I got 2 funny emails this past week — both about the health care bill.

I was admonished (by KF) to participate in the debate:

“Why haven’t you said anything about health care? You must have a view!!!

Three exclamation points? That’s a clear sign of an emotional, rather than logical perspective. I see that as a pointless debate, one I have no desire to engage in. So I ignore them.

However, this email (from JW) intrigued me:

“Your logical and data driven approach to markets and human psychology is refreshing. I am curious as to your thoughts regarding the pending health care legislation from that perspective (logic, rather than politics).

In that spirit, I will repeat what I told him, a) this isn’t an issue that I am particularly insterested in, and 2) I have no particular expertise in this area. And I am unfamiliar with the bill that is about to become law.

However, I can tell you what I think is wrong with the current US system — its a utter mess, and should be tossed out wholesale. Throw it out, start over, rebuild it from the ground up.

Here’s what I emailed JW about what is wrong with the current system:

“When it comes to health care, I will share with four factors that I find to be significant. Others have already beaten certain aspects of this to death — so these may not even be the most important factors overall. But in my experience, these are things that keep coming back to me about the health care issue:

1) Most of the industrialized world has national heath insurance — they (mostly) like it a lot. Speak to people from  England, Switzerland, Japan, Netherlands, Germany, France, Japan and especially Australia, they all love their natty health care. (Canadians, much less so). People in my office lived in Sydney for 10 years, swear by it. Talk to Europeans about our debate, and they will tell you Americans are insane.

2) We pay for medical care for 45 million people in the most inefficient way possible. Taking a kid with a high fever to the ER instead of the pediatrician makes a $60 office visit cost $8,000. Those parents don’t pay that bill, and so the costs are passed along to everyone else. That makes no sense whatsoever. I don’t know if its even possible to make medical care less efficiently priced than this arrangement if you tried.

3) Having a for-profit middle man between medical personnel and the patient is a recipe for disaster. This is an enormous inefficiency, and as as applied in the US has worked to raise costs and deny coverage. And, it make medical administration much more complex and costly than it should be. That seems like a lose/lose/lose to everyone — but the insurance cos.

4) Our system is weird: I can only speak from personal experience, and I can say as a person who has been fortunate enough to be relatively healthy. Our insurance system is simply freaky. I have a quick story about this in comments . . .

Those are my views about what’s wrong; I have no idea how to fix it . . .

Category: Current Affairs

Please use the comments to demonstrate your own ignorance, unfamiliarity with empirical data and lack of respect for scientific knowledge. Be sure to create straw men and argue against things I have neither said nor implied. If you could repeat previously discredited memes or steer the conversation into irrelevant, off topic discussions, it would be appreciated. Lastly, kindly forgo all civility in your discourse . . . you are, after all, anonymous.

196 Responses to “The Strange US Health Care System”

  1. Brief personal story:

    I used to be a pitcher, and somewhere between college and last year I tore my rotator cuff. Never knew about it, never bothered me. One night, I wake up in pain, Can’t lie on the shoulder. Gets worse, and worse, and after a month I finally go to the orthopedist. X-rays in his office, “yep, it looks like a problem, you need an MRI.”

    Here’s where we go down the rabbit whole.

    I say, let’s do it, and the doc tells me he needs permission from the Insurer. So a 24 year old girl with a High School diploma sitting in a cubicle in Syracuse has to give approval to my doc, (Yale undergrad, Columbia Med school). That makes no sense.

    Even worse, it takes a week to get permission, and then another week to schedule the MRI. This means I am in pain for 2 unnecessary weeks. Very annoying.

    MRI comes back positive, and I say (right from Rocky) Doc, cut me. He warns me its a six month long rehab — grueling physical therapy (PX), very uncomfortable. Better alternative is to try Physical Therapy before hand. 3X week for 4 months — massage (not the good kind — painful and no fun), strengthening, stretching.

    Further down the rabbit hole: It seems that every 4th visit, the insurer wants an evaluation done. This is a ridiculous waste of time — it seems as if they are trying to discourage the treatments. I speak to the insurer, get a colossal runaround. I speak to 5 different people, there is no way to waive this.

    I have a simple solution — cancel the PX, and get the Doc to schedule the surgery. My insurer SUDDENLY becomes way more responsive. Senior VPs are calling me, trying to get me to try PX first. My terms are simple Evals after every 10 weeks, not 4th visit. I keep getting bumped up to higher VPs.
    When we reserve the operating room for the actual surgery, they finally cave. I make them fax the pre-approval of the entire PX in writing. Surgery canceled, PX effective.

    That is the sign of a very broken system . . .

  2. Mannwich says:

    Kudos, BR. EXACTLY the same arguments that I’ve made ad nausuem with my “conservative” brother and other hysterical nabobs on the right.

  3. Stephen says:

    All these strange anectdotal stories puzzle me. I needed an MRI a few years back and the whole doc-MRI-report-doc again procedure took place in the period of one week. I believe the insurance at the time was an HMO, and I hate them. But a phone call or two and it was dealt with.

    Besides that, if I needed to, the cost of the MRI with the report was about $750. I had brakes put on my car that cost about half that and I didn’t cry for government control of mechanics. Could it be cheaper? Sure, but government is not going to achieve it.

    The biggest problem in this whole debate is that the solution is to put all of this in the hands of government, an organization that has proven over and over again (post office, the military, medicare, SS, medicaide, Fanny, Freddy, NASA, Veterans Admin, etc ad nauseum) that they are *the* most inefficient managers of money in history. Everything that they do costs twice as much as similar privately managed enterprises, corruption or not. The people in Europe and other socialized-medicine countries ‘love’ their health care like the elderly here ‘love’ their SS. That doesn’t mean that what they love is not bankrupting their country, just that they love it. And, by the way, we are already bankrupt on paper. We are just waiting for the end game. We are like a retiree with lots of saving but who is in debt more than he save and his expenditures so high that he will run out of money and still have 20 years to live. He’ll be fine for the next few years, but the catastrophe will come.

    At least it’s out on the table now, Barry is a big D democrat and not even close to the independent he claims to be. I thought that your lack of comment on this monumental debate was because you were a money guy and as soon as it passed you would start talking about what it means economically. Now I know that it is because you support socialization of another 20% of America (which will bring us to about 70% by the way) and are like most of the left leaning commentary I see, you believe that the government will do better.

    I stood in line at the post office the other day and marveled at the ineptitude and inefficiency there. I also was told that they would not be raising the rate ‘this year’ but that they were about $5 billion in the hole. How the hell does FedEx do it? Must be all that corporate corruption at FedEx stealing money and falsifying SEC reportage … right.


    BR: You are wrong about my political affiliation. And if other countries are so inefficient, why does the US pay double what they do for less healthcare?

    I always watch the way people make your arguments — yours is quite revealing! You managed to ignore the specifics of what I wrote about, make several false statements, invoke classic conservative bugaboos (post office, Fannie/Freddie, Social Security, Medicare, NASA) make false ad hominim statements about me, yet you avoided any actual discussion of the issues I raised. That tells me all I need to know about YOU.

  4. Mannwich says:

    @BR: And that was HOW long ago? Twenty years? The system has gotten appreciably worse since then, as most any sane thinking person knows. There are also way too many instances of people who think they are covered (when healthy) only to find out they are not when they get sick. That is just INSANE, criminal, actually, but it sort of fits with other aspects of our predator economy (e.g. Wall Street).


    BR: The tear was probably 20+ years ago — this was 2008!

  5. Pat G. says:

    I emphatically agree with your points 2 and 3. The medical care and prescription drug systems in this country are dysfunctional. But then, so is the USG who has allowed these systems to become this way because there’s more money in it for everyone sans the patient. This whole country is profit driven at the expense of the average American. Is your rotator cuff healed?

  6. Mannwich says:

    I say take the insurers out of the equation for everything but catastrophic coverage (like life insurance) and open up competition for that across state lines. There’s no reason that insurers should be involved in every regular doctor visit and/or prescription. All it does is serve to push up costs.

  7. Through the Looking Glass says:

    I agree with all your points there Barry. I just dont get whats going on here with all the heated fuss over this bill. It would seem like a conspiracy to take attention off the financial crisis but I just cant figure out why , whos behind it,and where is that rabbit hole they fell into. We are talking about health care here , helping people at their most vulnerable time. Its not about Wall street and banks crushing the American economy with their tactics destroying businesses,towns and homes or about the war in Iraq that cost a Trillion dollars for who knows what. This is a drop in the bucket compared to those mistakes. The republicans seem to want to appeal to the most emotional, and reactionary with obtuse chicken little arguments of how the world will end if this passes . I just cant believe these are adults, that’s the same arguments they were using when they feared Obama would be elected remember? Calm down folks the health care bill is not the problem, think about it, we can afford to be to do the right thing for a change. Wars are socialized, we all pay for them. Wall st and the banks have socialized risk and privatized profits and yet folks are outraged by health care? Its baffling to me, no kidding I just don’t get that at all.

