Friday, August 14, 2009


Ask the Administrator: Sixty Days

A midwestern correspondent writes:

I'm starting a new full-time job next month, and I'm really excited about it. But my new college has a 60 day waiting period between my start date and when I actually receive health insurance. I'm grateful for the job, of course, but I don't understand the 60 days. Do you know why I have to pay for COBRA for two months into a new job?

First, congratulations on the job! In this year's market, that's particularly great news!

That said, though, I'm at a bit of a loss to explain the 60 days. It's one of those policies I've heard of, but never understood. (Wise and worldly readers who can shed light are invited to do so in the comments.) It puts you in a really nasty position. For those leaving positions with health insurance, they're staring at a month or two of COBRA. Under COBRA, as I understand it, the former employee can continue prior coverage for a limited time at the low, low cost of 102 percent of the sum of the old employer contribution plus the old employee contribution. It's called COBRA because it bites; for family coverage, you're looking at easily over a thousand dollars a month. (This, on top of moving costs.) Incredibly, it's still usually cheaper than the individual market, but for a new employee on a modest budget, it's prohibitive.

(I've heard of some systems in which your premium for new coverage starts after 30 days, even though the coverage doesn't kick in until 60. So you get the double whammy of COBRA payments and the new premium on top of it. Ouch.)

I guess it's possible that the idea was to prevent gaming the system by making it impossible for someone to put a relative on the payroll on Monday just in time for a quadruple bypass on Tuesday. But that's something to address by managing how hiring is done. And if a new employee gets hit by a truck after six weeks on the job, it's not clear to me why that employee should be left defenseless.

As regular readers know, I'm a strong believer in a universal single-payer system. Decouple health insurance from employment, and consign terms like 'COBRA' and 'pre-existing condition' to the dustbin of history, alongside 'debtors prison' and 'poll taxes.' Adjuncts need coverage, too, and there's no earthly way for most public colleges to cover that through existing appropriations. But even if we fall short of the policy I'd prefer, the 60 day "hold your breath and hope for the best" period strikes me as perverse.

Wise and worldly readers -- is there a way this makes sense? I'm perplexed.

Congrats again on the job!

Have a question? Ask the Administrator at deandad (at) gmail (dot) com.

They probably got hit by a couple of new hires coming down with something expensive. In a medium size enterprise that can jack the rates up a lot.

Single payer is the way to go
If you get hit by a truck, health insurance won't help in a lot of states. For motor vehicle accidents, you'll be dealing with your car insurance company. (Even if you are a pedestrian and hit by someone else.)
According to my spouse, who works in HR, the COBRA legislation gives you 60 days to choose whether to use it.

If you're willing to take a chance, it *could* be worth it. Just make sure you have a power of attorney and health care directive in case you have an incapacitating health condition in the interim...
I work for a state university system that makes new employees wait 90 days before they're covered by insurance. It's a relatively new development, within the past five years, instituted by our idiotic state legislature, and applying to all new state employees, to save a few bucks. It's as simple, and offensive, as that.

"Welcome to state employment! Now don't get sick for three months or you're screwed!"
Anonymous 6:50 AM, it's more than a "few bucks." Multiply $500 or so by three months, then multiply that by the number of new employees. These 'waiting periods' are a symptom, not the underlying problem. Universities obviously wouldn't bother if health insurance didn't cost so much.
We need health reform NOW. We need to let our members of Congress know that the "Brooks Brothers rioters" can't stop reform because way too many people are sick of our cruel and broken health care system.

The 60 day delay is probably negotiated by the college as a way of keeping premiums as low as possible--premiums this year in my state have risen between 17-34%, so many employers have had to drop coverage completely. The reason insurance companies offer cheaper premiums for delayed start coverage is exactly as you suggested--to avoid "adverse selection" by sick new employees--the really sick ones can't take the wait, and it helps avoid enrolling previously uninsured people who don't have the COBRA option.

Another downside to be aware of--under HIPAA, your "continuity of coverage" can be affected if you go uninsured for too long. If you drop coverage to take a job where the insurance has a delayed start, you may face delays up to a year for coverage for preexisting conditions. I don't offhand remember how long that delay can be before you lose the protection of HIPAA--somewhere around 60-90 days. So COBRA may be your best option even if it's ridiculously unaffordable. the Obama stimulus plan offers help with COBRA premium payments right now if you can show you lost your previous job because of the economy.
Seriously, folks--is this insurance we are arguing over, or having someone (arguably, someone ELSE) pay for healthcare?

For years I have been paying quite a lot of money for life insurance, and I haven't seen a dime of it yet (and how interesting--*I* never will!) I also have been paying far more for car/auto insurance every month than I ever hope to get back. As anyone with a "family" of drivers knows, teenagers are VERY expensive to insure.

The problem really isn't "who pays" but rather the mindset that each of us should somehow be paying less than what we actually use (antithetical to the notion of insurance, to be sure, where as I noted above we expect to pay more than we hope to use.)

