U.S.A., A-OK

Great country, love the pirate-killinz. But [y]our health care system is messed up.

That is all.

Bookmark U.S.A., A-OK


  1. newly laid-off person says:

    Yeah tell me about it!!! (screams the newly laid-off person w/no insurance for family) This issue is very much keeping me up nights lately.

  2. The manager should be the next person on the chopping block.

    Seriously, the health care system is screwed up.

  3. Are you talking about how the nurse was let go, or that she was let go at all? If the former, I’m not sure the issue is necessarily systemic. If the latter, a bad economy means bad things for all kinds of workers, including those in health care.

  4. It’s even worse if you are a pirate. Btw–aren’t you one of us now?

  5. You are correct, Guy. Evans has joined us on the Dark Side!!

  6. If by “one of us” you mean a pirate, arrrr matey ’tis true.

  7. esodhiambo says:

    I’ve been singing this song a long time: job-linked health care and retirement is insane.

  8. Back when people worked at the same job their whole lives, our health care system may have worked.
    That’s not reality any more.
    Time for change.

  9. jimbob is right. Why all the fuss?

  10. Steve: You know what is really crazy. You have to pay for legal care. That’s stupid. There should be united legal care, where if you want legal services, the government takes care of it. Then this nurse who was laid of could sue the hospital without being chiseled by some Canadian jerk of a lawyer.

    Also, the linked statement has nothing to do with the Healthcare System.

  11. Matt, I think you were trying to jokingly insult me in that comment, but honestly I couldn’t be sure, nor do I really understand why you would do so. Care to rephrase?

  12. Re #10: Lawyer joke FAIL (?)

  13. Julie M. Smith says:

    Re #10: ironic that the govt legally has to provide you lawyer when you need one but not a doctor, eh?

  14. Having lived in Great Britain for a good amount of time, I still think health care is better here than there.

  15. Researcher says:

    We don’t often discuss health care policy at the dinner table, but my children sure like hearing the latest news on the pirates. They were spellbound this morning by a description of the rescue of the American ship captain. However, I imagine the pirates that they see in their imagination more closely resemble something out of a Robert Louis Stevenson book than the reality, which, like health care issues and reforms, is not a glamorous or romantic subject.

  16. 13: Yeah, but the government only provides a lawyer in criminal cases. In civil cases, which is where most of us have issues, you’re entirely on your own. No money = tough luck.

    Kind of like the health care system where government-paid paramedics will pick you up unconscious from the road where you’ve just been run over and get you to the hospital — but if you’re just living your life and realize that something inside just isn’t right, you’re entirely on your own. No money = tough luck.

  17. Julie Smith, FTW.

  18. Seriously, though — it sounds to me like some here aren’t aware of the indisputable fact that Lucifer started the War in Heaven by trying to force — FORCE — all pre-mortal spirits into an agency destroying single-payer health care system.

    For shame.

  19. Rebecca, does that comparison include the tens of millions who are uninsured in our country? I think Ferrari is a better car than a Civic, but that comparison is kinda useless for most people.

  20. Foul ball, Brad! You’re banned from baseball!

  21. The linked vignette has nothing to do with anything. There are tacky, obtuse bosses in every field.

  22. Latter-day Guy says:

    18, lol.

  23. Steve Evans says:

    Sam, you sure that it has nothing to do with anything? It seems to me, at least potentially, to be a serious ethical lapse to remove a health care worker mid-procedure.

  24. Welcome

  25. While not nearly rising to the same level of FAIL, my wife was once a waitress, and got fired while she had two tables waiting on their order (she’d just taken the orders, but hadn’t turned them in). Hope it worked out for those diners…

  26. Researcher says:

    Shhh! smb; none of us were going to mention that. (We undoubtedly all understand the point to be discussed, whether or not the linked article is something we really need to get steamed up about.)