  8. bergsten says:

    What we have here, Barry, is something you should be quite familiar with at this point.

    Too Big To Fail (in yet another guise).

    The only Health Care Reform that stands any chance of passing is effectively a(nother) bailout for Insurance companies.

    Quality, usefulness, efficiency, cost, value, benefit no longer figure into business success, let alone providing a means to compete. Past a certain size, it’s all influence and protectionism.

  9. jritzema says:

    I agree that we need to start over on healthcare, but the obsession with making the insurers “pay” perplexes me. They are poor at their jobs tis true, but they really do not make the most money in the system. If you look at the other countries that have the socialized systems, not every doctor is wealthy. It is usually a decent playing profession but not a way to become extremely wealth. What is it about the US where this is OK? If the government were to take out the middle man they would then need to cut the costs of doctors, drugs and devices. I don’t think they have the guts so the US would then have the worst socialized system in the world.

    A bit off topic but most doctors I have seen are good at what they do and OK to deal with but the back office/receptionists/scheduling people are rude and clueless.

  10. bjarnim says:

    Waiting weeks for health care? What kind of a system is that?
    The more I learn about the health care system in the US the less I understand it. Well there is only one thing to understand, it’s sole objective seems to be to make money for the insurance companies.

    I do love the system here in Iceland, despite all the savings that have had to take place in the last years following the meltdown, it is still fairly cheap with excellent service. Thankfully I haven’t had to use it much.

    Well good luck with creating a better and more efficient system.

  11. “…the current US system — its a utter mess, and should be tossed out wholesale. Throw it out, start over, rebuild it from the ground up…”–BR, above

    it, too, is, too much, like that.

    “…enormous inefficiency, and as as applied in the US has worked to raise costs and deny coverage. And, it make medical administration much more complex and costly than it should be. That seems like a lose/lose/lose to everyone — but the insurance cos. …”–BR, above

    “Health Care” Insurance Co.s give the whole Topic of ‘Insurance’ a bad name..

  12. The Curmudgeon says:


    My kid is recuperating from his second bone marrow transplant in his short fifteen years on the planet. You want some stories about health care? I’ve got a few. So many, in fact, I wouldn’t know where to begin.

    I’ll just say this: If we don’t come around to the realization that healthcare is not free, and that sometimes hard choices have to be made when the costs of treatment outweigh the expected benefits, not only to the patient, but also to society as a whole (particularly if society is footing the bill), then healthcare expenditures will do to us (and the rest of the advanced economies that similarly refuse to make such choices) what no foreign foe has ever been able: They will destroy us. What the prescription is–government rationing or whatever–is anybody’s guess. But the day of rationing is coming if we are to continue as a viable economic, and thereby military and political, power.

    How that fits with my recent experiences would take a book to explain, so I’ll just leave it at that.

  13. bsneath says:

    Australia appears to have a two tier health care system, a basic government administered system (called Medicare) with established fee schedules and patient co-payment requirements using public and private health care facilities, and a provision for obtaining additional private insurance for those who wish to obtain higher service levels. Thus everyone is covered under (entitled to) a basic level of health care but those who wish to pay more (and those in the health care professionals who demand to be paid more) can do so as well. This seems preferable to any of the alternatives being debated here.

  14. Mannwich says:

    Great points, Looking Glass. Extremely puzzling (and depressing) indeed, and many of these tea-baggers like to call themselves “Christian”. What could be more “Christian” and “pro-life” than trying to better our health care system so that their fellow citizen can have access (many of them hard-working poor)? Where was all the outrage over all those other things that you metnion, which would have been FAR more justified? Perhaps this is a subject that people think they can understand (even if they really don’t) or perhaps it’s about something else entirely (take one or two guesses)? Those thoughtless emotions and hysteria explain a lot about why this country is in such dire straits. I’m not making an argument for THIS bill, FYI. I really have no idea if it will work well. In fact, I’m pretty resigned to it not working well at all for everyone but the insurers, but the hysteria behind it amazes.

  15. gman says:

    “I see, you believe that the government will do better”

    If you read barrys comment it is not simple “belief”….other governements DO actually much better job than our “private/free market” system. It is you, who simply “believe” that a government CANNOT do it!


    Globally there is almost perfect corellation between healthcare spending and life expectancy(well at least in the “socialist” ones) And then there is the US, “heroic”,” free market”, “innovative” “best system” in the world which spend 200% as much per capita and HAS LOWER LIFE EXPECTANCY!

  16. phb says:

    @Stephen – Observing a broken system in action does not make a big D democrat out of anyone. Our system is skewed to two very expensive partners in crime – insurance companies in control of our health and tort attorneys that patiently follow ambulances (they don’t chase any longer since they have trained us that ANY injury is a payday). We need changes and we need them soon. Your anecdotal MRI is the exception and far from the rule. Ask around.

  17. soulmatic09 says:

    A few years back, I fell and broke my jaw on vacation. I went to the ER via an ambulance on a Thursday afternoon, and am finally admitted as an inpatient to have surgery at about 1 AM.

    After waiting all day Friday to hear from a doctor, they waited until 5 pm that day to tell me that hospital does not do jaw surgery. (Then why did ER guys admit me?) Not only that, the doctors offices were all closed at 5pm, so I had to wait in a hospital bed until Monday to a surgeon. No big deal, I figure they transfer me to the right hospital, have me eat pudding for a few days, I get my jaw fixed, and I go home.

    Monday comes around, nothing. Tuesday comes around and the surgeon shows up. “There’s a problem,” he tells me: “Your insurance company won’t approve this b/c they say it’s a dental procedure.”

    I’m like “WTF?!?! My jawbone is considered a tooth? What kind of messed up anatomy books are you guys using?” He tells me that he didn’t understand it either, and were working on getting the approval.

    I spend the rest of the week in the hospital, getting moved from room to room waiting for this simple surgery to be approved by HealthNet.

    By the end of the week, I am absolutely fuming, as is the surgeon. Keep in mind, this was my vacation, and I was due back days ago. My broken jaw is starting to set, and eventually the surgeon says “Screw it, I’m doing the surgery. We’ll figure out how to pay for it later.” And I had health insurance!

    I finally get the surgery done, and get the bill: $30,000. And you know what the bulk of the bill was? Inpatient services for being in the hospital for over a week and a half, which was the result of them rejecting the procedure day after day!

    I spent the next six months trying to get them to pay the bills; I was 25 years old & didn’t have $30k lying around. After getting them to realize my mandible isn’t a tooth, they denied the claim because of geography. (I lived in Glendale, CA, but had the operation in Glendale, AZ. They tried to say I had no coverage in Arizona, but my emergency coverage clearly stated it applies in all 50 states. Then they said my claim got screwed up because the name of the cities were the same.)

    Then I had to contest each claim one by one (the stack of claims was over 1 inch thick) but I finally got them to pay for it.

    There’s actually more to the story I don’t want to get into, but how on earth someone could say this is the greatest health system in the world?

  18. RW says:

    There are lots of interesting twists to the health care or, more accurately I guess, health financing debate but the peculiar thing BR is that your list of countries w/ universal health care illustrates the fact that we had a real-world menu, a host of active programs with hard data, we could have selected from and instead we wind up concocting a stew that may prove barely edible.

    Our political system appears to be as screwed up as our health-care system but surely a big hunk of that must be due to the horse-race, winner-take-all or purer-than-thou attitude that leads to a complete unwillingness to compromise: In the absence of compromise politics becomes nothing more than a dung heap with the beetles fighting for enough to make their own ball.

    I have no solutions to the health care mess in the US either but I hereby dedicate this song to Jim DeMint, Mike Pence, Michele Bachmann and all the rest of the hyperbolic, show-no-quarter crowd who made it a lot less likely that what we’re going to get will be as good as what was on the menu: http://www.youtube.com/watch?v=dH1mXTKp1JQ

  19. jpm says:

    That is the sign of a very broken system . . .

    Your medical issue was a “one-and-done” type of issue. Meaning, you had an issue, it gets addressed and then you’re fixed (nominally).

