28 October 2008

Oregon Health Plan != Private Insurance Company

NB: I initially wrote this late last night and hit "publish" instead of "save," accidentally releasing it into the wilds of the internet. I took it down when I realized my error this morning because it needed some editing in the harsh light of day, but not before it was linked a couple of times. (People actually read this! Wheeee!) Sorry for any confusion caused by the disappearing act.

It had been my intention to clean this post up rather a lot and take a somewhat less vitriolic tone, but since this has already been made public in it's immature form, I think I need to keep editing rather minimal. I guess that teaches me a lesson about blogging while sleepy.

In this post I discuss the case of Barbara Wagner, who got some really raw treatment from her state-provided medical insurance plan. I emphasize the state-provided part because ABC only mentions it obliquely in their article, continuing to refer to the Oregon Health Plan as an "insurance company." Many of the commenters to the site took this story of state failure as a prime opportunity to complain about private insurance and advocate for socialized medicine. Yeah, it doesn't make any sense to me either.

Because I get a little hot headed below, allow me to calmly state now my opinion that our current medical funding system is a terrible mess and needs lots of work. Neither fully privatizing or fully socializing it is the solution, and neither will save us from the nightmarish bureaucracy that Wagner's story is an example of. It is my position that the results from a more market-based system, while clearly sub-optimal, will still be better than the sub-optimal results from a more state-based system — but both will be very far from perfect. I am not trying to defend any particular health care plan or offer any solutions here though. That's a discussion that I'm willing to have with reasonable people. However, the use by many commenters of an anecdote about a state failure to complain about private failure is just too absurd for me to let pass at this point, so let the ridicule begin.

Here's one choice example, from cab_codespring:
It is chilling that so many of my fellow americans [sic] here are so cold hearted about their countrymen. I think you should watch "Sicko", [sic] I think every american [sic] should. I suppose there are a lot of people like them in europe etc. that have universal health care. [Like whom? Americans?] Lets just hope theat [sic] there aren't enough of you miserable selfish pigs to stop us from getting civilized health care. The bottom line is health care shoud [sic] never be for profit, for profit health insurance companies should be illegal, and only doctors should be making life or death medical decisions about care. BTW, of all the things you fear about universal health care, just try and find a significant number of examples, and dissatisifed [sic] people in those countries. They are miles ahead of us in every way. AND their taxes are not outrageous. You are just gobbling down the pap the lobbyist [sic] against it (paid by big corporations) are feeding you. Wise up. Could be YOU or your child or your parent next.
Well I can find one person who's dissatisfied with government-run health care. Her name is Barbara Wagner, and she's the subject of the article that has gotten cab_codespring in such a tizzy. Or we can go ask Paul Krugman about finding dissatisfied socialized health care "customers." Let me know how that works out for you.

Here's a doozy of a non sequitur from Hege123l:
I don't want a for profit company making life and death choices for me. Government healthcare seems to work fine for government workers, the military and our politicans... [sic]
Yeah, it just hasn't worked so well for Ms Wagner. Do these people even read the stories they comment on?

Here's another comment from the cleverly pseudonymed SlickCheney (oh! the satire!)
Healthcare has become a commodity. Healthy working people who have money are insurance companies favorite customers. That is all you are to an insurance company. Their goal is to make money off of your healthcare. Not to provide you with lifesaving services. Insurance companies absolutely adore you when your making your [sic] monthly payments, but as soon as you become sick or ill, well, then you are liability to them. Don't you get it people? Insurance companies only like you when they are benefiting from your policy.
Since we've already established that private insurance companies aren't responsible for this, let's revise SlickCheney's contribution to fit the story:
Healthcare has become something people want without paying for. People who have money and vote are politician's favorite people. That is all you are to a politician. Their goal is to make money off of your votes and taxes. Not to provide you with lifesaving services. Politicians absolutely adore you when you're getting them elected and giving them money, but as soon as you stop helping them, they stop helping you. Don't you get it people? Politicians only like you when they are benefiting from you.
And here's a great idea from sidewinder007:
Here is what we do, each and every one of us write a letter to our health insurance company and state that instead of paying the $200 a month premium, we will send $5. There is no price on a human life, this is absolutely absurd.
Well apparently there is a price and it's $5. The results of this "plan" will be that the insurance companies will shut down to seek greener pastures in other industries, leaving us to pay for medical care out of pocket. I'm assuming that's not what sidewinder007 has in mind though. How immature do you have to be to expect that you'll just pay whatever the hell you want and people will continue providing you with goods and services? Sidewinder007 also inadvertently reveals one of the benefits of private health care. If you don't like the service you're getting you stop paying and terminate your relationship with your provider.* If you try that with nationalized health care you get arrested for tax evasion.

