance, especially). Included also on this front page was a disturbing article about companies sending their employees to Mexico for their health care. Surgery in Tijuana? I'm scared. Terrific irony there, anyway. All these illegals risking their lives to come here from Mexico, yet we import our health care from Mexico?

Anyway, after reading all this and getting pissy, I came to the conclusion, okay, this sucks, it pisses me off, and it sucks, and I keep feeling that way, and I don't like it. What to do about that? Which brings me back around to your quote at top: How do we fix it?

Time to get involved. I've started with learning more about Prop 78 and 79 - health care Props coming up for a vote here in California in November.

Google brought me some good info. For example, check this out: http://www.lao.ca.gov/ballot/2005/79_11_2005.htm

I am close to deciding to support Prop 79 in an active way. (And I even own a store with T-shirts, buttons, stickers, etc.)

As far as all the non-Californians go here, you might want to check out what's going on out here in CA. What happens here usually winds up happening elsewhere in the country sooner or later.

PS: I've had personal experience with the Healthy Family program referred to in Prop 79 - it's a good program. Gray Davis, at one point, was about to expand it and extend it to families as well as children, but, well, you know how that story turned out, for a variety of reasons.

Carolyn

[rlohmann]

Why does it have to be "at no cost"? Why can't there be some basic level of insurance provided to everyone, with people paying or not paying for that insurance depending on their income/need/some combination and with some payment required beyond that (most insurance only covers a percentage anyway) for every service? We don't have to choose between 100% government service on one side and the disaster we have now on the other! It's not black-or-white, either-or.See Wayne's note to Carolyn.

Even your suggestion, reasonable on its face, is fraught with fraughtness. How, exactly, is the "basic level of insurance" to be provided? What will it cost? What will it cover?

How much payment can doctors, hospitals, laboratories, pharmacists, and pharmaceutical manufacturers expect, and for what examinations, procedures, tests, and medications? (Carolyn mentioned the cost of Advair. I know how much Advair costs. Advair is why I can come to your house and breathe while I collect reports from my two secret agents.) Should there be any limit on the cost of medications? If so, what should that limit be and how should it be established?

Who should administer this? The Social Security Administration, which can't give you the time of day? The ungodly tangle of bureaucatic boxes that Hillary Clinton presented? (Who would train these people, and how many lifetimes--given the inevitable complexity of the statute that would answer all of the above questions--would it take the trainees to get it right? She didn't explain that.)

The fundamental difficulty with any kind of government-directed health scheme is that government is not that good at doing most things that government tries to do. It can coin money moderately well, defend the frontiers, conduct foreign affairs, and pursue certain kinds of litigation, but most things it does badly, and some things it cannot do at all.

Anyone who, regardless of ideological perspective, wants government to pay the medical costs of its citizens needs to think long and hard about how.

[Dick K]

There are some in this group who would rather not think ill of the senior Senator from Massachusetts, and would rather seize upon something--anything--else in preference to doing so.
Unfortunately, Mary Jo Kopechne was not available for comment.

[Wayne Scott]

Carolyn: As almost always happens with California initiatives, these are both very complicated, especially 79. The awful thing about initiatives is that if they turn out badly, the legislature cannot deal with them. It takes another vote of the electorate OR the intervention of some tame judge to fix it.
My first instinct is to vote "No" on both, but I have until November to decide and I hope I'll learn more by then.
The problem is enormous, especially for people on limited means. I am taking lipitor. Even at Costco it is around $1.70/day. I can afford that, but to many people my age, 83, that would mean going without proper food or not taking the drug.
I don't know how much Pfizer spent developing this drug and getting it on the market, but it was a lot. There are also other drugs Pfizer has worked on at the same time that cost a lot and yielded not a single dollar in sales.
It's a puzzlement.
I'll think about 78 and 79 and I hope you will, too.

Wayne

[Wayne Scott]

I was once sick in France. I challenge your conclusion.

[Wayne Scott]

There are some in this group who would rather not think ill of the senior Senator from Massachusetts, and would rather seize upon something--anything--else in preference to doing so.

(I, of course, have no difficulty thinking ill of the senior Senator from Massachusetts.) :)
For a long time I had a bumper sticker on my car that said;
"NOBODY DROWNED AT THE WATERGATE" Then there was a little picture of the end of a dock with bubbles coming to the surface of the water.