    Try something really fun: inflammatory arthritis. Essentially, for no known medical reason, your immune system decides that the joints in your toes are foreign material, and need to be eradicated.

    Nobody really understands the cause, but the solution is to “modulate” (read: shut down) parts of your immune system. And this is accomplished by using drugs often meant for chemo, but in lower doses.

    Now: How do you think an insurer reacts to that? God help you if you move, because now you have a permanent pre-existing condition that insurers know is expensive.

    The worst part? There is no financial incentive to find a cure, because the treatments are lifelong and expensive. (Diabetes is similar.)

    How people can profit handsomely from the sick is truly beyond my comprehension.

  20. Mannwich says:

    @RW: We’re the U.S. gosh-darn-it, and better than everyone, therefore, we don’t need to look to other lesser countries for a model on how to do anything. Don’t you know anything? It’s that kind of arrogance (and ignorance) that’s taking us down the shitter.

  21. Chrisbo says:


    I think your point about insurer’s not being the primary expense has a grain of truth in it. However, if you look at it in terms of compensation for value added, they grab a disproportionate amount of money for the “value” they add. I run my own company and pay for my own individual policy. I do this with full knowledge that, should I come down with some chronic disease, my “insurer” will, at some point petition my state insurance board for permission to drop my policy. It has happened before in my state. And I am sure that executives at the insurer would claim they have a “fiduciary duty” to shareholders to do so.

    Through the looking glass:

    The obstinance the Republicans are showing has little to do with the merits of the legislation. As has been pointed out, many of the ideas in the plan were, at one time, proposed by Republicans. They simply have decided their fasted way back to power is to obstruct absolutely every bill in the congress, regardless of its merit. I think the plan was to say in November that the Democrats “didn’t accomplish anything”. Granted, for once, the Democrats don’t appear to be following the script.

  22. super_trooper says:

    All people around the world complain about their healt care system. There are anectdotal stories describeing how bad one system is compared to the other. Howeverm that’s why you don’t stick to anectodal stories rather than FACTS.
    1. The US health care system is the most expensive in the world/capita
    2. Health care cost increases are out of control.
    3. The life expectancy of the average american is poor compared to amount of money spent.
    4. Little money is sent on prevention

    Why not educate yourself about different systems, private and public (in particular the Swiss system was similar to the US when they went “universal” ten years ago”

    From Frontline, PBS, “Sick around the World”

  23. Mannwich says:

    @jpm: I have crohn’s disease, so I’m subject to similar meds to “modulate” my immune system as well. Fun stuff. Thank God we have coverage through my wife companies. If/when that ends, we’re screwed unless/until one of us goes back to a corporate job. How does this system encourage one to strike out in their own? Answer: it doesn’t.

  24. mbelardes says:

    I really don’t know anything about healthcare or our health insurance system. I just look at these huge numbers being tossed around on the news and have the following comment:

    How old is everyone that has posted?

    I’m 26. From what I can tell, all of our entitlement programs just look like generational borrowing. CBO report after CBO report points to all this stuff being unsustainable. I’ve seen all the charts and numbers that go every which way.

    All I can surmise is that my generation is going to get lower quality entitlement programs or higher taxes and I would guess it’s more like both.

    This piles on top of everything else, from absurd housing costs to heavy student loan debt. Add in a weak economic future and low real wage growth. Add in all my buddies currently serving overseas or recently home from another tour (I’m in San Diego, surrounded by military bases).

    Is all this stuff really to benefit America? Because from my vantage point it looks like we have built a system devoted to living it up today and figuring out solutions tomorrow.

  25. Mike in Nola says:


    I believe BR has stated in the past that he was a Republican who I believe is now a fairly cynical independent. I haven’t seen any great love for Nancy Pelosi in his posts.

    As he said in this original post he doesn’t have a position on the current bill, not knowing what’s in it. I’m in about the same boat. I was against it for awhile when it was pretty much a sellout to the insurers when a public option was needed, but don’t know if any of that has changed.

    What we are getting tonight is a result of Republican intransigence. They forced Obama and the congressional Dems to grow some balls (think Pelosi already had some) and now the American people will probably be impressed that they got something big done. I hope the Dems adopt the same in-your-face approach to financial regulation and tell Shelby to go F___ himself in a bipartisan way.

    BTW, I always hear the Faux News line about how inefficient government is in providing healthcare but never see stats to back it up. According to a study paid for by the health insurers, they eat up about 18% of every premium dollar. Medicare’s overhead is about 3%.

  26. Pat G. says:

    @ Looking Glass

    If passed, the bill will require the IRS to hire another 6500 agents to police us peeps in order to make sure that we are all being law abiding citizens in purchasing insurance or face criminal prosecutions. The IRS in effect will become collectors for the health care industry, driving up their profits while we pay their salaries not to mention that it is unconstitutional for the USG to order us to have something…

  27. jpm says:

    @mannwich: You know of what I am writing about, and I’m sorry to hear it.

    @super_trooper: To amplify, you will often hear about how our system is best in the world. Often, this is stated with anecdotes about how folks come to the US for treatment. However, these numbers have no spin: Life Expectancy and Infant Mortality.

    US Life Expectancy: #38, behind Chile, Denmark, and Cuba.
    US Infant Mortality: #33 (UN figures) or #46 (CIA Factbook).

  28. DL says:

    “I don’t know if it’s even possible to make medical care less efficiently priced than this arrangement if you tried”


    I think we’ll see just that if this HC bill ever becomes fully implemented (although I expect to see many changes to it after the 2012 election). If fully implemented, it will cost VASTLY more (in the aggregate) than what we have now.

    Nevertheless, the HC bill, if/when enacted will generate millions of winners and losers among those in the $20K to $200K income range.

  29. winstongator says:

    Did you pitch in college? Where? How’s the rehab coming along?

  30. DL says:

    Some people think that if we could just reduce profit margins at health insurance companies, that would solve the problem of cost. Profit margins at health insurance companies, however, are only about 4%. We spend about $2.5 trillion per year in this country on health care; less than 1% of that can be accounted for by after-tax profits earned by health insurance companies.

  31. gman says:


    Barry always likes info displayed graphically! Here is a graphic that powerfully backs up the general thrust of the entire thread! It is stunning how inefficient we are…and how few people in the US know it.

    Chart shows tight corelation btwn $ spent and life expectancy across countries…unless you use the heroic free mrkt, best system in the world, without a wait thing we do here….the you just spend a lot of money and dont live very long.


    BR: Awesome graph — I suspect that some of the life expectancy is cultural (Japanese eat lots of omega 3 rich fish, less fried food, heavy fat, etc.) , and some is economics.

    Another analysis shows that the US is very bifurcated in terms of the poor — for a middle class or higher economic strata person, the life expectancy is much higher than the median.

    We still pay way more than everyone else as a society, however.

  32. Mr.E. says:

    BR, You make great points. Using the rest of the developed world as a reference, the U.S. system is “weird”. But I don’t know that that’s a bad thing. Here’s my basic problem with the current debate: how does access to and payment for health care services differ from access to and payment for the basic human needs of food, clothing and shelter?

  33. Mike in Nola says:

    One thing I may never have mentioned here is how health insurance helped to depopulate New Orleans of the middle and upper middle income classes after Katrina. My wife worked in one of the hospital that was flooded. She was laid off end of October. Our health insurance had been through her, as I was a sole practitioner and even the State Bar group rates were pretty high. We were much better off than most, sitting on a nice chunk of cash and with a low house note and in pretty good health. But health insurance on people intheir 50′s is not cheap, even with COBRA and we could see it r eating up a lot of our cash while waiting things to reopen. She decided after a month or two to take a job in Houston. We got an apartment here and I commuted for 3 years before finally moving here a year ago.

    Heard similar stories about others having to leave. Even those who didn’t have had some trouble becaus of insurance. A good friend was a sole practitioner. Their insurance was through his wife who taught in Tulane School of public health. She was laid off via email and they were being eaten up by health insurance premiums. She managed to pick up some work, but no insurance came with it and she eventually took a job with an outfit in the Washington suburbs where she has to spend every other week sleeping at a friends house so the rent doesn’t chew up what she makes.

    Mannwich: sorry to hear about your illness. We’re sorta in the same boat, though with diff illnesses. Have had some stuff since I moved to Houston and were fortunate the wife works for a hospital. List price on the two hospital stays, totalling a week, was 75k.

  34. Mike in Nola says:

    DL: not disputing your point about profits, but salaries and bonuses get deducted first.

