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Monday, March 22, 2010

Tick Tock

It must be the needed breaks from kitchen cleaning while a chemical penetrates or a grate soaks is what is keeping me coming back to the Wolf's recent post, but after last night's vote to further nationalize healthcare, one-sixth of the economy, I'm not really sure that at the end of the day, between our own mismanagement and the command-and-control economy we are almost certain to end up living in, that there will be much more to discuss. Whether you are a supporter of the health care bill, or you are opposed to it in every way, shape, and form, there is no denying that the bill (should it not be thrown out in the court system or repelled after an upheavel in November) will fundamentally alter the economic landscape here in the United States.

One thought on my mind is that whatever starts to happen in the general economy will be magnified many fold within our own micro-economy. I believe that Jewish communities have an above average number of people employed in the healthcare sector (not just physicians, I'm thinking the big two: Occupational and Speech Therapy). I believe that we also have an above average number of people who draw some of their livelihood indirectly from those in the healthcare sector (lawyers, accountants, programmers, etc, etc, etc). There is already talk of raising taxes on investments, and another large group in the Jewish community draws their livelihood, directly or indirectly, from investors. Our synagogues, schools, and non-profits are also quite dependent donations from those who are directly or indirectly affected by this fundamental change.

In other words, nearly every sector of the American economy and nearly every sector of the Jewish economy, will be affected by this healthcare bill. With the exception of fighting "toeva marriage," I can't recall any of our umbrella organizations fighting against some of the big issues, e.g. the move to a command-and-control economy or the increasing tax burden on "the rich." On second thought, I do believe the OU had a statement regarding capping itemization for charitable donations, but in general the lobbying has been for more money for certain communities and projects and more money/tax credits for yeshivot.

Sorry for the gloom and doom, but I'm very concerned that at the end of the day there won't be much more left to talk about if our economy is fundamentally altered. That's one [wo]man's opinion.


Anonymous said...

To me, while it looks like this bill is bad for the MO community, it will give the yeshivish community more options. Covering "unmarried" children until the age of 26, subsidizing health care for those under 400% of the poverty level (which can be pretty high with a lot of kids) I wouldn't be suprised if a whole cottage industry pops up figuring out how to scam this system.

Orthonomics said...

As far as I can tell, there is a good deal of dependency on the MO community. The MO community receives plenty of visits.

As for the cottage industry. . . no doubt.

Bob Miller said...

Some of our Jewish office-holders and organizations are so focused on bringing home new goodies "from the government" (i.e., from taxpayers) that they fail to realize how insidious the ever-expanding government command and control is.

I want to see them tout their ability to liberate all Americans (not only Jewish constituents) from government intrusion and not to enslave them further.

Jews have done rather well at private enterprise, to everyone's benefit. Why should we want to smash that system?

Dave in DC said...


Isn't it just as plausible to argue that all Jews (and Gentiles) make their living within the American economy, and that since spiraling health care costs threatened that economy, efforts to shift the cost curve should be encouraged?

Do we believe that any flavor of Jew are somehow immune to the sad, simple cycle of misfortune that goes "Have Job. Have Insurance. Get Sick. Lose Job. Lose Insurance. Go Broke."?

Can we realize that Israeli universal coverage serves lots of Jews quite well with equivalent outcomes to the United States at less than half the costs?

Orthonomics is a great blog. Let's not turn it into Orthopolitics.

elanit said...

Amen, Dave. Especially to that last line.

Anonymous said...

Ditto to Dave and elanit. Thank you for some sanity. I am staying away from the Jewish cut and past news blogs today since I can't bear to read all of the Rush/Newt style commentary that so many members of the Tribe have swallowed. I did not expect to see politics here.

Lion of Zion said...


"I'm thinking the big two: Occupational and Speech Therapy"

i haven't really been following the health care debate, but i don't think it necessarily has an effect on st/ot. the most lucrative st/ot jobs, which is what a lot of the ortho jews work in, is in early intervention (EI). this program is funded and directed at the state/local level. of course this is not to say that that EI jobs are safe, as every year the state legislature attempts to pop the ST/OT bubble and for various i'm sure it will happen eventually (when i went back to school for a backup job i originally went for OT, but then went into a different health field in part for this reason. we'll see if it matters in the end.)

