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Miscellaneous thoughts and ramblings
Monday, April 03, 2006
Doctors tell Blair NHS doesn't work
(Or: Why Can’t Other People Pay for My Stuff?)

England’s nationalized health care system can’t sustain the levels of spending needed to deliver care to its citizens. When costs are redistributed away from the beneficiary of the service utilization and costs skyrocket and quality suffers. This should not be startling. They’re thinking about supplementing revenue by having patients (gasp!) pay for some of their care. Radical reform! That method of distribution seems to work pretty well for potatoes and socks and lawn-mowing. Maybe we should try it for healthcare, too.

Here’s the system I suggest. It’s very very technical so I beg your indulgence. Stick with me. Here goes: Have people pretty much pay for their own stuff. Have people who can’t afford any stuff get care through private charities or a marginal government sponsored safety net for the indigent. That’s it.
Isn't that kind of what we have now? Or is that your point? I have been dealing with "Toddler Spit-Up" all day, so forgive me if I am being dense. But I think our health care system here, while not perfect, is pretty decent. We pay a pretty signigificant chunk out of our own income, and we are fortunate that Mr. EK's job provides us with an excellent plan. i don't know much about national health care like they have in Canada or England, but our system seems to be ok. Expensive, but ok. The only issue I have is I think we need a better "saftey net" as you call it for people who can't afford health care. i would be willing to pay higher taxes to help other people, if i thought the government could be responsible and effective about it. IMHO.
EK - luckily, you can pay higher taxes to help other people. Instead of taxes, though, it's a contribution to an organization that provides healthcare or healthcare funding (and then you are actually paying lower taxes!).

I was speaking with someone a while back who said that since it's the government's job to protect its citizens' lives from bad guys (national defense), it should also be its job to protect its citizens' lives from disease (national healthcare). Since this someone had cancer I was not about to get into a debate on the subject. But I don't think we can rely on churches to develop or otherwise procure weapons (they could have bake sales, like the bumpers stickers say, but still) and secure our borders (of course, the government doesn't do that, either... Ha!).
All: It doesn't matter that our system isn't perfect. There is no perfection in the real world. The only thing that matters is that in almost every case (kibbutzim and small communes maybe excepted) the only way to distribute goods equitably is to have people pay for what they want. That's it.
Healthcare is somewhat different that consumer goods and services, IMHO. If someone needs heart surgery, I think they should be able to have it, whether or not they can pay. Whose responsibility it is to pay for those less fortunate is a whole other discussion. And I don't have a good answer for that one. I do think the Government should chip in, but how much and with whom is debatable. And while we're discussing who pays for what, I think insurance companies have WAAAAY too much control in this area. Aren't we paying a hefty premium for that service, only to be told that medications prescribed by competent physicians aren't covered? But I digres. . . .;-)
Tax policy favors companies providing health insurance to their employees, that should be changed to give people incentives to buy their own insurance.

Then you wouldn't be stuck if you changed jobs or lost your job.

We do need health care in order to survive but we also need food and shelter. Imagine a grocery system like an HMO where your boss bought and paid for all your food but you could only buy food in network -- you could shop only in Publix OR Winn-Dixie but not both, and if one had the peanut butter you liked while the other had your favorite cereal, tough noogies.

And your boss would choose which brand and size of everything you got to buy. Phooey.

HMOs are a kind of socialized medicine by the back door -- third party payments causing rationing, inefficiency, yada yada. Still better than Britain or Canada but getting worse.

I don't know why people think the government or any third party should provide healthcare -- just because that's life and death. Food is even more life and death, believe me.

Government-provided food-care, anyone remember how that worked in the USSR or Red China? Millions dying of hunger.

BTW poor people DO get health care, been to an emergency room lately?

Have you ever noticed that when liberals talk about universal health care they always talk as if the poor will get to go to the very top top doctors, just like the rich do now. How likely is that?

Dr Bean when we have national health care, will you take care of all the patients in the country and all the other doctors in the country won't have any patients at all?

Or else they talk like it's not fair the rich should get the best, so health care should be distributed by lottery.