  35. Chrisbo says:


    How much of every dollar I pay in premiums results in payouts for health care? I could care less how little “profit” is made at the insurers if they are still only paying out 65 cents out of every dollar they take in. All you’ve demonstrated is that they can inefficient. Perhaps they would be more profitable if they didn’t compensate their CEOs so well.

    Company / CEO / 1-Year Return / 2003 Pay (millions) /Above or Below Market
    Anthem Inc. / Larry Glasscock / 19% / $50.9 / 138%
    Coventry Health / Allen Wise / 122% / $14.6 / 81%
    Wellpoint Health / Leonard Schaeffer / 36% / $27.4 / 11%
    Sierra Health / Anthony Marlon / 129% / $3.6 / 2%
    UnitedHealth Grp. / William McGuire / 39% / $30.0 / -6%
    Amerigroup Corp. / Jeffrey McWaters / 41% / $2.9 / -21%
    Wellchoice Inc. / Michael Stocker / 44% / $6.9 / -24%
    Aetna Inc. / John Rowe / 64% / $16.2 / -28%
    Pacificare Health / Howard Phanstiel / 141% / $10.2 / -35%
    Oxford Health / Charles Berg / 19% / $5.4 / -41%
    Health Net Inc. / Jay Gellert / 24% / $7.9 / -50%
    Humana Inc. / Michael McCallister / 129% / $6.6 / -61%

    Granted, last years profit numbers were also skewed by their recent losses in the market.


  36. Jojo says:

    Watching the news tonight, some news people are giving credit to Pelosi for resurrecting what appeared to be a dead bill just a couple months back.

    While Pelosi deserves credit, the real reason this bill gained new life was the huge hue & cry from the Democratic base who equated the failure of the bill with the perceived failure of the Obama white house to accomplish much of anything to-date as they kept trying to kowtow to the obstructionist R’s.

    The Obama and the Dem leadership in Congress got the message that if they wanted future support from the base, then they better start notching up some of the big changes that Obama promised during his campaign. And if that meant kicking the say no Republicans in the teeth, then so be it.

    Looking at the big picture of the healthcare reform bill:
    Robert Reich
    The Final Health Care Vote and What it Really Means
    Sunday, March 21, 2010

    It’s not nearly as momentous as the passage of Medicare in 1965 and won’t fundamentally alter how Americans think about social safety nets. But the likely passage of Obama’s health care reform bill is the biggest thing Congress has done in decades, and has enormous political significance for the future.

    Medicare directly changed the life of every senior in America, giving them health security and dramatically reducing their rates of poverty. By contrast, most Americans won’t be affected by Obama’s health care legislation. Most of us will continue to receive health insurance through our employers. (Only a comparatively small minority will be required to buy insurance who don’t want it, or be subsidized in order to afford it. Only a relatively few companies will be required to provide it who don’t now.)

    Medicare built on Franklin D. Roosevelt’s New Deal notion of government as insurer, with citizens making payments to government, and government paying out benefits. That was the central idea of Social Security, and Medicare piggybacked on Social Security.


  37. crankitto11 says:


    Your Point 1 is succintly explained by this map you posted in November: http://www.ritholtz.com/blog/2009/11/the-world-according-to-americans/ ;)

  38. Richard R says:

    2 steps in the right direction:

    1. Use the Mayo Clinic model

    2. Make medical education free so doctors can concentrate on medicine.

  39. DL says:

    Chrisbo @ 9:44

    I think that much of the CEO compensation is tied to the stock price, and not simply taken out of revenue from premiums. Nevertheless, if imposing pay caps on CEO’s would appease those on the political left, I would not be opposed to it as part of a “package deal”. I don’t think it would have any effect on premiums, however.

    As for “efficiency”, I believe that the insurance companies would be as efficient as could be expected if they were allowed to compete across state lines.

    I find it hard to believe that Medicare is so much more “efficient”, although it has to be noted that it engages in a great deal of “cost shifting”.

  40. AndrewBW says:

    Barry, I’ve been reading about health care for a long time, and that’s about the clearest, most succinct summation I’ve ever read of the failures of our system. Good job.

    And as others have asked, how’s the shoulder feeling these days?

  41. Paul S says:

    Chrisbo’s data soundly refutes jritzema’s contention that the insurance companies are not making much money.

  42. Kort says:

    Guys, and BR, please get a clue.

    Our system is “broken” because our people are obese. Our bang for the buck per capita is crappy because our people are obese. Obesity is the #1 killer in the USA. You can have whatever healthcare “system” you want, but if people keep downing Big Macs, Big Gulps, Happy Meals, etc, it won’t matter. We’d have a lot more money and resources to help Barry out with his sore shoulder if we didn’t have to flush so much money and so many (medical) resources down the toilet dealing with obesity related problems.

    PS. Nice putdown of the high school educated worker…such class!


    BR: Its not put down of a HS educated worked, its an observation that medical decisions are not be made by Doctors, but instead by uneducated, unqualified clerical workers.

    A put down would be more along the lines of “If you went to college, you would understand why this is problematic . . .

    See the difference ?

  43. TakBak04 says:

    BR’s Post about his Rotator Cuff experience is interesting. Some injuries we’ve had in our family might have lead to surgery if we had not had doctors who took the physical therapy route before the “operation.”

    One would hope that some of the health care reform would give some emphasis over prescribing alternatives before expensive surgery, if one isn’t in an emergency. The physical therapy routines have actually advanced so much that much can be achieved to cure many instances where a doctor or patient might “jump the gun” thinking that the situation is so dire with the person complaining of pain that surgery is the only answer. Surgery often leads to more complications with the aftermath of adhesions (scar tissue) or even reactions to medications, etc. where the cure of surgery leads to more medical intervention when physical therapy might have been the best route.

    What I originally heard about this bill is that “Best Practices” information would be a leading reform where phyisician groups would start to look at when surgery is best or when “other mesures” are more effective. Just like the drugs people are being prescribed. Just because a leading Drug Company has some new drug they are touting as the latest block buster…should that be prescribed if it’s new on the market and the hype of the stock might be a factor in the prescription. Some research is showing that simple older drugs like “asperin” are more effective than some of the higher power drugs for some conditions and that in many cases lower doses for older Americans are better than the dosage strength for younger folks.

    So much is going on in medicine these days that there so much room for greed and marketing of Big Pharma to skew things for the average Doc. Having some kind of review could be good to come up with “Best Practice for Best Outcome.” Of course who decides all this is open to the same kind of corruption as our Financial Markets who put their cronies on boards and watch out for each other until the system implodes.

    I’m disappointed in this final bill. I was for Medicare buy in for all or Single payer. I have no idea why Obama dropped the ball early on and why it seemed a Dem Fiasco the way it was moved forward with such weak communications with the American People. I can understand why those on the Right took advantage to distort and actually misinform about the Bill. It’s so weak, this bill, that it’s hardly the “Socialized Medicine” that it’s touted to be by the critics. I have worries it will do much of anything and much of it doesn’t come into action for 4 to 8 years. Still…it’s a crack in the door for hopefully a Single Payer or at least Medicare Buy In for the 55 and older if the economy stays sluggish with employment not improving and more job losses.

  44. Paul S says:

    Dear Kort: Don’t forget asthma, which really burdens our urban ER’s in a big way.

  45. constantnormal says:

    I chuckle at Stephen’s post up top … I’ll bet a nickel that BR has been as busy as a one-armed paper-hanger blacklisting similar irrational ravings from this topic. I’ve long since given up attempting any reasoned discourse with their ilk — they are pretty much universally driven by blind rage and hatred toward our system of government.

    By our “system of government” I mean the notion that we struggle with issues in our political system (I’m taking the ideal of perfect representative democracy here, one that is devoid of the reality of corruption and lobbyist control, for the purpose of getting at what I believe is a fatal flaw in our system of government), a system where when the dust settles, some sort of “compromise” is reached, with the attendant winners and losers. In this hypothetical “perfect representative democracy”, the folks whose views failed to win the day are supposed to suck it up and try harder next time.

    But what has happened over the years — due to a lot of causes — is that political battles have degenerated into no-holds-barred contests for victory at any cost, with money being the principal weapon, escalating with each contest. We have steadfastly refused to limit the role of money in our political system (why? because the people who would enact such limitations are the ones receiving the money), so it has grown by leaps and bounds until we now have one of the most corrupt political systems on the planet, a grown-up banana republic, as it were.

