Congress will do as little as possible to enact legislation to help ordinary Americans as long as ordinary Americans don’t hold their elected representatives accountable. It really comes down to the electorate in red states. They should ask themselves why their representatives’ policies so clearly benefit the wealthiest Americans while doing absolutely nothing to help them. Really? Cutting Medicaid so that the wealthy can have tax cuts; voting against the minimum wage so that corporations like McDonald’s and Walmart can make even huger profits; voting to roll back regulations allowing coal companies to dump toxic waste in streams to cut corporate costs. The list goes on and on. Wake up Kentucky, Mitch McConnell and Rand Paul don’t have your back. Wake up Wisconsin, Paul Ryan is looking out for Paul Ryan. Wake up America - Trump does not care about you and he does not care about “making America great again.” It’s just a slogan that he trademarked so he can make more money.
24
kudos to nick kristoff ( I liked his polish spelling !- it should be used as a test for republican senators : if they can glance at it for 2 seconds and pronounce it correctly - they can vote their conscience ( personal, not political) on the GOP healthcare bill.
seriously, nick's column today needs to be made a required reading for all Americans. then, maybe, we'll finally hear the real outcry from the countryside about what a healthcare in the richest country of the world should look like.
seriously, nick's column today needs to be made a required reading for all Americans. then, maybe, we'll finally hear the real outcry from the countryside about what a healthcare in the richest country of the world should look like.
12
Congress has to do that, Nick. Congress. Not us. We can't do it. The pols have to do it.
Heck, the Constitution required Mitch to hold hearings and a vote on the Garland nomination. He simply ignored it and made a new rule.
In what universe do we get decent health care from these people via the measure you posit?
Will never happen here.
In a democracy? Maybe, but as the conservatives love to point out, the USA is not a democracy and they are making sure it is NOT.
Heck, the Constitution required Mitch to hold hearings and a vote on the Garland nomination. He simply ignored it and made a new rule.
In what universe do we get decent health care from these people via the measure you posit?
Will never happen here.
In a democracy? Maybe, but as the conservatives love to point out, the USA is not a democracy and they are making sure it is NOT.
19
But we don't like things that actually help like birth control or decent wages or financial aid of any sort for all except that class of people currently known as the one percent.
Poor one oercenters have to exist on a mere $650,000,000 of every billion they've earned. I could do it; you could do it. Heck, anybody who reads the NYT can do it. When you really think about it it probably would make more sense to donate the $650M to myriad good causes putting roofs over folks heads, paying for their inoculations, their schooling, and myriad other causes. The Gateses are doing it. The $36,500 a year people are doing it at a reduced level.
What's with those one percenters known as "investors"?
Let's have one of those old favorites, a prayer day, and see whether the congress and the cabinet can shake off the load of fear that seems to be gripping them and actually work together for programs that help the 99 percent. We might actually be proud of them!
Poor one oercenters have to exist on a mere $650,000,000 of every billion they've earned. I could do it; you could do it. Heck, anybody who reads the NYT can do it. When you really think about it it probably would make more sense to donate the $650M to myriad good causes putting roofs over folks heads, paying for their inoculations, their schooling, and myriad other causes. The Gateses are doing it. The $36,500 a year people are doing it at a reduced level.
What's with those one percenters known as "investors"?
Let's have one of those old favorites, a prayer day, and see whether the congress and the cabinet can shake off the load of fear that seems to be gripping them and actually work together for programs that help the 99 percent. We might actually be proud of them!
5
If you slash Defense Spending and the secret military blank check for items unaccounted for you'd have plenty of money to keep people healthy instead of maiming and killing the poor of the world.
16
Most of them were millionaires before they got elected anyway. In America these days, you need to be rich and well-connected to win an election.
3
As a Canadian who has enjoyed universal health care (without regard to location or pre-existing conditions) since 1967, I am saddened by the inability of the U.S. to make progress on health care. I can understand the difficulties in reaching any agreement in Congress when faced with a culture of profit above all else...from the Republicans. The health care and insurance industries have huge lobbying groups in place to ensure they keep profit in the forefront.
Basic health care is deemed a human right today. Making a profit on the backs of the sick, is about as immoral as it gets. Your Republicans love it, however, even as they profess their religious fath. Hypocrites all!