The cost of insurance continues to climb because each of us hope to get out of the system more than we put in. I will defer to CC Physicist on this, but if I remember correctly, that is not a sustainable physical model--or economic one.

So here is a new question for you: How do we change society's expectations of health "INSURANCE" so that we no longer "expect" to get our money's worth, but hope--as with life insurance--that we won't need to use it?
Our faculty don't get a paycheck for the first 60 days of their employ. Try figuring that one out.

I would still look at the individual market rather than COBRA for catastrophic coverage only with a high deductible for that 60 day waiting period. It might be the cheaper way to go, even with a family.
This is common with a lot of health plans, unfortunately. If you don't expect to need medical care for a few months, one option that's cheaper than COBRA is high-deductible temporary coverage, just in case you get hit by that truck, fall down the stairs and break your leg, etc.
The waiting period has been standard in non-academic settings for a while. I actually asked about it at my current college and their answer was that the 60 day period was the probationary period for all employees and the insurance folks don't want to enroll and then un-enroll the folks who don't make it off of probation.
The thing to remember about COBRA is that you don't pay for it UNLESS you use it. It's prohibitively expensive, yes, but at least you don't pay that cost unless you find yourself in a situation where it would be even uglier without it.
I think the waiting periods, more common in the private sector, are to discourage people from taking a job, getting a costly medical procedure and then quitting.

The only solution to avoiding that is health care reform that ensures universal coverage (however accomplished).

In our organization (a nonprofit organization representing community colleges), the only "wait" is until the beginning of the next calendar month, which is required by the California Public Employees Retirement System's health plan. So, your wait could be anywhere between one and thirty days.
The system up here isn't perfect, but I am so grateful for the healthcare that I pay for and receive in Canada. The debates going on in the US are, frankly, awful, and from up here it looks like complete lunacy to have so many uninsured people and weird insurance rules (60 days? really?) when it doesn't have to be that way. I don't fully understand the ins-and-outs, and am not trying to sound smug or give a lecture, just want to say that most people in Canada really support Americans who are striving towards universal care. From my experience the extra taxes are worth it!
grumpyabdadjunct said... "From my experience the extra taxes are worth it!"

I think it would help with the discussion if you could give us a sense of just how much your personal taxes increased by having the Universal Health Care? Did you end up personally paying 10% more? 5%? 0?
"I think it would help with the discussion if you could give us a sense of just how much your personal taxes increased by having the Universal Health Care? Did you end up personally paying 10% more? 5%? 0?"

A corollary question: how much higher are his wages, due to his employer not subtracting large pre-tax sums for health care? (I'm not talking about premiums themselves, but the employer contribution. That's money employees spend without even knowing it's been spent, and it affects wages. A lot.)

How is salary growth different, given that health insurance premiums are not a factor in determining raises? Lots of Americans have the sad experience of seeing their raises swallowed whole by rising insurance costs.
Anonymous @8:40

The question about "how much extra tax" isn't straightforward, because how much tax someone pays depends on their income.

However, there are some figures that may give you an idea:

First, in the US government and personal expenditure on health comes to about 16% of GDP, compared to about 10% on the UK. So, if all those bills were shared out equally, that leaves me paying 6% less.

Second, in actual numbers: in the US expenditure is about $7,000 per person; in the UK about $3,000.

Third, in terms of quality of care: life expectancy is slightly higher in the UK.

What that means is that IF the US switched to the UK system (which I know is impossible from the current starting point, and probably not desirable - the NHS isn't perfect!), that would still leave the "average American" with an extra $4,000 dollars a year to pay for extra/better/quicker services.

Fourthly: how much is peace of mind worth? I know that (a) I will always get medical treatment when I need it, and (b) I will never find myself in the position of having to sell my house/cash in my retirement savings/go bankrupt to pay for my health.
Yeah, other countries believe (correctly) that we are insane. My theory is that they don't have entire political movements formed around hating sections of the population. "It's okay if I eat mud as long as the [African-American persons] are eating [excrement]."
Even single-payer systems can have something like this. I'm an immigrant to Canada. When I shifted from employment visa to permanent resident, there was either a sixty or ninety day period where I was not covered by OHIP (the provincial health plan).

I'd been covered by OHIP while on my employment visa earlier, but somehow couldn't be transitioned back in after becoming a permanent resident. So these little catches can get you anywhere!
Thanks for the shoutout, The Professor, but my point was going to be that this debate would be very different if people knew that "insurance" is, itself, simply a way of socializing costs. It ends up costing more (even a non-profit has to pay actuaries) overall, a lot more if profit is made at each level of insurance and (the hidden elephant) reinsurance, but it has proven valuable enough that our society even insists on it for automobile drivers.

The principle is that we pay much less than we *might* use, somewhat more than we will *probably* (on an actuarial basis) use, but a lot more than we hope we use.

