The new target is... hospice? Wha?

Great Debates
101

Look. Let’s call a spade a fucking shovel here, okay? (Sorry, punchline to old joke having to do with a nun and a construction foreman.) What we’re talking about here is cradle-to-grave govenment-provided health care (and who doubts, given the number of people here who struggle to come up with $15 a year for SDMB membership fees, that as soon as a large enough number of people can’t come up with the dough for government-mandated health care insurance, that universal, government-provided health care for everyone is the next step), and that is a completely different animal than military or Medicare health services. (And if Medicare is that great, why do so many excellent doctors refuse to accept Medicare patients? I’ll tell you why: paltry fees and too much red tape.)

Congress people have no fucking idea how much this is all going to cost. Most people now don’t go to the doctor unless they really need to. Once government health care takes effect and people can go to the doctor every time they or one of their children cuts a finger or comes down with a fever, costs are going to be many, many times what estimates are now (IMHO, of course.)

So really, there is no correlation between limited coverage now for Medicare patients and/or military people vs. trying to pay for coverage for the country’s entire population.

Government, by and large, sucks at everything but running the military and collecting taxes. Central planning NEVER works! NEVER! There has never been a country in the world that has benefitted by governmental central planning and oversight, and I’ll be damned if I want to see my own and my family’s health care being subject to the whims and caprice and inefficiency of governmental beaurocracy.

As William F. Buckley once said, “Government can’t do anything for you except as it can do something to you.” (And as Scylla recently said, “This is the land of the motherfucking free. Home of the brave.”)

This country was founded on the premise of freedom from governmental control. Virtually every paragraph of the Declaration of Independence and The Constitution itself is dedicated to limiting government interference in our lives.

There may be many people nowadays who want government to function as their parents, dictating “fairness” for everyone regardless of merit and providing for every need, but I’m not one of them. I remember when I had to seek parental approval for what I wanted to do and how they held the power to either allow me to do what I wanted or to forbid me from doing it.

Well, I’m a grown-up now and I don’t need no steenkin’ government telling me who my doctors are going to be and what care they’re allowed to prescribe and how much my life is worth vs. forcing me to take a pill and have a nice death.

And let’s not forget that once everyone’s health care becomes everyone’s responsibility, the way everyone lives will become everyone’s concern. Do you smoke? Well, why should taxpayers pay to care for you when you don’t care enough about yourself to quit smoking? And if your cholesterol is too high or you weigh too much why should everyone else foot the bill for your heart bypass surgery, you brought the need for it upon yourself. And you drink more than the government-mandated allowable amount of booze? Well, fuck you and your liver transplant, you ruined your liver yourself so you live with the consequences.

People are most happy when they are free, and people who have to turn to their government to provide for their needs are not free. As H.L. Mencken once said: “The urge to save humanity is almost always a false face for the desire to control it,” and I for one don’t want the government controlling this most important aspect of my life.

102

Wow, mighty scary scenario. Bearing no relation to any actual health care plan currently being discussed in Congress, apparently, but an impressive rant all the same.

OK, I think we’ve got a feel for why some folks feel the need to make hospice into a bogeyman, which, as I recall, was the point of this thread.

103

I question this assumption.

Back when I had excellent health insurance and ample money for my needs, I certainly did not run to the doctor for every bump, bruise, cut, or fever. Normal people do not enjoy going to the doctor whether it costs them money or not.

So… you prefer the whims, caprice, and inefficiency of corporate bureaucracy such as you currently have? Gotcha.

No, instead right now you have a corporation handing you a list of “acceptable” doctors and a list of “acceptable” medications.

It is not in the interest of a government bureaucracy to kill off taxpayers, now is it? Would think that fact alone reduces the odds of “take this and have a nice death”.

No, you a private corporation do it instead.

104

Interesting poll:

Medicare got 59% saying 9 or 10 in 2008, with another 27% saying a 7 or 8.

So, Medicare deals with the elderly and the sickest and gets high ratings and doesn’t leave people on ice floes. Hmm.

105

As has been adequately proven multiple times so far, pretty much everything you’ve said here is total bunk. No one has advocated any of these ideas, mostly they are baseless right wing screaming points.

I will say, as a frontline worker in the healthcare field, that your access to lifesaving care is currently being limited by the flood of people coming to the ER for “fevers and cut fingers” because they don’t have any insurance or any primary care doctor. We’re required by law to treat all of them, but typically that comes at an average cost of 5 to 10 times what the exact same treatment would have cost at a doctor’s office or urgent care center.