    My family is in the curious position of having a child whom our state defines as severely handicapped (although as so many people say, you’d never know there was anything wrong with him — a line I wouldn’t advise using to a parent), so besides our employer-based health insurance plan, the state picks up his doctor and medicine and hospital and surgical copays with no limits on our income level. As long as we remain in this state with its special loophole coverage and as long as the state continues to provide it, we don’t have to worry about losing coverage for him, regardless of our job situation. But it is still a topic that my husband and I have thought about extensively. And of course, we wonder what our son will do when he gets to be an adult.

    I would propose a system like the health care coverage that the University of Wisconsin provides (or provided; I don’t know whether they still do) for their graduate student employees. The single most important provision being no preexisting conditions. That is a very important issue for many people.

    And returning to the example in the original post, I’m not sure why, but according to reports from other people, I recall that Deancare seemed to have a bit of a reputation as an unwieldy (incompetent) organization, but it’s been awhile since I was in Wisconsin, so I can’t provide any more information on Deancare’s reportedly bungled firing of their employee.

  27. Steve # 23

    It seems to me, at least potentially, to be a serious ethical lapse to remove a health care worker mid-procedure.

    Only in Canada

  28. Latter-day Guy says:

    Re: 23, “a serious ethical lapse”

    Yes, but it is only a lapse, serious though it may be. Do you think that this is somehow indicative of the US health care system? I rather think it must be an outlier. I don’t disagree that there are problems with the system, but this is hardly a smoking gun. Having said that, fire the manager; werf needs to go somewhere the stakes aren’t so high.

  29. MikeInWeHo says:

    I’m a manager at a hospital now (what on earth was I thinking??!), and if I handled a layoff that way I would be in big trouble if not fired outright. Thankfully I’ve never had to lay anyone off.

    Our health care system is a mess, but millions of people make serious money off of it and that’s why reform is so difficult. Every day I pull my little Smart car into a lot that’s like an 8-story BMW and Lexus dealership….and that’s not even where the doctors park!

    re: 14 Many would share that sentiment, Rebecca, but it depends on your perspective. Well-insured American professionals in urban areas get fantastic care, and fast. They have it better than their demographic counterparts in the U.K. But ask a fast-food worker in both countries to describe their experiences obtaining health care and you’d likely get a very different response.

  30. As MikeInWeHo says, there’s a lot of money going to health care–too much in my humble opinion. And if government started throwing even more money in that monster’s direction, the situation would be even worse.

    Employer-linked prepaid health care (face it folks, it’s not insurance when it pays for everything, not just catastrophes) is a survivor from the bad old days of World War II, when wages were frozen and employers started piling on perks to attract workers. And in a deal made by the devil (aka the House Ways and Means Committee, or maybe it was Senate Finance), employer-paid health insurance premiums became deductible as a business expense for employers, but were not taxed as income to the employee beneficiary. The perverse incentive for both employers and employees is to add ever thicker gold plate to the insurance plans, since the employer is indifferent where the money goes (whether to the health insurance company or the employer–it gets the deduction in either case) and the employee prefers the gold plate on the insurance plan, since he or she pays no tax on it.

  31. I would like to see:

    — More emphasis on very high-quality, super-accessible primary care. As it is, I’ll go to the ER for something only kind of urgent (e..g, UTI), instead of primary care, because the service at my primary care is sorely lacking and they never have available appointments. If you could walk right into quality primary care the way you can ER, people would do it and save us all a LOT of money.

    — Very conservative caps on malpractice awards. Maybe get rid of punitive damages altogether.

    — A complete shift in our thinking on end of life. Away from needless intervention and towards compassionate and comfortable care (hospice type). Not just a change in our practice, but a shift in our whole attitude about death and dying.

    — Less medicalized and more *truly* supportive maternity care. I had a high-risk pregnancy and I 100% appreciate medical care when needed, but a shift towards midwife and/or doula and/or birth center care and away from hospitals would be cheaper and better in the normal case.

    — Universal health care, preferably single-payer.