What needs discussion is why the HEALTH part is so out of whack from the other areas of insurance. The overhead at a body shop is nothing like it is at my HMO, for example. But at the body shop I actually see the bill and I know what the car is worth.

My take on The Professor's question is that the problem begins with ignorance. Most people, including most of the talking heads on TV, have no idea what their insurance actually costs and also have no idea what common procedures cost. (Heck, lots of the protesters don't seem to know that getting rid of socialized medicine means throwing them off of Medicare!) I was, frankly, stunned at how much a routine procedure like a colonoscopy costs, or the degree to which Americans subsidize the cost of drugs sold overseas.
Anonymous 5:59 AM has it right. When I switched jobs last year, I had the standard 60-day waiting period, and the option to buy COBRA coverage. I could choose to pay for COBRA right up to the 60-day mark, and if I didn't, it would be retroactively canceled.

So, why not roll the dice? If I get hit by a bus on day 33, I pony up the COBRA money so I don't wind up being counted as uninsured. If I don't need medical attention before day 61, I "forget" to pay for COBRA, they retroactively cancel it for the period I didn't need it anyway, and I'm good to go.
1. EVERYBODY gets sick, and EVERYBODY dies. Health "Insurance" can not follow the same Risk Pool rules as, say, automobile insurance. In order for the principle of risk pooling to work, the young, healthy, poor people MUST pay the costs of the old, sickly, rich people. [ps they are the same people, just separated by 50 year careers]

2. Americans spend a lot more on health care. By choice! My 84 year old mother in law just had a boob job and eyelid tuck. My sister just had a total body scan. A 350 pound, 62 year old colleague just got a hip replacement. Americans spend more on health care. By choice. We are getting things we want and we are paying extra for them. Americans spend a lot more on food than Somalians too. Oh No! Single Payer Food Care for us!

3. Life span is a "tree apples" to "horse apples" comparison. Account for lifestyle choices (accidental deaths, homicides, etc.) and US lifespans go back to the top of the stack. [for a great case study in "how to lie with statistics" see infant mortality rates calculations . . . if you let the child die "naturally" prior to passing throught eh birth canal, it doesn't go into the ratio. If you take heroic efforts to save it, and it dies, you just tanked your numbers. Et cetera.]

4. Survival rates are a better measure . . . rates of proper/timely diagnosis and treatment are much better measures. Again, the US system goes back to the top of the stack when you account for this.

5. O.K., so Big Pharma charges US citizens $10 a hit for Viagra in the US and $2 a hit for Niagra (generic Viagra) in Canada. It's called market segmentation and cross-subsidy. Force the company to charge everyone $2 a hit . . . and they won't invent Viagra II. There is a core fundamental reason why all the cool stuff gets invented in our horrible US health care system. Aesop had a goose once, that was accustomed to producing golden eggs . . . I'm not sure stifling innovation is the best long term solution (but it WILL certainly equalize outcomes!)
Anon at 8:40 - that's a complicated question to answer, but I'll provide some insight gained from teh internets (which you could easily use to get this information for yourself the next time around!).

I live in Ontario, which charges a sliding-scale health premium. If you make $20,000 you pay $300 a year, if you make more you pay more, up to $900. This is on top of the Federal money Ontario receives for healthcare, which comes out of the Federal taxes Canadians pay. At that level we have a progressive taxation system. According to wikipedia single Canadians with no children pay 31.6% (US people in the same category pay 29.1%), married Canadians with two children pay 21.5% (US couple with 2 kids pay 11.9%.

Here's the wiki site, which has a taxation comparison chart at the bottom:

Janice - I'd forgotten about the wait times for immigrants (I immigrated long ago as a child so these details weren't so important to me) and that is wrong, especially since you'd been working and paying taxes.
I'd like to challenge confused_professor to provide some statistics for his claims that US survival rates (for what? for whom) are better, as are lifespans (what "lifestyle choices" are you referring to?).

I'll also stick my neck out and say that while eye lifts and tummy tucks are medical procedures, they aren't, in my mind "health care" in the strict sense of the term, under any health system those things would almost always be considered 'elective' surgeries and be paid for out-of-pocket. Elective procedures aren't under scrutiny here, health care is.

First, thanks for asking. The misuse of the numbers in this argument is shameful. Like a lot of issues in our country,once you start talking about huge $$$$$, liars and opportunists will come out of the woodwork to push their "special interest" objectives.

1. Don't take my word for it. Check WebMD (or, better yet, access the peer reviewed scholarship on this). You'll be surprised at how much better survival rates are in the US compared to "Single Payer" systems. Worst case scenario (certain illnesses which are rare in the US and common elsewhere) the US survival rates are "at least as good" as the "best case" elsewhere. A big reason why is because in the US we run all kinds of "unecessary" (and expensive!) tests which actually help our timeliness and appropriateness of diagnosis numbers.

