late-night thoughts
Feb. 7th, 2010 01:35 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
lapsedmodernistSo I've had this sinusitis, and I finally went to my doctor on Monday, and they gave me antibiotics, and I took them and started feeling better in a couple of days, and then on Friday I woke up with a rash, and went back to the doctor, and it looked like an allergic reaction to the antibiotic I was taking, so the doctor prescribed me a different antibiotic to finish up with. Then we were talking about allergies, and I told him about the scary experience with my throat closing up over Christmas when I was at Saint Alp's Teahouse with ![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
klingrap and so he wrote me a prescription of an epipen just in case, and while we were at it he gave me a new prescription for the Albuterol inhaler, because I was out, and also I got my blood taken to do a foods allergy test (testing for 96 foods)--they should have the results in 10 days. None of this, including the prescriptions themselves and the labwork, cost me a cent.
This is by no means a novel idea, it's just something I think about almost every time I go to the doctor here. The Dutch health care system is an existing, functioning testament to the fact that all of the "complicated" negotiations over "health care reform" in the US are just bullshit, bullshit, and more bullshit. Okay, so Americans are atavistically in throes of The Red Scare, and politicians are using that to make sure that the US never has a government-run single-payer system like the NHS. But of course the real reason is that the politicians are bought and paid for by the HMOs, which run for profit, and now, in the awesome new synergy shat out by SCOTUS, in some escalating loop from hell, they will be able to invest tons of money into "electing" politicians that will ensure greater and greater profit margins. That is the core of the health care problem in the US, and it's not that I am being reductionist, it's that there is no more sophisticated analysis available for this particular issue. The false binary between HMOnsters and The Red Scare is about disabling any attempts at regulating profit margins by having a distracting Strawman debate about Free Market and Rugged Individualism vs. Collectivism & Stalin. Sure, there is other cultural stuff that maps onto that, like American willingness to embrace disenfranchisement, as long as their Black or Mexican neighbors are even MORE disenfranchised...but mostly it's about corporate profits in the large sense of What It's All About. American cultural false consciousness and penchant for voting against one's own interests is quirky and sometimes useful, but it's, like, not even on the radar of Why Things Really Happen.
Forget single-payer, forget the incredibly complicated multi-layer calculations with subsidizing a percentage of some health care plans and taxing some other health care plans, and some states getting funding in some complicated dealings over abortion in some other states, I meant what the fuck the point is, a reform where the end product would look like the Dutch system would be totally non-controversial, because there is nothing in it to use as fuel for inflating phobias and ignorant half-baked "applied politics" that are, like, an American culture-bound syndrome.
In the Netherlands health care is privatized, and it is mandatory for every individual over 18 to purchase it. The Dutch state also REGULATES THE FUCK OUT OF ITS HEALTHCARE SECTOR. There are 4 insurance companies in the country; they are all required by law to provide the same basic package to everyone, for the same price (around 90 EU/month). There is also a 150 EU annual deductible. That includes every kind of medical care you may need from your GP or specialist, any hospital visit, any test your doctor orders, and all prescriptions you have to fill. It covers limited dental and eye expenses (you can buy top-ups to get more covered) and unlimited therapy/mental health. There are no co-pays. There are things that insurance companies won't cover. For example, my coworker was complaining that her insurance company wouldn't pay for her to have a baby at the hospital, because she didn't have any medical indication for a hospital birth. I asked what she would do and she said she would have to pay for it out of pocket. I was, like, OMG because, of course, I am still in the US frame of mind where it costs thousands to have a baby (I saw my bill, which was accidentally sent to me instead of Mass Health, for Fionn's birth, which was midwife, rather than doctor-attended, and involved no medical interventions of any kind, and it was like $7000), but no, it turns out that here it costs around 300 EU to have a baby, out of pocket.
The companies definitely compete with each other; with one you may get a discount on a membership to a specific health club chain. With another you might get a discount towards a cruise or a spa. There are slightly different levels of coverage for alternative medicine. I pay about 20 EU more/month for my plan because I choose to have one that will reimburse me for medical care I may receive outside the Netherlands.