    And one of the uses that all this money is put to is inflaming the more extreme partisans to the point of insanity, where there are no terms of commonality that can be established to conduct a proper discussion. And the more money that is poured into the system, the larger the fraction of the population that has been driven simply nuts by all the absolutely insane behavior by their government. Usually this blind hatred is focused on one or the other of the political parties, such that if anyone fails to attack party X as they believe it should be attacked, they are thus supporters, and thus the Enemy. Completely nuts.

    I’ll toss out my own recent health care anecdote in a separate post, so that BR can expunge this one if he thinks is it not germane to the topic. But this is what I believe to be at the root of the systemic failure of our government to be able to do anything right, including health care. We are suffering from Political Toxic Shock Syndrome, and until we deal with that (and I have no clue as to how to fix it) we will not be able to accomplish ANYTHING — health care, financial reform, war against Al Qaeda, you name it — and the nation will continue to spiral into self-destruction. When dialogue is impossible, democracy in any form cannot exist, and that’s where we are today.

  46. Mannwich says:

    @Mike in Nola: To your point, former United Health CEO “earned” over a billion dollars while CEO of United Health Group. Part of that was illegally “earned” through back-dating of options (so he should probably be in jail, but I digress), but a good chuck was likely made by declining coverage for sick people. As a local Minnesotan, I’ve heard horror stories about them as an insurer. As a doctor, Mr. McGuire should be ashamed of himself, but, hey, he “gave” $7MM back so that Minneapolis could build a new park next to the Guthrie Theater, so all is good, I suppose, right?

  47. DL says:

    Kort @ 10:00

    Maybe Obama should start taxing Big Macs and fries.

  48. Marcus Aurelius says:

    Well stated, BR, and correct in all aspects. Now, imagine having no insurance.

  49. Mannwich says:

    @DL: And just how did those companies jack up their stock prices? Answer: In addition to some back-dating (see above), by finding ways to deny people coverage for their health incidents. It’s all the same, IMO. Health insurance does not = health CARE. This bill does nothing to change that one iota.

  50. Mannwich says:

    @Kort: Nice oversimplication. Although obesity is an enormous problem, it’s certainly not the only one. And don’t you think preventative care can play a role in stemming obesity (and its resulting conditions) for those without coverage?

    And I, for one, am NOT obese. At nearly 40, am in the best shape of my life, actually, and healthier than most, other than a lurking chronic condition through no fault of my own. In fact, my new obsession is my health so that I give as little money as possible to such a corrupt system. If that means working out like a maniac every day out of anger (there are worse obsessions, right?) and eating well out of spite, then so be it.

  51. Patrick Neid says:

    I don’t know what is more pathetic, cry me a river stories or the belief that the government is going to do a better job at health care. Yikes.

    Hey Barry at least you got an MRI within two weeks. You would still be waiting most other places.

  52. DL says:

    Mannwich @ 10:09

    Yes, there was back-dating. But Steve Jobs did it also.

    As for recission, my understanding is that the frequency of this is quite low. Moreover, all such recission decisions are subject to review by state authorities.

    If we had an infinite capacity to pay for entitlements in this country, I would be entirely in favor of adding another one. Or ten more.

    Perhaps when the national debt rises to 200% of GDP, people will re-evaulate the situation.

  53. scharfy says:

    Sweet a healthcare brawl.


    Those stats support the US having good healthcare, not refute it.

    People here are not HEALTHY, maybe that played a role in why our numbers are low? Its cuz we smoke, drink, and eat at Jack in the Box 5 nights a week and are 35% obese…


    Even though I’m a repuglican – I was hoping Obama would reform healthcare. I’d even have given him wiggle room on expanding his welfare state if he’d of made the system better.

    But all he’s done is expanded a broken system, with a few giveaways to the right people.

    It’s pretty sweet we had a healthcare debate for the last few months – without knowing what the bill is?

    Theater and anticlimax. I’m not gonna get riled because he passe a bill that changes nothing, just extends and expands an already busted system.

    Look medicare and medicaid already are over 50% of the medical bill in this country, so calm down right wing – Obama isn’t socializing medicine, we are already there. This is just a political photo op.

    But at least I can watch Glenn Beck rant, that shit is priceless..

    Back to work America, there’s nothing to see here

  54. zitidiamond says:

    Company / CEO / 1-Year Return / 2003 Pay (millions) /Above or Below Market

    Anthem Inc. / Larry Glasscock / 19% / $50.9 / 138%

    With money like that, my guess is Larry’s sporting Murano.

  55. foxmuldar says:

    Investors Business Daily provides a good argument why most americans don’t want Obamacare.


    We have a thief and a liar in the White House. Sorry if you don’t like hearing this Barry. But the facts speak louder then words. And that executive order isn’t worth the piece of paper it will be written on. Obama will repeal it as fast as he signed it. JMOP

  56. Mannwich says:

    @DL: Good point. Jobs should probably in jail too but there are different rules if one has enough power.

    And to reiterate – - I’m not jumping for joy over this bill. I honestly lost interest a long time ago and am pretty disgusted by the whole thing at this point. I just think there has to be a better way than the current system. Insurers clearly don’t need to be involved in every transaction from the consumer’s our health providers’ standpoint, but that’s how they make their billions, so it will continue for the foreseeable future.

  57. Mannwich says:

    @foxmuldar: Let me guess, you’re one of the 29% who STILL think’s W did a good job?

  58. Chrisbo says:


    It is simpler than that. Why should they get paid so well if they can only “earn” a 4% profit? Frankly CEOs across the board get paid too much because of lousy corporate governance. Compare US company CEO pay to comparably sized companies across the globe and their pay is most always multiples of their overseas competitors. Very rarely is this due to superior performance. But I digress….

    My bigger gripe is simply that insurance doesn’t seem to live up to it name anymore. I run my own business and have an individual policy. My premiums have gone up 400% over the last 10 years while my coverage has been reduced. Should I get a chronic disease, it is perfectly legal for my insurer to petition my state insurance board to drop my policy. Short of that, they can also challenge whether my condition was “pre-existing”. There have been examples of both happening in my state.

    I would like to expand my business (I certainly have enough work), but right now, I don’t trust that the “insurance” I could offer any future employee would actually deliver when they need it.

    Is the current bill perfect. No. But it appears to offer options far superior to the choices I have now.

  59. dss says:

    I don’t see why Grayson’s Medicare buy-in plan doesn’t get the full support that it deserves. Especially for people over 50. We are self employed, and our health care costs are about$25k a year for a healthy family of three. This includes deductibles, co-pays and things that they refuse to cover. Our insurance premiums have gone up 67% in the past three years with no change in coverage. Our biggest fear is getting sick and being denied the coverage we have paid dearly for.

    Even more scary is to be without insurance as a routine blood workup cost is billed at $878 yet BCBS will only pay them $289. Without insurance, I would be on the hook for $878.

    Self employed people have no bargaining power with health insurers like large corporations so we get screwed on price and screwed on service.

    People who think that the US health care system is not broken are healthy and have never actually had to pay out of pocket for their insurance or been denied coverage. Or they have never lost their jobs and their coverage and had pre-existing conditions in their family.

    We have the most expensive least efficient health care system in the world with ever declining outcomes.

  60. dss says:

    Really, Muldar if you want to be taken seriously you need to quit pimping your own website that has a giant evil clown as it’s mascot. What are you, 12?


    BR: I like the clown!

  61. Mannwich says:

    That says all you need to know about the tea-bagger variety on the right, dss. It’s beyond tiresome.

  62. wunsacon says:

    We Americans will eventually do the right thing, after we’ve tried everything else.

  63. dss says:

    Here is a little ditty about Cigna health care executive’s compensation

    The insurance giant Cigna last year gave compensation packages worth more than $120 million to two executives who left the company, according to a filing with the SEC on Friday.

    The vast majority of that total went to former chairman and CEO H. Edward Hanway who left his post with a retirement package worth $110.9 million — which included $18.8 million in executive compensation for 2009, as well as a healthy pension plan, deferred compensation and stock options.

  64. DL says:

    Chrisbo @ 10:21

    As I mentioned in my 9:23 post, millions of people will indeed be better off as a result of this legislation.

    I just think that the (aggregate) costs will be vastly greater than anything the CBO will ever be willing to put out.

  65. scharfy says:


    Thankyou for the clown hat tip.. Friggin funny.

    Seriously everyone should go and see the clown @ foxmuldar’s site.

    I’m not speaking about the material there, that might be gold. But the clown is hysterical.

    I hate clowns

  66. MichaelGat says:


    The title of your post implies that we have a “system.” I would argue that our biggest problem, and the most important thing differentiating us from the rest of the world is that we DON’T. We have multiple systems, designed to isolate people and prevent any meaningful competition.