(* I can already hear people thinking "But what if I've been paying my premiums for years and then I get sick and they deny treatments?" They're right, that's deplorable. But what do you do if you've been paying into a socialized system for years through your taxes and then get denied treatments by the government? Move to another country? Good luck getting your new homeland to cover your expenses. New Zealand won't even let you immigrate if they suspect you might cost their national health system too much money because your BMI is over the limit. I can't imagine how quickly they'd bar the gates if you told them you were moving just to get them to pay for an existing condition that your previous government wouldn't pay for.)

Tashibelle weighs in with this:
The real villain here is the drug company that charges $4,000 for a medication that has only a small chance of extending this patient's life - not the state who has to answer to taxpayers about every penny they spend and must set criteria to justify spending money - this medication did not meet the set criteria.
Lacking any evidence to the contrary, I'm going to assume that tashibelle has absolutely no clue what Tarceva ought to cost. Neither do I. I know nothing about how long it took to develop, how hard it is to synthesize or what the demand is. Neither does tashibelle. But (s)he probably sees a bottle of tylenol that costs $8, thinks pills are pills, and why the hell should some cost $8 and some cost $4000? Who the hell is she to tell me one price is immoral? What's the right price then, genius? $17? $230? People need to stop pulling these qualitative judgements out of their fundaments and acting like they're moral imperatives from on high.

Ramoth_the_Queen contributes this feel-goodery:
Poverty, healthcare and homelessness are moral issues and we need to be a moral country. For too long we have been self absorbed and self centered and that isn't the America we used to know. Money shouldn't be an issue when someone wants to live even for an hour longer.
Money isn't an issue? For an hour? Are we back in Fairy Land where there is no scarcity and no trade-offs? Would we extend someone's life for an hour at the cost of one trillion dollars? (Money isn't an issue after all...) What if that trillion could have extended a thousand lives by a decade instead? We spend another trillion? What if that trillion could have taught a million children to read? Spend another trillion? What if that billion could have put a roof over the heads of ten thousand people?

Reading deep into the ABC article we discover this is the case with Ms Wagner. The Oregon Health Plan has a prioritized list for how they use their finite funds. Disease prevention is up near the top, and presumably high-cost, low-effectiveness lung cancer drugs for lifelong smokers are near the bottom. This is a cold calculus to play at, but there's not much way around it when you're asking someone else to foot the bills for you.

It's an ugly fact, but scarcity exists. We can't have everything we want. And we can't get it with wishes and dreams and hugs and warm fuzzy feelings. Them's the breaks.
The business that makes it their choice and not the choice of the individual needs to be done away with.
Does Ramoth extend this same conclusion to governments that make it their choice and not the choice of the individual? We are, after all, talking about the State of Oregon here. Or is it okay for them to restrict choices because they know better than the rest of us? And how about a business owner's choice of price point for the goods and services that he is making available? Is this not an individual choice worthy of our deference?
First do no harm is all the doctors need to know.
The second thing they need to know is that the they may be required to work for nothing. We'll just pay them whatever we want, since it's all about our choice and they don't get a say. If this sounds preposterous then why is it any more reasonable to legislate limits on an insurance or pharmaceutical company's revenue? Once you start dictating what the fruits of labor are worth for some people why not do so to everyone?
Indviduals [sic] should have the right to choose for themselves how they want to end their lives as well as if they want to save their life. It's their body, its their choice.
Their body, their choice, but we get to pick up the tab. Lots of rights, no responsibilities. Sounds fair.

According to Ramoth we can shutter the FDA now. Why should they get to decide what drugs I put in my body? It's my body and it should be my choice.

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