Private Health Insurance Quotes

In a society in which nearly everybody is dominated by somebody else's mind or by a disembodied mind, it becomes increasingly difficult to learn the truth about the activities of governments and corporations, about the quality or value of products, or about the health of one's own place and economy. In such a society, also, our private economies will depend less and less upon the private ownership of real, usable property, and more and more upon property that is institutional and abstract, beyond individual control, such as money, insurance policies, certificates of deposit, stocks, and shares. And as our private economies become more abstract, the mutual, free helps and pleasures of family and community life will be supplanted by a kind of displaced or placeless citizenship and by commerce with impersonal and self-interested suppliers... Thus, although we are not slaves in name, and cannot be carried to market and sold as somebody else's legal chattels, we are free only within narrow limits. For all our talk about liberation and personal autonomy, there are few choices that we are free to make. What would be the point, for example, if a majority of our people decided to be self-employed? The great enemy of freedom is the alignment of political power with wealth. This alignment destroys the commonwealth - that is, the natural wealth of localities and the local economies of household, neighborhood, and community - and so destroys democracy, of which the commonwealth is the foundation and practical means.

On average, Medicare only reimburses hospitals 87 cents for every dollar spent.37 How do hospitals stay in business? By charging people with private health insurance significantly more for health care services to make up the difference.

He doesn’t see private health insurance rebates or support for private school education as middle-class welfare. He sees it as backing family aspiration, sound public policy encouraging people to do more for themselves. And help should not be cut off simply because a family is earning a hundred thousand dollars or more a year.

You might also be wondering how the Obama administration thought they would get away with this disaster. I think their intention was simply to blame insurance companies when people started seeing their health insurance plans canceled. Liberals excel at vilifying the business sector, and the more they can demonize private-sector insurers, the more leverage they believe they will have for continuing to move toward the Holy Grail of the left that Ronald Reagan warned against in 1961—a single-payer, government-funded, socialized health-care system.

New Rule: Republicans must stop pitting the American people against the government. Last week, we heard a speech from Republican leader Bobby Jindal--and he began it with the story that every immigrant tells about going to an American grocery store for the first time and being overwhelmed with the "endless variety on the shelves." And this was just a 7-Eleven--wait till he sees a Safeway. The thing is, that "endless variety"exists only because Americans pay taxes to a government, which maintains roads, irrigates fields, oversees the electrical grid, and everything else that enables the modern American supermarket to carry forty-seven varieties of frozen breakfast pastry.Of course, it's easy to tear government down--Ronald Reagan used to say the nine most terrifying words in the Englishlanguage were "I'm from the government and I'm here to help." But that was before "I'm Sarah Palin, now show me the launch codes."The stimulus package was attacked as typical "tax and spend"--like repairing bridges is left-wing stuff. "There the liberals go again, always wanting to get across the river." Folks, the people are the government--the first responders who put out fires--that's your government. The ranger who shoos pedophiles out of the park restroom, the postman who delivers your porn.How stupid is it when people say, "That's all we need: the federal government telling Detroit how to make cars or Wells Fargo how to run a bank. You want them to look like the post office?"You mean the place that takes a note that's in my hand in L.A. on Monday and gives it to my sister in New Jersey on Wednesday, for 44 cents? Let me be the first to say, I would be thrilled if America's health-care system was anywhere near as functional as the post office.Truth is, recent years have made me much more wary of government stepping aside and letting unregulated private enterprise run things it plainly is too greedy to trust with. Like Wall Street. Like rebuilding Iraq.Like the way Republicans always frame the health-care debate by saying, "Health-care decisions should be made by doctors and patients, not government bureaucrats," leaving out the fact that health-care decisions aren't made by doctors, patients, or bureaucrats; they're made by insurance companies. Which are a lot like hospital gowns--chances are your gas isn't covered.

Mussolini envisioned a powerful centralized state directing the institutions of the private sector, forcing their private welfare into line with the national welfare. Isn’t this precisely how progressives view the federal government’s control of banks, finance companies, insurance companies, health care, energy, and education?

Well, “maybe it is,” Chotiner wrote, “but the Republican Party must do something more than point out the evils of the administration’s plan—it must show that it is ready to meet the needs of Tom Jones when illness strikes.” And so Congressman Nixon joined with other Republican moderates to introduce a national health insurance plan in which the states and federal governments would subsidize the purchase of insurance from private companies. “Our bill involves neither socialized medicine nor medicine for indigents only,” the announcement said. “It recognizes that the problem of medical care for the people is urgent and that government should participate in its solution.

The results of that mistake are everywhere. In 1950, the median home price was 2.2 times the average annual income; by 2020, it was 6 times the average annual income.5 Between 1999 and 2023, the average premium for employer-based family health insurance rose from $5,791 to $23,968—an increase of more than 300 percent—and the worker contribution to that premium more than quadrupled.6 In 1970, the average annual cost of tuition and fees was $394 at public colleges and $1,706 at private colleges. In 2023, it was $11,310 at public colleges for in-state students and $41,740 at private colleges.7 Child care for an infant and a four-year-old costs, on average, $36,008 in Massachusetts, $28,420 in California, and $28,338 in Minnesota.

