The United States, of course.

Oh, no, wait, it’s Canada.

Actually, I think it could be Germany.

Geez, now I think it might be the UK.

You could go on and on like this.  But you know what?

No matter how good or bad your system is, there are certain universal truths.

Here are four of them that might make you look at global health care a little differently.

First, health care is getting more expensive, all over the world.  A new study by the global consultant, Towers Watson (disclosure: Towers Watson is a Best Doctors client) found that the average medical cost trend around the world will be 10.5% in 2011.  In the advanced economies costs will rise by an average of 9.3%.  While Americans tend to think of rising medical costs as a uniquely American problem (they’ll rise by 9.9% here), it’s just not true.  Canadian costs will rise by 13.3%.  In the UK and Switzerland, they will increase by 9.5%, and in France by 8.4%.

Why is it happening?  As ever, the main drivers are the increasing availability of new medical therapies – and inappropriate use of care.  We see the same phenomenon at Best Doctors in our global experience.  Across the world, our data for 2010 showed that just over 20% of patients had an incorrect diagnosis, and about half were pursuing inappropriate treatment plans.

Second, consumers are increasingly dissatisfied with their health care experience.  The Commonwealth Fund’s 2010 survey on views of health care found that 68% of Americans think their health care system needs to be fundamentally changed or completely rebuilt.  But 61% of Canadians thought the same thing, as did 58% of French people, 52% of Swiss, 48% of the Dutch, and 75% of Australians.  All of these places have remarkably different systems, and yet none of them are very well-liked at all.

Third, time spent dealing with insurance restrictions is a major barrier to quality care in the United States – but it’s becoming a problem elsewhere, too.  According to the Commonwealth Fund, 48% of American doctors said that coverage restrictions were a “major problem” getting in the way of delivering needed care.  While it’s less of a problem outside the U.S., nearly 20% of Canadian doctors reported the same problem.  As other countries adopt U.S.-style cost controls to deal with the rising cost of care, it’s likely that doctors in those countries, too, will start to report the same trouble.

Fourth, some employers, insurers and governments are looking for a better way.  The Towers Watson study reflected something we found in our own study.  Payers are increasingly implementing programs to get people to take better care of themselves and be more involved in their health care decisions.  Programs like wellness and prevention and higher deductible plans are part of an overall approach to getting consumers more engaged in their health.  But one of the fastest growth areas is still what some call “second opinion” – programs like what Best Doctors provides – where the goal is to help make sure that every person gets the right diagnosis and treatment.  Towers Watson found that 25% of health care payers across the globe have implemented these programs.  They help make sure each person is dealt with as a patient, regardless of how good or how bad their health care system might be.

So, who really has the worst health care system?

I don’t think there’s an answer to that question, except for this: don’t get sick.

Evan Falchuk is President and Chief Strategy Officer of Best Doctors, Inc. Prior to joining Best Doctors, Inc., in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases.

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52 Responses for “And the Worst Health Care System in the World Is…”

  1. Babe says:

    This is superficial drivel and doesn’t really deal with health care at all, but merely plays with numbers.If you want to really learn about health care in the developed world, read T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.

  2. Matthew Holt says:

    It’s clearly not America. Because we don’t have a system. At least those other countries have an attempt at one.

  3. Peter says:

    Since other countries do healthcare for about half what we do it for, 10% of $100 is $10 and 10% of $50 is $5, which increase would you rather pay?
    “While it’s less of a problem outside the U.S., nearly 20% of Canadian doctors reported the same problem”
    Question is how many patients (not doctors) reported insurance restrictions getting in the way of care in other countries as opposed to the U.S.?

  4. Bob De Vita says:

    The author’s title at the end reveals his bias re: getting second opinions from the Best Doctors; and he’s President of Best Doctors? Not an objective commentary at all. More like a marketing job. Too bad. I was looking for data; like: why the US ranks highest among among all nations in per capita cost and far lower in outcome measures like infant mortality. See Commonwealth Fund.

  5. nate says:

    “Since other countries do healthcare for about half what we do it for,”
    Peter could you define “healthcare” for us please. I assume since your doing such a direct comparison of cost, “healthcare” in the US must be exactly the same as “healthcare” in the rest of the world. We all have the same quality of facilities, all suffer the same wait times, and everything else.
    Otherwise your comment would be as inteligent as saying China does cars for 1/10th the price we do. And we know your not prone to stupid statements.

  6. John Ballard says:

    This post is a good illustration of how non-medical professionals muddy the already complicated picture of health care. That first comment’s description of “superficial drivel” was more than generous. [Insert favorite lawyer joke here.]
    A career in food service managing the working poor has left me with a very jaundiced view of health care in America. Most of my employees live their lives with little or no contact with the system, a shameful circumstance in the richest nation on earth. Nothing here suggests that Mr. Falchuk is aware that this population even exists.