As we have aged, both my wife and I need more care. One hip replacement and two surgeries last year for us...cost out of our pockets...$0. We pay for health care in Canada through taxes. Everyone, without exception has health care under the Canada Health Act. We expend far less per capita on health care, and have better outcomes...and life expectancy, than the US. With your President focused on tweets, you are losing sight of reality, and a quickly changing world order. Trump isolationism is a disease slowly creeping up on the U.S., with the distractions of several investigations and the Twitter world blinding you to this eventuality. Sad indeed!
Basic health care is deemed a human right today. Making a profit on the backs of the sick, is about as immoral as it gets. Your Republicans love it, however, even as they profess their religious fath. Hypocrites all!
As we have aged, both my wife and I need more care. One hip replacement and two surgeries last year for us...cost out of our pockets...$0. We pay for health care in Canada through taxes. Everyone, without exception has health care under the Canada Health Act. We expend far less per capita on health care, and have better outcomes...and life expectancy, than the US. With your President focused on tweets, you are losing sight of reality, and a quickly changing world order. Trump isolationism is a disease slowly creeping up on the U.S., with the distractions of several investigations and the Twitter world blinding you to this eventuality. Sad indeed!
20
Move to a new community in the US and try to find medical care. We have such a shortage of doctors in this country and so many of them are specialists or turning to concierge care that it is hard to get on the list as a new patient. And when they will take you on, they are booking months out. If you get sick suddenly or have unusual symptoms, the ER is your only option and they charge an arm and a leg! If you are in a European country they will see you very quickly and give you excellent care. Wish we had that in this country.
8
Tie Congress's paychecks to how much we pay in taxes.
Those over 65 are happy to have basic universal health care called medicare. Too many of them do not want it for those under 65, Those who have health insurance from their work are happy to have "universal" work coverage but many do not want it for those who are not working at their successful company. The problem is we do not realize the damage to our entire society resulting from the lack of universal coverage for all. When you have millions of Americans with inadequate health coverage , the entire country pays the price.
25
If you took a sum of all the money paid into the insurance companies you would probably have a pool of money sufficient to subsidize a Medicare for all system. I remember a couple years ago one health insurance CEO received a 13 million dollar salary. So there seems to be an enormous input of money in this industry.
23
With a lot left over. Now about 18% of GDP flows into health care, while modern nations providing full coverage for all get it with 12%.
17
He was a piker. In 2006 Bill McGuire, the CEO of United HealthCare, was caught with his hand in the till and forced to retire. His compensation that year was $148,000,000. In spite of the fact he left under a cloud, he was awarded a pension plan that was costed out at $1,500,000,000. Now if you invest that properly and don't serve Chateau Petrus on weekdays, you can live on that. My point is not that private insurers waste money on obscene compensation, but that this shows what executives in the industry can hope to get. Maybe not quite that big any more, but still amounts of money that would embarrass an oriental potentate. But they ain't gonna get it unless they can keep the scam going.
9
i am a huge fan of Nicholas Kristof, and am in fear and loathing as I look at the bills offered by the Republican congress. That said, it is important to look behind numbers comparing complicated summaries. I sent this article to an informed analyst who responded:
"I just wanted to chime in with a few thoughts about the comparison of the infant mortality rate in the US vs other countries. It is very hard to compare infant and maternal mortality data from the US with other countries because the measurements are made differently.
There are children born in the US who would not survive birth in some of the countries mentioned in the article. Also child who dies during delivery is not counted in infant mortality data. Some countries do not include babies who die within a few hours of birth in the infant mortality data, resulting in an artificially low infant mortality rate.
I believe that when the combined late term stillbirth data and infant mortality data is compared across countries the US looks comparable or even better.
On maternal mortality, the US considers a longer time window (1 year) after birth for catching maternal deaths. As a result, there are deaths classified as maternal deaths in the US that would not be classified as maternal deaths in other countries. "
Facts really do matter and must be respected by all participants in the debate.
"I just wanted to chime in with a few thoughts about the comparison of the infant mortality rate in the US vs other countries. It is very hard to compare infant and maternal mortality data from the US with other countries because the measurements are made differently.