The United States is famously resistant to anything smacking of redistribution. Yet it allocates 19 percent of its GDP to social services, and despite the best efforts of conservatives and libertarians the spending has continued to grow. The most recent expansions are a prescription drug benefit introduced by George W. Bush and the eponymous health insurance plan known as Obamacare introduced by his successor. Indeed, social spending in the United States is even higher than it appears, because many Americans are forced to pay for health, retirement, and disability benefits through their employers rather than the government. When this privately administered social spending is added to the public portion, the United States vaults from twenty-fourth into second place among the thirty-five OECD countries, just behind France.

Consider almost any public issue. Today’s Democratic Party and its legislators, with a few notable individual exceptions, is well to the right of counterparts from the New Deal and Great Society eras. In the time of Lyndon Johnson, the average Democrat in Congress was for single-payer national health insurance. In 1971, Congress overwhelmingly passed the Comprehensive Child Development Act, for universal, public, tax-supported, high-quality day care and prekindergarten. Nixon vetoed the bill in 1972, but even Nixon was for a guaranteed annual income, and his version of health reform, “play or pay,” in which employers would have to provide good health insurance or pay a tax to purchase it, was well to the left of either Bill or Hillary Clinton’s version, or Barack Obama’s. The Medicare and Medicaid laws of 1965 were not byzantine mash-ups of public and private like Obamacare. They were public. Infrastructure investments were also public. There was no bipartisan drive for either privatization or deregulation. The late 1960s and early 1970s (with Nixon in the White House!) were the heyday of landmark health, safety, environmental, and financial regulation. To name just three out of several dozen, Nixon signed the 1970 Clean Air Act, the 1970 Occupational Safety and Health Act, and the 1973 Consumer Product Safety Act. Why did Democrats move toward the center and Republicans to the far right? Several things occurred. Money became more important in politics. The Democratic Leadership Council, formed by business-friendly and Southern Democrats after Walter Mondale’s epic 1984 defeat, believed that in order to be more competitive electorally, Democrats had to be more centrist on both economic and social issues.

The Libertarian Party platform on which Koch ran in 1980 was unambiguous. It included the following: • We favor the abolition of Medicare and Medicaid programs. • We oppose any compulsory insurance or tax-supported plan to provide health services. . . . • We favor the repeal of the . . . Social Security system. . . . • We oppose all personal and corporate income taxation, including capital gains taxes. • We support the eventual repeal of all taxation. • As an interim measure, all criminal and civil sanctions against tax evasion should be terminated immediately. • We support repeal of all . . . minimum wage laws. . . . • Government ownership, operation, regulation, and subsidy of schools and colleges should be ended. . . . • We support the abolition of the Environmental Protection Agency. . . . • We call for the privatization of the public roads and national highway system. . . . • We advocate the abolition of the Food and Drug Administration. . . . • We oppose all government welfare, relief projects, and “aid to the poor” programs.44 The list went on from there, including ending government oversight of abusive banking practices by ending all usury laws; privatizing our airports, the FAA, Amtrak, and all of our rivers; and shutting down the Post Office.

In March 2002, the National Academy of Sciences, a private, nonprofit society of scholars, released a high-profile report documenting the unequivocal existence of racial bias in medical care, which many thought would mark a real turning point. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care was so brutal and damning that it would seem impossible to turn away. The report, authored by a committee of mostly white medical educators, nurses, behavioral scientists, economists, health lawyers, sociologists, and policy experts, took an exhaustive plunge into more than 480 previous studies. Because of the knee-jerk tendency to assume that health disparities were the end result of differences in class, not race, they were careful to compare subjects with similar income and insurance coverage. The report found rampant, widespread racial bias, including that people of color were less likely to be given appropriate heart medications or to undergo bypass surgery or receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments, and people of color were also less likely to receive the most sophisticated treatments for HIV/AIDS. These inequities, the report concluded, contribute to higher death rates overall for Black people and other people of color and lower survival rates compared with whites suffering from comparable illnesses of similar severity.

The proof that the One Stone Solution is political lies in what women feel when they eat “too much”: guilt. Why should guilt be the operative emotion, and female fat be a moral issue articulated with words like good and bad? If our culture’s fixation on female fatness or thinness were about sex, it would be a private issue between a woman and her lover; if it were about health, between a woman and herself. Public debate would be far more hysterically focused on male fat than on female, since more men (40 percent) are medically overweight than women (32 percent) and too much fat is far more dangerous for men than for women. In fact, “there is very little evidence to support the claim that fatness causes poor health among women…. The results of recent studies have suggested that women may in fact live longer and be generally healthier if they weigh ten to fifteen percent above the life-insurance figures and they refrain from dieting,” asserts Radiance; when poor health is correlated to fatness in women, it is due to chronic dieting and the emotional stress of self-hatred. The National Institutes of Health studies that linked obesity to heart disease and stroke were based on male subjects; when a study of females was finally published in 1990, it showed that weight made only a fraction of the difference for women that it made for men. The film The Famine Within cites a sixteen-country study that fails to correlate fatness to ill health. Female fat is not in itself unhealthy.