  7. Evan Falchuk says:

    Thanks for all of the comments.
    Bob De Vita -
    You caught me, I am biased.
    My bias is that everyone should get the right medical care. Too often, they don’t.
    We do business in dozens of countries, covering millions of people in pretty much every kind of health care system. I can tell you that the experience of being sick is distressingly similar, no matter where you are.
    Far too often, patients face important decisions without the support they need. I have yet to see a system which is a success at this, which is what really matters.
    Health care, unfortunately, gets so steeped in politics that it is hard to talk about in terms of what things are really like. These studies paint a picture that is quite different than what you would expect, and so they deserve more attention than they have gotten.
    Cheers,
    Evan Falchuk

  8. nate says:

    “Most of my employees live their lives with little or no contact with the system, a shameful circumstance in the richest nation on earth.”
    Interesting joinder of perceptions, probably not intended, John. These people that have very little or no contact with the system, how many of them own a cell phone? How many smoke? How many drink? How many wear nice clothes and have a flat screen TV on which they play PS3 or X-Box 360?
    You are correct we are the richest nation on earth, our poor live better then the middle class of almost all other nations. Bigger homes, more cars, AC, etc etc.
    Is it a flaw of our nation that people that enjoy so much frivilous consumption don’t have enough money left for healthcare or is it a flaw of the people that value a flat screen TV over a check up?
    I also am in contact with a large population of poor and don’t feel I need to work harder and pay more in taxes so those who give a fraction of my effort can live even more comfortably.

    • Heather says:

      Nate, I find your comment amusing, because a month of our COBRA would cover a cell phone, a flat screen television, a few cases of beer, some nice clothing, and an X-Box 360.

      It is, perhaps, a triumph of our age that material goods are now so disposable and cheap that “everyone” can afford them.

      It is not, however, a moral failing (as you seem to imply) that some people choose them over the health care they would still not be able to afford.

      • nate ogden says:

        no one in the entire country chooses consumer luxary over insurance necessitity? No moral short commings at all?

  9. Peter says:

    “Peter could you define “healthcare” for us please.”
    assets.opencrs.com/rpts/RL34175_20070917.pdf

  10. Evan Falchuk says:

    Hi Mr. Ballard,
    I guess it’s fair to say there’s nothing in my post about the working poor. Then again, it wasn’t the subject of my post.
    Now, you raise an interesting point.
    There is the problem of health coverage on the one hand, and health care on the other.
    We have a problem in America with making sure all of us have good health coverage – and not just those with the means to afford it.
    But we also have an insidious problem with health care. Everyone, covered or not faces challenges with getting the right care – and it’s getting worse.
    Published studies show it, so you don’t have to take my word for it.
    It’s driven by the fact that policy-makers don’t value the time patients have with their doctors. They don’t value the ability of doctors to think about their problems, integrate information, and come up with good solutions.
    It’s not just in America, but all over the world. It’s killing medicine, and hurting patients.
    Evan Falchuk

  11. rbar says:

    Nate, you are just propagating the libertarian welfare myth. I simply don’t believe that you are in contact with many poor people; and your perspective who is poor and who not and what they consume may be warped. I see working poor in the hospital and occasionally in outpatient practice, and I also see their usually decrepit cars on the streets or in parking lots. Fact is that outside of some urban areas, you cannot get around and to work except without a private car. Yes, most of the cars that were build in the late 80s or later have AC anyway (working or not). I would bet that some poor may own flat panel TVs, but this is relatively low cost, one time expense that cannot be equivocated with the cost of health insurance on the private market. I am making a very good income but I am still able to see poverty, even though I wished it doesn’t exist; you just perceive what you want to see.
    Re. HC abroad, I worked in 2 European countries (France and Germany), care was good and included high cost services like transplant sx etc. I would admit that certain peak institutions (such as Mayo Clinic or many academic centers) have a consistent level of excellence in most subspecialties that MAY be unmatched in Germany (not so sure whether some university clinics in France are at a similar level), but that also comes with an extreme price tag and applies only to a small fraction of US HC.

  12. DJK says:

    Hmmm…
    Am I to gather that bloggers who discuss topics that relate to their own companies should keep their “superficial drivel” to themselves? If yes, I think you’ll see a number of bloggers out of business.
    Many times it is their experiences gathered through their professions that allow them insight into healthcare that some of us find quite interesting, regardless if it is perceived as “marketing”. In fact, I’m pleased to say that my company offers the Best Doctors service. I’m even more pleased to say that I have not had a reason to use it! (No offense, Evan!)
    Babe, were you expecting a solution to the healthcare system that fixes all of its ills? Keep in mind that this is a short blog. Maybe you should wait to read Evan’s book which is coming out….well, I have no idea if he’s writing a book. My point is this: you can only do so much in a blog vs. writing a book.
    As far as sharing a few key facts in a short blog, I think the piece hit the mark. Drivel or no drivel… ;)
    Signed,
    DJK
    author of A Musing Healthcare Blog
    http://amusinghealthcareblog.wordpress.com
    Twitter: @a_musinghcblog
    (Wait, can I market here? Ah, too bad…I just did. Enjoy my senseless drivel, everyone!)