    Those of us who are under 65 and employed by a larger firm probably have access to a health plan but don’t have any meaningful way to impact the “market” because the choices about what is available are already made for them.

    Those of us who are under 65 and self employed and not working for one of those larger firms are in a different system.

    Those of us who work for the Federal government are in yet another system. I won’t even begin to address the number of parallel systems that exist for state or local government, some of which piggyback on states, some of which operate like other private employers, etc.

    Except, those of us who work for the Federal government in a military capacity are managed through yet another system. Those of us who are retired from military service are in still another (VA).

    People over 65 are generally in the largest single system (Medicare), unless we have union benefits or are military retirees, in which case we’re in one of the categories above.

    Poor people are in one of 50 similar-but-different Medicaid system.

    Some kids, mostly poor, in some states have additional systems set up for them.

    Some people with certain politically-favored conditions have special systems and programs set up for them outside the primary systems that they may or may not already be covered under.

    There is no other place in the world, no matter what type of system they choose where such weirdness exists. Everyplace else sets one set of rules that everybody lives with.

    As with “over the counter” products on Wall Street, there can be no efficiency when the market it balkanized and its operation hidden from the view of the people who use it.

  67. Mannwich says:

    Wow dss. What more needs to be said about the insurers. They’re no better than Wall Street. Parastic capitalism at its worst.

  68. Mannwich says:

    That’s “parasitic”…….

  69. wunsacon says:

    Foxmuldar, I’ll ask again: how did you fit all that on your hand?

  70. DL says:

    This is all just the opening salvo.

    After 2012, we’ll get something very different.

  71. Marcus Aurelius says:


    Damned shame. Have a 14 y.o. myself, and can’t imagine what you, your kid and family are going through. You and your family have my sympathy and my best wishes. Tell the kid to be tough and keep his chin up, and be the patient his docs always dreamed of (follow the orders to the letter).

    That brings us to young and clueless mbelardes.

    When I was 24, young and just out of college, I suffered a catastrophic accident due to poor blood sugar metabolism (hadn’t eaten all day at work and had a soft drink on the way home). Years of operations (with my nascent (ha!) career on hold), painful PT, and huge financial hits (even though I was insured, my portion of the bill was in excess of $75K, and these were 1983 dollars), I finally got myself back to normal, functionally. My insurer refused to pay for ancillary treatments recommended by my doctors (and they were fuming mad). I still suffer side effects and, I’m uninsurable due to preexisting conditions related to that event. Overall, the impact of the accident changed my life forever in many ways that I never considered prior to the event. I can’t say that I’ve ever fully recovered, and I’ve grown used to providing for my self in issues medical, and have gone for long periods (being self-employed throughout most of the time since) without health insurance.

    mbelardes: Shit happens, and it can, and eventually, will, happen to you. You’ll be surprised how quickly you feel the inequities and injustices of our current system once it does.

    It also helps to remember that no matter what happens to you, there is a dude in the next bed or down the street who has something that makes your own personal tragedy look like a head cold.

  72. Mannwich says:

    Agreed, DL. That’s a long ways away though. And the one entity (along with Wall Street) that most of the public loathes as much as they loathe our gov’t (if not more so) is the health insurance industry. This one is going to be interesting to watch play out. Assuming that the health insurance industry and Wall Street continues to overreach (as I’m sure they will), we could have some drastic changes in both by then if enough people get fed up to do something about it.

  73. GYoung says:

    You are someone I read all the time (but this is the first comment I have left). I agree and disagree with your points of view…but, in either eventuality, appreciate the clarity that you bring to issues you address.
    Same apples to these healthcare comments. However, I must take exception with your mention of Canada and our healthcare. It is just not true that Canadians are “much less” happy with our system than other peoples who have national healthcare. Certainly, there is a vocal group of public healthcare adversaries here. They can pretty much all be traced to the type of thinking and rhetoric that is currently emanating from the US Republican Party and vested interests within the health industry. They and their “survival of the fittest” and NIMBYism have been around for a long time. Otherwise, however, the vast majority of us Canucks would revolt if anyone tried to take away our current system. So much so, for instance, that our current Prime Minister (a dyed-in-the-wool conservative admirer of Bush, Howard, Thatcher, Rove, et al) has carefully packed away all his anti-public healthcare talk that was a hallmark of his days running the National Citizens Coalition up here. He knows that if you wish to govern here you’d best accept public healthcare and work to improve it…even if it means swallowing your own ideological self whole.
    Most of us up here are amazed that many Americans can rest comfortably knowing that so many people cannot get catastrophic care without fear of financial ruin, let alone basic coverage. How long will Americans continue to pay increasing shares of GDP and emotional turmoil before they realize that health and healthcare access is a basic “right”? Surely as strong a “right” as your sacred one to bear arms.
    GY from Canuckistan

  74. Mannwich says:

    @douchebag neid: I find your lack of empathy “pathetic”. No go fuck yourself.

  75. crankitto11 says:

    I came out in nearly the same place as Barry.

    I know the system is broken– 1) we are the only country among the top 20 or so industrialized countries without universal health care, but okay, even conceding that the rest of the world is a bunch of socialist pu**ies and we are the only true defenders of the Reaganesque flame of freedom; 2) our health care system is ENORMOUSLY inefficient, consuming 17% of GDP, versus an average of about 10% for those universal care countries. As Warren Buffett has said, those excessive health care costs are a tapeworm in our economy that makes us less competitive in the world economy. And as for the extra costs being justified because we get the “best medical care in the world,” again the statistics do not support that– US infant mortality and average lifespan rank somewhere around 30th place in the world– about the same as Poland and Croatia. Although I will concede that for very expensive, cutting edge procedures –multiple transplants, etc.– we probably do have the world’s best health care.

    But like Barry, I can’t say with certainty what is the true cause of the system’s inefficiency, much less whether current iteration of the Obama package will solve it.

  76. dss says:

    And let’s not forget UNH’s McGuire who is the poster boy for corrupt CEO’s in this country:

    One of the country’s highest-paid executives has stepped down from his position amidst allegations of stock options backdating. Minnetonka-based UnitedHealth Group announced on Sunday that Dr. William McGuire will no longer serve as chairman of the board and will retire from the company by Dec. 1. The company named UnitedHealth President and Chief Operating Officer Stephen Hemsley to be the new CEO. McGuire is one of the most prominent CEOs to lose his job over the backdating of stock options.

    It’s not bad enough when the CEO gets more than a billion dollars in stock options, but then he has to cheat to make the options worth more. If I did that, I would go to jail. This criminal is probably flying around in his private jet to his private island so he doesn’t have to mix with the rabble.

    From Amnesty International:

    The report, titled “Deadly Delivery,” notes that the likelihood of a woman’s dying in childbirth in the U.S. is five times as great as in Greece, four times as great as in Germany and three times as great as in Spain. Every day in the U.S., more than two women die of pregnancy-related causes, with the maternal mortality ratio doubling from 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006.

    “In the U.S., we spend more than any country on health care, yet American women are at greater risk of dying from pregnancy-related causes than in 40 other countries,” says Nan Strauss, the report’s co-author, who spent two years investigating the issue of maternal mortality worldwide. “We thought that was scandalous.”

    In bankrupt Greece women have a less chance of dying in childbirth than the big fat rich USA. How sad is that. And Stupak is worried that federal funds might pay for abortions, he doesn’t care if American women and their babies die because of lack of health care.

  77. Mannwich says:

    @dss: I mentioned him already, but thanks for the supporting evidence. The man is a class A douche.

  78. dss says:

    His entire sordid history is just a google away. :-)

  79. gman says:

    The clowns like like Neid, f@cks mulder and stephen who fall back the argument that “well yeah but the government cant do any better” are missing the point of the many links on this thread…ALMOST ALL SHOW GOVERNMENTS AROUND THE WORLD IN FACT DO DO BETTER! Of course with lobbyist hard at work to see the govt screw it up….the US govt may not be able to do better!

  80. Mannwich says:

    The main problem everywhere is lack of trust in our gov’t and in each other. If the gov’t (and our corporations) worked to gain and keep our trust, we’d already have a workable solution in place in health care and probably with our financial system. When all trust and confidence in each other breaks down, this is what you end up with (similar to what constantnormal wrote above) – a clusterfuck and no real solutions to big problems. We get the gov’t and policies we deserve at the end of the day as a result.