These anti-government healthcare rants strike me as the most stubborn of all right wing rants. All of the evidence points against you, so it must be some “conspiracy”.

106

I’m sorry, but no it hasn’t. It has been denied multiple times before by people with an agenda, but denial doesn’t equal proof.

“Pretty much”? I’d be interested in knowing which of my points you feel is not “bunk.”

Of course no one had advocated them. Health care would never get passed if they did. But that doesn’t mean that they won’t happen. Not by a long shot. Prior to last November’s election was anyone “advocating” the nationalization of the nation’s automobile industry; the virtual government takeover of certain Wall Street firms and government interference with executive compensation; a huge pork bill that had to be rushed to Obama’s desk with such urgency that it couldn’t be posted to the White House website like Obama promised, yet could still languish there for three days while the President was on holiday; a four-trillion dollar public health care program; etc., etc., etc.

[/quote]
mostly they are baseless right wing screaming points.
[/quote]
Not in my case. Rather they are concerns and predictions based on decades of watching how this country’s government (and its liberal Democratic base) does things.

And whose fault is that? It’s the fault of a government which frivolously dictated that you must take on that expense without providing any way to fund it.

And now you want to put that same frivolous, financially unconcerned and dictatorial government in charge of financing and furnishing health care for everyone, and you trust it to provide adequately for everyone’s needs?

They are right-wing rants because they are right-wing concerns. Right-wingers tend to be guided more by practicality and the realities of the world rather than simply by what they want.

Hardly. We have had the experiences of posters in other countries that do have government health care to back us up. Remember the guy from Canada whose mother had to wait nine months to begin cancer treatment, or the other Canadian whose wife/mother/I forget had to wait two months for a CAT scan? Or Maastrich, who spoke so supportively of the way things are done in The Netherlands where efforts to save elderly lives are withheld in favor of “palliative care” in which citizens are “given a pill to make them comfortable” and left to die? And there have been numerous descriptions by posters from the UK describing the waits and shortfalls associated with health care there.

And if you don’t think that once everyone’s health care becomes everyone else’s concern, everyone else (especially liberals, given their passion for telling everyone else how to live) isn’t going to start insisting on govenment lifestyle requirements in order to obtain coverage, and that the govenment – underfunded and looking for corners to cut as always (when have you ever known of an adequately funded and efficiently operated government social program?) – won’t eagerly hop on that bandwagon as well, you are naive beyond what appears to be your years.

Nope. Never said it was a conspiracy, never meant to say it was a conspiracy. But as Phil McGraw says, the best predictor of future behavior is past behavior, and the government’s past behavior in terms of wasteful, inefficient beaurocracy; woeful underfunding of social programs; and willingness to cut benefits when funds set aside for one purpose get used for other purposes and then find they can’t raise taxes enough to cover the shortfall, all tell me that I don’t want the U.S. government anywhere near being responsible for making decisions on the health care my family and I receive.

And of course all of this is completely beside my other concern, which is that, like I said above, people are happier when they are free, and people are not free when they have to petition the government to provide for their needs.

Whenever and wherever the government spends money, the government calls the shots. And the more people who turn to the government to take care of them, to protect them, to make things “fair”, the more they become serfs to the government itself, and I happen to think this country’s founding fathers had it right when they wanted to create a country whose citizens were to live free from the dictates of government.

107

This is all just a smokescreen to get us to forget about the REAL issues, like gay marriage and marijuana legalization! :smiley:

108

Just a year or so ago my mother was diagnosed with skin cancer. Her insurance company decided that her policy had lapsed and she was not going to be covered for treatment. Fortunately, she was able to prove that they had cashed a check from her three or four months previously, and that they were full of shit. Unfortunately, the insurance companies have the resources to pay people on commission to scour claims and files looking for the faintest reason to deny a claim or refuse to cover treatment. It’s in their interest to refuse to pay for the healthcare needs of its customers, so it is a business investment to pay people thusly.

No.

What we have now is a system of programs that takes our dimes now and tries as much as possible to withhold them when our lives or those of our loved ones are on the line.

109

Shorter Starving Artist: Government can’t do anything right. I don’t have to prove that, I have anecdotes and my own infallible experience. You think things are bad now, just wait till the Government gets its hands on Medicare!

110

No, the rest of us are talking about how hospice care will be affected (or not) by a government proposal to extend health insurance coverage to those currently unable to afford it. Neither Obama nor Congress is proposing cradle-to-grave government-provided healthcare. Which you yourself have stated:

So you admit to arguing against a straw man you’ve built yourself. Can you do this quietly in a corner somewhere and let the rest of us talk about practicality and the realities of the world rather than what you want or don’t want?