  13. inchoate but earnest says:

    DJK,
    and here I thought Babe was giving Evan a recommendation for some hip new hair gel…
    8^)

  14. Evan Falchuk says:

    Bang!
    I actually think Superficial Drivel would be a good product name.
    Evan

  15. Evan,
    Here is an essay on healthcare in the homogenous country of Finland:
    http://medicalexecutivepost.com/2009/03/29/reflections-on-healthcare-and-karate-in-finland/
    Hope R. Hetico RN, MHA
    [Managing Editor]

  16. nate says:

    “I simply don’t believe that you are in contact with many poor people”
    Based on what rbar? its inconvient for your narritive? I went to a terrible high school in a not so great neighborhood where majority of kids are poor. most of my high school friends are from poor families. My first 10 years of work included a lot of fast food in poor neighborhoods so friends I made those years. Currently and for the past 5-7 years I have been involved in the local hip hop scene, again most of whom are poor. I’m comfortable saying I speak to more lower income people on a monthly basis then you have shaken hands with in your entire life. If you still question it come to Vegas and I’ll take you around the projects and introduce you.
    Sorry the facts get in the way of your propoganda but I’m not a liberal, I actually know what I am talking about before I open my mouth.
    “your perspective who is poor and who not and what they consume may be warped.”
    When I am in the projects or section 8 housing what I see is what I said. Unless my eye sight is so bad I can’t tell the difference between a 55 inch flat screen and a 13 inch CRT the only thing warped is your ability to reconsile reality with your perception of how it should be for your dogma to hold relavense. There has also been numerous studies done to support the size of houses, number of TVs and all that.
    “I see working poor in the hospital and occasionally in outpatient practice,”
    But your never in their house? Do you rent them aprtments and condos and see how they live in those? So because your isolated from the poor I must also be isolated from the poor? You sound like margalit now. Sorry to hear your sheltered and not exposed to reality, that does explain alot of your positions. Go to any public school after work and start playing basketball, or if you have money to piss away get into music and see how poor life really is.
    I work with musicians that sleep on friends sofa and have no health insurance yet have a wardrobe that easily cost 10K a year. Look at the use of ciggs, alachol, and pot, you can easily measure hopw many billions a year are spent on those, that is all wasted money that could easily purchase every low income person great health insurance. You have to see the effect of those at work, where does that money come from, where could that money go?
    “I would bet that some poor may own flat panel TVs, but this is relatively low cost, one time expense that cannot be equivocated with the cost of health insurance on the private market.”
    Then they get the PS3, then the games, etc etc is a series of one time expenses that never ends that prevent them from affording insurance.
    Let me give you an example, I love picking on alternative paper “journolist” they are very liberal and to stupid to even get a job as a normal journalist which doesn’t require any inteligence. One of them wrote an article in Las Vegas weekly I beleive, complaining about the cost of health insurance, he set the picture of how he struggles to make any money because he was a dumb ass that borrowed money to get a degree that doesn’t pay anything and the high cost of insurance was just out of reach and it wasn’t fair. Some how he works into the story he sits at cafes drinking coffee and smoking a pack a day. I sent the paper the rates for a single male to purchase a good insurance plan. That plan cost less then his coffee habit, smoking habit, and student loans for a worthless degree. He could afford to buy three policies for the price of poor decisions he makes.
    I do business with these idiots every week. They make terrible decisions and that by far is the majority of their problem. Its like the musician that thinks he would blow up and be rich if only he could get some studio time, which he complains about as he gets high, doesn’t work, and drinks 5 nights a week.
    Until you actually work with the poor outside your ivory castle your really not qualified to make any of the arguments you did.
    Tell you what I know a few people that need some money to put out some albums, for $5,000 I’m sure they would let you run around with them for a week and keep you safe.

  17. steve says:

    “how many of them own a cell phone? How many smoke? How many drink? How many wear nice clothes and have a flat screen TV on which they play PS3 or X-Box 360?”
    My observations of the working poor, direct and indirect.
    1)Cell phone. Many working poor no longer have land lines, just cell phones. For many of the kinds of jobs they have, they are almost essential. Basic cell coverage is pretty cheap.
    2) Too many smoke.
    3)Nice clothes? Not many. Most seem to wear basic WalMart. I see a lot of activity at the Salvation Army also.
    4) Flat screen and X-Box- Can be had on the used market fairly cheaply. Refurbished ones are cheap too. When I visit the homes of the poor, the picture quality usually seems pretty bad. Is that what you notice or do the poor in your area have better TVs? They last for years. So, maybe $600 for a used TV and X-box combo.
    5) Health insurance for a family of 4 averages about 15K.
    Steve

  18. nate says:

