« Milan Kundera | Main | Monday Bonus Norway Blogging »

Blogosophere Gets Results

16 Jul 2007 09:02 am

The shrillest professor unloads on waiting times:

A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures — and I suspect that France, which wasn’t included in the study, matches Germany’s performance.

What's more, as Krugman goes on to point out, it's one thing to have your procedure delayed because the equipment or personnel are needed to treat someone else's more acute condition. It's another thing entirely for the delay to be caused, as it typically is in the United States, because a company is trying to earn more money:

his can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. “It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments. [...]

To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs. But there’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their “medical losses” — the industry term for actually having to pay for care.

We also see further demolition of hip replacement myths. It's worth saying, of course, that people who kill people in exchange for money in the US health care sector aren't, on some level, bad people. If you worked for an insurance company and construed your job as facilitating the delivery of medically useful health care to patients in need, you'd rapidly find yourself unemployed. Similarly, a doctor whose practices don't serve the insurance company's needs will find himself off the roster and useless to anyone. A company that cared more about helping sick people than earning profits would see its stock value decline to the point where it would be taken over by some other company that was willing to kill for money.

It's the logic of the system and on some level it's no different from any other business. But whereas Apple or Toyota or Starbucks make money by delivering their products to people, insurance companies make money by not delivering health care to sick people.

Share This

Comments (16)

If you'll allow me to suspend Godwin's Law for a second, I'm pretty sure SS Officers would have been fired if they refused to kill Jews, too.

“It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; ......

......To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs"

This is a wonderful example of how myth becomes fact. Ignore the details, simply repeat the hypothesis as if it is not merely a hypothesis ("It's another thing entirely for the delay to be caused, AS IT TYPICALLY IS in the United States, because a company is trying to earn more money:")
, and run with it.

This blog is a veritable petrie dish of spin. In the future, Matt, when spinning and lying in this manner, it would be more effective to distance the actual quote from the made up summary. Perhaps have two posts: one showing the actual quote ("To be fair, Mr. Kleinman is only surmising..."), and a different post, distant in time and space, that restates it in dramatically different fashion ("It's another thing entirely for the delay to be caused, AS IT TYPICALLY IS in the United States, because a company is trying to earn more money:")-hopefully your audience will have forgotten the first by the time they read the second. Putting both quotes in the same post simply makes it easy for people to see that you're lying.

Ultimately, of course, you want to altogether dispense with real quotes that are harmful to your cause-but don't worry, you're young and still learning. That kind of intellectual dishonestly will come with time.

Sk

I see Sk is the type of person who's willing to kill others for free.

This blog is a veritable petrie dish of spin.

Hey Sk-

1. It's Petri dish.

2. What's your alternate explanation for why Kleiman's treatment was delayed? Do you contend that, given the for-profit structure of the insurance industry, that this kind of behavior isn't "typical" or widespread?

Most people wouldn't work certain companies.

The leadership of these companies make choices, they could choose to lobby the government to create mandated minimal care requirements or other regs that keep the competition from under cutting them. Historically there are some examples of companies wanting the government to come in and keep the market from working or doing things volunterarily to prevent governmment regulation.

As far as I know healthcare companies don't do anything to blunt the features of the system that encourage evil behavior, if anything they encourage those aspects of the system in their legislative efforts. I would argue that it would be in their long term interests to be less evil so since every person they screw with is a human interest reporter away from the making them look bad in the paper and if they get unpopular enough there is no reason society can't decide private insurer just shouldn't exist anymore

Walmart/Walgreens/CVS/Target health clinics might be able to speed up medical attention. They don't require an appointment and are open during pharmacy hours including evenings and weekends.

"What's your alternate explanation for why Kleiman's treatment was delayed?"

I don't know. If I came up with one, I'd be, like Mr. Kleiman, merely 'surmising,' which would be utterly unreliable-don't you agree?

Really, though, my post wasn't about Mr. Kleiman's insurance company. It was about Matt's awkward baby-step attempts at spin. As I said-separate fact from hypothesis more effectively (thus blending the two), and ultimately ignore facts altogether and replace them with hypothesis entirely-those are the take-aways from my post. Insurance companies, the Iraq War, the economy- the topic is irrelevant. Its the rhetorical tools we are trying to develop here!