[Judy G. Russell]

Anyone who, regardless of ideological perspective, wants government to pay the medical costs of its citizens needs to think long and hard about how.
I'm not sure I do want government to pay the medical costs of citizens. I do think that government can work with private insurance to cover many more people than are covered now. And while I think any approach to this requires that we think "long and hard about how," I also think it's time we did more than just think about it.

[Jeff]

>>The fundamental difficulty with any kind of government-directed health scheme is that government is not that good at doing most things that government tries to do.

True. But... From the local fishwrapper:

http://www.postindependent.com/article/20050818/VALLEYNEWS/108180028/-1/ARCHIVES04

"Glenwood Springs' ambulance fees would increase an average of 45 percent under a proposal to be considered by Glenwood Springs City Council tonight."

And here's why:

"Piper also notes that insurance companies make payments based on "reasonable" charges for services, determined according to what other providers in an area charge. "When one service does not bill at the level of other services in the area, all services are penalized by the amount the insurance companies will pay. Any amount of the bill not covered by insurance becomes the responsibility of the patient," he writes."

What, exactly, do you call that kind of cause and effect? The government service was too cheap by 45%?

- Jeff

[RayB (France)]

**Unfortunately, Mary Jo Kopechne was not available for comment.**

Since becoming elderly last week, my remembering isn't as good as it used to was. Wasn't that something about 'Youth-anasia' or something?

[RayB (France)]

I was once sick in France. I challenge your conclusion.

To what are you referring, Curm? I missed it.

[Lindsey]

The fundamental difficulty with any kind of government-directed health scheme is that government is not that good at doing most things that government tries to do.
You keep asserting that, but you offer no data to back it up. I'm on vacation right now, and not inclined to spend a whole lot of it researching health care, but here are a few facts that I managed to dredge up quickly:


In 2001, spending on health care in the US amounted to 13.9% of GDP. Contrast that with 8.7% in Sweden, 9.5% in France, and 9.7% in Canada.

A 1991 GAO study concluded that if the universal coverage and single payer features of the Canadian system were applied in the US, the savings in administrative costs would have been $66.9 billion--enough to fund coverage for everyone that was then uninsured with enough left over to fund reduction or even elimination of co-payments and deductibles.

In early 2004, a comprehensive study published in the International Journal of Health Services concluded that "the US wastes more on health care bureaucracy than it would cost to provide health care to all its uninsured."

In June of 2004, GM President and CEO Richard Wagoner, Jr. (hardly a flaming socialist, I would think) observed that judged by 16 top health care indicators, the US ranks 12th among 13 industrialized countries.


Bottom line: We're spending a lot more to achieve a lot less. And because our current health care system is largely funded by employers, we're putting ourselves at a competitive disadvantage with the rest of the industrialized world. GM spends something like $4 an hour more on its workers in the US than on its workers in Canada just to pay for health insurance.

Even your suggestion, reasonable on its face, is fraught with fraughtness. How, exactly, is the "basic level of insurance" to be provided? What will it cost? What will it cover?

How much payment can doctors, hospitals, laboratories, pharmacists, and pharmaceutical manufacturers expect, and for what examinations, procedures, tests, and medications? (Carolyn mentioned the cost of Advair. I know how much Advair costs. Advair is why I can come to your house and breathe while I collect reports from my two secret agents.) Should there be any limit on the cost of medications? If so, what should that limit be and how should it be established?
Why do all the details have to be provide before the issue can even be discussed? Our health care delivery system as it is is broken. It is driving increasing numbers of middle class people into bankruptcy. I refuse to accept the proposition that what we currently have is as good as we can do. We can do better. We have to do better.

--Lindsey

[Lindsey]

I was once sick in France. I challenge your conclusion.
Call:

France's health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.

So France spends less, gets more, and does so through a public-private hybrid that's heavily, heavily public. Socialized medicine sure is scary.

http://ezraklein.typepad.com/blog/2005/04/health_care_fra.html
Finally, the U.S. health care system is wildly inefficient. Americans tend to believe that we have the best health care system in the world. (I've encountered members of the journalistic elite who flatly refuse to believe that France ranks much better on most measures of health care quality than the United States.) But it isn't true. We spend far more per person on health care than any other country - 75 percent more than Canada or France - yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.