But as Bill Gates said to us when Mark and I met with him in his Seattle-area office, “People invest in high-probability scenarios: the markets that are there. And these low-probability things that maybe you should buy an insurance policy for by investing in capacity up front, don’t get done. Society allocates resources primarily in this capitalistic way. The irony is that there’s really no reward for being the one who anticipates the challenge.” Every time there is a new, serious viral outbreak, such as Ebola in 2012 and Zika in 2016, there is a public outcry, a demand to know why a vaccine wasn’t available to combat this latest threat. Next a public health official predicts a vaccine will be available in x number of months. These predictions almost always turn out to be wrong. And even if they’re right, there are problems in getting the vaccine production scaled up to meet the size and location of the threat, or the virus has receded to where it came from and there is no longer a demand for prevention or treatment. Here is Bill Gates again: Unfortunately, the message from the private sector has been quite negative, like H1N1 [the 2009 epidemic influenza strain]: A lot of vaccine was procured because people thought it would spread. Then, after it was all over, they sort of persecuted the WHO people and claimed GSK [GlaxoSmithKline] sold this stuff and they should have known the thing would end and it was a waste of money. That was bad. Even with Ebola, these guys—Merck, GSK, and J & J [Johnson & Johnson]—all spent a bunch of money and it’s not clear they won’t have wasted their money. They’re not break-even at this stage for the things they went and did, even though at the time everyone was saying, “Of course you’ll get paid. Just go and do all this stuff.” So it does attenuate the responsiveness. This model will never work or serve our worldwide needs. Yet if we don’t change the model, the outcome will not change, either.

Finally, as I’ve emphasized, there is the level of conscious public policy. A Soviet official issuing a planning document, or an American politician calling for job creation, might not be entirely aware of the likely effects of their action. Still, once a situation is created, even as an unintended side effect, politicians can be expected to size up the larger political implications of that situation when they make up their minds what—if anything—to do about it. Does this mean that members of the political class might actually collude in the maintenance of useless employment? If that seems a daring claim, even conspiracy talk, consider the following quote, from an interview with then US president Barack Obama about some of the reasons why he bucked the preferences of the electorate and insisted on maintaining a private, for-profit health insurance system in America: “I don’t think in ideological terms. I never have,” Obama said, continuing on the health care theme. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents one million, two million, three million jobs [filled by] people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?”9 I would encourage the reader to reflect on this passage because it might be considered a smoking gun. What is the president saying here? He acknowledges that millions of jobs in medical insurance companies like Kaiser or Blue Cross are unnecessary. He even acknowledges that a socialized health system would be more efficient than the current market-based system, since it would reduce unnecessary paperwork and reduplication of effort by dozens of competing private firms. But he’s also saying it would be undesirable for that very reason. One motive, he insists, for maintaining the existing market-based system is precisely its inefficiency, since it is better to maintain those millions of basically useless office jobs than to cast about trying to find something else for the paper pushers to do.10 So here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs.

A recent survey of private US health care facilities estimated that the support staff of hospital physicians spends nineteen hours a week interacting with insurance providers in prior authorizations, while clerical staff spend thirty-six hours a week filing claims. The cost of interactions between private health care providers and private insurance providers was estimated to be $68,000 per physician per year, totaling a whopping $31 billion per year—equivalent to the GDP of the Dominican Republic in 2005.22 The interaction costs in 1999 for the entire health care system, including private and public, were estimated on the low end to be $31 billion and on the high end to be $294 billion—which is comparable to the present day GDP of Singapore or Chile.

What American Healthcare Can Learn from Italy: Three Lessons It’s easy. First, learn to live like Italians. Eat their famous Mediterranean diet, drink alcohol regularly but in moderation, use feet instead of cars, stop packing pistols and dropping drugs. Second, flatten out the class structure. Shrink the gap between high and low incomes, raise pensions and minimum wages to subsistence level, fix the tax structure to favor the ninety-nine percent. And why not redistribute lifestyle too? Give working stiffs the same freedom to have kids (maternity leave), convalesce (sick leave), and relax (proper vacations) as the rich. Finally, give everybody access to health care. Not just insurance, but actual doctors, medications, and hospitals. As I write, the future of the Affordable Care Act is uncertain, but surely the country will not fall into the abyss that came before. Once they’ve had a taste of what it’s like not to be one heart attack away from bankruptcy, Americans won’t turn back the clock. Even what is lately being called Medicare for All, considered to be on the fringe left a decade ago and slammed as “socialized medicine,” is now supported by a majority of Americans, according to some polls. In practice, there’s little hope for Italian lessons one and two—the United States is making only baby steps toward improving its lifestyle, and its income inequality is worse every year. But the third lesson is more feasible. Like Italy, we can provide universal access to treatment and medications with minimal point-of-service payments and with prices kept down by government negotiation. Financial arrangements could be single-payer like Medicare or use private insurance companies as intermediaries like Switzerland, without copying the full Italian model of doctors on government salaries. Despite the death by a thousand cuts currently being inflicted on the Affordable Care Act, I am convinced that Americans will no longer stand for leaving vast numbers of the population uninsured, or denying medical coverage to people whose only sin is to be sick. The health care genie can’t be put back in the bottle.