Anonymous said...

With respect to your comments about the OU and other umbrella organizations not taking on issues like the health care reform debate, I think that is entirely appropriate. There are many different opinions among jews of all denominations and the umbrella organizations have nothing to gain and a lot to lose by antagonizing people. Also, you assume that if they took a position it would be anti government involvement. However, many would argue that the Torah true position would be to support universal health care. It's hard to say you support a culture of life without wanting to make health care coverage available and affordable for all. Similarly, you can't say that the government has the right to tell people who they can marry, but not that they have to buy health insurance. There were lots of good reasons for the umbrella organizations to stay away from this and focus on their core issues.

Mike S. said...

Well, to the extent that we have doctors, nurses and hospital administrators in our midst, it will be fine. This bill will greatly raise their income as it increases demand for health services with no increase in supply or regulatory cost control measures.

Anonymous said...

There is already talk of raising taxes on investments

What do you mean by "talk"??? The bill was passed yesterday and will be signed by the president into law in a few days.

On Thursday night I spent some time reading the bill (the parts that were released), and it essentially is a large tax increase for many, followed by some benefits for others a few years later.

For many people, capital gains will now, for the first time ever, incur an additional "Medical" (similar to Medicare taxes on wages today) tax of 3.X%. This new tax is on top of the increase by 5% next year when the Bush temporary tax changes expire.


Anonymous said...

I would estimate that those in the medical profession have another 7 to 10 "fat" years. What is likely to happen is that insurance, with the new mandates, will rise in cost. That rise in cost will drive customers away (as has been occurring with previous increases in cost). More and more companies will opt out of providing health insurance, and their employees will opt into the various government subsidized forms of health insurance. The increases in cost will get worse with more and more government mandates regarding coverage (first example is covering preexisting conditions, later there will be other costly regulations imposed), and the abandonment of traditional health insurance companies will accelerate. More and more people will be on government subsidized insurance programs, and the budget for it will balloon. That's when budget cuts will strike, and when medical professionals, along with hospitals, device makers, etc will have their fees/prices cut. Only a few percent at first, but that will increase as budget pressures increase. And there won't be much of an alternative choice at that point as an ever increasing percentage of the population will be covered by one of the government plans. The trajectory will be towards single-payer, with perhaps a few percent (maybe as much as 10%) of the people remaining under a system similar to the current one.

Every medical professional should begin their planning for this eventuality (and probably a very likely one).

lrg said...

Let me make an economic argument. If nothing was done then as the cost of health insurance continued to rise at a rate greater than inflation, fewer people would have health insurance.

There is a relationship between the price and the number covered. In my area many if not most medical practices are owned by hospitals, the result would be to cut doctor pay or lay off doctors, and other health professionals. The reason would be that the demand of paying customers would decline and the supply of professionals or their wages would be reduced.

This bill only smooths some rough edges.
Ineveitably, with or without this law the market will force salaries down. In Germany doctors are making about 3.4 times median income. the US is at about 5.5 times median income. Obviously, this varies by specialty. The US median income is about 50k. So, a back of the envelope calculation is that with or without this law, market forces will eventually reduce doctor income around 35%. This will be done either by layoffs, reduced wages or holding wages the same for about 15 years. It is likely to be some combination.

Commenter Abbi said...

wow, SL, maybe open the window a little more while you're cleaning. Why the apocalyptic tones? "Command and control economy"? That's a partisan soundbite if ever heard one. The US is the very last developed country to have any systematic way of providing universal healthcare for its citizens. You should be more ashamed and concerned bout that than doing something to actually solve the problem. And for simple economic reasons, as Dave mentioned and Irg

I'm very grateful to live in Israel where I never have to worry about losing my health insurance when I change jobs or decide to do freelance. I never have to worry about medical bankruptcy. I never have to worry about seeing the dr. too many times when I suspect my kids are sick. All this and last I checked our economy is quite far from that of Zimbabwe's or North Korea's, even in these times of global financial crisis.

rachel q said...