Or they make noises like the very best doctors shouldn't get more money than anyone else. So pretty soon the biggest brains are going to Wall Street or law school and how will you force them to go to medical school?

When you socialize ANYTHING everyone gets the same "it" -- and inevitably, what everybody gets is the lowest, not the highest standard, of whatever "it" is.

One other thing I notice, as medicine gets more socialized (even here in America with HMO's) it's more attractive to women and less attractive to men. Women are much more likely to accept lower salaries for a job with set hours and a predictable paycheck, where they don't have to hustle or be very aggressive and competitive. And they want to be able to go home at a reasonable time and be with their families.

Will women doctors mean a lower quality of health care? Well -- not right away. But that aggressive and competitive edge men have -- it does tend to keep them at the top of their game. Women are better at the bedside manner and emotional hand-holding side of medicine, but America is tops in the world because of competition and that is slowly going to slide.
Toby: You go girl!
I don’t know if a totally free market healthcare system would or would not work. In America, those who can’t afford to pay, of which there are many, end up being subsidised by those who can. That is why healthcare in the States is so very, very expensive. The hospitals don’t turn people away. They just charge 5 times the cost of any procedure. Ouch!

Whatever system the politicians decide we should have, it would be helpful if those responsible for its creation would show some genuine commitment by using the NHS exclusively in their own medical treatment. I am suggesting that MP’s get serious about this issue of our health by getting on the back of the waiting list cues like everyone else.

I am inviting all UK citizens to sign such a petition which asks ‘that elected representatives of all UK political parties and their immediate families voluntarily refrain from self-paid or insurance-paid medical care treatment.’ Anyone can sign this petition by sending from a mobile phone the keyword 'Reform' to the mobile short code '80818'. Alternatively, they may sign by visiting OurPetition's website at http://ourpetition.org where an up-to-date list of petition signatories is available for viewing.

If the politicians were to put their lives on the line, as it were, by committing to exclusively use the NHS themselves, then the one million people who work in the NHS on the frontline trenches might gain a measure of belief that their own day to day efforts could transform the NHS into the ‘world-class’ institution that all who live in the UK would be happy and proud to use. Forcing the issue of healthcare reform onto the political agenda would also grant the UK electorate the opportunity to vote for a leadership in the next general election that is firmly committed to healthcare reform, as opposed to one that can seek private medical care refuge the average citizen may not be able to afford.

Richard Solomon
Ezer Knegdo: I agree with you that our current system in the States is “pretty decent”. Most people do pay for their own care, with two important exceptions. These exceptions are responsible for the high price that you and your husband have to pay for reasonable care. The most important exception is Medicare. Medicare is an enormous transfer of wealth from tax payers to beneficiaries who qualify to receive this handout not by being poor but simply by being 65 or older. Americans 65 and older on average have more assets (but less income) than everybody else, but no matter, they all get a very valuable benefit subsidized by everyone else. This dramatically increases utilization of services, and therefore prices. (In the 60s when Medicare first started, the average life expectancy in the States was 65. Since that time is has increased tremendously, but the age of receiving benefits has stayed the same, so the number of beneficiaries has skyrocketed.) The second non-market factor inflating prices is that there is a tax incentive to get more insurance than you need. Medical insurance premiums are tax deductible while payments to your doctor (below a certain amount) are not. So there is an incentive for patients and employers to buy insurance that covers routine care. That’s like having home insurance pay for your gardener. If everyone did that, gardeners would get very expensive. It’s much cheaper to pay your doctor (and your gardener) directly for non-catastrophic care.

“If someone needs heart surgery, I think they should be able to have it, whether or not they can pay. Whose responsibility it is to pay for those less fortunate is a whole other discussion.” Who pays for which services for whom is the entire discussion. Choosing a heart surgery as an example is perfect, because the vast majority of people couldn’t afford a heart surgery – they cost tens of thousands of dollars. Yet most Americans receive heart surgery without charity donations. This is because most Americans have insurance (or Medicare). This is a perfect example of what insurance should be for: to cover unanticipated but financially crushing expenses. What happens to those without the responsibility or the income to buy insurance? They should rely on the federal medical system for the poor and disabled (Medicaid) or on charities.