In terms of care, I have never had to wait longer than 24 hours for an appointment with my GP's office (with the only exception being when I request to see a specific doctor out of the three available there--then I might have to wait 2 or 3 days); usually if I call in the morning I can be seen the same day. The few times I've had to see specialists I had to wait between 7 and 10 days for an appointment. The only exception was a gyneocologist, where I would have had to wait 3 weeks for an appointment, and I ended up going to see a doctor in Germany instead, where an appointment was available the next business day, and the insurance will reimburse me. I have a wonderful therapist that I see every week, and there is no limit of sessions per year.
All the US would have to do to get this kind of model implemented would be to regulate the insurance companies. No boogeyman of the "government running healthcare," no phobias about socialism, no new insurance companies, no new agencies, just regulation: everyone has to buy a policy, and the basic policy has to cost the same reasonable amount, and cover everyone in the same way. And the public would love it--Gov't Protects People From Bloodsuckers! Gov't Reigns In Insurance Companies! People could have their Aetna or Blue Cross or whatever, they would just all pay something like $150/month, and never worry about copays or preexisting conditions or annual or lifetime spending caps or any of that bullshit.
There are systems that function well that fall that are neither the NHS nor the American HMOstrosity. It's just that "socialism" makes for a good scarecrow, and is better for obfuscating that the single, the ONLY reason that there is no "reform" happening is that both health care lobbies and politicians prioritize HMO profits, even as they pathetically try to append some secondary concerns about public impression management. Maybe the real question that people should be asking is--why is the American government unwilling to regulate the health care industry on the level of basic consumer protection? Well, because the more Aetna and BCBS make, the more money they can put into politicians' pockets, of course! Especially now! Thanks, SCOTUS!
klingrap and so he wrote me a prescription of an epipen just in case, and while we were at it he gave me a new prescription for the Albuterol inhaler, because I was out, and also I got my blood taken to do a foods allergy test (testing for 96 foods)--they should have the results in 10 days. None of this, including the prescriptions themselves and the labwork, cost me a cent. This is by no means a novel idea, it's just something I think about almost every time I go to the doctor here. The Dutch health care system is an existing, functioning testament to the fact that all of the "complicated" negotiations over "health care reform" in the US are just bullshit, bullshit, and more bullshit. Okay, so Americans are atavistically in throes of The Red Scare, and politicians are using that to make sure that the US never has a government-run single-payer system like the NHS. But of course the real reason is that the politicians are bought and paid for by the HMOs, which run for profit, and now, in the awesome new synergy shat out by SCOTUS, in some escalating loop from hell, they will be able to invest tons of money into "electing" politicians that will ensure greater and greater profit margins. That is the core of the health care problem in the US, and it's not that I am being reductionist, it's that there is no more sophisticated analysis available for this particular issue. The false binary between HMOnsters and The Red Scare is about disabling any attempts at regulating profit margins by having a distracting Strawman debate about Free Market and Rugged Individualism vs. Collectivism & Stalin. Sure, there is other cultural stuff that maps onto that, like American willingness to embrace disenfranchisement, as long as their Black or Mexican neighbors are even MORE disenfranchised...but mostly it's about corporate profits in the large sense of What It's All About. American cultural false consciousness and penchant for voting against one's own interests is quirky and sometimes useful, but it's, like, not even on the radar of Why Things Really Happen.
Forget single-payer, forget the incredibly complicated multi-layer calculations with subsidizing a percentage of some health care plans and taxing some other health care plans, and some states getting funding in some complicated dealings over abortion in some other states, I meant what the fuck the point is, a reform where the end product would look like the Dutch system would be totally non-controversial, because there is nothing in it to use as fuel for inflating phobias and ignorant half-baked "applied politics" that are, like, an American culture-bound syndrome.
In the Netherlands health care is privatized, and it is mandatory for every individual over 18 to purchase it. The Dutch state also REGULATES THE FUCK OUT OF ITS HEALTHCARE SECTOR. There are 4 insurance companies in the country; they are all required by law to provide the same basic package to everyone, for the same price (around 90 EU/month). There is also a 150 EU annual deductible. That includes every kind of medical care you may need from your GP or specialist, any hospital visit, any test your doctor orders, and all prescriptions you have to fill. It covers limited dental and eye expenses (you can buy top-ups to get more covered) and unlimited therapy/mental health. There are no co-pays. There are things that insurance companies won't cover. For example, my coworker was complaining that her insurance company wouldn't pay for her to have a baby at the hospital, because she didn't have any medical indication for a hospital birth. I asked what she would do and she said she would have to pay for it out of pocket. I was, like, OMG because, of course, I am still in the US frame of mind where it costs thousands to have a baby (I saw my bill, which was accidentally sent to me instead of Mass Health, for Fionn's birth, which was midwife, rather than doctor-attended, and involved no medical interventions of any kind, and it was like $7000), but no, it turns out that here it costs around 300 EU to have a baby, out of pocket.