At the time, few people had or felt the need for private health insurance. Most Americans paid their doctors visit by visit, but the field of medicine was quickly growing more sophisticated, and as more diagnostic tests and surgeries became available, the attendant costs began to rise, tying health more explicitly to wealth. Both the United Kingdom and Germany had addressed similar issues by instituting national health insurance systems, and other European nations would eventually follow suit.

labour? The elite cared not that education standards were falling in the state sector, because by and large they had no connection with the state sector. For the most part they had private health insurance too. And in a sense the economic shibboleths of the 1980s paid for these people to live the less dirigiste social lives made possible by the new freedoms of divorce and separation. The poor, as we have seen, still cannot afford to divorce. When they do, the misery – economic and social – is boundless. I do not want to kill

There was a watered-down version in the Senate Health and Education Committee bill, requiring any government-run insurer to charge the same rates as private insurers, but of course that would have defeated the whole purpose of a public option. My team and I thought a possible compromise might involve offering a public option only in those parts of the country where there were too few insurers to provide real competition and a public entity could help drive down premium prices overall. But even that was too much for the more conservative members of the Democratic caucus to swallow, including Joe Lieberman of Connecticut, who announced shortly before Thanksgiving that under no circumstances would he vote for a package that contained a public option. When word got out that the public option had been removed from the Senate bill, activists on the left went ballistic.

While Roosevelt ultimately lost the 1912 election, his party’s progressive ideals planted a seed that accessible and affordable medical care might be viewed as a right more than a privilege. It wasn’t long, however, before doctors and southern politicians vocally opposed any type of government involvement in healthcare, branding it as a form of bolshevism. After FDR imposed a nationwide wage freeze meant to stem inflation during World War II, many companies began offering private health insurance and pension benefits as a way to compete for the limited number of workers not deployed overseas. Once the war ended, this employer-based system continued, in no small part because labor unions liked the arrangement, since it enabled them to use the more generous benefit packages negotiated under collective bargaining agreements as a selling point to recruit new members. The downside was that it left those unions unmotivated to push for government-sponsored health programs that might help everybody else.

To be clear, the beneficiaries of Truman’s universal coverage would have been overwhelmingly white, as white people at the time made up 90 percent of the U.S. population. Few Americans, Black or white, had private insurance plans, and the recent notion that employers would provide it had yet to solidify into a nationwide expectation. The pool of national health insurance would have been mainly for white Americans, but the threat of sharing it with even a small number of Black and brown Americans helped to doom the entire plan from the start.

The potential profit upside was impressive. Remdesivir cost Gilead $10 per dose to manufacture.18,19 But by granting Gilead an EUA, regulators could force private insurers, Medicare, and Medicaid to fork over around $3,120.00 per treatment—hundreds of times the cost of the drug.

Many in the proudly working-class city of Liverpool were pleased to find that the Swabian’s convictions echoed their own. ‘I wouldn’t call myself very political but I’m on the left, of course. More left than the middle,’ Klopp told taz in 2009. ‘I believe in the welfare state, I don’t mind paying for health insurance. I’m not privately insured, I would never vote for a party because they promised to lower the top tax rate. My political understanding is this: if I’m doing well, I want others to do well, too. If there’s something I’ll never do in my life it’s voting for the right.

massive transitions to something entirely “new” were always defined in terms of a response to a violent external shock or the threat of one to come. World War II, for example, led to the introduction of cradle-to-grave state welfare systems in most of Europe. So did the Cold War: governments in capitalist countries were so worried by an internal communist rebellion that they put into place a state-led model to forestall it. This system, in which state bureaucrats managed large chunks of the economy, ranging from transportation to energy, stayed in place well into the 1970s. Today the situation is fundamentally different; in the intervening decades (in the Western world) the role of the state has shrunk considerably. This is a situation that is set to change because it is hard to imagine how an exogenous shock of such magnitude as the one inflicted by COVID-19 could be addressed with purely market-based solutions. Already and almost overnight, the coronavirus succeeded in altering perceptions about the complex and delicate balance between the private and public realms in favour of the latter. It has revealed that social insurance is efficient and that offloading an ever-greater deal of responsibilities (like health and education) to individuals and the markets may not be in the best interest of society.

Netherlands, which has a restrictive immigration policy compared to the United States. Most European nations, including the Netherlands, after all, have universal health insurance coverage, which makes drug treatment and psychiatric treatment more available, and the Dutch government subsidizes more housing. Finally, the Netherlands’ big success was with heroin, which has effective pharmacological substitutes, methadone and Suboxone, not with meth, which lacks anything similar. But there may be fewer obstacles than appear. The Netherlands has a private health-care insurance system similar to that of the United States and covered the people who needed health care in ways similar to Medicaid and the Affordable Care Act, which significantly expanded access to drug treatment, including medically assisted treatment, in the United States.4 San Francisco subsidizes a significant quantity of housing, as we have seen. While California is larger than the Netherlands, the population of Amsterdam (872,000) is nearly identical to San Francisco’s (882,000).5 And while California’s population and geographic area are larger and more difficult to manage than those of the Netherlands, California also has significantly greater wealth and resources, constituting in 2019 the fifth-largest economy in the world.6 And the approach to breaking up open drug scenes, treating addiction, and providing psychiatric care is fundamentally the same whether in five European cities, Philadelphia, New York, or Phoenix.