111

Sounds to me like she probably sent her payment in late and that the policy did indeed lapse (I’ve done the same myself) but when the check arrived they went ahead and cashed it, thereby renewing or continuing the policy. Still, the two likely didn’t get connected up in their computer so when her claim arrived the computer kicked it back as being a lapsed policy. When she was able to prove that they had accepted her payment months before, her coverage was honored.

I can’t imagine that any insurance company would be so naive as to think that they could deliberately deny coverage to a cancer victim on the false premise that the policy had lapsed and the cancer victim would just let it drop.

Thus the entire episode only serves to bolster my position, which is that with insurance companies you have RECOURSE! They are bound by contract and by law (which in this case states that if they cash the check even if it’s late, they have to honor the policy). With the government there is no recourse to speak of. Yeah, you might, if you have the money, file a lawsuit, but good luck trying to get it resolved in your favor…and even more importantly, good luck in trying to get it resolved in time to do any good.

CFNR

(Content free, no response)

YOU might be talking about that, but that isn’t the subject of the OP. The subject of the OP was why is the right saying negative things about hospice care right now. And the only reason that the right is being critical of hospice care right now is that it provides an avenue for the government health care system to blow off saving your life while still presenting a false face of “caring” about you. So government health care is central to the entire issue. If not for the prospect of government health care no one would be saying anything negative about hospice, just like they haven’t up till now.

112

I should probably clarify for the sake of accuracy that my late payments were years ago and in regard to automobile insurance, but the premise is still the same.

113

You have quite obviously never ever dealt with an insurance company–and for that you are a very lucky person. I learned the hard way that our current system–no matter how “good” your insurance, will cause you no end of grief and paperwork and endless phone calls to automated telephone systems, agents who will lie to you about your coverage or payments, claims denied for frivolous reasons (or no reason at all). Finally in desperation, I appealed to our state’s insurance commissioner (who didn’t actually have any jurisdiction due to the origin of our insurance contract) and then miraculously claims started being paid. The nightmare scenario you envision as a result of government health care is exactly the system that we currently have.

I realize that this is just an anecdote, but my story is hardly unique. It has also been my experience that people who think our current system is working have actually never had a major claim.

114

As long as it’s anecdote time:

115

Almost everyone I know has health insurance and none of them has the problems getting coverage that people around here portray as routine. They all get their operations, they all get their office visits, and they all get their medications. The biggest problem any of them have is sometimes having to pay more out-of-pocket than they think they’re on the hook for.

Now, like with you, this is anecdotal. But it seems odd to me that my experiences over the last several decades in this country seem invariably to be so totally at odds with what people around here decry as being the norm.

Still, I’m not saying that insurance companies are wonderful, caring entities that willingly and happily provide coverage that everyone needs. But there are many types of businesses in this country that are regulated or overseen and not allowed to operate in blatantly dishonest and/or deceitful ways. If insurance companies are operating in dishonest ways to the degree you and others here say, why not pass laws addressing those problems and forcing insurance companies to operate properly instead of creating a huge government beaurocracy to take their place…particularly when that beaurocracy will have the same incentive to cut costs (i.e., limited funds) that insurance companies do but will be more bulletproof as to recourse?

116

The argument against “evil insurance companies,” including not only obfuscation but also dropping coverage when you get really sick, is seductive. The problem with this argument is that it proves far too much. The same argument applies to life insurance and home insurance. You dutifully pay your premiums for years. Then you suddenly die, or your house burns down. What’s a profit-maximizing insurer to do? Say you died or the house burned down because you were smoking in bed, of course! Can you prove otherwise?

Yet in practice, people almost never complain about disingenuous disputes with life or home insurers. Why not? The obvious explanation is that life or home insurance companies that shirk their responsibilities hurt their reputation. It might seem profitable to reject expensive claims, but in the long-run, an insurance company that mistreats its expensive customers is going to have trouble attracting any customers at all. After all, what’s the point of buying insurance from a company that won’t pay when you need it most?

I agree that there is a popular perception that health insurance is an unusually crooked industry. My main explanation is that customers of health insurance companies have more latitude for unreasonable demands. If your dad dies, the life insurance company owes you $X. If customers ask for $X+1, the firm refuses, and no one sees this as proof that the free market can’t be trusted with life insurance. If you get sick, in contrast, it’s hard for an insurance company to decisively prove that they’ve lived up to their agreement. You can always insist on another expensive test, even if the insurer knows it’s useless.