Thank you Dave...
and I agree with Abbi. Having plenty of experience with both the US and Israeli health care system I choose the israeli one. Many people in the US are simply afraid of socialized medicine without ever having experienced it or knowing that much about it. It's mostly fear based on ignorance.

Shevy said...

As a Canadian, I am thrilled that Americans will finally have at least a semi-decent version of the excellent system that we've had for as long as I can remember.

For those who talk about how "expensive" universal healthcare is or how "high" our Canadian taxes are I can only say that families of 3 or more here in BC pay $108 per month (per *family* not per person) for coverage that includes all doctors, specialists, hospital care, tests such as xray, ultrasound, CT or MRI, all prenatal care and childbirth (whether by a doctor or midwife in hospital or at home) etc, etc. While many GPs are not currently taking new patients because they have very full practices, there are no restrictions on the doctor you can choose (a la HMOs). There's no nonsense about not being covered for "pre-existing conditions" or having copays or about losing your health insurance if you change jobs or are unemployed. I once did a comparison of income taxes between someone living in Vancouver, Canada or Seattle, WA (highly equivalent cities about 3 hours apart) and figured that the Canadian taxes were very slightly lower.

I doubt that your system will be as good as ours. I think it will be overly complex and have expensive redundancies built in and it may have more limitations as well. But it's got to be ten thousand times better than the horrible situation you've had up until now.

I know lots of frum girls who've married Americans and are living in the US. I can't believe the kind of money they spend (even with "good" insurance, in some cases) just to have a baby or to get a child's ear infection treated, never mind if they have something serious (G-d forbid) like appendicitis or broken bones or develop a chronic illness. And far too many don't have insurance!

If you've just fallen off a ladder or are having a heart attack the last thing that should have to run through your mind is "how will we pay for the emergency room fee?"!

Commenter Abbi said...

Rachel q, I agree with you that this is about fear and ignorance, heavily trumped up by partisan politics, and very little to do with reasoned economic analysis.

Anonymous said...

I think the true "orthonomic" position is that no one should have to worry about losing their health insurance if they lose their job or have a pre-existing condition or going bankrupt or losing their retirement savings because of medical problems.

I, for one, am very thankful that the bill passed. I am just disappointed that there is no public option. I think it is outrageous that so much of our health dollars goes to insurance company/hmo profits. It is a shame that the wealthiest nation in the world lags so far behind other developed countries in providing health care for all.

Anonymous said...

If put to a vote, would the Israelites of the exodus also have opposed universal manna?

Bob Miller said...

No one was taxed to supply manna.

Orthonomics said...

I have no intention of turning this blog into "Orthopolitics" but I don't think we can ignore anything that will fundamentally change the economy because we live in this economy. Even if you favor this bill, I don't think you can ignore the impact if will have in American and within our micro-economy.

We already know that the Yeshiva/Day School system is hanging by a thread. I am very strongly against this bill, but will be taking my fight directly to the ballot box, not to my blog. But I have to wonder if, in terms to changing day schools, there isn't much left to talk about. Doom and gloom? Perhaps. Reality? Perhaps. Nonetheless, I hope that our umbrella organizations are considering the impact on our communities, not just thinking about what "goody" they can secure next.

And, just because something "works" in Europe, Israel, or Canada, doesn't mean the result can be replicated in America.

Anonymous said...

I am happy that the bill passed. I'm also dismayed by the lies and misinformation I hear. I also don't like it when yeshiva teachers, especially the right wing ones, propogate their political views to their students.

I have to laugh at some of the ignorance, though. My HS daughter was told by a classmate that a provision of the bill is that all doctors will make the same salary. Thankfully, she is educated enough that she didn't believe that one.

Anonymous said...

I'm also dismayed by the gloom & doom tone. If the yeshiva system fails, we will find other ways to provide chinuch to our children. Jews have survived thousands of years in adverse conditions: I can't imagine that even a major economic shift in the economy of the richest country in history is going to cause our downfall ch"v.