Ralphie: I can’t believe you used to be a Democrat! You’ve come such a long way. Were you always a free market / small government type?

ball-and-chain: Well said. You’re like Milton Friedman, only gorgeous.

Ms. Katz: Great. I don’t have a single word to add.

Mr. Solomon: Welcome to our Coffeehouse! I’m delighted that you would take time from your campaign to comment here. The subsidization of those who can’t pay by those who can is, indeed, one of the reasons for the very high prices we pay in the States, but not the main one. The actual number of people who would require subsidized care is much smaller than those who currently receive it. The bigger reasons for our runaway prices are the two reasons I listed in my response to Ezer Knedgo: (1) Medicare and (2) the tax incentive to pay for routine care through an insurance company. Medicare beneficiaries are currently receiving subsidized care though most of them could buy their own insurance (just as most of them did when they were 64).

As to your idea of MPs committing themselves to receiving care only though the NHS (National Health System), may I respectfully submit that you’re out of your mind. The desire of those with more wealth to acquire goods and services that are more numerous and higher in quality than those acquired by everyone else is hard-wired into human nature. No one with the talent and ambition to become an MP would then put their lives in to the hands of NHS when they could spend their money on a better alternative. To believe otherwise is to believe in a version of human nature that is currently only subscribed to in Cuba and North Korea. Even China doesn’t believe it any more. You would do as well with a petition to ask MPs to defy gravity.

Please visit again.
I'm going to start saving up now for my inevitable Cardiac Catheterization. For the price of a cup of coffee a day, I should have enough to cover the cost in...137 years, not counting inflation, of course.
Ok, well I don't know what a "liberal" is here at the coffee house, but the way the term is used by Ms. Katz I get the impression it is akin to a 4-letter word, so I won't comment on that (keeps with my personal policy to stay as far away from political conflict as possible; didn't I marry the right man for that policy? :-)). I also don't know if I agree that women's less aggressive nature means that the quality of healthcare will slide; that feels pretty 1954 to me. I think it just means that women will find another way to acheive that is different from the alpha-male model. Which is what I think they (we) are doing. I do believe that we are not just responsible for ourselves in this world; we have a responsibility to our communities and society WITHIN REASON. I don't think that it should be every man for himself and if you can't pay too bad, and I don't think the other extreme where society/governemet pays for it all is the way to go either. But I do think there is a middle ground, and I think the US does a decent job. I don't have a problem with Medicare or Medicaid in theory. The way it is executed needs tweeking, yes, but I think some amount of communal healthcare is ok for the poor and elderly. Those of us who are healthy and financially able should pay as much as we can. Which we do. BTW, I have never heard of a lotto system for healthcare. That is mishegos - who thought that gem up?
EK - I don't know where you live, but here in California we can go to the 7-11 and buy a "Healthcare" scratcher lotto card. If two medicines match, you get to buy one for the non-formulary price of $35! Otherwise it's $157.20, or you can continue coughing up blood. Your choice.

But I kid!

I also don't know what your husband does, so I don't know if you married a person who avoids political conflict.

We here at the coffeehouse enjoy a nice, civil conflict with our decaf nonfat machiatto lattes. I would say that "liberal" is somewhat of a four-letter word around these parts, only with three extras letters. I think I speak for most of us when I say that I think that most liberals have the best of intentions, but just go about achieving their goals the wrong way. What gets me riled up is that for the most part liberals seem to think that conservatives, instead of having good intentions and going about them the wrong way, are actually evil racists. Now, I certainly don't get that impression from you - I'm just trying to explain the orneriness of some folks at the next table.

Take me. Please! (Again, I kid.) As the good doctor implied, I myself used to be a good liberal. But then again maybe I wasn't that "good," because I don't think I ever really thought about what I believed - it was just sort of inherited from my family and social circles. I'm not saying I was typical or that this is how most liberals are.