critics would complain if he spent billions on vaccines and nothing on therapeutics. However, any licensed, repurposed antiviral that was effective against COVID for prevention or early treatment (like IVM or HCQ) could kill his entire vaccine program because FDA wouldn’t be able to grant his jabs Emergency Use Authorization. Remdesivir, however, was an IV remedy, appropriate only for use on hospitalized patients in the late stages of illness. It would therefore not compete with vaccines, allowing Dr. Fauci to support it without compromising his core business. Furthermore, while HCQ and IVM were off-patent and available generically, remdesivir was in the sweet spot of still being on patent. The potential profit upside was impressive. Remdesivir cost Gilead $10 per dose to manufacture.18,19 But by granting Gilead an EUA, regulators could force private insurers, Medicare, and Medicaid to fork over around $3,120.00 per treatment—hundreds of times the cost of the drug.20,21 Gilead predicted remdesivir would bring in $3.5 billion in 2020 alone.

Most schools fulfill this legal obligation by providing services that won’t involve a perpetrator, such as academic accommodations or healing resources. At Western University, victim advocates would broker agreements between survivors and their professors to get extensions on assignments or excused absences. They would also help survivors submit paperwork to receive refunds for classes they dropped or failed due to the strains of their traumatic symptoms. To improve survivors’ mental health, the Counseling Center hosted group therapy for sexual assault survivors and offered one-on-one counseling at a cheaper rate than the insurance co-pay at most private practices. Advocates also had a small fund available to cover survivors’ trauma-related expenses. Overwhelmingly, survivors who received these resources benefited from them. Some called them life-changing. However, few survivors felt comfortable actually using them. Especially more than once.

comprehensivist.” (IBM’s Grundy coined this term. He’s also president of the Patient-Centered Primary Care Collaborative, a set of large employers, provider groups, and private insurers looking to transform health care.) Comprehensivists are skilled project

I feel that the government should uphold the concept that it is there for us, “We the People.” That it does what we alone cannot do. By standing unified and proud, we have strength because of our numbers and the power to do what is right. That we always remain on the right side of history and care for and respect our less fortunate. Now, you may think that I’m just spouting out a lot of patriotic nonsense, which you are entitled to do, however I did serve my country actively in both the Navy and Army for a total of forty years, six months and seven days as a reservist and feel that I have an equal vested interest in these United States. If we don’t like what is happening we have responsible ways and means to change things. We have Constitutional, “First Amendment Rights to Freedom of Speech.” There are many things I would like to see change and there are ways that we can do this. To start with we have to protect our First Amendment Rights and protect the media from government interference…. I also believe in protecting our individual freedom…. I believe in one person, one vote…. Corporations are not people, for one they have no human feelings…. That although our government may be misdirected it is not the enemy…. I want reasonable regulations to protect us from harm…. That we not privatize everything in sight such as prisons, schools, roads, social security, Medicare, libraries etc.….. Entitlements that have been earned should not be tampered with…. That college education should be free or at least reasonable…. That health care becomes free or very reasonable priced for all…. That lobbyist be limited in how they can manipulate our lawmakers…. That people, not corporations or political action committees (PAC’s), can only give limited amounts of money to candidates…. That our taxes be simplified, fair and on a graduated scale without loop holes….That government stays out of our personal lives, unless our actions affect others…. That our government stays out of women’s issues, other than to insure equal rights…. That the law (police) respects all people and treats them with the dignity they deserve…. That we no longer have a death penalty…. That our military observe the Geneva Conventions and never resort to any form of torture…. That the Police, FBI, CIA or other government entities be limited in their actions, and that they never bully or disrespect people that are in their charge or care…. That we never harbor prisoners overseas to avoid their protection by American law…. That everyone, without exception, is equal…. And, in a general way, that we constantly strive for a more perfect Union and consider ourselves members of a greater American family, or at the very least, as guests in our country. As Americans we are better than what we have witnessed lately. The idea that we will go beyond our rights is insane and should be discouraged and outlawed. As a country let us look forward to a bright and productive future, and let us find common ground, pulling in the same direction. We all deserve to feel safe from persecution and/or our enemies. We should also be open minded enough to see what works in other countries. If we are going to “Make America Great Again” we should start by being more civil and kinder to each other. Now this is all just a thought, but it’s a start…. “We’re Still Here!

We should remember why those programs were started: before the arrival of Medicare and Social Security, the private sector left most elderly bereft of support, the market for annuities essentially didn’t exist, and the elderly couldn’t get health insurance. Even today, the private sector doesn’t provide the kind of security that Social Security provides—including protection against market volatility and inflation. And the transactions costs of the Social Security Administration are markedly lower than those in the private sector. In addition, many of the people who receive government benefits without paying for them are our young, obviously unable to pay, say, for their own education. But spending on them is an investment in the country’s future. An

The worst thing about pills was that they worked. Without them, you might just adapt; medical optimism suspended you in a maintenance reality. He'd never known how sick he was until he'd gotten health insurance. The pill that really wanted inventing was the bitter one that cured you of optimism and made time go faster.

