sorry bout the caps.
the hack claims first that JH says that medicare recipients are "much happier than those with private insurance". Watch out, he's intentionally altering the original statement which was "high levels of satisfaction" among MC patients. I know it's a subtle difference but satisfaction usually pertains to a singularity (in this case insurance coverage) whereas "happiness" usualyy describes the general nature of a situation. I know, i know, subtelty and the meaning of words is lost on these people.
He then tries to stake a claim to the fact that private insurance is better b/c only a small % of people are MORE satisfied with MC. Misdirection anyone? Or is that just the workings of a pathetic mind? Can't tell.
He then goes on to cite a report underwritten by those with a vested interest in obfuscating the reality of their own outrageously expensive insurance. Simply disigenuous. JH cites that private insurance admin costs are ~20% whereas DH says MCs hiding its staggering admin costs, which are really 5% not 2%. 5%

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Some people are so easily fooled when there's numbers involved. Particularly in a situation where there's more than one variable, such as in the example cited of satisfaction with public versus private.

As a maths geek (yes, oh the shame, I've revealed my dark secret), it irritates me the way idiots constantly misuse statistics for their own fell purpose, and this is another fine example. You'd think it would be impossible to fool people, wouldn't you? Think on this: "Well, we could have people paying quite a lot to be somewhat satisfied with their health care, or we could pay a whole lot less to get them slightly more satisfied. What's it to be?" I mean, really. Where's my logic pills, I need to think about this one.

There's a caveat to this, of course: satisfaction is a qualitative, not a quantitative measure. So people who pay a great deal more for their health care might expect more, and therefore be less easy to satisfy, than people who pay bugger all.

But the basic premise remains rock solid: the US pays squillions for a system that works far less well. If we were talking about sport, there'd be no problem: the trainers would be travelling the world trying to find out how the winners were doing it, and spending buckets on research to find the absolutely optimal path. Which brings up another question: the US government cares a lot about sport, and being the best in that arena, but doesn't give a toss about health care. I'd love to hear some comments on this conclusion.

Oh, and by the way, the title of my post is an actual book, and a good one (and a thin one too). It's written by a statistician, and it's about 40 years old, but it illustrates very well how some folks can misuse statistics for their own ends. Well worth a look, so you can be forewarned about how they can mislead you.

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My history includes starting my health care early on at a med school clinic after the doctor on the corner wanted to remove my, maybe eight-year old, appendix. The clinic diagnosed it as a 'cold' in my kidney. No more doctors on the corner after that.

So I am accustomed to paying a fee at a window and waiting for hours to see a doctor. It usually turned out it was a whole room full of doctors and interns. So I was taught to swap privacy for quality.

Just got back from celebrating my dear mother's 99th birthday. The clinics don't get all the credit, even though my mother insisted on them for any necessary surgery--and still only after a second opinion. So I had a semi-socialized medical care growing up. And now I'm in an HMO. Put me down as "satisfied."

And, Holland, while the logic of your reply to wli is certainly true, that big business has a lot to gain from unloading their private health care insurance, big business also had a lot to gain by dealing with global warming and nuclear disarmament.

"Stupid is as stupid does," to quote Forrest Gump.

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A family of 4 could owe $14,200 a year just on Rx on Medicare, it's the law ($3,600 per year, per person with Rx coverage). Plus, Medicare charges $88.50/ per person, per month, for Part B premiums, it's the law. A family of 4 would owe $354 a month just for Medicare Part B premiums. Taxpayers still pay 75% of Part B premiums or 3 times more, $1062 per month, it's the law. Medicare Part B is just outpatient physician charges only. Medicare Part A is hospitalization and that cost more, a lot more, paid for by the Medicare tax.

President Bush supports Tax Free HSAs. Many families have HSA health insurance for $200 a month from America's oldest health insurance company. Medicare pays more than $200 a month for a family of 4. Medicare pays more for a single than $200 a month.

I enrolled America's first MSA, now HSA, in 1996. You might confuse some people with this article but I know better. President Bush says, "Become empowered with an HSA."

2 million people have enrolled in tax free HSAs in the last 10 months. By 2008, 20 million people will have enrolled in tax free HSAs. If you have a good arguement against the HSA and Republican health care reform please present it. Otherwise, the smart move is saving premium, eliminating taxes and building wealth. Tax Free HSA funds that are never taxed will last longer in retirement. Like President Bush says, "HSAs are amazing."