I don't know why Bean is asking me about my free market proclivities, when he knows full well that it was he and Ball-and-Chain who tortured me into submission using a red-hot fireplace poker, vaseline, and a rubber chicken filled to the beak with marshmallow fluff (the shul mishloach manot basket came with a 5-quart vat of the stuff so they had to do something with it).
I also don't know if I agree that women's less aggressive nature means that the quality of healthcare will slide

I have never heard more BS in my life.
I'm always amazed at how other people jump at the chance to spend my money on their pet programs.

How about, if anyone things "the government" should be doing X, that person should be the biggest contributors to that cause? Having the government involved in healthcare is why is has the trouble it has.
One of my ICU professors when I was a medical resident proposed a relatively quick fix to Medicare which I haven't heard too much discussion of since. It is a known fact that the vast majority of health care expenditures in the U.S. is at the end of life, or in the few months preceding the end of life. We go to great heroic measures to prolong the lives of people who by all rights should be dead, and in fact, if they had a choice in the matter probably would be.

Therein lies the point, as my prof pointed out. It should be a requirement that anyone who enrolls in Medicare have an advanced directive, as well as a health care proxy who will make decisions for them when they become incapicated. These should be kept on a centralized database, easily accessible in any emergency room (and changeable if the subscriber so desires).

Doctor Bean and Psychotoddler can tell you about the endless and very expensive days elderly, chronically ill, demented, unresponsive people, with no quality of life whatosever spend languising in our hospitals, ICUs and yes, nursing homes. They are kept alive because they never made their end-of-life wishes known.

The current assumption is that as health care professionals, we should be prolonging life at all costs. The same assumption applies to Medicare/Medicaid and that as a society we should contine to prolong life at all costs. That assumption needs to change. There is nothing wrong with dying, at the appropriate time.

A mandatory advance directive would be relatively easy to enact, simply becoming an integral part of the application for Medicare/Medicaid. I firmly believe that this would result in substantial savings to the health care system and slow the runaway train of ballooning health care costs.

Do those of you reading this have an advanced directive? Do your loved ones know what you would want done if you were terminally ill? Have you designated a person to be your health care proxy in that event?

Sorry about the long comment, and Psychotodder, if you need a cardiac cath (G-d forbid), for you, we'll do it wholesale.
Excellent point, wanderer. I am still thinking about the rest of it, will comment more later. Car pool is calling . . . but definitely food for thought.
Wanderer: Great idea! Most medicare beneficiaries have, however, been unable to sign up for the new Medicare drug benefit, so they are clearly not capable of choosing end-of-life care. Also, don't you think that people would suddenly realize that Aunt Sally didn't want her life prolonged artificially if they themselves to had to pay for it? Cruel? Maybe, but there is no other way.

An aside....
I took a class in college about healthcare delivery. The professor was some kind of leftist (surprise) but I left the class realizing what I should have known when I went in. There are two ways to distribute goods, by money and by others deciding who "deserves" them. The problem with the first model is that the total scumbags with trust funds who have wasted their whole lives on drugs, women and booze can afford all the best medical care and tiny, precious, innocent babies born to the poor can't. The trouble with the second scenario is that it evolves into an Orwellian state where other people decide who is more worthy. I never want others deciding whose life is more valuable, so I opt for the former.
I guess I want to live in a world where there is a way to make your former option more equitable without it turning into your latter option. I'm not saying I have answers, mind you, and I am not in anything remotely connected to the medical profession (I don't even play one on TV). But I do wish there was a middle ground.
Have people pretty much pay for their own stuff.

But, this is so simplistic, Bean.

It's so.....hierarchical.

It's so...mean-spirited. What about the community? What about those who can't afford your high-priced medical care, huh?? What about them?

Paying for my own stuff? How dare you impose your eurocentric values on me.

What if I want you to pay for my stuff? Did ya ever think about that?

Legal Eagle

p.s. The above is satire. Bean's revolutionary idea is sound and decent and would likely help restore our great medical care system.
Healthcare doesn't have to be high priced. It should not cost the equivalent of a utility bill to see a doctor. People shouldn't have to go without food to get their meds. The medical industry and the insurance industry, and to some extent, too, the consumer- have driven the costs to unreasonable levels. And have done so without providing the quality of service found in other similarly compensated industries. The issue is complex, and the answers are bound to be complex and painful- but something has to be done. At present, the US ranks far behind many other nations in healthcare (France, Italy, japan, etc. etc) but has the highest healthcare costs by at least an order of magnitude. And there's no end in sight.