    Health Inurance averages 15K but the poor aren’t all living in MA, working for Unions with silly rich benefits, and in need of $250 deductible plans. In most states you can get affordable decent insurance for $6000 a year. And remember we are talking about the poor that make enough not to qualify for Medicaid. When you factor in that to nopt qualify for SCHIP your family of four needs to be making 50K plus we are really talk,ing about only needing to cover the parents, sadly that usually means parent who mom can get good coverage for $150-$200 and Dad $100-$150
    There are levels of poor and the general poor population is cash rich, I see both extrems, there are many that barely afford a working TV and I see plenty of brand new big screens as well.
    Remember poverty is based on reported income, there is a thriving non reported economy in most poor neighborhoods.
    stay at home mom with three kids, why does she need the iphone for $99+ a month? Not sure what part of the country you are in but NV and CA cell phones are not affordable and not only carried for necessitity. Every kid has at least one. For all the unemployed they obviously aren’t job requirements….well legal job at least
    for the one item we do agree on smoking, what about alcohol?, what would you peg that cost at? Would that not contribute sonsiderably to their monthly cost?

  19. BobbyG says:

    “…your narritive? I went to a terrible high school”
    ___
    Some things are patently obvious.

  20. John Ballard says:

    Mr. Falchuk, thank you for your reply.
    I suppose there is a difference between “health care” and “health coverage” but that strikes me as a disingenuous dodge. “Interesting point” indeed.
    nate, I wouldn’t speak of ivory towers if I were you.
    Having grown up in the South, your remarks remind me of how white people once spoke about Blacks.
    http://whatever.scalzi.com/2005/09/03/being-poor/

  21. nate says:

    John why are your racial problems anyone’s problem but yours?

  22. TTT says:

    Nate makes glib right-wing misanthropy all too plain.
    ["an insurance plan I sent a stupid liberal"] cost less then his coffee habit, smoking habit, and student loans for a worthless degree.
    And so for his sin of having invested in the wrong career, of course this young man deserves to go without healthcare. If he dies of a treatable illness for lack of affordable coverage, he’d deserve that too.
    You say he fancies himself a journalist–well, I’m sure he had every reason to believe his degree would actually help him get a job, and until about 5 years ago it very likely would have; he was just doing what the previous 100+ years of candidates in his chosen field had done. Obviously if he’d known in advance that his degree would be worthless, he wouldn’t have gotten it. Like, duh.
    In the right-wing mentality, getting the wrong major in school is just one of the many signs that you are less than a real person and your life is worthless. The great Alan Grayson perfectly represented the true winger approach to healthcare: “don’t get sick, and if you do, die quickly.”

  23. Lynn says:

    Wow! what a lively dialogue. So all countries have the same health problems: access — who gets care, quality –right care at right time, and costs–right care, right time at an affordable price.
    Not getting sick isn’t a reliable option, just like I needed to have parents who were independently wealthy…how’s that working for you? It’s not working for me, but there is always the Publishers Clearing House …
    Health care delivery for all countries is a work in progress and is a function of culture, politics, and economics. Evan you’re correct, determining the best/worst health care depends on perspective (perhaps national origin bias) and whether or not someone has had a “major” health event for themselves or someone they care for.
    There was a time we never discussed this stuff, we just assumed “doctor knows best!” I’m glad we are engaged and civilly discussing this. I’m copying this for class discussion in a health administration class. You’ll wake up that 8 a.m. class, thanks.

  24. nate says:

    TTT you seem to be one of those not so bright liberals.
    FIrst I noticed you left off the smoking and coffee in your retort, why was that?
    “And so for his sin of having invested in the wrong career, of course this young man deserves to go without healthcare.”
    So instead; for the sins of his investing in the wrong career I deserve to go without something? Why do I pay for his poor decisions?
    And its not really accurate to call it investing, investing is usually predicated on the assumtion you put in an amount of money to get more money back. According to PayScare a journalist makes 26K to 46K assuming you can even get a job in the field. At that salary a 50K to 100K education is NEVER an investment it is wasted money. Further nothing in jourmnalism requires 4 years of intense study, its a craft that would better prepare workers with on the job training. Now if journalist were speciailized and went to college to earn a degree in that speciality to them report on that speciality then that would be a different story, thats not how the industry works, and thus why so few journalist have any grasp of what they speak.
    “bviously if he’d known in advance that his degree would be worthless, he wouldn’t have gotten it. Like, duh.”
    wow, I have tried to tone it down but after that comment your an idiot. Like no one graduates with history degrees, liberal arts degrees, women studies, or any of the other dozens of degrees that have next to no job potential. I heard on the radio someone just got their masters in Beatles, she was in a class of 12, exactly what job does that qualify you for? If you really think kids don’t go to college for pointless degrees you have checked out.
    Do you know how many applicanats I see with Medcial coding, massage, and other “degrees” certificate that were nothing but a waste of 2-4 years and tens of thousands of dollars. Put the pitcher of coolaid down and wake up.
    “getting the wrong major in school is just one of the many signs that you are less than a real person and your life is worthless.”
    versus the oh so effecticve liberal belief that a meaningless piece of paper somehow means your qualified and should be paid more. Like Social advancement your just not smart enough to get it.