2. I agree that "elective" stuff shouldn't be included in the comparative numbers. But that is not how the comparisons are being made. Subtract the billions of dollars americans spend on treatments/tests/procedures that are not allowed/available elsewhere, and our per capita costs fall right in line with the "most efficient" systems. Again, don't take my word for it- look it up yourself. This one is harder to do because the US elective/experimental stuff is ALWAYS lumped in with our total costs. You have to manually subtract the costs of huge swaths of stuff we do over here that you can't get "over there" in order to get a fair comparison. Take away AIDS and gunshots (both the result of lifestyle choices) and the costs become a whole lot less lopsided. Take out the hair plugs and botox, and we achieve comparability. Take out the stuff that isn't generally covered outside the US (hip replacements for 100 year olds), and US costs are actually less . . .

Hell, here in the USA we think nothing of replacing the pacemaker of a guy with terminal cancer . . . and we aren't ashamed one bit by it. Quite the contrary.

Of course, instead of making rational comparisons, it is so much easier and so much more fun to just demagogue the numbers with bogus "statistics" about average life span and per capita costs . . .

[p.s. sorry to be so irritatingly "Socratic" about this but no matter what "numbers" and/or "cites" I provided they would be nowhere near as powerful an argument as what you come up with on your own, using your own criteria.] My purpose is to expand the discussion, not take a side.]
Oh right someone just reminded me by IM that we divide total costs by the number of legal residents in the US. If we used actual population in the denominator, and excluded the cost of health care provided to legal visitors, it would tweak the numbers a bit lower as well.

In addition, the comparisons between the US, Switzerland and Germany (numbers 1, 2, and 3 repectively in terms of per capita costs)are as far as you really need to go. The differences between "what is covered" (everything in the US; not so much in Switzerland and Germany) and what is "not covered" in those countries is pretty enlightening.

Again- you aren't going to trust my numbers and/or references in any case. Assume I am just proposing a "thought experiment:"

"What would happen if we compared outcomes and costs uniformly between health care systems?" and see what happens.

[The much cited WHO report ranking the quality of health care is ludicrous . . . read it! Pay particular attention to the methodology associated with the ranking criteria. "Social Justice?!" Yikes! We are all to be equal(ly sick and underserved) in our misery . . . ]
Grumpy: Speaking as anon 8:04 or whatever, I couldn't actually look up on the internet what I was asking. You said it was worth your paying the extra taxes, and I was wondering just what *your* additional burden was to have this health coverage.

I will be less obtuse: it is easy to say I think it is well worth some rich person paying higher taxes so I can have cheaper care. But not very convincing.

Here is my suggestion, since everyone seems to think we need to be "fair"--let's charge everyone the same flat rate. Each person. Regardless. If everyone is entitled to the same care, and if we are, as I so often hear "in the same boat," then we should all share an equal burden.

Fair. Equal. Democratic.
anon at 8:40 - Your original question was how much my personal income taxes increased by having universal care. Well, I can't answer that because healthcare has always been covered under my taxes, so there hasn't been an increase just for healthcare. So I provided you with a more general answer in an attempt to address how much overall tax Canadians pay, and what our healthcare premiums are on top of that.

For clarity I'm near the bottom of the pay scale so pay the $300, but I'm happy to pay more when I make more. But I'm a firm believer in progressive taxation, and I do think people that earn more should pay more. I'm not necessarily concerned with 'cheaper' care, but universal care is important to me. I am grateful that I live in a place where, for the most part, no one needs to be convinced about the benefits of this to our society.

A flat fee would only be fair, equal and democratic if everyone also received a flat fee minimum wage guarantee, or indeed equal pay across the board.
Dear Yet Another Confused Professor

I'd like to take you up on the issue of "survival rates".

The figures usually published are the 5-year survival rate - ie the proportion of patients who are still alive 5 years after diagnosis.

Clearly where there are effective cures, it is important to diagnose early, but there are still cancers where there are no effective treatments.

It's also important to note that many cancers are both very slow- growing, and initially asymptomatic.

This means that if you routinely screen everyone annually, you will diagnose such cancers early (before any symptoms appear). If you don't screen until a patient reports symptoms, then you'll catch the cancer later.

As an example: prostate cancer.

A 65 year-old man who reports to his doctor with symptoms will, sadly, probably be dead by 70.

A 60 year old who is screened and diagnosed still won't have any symptoms until he's 65, and will probably still be dead by 70.

Based on 5-year survival rates, the first man won't have survived, the second will, but they'll both have the same life expectancy.

I am also confused by your first point. Do you think young, healthy people should be paying for the health costs of the elderly, or not?

And finally, you say "We are getting things we want and we are paying extra for them". What about all those who can't afford it, or those who though they could, and then find their insurers using small-print to deny them coverage. Should anything be done to help them, or is it just their own fault for not being rich enough?
There's a tool at the WHO that is handy. I ran the 2006 numbers for the UK, US and Canada and the US came out on the bottom except for spending! But I'm sure if confused prof could eliminate those 'lifestyle choices' he might get results that prove his point (and yes, you do have one CP, as do we all).
My public university has a 31 day waiting period on the theory that insurance must be prepaid. With a monthly payroll, that means that insurance won't start until after the first month's premiums are paid.