Paul Krugman, NY Times, 11 April 2005
http://www.pkarchive.org/column/041105.html
--Lindsey

[Lindsey]

I do think that government can work with private insurance to cover many more people than are covered now.
And that approach would probably have the greatest chance of successfully running the political gauntlet, too. There's no way that the health insurance industry is going to allow the government to put it out of business. But some sort of public-private partnership could surely be hammered out that would give us a fairer and more efficient system than we have now.

--Lindsey

[Dick K]

**Unfortunately, Mary Jo Kopechne was not available for comment.**

Since becoming elderly last week, my remembering isn't as good as it used to was. Wasn't that something about 'Youth-anasia' or something?
Huh? Mary Jo Kopechne was the young woman who drowned at Chappaquiddick when Teddy Kennedy drove his car into the drink, swam to shore, and immediately mobilized all resources available to save...his career.

[RayB (France)]

Huh? Mary Jo Kopechne was the young woman who drowned at Chappaquiddick when Teddy Kennedy drove his car into the drink, swam to shore, and immediately mobilized all resources available to save...his career.

I know, Dick, I know!! I remember it VERY well but apparently the people of MS haven't over all these years. I was just playing with words

[rlohmann]

[To my assertion that government doesn't do well many things that it does.] You keep asserting that, but you offer no data to back it up. I'm on vacation right now, and not inclined to spend a whole lot of it researching health care....I'm not sure I understand. The general proposition is that health-care delivery in this country is unsatisfactory. It's hard to quarrel with that, but you seem to be challenging my lack of enthusiasm about government efficiency.

Where do I start? The Hoover Commission? The various civil service reform acts? The present initiatives to introduce the concept of pay for performance in several agencies?

I could probably use up the entire storage capacity of this forum with personally observed instances of government waste, ineptitude, inefficiency, stupidity, and malice, but it might make more sense to turn the question around: What is your evidence that government is capable of designing a better system? I assume you recall Hillary Clinton's scheme. Do you think that's a step in the right direction?

IMWTK

[Mike]

The people of Mississippi? Or do you mean the people of Massachusetts (MA)?

[RayB (France)]

The people of Mississippi? Or do you mean the people of Massachusetts (MA)?

Oooops! Got my M's mixed up. I prefer the old 'Mass' and 'Miss' abreviations.

[Judy G. Russell]

Oooops! Got my M's mixed up. I prefer the old 'Mass' and 'Miss' abreviations.
It does get confusing, doesn't it? I constantly have to stop and think when I see "NE" -- is that Nebraska (yes) or Nevada (no)? But then even four letters wouldn't eliminate all questions -- is is Mississippi or Missouri?

[RayB (France)]

It does get confusing, doesn't it? I constantly have to stop and think when I see "NE" -- is that Nebraska (yes) or Nevada (no)? But then even four letters wouldn't eliminate all questions -- is is Mississippi or Missouri?

Good point! The good news is that I only send stuff to FL, CO and NY these days. Those I can remember even with my rotting brain.

[Lindsey]

it might make more sense to turn the question around: What is your evidence that government is capable of designing a better system?
Oh, no. You're the one who claims the government is by definition more clumsy and inefficient that any possible alternative. I'll leave it to you to provide data (as opposed to anecdotes) to back it up.

--Lindsey

[Judy G. Russell]

CO could, of course, also be Connecticut! (I really hate the two-letter abbreviations!)

[Dick K]

CO could, of course, also be Connecticut! (I really hate the two-letter abbreviations!)And is AL Alaska (no) or Alabama (yes)? So that means AK is Alaska,...unless it is Arkansas (which is really AR),...unless AR is Arizona (actually AZ). Pfaugh!

[Judy G. Russell]

Let's see here:

ALabama or ALaska
ARizona or ARkansas
COlorado or COnnecticut
MAine or MAryland or MAssachusetts
MIchigan or MInnesota or MIssissippi or MIssouri
NEbraska or NEvada
TEnnessee or TExas (or, in fact, neither!)

"Pfaugh!" is right!

[Wayne Scott]

I find confusion about Calorado, Cannecticut and Colifornia in this 2 letter thang.

[Judy G. Russell]

I find confusion about Calorado, Cannecticut and Colifornia in this 2 letter thang.
ROFL!!! Oh man... I never even thought about the ... how do we say it these days? ... spelling impaired!