  25. rbar says:

    I wouldn’t deny that there are many people who make poor lifestyle choices, but Nate, in his libertarian fervor, just declares every poor person to be responsible for their misery. That’s rather an act of faith than rational discourse. And when the numbers don’t support his case, he just alludes to a “thriving non reported economy” in poor neighborhoods.

  26. Evan Falchuk says:

    Lynn, thanks for the thoughtful comment.
    You describe the problem well. On the other hand, I now feel guilty for waking up students who would like to be sleeping.
    Evan

  27. TTT says:

    “You left off the smoking and coffee in your retort, why is that?”
    One, because they’re too small to be relevant. ~$30/week is not a problem at the same scale as ~$1,000/month.
    And two, because I had already sufficiently exposed your ongoing death-wishing of this guy as being trivial and misanthropic. If for some reason you consider that still unproven, then, uh, sure, take everything I said about student loan debt and repeat it twice more for coffee and cigarettes. You’re still cool with seeing him dead, so I’m still cool with everything I said about your priorities.
    You don’t get it and you never will. “Of COURSE he’ll die young from a preventable disease–he took the wrong job path when he was 17″ is a guaranteed loser of an argument among normal, sane, well-adjusted people. This is why Obama won the election, and why “Obamacare” was passed and will never be repealed. You think just repeating your trivial and misanthropic death-wish justifications even louder will make the majority of the country less morally horrified by it… well, good luck with that. See you in 2017.

  28. Peter says:

    “In most states you can get affordable decent insurance for $6000 a year. And remember we are talking about the poor that make enough not to qualify for Medicaid…sadly that usually means parent who mom can get good coverage for $150-$200 and Dad $100-$150.”
    In NC the income requirements for Medicaid for families and children range from $362 per month to $648 per month depending on number in family (up to 5), and with a $3000 resource limit. How many families just over the Medicaid income limit do you work with Nate?

  29. nate says:

    familes or individual? as a landlord over the course of a year a dozen or so
    Individual insurance couple dozen
    on group health plan couple thousand
    in regards to music a few dozen
    “One, because they’re too small to be relevant. ~$30/week is not a problem at the same scale as ~$1,000/month.”
    Well TTT if you ever passed a math class you might grasp the flaw in your argument. First pack a day habit runs more then $30 a week, second why do you look at smoking as a daily cost and insurance as a monthly cost? You under price the first, over price the second then sckew it further by using different measures, your a freaking liberal scientist with that argument. You and Al Gore must have gone to the same college.
    “but Nate, in his libertarian fervor, just declares every poor person to be responsible for their misery.”
    So you can’t intellectually argue with me rbar so you go on a strawman killing spree, feel good about yourself now? every poor person, lets see I talked about smokers and drinkers and that was it. So if that means every poor person rbar is now claiming EVERY poor person smokes and drinks. I personally have much more faith in people then racist sexist poor hater rbar, I think there are many people that are poor not by their own fault, not by lack of effort, nor lack of wanting a better life. Its these people that I gladly support and think we should all be doing more for. Unfortunetly for them evil people like rbar rather give small trivial sums to not only the needy but those that would it on smoking drinking drugs and what ever else they feel like. People like rbar rather keep them poor and subservant instead of actually seeing those capabale and desireous make it out.
    “And when the numbers don’t support his case, he just alludes to a “thriving non reported economy” in poor neighborhoods.”
    alludes to, you cought me, there is no drugs, prostitution, or black market in the hood, I made it all up. Those DVDs at the swapmeet are real and all taxes are paid on them, the colegne outside the grocery store sold from the truck is also real with taxes paid. The guy selling me speakers out of his van at the gas station totally on the up and up.
    anything else you would like to say rbar?

  30. nate says:

    hopefully there are no IRS agents here but of the thousands of CDs and DVDs sold not one was ever through a store with sales tax. You rich white liberals really have no idea what 90% of this country is really like do you?

  31. rbar says:

    No Nate, I have nothing to add. As always, when cornered, your delusional and hateful comments speak for themselves.
    But your proclamation of antiestablishment furor (“You rich white liberals”) made me smile a little bit.

  32. Peter says:

    “as a landlord over the course of a year a dozen or so”
    So, you’re a slum-lord? How many of your tenants have you gotten health insurance for? Care to share the incomes?
    “Individual insurance couple dozen,”
    So, maybe you could give us the details on age, income, coverage, deductibles, co-pays, premiums and health status so that we could see how someone making just over the Medicaid income requirements can afford health insurance – as you claim.
    “on group health plan couple thousand”
    But that doesn’t count does it, since those employees are supposedly getting their employer to cover their insurance premium, but income/coverage and costs would help us understand exactly how you do it.