A more important note for this correspondent: maintaining continuous insurance, through COBRA or privately, could be absolutely essential if you have any pre-existing conditions, which your new insurer may refuse to cover if you have not had continuous prior insurance.
YACP writes in item 1:

Health "Insurance" can not follow the same Risk Pool rules as, say, automobile insurance.

It can and it does. Have you ever purchased private (individual) health insurance? That is exactly how it works. Ditto for the plans used by one local small business, where there is a different premium for each employee.

There is also a risk pool for large group health insurance plans. If that sort of analysis didn't work, my HMO would go broke. Their bid is based on the actuarial data for the population they will be covering.

Regarding item #5:

Thanks for making my point that our health insurance system is subsidizing low prices in other countries.

My point is not that we don't try to treat health insurance just like we do other forms of insurance (we do); my point is instead that it is *inappropriate* to treat it the same way.

- Not everyone in the risk pool for homeowner's insuranc has a fire

- Not everyone with automobile insurance has a collision

Etc. In those risk pools, those who don't experience the "event" subsidize the coverage of those who do.

And the risk factors over time remain somewhat static, and/or re readily assignable (yielding higher car insurance rates for younger/older drivers etc.).

Those characteristics form the conceptual basis for the idea of shared risk and risk pools.


Some estimates place 80% of the total cost of US health care on "End of Life" issues.

So you can't (well, we try! maybe more approapriate to say we "shouldn't") treat the risk pools for health insurance the same way zs we do the risk pools for other stuff.

Instead of pooled sik, and the static subsidy of outcomes, we get instead an intergenerational transfer of wealth.

The young and healthy end up having to pay for the events that WILL INEVITABLY (no "risk" at all- it's a certainty) befall the aged and infirm.

Calling it "health isurance" is just as inapt as calling Social Security a "retirement savings plan."

Inboth cases, young, poor people must be forced to pay for hte costs incurred by the old, wealthy people.

The rub is- they are the same people, just at different stages of their lives.

If we could get the young, healthy people to SAVE UP and build a actual "health care fund" to cover themselves in their later years (ditto for retirement savings) the system would work.

Instead, our "something for nothing" mentality tries to collapse the risk-tme continuum and we end up reverse-Robin-Hooding the whole thing.

And no need to thank me for recognizing the truth of cross-subsidy. It is what it is.

Extend the concept- what has happened to the costs of medical procedures and technologies in the areas where individual people pay out of their own pockets for care?

Laik, Botox, face lifts, etc. are all much cheaper, much more effective, and continue to develop.

Market forces (sorry) still work much better than any centralized, bureaucratic, communal "wisdom" handed down from on high.

The "godd news" is that when the us health care system is destroyed, and innovation stagnates, nobody will notice. The whole "unrecognizable victims" vs. "recognizable beneficiaries" thing.
Like a lot of issues in our country,once you start talking about huge $$$$$, liars and opportunists will come out of the woodwork to push their "special interest" objectives.

Finally, something yacp and I agree on fully.
yacp, could I have a cite on the 80% number? The numbers I've read are more like 30%, which is still a huge deal, but inspires a little less "Logan's Run" kind of thinking.
Actually, you know what?

yacp, if you're interested, we can contact a local escrow form, because I will bet you twenty thousand dollars, adjusted for inflation, that in 20 years, if we pass a plan with a public insurance option:

1) Other countries' survival rates for various illnesses will continue to improve, showing that there was no free-riding on the US system, and

2) US survival rates and other demographic stats such as infant mortality and life expectancy will climb into roughly the middle of the pack of developed countries.

I wish we could do it earlier, since 20k will be far more useful to me now than it will be then, but I am so absolutely certain of this that I will extend this offer to as many of your fellow travelers as you can possibly find. I'm just not going to have to cover those bets.

I notice you haven't responded to my comments about survival rates - any reason?
YACP wrote:
"Take away AIDS and gunshots (both the result of lifestyle choices) and the costs become a whole lot less lopsided"

The only two not-in-the-military people I've known to receive gunshot wounds were people caught in the wrong place at the wrong time (e.g. my grade school classmate who was killed by a stray driveby bullet). I know it's only anecdotal evidence, but both of these people did not receive gunshot wounds due to 'lifestyle choices.' I find your generalization insensitive.

My response was (paraphrased) "it would be better if you sourced your own data, since I am not arrogant enough to believe you would trust *any* numbers I provided myself."

I did give a caution about using the WHO data (which you ignored immediately), so I don't see how it would be possible for you to take anything more specific ffrom me at face value!

Apparently nobody is interested in actually trying to dig these issues out? I agree, it is not easy to discover the details of how "cost comparisons" (between USA and Switzerland, for example; #1 and #2 in "cost per capita") are calculated.