I don't know what the answers are. I'm pretty sure they don't begin with spending MORE tax dollars.
Ezer Knegdo and Stacey ...now you go girls!
But should I have to go without my 80-hour high-definition Tivo to get my meds?
Doesn't France have national healthcare? What makes their system better than ours?
EK - France's system is better because it comes with good cheese and fine wine. (The preceding sentence is much funnier if you read the terms "good cheese" and "fine wine" with an unnecessarily exaggerated French accent.)

As for universal health care, looks like Massachusetts has that now, too. No word on whether it comes with refreshments.
Has anyone read the article that Dr. Bean linked to? Best line..
"'By the end of 2008 we have a commitment to a maximum of 18 weeks from the time you see your doctor to the time you have your operation,' (Tony) Blair said." That's over four months and (apparently) a highly ambitious target at that. yikes!

The middle ground is where private charities and a basic safety net fill in the middle ground. Did you guys know that we are the most charitable nation?
B&C: Wow. Scary.

Ralphie: Excellent! Cheese and Wine with my bypass! Clog one artery while they unclog another! Vive la France!
Ezer, the fact is, that europeans cosume a great deal more fatty foods etc, than Americans. And with fewer of the related health troubles. There are a lot of theories as to why, but I don't buy most of them.
Don't know, Og. I'm guessing portion control, more active lifestyle, fewer "Big Macs". But since, as I said, I am not a medical professional, I could be full of crap.
Hey, where can I get myself one of those stereotypical 1950's Father Knows Best wives. Stacey, get your ass over here with my paper and slippers. And while you're at it make sure to iron my shirts. Oy, this places kills me.
It doesn't sound like Massachusetts is offering universal healthcare, but rather requiring people to actually pay for their own if they can afford it, and require businesses to provide coverage for workers. Hmmmm. . . .
"I'm guessing portion control, more active lifestyle, fewer "Big Macs""

Um. No. The point is, with NO portion control, with NO more active lifestyle, europeans have less health conditons. And eat richer foods. As I said formerly. I have my own theories, but as I'm not a physician, I keep them to myself.
"Routine Care" doesn't have to cost very much. Medications are overpriced.

The real problem is that anything beyond "routine care" costs a fortune. Or at least a car.

Physical therapy will run you several hundred to a thousand dollars.

A stress test is about $2500. MRI is 2-3000.

An overnight stay in the hospital for any reason will cost upwards of 3000.

ANY operation, even the most minor, as an outpatient, is several thousand dollars.

An inpatient operation, say something routine like an appendectomy, is upwards of $10,000.

Your "wholesale" cardiac cath, PTCA, maybe throw in a stent or two for good measure, overnight stay, is $50,000 (I got that figure from my favorite cardiology nurse--whose husband got "wholesale" care from the cardiologist who employs her).

Meanwhile, people balk at paying their $20 copays to see their PCPs, not realizing that the insurance company reduces its already low reimbursment rates by that much. So I make about 30 cents on the dollar.

Yeah, I guess we can ask people to pay out of pocket for "routine care", but that's not where the system is hemorrhaging.
Whew! Gets hot over here at the coffee house! :-)
PT: Third party payments and treating illegal aliens and the uninsured are the reasons why those procedures cost so much. You also know, of course, that no-one actually pays those outrageous amounts anyway. Insurance companies adjust them down. If an uninsured patient were ever to call and try to pay their bill they would also find that they could easily get the discounted rate. The hospital would be so thrilled that they hadn't just left a bad address and skipped town.

Jack: We 1950-era housewives can be found in the biology department at your local medical school. Whodda thunk? Gotta go. Gotta bring the good doctor a martini.
Ezer Knegdo: “I think some amount of communal healthcare is ok for the poor and elderly.” That’s where I’d like to tweak your thinking a little. The poor makes sense, but why include the elderly? Is it because we think of the elderly as mostly poor? But if so, they’d already be included in the first category. What is it about being 65 that should automatically entitle one to a massive subsidy regardless of one’s means?