  33. nate says:

    just a little bit? That is disappointing, I was hoping for a full on belly laugh. In regards to the dillusional and hateful part, which was very tongue in cheek, would you concede your comment that I think ALL poor people deserve to be uninsured and suffer thusly was inaccurate and unfair? In the future maybe discussion would be better servered discussing what people actually say and think and not inflating it? I was meerly praticing my Obama inspired “if they bring a knife I bring a gun” debating method. Argue what I actually say and I wont make you look like a racist sexist lilly white liberal:)
    “How many of your tenants have you gotten health insurance for?”
    And Peter takes us back to stupid land. How or why would I get a tenant health insurance? One, what your saying might be illegal, you can’t just go and buy people insurance unless you were to do it through a filed charity or 1099d them. Either way your comment just doesn’t make any sense. You want to do away with employer provided insurance and have it come with your residence now? Talk about lack of portability.
    “how someone making just over the Medicaid income requirements can afford health insurance”
    Healthy 23 year old female kid covered by SCHIP needs insurance in case she hurts herself at work or has an accident looking at $5000 HSA for $85 per month
    Don’t understand your last one
    FYI 18-24 male can get $2500 for $64 or $5000 for $37 and those plans have Rx co-pays and office visit co-pays so the high deductible only applies to more serious treatments

  34. Peter says:

    “your comment that I think ALL poor people deserve to be uninsured and suffer thusly was inaccurate and unfair?”
    And where would that comment be?
    “You want to do away with employer provided insurance and have it come with your residence now?”
    Again, where did I say that? You said your tenants are people that you worked with, with incomes slightly over my states Medicaid eligibility, in response to my question. I assumed “worked with” included a knowledge of how they can afford health insurance. Would you not want to assist them in getting health insurance since you tell everybody you’re the expert.
    You said poor people (apparently your tenants), not eligible for Medicaid, can afford a $6000 per year policy – “In most states you can get affordable decent insurance for $6000 a year. And remember we are talking about the poor that make enough not to qualify for Medicaid” I was interested to see how you would do that and at incomes above my state’s Medicare income thresholds.
    “18-24 male can get $2500 for $64 or $5000 for $37 and those plans have Rx co-pays and office visit co-pays so the high deductible only applies to more serious treatments”
    What is the $2500/$5000 the deductible? Would incomes slightly above my state’s Medicare limits be able to pay those deductibles, let alone the co-pays for a serious illness, oh and miss work and still be able to pay the premium? What would the Rx co-pay and office visit co-pay be? Just trying to understand how you think poor people can afford private health insurance?

  35. nate says:

    the tenants are just that tenants besides hopefully paying their rent sometime close to when it is due I don’t have any involvement in the financial affairs except for information they volunteer, like my disability check was late or the construction company laid us off etc.
    All poor people was in responce to rbar
    “Would incomes slightly above my state’s Medicare limits be able to pay those deductibles,”
    This is the trap most liberals tend to fall in. 10-15% of people hit their deductible in any given year. You want to design a plan or social system to help the 10-15% of the population that actually hits their deductible plus the 85-90% that don’t. This was the flatal flaw of Medicare, only 13% of seniors needed help paying for medical expenses. Liberals created a plan, Medicare, claiming to help the 13%, but didn’t help them at all, it actually excluded the expenses they needed help with.
    Your average working poor’s greatest need is not catostrophic coverage, if they get really sick they wont be able to work, wont have any income, don’t have any savings or disability coverage and will be financially harmed either way. At their level a $2000 expenses really isn’t any different then a $5000 or $10,000. First dollar coverage to treat the little illnesses and accidents plus coverage so providers will treat them if something really serious happens. Meeting the deductible is the lowest concern. Frequently they can get it written off by providers anyways or financied by them.
    A lower deductible plan would not be affordable for them and thus they would be out of the system completly. That is why ObamaCare and its $2000 max deductible and unlimited lifetime and annual limits is so completly stupid, he just priced 50 million people out of the market. Yes if there was a pot of gold at the end of the rainbow then $100 deductible plans for everyone would be great, being that those don’t exist then being smart about the coverage we buy and offer people is necessary.
    “Just trying to understand how you think poor people can afford private health insurance?”
    Back to the original comment, how do poor people afford to smoke and drink and consume to many calories? I have shown you the cost of a decent policy is a fraction of the price of smoking or drinking. If they can afford to vice then they can afford the insurance. Is it the best insurance policy available no, they aren’t all smoking cubans or drinking 100 year old louie either.
    Seeing the numbers and facts in front of you why do you think they can’t afford insurance?

