Saturday, March 05, 2011

Botswana or Bust!

Did everyone forget that all our problems were solved by the POS known as the "Affordable Care Act"? I guess so, because here's the zombie health insurance debate back for more brains, via Ezra Klein:
It’s very important that health-care reform leaves a lot of room for insurers to experiment with different benefit designs and ways to keep people healthy. That could slow the growth in health spending, which is why I think the administration should be as vague as possible when defining “essential benefits.” But just making insurance progressively less generous doesn’t do you much good, and may in fact do you some harm. It’s hard to imagine any good that’s going to come from a deductible that’s above five figures: If you’re paying $10,000 out of pocket for health care in one year, you’re probably quite sick and just doing whatever the doctor tells you. Meanwhile, the sorts of intensive insurance programs that might keep people from getting so sick will probably be fairly generous, even as they’re cheaper in the long-run.
"It’s very important that health-care reform leaves a lot of room for insurers to experiment with different benefit designs and ways to keep people healthy"? No. It's not. Health insurers are not in the business to keep people healthy. They are in the business to make money. They make money in the US by being parsimonious with their benefits and charging high premiums. Denying health care by making it so expensive that people spend their money on more immediate-seeming needs (or do their own home surgery) is not solving the problem, and this is basically the "solution" conservatives and insurers have chosen.

And all this dreck about how people need to take responsibility for their own health is a thinly veiled way of saying, "Don't make me worry about caring for the sick and dying." We live in a toxic soup of an environment, and rig the game so our poorest citizens live in the very worst environments under the most challenging conditions, and then rail at them for not pulling themselves up from the mess by their bootstraps. And the better off we are, the more we rail. In 2008 the World Health Organization released released a report of health disparities that included the following findings:
The world's poor tend to die prematurely and log more life-years spent ill or suffering or depressed also because they are more likely to live in dangerous neighborhoods, have limited access to clean drinking water, be forced to endure long, sometimes arduous commutes to work, labor in unsafe environments and have little representation in the governance of their local society. If you're about to lose your job, the effects of eating too many trans fats may not be high on your list of worries. "Behavior and lifestyle are determined by the circumstances in which people find themselves," Marmot says simply....

...this "gradient," or the degree to which different groups are unequal in health, is far steeper in the U.S. than in most other industrialized countries. One reason, according to commissioner David Satcher, a former U.S. Surgeon General, may be that the U.S. comprises a more diverse population than other places, mixing a high proportion of recent immigrants with long-time American dwellers, which makes it all the more difficult to tackle social determinants early in life. "Two," Satcher says, "[the U.S.] invests probably less in improving that social gradient. There are countries that really invest in making sure that all children have quality education regardless of the education of their parents. There are countries that invest in making sure that everybody has access to a [minimum] level of quality of [health] care. We're one of the few countries that does not do that."
But fear not, American deficit hawks! It can be done:
Marmot cites the national pension plan in Botswana, which shows that even poor nations manage to provide income security to their elderly; and an Indian rural employment guarantee, which assures workers a minimum number of days of paid manual labor for the state, demonstrating that the poor can still give workers some measure of job security.
Let Botswana lead the way!

Every damn one of us is only one car accident or sudden fall from medical bankruptcy, so don't give me this crap about how the unicorns would play in the chocolate fountains if only fat people would go on a diet and the smokers we rely on for taxes to care for our elderly would just stop smoking.

Really, the hypocrisy is just breath-taking.