If you're a public official who wants to to use numbers, use correct numbers, and if you're going to speculate, try not so speculate wildly, lest you end up telling brazen lies to the American people
Thanks for a more balanced overview of the American health care system than that generally found by substack authors. Several substack authors target an audience of naysayers who badmouth every aspect of our healthcare system. Some prolific authors publish 2-3 or more articles daily, hashing the same screed repeatedly. They are after monetary gain rather than public safety.
1) relatively poor driving compared to rest of rich world
2) high gun-related deaths (homicides and suicides) compared to rest of rich world
3) greater use of opiates compared to rest of rich world
4) high obesity.
I know this has shades of “How did you enjoy the play Mrs Lincoln?” But my point is that if you are a mentally stable American who stays away from weapons, drives cautiously, and eats well you are likely to live a very long life. Much of this is due to a very effective healthcare system at point of treatment.
The single most effective and simplest public health intervention in the US would be a reduction in opiate prescription rates to European levels.
Eliminate a certain subgroup of a subgroup and the homicide effect crashes.
My personal idea to improve the US in total? Anyone who talks about self-ownership and is worried about suicide gets a choice of either shutting up or being tossed in a mass grave.
Agreeing with you that Senator Murphy's numbers seem imaginary, but I disagree about excluding Medicare recipients. I recollect that about half of Medicare people are in "Medicare Advantage," where "insurance" companies can and often do make it difficult to get treatment paid for.
You can choose to enroll in original Medicare instead of Advantage, and Advantage is very much guided by the CMS, and not something he and other Medicare-for-All advocates would want to get rid of given its performance.
You are trying to inject rationality into this discussion!
Some of my colleagues unwisely chose Medicare Advantage and would like to return to "original" Medicare but can't get supplemental insurance to do so. And one physician complained to me about how much time he has to spend trying to convince Medicare Advantage "insurers" to pay for needed treatment. So I surmise that due to this some 65+ folks are dying earlier than they otherwise would, in order to enhance profitability of the "insurance" companies.
I mean if you choose to forego insurance that covers everything* (ffs Medicare) to get cheaper insurance that doesn’t cover everything (advantage) I think it’s hard to blame the insurance company.
And within advantage people can choose all sorts of different plan types (want to go out of network, choose a ppo).
*Also, there are a ton of things FFS Medicare doesn’t cover even if you stick with it. Should we therefore blame Medicare for those denials.
That always amused me; hearing how "Medicare For All" would mean no direct cost to you. That's Medicaid, but people who don't have the disadvantage of being an elderly Vermont Senator so easily confused should know better.
At this point more then 50% of the population has chosen advantage, so it’s worth asking what’s so “unwise” about it.
Due to upcoding and other shenanigans, Advantage plans have more revenue than equivalent FFS coverage. As a result, even after admin and profit, they provide more overall coverage than FFS. Some people take that in the form of lower premiums, some in fringe benefits (dental, etc), others in lower FFS cost shares (having a MOOP/copays without having to pay for supplemental).
That doesn’t seem “unwise”.
Now if you’re pretty well off I think FFS + supplemental + private dental makes a lot of sense, but that’s an expensive combination. Lots of less well off people aren’t going to find that as compelling.
I’d also note that that so many people at end of life just end up on Medicaid anyway, so “I might have an easier time getting an expensive treatment at 80 when I have cancer” doesn’t really matter to those people anyway.
Now if you asked me how advantage effects “the system” I’d say it’s a scam, but it’s a scam old people love (basically, they love insurance companies using upcoding to get them more government revenue to spend on themselves).
what if he'd said "thousands of people a year" instead of "thousands of people a day". what if he'd avoided that little slip of the tongue. what would you have written your article about?
Isn't it simpler to assume that the Senator meant something like "thousands of people die" (in total) from insurance denial, and the "every day" part was meant to emphasize that this is something that happens every day and not provide a term for multiplication?
Interesting. I mean, i would hate to live in a society where huge medical bills and related admin can land on you out of the blue, but... okay i am convinced that the medical care, and the gaps in it, in the US isnt a major driver of the shockingly low life expectancy (LE) and other poor health outcomes, worse than a lot of much poorer countries.
In which case... what is driving poor health outcomes and low LE?
- Food and diet?
- poor environment ( air quality etc)?
- Car(/TV) culture and resulting lack of exercise?
- Stress of living in a driven and competitive society, the downside of factors driving that successful economy?