The companies definitely compete with each other; with one you may get a discount on a membership to a specific health club chain. With another you might get a discount towards a cruise or a spa. There are slightly different levels of coverage for alternative medicine. I pay about 20 EU more/month for my plan because I choose to have one that will reimburse me for medical care I may receive outside the Netherlands.
In terms of care, I have never had to wait longer than 24 hours for an appointment with my GP's office (with the only exception being when I request to see a specific doctor out of the three available there--then I might have to wait 2 or 3 days); usually if I call in the morning I can be seen the same day. The few times I've had to see specialists I had to wait between 7 and 10 days for an appointment. The only exception was a gyneocologist, where I would have had to wait 3 weeks for an appointment, and I ended up going to see a doctor in Germany instead, where an appointment was available the next business day, and the insurance will reimburse me. I have a wonderful therapist that I see every week, and there is no limit of sessions per year.
All the US would have to do to get this kind of model implemented would be to regulate the insurance companies. No boogeyman of the "government running healthcare," no phobias about socialism, no new insurance companies, no new agencies, just regulation: everyone has to buy a policy, and the basic policy has to cost the same reasonable amount, and cover everyone in the same way. And the public would love it--Gov't Protects People From Bloodsuckers! Gov't Reigns In Insurance Companies! People could have their Aetna or Blue Cross or whatever, they would just all pay something like $150/month, and never worry about copays or preexisting conditions or annual or lifetime spending caps or any of that bullshit.
There are systems that function well that fall that are neither the NHS nor the American HMOstrosity. It's just that "socialism" makes for a good scarecrow, and is better for obfuscating that the single, the ONLY reason that there is no "reform" happening is that both health care lobbies and politicians prioritize HMO profits, even as they pathetically try to append some secondary concerns about public impression management. Maybe the real question that people should be asking is--why is the American government unwilling to regulate the health care industry on the level of basic consumer protection? Well, because the more Aetna and BCBS make, the more money they can put into politicians' pockets, of course! Especially now! Thanks, SCOTUS!
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no subject
Date: 2010-02-07 01:18 am (UTC)I'm starting to get a bit tired of all the stuff in the medical school apps about how you have to want to work with the "underserved." The underserved aren't going to stop being the underserved until the way health care is provided changes. Demanding that people about to go over a hundred thousand dollars in debt show a willingness to...participate in something broken in a self-destructive way is pretty bad. Mostly because it's really a display that's being demanded. At the expense of the people who need actual help.
no subject
Date: 2010-02-07 09:25 am (UTC)no subject
Date: 2010-02-07 01:32 am (UTC)no subject
Date: 2010-02-07 09:26 am (UTC)no subject
Date: 2010-02-07 02:01 am (UTC)... is such a distilled piece of reasonable-and-extremely-smart-person. I kind of want to see distributed from on high, aloud, as a sort of spoken word air-bombing for the correction of the blight of craven money-oiled American politics.
Even the looniest tea-partiers don't shriek 'socialism!' about Medicare, the Post Office, or clean municipal water, and yet they all work with far less
bureacratic fuckwittery(ahem) infrastructure than we already have for medical care.no subject
Date: 2010-02-07 09:28 am (UTC)no subject
Date: 2010-02-07 02:24 am (UTC)no subject
Date: 2010-02-07 09:23 am (UTC)well, at least not in the US. In Cape Town, Cochabamba or Guayaquil it's a whole other story, right?
no subject
Date: 2010-02-07 03:48 am (UTC)Sing it.
no subject
Date: 2010-02-07 09:28 am (UTC)no subject
Date: 2010-02-07 06:58 pm (UTC)However, in this system where "choice" rhetoric gets appropriated under both the healthcare ridiculousness (hey, you get to "choose" your own health plan! but you can only choose the ones an employer provides, and then THE PLAN gets to choose whether or not to reimburse you) and under the abortion debate (we want women to choose to keep their babies, but, oh wait, they already have the right to do that), I honestly don't even think that some words mean anything anymore. Most notably, "choice" and "healthcare."