  32. >Well-insured American professionals in urban areas get fantastic care, and fast. They have it better than their demographic counterparts in the U.K. But ask a fast-food worker in both countries to describe their experiences obtaining health care and you’d likely get a very different response.

    I’m not sure that’s true. UK taxes pay for universal, free healthcare for the entire country. So yes, the fast-food worker has it good. (And the NHS *is* good, especially since Blair reversed a Thatcherite trend and actually ploughed money into it.) However, the wealthy urban professionals in the UK will also have employer-linked private health insurance, which gives them faster, fancier care in many cases. So, it’s social medicine with a nice layer of capitalism on top. Hurrah! I have an experience with this: when I was 17 I tore my ACL. Had we been poor, my knee would have been fixed for free but I’d have had to wait a couple of months for the operation. Because my dad had private coverage as a perk with his white collar job, I had surgery within two weeks. Upper middle class FTW.

    Re: maternity. We can all trade anecdotes, but our experience in the US vs. midwifery in the UK confirms, I think, your point. Rebecca certainly enjoyed the fancy room they put her in and the guy that played on the grand piano in the hospital lobby (co-pay bill = $500), but the OB/GYN was useless, only just managing to be at the birth (she was doing a caesarian upstairs while our baby was crowning) and then charging us a fortune for the privilege (co-pay bill = $1500).

  33. I don’t remember private medicine to be all that great. The giant HMO to which I could afford to be insured was bureaucratic, impersonal and full of hidden co-payments.

    Here’s what blew me away about the British NHS: the midwives who came to see us at our house once a week for the first three months or so, just to make sure everything was peachy. And how much did those house calls cost? Nothing.

  34. Peter LLC says:

    Dickens on US healthcare:
    It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to heaven, we were all going direct the other way…

  35. National Health in England Stories.

    My Uncle Ron badly needed a heart surgery but was told the next opening was 11 months away. See you then if you make it. Due to fear he totally changed his lifestyle and diet and completely reversed his heart problems and dropped a ton of weight. That wouldn’t have happened in the US as he would have got the surgery right away.

    Now my Nan also had some pretty severe problems that could have been relatively easily treated but was told she was too old to be scheduled. She died within a few months.

    The point is free healthcare is great, but it comes at a cost of service, and speed.

  36. My youngest son was diagnosed with a chronic disease (diabetes) when he was 2 1/2. Shortly thereafter I started a small business with two partners and tried to obtain group health insurance for our group (about 8 people) and found that no insurance company – NOT ONE – would insure us. When I joked about agreeing to a million-dollar-a-month premium the insurance agent just looked at me with a cold stare and said, “It wouldn’t matter.” Private insurance in America (US) didn’t work for me when I attempted to live the American dream.

  37. Peter LLC says:

    The point is free healthcare is great, but it comes at a cost of service, and speed.

    Your sentiment reminds me of a common meme on bike forums: Cheap, strong or light–pick two.

    Applied to healthcare, I think it’s something of a false trichotomy; comparative studies have shown that plenty of Americans spend a fortune on health care only to receive middling service in a less than timely fashion.

  38. MikeInWeHo says:

    re: 32
    Fair enough, Ronan. I didn’t mean to imply in my earlier comment that I was defending the American system. It’s indefensible from any perspective: cost, preventative care, patient satisfaction, clinical outcomes.

    Anybody with a knowledge of other options (Canada, France, the UK. et.al.) who isn’t completely blinded by ideology will readily acknowledge that other countries do health care better overall. Our profit-driven mixed public/private system is a scandal, if only for the waste alone which is just stunning.

    My sense is that Americans, because we are prone to hubris and magical thinking in our politics, have consistently refused to make the hard decisions that true health care reform would require. We thus end up with a patched-up, ever-expanding behemoth with so many powerful stake holders defending their turf that radical reform ironically becomes more difficult even as everyone acknowledges its necessity.

  39. Bad manager + ill-timed termination = bad US healthcare system. Gotcha. ;-)

  40. lamonte makes a great point. Affordability being the problem would be GREAT for many Americans. Simply put, if you aren’t employed by a large corporation, you’re hosed.