There are children born in the US who would not survive birth in some of the countries mentioned in the article. Also child who dies during delivery is not counted in infant mortality data. Some countries do not include babies who die within a few hours of birth in the infant mortality data, resulting in an artificially low infant mortality rate.
I believe that when the combined late term stillbirth data and infant mortality data is compared across countries the US looks comparable or even better.
On maternal mortality, the US considers a longer time window (1 year) after birth for catching maternal deaths. As a result, there are deaths classified as maternal deaths in the US that would not be classified as maternal deaths in other countries. "
Facts really do matter and must be respected by all participants in the debate.
6
What matters most is the increase in infant and maternal morality in the US. The comparison to other countries can be apples to oranges but the US's internal stats show a rise.
13
I am not the first person to say this, nor will I be the last. But the US, for whatever reasons is not ready for Medicare for all. Let's hear the Republicans tell us why Medicare for everyone who wants it (and there is a monthly premium) and private insurance for everyone who thinks the government can't add 2+2 and get 4 is not the answer. I have never heard one Republican address this proposal.
3
James the reason is that a lot of the savings in single payer is that everyone is treated the same. There aren't thousands of different plans with thousands of different forms. In addition, there is one entity that can gather data, analyze it and make recommendations and rules to eliminate medically necessary treatment.
11
Er-r-r-r-r-r. Bad day. I meant "medically UNnecessary treatment"
2
Another detail: Our hard-working members of Congress typically work 3.5 days per week (or less), yet many of them laugh at the French' 35-hr work week.
17
Their 3.5 days "working" recently included Wednesday morning baseball practice.
Their real work is the rest of the time, that they are getting money from donors. The 3.5 days is their time to enjoy the fruits of all those donations they got.
Their real work is the rest of the time, that they are getting money from donors. The 3.5 days is their time to enjoy the fruits of all those donations they got.
13
We need to be them on commission. They only get paid when they do a good job for ALL Americans. Or in a perfect work give them $15 an hour and no health insurance or pension.
15
Great column, Mr Kristof. Thanks especially for pointing out once again that Congress provides great health care for legislators, giving them no incentive whatsoever to do anything constructive about the rest of the country. We need to keep that in front of the public. Maybe one of these days it will penetrate the collective consciousness.
31
Inspired, perceptive piece. Thanks!
2
Don't forget random drug testing! Republicans are all for it, for others on the government dole. I'm sure they'd understand it's only fair for them to have it too. After all, if they're not doing anything wrong, they've got nothing to worry about, right?
2
"I suggest we introduce pay for performance, using metrics like, say, health."
Brilliant. Let's change this conversation (many public conversations need to be changed.) State and federal legislators can adopt these goals:
Instead of adopting legislation with a goal of "balancing the budget", let's adopt legislation that helps achieve the goal of improving U.S. life expectancy so that we are #1 instead of #42.
Instead of adopting legislation with the goal of "reducing income tax", let's adopt legislation that helps achieve the goal of reducing the U.S. child mortality rate so that ours is the lowest.
Instead of adopting a policy that for every new regulation one (or more) existing regulations must be eliminated, let's adopt a policy that every dollar given to DOD must be doubled in dollars given to public health.
I'm sure we can find many good ways to change the conversation. Others have been controlling the language in our dialogue for too many years.
Brilliant. Let's change this conversation (many public conversations need to be changed.) State and federal legislators can adopt these goals:
Instead of adopting legislation with a goal of "balancing the budget", let's adopt legislation that helps achieve the goal of improving U.S. life expectancy so that we are #1 instead of #42.
Instead of adopting legislation with the goal of "reducing income tax", let's adopt legislation that helps achieve the goal of reducing the U.S. child mortality rate so that ours is the lowest.
Instead of adopting a policy that for every new regulation one (or more) existing regulations must be eliminated, let's adopt a policy that every dollar given to DOD must be doubled in dollars given to public health.
I'm sure we can find many good ways to change the conversation. Others have been controlling the language in our dialogue for too many years.
28
The NYT should do a series on the list of nations below---all the news fit to print is its motto. This is how the press could fulfill its role of informing the public and lawmakers in a democracy.