PayingParent said...

This bill is a nightmare waiting to happen. We can't afford it. In insurance terms, the effects are called "adverse selection" - wherein the pricing or social conditions of insurance cause people with really high medical costs to sign up for insurance while people with low costs are deterred. This causes higher premiums for everybody except the worst off.
Why the comparisons to Israels healthcare? You could wait a whole day in a clinic there just to get a prescription. THe standard of living in Israel is far below the US, with higher taxes.
THe only positive outcome that may come out of this bill, is that enough Republicans will be voted in to reflexively pass some of their social agendas- such as school vouchers. They will need to cut the budget somewhere- maybe they will finally go after those teacher unions like they should.

Larry Lennhoff said...

You might want to try the Washington Post's Health care calculator to see what the first order impact of the bill will be on you.

PayingParent the point of the individual mandate is to remove adverse selection as a concern.

dan from cleveland said...

i'm also very happy that the bill passed. having lived in israel, i cannot but appreciate what gov't health care has to offer.
I dont see why the OU should say a/t about it. they don't have a crystal ball, and who knows if the outcome will be good or bad for the jews?
it's presumptuous to think that our umbrella orgs should take sides on a complicated issue like this and alienate a chunk of their constituents.

efrex said...

I think it's extraordinarily premature to try to figure out all of the effects this bill will have on the long-term economic health of this country in general or klal in particular. There will almost certainly be extremes on both ends: wealthy donors are likely to give less as taxes increase; at the same time, I would expect to see significantly increased entrepreneurship, as people start their own businesses rather than being forced to work for established companies.

No matter how you slice it, though, neither our current healthcare system nor our yeshiva financial system are sustainable at their current levels. Major change is necessary in both, and I think that the overlap, no matter how significant, is not going to be the "make-or-break" difference.

PayingParent said...

The individual mandate does nothing to prevent adverse selection- it is only $695/ year. Considering that the basic insurance costs are 5 or 6 times that at least, it won't make a difference.
The only ones who will be rushing to sign up for health care because of this bill are those who can now get it free from the governemnt or those who have really high medical costs and have been denied coverage in the past.
Either way, the costs being added into the system far exceed the additional premiums. Translation: higher premiums for all.

Anonymous said...

PP: what should people who have high medical costs but don't qualify for Medicaid, and can't afford private insurance, do? What would you do if you were in that position?

Anonymous said...

Let me clarify: before the bill, what would you do if you had no insurance and ch'v high medical costs? Why is it that the people who are against the bill are those who already have insurance and somehow feel that they will not lose it?

Anonymous said...

PP - The individual mandate does nothing to prevent adverse selection- it is only $695/ year.

This is true, the maximum penalty (if it is even declared constitutional) is $695. And I also suspect that many of the people without insurance will simply not pay the penalty, and eventually the government will forgive the debt because most of those people are not in such great financial shape to begin with.

This bill is primarily a tax increase, at least for the first few years. But it is also a huge State tax increase because of the massive unfunded mandates included in it.


Anonymous said...

What about the benefit the community will recive with day school teachers who will no longer have to pay 6-digits to cover their families insurance costs.

This will also help people who want to get off programs. How many people are afraid of earning too much to avoid losing their right to govt provided healthcare.

As suggested above, in my experience there is much more entrepreneurship within the orthodox community, with a little more of a safety net.

JS said...

Was a bit disappointed to see this post. I simply don't understand why there is such incredible pessimism to the point that people feel this country really is going down the drain. I used to be incredibly conservative and proudly voted Republican, but I am just so ashamed of how these respective groups have acted in the last few years culminating with the obstructionism, outright lies, and cynical attempts to raise money from constituents at the expense of working for this country's future with regard to the health care bill. I mean, seriously, death panels?

I find it amazing that the people who are against the bill are generally people who have health insurance, don't have major medical issues, and are secure in thinking their insurance will never go away and will pay for any emergency no matter what.