My proposition is that there aren't as many 84 year old boob jobs and 300 pound hip replacements in Switzerland as there are in the USA . . . and that there aren't as many (uncounted) non-citizens in Switzerland either, for that matter.

So why does the WHO studiously ignre the comaprison?

Ahhh, right; they are more concerned about "equity than "health care outcomes!" (read the infamous report upon which much of this disinformation is based)

Oh and thanks- I forgot that to make a fair comparison, we also need to exclude the cost of military health care from the numbers . . . the USA tends to bear the brunt of (without arguing just/unjust war opinions) violence across the planet, not just in our own country.

The CDC collects data on mortality rates. You will be surprised at how tiny a fraction of shootings are accidental.

The world is a harsh place when you see it as it is, not as you would wish it to be.

Good to see Punditus back in form!

Also, a sincere "Huzzah!" to Yobama (he sure as heck ain't *my* bama) for backing away from trying to spin this as a "Health Care Problem" (it ain't), and craw-dadding away to more apropriately characterize it as an "insurance" or "who pays" (as opposed to "cost") problem.

Progress in the discussion, however slight and incremental, is welcome.

From the CDC website:

Firearms deaths per 1,000:
All: 179,065
Unintentional: 121,599

Did you really think no one would check your references? You gotta stop hanging our libertarians; facts aren't like garlic and wolfsbane to liberals.
"hanging out around," sorry. My meaning was clear.
And, finally, that obviously wasn't per 1,000. The per 1,000 numbers are:

Unintentional: 40.70
Total: 59.94

Only in libertarian land is a 2/3rds majority a tiny percentage.

You've completely missed the point!

Could you please go back and read again my comments about the links between early testing for incurable cancers and definitions of survival rates.

Once you've done that, could you please explain whether you are talking about 5-year survival rates (in which case you need to deal with the issues I raise) or some other, non-standard measure.

Your link led to a "WISQARS Injury Mortality Reports, 1999 - 2006" request page. Since I don't know what you selected for your request, I can't get the same results you did. However, the printed reports do not seem to present the same numbers (nowhere even close) that you do.

(However, I found it odd that the total number of deaths from all accidents is the same number as what you are claiming are the accidental deaths from firearms . . . )

Follow for a better table. Accidental deaths from firearms hover around 2% of all firearm deaths for the last 10 years or so. If yu prefer the CDC numbers, then for one single year (2001) the numbers spiked: total number of FIREARM deaths (29,573) vs. the number of accidental FIREARM deaths (802). This gives us somwhere around 2.711% of firearm deaths being accidental (the numbers for intentional/unintentional injury are similar).

3% is, well, what I meant by "a small percentage." Sorry if I was unclear. I didn't intend to imply that total firearm deaths (accidental plus intentional) were a small percedntage of all accidental deaths- which doesn't even make sense.

The point is the vast majority of firearm deaths are INTENTIONAL. So to include VOLITIONAL acts of death in the same stats as falling down the stairs, drowning, or auomobile accidents (now *there's* another "tree apples to horse apples" comparison for ya! Gee, do ya think Amurricans have more automobile related health care costs than Switzerland? Do ya think?)

The point is (still) that a whole lot of what goes into health care costs in the USA (total and per capita) are NOT directly comparable to other nations and cultures. When you make rational cause-cause comaprisons, the whole "Health Care in the US is not as good as X" totally fall apart.

John, use either of the two standard measures. I don't really have a preference. If you do have a prefeerence, then by all means, choose the one that helps your argument.

Again, the point is that "life expectancy" is a crappy measure of comparison. The 5 year survival rate from day of diagnosis is one of the most popular (with or without recurrence) used with the various cancers. I note the UK, the CDC in the USA, and the WHO have done a good job of trying to compare survival rates equitably . . . but each KPI used will tend to favor one or another "spin" on the outcomes.

I'm not trying to force any one preferred method of measuring survival rates on you.

I expect you will prefer the one preferred by your national health service . . . which is the one (of course) that puts the performance of your national health care system in the best light.

The two main arguments for Yobamacare:

- Health Care in the US sucks because it costs too much
- Health Cae in the US suks because we don't even live as long as other folks

are BOTH totally egregious BS.

No, worse than BS, because of the immoral intentions underlying the argumens. If the arguments were just stupid, or wrong, that would be one thing. But to make stupid and wrong argumnts to achieve a "bitter end" is even worse.


Point of clarification (raised by a private message).

It's been around 2% for the last ten years (as I said). It has been coming down over time. The "high point" of 2.7% was in 2001 . . . of the most recent data, not going back to 1999 as the DOJ table shows.

I can't believe someone sent me a blistering personal email calling me a liar just because 2.7% was not the "high point" on the DoJ table.


I guess if quibbling is all ya got . . .

Still waiting for someone to try to defend the ludicrous WHO comparative health care "study!" [sic]
I don't know enough to either dispute or support WHO's health studies in any particular case. WHO has a lot of credibility in general; they are the ones who coordinated the eradication of smallpox and are currently finishing off polio. The US does do badly in population measures of health, including infant mortality and life expectancy at any given age.