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We hear different numbers for this. In JH's post, the numbers -- whether 20% or 16.7%-- seem to refer to the administrative costs on the side of the insurer.

What about admin costs on the side of the care provider? What does it cost for providers to hire staff to wade through thousands of different insurance plans? What does it cost for providers to wait 60, 90, 120 days for payment, and then write off payments that are inexplicably denied? How many denials of payment are uncontested because it is not cost-effective for providers to argue?

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The bottom line is, we pay considerably more for health care than all other industrialized nations and we achieve much poorer results. Results are guaged by such things as infant mortality, life expectancy etc...

We arguably have the "best health care in the world", meaning our technology and training are second to none. Our failure is primarily a matter of access, and financial barriers are the biggest contributor to inaccessability.

"Managed care" was the great compromise that came out of the Clintons effort to reform health care. The Health insurance industry screamed "SOCIALISM" at the reformers and convinced Congress (dominated by Republicans) that placing more control in industry hands would result in better care, greater accessability and lower costs. It hasn't worked out that way. Everything has gotten worse (except for industry profits).

First, we need to elect a Democratic Congress (which I'm convinced would be less corrupt than the Republican one we now have). Then, we need to make health care reform a priority. Health insurance companies should be contracted to do what they're best equipped to do, process claims. There is no need for them to do anything else.

There is already enough money flowing through the system to pay for all the health care that everyone in America needs, the unfortunate reality is that too large a percentage of it goes into corporate "overhead", which includes huge CEO salaries and construction of glass palaces along the interstate. They've completely screwed up the system and it's time for the citizens (through their elected representatives) to take back control. No doubt there will be some problems and complaints, but just as certainly there will be tremendous improvements.

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My 82-year-old Mother paid for 10 months a medical expense that was covered under Medicare. The expense was $300 a month or $3,000. Her doctor knew it and he didn't tell her. When she figured it out she spent 2 weeks wasting her time calling and writing to Medicare so they would pay the covered medical expense. Lucky, she is retired and can spend all day, every day, calling Medicare's customer service.

Medicare needs to spend a bit more on adminisration and train their customer service reps and update their computers. Joshua would want to give every American the exact same number for customer service, that's pathetic.

Taxpayers owe $65 trillion dollars on future unfunded Medicare and Social Security benefits and the number grows every year. So Joshua thinks we should expand the program so young taxpayers can owe more.

If you're young, you should take your Social Security tax and have it MATCHED BY YOUR EMPLOER and sent to the bank, FDIC insured. You should have the option of mutual funds because you are smarter than Liberals think. Of course the Tax Free PSA is just a dream of President Bush to save Social Security (A pay-as-you-go Ponzi Scheme). But the bigger half of the Ownership Society is the Tax Free HSA in health care. The Tax Free HSA is already the law of the land and can't be stopped.

President Bush said, "I believe in more options, more choices, more freedom in Medicare including Medical Savings Accounts (MSA)." Zogby polling indicates 91% of Democrats and 90% of Republicans prefer the option of MSAs (Now HSAs in the under-age market) in Medicare. The Tax Free HSA will attract voters over 65 to the Republican Party. When Liberals say Medicare For All, that is so boring and expensive.

Vote Republican if you want to be a multi-millionaire. Support Democrats if all you want is what you wear.

Vote Republican so the young don't end up being taxpaying zombies.

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First Off,

If HSA's were universal they would not cover all medical costs. The poor and elderly (quite often the same thing, especially without "government hand outs") would not be able to afford the high deductibles. HSA's could never be a universal scheme. If someone in their thirties who has a family and is young and healthy runs into serious medical trouble, it will be a personal calamity both financially and physically. Who cares if in some instances premium costs are low, it is premised on you the customer not actually getting any serious injuries or illnesses, if you do, you'll become one of the next American's going bankrupt every thrirty seconds from healthcare debts.

The most fundamental error made by Save 101 here is in not analyzing the differences in costs between an entire health industry based on private enterprise like in the USA and universal schemes linke in Canada or much of Western Europe. The US pays the most per person out of any OECD nation, and yet has the lowest lifespan, highest infant mortality rates, etc.