It is an embarrassment that the richest nation in the world, which spends the most on health care has something like the 35th or so best health care in the world. Even more so that we have 30-40 million who can't afford health insurance, that the leading cause of personal bankruptcy is medical costs, that a black market in prescription drugs exists due to high costs, that if you get sick your insurance can drop you, that pre-existing conditions make you ineligible for coverage, that if you lose your job you lose your coverage (or have to pay a lot more), etc.

The most important thing about this bill is that is solves many of those problems. The framework is in place. Is it perfect? No. Is it at least a step in the right direction? Yes. The fact is that no one knows what the effects will be. It's such a far-reaching and sweeping bill we don't know what will happen to premiums, for example. But, the framework is in place and if we need to tweak, we can then tweak.

In terms of the Orthodox community, I think the bill will be beneficial. One of the largest costs for (MO) yeshivas is health insurance. This should make things cheaper. Or, for the RW yeshivas who don't offer benefits, the exchanges will allow cheaper insurance. Also, all the frum Jews who don't work for companies and are independent contractors (OT's, PT's, ST's, etc) can get insurance more easily.

I think also that many hospitals and doctors will be better off as they lose so much money on people who skip on bills and don't have insurance.

I could go on, but as was mentioned this isn't orthopolitics. I just think the doom and gloom is misplaced, we should remember how horrible the system in place is now, remember that tweaks can come later, and recognize that a lot of people in our community are getting killed by the current system.

PayingParent said...

Tesyaa- "Let me clarify: before the bill, what would you do if you had no insurance and ch'v high medical costs? "
There are government programs for the elderly and children already in place, so I assume you mean the guy who went voluntarily without health insurance because their job did not offer any. Perhaps if my job did not offer insurance, and I was reasonably healthy, I might make the choice that individual insurance programs are too pricey and not worth it. But then I would put aside a considerable sum each month to pay for medical costs. If something major happened and I had a real emergency, no public hospital refuses emergency care due to no insurance.
But to change an entire system due to a couple of sob stories that slip through the cracks is stupid and irresponsible.

PayingParent said...

Anon- "What about the benefit the community will recive with day school teachers who will no longer have to pay 6-digits to cover their families insurance costs.
This will also help people who want to get off programs. How many people are afraid of earning too much to avoid losing their right to govt provided healthcare. "

I will eat my shirt if those people on assistance use any extra cashflow that comes their way due to this bill to pay their Yeshiva bills. That's all Im going to say on that.
This might also hurt the day schools that pay insurance to their teachers since they will see their premiums go up.

Anonymous said...

If something major happened and I had a real emergency, no public hospital refuses emergency care due to no insurance.

That says it all. Who, exactly, would be paying for the care YOU would be receiving if you went this route?

PayingParent said...

The taxpayer currently subsidiezes emeregnecy, sobstory situations. Noone is dying due to no having healthcare. So why would we pass a bill like this?
By expanding the SYSTEM, all you do is add costly layers of bureacracy and open the taxpayer up to more corruption and abuse.
The system is place for the elderly, poor and children is already fraught with abuse.
What we have now is not perfect, but it does the job.

JS said...

Oh please. When they created medicare and medicaid (The system [in] place for the elderly, poor and children), people bitched and moaned as much as they are now and said "What we have now is not perfect, but it does the job."

Even with the abuse, they're good programs and essential to millions of Americans.

You say you'd go without insurance and put away money every month. Good luck to you. Even a minor emergency can cost tens of thousands of dollars between surgeons, anesthesiologists, hospital stay, nurses, etc. God forbid something more serious and you'd be of of the sob stories who had to declare personal bankruptcy for medical bills. By the way, just because the hospital can't refuse you, doesn't mean you don't get billed for it. It also means you may have to go to a lesser hospital as the private hospitals will refuse you. Not having health insurance would also likely mean you wouldn't get normal, preventative care as you feel fine so why spend a few hundred bucks a year needlessly? It's this attitude and lack of focus on preventative care that causes so much of our health problems - all because it's too expensive currently. And by the way, it's not a "few sob stories." Several hundred thousand people every single year declare bankruptcy because of medical expenses.