  36. rbar says:

    Nate, I don’t think there is any reason to continue arguing with you since you often post like a troll, and the best thing may be not to reply to you at all. You just make that resolution difficult by occasionally saying something meaningful.
    But for clarity, you were writing that many people are to blame for not having health insurance due to wrong choices:
    “These people that have very little or no contact with the system, how many of them own a cell phone? How many smoke? How many drink? How many wear nice clothes and have a flat screen TV on which they play PS3 or X-Box 360?
    You are correct we are the richest nation on earth, our poor live better then the middle class of almost all other nations. Bigger homes, more cars, AC, etc etc.
    Is it a flaw of our nation that people that enjoy so much frivilous consumption don’t have enough money left for healthcare or is it a flaw of the people that value a flat screen TV over a check up?”
    That appears to be your main argument here. I am well aware that every kind of welfare or protective measure may benefit the undeserving – “in dubio pro reo” may very well let the criminal get away at times, and pieces of the social net will obviously go to a certain percentage of people who continue to make wrong choices. You appear to argue that universal coverage is wrong because one subsidizes the undeserving. Apparently, not all poor are undeserving in your eyes since you so vehemently reject what I thought you think. So is there in fact someone who deserves some kind of subsidy? What family- and income situations are you talking about? Or are you just saying that no one gets a free ride, even though not all poor are deserve to be poor?

  37. nate says:

    rbar I think we reached that magical point where we can have a meaningful and factual conversation, assuming you meant troll in the kindest of ways.
    In regards to where the flaw lies I would say both. Mainly it is the flaw of the individual for not valuing a check up more then a TV but it is a flaw of our society that we foster and almost feed people to it. If you tell someone to consume consume consume and help them do it I don’t think you can solely blame them for doing it. That being said just becuase someone puts a plate in front of you and tells you to eat doesn’t mean you need to eat till you die, sorry grandma.
    There are millions of people who deserver assistance, I think we just need to be smarter how we deliver it. You can design assistance programs that aren’t nearly as suseptable to fraud and abuse as others. You can also design them so they foster growth and developement out of the program instead of enslaving them to it.
    No one should EVER be given assistance for nothing unless they are truly incapable of earning it, i.e. developmentally disabeled. I can think of a million jobs that we as a sociaty would benefit from that aren’t done becuase we can’t “afford” them, at the same time we pay people not to work. Care for the elderly, pick up trash, sort trash to recycle, crossing guards, tare down old busildings, etc etc. If you don’t have a job, housing or insurance then you would report to these jobs and make under minimum wage and get Medicaid. These would be terrible jobs and in no way intended for more then short periods of time. The point of them is not to give people lifetime employement but get them by until they can find a real job. At the same time society is helping them though they would be giving back to society.
    Enrollment in Medicaid would come with mandatory wellness requirements, no smoking, no drinking, quarterly check ups, and education on healthy living.
    If someone is willing to work for it I have no problem giving them all the assistance they need.
    For those that are truly incapable of caring for themselves we need to do much much more then we do now. The real shame is not how we treat those that can help themselves but how we have treated those that can’t help themselves.

  38. TTT says:

    your a freaking liberal scientist with that argument
    And you’re an autistic Randroid whose frothy-mouthed deathwishing of millions of people would undercut your arguments, if you had any arguments in the first place.

  39. Peter says:

    “Your average working poor’s greatest need is not catostrophic coverage, if they get really sick they wont be able to work, wont have any income, don’t have any savings or disability coverage and will be financially harmed either way. At their level a $2000 expenses really isn’t any different then a $5000 or $10,000. First dollar coverage to treat the little illnesses and accidents plus coverage so providers will treat them if something really serious happens. Meeting the deductible is the lowest concern. Frequently they can get it written off by providers anyways or financied by them.”
    “A lower deductible plan would not be affordable for them and thus they would be out of the system completly. That is why ObamaCare and its $2000 max deductible and unlimited lifetime and annual limits is so completly stupid, he just priced 50 million people out of the market. Yes if there was a pot of gold at the end of the rainbow then $100 deductible plans for everyone would be great, being that those don’t exist then being smart about the coverage we buy and offer people is necessary.”
    But you said;
    “In most states you can get affordable decent insurance for $6000 a year. And remember we are talking about the poor that make enough not to qualify for Medicaid”
    Even if the “poor” (above Medicaid eligibility) give up drinking and smoking why would they think they would gain anything from purchase of high deductible plan? Maybe you could help us see your disdain for the poor not buying health insurance? As a slum-lord what do you charge your tenants for rent? What would it cost them for food, transportation, power, telephone, misc, emergency funds? I’m sure you appreciate minimum wage earners making the products you buy and the services you get cheaper and providing you with available tenants for your low income (slum?) housing?