Ralphie: Hee hee. You know you loved it.

Stacey: OK. Let’s start at the beginning so I don’t offend anyone’s feminist sensibility. Let me first set the table by agreeing that (1) women should do whatever the heck they want with their lives and (2) I have known individual women who are as committed to medicine, as aggressively competitive, and as excellent in their field as any men. Having said that, can you not agree that while (2) is true for individuals, it is false on average, since women (again, on average) tend to prioritize family over work? (This is not a criticism; I’m glad they do this.) Can you name a single previously male-dominated field in which wages and quality did not decline as women gained equality? This is not to say that women should be kept out (see 1 above), but simply to say that (again on average) women work fewer hours in their career (a good thing, IMHO) and value their family over their customer/client/patient.

Og: Yup.

Wanderer: Excellent point. I want to nudge you just a little, though. I totally support advance directives, and think it’s very important to refrain from delivering care that the patient would not want delivered (or refraining from delivering care that the patient would want if the patient is really annoying. Kidding!). Nevertheless, I think the criticism that our system spends the most in the last year of life is a bogus one (that comes largely from the left). Let me try to convince you that in any system in which patients are free to choose or refuse care, the most resources are going to be used (on average) in people’s last year. This is because even for non-futile and for care that is desired, that’s when the resources are needed. That’s because we don’t know at the beginning of any year that it will be the patient’s last. We just know they’re sick. Preventive care, on the other hand, is very inexpensive, so no matter how much we spend keeping people healthy, it’ll never be as much as when they need a week in an ICU. Now if they have no chance of recovery, that’s one thing, but frequently that’s not known at the outset. Imagine a 62 year old in a serious car accident. He has multiple surgeries and a long ICU stay. If he dies, he will have consumed tons of resources in his last year, but there’s no way of knowing whether he’ll die or not so we press forward and spend the resources. Most people don’t die suddenly, and even if you remove all the people with terrible quality of lives who would not want further care, you’d still have lots of people who want to live whose last illness or injury is very expensive. I’m delighted that we spend the most in people’s last year, ‘cause that’s where the money’s needed. At the same time I agree that way too much futile and unwanted care is delivered, and that is of course totally unethical besides being expensive. But fixing that won’t change the timing of expenditures.

ball-and-chain: You were a capitalist way before it was cool.

Ezer Knegdo: The middle ground is capitalism with a small and slightly uncomfortable safety net. Any deviation from that in either direction increases misery. Medicare is hurting our country.

Legal Eagle: Remember all the late night conversations 20 years ago when I was a lefty? I hope you’re proud of the rabid free-marketer you’ve made me. By the way, when do I start receiving checks from the International Conspiracy to Oppress the Workers?

Og: Part of the better health of France, Japan, etc… Is that they’re genetically very different from us, i.e. they’re full of French and Japanese people with very different genetic susceptibilities to diseases than our diverse American population. French and Japanese immigrants to the U.S. certainly don’t have worse health than their parents did in the old country. The way to compare healthcare systems, therefore, can’t just rely on the health of the citizens but has to look at the delivery of care. For those measures, we’re unsurpassed. There is no place in the world, for example, that one is more likely to survive his first heart attack than the US.

Sweettooth120: Thanks for the cheer. Come back again and tell us what you really think.

Ezer: Right. That’s exactly the point I’m making to Og also. I think their system is worse.

Jack: Yes. Yes. You’re very modern and egalitarian and progressive. See my comment to Stacey above. By the way, ball-and-chain has a Ph.D. in immunology and is doing exactly what she wants with her life. She’s more educated and shoots better than me (or you). So be careful about who you’re trying to liberate.

Psychotoddler: But those high price items would be much cheaper if they weren’t massively subsidized by Medicare. Look at other technologies. Computers get better and cheaper every year. A CT scan should be a few hundred bucks, and would be if the marketplace set the price. But to have a marketplace you have to have some people that can’t get a CT. That’s the only thing that lowers prices. If everyone can afford a product, the price will always be sky high.