PayingParent said...

"Several hundred thousand people every single year declare bankruptcy because of medical expenses."
So we should overhaul a system that serves millions well for the sake of a couple hundred thousand a year?! I understand making programs and modifications to try and plug the holes, but this idea of "sweeping health care reform" is idiotic.
Thousands of people also go into bankruptcy because they buy cars and houses that are too expensive. Should we pay for those too? Oh wait, the government tried that also...
This bill does not fix any of the unsderlying problems of the current system, it just spends more money to pay for more health care for more people.
As far as "preventative care", the top 10 costliest conditions in the US are (according to Forbes Magazine):
1) Heart Disease
2) Trauma (such as car accident ER visits)
3) Cancer
4) Mental Disorders/ Depression
5) Asthma
6) Hypertension
7) Diabetes, Type 1 and 2
8) Osteoarthritis and other Joint diseases
9) Back Problems
10) Normal Childbirth
Few of these conditions can be "prevented" by regular doctor visits. ANd even the ones that you can say may be helped by additional Dr visits, will in all likelihood just be more frequently diagnosed, not prevented.
You cna't prevent old age, childbirth, trauma, genetic disease and cancer, which accounts for most fo this list.

YoelB said...

You can't separate economics from politics. To begin with, the costs on Obamacare are grossly understated.
Next, the plan mandates a large growth in government hiring; it's nationalizing a sixth of the economy. As it stands now, the biggest area of job growth in the last couple of years is government; jobs in government now tend to pay more than comparable jobs in the private sector and have better benefits, earlier retirement and better pensions.
State and local governments have their pension and retirement obligations guaranteed by the taxpayer. Worse, state and local governments, not to mention the Feds, are playing fast and loose with their accounting to claim that their obligations are soundly underwritten. Actually, in too many cases, the underwriting is more like: Buy lottery ticket. Win. Retire.

Add it up:
Shrinking private sector; private sector increasingly less attractive than government work
Unfunded entitlements: Medicare, Social Security
Unfunded government liabilities for retirement
Massive government borrowing
Disincentives for investment
Expanding demand for medical care as boomers retire
Likely shrinkage in physician supply.

In the UK, the National Health Service is the largest employer, amounts to almost half the budget and takes up a LOT of time with Parliamentary questions.

In addition, If Congress can require you to buy health insurance because of the ways in which your uncovered existence effects interstate commerce or because it can tax you in an effort to force you to do any old thing it wants you to, it is hard to see what - save some other constitutional restriction - it cannot require you to do - or prohibit you from doing.

Basically, anybody under 40 in this country is in deep, deep trouble and most can anticipate shrinking chances for prosperity. All this to insure 30,000,000 people (and that's heavily spun figure, too;) that's assuming we don't get severe inflation, aka the government (continuing its) printing of lots of money.

Look at it this way: Chazal tell us that the oppression in Egypt was so severe that people spent a third of their time working for the government. How well are we doing with that?

But let's not talk politics.

Commenter Abbi said...

PP your description of Israeli healthcare is circa 1986. I can make appointments to see my GP or ped 24 hours a day for the same day or the next morning and the wait is no more than 15-20 minutes on average.

If I need to see another dr. because mine is away, all of my records are on my magnetic card. If I need urgent care late at night or on weekends when my dr. is off, there is an HMO urgent care center open till midnight and on weekends.

OT/PT is covered and I get discounts on accupuncture. Seriously, for all the ranting about single payer, you have no idea what you're missing.

I understand, pple don't want to pay more taxes. But this is simply what it takes to live in a modern society ie: the way in which every other developed lives.

Anonymous said...

The orthodox community is facing major economic stress. Very few are doing much about it.

Anonymous said...

Anon 1:32: We would be less stressed if we scrapped the social requirement for universal private education. Ideally, people could choose homeschooling or public schooling without fear of social reprisal, and provide chinuch for their children in whichever way they saw fit. I'm looking forward to the day when social pressure, and financial pressure, doesn't rule people's lives.