  41. Mike,
    Not sure we’d have the will nowadays either, but the British NHS was born in the wreckage of WW2.

  42. Hmmm, I wonder what Natasha Richardson would say about U.S. healthcare. If she had been at any major ski resort in the U.S. when she had her little accident, she would be alive today. Unfortunately, she was in Canada, where basic medical facilities are not as advanced as the bad ol’ USA.


    Don’t get me wrong: the U.S. system needs major, and I mean major, reform. All is not right in the U.S. It is horrible that so many people do not have health insurance, and it is horrible that so many doctors are millionaires while working families face $10,000 bills for the most basic hospital visit. Everybody on this blog I’m sure has a story to tell about sticker shock and horrible insurance companies, etc.

    But the solution is to let the free market bring down prices through competition, not more government control. And you may want to consider the issue of basic tort reform. It’s horrible that so many lawyers are making so much money by suing doctors, who must raise rates on Joe Working Class to pay off their medical school loans.

    Don’t expect many people on this blog to agree with me. I am a voice crying in the wilderness….

  43. MikeInWeHo says:

    “But the solution is to let the free market bring down prices through competition, not more government control….”

    A voice crying in the wilderness? That’s been standard right-wing rhetoric for as long as I can remember. Even my millionaire doctor friends reject it these days.

    Allowing the free market to run our health care system makes as much sense as allowing the free market to run our national defense. Hey, let’s eliminate the DoD and privatize the Pentagon! Rather than paying my taxes to support the military, I could use those funds to purchase my own protection plan. (Personally, I’d go with a company that focused on nukes, but that’s just me).

  44. Steve Evans says:

    Geoff, that article is insultingly ridiculous, and your conclusions are specious. So there. Blaming Canadian health care for her death is beyond the pale. Seriously.

    Let me ask a question, though, about the substantive point you raise: “the solution is to let the free market bring down prices through competition, not more government control.” Is there any evidence that what you propose would work? Are there any countries out there that are able to provide generalized health care benefits to all with low prices brought down through market competition?

    Also, tort reform is a nice thing that everybody would like to see. But don’t blame high health care costs on tort lawyers; that’s a fairly classic red herring. Lawsuits are but one of many many factors that make health care expensive. Also your sentence, “It’s horrible that so many lawyers are making so much money by suing doctors, who must raise rates on Joe Working Class to pay off their medical school loans” seemed like a couple of nonsequiturs to me.

  45. Steve Evans says:

    Geoff, kicking about the corpse of Natasha Richardson is poor form. I am removing that extra comment of yours.

  46. MikeInWeHo: Our new blog has taken an editorial position on the Smart Car. http://www.jrganymede.com/2009/04/09/dave-burge-for-car-czar/

  47. Steve, I thought there were some substantive arguments in those articles, but it’s your blog.

  48. Geoff, there may have been — but the problem is that once you start trotting out corpses as a way of shocking and poo-poohing another country’s socialized medicine, substantive arguments have already gone out the door. Start with the substance and save poor ms. Richardson for another day, I think. You do have substantive arguments, so let those work for you.

  49. Geoff, perhaps re-post your articles, but with an instruction for the reader to “find and replace” Ms. Richardson with “Actress X”?

  50. “And you may want to consider the issue of basic tort reform. It’s horrible that so many lawyers are making so much money by suing doctors, who must raise rates on Joe Working Class to pay off their medical school loans.”

    It’s been a while since I looked at the numbers, but I remember seeing stats once that suggested that the med mal practice was driven by the 85/15 rule: that 15% of the doctors create 85% of the botched procedures that lead to med mal suits. To my mind, that suggests that tort reform isn’t the answer, but that doctors should do a better job policing their own ranks.

    But then again, I’m a lawyer, so take that with a grain of salt. And not just any lawyer, but a lawyer quoting statistics he thinks he remembers seeing once. Not a firm foundation, exactly.