Ezer: “Whew! Gets hot over here at the coffee house! :-)”

What do you expect with that bag over your head?! (-:

ball-and-chain: I love you, honey!
I've been following this discussion carefully...very interesting. I agree with B&C about why the cost of those procedures are so high. That is a big problem. I also believe that what the insurance companies have done is slowly brainwashed people over time, that they cannot have any type of procedure or care, be it medical or dental, by actually paying for it. Patients are willing to go to BAD dentists and doctors as long as their insurance pays. They are willing to leave good care if their insurance no longer covers a particular doctor. So, getting people to actually pay for care? Good luck.
Also, somebody up-thread said it more eloquently than I, but...

That we have a system where people do not pay for their own stuff leads to the exhorbitant high price of stuff.

Example: My 4 year old does not pay for his own stuff. He has somehow convinced his parents (us) to pay for his stuff.

As a result, he has too much stuff and way too much expensive stuff.

If he had to pay for his own stuff, (a) he would have less stuff, (b) cheaper stuff and (c) would be just fine.

Same principle with health care.
To be perfectly honest here, if my 4-year-old had to pay for her own stuff, she would have zero stuff. Oh, she'd do okay bartering for a while, but once the My Little Ponies and ketchup ran dry, she'd be outta luck.
Ralphie: No way, your daughters would get by on good looks alone.

LE: Is he 4 already?! Where does the time go?
I will overlook the fact that my comment was the only one ignored :(
I'm not sensitive...really...not at all.
cruisin: that happens to me all the time on other blogs. Sometimes I think my comments may be invisible. The truth is, I'm just not funny. In answer to your question, people who get it are willing to pay more for their healthcare. I'd give you specifics but that would out Dr. Bean.
you certainly started a firestorm here!!

my only "gripe" with the current system might be misunderstanding. I have 2 kids. The second one cost $20000 according to the hospital bills. I think we ended up paying about $3000 out of pocket. Insurance paid about $13000. That leaves about $4000.

If we didn't have insurance, we wouldn't have been able to get the insurance brass-knuckles rate, right? We would have been garnished for the full $20K, not simply $16K. So, the working poor get smacked twice.

Or do I have it wrong?

Dr. Bean, hangin' with your crowd, I'd better wear a bag over my head; I hear you all carry guns. ;-)

***For those with no sense of humor, that was a joke.
Cruisin-mom: Some patients are realizing how little their insurance buys. They’re paying for their own care. The numbers are small but growing. That’s what the whole Health Savings Account trend is all about.

Birdwoman: You have it pretty much right, except for that if you were uninsured you could most likely call the hospital and negotiate a lower rate for yourself. The high fees are usually only paid by visiting dignitaries and such. If you called and said “How about if I pay you what Blue Cross (or whatever) would have paid?” They’d most likely agree with delight since most uninsured patients pay nothing and have to be tracked down and sent to a collections agency.
Birdwoman: You could also give birth at a birthing center or at another cheaper facility. You illustrate another thing that is wrong with insurance, insuring for inevitable events. Most woman will have children so they could save up for what it costs. If the birth goes badly or the baby is born sick, that is when the insurance would kick in. Trust me, if women paid for delivering children, it would never cost $20,000. J
You are right about that. Most women don't even realize that birth does NOT have to include many of the interventions that occurr. Between physician fear of malpractice and women's fear of the unknown (because many women will research the refridgerator they are going to buy more than their own healthcare), so much is done to women and babies that is unnecessary and expensive. I am not a "let's all have homebirths in a field of daisies" type of woman ("not that there's anything wrong with that"), but I do believe that women have a responsibility to educate themselves and their partners about what happens to one's body during pregnancy and birth, and what are reasonable amounts of interventions and what is simply unnecessary in most healthy situations. OBVIOUSLY life-threatening or emergency situations deserve whatever interventions are necessary. Pain relief is a good thing for many people. I am not against any of that. But I saw on the Today show a segment about healthy women with healthy, full term, correctly positioned babies ELECTING to have non-medically necessary C-Sections, simply to avoid labor & delievery. I know women personally whose doctors allowed them to schedule and induction around specific dates and family vacations. Several of those women ended up in the OR because of it. That has to affect costs, doctor visits and care in general.
EK: Best line..."let's all have homebirths in a field of daisies" type of woman ("not that there's anything wrong with that") I actually did LOL
*Sigh* I miss Seinfeld . . . :-)
But seriously, that whole topic pisses me off. Intelligent women who just close their minds the minute they are pregnant. Not that I don't trust doctors/midwives, but please people, you have to be responsible for what is happening to you. and rather have major abdominal surgery than a safe labor and delivery? are you kidding me?
Manhattan, 1972 - Marcia Smith-Cummings completes the first recorded underwater birth. The other patrons ofthe 92nd-street Y pool are thoroughly grossed-out.
It is completely and totally ludicrous to suggest that salaries go down as women gain equality. There is a plethora of more factors that go into the equation that woman! For instance, in my field foreigners will work for peanuts.
Jack: Yes. Yes. You’re very modern and egalitarian and progressive. See my comment to Stacey above. By the way, ball-and-chain has a Ph.D. in immunology and is doing exactly what she wants with her life. She’s more educated and shoots better than me (or you). So be careful about who you’re trying to liberate.