JS said...

There's something very wrong with an ideological system that thinks helping several hundred thousand people annually not go into medical expense related bankruptcy or helping 30+ million people have the security and proper care that comes with insurance is pointless or laughable.

Commenter Abbi said...

"You cna't prevent old age, childbirth, trauma, genetic disease and cancer, which accounts for most fo this list."

Yes, but once you are suffering from any of these conditions, increasing dr. visits are required. So what's your point? Are you suggesting cancer isn't helped by seeking treatment from a doctor? Women under the care of doctors don't give birth to healthier children than those who don't? Where are your numbers?

"Noone is dying due to no having healthcare."

What planet are you on?

"Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday....Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage."

This woman died because her Medicaid dental insurance ran out:

Sorry, this is not a few sob stories falling through the cracks. This is millions of lives at stake and it's mind boggling that you're so cavalier with their lives.

Anonymous said...

Abbi, it's because it's "their lives" that people are so cavalier. The vast, vast majority of people opposed to this bill DO NOT LACK health coverage.

PayingParent said...

I was responding to JS's comment that "It's this attitude and lack of focus on preventative care that causes so much of our health problems - all because it's too expensive currently."
It is a false idea that making preventative care accessable to everyone will severely decrease health problems or medical costs in this country.
I would love for everyone in this country to get free healthcare, education, transportaion, housing, etc... the list goes on!
The fact is that our government can't afford it. Not unless we would like to switch to a socialist system, in which case Im quitting- there is no reason for me to bust my butt 60 hours a week when the government pays for everything anyway.

Anonymous said...

I would go so far as to say that those who have health coverage, yet object to expanding coverage to those not so fortunate, believe that they have their blessings due to kochi v'otzem yadi - due to their own powers, and not due to the actions of Hashem.

gavra@work said...

I like the idea of expanding coverage, but we could have paid for it in a much simpler fashion:

1: No MedMal for anyone on govmt programs.

2: MedMal premiums reduced by % of patients on govmt care.

3: Doctors get paid less by the govmt by the % of medmal they save

4: Repeat over Medicare, Medicaid, etc.

We could even end up saving money overall. Alas, the Ambulance Chasers give lots of moola to the Dems.

Lets see what happens.

Anonymous said...

The problem is that the government already has their own ideas about what constitutes medical care - excluding such tried and tested options such as accupuncture, homebirth, and most chiropractics. With choices in insurances you can sometimes/often find a plan that includes these "alternative" options, but with a government plan, there will be no chance.

Larry Lennhoff said...

The CBO study on medical malpractice insurance points out that

Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.

Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

JS said...

In terms of cost/care, I had a very interesting conversation with a doctor at shul recently. He is in his mid-40's and practiced medicine for a long time in South Africa. He then moved here and was forced to go to medical school all over again to get certified to practice here.

He said what he found most appalling about the American medical system and the way American doctors are taught is that here we have a test first attitude. If someone complains of a headache, the instinct is to send the person for a CT scan or an MRI or some other expensive test and then, based on what the test shows come up with the diagnosis. If the test shows nothing, the person is sent to more tests or sent home.

In other countries, doctors are taught to diagnose and use tests to CONFIRM a diagnosis, not to come up with the diagnosis in the first place. They use expensive tests far less often and spend more time talking to the patient and looking at medical history to determine likely causes.

He was saying that here doctors receive phenomenal training and are then taught to shut that part of their brains off because it's easier to test first, diagnose later and it's safer from a liability perspective.

Just his two cents, but I found it eye-opening.

Isaac said...

Re: gavra@work:

> 1: No MedMal for anyone on govmt programs.

It's not like suing for medical malpractice is [just] some sort of perverse lottery system (though it is for some). When people are harmed or killed by doctor negligence, they need a recourse for recovery, whether they're rich or poor.

It might make sense, for various reasons, to reform the medical malpractice process, e.g. as Dr. Atul Gawande suggests in "Better," but as Larry Lennhoff indicates above, the bottom-line impact would be small or indirect and hard to attribute.