Sk

Sk--

You are not only disingenuously obtuse, as well as a poor speller, but your reading comprehension appears to be lacking as well. The "dishonest" quotes (though I might call them sarcastically on the money quotes) that you criticize Matte for are instead quotes from Paul Krugman's column, though clearly endorsed by Matt.

a little off topic: I think there is a serious drain on medical and dental resources simply because so many professionals move into fields such as cosmetic enhancement, liposuction, rejuvenation, etc.

In a society which almost worships consumption, wealth, and youth there is plenty of money to be made.

It can be argued that medical professionals often donate services to the poor, etc. But there is absolutely no obligation to do so. I suspect it is done less and less.

There seems no agreeable solution. People should not be yoked to serve others. But I think the problem exists and bears upon medical costs.

Sk, you're retarded. As Marlowe pointed out, it was Krugman, not Yglesias who wrote what you criticized. If you're that stupid, how can you expect anyone to take what you say serious.

As for your own comments, they seem quite garbled to me and I hardly see much point in trying to parse and reply to them.

Yep. The biggest problem with the current system is that it massively incentivizes bad behavior, and punishes good behavior.

Don't forget there is another player in all this: the health care providers. Hospitals and doctors can choose to refuse certain carriers if their policies stink too badly. Also, hospitals and doctors shoulder a good deal of the blame for the current situation by escalating costs and procedures until their judgment about what was truly medically necessary or a fair cost could no longer be taken at face value.
Finally many patients make a decision about what kind of insurance to get and most complaints about insurance are of the variety that they want more than they paid for with attendant whining about how precious their health is and how cost should not matter. It matters to them of course when they choose insurance.

Would SK mind explaining to us why insurance companies WOULDN'T be strongly tempted to hold down their financial losses by refusing to pay for genuinely needed care? This, after all, is the central flaw in unregulated capitalism -- even if an individual business wants to act morally and generously, it cannot do so because its less scrupulous competitors will undercut it.

I found this part interesting: "and that America is the worst place in the advanced world if you need care after hours or on a weekend", because I have two children. Had normal deliveries at a typical hospital--one was born on a Saturday and one on the day before Thanksgiving.

I got bare-bones care, especially postnatal care, and it was slow, late, sometimes sullen, or just never arrived.

Wasn't charged any less, though, of course.

Doug,

The principal problem with the latter part of your rather idiotic comment is that most Americans buy the health insurance they can afford, or more likely take what is provided through their employer. Your comment, were it to make any sense at all, assumes a level of economic comfort and buffering (and disposable income) that is simply not the existing reality for many Americans. But you just go on and attempt to rationalize the current system to your heart's content. As for me, I'll go with the shrill professor.

Doug: As President Bush pointed out, his Administration's policies of "the poor should eat cake" (in emergency rooms, of course) have led millions of the uninsured to visit emergency rooms for every kind of care. While attempts are made by the uninsured to pay medical bills, frequently the reason for the E.R. visit is that doctors and clinics outside the E.R. make the uninsured pay for care up front, something the uninsured frequently cannot do, while the E.R. bills for care already received.

If the uninsured patient is unable to pay for his E.R. care quickly enough (if at all), the hospital must shoulder the cost somewhere else, such as escalating the cost of treatments and procedures for everyone else. With all that added cost and the need to find ways to pay for the medical bills of the uninsured, hospitals and doctors might be (and many seem to be) willing to turn a blind eye to insurance company practices just to make sure they can still stay in business. Some money is better than no money at all.

This is a vicious circle. People go to E.R.s for medical care for which they can't afford to pay, hospitals "pay for" that medical care by handing the costs onto private insurance and fee-for-service patients, private insurance handles the increased costs by refusing to pay for certain types of care, and people--even the insured--who can't afford the care they need, go to E.R.s for medical care for which they quite likely can't afford to pay.


Comments closed July 30, 2007.

Copyright © 2008 by The Atlantic Monthly Group. All rights reserved.