[RayB (France)]

Let's see here:

ALabama or ALaska
ARizona or ARkansas
COlorado or COnnecticut
MAine or MAryland or MAssachusetts
MIchigan or MInnesota or MIssissippi or MIssouri
NEbraska or NEvada
TEnnessee or TExas (or, in fact, neither!)

"Pfaugh!" is right!

Ah yes! A prime example of simplification to the point of uselessness.

[Lindsey]

Ah yes! A prime example of simplification to the point of uselessness.
Well, not completely useless. That system was put into place to allow the postal service to better automate the sorting of mail. It works pretty well for computers, too. It's only we humans who find it a bit confusing. ;)

--Lindsey

[earler]

I've read all these remarks about the wonders of the french health system and can't resist making some comments and corrections, based on living here for some 4 decades.

First of all, the government social security doesn't cover all costs. Most people are obliged to subscribe to supplemental health insurance, which isn't cheap, if they can afford it. Add to this the fact that the social security system runs a whopping deficit every year and general tax revenues must be moved over to cover it. Reimbursement for dental care is ridiculously low, as well as for eye glasses. However, for cancer there is 100% reimbursement of expenses. Given the huge deficit and the need to have supplemental insurance coverage, I'd take the official figure for expenditure on health care with some scepticism.

Hospitals are a problem. There is a severe lack of diagnostic material. For example, france has the lowest level of mri's in all of europe. Further, the hospitals themselves are often tatty and with little real comfort, though the food is usually reasonably good. There have been more problems with legionaire's disease than elsewhere. There is a severe shortage of personnel, to a great extent due to the 35 hour week that was forced upon the country a few years ago.

I noted in another message someone saying that france has more doctors than some other countries. Well, that isn't really true either. First of all, there is a growing shortage of anesthetists and of pediatricians, and an incipient one for surgeons. Because there were too many doctors being turned out by the medical schools in the 70s, a numerus clausus was instituted, and it has turned out to be too low. Consequently, it will have to be increased and there will be doctor shortages. As in other countries, doctors tend to migrate to areas where there is a high patient density, so rural areas are hurting for doctors.

On the positive side, the life span of frenchmen is the 2nd longest in the world for a developed country, just behind japan's. This is more due to a better diet than to anything else. And it isn't due to the huge amount of tranquilizers consumed, much higher than in any other country in the world.

Infant mortality is also lower, in part because of obligatory vaccinations at an early age. Parents must have vaccination proof in hand when registering their little ones in a nursery school and then in kindergarden.

-er

[Judy G. Russell]

Well, as noted, even a four-letter abbreviation ain't perfect, as witness Mississippi and Missouri. So I guess we'll all have to learn... or brush up on our longhand skills!

[Judy G. Russell]

Further, the hospitals themselves are often tatty and with little real comfort, though the food is usually reasonably good.
Whereas most hospitals here are reasonably comfortable and the food is appalling.

[RayB (France)]

Well, not completely useless. That system was put into place to allow the postal service to better automate the sorting of mail. It works pretty well for computers, too. It's only we humans who find it a bit confusing. ;)

--Lindsey

In a number of computer classes I have taught I have called computers 'high-speed morons'. They only know what we tell them are are extremely capable of compounding our errors with lightning efficiency. So, I guess in this case, it will misdirect our mail in the same manner.

[Lindsey]

Hi, Earle!

I'm not saying that the French system is perfect, only that measured across the whole society, it is doing a better job of delivering health care than the one in the US.

I'm getting caught up on some of my reading after returning from vacation; by happy coincidence, the cover article (http://www.newyorker.com/printables/fact/050829fa_fact) by Malcolm Gladwell in the August 29 issue of The New Yorker deals with the problems in the US health care system.

One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. . . . [T]he United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.
(That last is no exaggeration; it is a reference to an earlier citation in the article of the case of one construction worker who could not afford health insurance.)

French patients may experience some frustrating problems with their health care system, but at least every French citizen has access to it. In the US, the system is increasingly developing into a tiered system: Very good care for those with good insurance, and minimal care for those without; inexpensive insurance for those who are in good health, and expensive or unobtainable insurance for the sickest. French patients may have to suffer less than luxurious hospital rooms, but they are at least not reduced to pulling out their own teeth.