The iron law of social science strikes again ("if it can be composition effects, it is composition effects"). If you do like-for-like comparisons (same age japanese for example), americans afaik have better outcomes than many other places.
That doesn't tell you the exact reason, but it does give you a good hint that it's most likely either genetics or group-level differences in lifestyle-related.
Everybody wants to talk about healthcare this, healthcare that, but most people refuse to take care of themselves, and refuse to look at the reasons why Americans are so fucking unhealthy compared to other Western nations. The cultural significance of this debate is also driven by our general culture of death-denial.
People will eat, drink, smoke, and generally fatass their way into an early grave and then have the audacity to bitch about insurance companies not forking over the money for wunderdrugs and Harvard-educated doctors. The healthcare system might be fucked, but considering the fact that modern medicine as we know it has scarcely been around for a hundred years, I dont know what everyone expects.
Yes a fair chunk of it is individual behaviours... although... I would add that some of the factors are driven by public policy - eg food regulations (US is more of a free for all for big companies and bad ingredients and limited nutritional info), and eg patterns of US town and city development that favour car use over walking / active travel (free parking, gappy sidewalks and few cycle lanes)... and also that the profit motive in the insutance and healthcare sectors creates some adversarial relationships between patient and provider/funder, which might or might not impact LE but are unpleasant, stressful and unproductive. Uk/ EU systems of healthcare also have gaps in their care (under resourcing etc) but they dont have much of this routine headbutting.
Feels to me like it is harder to manage your health positively in the US, but others might have a different angle?
I think its FAR more difficult for the less intelligent, the working class, those with low impulse control, to make good decisions about their health in this country than many others, without a doubt. Ready access to processed foods, the destruction of two parent households (households not cooking at home), jobs that facilitate sedentary lifestyles, etc.
But these are consequences of living in a fake country; America's rulers dont care about banning toxic food chemicals or repairing the predatory aspects of the healthcare industry because we are not a coherent people constituting a nation, we are an empire and an economic zone. Now we want to plaster over this gaping sore with universal healthcare and Medicare for All, like the solution is just to double down on the technocratic hellscape.
The smartest take down on the dumbest senator.
Thanks for a more balanced overview of the American health care system than that generally found by substack authors. Several substack authors target an audience of naysayers who badmouth every aspect of our healthcare system. Some prolific authors publish 2-3 or more articles daily, hashing the same screed repeatedly. They are after monetary gain rather than public safety.
How much did they pay you to write these essays defending the insurance companies?
Here is a classic example of one of the naysayers who escaped from the substack authors I wrote about above.
The following is a nuanced take.
US life expectancy is very good if you exclude:
1) relatively poor driving compared to rest of rich world
2) high gun-related deaths (homicides and suicides) compared to rest of rich world
3) greater use of opiates compared to rest of rich world
4) high obesity.
I know this has shades of “How did you enjoy the play Mrs Lincoln?” But my point is that if you are a mentally stable American who stays away from weapons, drives cautiously, and eats well you are likely to live a very long life. Much of this is due to a very effective healthcare system at point of treatment.
The single most effective and simplest public health intervention in the US would be a reduction in opiate prescription rates to European levels.
Eliminate a certain subgroup of a subgroup and the homicide effect crashes.
My personal idea to improve the US in total? Anyone who talks about self-ownership and is worried about suicide gets a choice of either shutting up or being tossed in a mass grave.
Agreeing with you that Senator Murphy's numbers seem imaginary, but I disagree about excluding Medicare recipients. I recollect that about half of Medicare people are in "Medicare Advantage," where "insurance" companies can and often do make it difficult to get treatment paid for.
You can choose to enroll in original Medicare instead of Advantage, and Advantage is very much guided by the CMS, and not something he and other Medicare-for-All advocates would want to get rid of given its performance.
You are trying to inject rationality into this discussion!
Some of my colleagues unwisely chose Medicare Advantage and would like to return to "original" Medicare but can't get supplemental insurance to do so. And one physician complained to me about how much time he has to spend trying to convince Medicare Advantage "insurers" to pay for needed treatment. So I surmise that due to this some 65+ folks are dying earlier than they otherwise would, in order to enhance profitability of the "insurance" companies.
I mean if you choose to forego insurance that covers everything* (ffs Medicare) to get cheaper insurance that doesn’t cover everything (advantage) I think it’s hard to blame the insurance company.