I used the website for firearms deaths incorrectly; upon examination, your numbers are more accurate. However, the site does not distinguish between firearms deaths due to violence where the person injured or killed was the intended target as versus bystanders, which is the scenario posited by Anonymous above. If you're holding that "being in the wrong place at the wrong time" is a lifestyle choice, rather than a lifestyle imposition . . . well, that's the kind of incapacity to comprehend the lives of others which is inherent to libertarian policy.

The argument seems to be that socializing medicine will somehow produce worse outcomes. However, the opposite is clearly true; life expectancy fairly closely tracks government expenditures on health.

Check out the outliers -- countries well above the curve tend to have extensive government expenditures on health, and countries below the curve tend to have extensive private expenditures.

The data is pretty clear that health is a public concern; it's one of the things which governments handle better than private entities. Libertarians should concentrate their arguments on appealing to the envy and greed of their persuadables, rather than pretending that it is possible that a private system (or the current system) could conceivably deliver superior outcomes. Singapore is a prime example of this -- even though their health care system is a public/private mix, it is incredibly closely controlled. And the government pays 80% of basic services, flat-out, period, done.

If libertarians wanted to contribute to the debate, they could pound on the fact of non-transparency in health costs. That would be consistent with their supposed ideology and allow them to actually improve the system. Of course, they never will, because libertarians don't actually believe what they say they believe and they don't want to contribute to the debate.
Actually, you know what? That's it! That's the thing that's been bothering me about libertarian pretenses to contributing to the debate. If any market-oriented system is going to work, it will have to depend crucially on transparent pricing and outcomes so that people can make informed decisions.

Why in the name of the sacred Rand is this not the primary reform being desperately waved by libertarian groups? This reform is flat-out necessary, utterly needed for any market system to function. And yet, nothing.

Which two standard measures are you talking about?

The only "standard" measure is the 5-year rate - proportion of patients surviving 5 years after diagnosis. This is used in both the UK and the USA, and on this measure the UK often comes out worse.

I was pointing out that how meaningful this comparison is depends on whether noth countries use the same screening regimes. They don't - screening happens earlier in the US, so there's a greater likelihood of surviving for more than 5 years, but (for many cancers) no greater average age at death.

You are the one who, quite rightly, is wanting to not compare "tree apples" with "horse apples". Still, if you want to quote the figures that favour you, without worrying about whether you're comparing like with like, that's your prerogative.

At least you did (sort of) address the issue.

So how about my final point:

And finally, you say "We are getting things we want and we are paying extra for them". What about all those who can't afford it, or those who thought they could, and then find their insurers using small-print to deny them coverage. Should anything be done to help them, or is it just their own fault for not being rich enough?
I don't know what happened to the reply I posted to YACP, but it was probably too long anyway.

All that really needs to be said is that his statement that "everyone gets sick and dies" is false. Lots of people die without going through the cost and pain of months of expensive end-of-life care but, more importantly, much of that cost is currently being paid for by that evil socialist program called Medicare. It has a much smaller effect on the private and group plans that provide the bulk of insurance for people under 65 than it does for Medicare.

All my insurer cares about is whether I stay healthy until I retire and/or turn 65. At that point their risk is over. But they still have to set their rates at a level that matches their actuarial risk for a group of college employees in this area, and they do.

I stand by my original statement that health insurance is governed by the same socialization of cost that applies to all insurance: The principle is that we pay much less than we *might* use, somewhat more than we will *probably* (on an actuarial basis) use, but a lot more than we hope we use.

And I think I also pointed out that we have already tacitly agreed to pay 1/6 of our national income on health care and have tacitly agreed to increase that spending at an alarming rate WITHOUT any federal involvement. Some of that is via a variety of federal and state taxes, and some of it is via a very regressive hidden "tax" paid when an employer hires someone into a job with health insurance. For some of the jobs at my college, that tax is around 20% -- bigger than FICA. We ought to be able to do better at the same or smaller cost to the nation.
"Yobamacare" @12:36PM posting....

I really don't mind when people give us this sort of insight into their thought process, because seemingly race-loaded "humorous" allusions like that will not make your argument stronger in the eyes of MOST Americans.
"Race Loaded?"

C'mon, CC, you are better than that.*

33% of eligible voters (high side; actual numbers probably less due to fraud) put the current administration in power.

The current head of the administrative branch has made it quite clear that he has no expectation or desire to be the president of "all the people."


Back to the main issue: We are continually bombarded with lies about how bad our health care system is, and how badly it needs to be "fixed."

If it isn't as bad as is being claimed, and it doesn't need to be "fixed," then we don't need to saddle future generations with the incredible expense and pain of government rationing, quality of life panels, loss of innovation, prohibition on "elective" procedures (like hip replacements for 70 year olds), and all the other crap us serfs would have to put up with under a more "socially just" system of "health care."