--Lindsey

[earler]

Mr. gladwell changes his version from time to time. See this when he was quite critical of the canadian system: http://www.washingtonmonthly.com/features/2000/0003.gladwellgopnik.html

He is also quite wrong in espousing his antipathy toward co-payment. The british and the french learned years ago that co-payment is necessary to rein in over usage of medical facilities.

I certainly don't wish to defend the current system in the states, which has many problems. But, it isn't all bad, as gladwell's contents in the above referenced discussion with adam gopnick make very clear.

Finally, I can't help but point out that preferring more reliable cars and cheaper t-shirts isn't just an american phenomenon. American manufacturers made bad cars. First volkswagen, then the japanese arrived and provided quality automobiles. I understand american cars are now better than they were back then. Part of the problem was with management of the automobile companies and part of it was with the labor unions As for t-shirts from china, everyone buys them if they can since they are cheaper, be they the french or the americans.

-er

[Lindsey]

That article was written five years ago; maybe Malcolm Gladwell has changed his mind since then. People are allowed to do that, you know.

He is also quite wrong in espousing his antipathy toward co-payment. The british and the french learned years ago that co-payment is necessary to rein in over usage of medical facilities.
I'm not sure what gave you the idea that Gladwell had an antipathy for co-payments; I didn't take that away from his article at all. But I'm curious as to what constitutes "over usage of medical facilities." I don't pay anything at all for dental checkups--my insurance covers the entire cost. But that doesn't make me want to go for a checkup every month. And if things like dental crowns were covered (which they aren't), it certainly doesn't mean that I would elect to receive crowns I didn't really need.

I certainly don't wish to defend the current system in the states, which has many problems. But, it isn't all bad, as gladwell's contents in the above referenced discussion with adam gopnick make very clear.
No, it's not all bad. But its problems are severe and, it appears to me, getting steadily worse.

Gopnick made in interesting point in that article you referred to:

I think that the question then becomes . . . what the trade-offs are, because what you're describing, what you're basically saying now in plain English is, we'd rather have a system in which you have the possibility of superb care, an MRI in every doctor's office, and the understanding that means there will be many people who will simply drop off the lower end--there will be kids who get a stick in the eye and never recover from it--than have a system which attempts to equalize every stick in every eye and in doing so, fails to deal adequately with everyone. These are kind of classic questions of egalitarianism and free enterprise that go far beyond health insurance.
Or, as he says later, a question of what kind of society you want. I always thought the US was supposed to be an egalitarian society. Why, then, shouldn't health care be delivered on a more egalitarian basis?

Gladwell made an interesting point in that article, too: that men and women use health care in different ways, that men mostly need little in the way of health care for most of their life, until they reach about the age of 60, and then what they need is most likely to be of the extraordinary, heroic sort; while women and children need regular, ongoing, mostly low-tech care. The Canadian system, then, is ideally suited for women, while the US system is better suited to men. I never thought about it that way before, but that's an intriguing perspective (and explains, perhaps, why in the US, some health insurance is more likely to cover prescriptions for Viagra than for birth control).

--Lindsey

[Judy G. Russell]

that's an intriguing perspective (and explains, perhaps, why in the US, health insurance is more likely to cover prescriptions for Viagra than for birth control).
I think that latter is explained more simply by the fact that men generally control the decision-making, and it's easy for them to see why they (er... their insureds) should be able to get Viagra than it is for the "little women" to need anything for themselves.

[Lindsey]

I think that latter is explained more simply by the fact that men generally control the decision-making, and it's easy for them to see why they (er... their insureds) should be able to get Viagra than it is for the "little women" to need anything for themselves.
Well--that may be the reason the health care delivery system in general is better geared to the needs of men than of women also.

--Lindsey

[Judy G. Russell]

Sigh... unfortunately that's really only too likely.

[Dick K]

I always thought the US was supposed to be an egalitarian society. Why, then, shouldn't health care be delivered on a more egalitarian basis?Fine, but should we accomplish this by lifting those at the bottom of the scale, or by chopping down those at the top?

I never thought about it that way before, but that's an intriguing perspective (and explains, perhaps, why in the US, some health insurance is more likely to cover prescriptions for Viagra than for birth control).Is there any real documentation that such a situation really exists today (and, obviously, I do not mean in health plans sponsored by groups which do not believe in birth control), or is it just another apocryphal anecdote?