  81. Simon says:

    @ Mannwich too true

    This is what happens when a country loses it sense of community. Community matters and it takes trust.

  82. dss says:


    I don’t think it has anything to do with a lack of trust and everything to do with greed.

    This type of wrangling which is really class war fare, has been going on since the US was a young country. The Republicans need to disguise their agenda and cloak it in guns, God, and patriotism so that the average American is “hypmotized” into voting against their own self interests. The same fight went on during the SS debates in the 30′s and in the Medicare debates in the 60′s.

  83. Mannwich says:

    @dss: Yes, I agree. The rampant greed has led to that loss of trust & confidence in each other, I think.

    I also agree with your second point, 100%. The dumbing down of this country isn’t helping the cause either. People don’t think for themselves anymore.

  84. constantnormal says:

    And here’s my own contribution to the litany of anecdotal evidence that our health care system is broken beyond repair …

    A bit of personal history … I will turn 60 this year. My mother’s side of my family tree has serious problems with cardiac issues, of her 7 siblings (4 brothers, 3 sisters), all of the males had coronary bypasses by the time they were 50, and one of her sisters has. She herself has had surgery to replace a heart valve and repair a congenital hole in her heart. All of them have problems with cholesterol, triglycerides, and such things. I have paid attention to those things and dealt with them from the point at which my own metrics began to veer off-track in my early 30s.

    I regulate my cholesterol, triglycerides, etc very well via diet and moderate dosages of statins. I also have high blood pressure (from my father’s side of the family, I think), and have also dealt with that with diet and mild dosages of pretty standard drugs. And by all indications, I am otherwise in the pink of health.

    But a couple of years ago, on a Saturday (why do these things never occur during the week?) I noticed a diffuse pain in my chest of some significance. Checked my blood pressure (completely normal — in the 128/75 neighborhood), took some aspirin, but it continued to slowly and steadily increase through the day, to the point where I couldn’t sleep. On Sunday mnorning, I decided that I had better go in and get checked out, at least to the point of confirming whether or not I was having a heart attack. So about 8 am on a Sunday morning, the wife drove me in to the local ER, where I explained the symptoms and explained that I wanted them to check to see if I was indeed having a heart attack.

    So they slapped on the electrodes, and quickly confirmed that I was not having any sort of cardiac problems. They also took a blood sample and quickly determined that my potassium was ‘way low (as it turned out, the diuretic I had been taking for the past 30 years had a side effect of flushing potassium out of my system, along with the sodium). I never have got anyone to tell me exactly how low the numbers were, but when my family physician reviewed the numbers, he certainly seemed surprised, commenting something along the lines of “wow, that’s low, all right” (or words to that effect). We changed the prescribed diuretic to one that did not have that side effect.

    But beyond putting me on an immediate infusion of IV potassium, the ER tossed aside any thoughts of that being in any way responsible for my pain. I also received a shot of demerol to deal with it. And then my magical mystery tour through the diagnostic labyrinth began in earnest. X-rays, CAT scans, ultrasound … I was run through every diagnostic tool at their disposal. At the end of the day (about 8-9 hours later), they decided (for an apparent need to provide some diagnosis) it might be acid reflux (I’ve never had any indication of that before or since), wrote me a prescription for Nexium (of which I took one pill and decided it was their notion of a placebo) and sent me home.

    I stopped by to see my family physician the next day, and he noted the potassium depletion and changed my diuretic to one that did not deplete potassium. We discussed the situation, and he also had no clue as to what the pain might have been. 2 years later, and it remains a solitary instance, with no real treatment other than treating the potassium levels in the bloodstream, bringing them back to normal. A bit of a mystery (although I suspect that extremely low levels of potassium might lead to symptoms of that sort, uninformed by any real knowledge in the field as I am, and trusting no one to give me the straight scoop).

    And what was the bill for all the diagnostic overkill? About $7500, of which the insurance company covered about $7300. Was it necessary? Almost certainly not. All of the diagnostic tests that related to the immediate problem were dealt with in the first 30 minutes, without any of the expensive tools that ultimately uncovered nothing of substance.

    It was the foolish patient waltzing into a major medical facility’s ER and providing an excuse to run him through every diagnostic tool that could remotely detect anything. It’s not for nothing that our COBRA insurance coverage ran about $14K per year. We have since switched to a policy with MUCH higher deductibles, and I vow that the next time I enter a diagnostic factory, it will be because I am unconscious and cannot prevent it.

    Where was the “do no harm” mantra here? Is it the responsibility of the patient to understand and authorize every detailed procedure and question why it is being performed?

    The insurance company has no beef with this, as it justifies their exorbitant rates, bumping up their cash flow and doubtless providing data for future exclusions/rescissions, if the diagnostic exploration had turned up anything, related or otherwise, to my problem.

    But the point is that I suspect insurers NEVER block diagnostic procedures, as that expense is more of an “investment” in future claims rejection and a lever for higher premiums. Perhaps I am overly cynical in this, but I began to perceive an unholy relationship between the diagnostic facilities and the insurance companies, operating a money pump that ultimately begins with the patient/society, with the monetary transfers feeding their immense cash flows.

    Our health care system is designed to manage cash flows, not to regulate the health of a population.

  85. Mannwich says:

    Interesting story, constantnormal. I think you might be onto something there and certainly don’t think it’s possible to be too cynical when it comes to big corporate interests and what they’ll do to keep the party going for each other (see dss’ comment about greed above).

  86. Randlepmurphy says:


    I believe we badly need reform but the federal government is so corrupt I don’t believe that it can be done without wholesale changes elsewhere within government. Since you had a physical therapy/private insurance story I tell one myself. I live in one of the Appalachian Mountain states. We have a sizable veteran population in the mountains that, due to lack of private insurance, heavily utilize the services of a metropolitan Veterans Administration Hospital. If they have other payors they do not use the VA! Most of these folks travel between one and two and one-half hours for their initial PT evaluation. It is totally impractical for these people to travel to the hospital clinic 3x per week for ongoing therapy. As a result they get an evaluation, a home exercise plan and are sent back home to treat themselves. This has been the case for over 30 years. Why haven’t they contracted with some clinics closer to their customer base? Or, why haven’t they established small outpatient clinics to deal with this type of care. If it was a private organization that would have been fixed a long time ago.

    A second VA story from a cardiologist I know. He did one of his residencies in a large VA hospital. It is his claim that it was best not to be in the hallways of the hospital at 3:30 PM or you were at risk of being trampled to death by the VA labor force stampeding to the time clock and out the door. This was obviously somewhat tongue in cheek but based none the less on his observation of the VA hospital labor force.

    The VA is probably the closest thing we have to an existing model of federal government run health care. God help us!

  87. “I’m 26. From what I can tell, all of our entitlement programs just look like generational borrowing. CBO report after CBO report points to all this stuff being unsustainable. I’ve seen all the charts and numbers that go every which way…
    …Add in all my buddies currently serving overseas or recently home from another tour (I’m in San Diego, surrounded by military bases).

    Is all this stuff really to benefit America?”– mbelardes Says: March 21st, 2010 at 9:14 pm


    You’re asking the Critical Questions that We, all, should be pondering. All I know is that ~60% Tax Rates to support BBoomers inflated expectations of ‘entitlements’– from an Economy they’ve done little more for than loot, ain’t happenin’..

  88. markd says:

    some of you people (and you know who you are) never get tired of being on the wrong side of history do you?

  89. wunsacon says:

    >> But all he’s done is expanded a broken system,

    Agree with you there, scharfy.

    >> gman @ March 21st, 2010 at 10:48 pm


  90. scharfy says:

    I’m not disputing all the corporate greed that goes on…… but, but , but

    How do you explain Lasik eye surgery going down in price and up in quality for the last 10 years every year?

    Anything untouched by our insurance system seems to drop in cost – like computers, cell phones, and flat panels?

    I wouldn’t be so quick to discard a market based system. Some middle ground should be found whereby innovators in the medical field are rewarded for improving a process.

    [Note this is vastly different than charging 850$ for bloodwork and calling it profit.]

    I think much of excessive cost increases are due to the structural architecture of our system. It enables doctors and insurers to price gouge.

    The customer is insulated from direct pricing- in effect they are billed as a group, thus have little say in the matter. Bad design.