Senator Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance,” Chelsea said of Sanders’s Medicare-for-all health care plan. “I don’t want to empower Republican governors to take away Medicaid, to take away health insurance for low-income and middle-income working Americans. And I think very much that’s what Senator Sanders’ plan would do.

Net wages: “It’s not what you make, but what you net” after paying the FIRE sector, basic utilities and taxes. The usual measure of disposable personal income (DPI) refers to how much employees take home after income-tax withholding (designed in part by Milton Friedman during World War II) and over 15% for FICA (Federal Insurance Contributions Act) to produce a budget surplus for Social Security and health care (half of which are paid by the employer). This forced saving is lent to the U.S. Treasury, enabling it to cut taxes on the higher income brackets. Also deducted from paychecks may be employee withholding for private health insurance and pensions. What is left is by no means freely available for discretionary spending. Wage earners have to pay a monthly financial and real estate “nut” off the top, headed by mortgage debt or rent to the landlord, plus credit card debt, student loans and other bank loans. Electricity, gas and phone bills must be paid, often by automatic bank transfer – and usually cable TV and Internet service as well. If these utility bills are not paid, banks increase the interest rate owed on credit card debt (typically to 29%). Not much is left to spend on goods and services after paying the FIRE sector and basic monopolies, so it is no wonder that markets are shrinking. (See Hudson Bubble Model later in this book.) A similar set of subtrahends occurs with net corporate cash flow (see ebitda). After paying interest and dividends – and using about half their revenue for stock buybacks – not much is left for capital investment in new plant and equipment, research or development to expand production.

HMOs have been so successful that they now occupy a dominant position in the market for health care in the United States. Approximately forty-five million Americans are uninsured. Of the remainder, about half are enrolled in some type of HMO. Most others receive some sort of managed care plan. Less than 10 per cent of Americans still have classic fee-for-service private health insurance (down from more than 70 per cent in the late ’80s). So even though many people equate HMOs with private health care, these sorts of corporations exist only because of the failure of private markets to supply appropriate health care. HMOs succeed precisely because they are more efficient than insurance markets. There should be no illusions about the character of these organizations—they are giant bureaucracies. The largest of them, Kaiser Permanente, employs over eleven thousand physicians and has more than six million subscribers in the state of California alone. This makes Kaiser larger than most of the government-run health care systems in Canada. And while the Canadian system is extremely decentralized, Kaiser Permanente is a single, vertically integrated corporation.

Today 60% of workers in the private sector receive their insurance through their employer. I believe that by 2025 fewer than 20% of workers at private companies will continue to receive their health insurance through an employer-sponsored program. Nevertheless many will still receive an employer contribution, a so-called defined contribution toward the purchase of health insurance in the exchange. I believe the majority of private-sector workers will get their coverage through the exchanges.

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Of course, even that day may come. The idea of mandatory contraception has been bruited about at the state level for drug-abusing or welfare-abusing mothers; and it is not hard to imagine that with the federal government counting on Obamacare cost savings from contraception that it could become as mandatory as having health insurance. And if gay marriage really is a civil right, how long will the federal government allow churches to opt out from respecting it? Obama’s supposed respect for the integrity of religious “sacraments” isn’t worth taking seriously. Under the nanny state of the left, nothing remains “private” for long. Should Obama win a second term, one can imagine his friends at Planned Parenthood calling for forcible sterilizations to “save costs” and gay groups calling for “hate crime” fines to be levied on Catholic priests who refuse to bless gay unions. Already in Canada and Western Europe, nonconformists can be dragged before judges for harboring the “wrong” thoughts. The French actress Brigitte Bardot has been “tried” several times for criticizing Islam. So was the late author Oriana Fallaci, who stood trial in Italy for “defaming Islam.” Do not kid yourselves: it could happen here. In a second term, the Obama administration will bring that day much closer.

A far better way to slow medical costs is to use Medicare and Medicaid’s bargaining power over drug companies and hospitals to get lower prices and to move from a fee-for-service system to a fee-for-healthy-outcomes system. And because Medicare has far lower administrative costs than private health insurers, we should make Medicare available to everyone.

Unhorsing capitalism was never the New Deal’s intent anyway. Especially since the outset of the war, the regime had largely come to agreeable terms with big business interests. It shed most programmatic overtures to universalize the welfare state and extend it into areas like health and housing. Structural reconfigurations of power relations in the economy, long-term economic planning, and state ownership or management of capital investments (commonplace during the war) were all offensive to the new centers of the postwar policy making, what soon enough would be widely referred to as the Establishment. Moreover, the “welfare state,” for all the tears now shed over its near death, was in its origins in late-nineteenth-century Europe a creature of conservative elitists like Bismarck or David Lloyd George, and had been opposed by the left as a means of defusing working-class power and independence, a program installed without altering the basic configurations of wealth and political control. As the center of gravity shifted away from the Keynesian commonwealth toward what one historian has called “commercial Keynesianism” and another “the corporate commonwealth,” labor and its many allies among middle-class progressives and minorities found themselves fighting on less friendly terrain. If they could no longer hope to win in the political arena measures that would benefit all working people—like universal health insurance, for example—trade unions could pursue those objectives for their own members where they were most muscular, especially in core American industries like auto and steel. So the labor movement increasingly chose to create mini private welfare states.