  51. S.P. Bailey says:

    Some commenters have clearly drank tort-reform cool aid. The claim that malpractice litigation is what is wrong with American health care is demonstrably false. This article is a nice little primer on the subject. The currency of tort-reform arguments says lots about the health care industry’s multi-million-dollar propaganda/lobbying efforts and very little about reality. Holding docs, hospitals, drug companies, and their ilk less accountable for their mistakes would be a disaster.

  52. Researcher says:

    In the online congenital heart defect community that I belong to, there are parents of children from all around the world. The Canadians rarely if ever report difficulties with their medical care. This particular fairly rare heart defect is usually treated at Toronto Children’s Hospital, which reports very good statistics for mortality and morbidity rates. About as good, in fact, as the four big heart centers in the United States (Boston, Philadelphia, Texas Children’s, and Ann Arbor). We have no reason to go out of the country for care for our child since we live near Philadelphia, but if we did, based on the reports from parents, I would have no hesitation using the Canadian health system.

  53. Actually, if Mark Twain was right*, Natasha Richardson may be the wrong person to ask. She may be happier with the way things turned out.

    “Why is it that we rejoice at a birth and grieve at a funeral? It is because we are not the person involved.”

  54. Mark Brown says:

    Geoff, I’d like to suggest that the classic appeals to the free market don’t apply to health care. Here’s why.

    Markets drive efficiency through competition and pricing mechanisms. But if my wife gets sick, I don’t want the cheapest doctor. I want the best and most expensive one. When it comes to our health care, the incentives are all pushing us away from efficiency and low price. An appeal to the free market would have to take this behavior into account and explain how it could be overcome. In my opinion, I don’t think it can be.

  55. I think we should ban skiing in Canada. Canadian snow is inferior to US snow. I decided. :P

  56. MikeInWeHo is speaking from inside the system – very openly and very clearly. I appreciate his contribution to this discussion very much.

    Health care in the US is like education in the US – a bloated corpse that has too many layers of insulated fat to fix with any quick operation. Liposuction won’t work, since the patient is just going to gorge himself again; giving it more money won’t work, since it’s eating habits will only use the extra money to add one more layer of insulation. It’s going to take radical surgery, and I’m not sure we have the willpower as a country to undergo that.

  57. “It’s going to take radical surgery, and I’m not sure we have the willpower as a country to undergo that.”

    This would be my worry. We already have crowded clinics, hospitals, and doctor’s offices. If my wife has to reschedule an OB appointment or one of the kid’s Dr. appointments, it’s usually several weeks before she can get back in.

    We also have fewer Med students choosing primary care due to too much paperwork and not as good a salary as other fields.


    So while I personally wouldn’t mind seeing some sort of universal healthcare, could we realistically go from where we are today to universal healthcare?

  58. I am just thinking out loud here.

    Suppose we applied the conservative prescription for public schools to medicine.

    Every citizen would have a right to health care at no charge at a public clinic or hospital. (I.e., roughly equivalent to the right of any child to a free public education at a public school.)

    Any citizen could “opt out” of the public system and receive a voucher to purchase medical care/insurance from a private provider. Just as with private schools, the vouchers might or might not cover the cost.

    In theory, the private providers were compete with one another–to some extent the competition would be with respect to price, to some extent the competition would be with respect to service. Again, similar to the private school scenario.

    One difference, for this to work, all providers would have to accept any or all citizens who apply (unlike private schools, that can be selective about admissions). If more apply than there is room, then first come first serve would need to apply.

    Please note, that as with the education voucher model, the same voucher/subsidy would be provided to all, regardless of income.

  59. #51 I learned everything about tort law from one of the greatest legal minds of our generation – the writings of John Grisham :-)

    Having lived half my life in England with national healthcare and the other half in the US, if I ever got chronically sick I would rather it be here in America, for what little that is worth.