Anyway, sorry for ranting in the comments... :P
no subject
Date: 2010-02-07 05:30 am (UTC)no subject
Date: 2010-02-07 09:30 am (UTC)no subject
Date: 2010-02-07 06:04 am (UTC)I love Paul Farmer, I love his ecumenical use of liberation theology as a way of conceptualizing health care for the poor. And I can't believe SCOTUS either.
Also, let's not get into Obama and the protections he's extending to reproductive rights here. Or let's; I am feeling stabby already anyway.
no subject
Date: 2010-02-07 09:29 am (UTC)no subject
Date: 2010-02-08 03:53 am (UTC)http://www.pbs.org/moyers/journal/02052010/watch3.html
no subject
Date: 2010-02-08 04:45 am (UTC)http://www.youtube.com/watch?v=53RbYauyv_8
no subject
Date: 2010-02-08 06:32 pm (UTC)I am a Farmernaut, I really am. I love his realistic but optimistic approach towards all the world's inequalities.
no subject
Date: 2010-02-07 09:48 am (UTC)Being nosey - what happens under the Danish system if you're unemployed or unable to work due to illness?
no subject
Date: 2010-02-07 09:52 am (UTC)no subject
Date: 2010-02-07 10:25 am (UTC)And, thanks. Handy to know :)
no subject
Date: 2010-02-07 09:34 pm (UTC)the u.s. spends over 15% of GDP on health care each year. the IMF reported on what other industrialized countries that provide universal health care spend as a percentage of GDP. The next nearest percentage was about 10% (Canada, if I recall correctly). So, the u.s. spends unproductively at least 5% of GDP on health care (insurance, medicine, co-pays, deductibles, the gamut).
the GDP of the u.s. is about $14 trillion per year. 10% of $14 trillion is $1.4 trillion. 5% is 1/2 of 10%, or $700 billion. so, this is, at a minimum, how much is being charged each year for unproductive work (profits, ridiculous salaries and bonuses, all of the extra people who are hired to deny care and to handle the blizzard of paperwork, building, heating, lighting, and maintaining all of the insurance company buildings, etc.) that is each year -- $700 billion -- poof!
add to this the recent news that health care in the u.s. has increased in cost from 16.2% to 17.3%*, and the amount spent unproductively increases to over $1 trillion per year. each year. year after year. (I use 15% because it allows people to easily see the arithmetic, and because it underestimates, rather than overestimates the cost.)
last year, while the debate was underway, there were studies that came out that said that somewhere between 18,000 and 40,000 people are dying in the u.s. because they don't have sufficient insurance (or any). some people who supported the senate bill were arguing that it had to be passed because not to do so would leave these people to die in the coming year (never mind that the senate bill would not take effect until 2014 -- who cares about the people who would die before then?) in effect, what they are doing is holding these people hostage. "give us our $700 billion to $1 trillion, or these people will die."
if my name were dick c., i would say these hostage takers were terrorists.
* http://rawstory.com/2010/02/health-costs-eat-record-fraction-economy-2009-report/
p.s., also, the $1 trillion is an underestimate because 40 to 50 million people have no insurance. if they were all to buy insurance at the same proportionate level as the rest of the population, we could reasonably expect the percentage of GDP spend on health care to go up by 1/6, or from 17.3% of GDP to over 20% of GDP.
no subject
Date: 2010-02-07 09:51 pm (UTC)* 69% of all people employed by the Pentagon are now private contractors -- http://www.truthout.org/1218098
no subject
Date: 2010-02-08 03:10 am (UTC)no subject
Date: 2010-02-08 04:55 pm (UTC)no subject
Date: 2010-02-20 08:15 pm (UTC)no subject
Date: 2010-02-20 11:55 pm (UTC)welcome home! welcome back to the fight for our country!
jack nicholson in "easy rider": "This used to be a hell of a good country. I can't understand what's gone wrong with it."
no subject
Date: 2010-02-21 12:03 am (UTC)no subject
Date: 2010-02-21 01:02 am (UTC)no subject
Date: 2010-02-21 12:01 am (UTC)I don't know if the facebook message I sent you got lost in the bowels of facebook...but I still don't know where your apartment is! Also I have some interesting stuff to tell you...xoxoxo