Obamacare is a program designed to shift control of the health care industry from the private sector to the public sector, from doctors, hospitals, and insurance companies to the federal government. The program was sold by Obama feigning outrage over insurance companies refusing to grant insurance to people with “preexisting conditions.” But this is the same as an insurance company not granting fire insurance to a guy whose house has already burned down. The whole point of insurance is to share the risk before the catastrophe occurs, not to have a catastrophe and then get other people to pay for your losses.

Private health insurers allow so much fraud that prosecutors use an idiom to describe the rare person who gets caught: “Pigs get fat, hogs get slaughtered.

private insurance and away from Medicare. The result would be “two-tier medicine,” a term that is as pejorative in Canada as “socialized medicine” is in the United States. Many fear that if Canada did move to two-tier medicine, the rich might get better care, with less waiting, than the poor. The rich getting better access to health care—that’s a fact of life that we take for granted in the United States. But in Canada, such a result would violate the powerful egalitarian impulse that is a crucial element of the national culture.

All the same, Kiev was a melancholy city. Its defining features were failures, absences. Some were obvious: only one supermarket (dollars only), few private cars (six at an intersection counted as a traffic jam), a joke of a postal service (to send a letter, one went to the railway station, and handed it to a friendly face going in the right direction). Others one only felt the force of after a time. With benefits and pensions virtually non-existent, the crudest health care (drugs had to be paid for; doctors wanted bribes), and no insurance (a few private firms had sprung up, but nobody trusted them with their money), Kievans were living lives of a precariousness unknown in the West, destitution never more than an illness or a family quarrel away. It showed in their wiry bodies and pinched, alert, Depression-era faces; the faces of people who get by on cheap vodka and stale cigarettes, and know they have to look after themselves, for nobody else will do it for them.

Many therapists—psychiatrists, psychologists, and those in behavioral health—won’t take private insurance, exchange plans, or Medicaid plans because they don’t pay providers well, which means outpatient care is still an issue. Covered treatment becomes an emergency room issue and is reactionary rather than preventive. And, according to the National Alliance on Mental Illness, in our contemporary mental health crisis, people are more likely to encounter police than get medical help. “As a result, 2 million people with mental illness are booked into jails each year. Nearly 15 percent of men and 30 percent of women booked into jails have a serious mental health condition.

No other developed country in the world has such an outdated, fragile health insurance system. Health insurance in many such countries is considered a right and is provided by their government, paid by taxes. It is like Medicare without an age limit. Other countries offer insurance through private options also, but there is universal coverage. In our country, the most common cause of personal bankruptcy is medical bills.

A rational system of health care has to have the ability to say no, and to have it stick. This is the only way to protect patients from misguided, scientifically unproven interventions, to cut out waste, fraud, and abuse. Those who pay—private insurers or the government—need to be able to protect the public from the miscarriage of medicine.

Some of these tasks are interesting. Tinkering with machines is fun. Marketing decisions, especially how to manage the Web site and AdWords, are an intellectual challenge. Some are unpleasant but lead to a satisfying conclusion, like nagging customers for past-due payments. (They've always paid me, eventually.) Some are frightening, I can change an employee's life with my decisions about pay rates and whether to hire and fire. And many are just aggravating: the taxes, insurance purchases, legal issues, and some of the employee interactions. Each layer of government, each enormous and indifferent private bureaucracy, requires its own special knowledge: the right form filled out the correct way and filed at the right time. Learning how to complete on type of tax filing tells you nothing whatsoever about how to fill out the next form. One health insurer presents a quote one way, another in an entirely different way, and both require extensive study to determine the best choice. It's like stepping back to an old, old world where every tree, every rock, every stream is inhabited by its own resident spirit, and each needs to be mollified in the correct manner. Or very bad things happen. I didn't start my company to do any of this. I had no idea, when I decided that I would make furniture in exchange for money, that this was in my future. And the strange universe of administration expands as the company grows.

Luntz used polls, focus groups, and “instant response dial sessions” to perfect the language of health-care attacks and then tested the lines on average Americans in St. Louis, Missouri. Out of these sessions, Luntz compiled a seminal twenty-eight-page confidential memo in April warning that there was no groundswell of public opposition to Obama’s health-care plan at that point; in fact, there was a groundswell of public support. By far the most effective approach to turning the public against the program, Luntz advised, was to label it a “government takeover.” He wrote, “Takeovers are like coups. They both lead to dictators and a loss of freedom.” “I did create the phrase ‘government takeover’ of health care. And I believe it,” Luntz maintained, noting too that “it gave the Republicans the weapon they needed to defeat Obama in 2010.” But most experts found the pitch patently misleading because the Obama administration was proposing that Americans buy private health insurance from for-profit companies, not the government. In fact, progressives were incensed that rather than backing a “public option” for those who preferred a government insurance program, the Obama plan included a government mandate that individuals purchase health-care coverage, a conservative idea hatched by the Heritage Foundation to stave off nationalized health care. Luntz’s phrase was so false that it was chosen as “the Lie of the Year” by the nonpartisan fact-checking group PolitiFact. Yet while a rear guard of administration officials tried lamely to correct the record, Luntz’s deceptive message stuck, agitating increasingly fearful and angry voters, many of whom flocked to Tea Party protests.