The lies continue . . . we are told the "public option" is off the table, but [government sponsored, controlled, and regulated] "Co-Ops" are being considered . . . HELLO?

*Last refuge of the modern scoundrel . . . ethnographers will be arguing for years over how much of the preferential treatment given to the current president was race based vs how much was ideological. Personally, I think it's mainly ideological. But that doesn't explain the full effect certainly.
Not sure about your religious proclivities, CC, but the claim that not everyone gets sick and dies is, well, curious.

You do admit that everyone dies, right?

You do admit that everyone gets sick (at least once?), right?

What part of "everyone gets sick and dies" then is not true?

Do you have a counterexample of someone who has either never been sick, or never died?

I guess a still borne baby could be said to have never gotten sick . . . ?

[Shout out: the WHO study I am referring to is the infamous "Comparative Health Care" used by the current administration and its fellow travellers to make ridiculous statements like "US health care is rated "Nth" in the the world" (where N is some shameful number larger than 10).]
As I follow the health care reform issue from the outside, I am rather bemused at how quickly the 'debate' has turned into shouting and name-calling.

Is name-calling normal behaviour for American adults? On this side of the ocean it is considered juvenile, something you grow out of when you are a teenager.
"less due to fraud" -- I'm sorry; I'm not nearly racist enough to subscribe to that particular conspiracy theory.
Nothing at all racist about the documented illegal activities of various left-wing organizations, Punditus.

And yes, I accept your (non) apology over the firearm mortality issue.

Glad to see you are being so mature about it . . .
yacp -- there are virtually no documented anything of left-wing groups. The DOJ under the Bush Administration found 120 instances of fraudulent voting over the course of five years, almost all of which were ordinary errors by individuals.


You really have to ask yourself why you're so susceptible to such obvious false claims.
Are yoiu *really* sure you want to do this again . . . and so soon after the last time!

You're still ignoring me.

And finally, you say "We are getting things we want and we are paying extra for them". What about all those who can't afford it, or those who thought they could, and then find their insurers using small-print to deny them coverage. Should anything be done to help them, or is it just their own fault for not being rich enough?

Or do you think the above isn't true, and there in fact no such cases of Americans without health cover?

Not sure what type of response you were looking for . . .

is this related to the common misunderstanding that health care and health insurance are the same thing in the US?

No, anyone can present at any hospital/clinic/ER in the USA and receive medical care.


The really interesting question is this: how does (let's call it) "baseline care" inthe USA compare to "national health care" in other countries?

I am assuming it is "much less than" the level of care that Canadians and Europeans receive- but *how much* worse?

(p.s.- the uncovered cost incurred by treating indigent patients in the US . . . as well as the un- and under-reimbursed Medicare/Medicaid costs . . . are passed along to . . . the evil [overpriced] insurance companies! Go figure!)
yacp -- nice dodge. I assume this is like the 80% end-of-life stat, where there is no cite and will be no cite, ever.
And yes, any person can present to any ER, thus guaranteeing from the moment they step into the door that they will be required to declare bankruptcy. If they're allowed to.

That's actually not cool, in a general sense, if we're trying to create a society in which people actually build up wealth and credit.
Well, since the thread has been thoroughly hijacked a long time ago . . .

1. Are you denying that ER treatment provided for free does not generate cost?

2. Are you denying that MedicAreAid reimbursements do not cover actual costs?

Where, then, do the unreimbursed costs go? Who pays?

3. You are using the stat about what percent of medicare costs are incurred in the last year of life (27%). That is a narrow wedge of costs, and a narrow wedge of data. I am using the holistic RAND study that specifically tracks spending over a lifetime. The numbers look very different when you fence out most of the data.

Simpler put: if you look at only the last 30% of life (capturng the final 60% of spending), and then compare the last 1% out of the last 30% (lets see now .01 times .30) you would get a much smaller percentage than if you were to look at toal spending over a total lifetime.

The main point is this: the two main premises for our NEED TO DO SOMETHING NOW! are

1. We pay more for health care in the USA; and

2. We get worse health care in the USA

Both premises are only "true" if you cook the books a certain way.

How much pressure would there be for nationalized health care if we made legitimate comparisons of both cost and quality?

We pay more; we get more. How much more do we pay, and how much more do we get?

*NOBODY* on either side of the issue seems to be interested in finding out . . .

Anyhow, I have to get back to work.

Somebody has to pay for all that unreimbursed health care costs!
We pay way, way more than the Swiss, and I'd way, way rather live in their system. Same goes for the French. Same goes for the Brits, who definitely have the 2nd worst system, it's just that ours is so much worse.
yacp -- there still is no lefty vote fraud, and it says a lot more about you than about the world that you think there is.
Guys, seriously. This dead horse is thoroughly beaten. Let's shake hands and move on.
So you are implicitly condoning the use of unfounded accusations of racism in your blog?

A little introspection is probably in order.

Don't bother banning me. I know the way to the Gulag by now.
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