  60. Molly Bennion says:

    Question for you in national health care systems: Have you knowledge of under-the-table payments to get better care? I am very familiar with a friend’s experience of having to leave envelopes of money in his mother’s nursing home drawer to secure decent care (basic services like turning her regularly to avoid bed sores) in one of the largest of those systems. And that solution wasn’t his idea.

  61. TStevens,
    Which half of your life did you live in England?

  62. Molly,
    Given the glee with which our press enjoy medical and social scandals, I’m sure such shenanigans would have been reported. As far as I know, they haven’t. Having said that, nursing homes in the UK are privately run. It’s something that isn’t fully “socialized” (to borrow a term).

  63. The first half

  64. But my relatives are from Swindon, so most of my opinions are from their experiences

  65. I would like to point out that the US has 100% socialized health care for precisely the most expensive segment of the population: the elderly. All elderly qualify for medicare. Adding the young and healthy wouldn’t add that much cost, but would do wonders for relieving worry about losing a job and losing that health insurance “just in case” something goes wrong.

  66. DavidH,

    >Please note, that as with the education voucher model, the same voucher/subsidy would be provided to all, regardless of income.

    Most voucher programs around the country do not operate like this; almost all of them are income-adjusted.

  67. “Allowing the free market to run our health care system makes as much sense as allowing the free market to run our national defense. Hey, let’s eliminate the DoD and privatize the Pentagon!”

    Well, we are not far off from that. Way too many contractors and corporations have a vested interest in global conflict.

    On the actual topic of health care, anyone that supports the current US system probably hasn’t had to do without health care for any length of time.

  68. SB2–

    >Adding the young and healthy wouldn’t add that much cost


  69. Ya ok after I wrote that I realized it could use more nuance. :-)

    But seriously, it makes little sense to only socialize the expensive folks.

  70. Perhaps the decision to socialize them has more to do with…say…being on fixed income than, say…age alone.

    This ignores the reality that many seniors are in fact the wealthiest in society, but there are proportionately far fewer young folks who have upward mobility in income than octogenarians.

  71. oops….take that last sentence….turn it around. Got it? Okay….there.

  72. Peter LLC says:

    I would like to point out that the US has 100% socialized health care for precisely the most expensive segment of the population: the elderly.

    And the uninsured (assuming they use the emergency room).

  73. Molly Bennion says:

    Even though Medicare is far over extended and unsustainable as is, it is not 100% socialized in the sense of paying all costs. Without additional “Gap” insurance to pay the difference between what Medicare pays and what costs are, medicare recipients can be in a world of hurt. It’s difficult to find a primary care physician who will take new medicare patients (one Spokane friend recently called 13 recommended doctors and 11 would not take a new medicare patient) and close to impossible without gap insurance. Make sure your elderly family members have it and are mentally able to remember why they have it and to pay it on time. (My estate attorney’s father canceled his on a whim and caused a family financial crisis.)
    Of course we need to fix a flawed system, but Medicare is a flawed model.
    Ronan, it wasn’t the UK and I’m glad to hear your report.

  74. I will completely agree that the U.S. has a flawed health care system. I have lupus and have faced that being unable to get insurance because of it. I’m fortunate, that my husband has a good job with good benefits. But I’m not naive enough to think that is security. Given the current economic climate, that job could go kaput and there goes my health care. It’s a scary position to be in.

    HOWEVER, I live in Sweden for 5 1/2 years. Sweden has a nationalized health care system that is pretty good by most standards. It is not an ideal system either. I would never advocate for it.

    I have a whole host of reasons, but don’t want to monopolize space.

  75. And Steve, while I agree with you that the health care system is messed up, I don’t this article proves your point. It proves that our country is having severe economic problems and that the health care industry is not immune to those problems. This is the same in every country experiencing economic difficulties. Layoffs happen in the health care system happen in Sweden too, despite it being a nationalized health care system. With the unemployment rate rising in Sweden, this means that the government is doling out more money to people who are drawing more welfare benefits and consequently, fewer people are paying into the system which employs the health care workers.


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