Furthermore, there is not as much competition in the insurance company as there could be. The linkage to employment means that everyone has only a few choices. Even in this case, consumers are free to reject the package - job+insurance, if the insurance company has a really bad reputation. As it happens, one way to introduce more competition is to revoke the tax-exemption of employer-provided insurance, something that John McCain proposed during the campaign and Obama ridiculed.

I agree that there is a popular perception that health insurance is an unusually crooked industry. My main explanation is that customers of health insurance companies have more latitude for unreasonable demands. If your dad dies, the life insurance company owes you $X. If customers ask for $X+1, the firm refuses, and no one sees this as proof that the free market can’t be trusted with life insurance. If you get sick, in contrast, it’s hard for an insurance company to decisively prove that they’ve lived up to their agreement. You can always insist on another expensive test, even if the insurer knows it’s useless.

Am I saying that health insurance companies never play dirty tricks on their customers? Of course not. It’s a big world, lots of bad stuff happens. What I’m saying, rather, is that reputation works well even in industries where firms have big, lumpy liabilities. There are plenty of examples. What reason is there to think that health insurance isn’t one of them?

117

That all said, the central question concerns remedies. Presumably the critics believe that egregious violations of law and contract are occurring, in particular on the dropping-coverage side of things. If that is the case, why not just enforce the law more strongly and raise the penalties – significantly – for unjust treatment of sick individuals? You can call this market failure, which it is, but it’s also legal and regulatory failure as well. Presumably if illegal breaches of contract were occurring, the ambulance-chasers would be having a field day.

If those legal parties cannot implement and enforce basic laws, can other legal parties successfully take on larger responsibilities for managing the U.S. health care sector? Somehow it is assumed that the answer here is “yes.” I’m less certain.

118

No, neither is that remotely accurate, nor did anything I said sound like that.

It does illustrate your penchant for essentially delusional fabrication.

119

Unlike homeowner’s insurance claims, health insurance is very complicated. I thought because I paid my premiums, read my little–and very confusing–booklet about what was covered and what was required, made sure that the doctor was on the list, etc etc., that I would be covered, right? I did all the right things. And then our daughter had a health issue that required expensive treatments and therapy. Then came the avalanche of denied claims, and the blizzard of paperwork. They would cover a treatment on Monday and Tuesday, but it was deemed not medically necessary on Wednesday and Thursday. They would reject claims for having the wrong codes, and then after multiple calls to both the doctor’s office claims clerk and the insurance company agents, I would get the form resubmitted with the right code, only to have it rejected as being a duplicate claim. Working, at the time, in the banking industry, I understood the need to have the paperwork in order, but this was completely out of hand and ridiculous.

I realized that, unlike a car insurance claim, my health insurance provider had no real motivation to keep me as a customer and that the more complicated and difficult and confusing they made the entire process, the greater the likelihood that I would end up paying out of my own pocket.

That hit me as being not just unfair, but morally & ethically wrong. So I went to see what it would take to gain some relief from this and I found there was no one. Our particular insurance is a result of a collective bargaining agreement, so the state Insurance Commissioner has no jurisdiction (although they agreed to look into it for me). There was no contact person at the union headquarters whose job it is to help with insurance claims. I have long hoped for crackdowns on the insurance companies, but it seems that the deep pockets of the insurance companies have blocked any kind of real health care reform.

I have also seen the difficulties faced by a family member without insurance–he has a job, but not much in the way of benefits. Sometimes they’re poor enough to qualify for Medicaid, but mostly they just go without. There’s no way they can scrape enough money together to buy stand-alone health care, they’re doing good just to afford rent and food and sometimes utilities. Something that gets often lost in discussions about how reckless the working poor are is the large percentage of their net income it takes to pay their rent. He’s not a bum looking for a handout–he works hard and tries to provide for his family, but he has very little skills. It’s quite likely that he’ll never have a job that provides health insurance, and probably never going to earn enough money to be able to afford private health care. Does that mean that if he gets sick it’s his own tough luck that he’s not smart enough or skilled enough to have a better job?? What does he have to do to “deserve” health care?

I realize that I have again just provided anecdotes rather than hard data, but without my experience of dealing with what I had thought to be a reputable, above-board major insurance carrier, I would have bought into the talking points as well. And when I share that story, inevitably someone else chimes in with a similar story, so I don’t think ours was a unique case.

120

So it’s your contention that her policy payments were always paid on time with never a hitch, but when she needed treatment for cancer, they, with absolutely no basis in fact, simply claimed her policy had lapsed in the apparent hope that she’d just say okay and go away?

That does not compute.