You don't know me well enough to say who is better educated. It is a cheap shot to try and marginalize my opinion and not really salient to this discussion.

I would guess that you would agree that there are many ways to define a good education. I suspect that in this case you are referring to a college education. And I rather suspect that you have your opinions on whether a degree has value.

A P.H.D. in immunology is nice, but it is not a degree in economics. It doesn't bestow any particular insight on socioeconomics as we are discussing them in this context. Maybe she has something else in her sleeve, like a BA in a field that pertains to this discussion.

Maybe there is something more that I am not aware of, but as currently constituted your comment was just another way for you to express appreciation to your wife. That is good, it is admirable and makes for a good marriage but it doesn't lend any value or credence to your position here.

And just because I feel like going on let me add that you really don't know who is the better shot. But if we are going to engage in a pissing contest let me be blunt and guarantee 9 times out of ten I could disarm B&C before she had a chance to fire her weapon.

Six out of 10 times I could disarm both of you before you could fire your weapons.

I used to bench press well over three hundred pounds, could curl more than you weigh and could run for days without getting tired.

The last three people who hit me in the head broke their hands and ended up visiting doctors who don't live a Beverly Hills boutique lifestyle.

But what does any of this have to do with anything relating to this discussion.

Not a bleeping thing, which is ok because your comment didn't either.

The bottom line is that until you bring in real facts here your opinion doesn't carry any more weight than any other.

One more thing, it is really easy to shoot a paper target and much harder to shoot a person.

Wow, I feel so virile.

I didn't read them, just wanted to say 50 comments!

Er, 51

Jack, can we get a PPV of you pissing at Dr. Bean and headlocking B&C or whatever the f*** you were talking about?
Hey, don't get your panties in a twist. Reread Bean's comment. Bean wasn't saying that I am better educated than you (how would he know) just that I am a better shot (maybe). It was a joke. Assuming that I am a better shot is hardly a tremendous insult. His point was merely that I like my job as housewife, your snide comments notwithstanding(which I do). Take a warm bath and relax. We don't serve liquor at the coffeehouse ot I'd pour you a scotch.
Jack, two questions:

1.) Regarding running for days without stopping, wouldn't you at least need to take a nap at some point?

2.) Why are people hitting you in the head so often?
Jack: OK. I'm sorry. I have no idea how her shooting or education compare to yours. I was only saying (poorly apparently) that she is a very smart and independent woman who is doing exactly what she wants with her life and doesn't require liberation from her 50s housewife role. I really am sorry.
B&C is NO 50s housewife. 70's, tops.
Bean - what's the matter with you? Grow a pair and kick his a$$.

CUT TO: Bean, bloodied and broken in an alley somewhere in North Hollywood.

Ralphie: Then again, maybe you should have gone with your original instinct.
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