[earler]

There are several types of overusage of medical care. A common one here in france is serial medicine, where a patient goes from one specialist to another to get yet another opinion. But, perhaps the most common one here is seeing a practitioner for really minor things that don't require a doctor, such as a sore throat or the sniffles. The patient can readily get a week or 10 days off from work, too. Sweden seems to lead in this regard, where 20% of employees are absent each day. In the states, litigation concerns lead doctors to prescribe expensive diagnostic procedures far too often.

You say the situation is getting worse in the usa. In fact, it is getting worse everywhere. The cost of keeping people alive or curing their ailments is increasing and will continue to do so. I'm afraid that rationing of one sort or another is going to become more and more the norm. Every state-run medical system is struggling. As I have already pointed out, here in france you need to pay for supplemental insurance coverage and its cost is increasing as the government reduces what it will pay. In spite of this, the deficit increases each year.

The usa is a republic, not an egalitarian society. Nothing in the constitution says otherwise. I see the problems with the over emphasis on egalitarianism here in france, where the concept of 'égalité' is interpreted by the left to mean pushing down the level for everyone rather than offering what is required: equal opportunity for everyone.

Finally, I too was intrigued by the comments as concerns men's health versus women's. However, I believe he has overstated this. While it is true that breast and ovarian cancer are problems for women, men have begun to realize they are in danger from intestinal, prostate and testicular cancer, too, as well as cardiac problems. I know from speaking with my children, nephews, etc. that the younger generation is not waiting until the age of 60 to begin monitoring their medical condition. What mr. gladwell says was true of my generation, not of the one now reaching middle age.

As for the idea of an mri in every american doctor's office, this is pure hyperbole. While it may be true there are too many mri's in the usa, it is equally true there aren't enough of them here in france.

-er

[Dick K]

There are several types of overusage of medical care. A common one here in france is serial medicine, where a patient goes from one specialist to another to get yet another opinion. But, perhaps the most common one here is seeing a practitioner for really minor things that don't require a doctor, such as a sore throat or the sniffles.
What you fail to appreciate is that the superiority of medical care in France to that in the United States is an article of faith to the American left. As is the case with most faith-based belief, it is supported by holy scripture (e.g., the pages of "The Nation" and the "New Yorker"), and the true believers will not be swayed by facts, logic, or empirical evidence.

[Lindsey]

There are several types of overusage of medical care. A common one here in france is serial medicine, where a patient goes from one specialist to another to get yet another opinion.
I don't doubt that there are people who do that, but the question is how prevalent it really is, and anecdotal evidence really doesn't speak to that. In any case, there certainly are ways that could be controlled--for instance, by increasing the cost to the patient beyond a certain number of separate opinions for the same complaint. Meanwhile, here in the states, until fairly recently it was not uncommon for female patients to have to get a referral from a GP even to make a regular visit to the gynecologist. Most plans have stopped that, thank goodness, but I think some of them require instead that you designate your gynecologist as your primary care physician, which doesn't make a lot of sense, either. I don't especially want my gynecologist treating me for high blood pressure.

But, perhaps the most common one here is seeing a practitioner for really minor things that don't require a doctor, such as a sore throat or the sniffles. The patient can readily get a week or 10 days off from work, too.
Again, without some actual figures on how common this really is, it's hard to judge whether it's actually a serious problem. But I'll have to say, I sometimes wish that people who come into the office with serious coughs or bad colds would stay home for a few days and try to avoid making everyone else in the building sick.

I'm afraid that rationing of one sort or another is going to become more and more the norm.
And the question really is: if health care is a scarce resource, on what basis are you going to ration it? On ability to pay, as it is in the US? Or on some more rational form of triage? It seems hardly fair for the well-to-do or those fortunate enough to have gold-plated health plans to get whatever medical treatment they want when others less fortunate or less well off can't afford even basic care.

Providing Cadillac care for everyone is a noble goal, but I have yet to see anyone propose how it should be accomplished. I would, though, very much want to see everyone receive, as you put it, "what is required." The trick, of course, is in determining just what is required.

The usa is a republic, not an egalitarian society. Nothing in the constitution says otherwise.
Egalitarianism is a political philosophy, not a form of government. The Constitution is not our only founding document; one other very important one is the Declaration of Independence, which quite prominently trumpets the conviction that "all men are created equal." And even the Constitution is not entirely silent on the subject--it clearly sets out a system in which all are equal under the law, so it does at the very least assume a legal egalitarianism.

--Lindsey