  40. Peter says:

    Oh, and Nate, this just in;
    http://www.nytimes.com/2011/01/29/us/politics/29medicaid.html
    Maybe more “poor” clients for your “affordable” health insurance that those “liberals” were codling?
    But hey, it’s the poor’s fault.
    http://theweek.com/article/index/208113/wall-streets-record-bonuses-how-outrageous-are-they
    Maybe you’d like to read this;
    http://www.fcic.gov/ and this;
    http://www.charlotteobserver.com/2011/01/29/2018598/probe-not-blaming-us-lending-law.html

  41. nate says:

    “As a slum-lord”
    You base this on what? Why can’t you left livers ever have a discussion based on facts and information you actually know instead of just making stuff up?
    As usual I dont understand the point of your links, because some liberals in NY are overpaid crooks Medicaid is being cut? Can you articulate any points of your own instead of linking random articles? As a deathwisher I would have no problem executing 90% of Wallstreet and wouldn’t even want a trial.
    Don’t know why you linked the housing study but personally I always place great faith in stuides performed by politicians that start like this;
    “Another dissenting member said he pressed for a deeper investigation of CRA, but the panel didn’t gather the necessary data.”

  42. Mike MD says:

    Where is it written in the constitution that a HDHP/HSA combo could not be subsidized on a sliding scale by the taxpayers? The concept of giving the patient more control over how the money is spent is a separate issue to that of where the money comes from in the first place. The sad truth of the matter is that those who oppose HSA’s are really opposed to giving up the control they want to exert over their fellow citizens.
    Medicaid in my state had a project in which they gave patients with mental illnesses nearly complete control over how their mental health dollars should be spent. Costs went down, satisfaction went up, and yet the project has not been expanded to the entire state. Control is intoxicating – stop drinking the coolaide.

  43. Peter says:

    My “slum-lord” comment was followed by a ?, if you were uncomfortable with the question maybe I hit a little too close?. I was also a low income landlord Nate, but made sure my tenants were treated with respect and got safe, clean housing where the maintenance was never neglected. My link to the other web sites, since you seem to miss the obvious point more times than not, was to show that being poor is not always due to bad choices (unless you think choosing birth parents is a choice), and that we spend billions making sure the connected wealthy stay that way, especially through the tax code and bailouts. When the financial crisis first hit Wall Street tried to say poor people being given government mandated housing loans caused the crisis – we know that was a lie.

  44. nate says:

    “My “slum-lord” comment was followed by a ?, if you were uncomfortable with the question maybe I hit a little too close?.”
    So it would be fair to say,
    Peter as a;
    Racist?
    Sexist?
    Rapiest?
    Murderer?
    do you feel your a postive impact on society that is all ok, becuase there is a ? on the end? You sound like the left wing media that will character assasinate someone and justify it as reporting on what others are saying so its ok. If there is no reason to think your a murderer then I shouldn’t be putting it out there. I understand why people that aren’t up for an argument do it but its still pretty pathetic.
    No none of my rentals are even close to sumlord status, they are all up to code and in the top of quality in their developement.
    So about those people you killed?

  45. nate says:

    “Where is it written in the constitution that a HDHP/HSA combo could not be subsidized on a sliding scale by the taxpayers?”
    doesn’t IL or IN do this with Medicaid already? Or state employees. nope way off Iowa apparently
    http://www.cahi.org/cahi_contents/consumerinfo/implementationguide.asp
    I would be worried about them taking the money out and paying the penalty, wonder if there is a way to lock them down to prevent that

  46. Peter says:

    “You sound like the left wing media that will character assasinate someone and justify it as reporting on what others are saying so its ok”
    Really, the “left wing media” as character assignation, now that’s the kettle calling the pot black. Listened to Right Wing Rant Radio lately – opps sorry, I didn’t mean to unfairly insinuate you’re a conservative as you have much better character than that. You said your association with low income people was as landlord, I asked in what capacity you rent to low income as many times it is as a slum-lord. Now if you had said you have only white people in your units, or males, or heterosexuals or felons, would I be justified in asking racist, sexist, homophobic or criminal, and would that be character assassination?

  47. John Ballard says:

    Wow! Almost fifty comments.
    It’s called The Last Word Game.
    Reason and logic are not part of the equation.
    Whoever has the last word wins.
    For those who haven’t figured it out yet, nate always wins.
    Most trolls are innocent of any sense of reason and he is no exception. He seems to be a deeply wounded individual, incapable of compromise, courtesy or sincere apology. However, I think he must be very successful in his work because, as seen here, he stays on task with unrelenting energy and determination. That level of commitment takes exceptional dedication.
    Okay, sir.
    Your turn…

  48. David Macfarlane says:

    That series of exchanges was not worthy of this very worthwhile source of information. I hope it isn’t a sign of how this forum is changing.

  49. MS says:

    It makes me sick what the politicians have done to this country, including but not limited to Health Care. We pay the most for health care than any other country and we are behind some third-world countries when it comes to decent health care for everyone. Why? Mismanagement and higher administrative costs. One big problem is, like other professions, the medical profession has bought the people’s government with their strong lobbies that work against what this country was built on and replaced it with self-indulgent greed. SHAME ON THEM ALL!

  50. tf1AiqYC says:

    527949 883640when i was a kid, i really like to receive an assortment of birthday presents like teddy bears and mechanical toys, 14986

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