As a Canadian who knows I pay less for health insurance and will a) live longer b) have far less a chance my newborns will die int heir first year of life c) will never go bankrupt because of backwards healthcare priorities (profit over human need), I can only laugh and shake my head Save101

Just be honest brother and tell us why you are really here...you know HSA's can't universally protect all Americans from the crippling costs of Cancer, MS, months of recuprative surgery and therapy after accidnets, etc... you're just hawking your insurance to twenty to forty somthings who you'll hope will take a risk on their families health by saving a few bucks now in the hopes they don't run into any serious personal tragedies...

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Dear Save101,

While you're at it putting people in precarious insurance schemes that probably are getting you on your way to being a republican multi-millionaire, I thought I could suggest to you a very lucrative line of salesmanship that can be just as rewarding and enriching.

Start selling USED CARS! It's the perfect line of work for an upstanding gentlemen like yourself.

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I have mixed feelings about engaging this guy. He's obviously some flack for HSAs who just signed up to comment on this post.

Professional propagandists don't care about the facts. It's that simple. So, are we wasting our time?

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Save101 and josh have been going at it on HSAs, let me offer a reason whyt he premise of HSAs is a little off.

First, the assumption with savings-oriented plans is that people will spend less on healthcare when their liabilty increases. This is true as far as it goes, for healthy people. But it assumes that health is discretionary.

If I break my leg, I can't shop around for a good provider, nor do I have time to compare costs. And most people aren't really qualified to judge treatments anyway outside of very specific things. There is a reason med school takes a while.

This means that the market forces HSA proponents talk about have the problem of incomplete information on the part of the consumer, as well as misreading what people spend on and why.

Even if an HSA covers catastrophic care, the other problem is that it is often better to spend a bit on many doctor visits than a lot on one. To give an example, treating TB costs very little if it is caught early. But if I am discouraged from spending -- because the money is mine and hits me directly -- I might leave that treatment until it is really expensive to treat. By that time the cost has increased ten-fold. Cancer is a similar issue--checkups once yearly are coparitively cheap compared to the cost of treatment for later stages.

In traditional insurance, are there people that overuse the system? Sure there are, but last I checked I couldn't find many people just itching to go to the doctor.

In any case, the other problem with many HSA schemes is that it assumes one could save enough money to cover certain treatments. This is sometimes true, but not always.

The whole point of the group insurance model is that the healthy subsidize the sick, thus spreading out the risk.

Now, there are several reasons that healthcare in the US costs more than anywhere else. Let me offer a few:

1. The cost of medical education is so high that doctors are discouraged from primary care fields. This means that only specialists are out their offering their services and that is expensive (they also have to make a living). It also drives up the cost of being a doctor. I contrast this to other nations, such as Germany, Astralia, France and even the much-maligned UK, where the cost of being a doctor is something like 1/10th what it is in the US, where you can easily spend $250K -- after college.

2. The private insurance industry has a whole bureaucracy to decide what treatment to fund and what not. (This is the same "rationing" of health care that conservatives complain about in single payer systems. The difference is that it is according to how much money you have). The problem is that it adds a layer of inefficiency to the system with the dickering that has to happen between three parties -- the doctor, the patient and the company.

3. De-mutualization. The insurance companies used to be owned by the people that paid the premiums. In the late 1990s this model went out the window (I think only Vanguard still works this way, not sure). Anyhow, this made rates of return on public shares a much more important issue than it was. It creates serious problems for the gruop insurance model.

Universal coverage could be achieved -- and it could even be kept in the private sector. I would propose the "AT&T model." AT&T was required to serve everybody, everywhere. There were strict rules about that, as well as how much the company could charge and the rate of return it had to have for shareholders. It was hugely successful. Think of how unusual it was to fnid a family minus a phone by 1984.

Will there be "rationing" decisions to be made under any system? Yup. But let's not make them according to who was lucky enough to be wealthy- that isn't the only measure of worth.

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I have been reading left-leaning, progressive and other far out stuff for a long time now and that is the best term for what I consider to be the main enemy of a good life in America and the world. I have read a lot of your Alternet stuff and I think you are doing a great job. Thanks.

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