  91. philipat says:

    I spent 30 years all over the world in the healthcare business and, yes, the US system is broken. The US spends 17% of GDP on healthcare compared to half that amount in other developed countries, yet with worse outcomes as a national average. My 10 cents worth as follows:

    1. Insurance Companies must be forced to function as the risk pools they were intended to be. No patient should be excluded on the basis of a pre-existing condition. There needs to be more competition. Can anyone provide one good reason why health insurers cannot operate over state lines?
    2.The “Fee for service” model has been synonymous with out of control costs all over the world. Physicians (Nice folks but they ARE part of the problem) and hospitals have no constraints on what tests, procedures etc that they conduct and charge for. Remember that medicine is not truly a “Free” market in the normal sense because most folks know little about medicine and will simply accept the word of the physician on trust without “Shopping around” as for other goods and services.
    3. Compounding the above, physicians use the latest and most expensive tests, procedures and medicines because, if they do not and there are any, even minor, problems they will be up for malpractise. This encourages a conservative and very costly type of medicine. And the cost of Malpractise Insurance can amount to hundreds of thousands of dollars pa, depending on the specialty. Many times, simple approaches (If it walks like a duck, and it quacks like a duck……..) are just as effective and a lot less expensive. There are now very few “Must have” blockbuster drugs and simple generic medicines are often just as effective and frequently much safer.
    4.The MNC drug Companies make about 80% of TOTAL profits from the US market alone. Why do drugs in Canada cost so much less than the US? Re-importation of US manufactured goods from Canada should be permitted (Until the supply chain in Canada miraculously starts to run out of stock?) OR there should be effective purchasing mechanisms in the US through which prices can be truly negotiated with drug Companies ON BEHALF OF END-USERS and not have the savings creamed off by a middleman rent-seeker.

  92. Our “health status”, measured by the most comprehensive qualities that constitute “health”, is ranked #37. For example, we do not live the longest, and our average life expectancy is around 78 years of age; yet many are spent in a vegetative state. That is really something to think about, especially when most Americans consider us having the best health care in the world.

    Canadian healthcare costs less and they have higher life expectancy.

    You gotta be able to put 1 and 1 together and get 2.

    Obviously, when costs are through the roof (we currently have the most expensive health care system in the world) and we’re still ranked #37, it means something is wrong. With the most money spent, we ought to rank in the top 10 if not the top 5 — but that is not the case.

    A logical person would end the discussion there, and try universal care, if the only choices are the current one we have or the one the Canadians have. Certainly, the Republicans never put forth a viable health care overhaul plan of their own.

    At one time, Canadians have a health care system similar to ours but they eventually went Universal. Currently, they are ranked #30 in health status. Not that great, but better and costs less than ours.

    At the very least, I believe the bloodletting has stopped as a result of this historic reform.

    Main Street and Wall Street will eventually all embrace it.

    Here’s a quicky comparision of the two systems: http://en.wikipedia.org/wiki/Comparison_of_Canadian_and_American_health_care_systems

  93. constantnormal says:

    BTW — I opposed the health care legislation, as I judge the benefits to be grossly outweighed by the penalties.

    I acknowledge that we pay more than most (all?) other nations for our national health, and receive poorer health care than most developed nations for our troubles. But that is one of our smaller problems.

    The legislation (that has now been passed, as expected) does nothing to regulate abuses in the system, so far as money is involved. It brings more people into the system that are otherwise priced out of it, but only by compelling the rest to pay for the health care of those who cannot afford it, while doing zero to rein in out of control costs and inefficiencies in both health insurers and medical facilities.

    I believe that the intent of the legislation was to preserve the existing edge that the health care industry has over their victims (the rest of society), and ramp up the amount of money pouring into it.

    I expect similar legislation will eventually arise to deal with financial “reform”, beefing up the cash flow through that industry, enhancing the concentration of the industry into fewer players who will become even bigger leeches upon society.

    This has nothing whatsoever to do with Republicrats or Demonicans, either would be happy to enact the legislation, and their opposite number would be ecstatic to demonize them for it and further inflame the population. This is about a completely corrupt system of government, and a culture of class warfare, with both political parties eagerly participating in the destruction of the nation.

    We have a cancer in our nation, and that cancer is our political system. An astonishing development in a nation that was unique in being constructed to protect its citizens from itself, first and foremost. The founders built well, but no design is perfect. And they saw that, and built it to allow it to be changed to reflect changing times and the needs of society. For a long time, the changes were on balance, net gains, improvements (the end of slavery, expansion of equality) outweighing mistakes.

    But somewhere along the way, the balance tipped, with special interests managing not just an edge, but complete, unimpeded control over the purse-strings and power of the government. maybe it was the military-industrial complex that Eisenhower warned of, maybe if was something else. But the system is completely and irrevocably broken.

    I can see nothing that will stop this and leave the nation intact.

  94. bman says:

    Yes I agree with the for profit middleman problem. Americans don’t want Health Insurance. Americans want Health Care. That has been the biggest problem with selling this ball of goo to the american people. They do not trust the insurance companies. Contemplating government mandated insurance companies scares the hell out of them.

    So while this bill is aimed at providing health care, the path to providing it involves paying off and getting in bed with the greedy no good bastards that have caused the problem to begin with.

  95. greenback says:

    I don’t want to defend the insurance industry. Its real value in American health care is something of a mystery. In theory insurance is supposed to guarantee that you pay a fixed amount so you don’t have to worry about a catastrophe. That isn’t the way people use health insurance though (e.g. reimbursements for $100 office visits), and considering the insurers’ some-time options of canceling a policy and the infamous bankruptcies from health expenses even for people who have health insurance, it isn’t the way insurance is administered. They’re middleman who’ve found a way to get an undeserved piece of the pie.

    All that said, you could make every health insurance company in the US a non-profit, complete with CEO’s making one-tenth what they all make now, and it’s not going to do much. You’ll get a one-time benefit in your health insurance premium, but the margins for health insurers just aren’t that wide. About two years down the road your premium will be back to where it is now, and the price of health coverage will then continue to escalate at its torrid pace. Again, I don’t see how for-profit health insurers are part of the solution, but they also aren’t the real problem. Insurers just pass the ever-expanding medical costs onto their policyholders. Eventually we’ll have to solve the cost problem directly — drug costs, the cost of a doctors’ education, malpractice insurance, CYA testing, etc. This simply isn’t addressed in Obamacare.

  96. Mike says:

    I’m not certain that Canadians like their national health care system “much less so” than other developed countries with national systems… I suspect the opinion you get down there is filtered through the very polarized and most vocal proponents of “leave it alone” in the U.S.

    Our system is not perfect by any means, but it is universal and by and large, and statistics bear this out, people get the care they need and our outcomes are as good or better than those in the U.S. at a much lower cost. And everyone is covered. And it is a competitive business advantage for businesses up here competing with business in the U.S.

    In fact the Canadian health care system is pretty much a sacred notion that no politician would dare muck with here, unless they desire to be consigned to the opposition benches for a decade or more. Sure, some of the more rabid neoliberals want to go there, but common sense at ballot time always holds them in check.

    We don’t have the ultra-aggressive malpractice and torte problem you folks have, in fact malpractice is not something you hear about commonly at all here.

    Decades ago the province of Saskatchewan was the first to implement a universal health care system and they went through the same scaremongering that the right-wing in the U.S. is currently engaged in. Guess what, it wasn’t a fiasco and soon the entire country adopted universal health care for one and all, a good thing.

  97. investorinpa says:

    As a physical therapist, thanks for the ringing endorsement Barry!

  98. Connie Jacobs says:

    That’s unbelievable! You were a pitcher??

    sorry couldn’t resist :)

  99. Jojo says:

    Here’s a good piece that takes the CBO claims of deficit reduction to task for this health “reform” package. I don’t know enough to opine whether what is written is correct or not, but if it is, there are many hurdles left to jump with a potential $600B jump in the deficit, instead of a $138B decline. Oops.

    March 21, 2010
    Op-Ed Contributor
    The Real Arithmetic of Health Care Reform

    Arlington, Va.

    ON Thursday, the Congressional Budget Office reported that, if enacted, the latest health care reform legislation would, over the next 10 years, cost about $950 billion, but because it would raise some revenues and lower some costs, it would also lower federal deficits by $138 billion. In other words, a bill that would set up two new entitlement spending programs — health insurance subsidies and long-term health care benefits — would actually improve the nation’s bottom line.

    Could this really be true? How can the budget office give a green light to a bill that commits the federal government to spending nearly $1 trillion more over the next 10 years?

    The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out.

    In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion.

    Gimmick No. 1 is the way the bill front-loads revenues and backloads spending. That is, the taxes and fees it calls for are set to begin immediately, but its new subsidies would be deferred so that the first 10 years of revenue would be used to pay for only 6 years of spending.