Tova said...

"You can't separate economics from politics."

YoelB, I was waiting for someone to say this here!

SephardiLady, yasher koach on expressing your viewpoint - one that isn't tainted by statist propaganda.

Anonymous said...

I'm not sure if you realize it, but the number you cite of people who go bankrupt for medical reasons is a trumped-up farce of a statistic, useful as it may be to people arguing your position. Those numbers include bankruptcies due to death in the family, drug and alcohol addiction, and - wait for it- gambling addiction.
Sorry, but in spite of the moving anecdotes, this is not as common as you're trying to portray.

Incidentally, re: your detailed quoting of your sanctimonious South African MD friend is just silliness, and a classic rationalization of NOT using expensive test because of government rationing or lack of availability due to interference in the market. How about using fabulous diagnostics AND expensive medical procedures? There's a reason the US has way better cancer survival stats than most other countries, and part of it is those tests.

Anonymous said...

Anon @ 2:49 said:
"I would go so far as to say that those who have health coverage, yet object to expanding coverage to those not so fortunate, believe that they have their blessings due to kochi v'otzem yadi - due to their own powers, and not due to the actions of Hashem.

Okay, let's throw around irrelevant and frum-sounding insults. How about: you were just motzi shem ra al ha-rabbim, and now you better start figuring out how to be mechaper.

Whoops. Mine was relevant.

YoelB said...

Anon 8:11 PM wrote:"I would go so far as to say that those who have health coverage, yet object to expanding coverage to those not so fortunate, believe that they have their blessings due to kochi v'otzem yadi - due to their own powers, and not due to the actions of Hashem.

No, some of us object to a multitrillion dollar entitlement being enacted with a sixth of the economy being nationalized. It would have been a whole lot cheaper to subsidize the partially mythical 30,000,000 -- as in fact was suggested by a number of Republican legislators. This was never about "health care." It's a statist power grab.

So knock it off with the motzi shem ra yourself.

Med Student said...


Have you or your South African friend heard of evidence-based medicine? Some "expensive tests" save lives, some don't. Studies are done to determine which are effective and which aren't.

Incidentally, a patient presenting with a headache will not be given a CT or MRI scan absent other "red flag" symptoms.

Anonymous said...

Anon 8:05pm - Those numbers include bankruptcies due to death in the family, drug and alcohol addiction, and - wait for it- gambling addiction.

The numbers also include those who went bankrupt due to a $5,000 unpaid medical bill, yet who paid $12,000 in car payments overt he previous year for his and hers SUV's.


RAM said...
This comment has been removed by the author.
RAM said...

For those of you who wonder if the government would refuse some potentially lifesaving medicine or treatment because the patient is in a unfavored class (such as "too old"), see what goes on today all over the world.

Also, Dr. Ezekiel Emanuel has some disquieting thoughts on this:

Anonymous said...

JS - I simply don't understand why there is such incredible pessimism to the point that people feel this country really is going down the drain.

That may be overstating it, but I believe the main reason for the pessimism is embodied in this small graph -


Commenter Abbi said...

JS: I think pple just don't want to pay higher taxes. At least that's why my parents are annoyed.

RAM: The government will refuse treatment? This statement seems to imply that insurance companies don't currently refuse treatment every single day and continue to do so? It sounds like you currently have insurance. Why are you so sure that your company won't find some way to refuse you treatment for a life threatening disease tomorrow even if you've regularly paid premiums up until now? Ask your grandmother for what and when Medicare refuses to pay for treatment.

Seriously, it astounds me that even after 18 months of these debates pple still bring up these "reasons" why having the government involved in healthcare is evil.

David said...

The new law is over 2,000 pages, with lots, and lots of *intended* consequences, and certainly lots more *unintended* ones.

Here's one, which renders the above-mentioned Washington Post medical calculator worthless (it said my taxes would be unaffected):

There is now a $2,500 cap on FSAs, and a new 40% excise tax for employers who offer them. This throws a wrench into the lives of those of us who DO deal with major chronic health expenses every year.