And within advantage people can choose all sorts of different plan types (want to go out of network, choose a ppo).
*Also, there are a ton of things FFS Medicare doesn’t cover even if you stick with it. Should we therefore blame Medicare for those denials.
That always amused me; hearing how "Medicare For All" would mean no direct cost to you. That's Medicaid, but people who don't have the disadvantage of being an elderly Vermont Senator so easily confused should know better.
At this point more then 50% of the population has chosen advantage, so it’s worth asking what’s so “unwise” about it.
Due to upcoding and other shenanigans, Advantage plans have more revenue than equivalent FFS coverage. As a result, even after admin and profit, they provide more overall coverage than FFS. Some people take that in the form of lower premiums, some in fringe benefits (dental, etc), others in lower FFS cost shares (having a MOOP/copays without having to pay for supplemental).
That doesn’t seem “unwise”.
Now if you’re pretty well off I think FFS + supplemental + private dental makes a lot of sense, but that’s an expensive combination. Lots of less well off people aren’t going to find that as compelling.
I’d also note that that so many people at end of life just end up on Medicaid anyway, so “I might have an easier time getting an expensive treatment at 80 when I have cancer” doesn’t really matter to those people anyway.
Now if you asked me how advantage effects “the system” I’d say it’s a scam, but it’s a scam old people love (basically, they love insurance companies using upcoding to get them more government revenue to spend on themselves).
what if he'd said "thousands of people a year" instead of "thousands of people a day". what if he'd avoided that little slip of the tongue. what would you have written your article about?
Isn't it simpler to assume that the Senator meant something like "thousands of people die" (in total) from insurance denial, and the "every day" part was meant to emphasize that this is something that happens every day and not provide a term for multiplication?
Interesting. I mean, i would hate to live in a society where huge medical bills and related admin can land on you out of the blue, but... okay i am convinced that the medical care, and the gaps in it, in the US isnt a major driver of the shockingly low life expectancy (LE) and other poor health outcomes, worse than a lot of much poorer countries.
In which case... what is driving poor health outcomes and low LE?
- Food and diet?
- poor environment ( air quality etc)?
- Car(/TV) culture and resulting lack of exercise?
- Stress of living in a driven and competitive society, the downside of factors driving that successful economy?
- Guns and opioids?
Would be good to know what is driving it.
The iron law of social science strikes again ("if it can be composition effects, it is composition effects"). If you do like-for-like comparisons (same age japanese for example), americans afaik have better outcomes than many other places.
That doesn't tell you the exact reason, but it does give you a good hint that it's most likely either genetics or group-level differences in lifestyle-related.
Everybody wants to talk about healthcare this, healthcare that, but most people refuse to take care of themselves, and refuse to look at the reasons why Americans are so fucking unhealthy compared to other Western nations. The cultural significance of this debate is also driven by our general culture of death-denial.
People will eat, drink, smoke, and generally fatass their way into an early grave and then have the audacity to bitch about insurance companies not forking over the money for wunderdrugs and Harvard-educated doctors. The healthcare system might be fucked, but considering the fact that modern medicine as we know it has scarcely been around for a hundred years, I dont know what everyone expects.
Yes a fair chunk of it is individual behaviours... although... I would add that some of the factors are driven by public policy - eg food regulations (US is more of a free for all for big companies and bad ingredients and limited nutritional info), and eg patterns of US town and city development that favour car use over walking / active travel (free parking, gappy sidewalks and few cycle lanes)... and also that the profit motive in the insutance and healthcare sectors creates some adversarial relationships between patient and provider/funder, which might or might not impact LE but are unpleasant, stressful and unproductive. Uk/ EU systems of healthcare also have gaps in their care (under resourcing etc) but they dont have much of this routine headbutting.
Feels to me like it is harder to manage your health positively in the US, but others might have a different angle?
I think its FAR more difficult for the less intelligent, the working class, those with low impulse control, to make good decisions about their health in this country than many others, without a doubt. Ready access to processed foods, the destruction of two parent households (households not cooking at home), jobs that facilitate sedentary lifestyles, etc.
But these are consequences of living in a fake country; America's rulers dont care about banning toxic food chemicals or repairing the predatory aspects of the healthcare industry because we are not a coherent people constituting a nation, we are an empire and an economic zone. Now we want to plaster over this gaping sore with universal healthcare and Medicare for All, like the solution is just to double down on the technocratic hellscape.
Interesting