They were eager to get rid of me at Mount Sinai Hospital. I had only a “catastrophic” health insurance policy (private insurance is expensive and I never get sick) and there was some debate over whether hitting your head on a sidewalk after passing out from what amounts to a panic attack was exactly catastrophic. There was some debate over the meaning of the word and whether it was the incident or the result of the incident that had to be life threatening in order to be covered. Since

Income volatility can also interfere with the existing social safety net. Some welfare programs require beneficiaries to work a certain number of hours each week, assuming that the number of hours worked is under the control of the employee, rather than the employer.53 Qualification for programs like food stamps and health insurance subsidies is based on an average monthly income threshold. But of course volatile incomes mean that families bounce in and out of eligibility.54 Bouncing in and out of Medicaid ineligibility causes interruptions in care for chronic conditions, particularly in places where the doctors who accept Medicaid and private insurance don’t overlap.55 There can also be severe penalties for “fraud” in these programs, receiving benefits when your income is too high. But households subject to volatile incomes may not, themselves, know when or whether they will cross thresholds of eligibility. For instance, as of 2016, the Pennsylvania Medicaid Application asks whether anyone in the household has a hard time predicting their income, but in the very next question requires applicants to do exactly that—for the next twenty-four months—in order to establish eligibility.

Every American should be able to expect certain standards, freedoms, benefits, and opportunities form a twenty-first-century health system. If they are willing to participate and be responsible, they will gain: •Improved health; •Longer lives with a much better quality of life; •A more convenient, understandable and personalized experience -- all at a lower cost; •Access to the best course of treatment for their particular illness and their unique characteristics; •A system that fosters and encourages innovation, competition, and better outcomes for patients; •A system that truly values the impact that medical innovation has on patients and their caregivers as well as on society as a whole; •A government that facilitates and accelerates extraordinary opportunities to improve health and health care; •Continuous but unobtrusive 24/7 monitoring of their general health, chronic conditions, and acute health problems; •Access to the most modern medical knowledge and breakthroughs, including the most advanced technologies, therapies and drugs, unimpeded by government-imposed price controls or rationing; •The chance to increase their personal knowledge by learning from a transparent system of information about their diagnosis, costs and alternative solutions; •A continuously improving, competitive, patient-focused medical world in which new therapies, new technologies, and new drugs are introduced as rapidly and safely as possible -- and not a day later; •Greater price and market competition, innovation and smarter health care spending; •A system of financing that includes insurance, government, charities, and self-funding that ensures access to health and health care for every American at the lowest possible cost without allowing financing and short-term budgetary considerations to distort and weaken the delivery of care; •Genuine insurance to facilitate access to dramatically better care, rather than the current system, which is myopically focused on monthly or annual payments; •A health system in which third parties and government bureaucrats do not impede the best course of treatment that doctors and their patients decide on; •A health system in which seniors, veterans, or others under government health programs receive the same quality of care as their children in private markt systems. Big reforms are required to transform today’s expensive, obsolete health bureaucracy into a system that conforms to these principles.

Cost-effectiveness analyses can be undertaken from a number of different perspectives. The choice of the study perspective is an important methodological decision because it determines which costs and effects to count and how to value them. The appropriate perspective depends on the objective of the study, the context, and the relevant decision makers. As indicated above, we recommend that analysts conduct Reference Case analyses from both the healthcare sector and societal perspectives (Recommendations 2–5). Other perspectives may, however, be relevant for specific decision makers. To illustrate, we briefly consider four perspectives potentially relevant to the analysis of health interventions: the payer perspective, the healthcare sector Reference Case perspective, the healthcare sector with time cost perspective, and the societal Reference Case perspective. Although we note two additional perspectives here, the remainder of this book will focus on the healthcare sector and societal Reference Case perspectives. The payer perspective includes the consequences that a specific payer considers relevant. This perspective will be more or less narrow depending on whether the payer is private or public. For a US private commercial payer (insurer), for example, costs might include reimbursement for medical care paid for by the insurer and consequences for patients covered by the insurer.

Anyone under the age of 65 that has private health insurance is not the true customer in American healthcare. Large and small group employers are.

A neomaterialist explanation has been offered by Robert Evans of the University of British Columbia and George Kaplan of the University of Michigan. If you want to improve health and quality of life for the average person in a society, you spend money on public goods—better public transit, safer streets, cleaner water, better public schools, universal health care. But the more income inequality, the greater the financial distance between the wealthy and the average and thus the less direct benefit the wealthy feel from improving public goods. Instead they benefit more from dodging taxes and spending on their private good—a chauffeur, a gated community, bottled water, private schools, private health insurance. As Evans writes, “The more unequal are incomes in a society, the more pronounced will be the disadvantages to its better-off members from public expenditure, and the more resources will those members have [available to them] to mount effective political opposition” (e.g., lobbying). Evans notes how this “secession of the wealthy” promotes “private affluence and public squalor.” Meaning worse health for the have-nots.

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