True Cost Blog:
"32 of 33 developed nations have universal health care. The US is the lone exception. This list, compiled from WHO sources where possible, shows the start date and type of system...Universal health care does not imply government-only, as many countries have both public and private insurance and medical providers.
Country Start Date of Universal Health Care & System Type
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014 Insurance Mandate
True Cost Blog:
"32 of 33 developed nations have universal health care. The US is the lone exception. This list, compiled from WHO sources where possible, shows the start date and type of system...Universal health care does not imply government-only, as many countries have both public and private insurance and medical providers.
Country Start Date of Universal Health Care & System Type
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014 Insurance Mandate
17
That should have happened a long time ago. You'll never be able to get rid of the health insurance companies who make billions and never see a patient. The system is corrupted.
11
How bright and educated are these congressmen compared to our doctors, scientists, lawyers and other professionals who keep the society running, industry producing and economy growing? Except in few cases, most of them are greedy, money grabbers, cheaters, instant photo opportunists and basically crooks. They are elected poor but when they leave they become millionaire when they leave Washington? Why and how? Not the pay check but all the power they exercise for their own self-interests. If we limit their term like the presidency we can reduce their influence and the wealth can be distributed evenly across many people. Congressmen control our life but the party controls congressmen's life who oppose fair things across party lines - what a mess we are in.
6
Ah, here's the problem: the American public has been told over and over that we have the best healthcare system in the world! Why, look at the waiting times people in Canada and England have to endure to get treatment! Look how impressive our hospitals are with all that fabulous equipment. Other countries' hospitals just can't compare! Socialized medicine will make things here infinitely worse! We've heard these story lines over and over for years.
Yet, as you suggest, look at our outcomes. They are an embarrassment. We spend so much more and get so much less. Does anyone in Congress ever look at the facts? Does congress even know what problem it is trying to solve? It doesn't look like it.
Yet, as you suggest, look at our outcomes. They are an embarrassment. We spend so much more and get so much less. Does anyone in Congress ever look at the facts? Does congress even know what problem it is trying to solve? It doesn't look like it.
24
The problem with this concept is a majority of people in Congress are multi-millionaires. They could care less about congress pay - its chump change - they already spend millions to get elected.
17
They should be earning minimum wage and be forced to buy their own health insurance. You would think that $174,000 is enough to immunize them from the monied interests, but obviously that has not worked. So give them the minimum. Money doesn't just attract talent - it attracts greed.
It is the lack of term limits that has bred laziness, complacency and dependency in these politicos.
Single payer health care does not mean that the wealthy will stop having access to velvet glove health service - they have the means!
It is the lack of term limits that has bred laziness, complacency and dependency in these politicos.
Single payer health care does not mean that the wealthy will stop having access to velvet glove health service - they have the means!
14
Health Care and Lottery Tickets. Billions spent by people in this country every year on Lotto tickets. Attach a 10% portion of each ticket sold to cover people who can't afford for profit insurance policies. Cover everyone else in this manner. So. Buy a lottery ticket - get comprehensive health coverage.
Because being healthy is a lottery.
Being covered shouldn't be.
Because being healthy is a lottery.
Being covered shouldn't be.
8
Even if their pay were tied to performance, it may have no impact. For how many is their Congressional salary more than a mere supplement?
To achieve single payer health care we must elect public-spirited, conscientious, fair-minded people. And we do have some.
To achieve single payer health care we must elect public-spirited, conscientious, fair-minded people. And we do have some.
11
I have heard so often, comments about the health care/insurance coverage that members of Congress have as part of their benefits package. But, I've never seen it described in any kind of detail. Is this coverage for life - even after they leave office? Let's compare what they get compared to what the GOP is now "offering" their constituents.
11
A quick search brought up this: http://www.factcheck.org/2009/08/health-care-for-members-of-congress/ Essentially, Members of Congress can choose between over 300 private plans and get a 72-75% subsidy. So basically the same as health benefits from big employers, just that the Federal Government is the biggest employer in the country.
8
Duh... a search. Thanks for doing what I should have done!
1
Florida has more or less shut down the pill mills, but obviously led the country in opioid abuse. Medicaid won't be expanded and the legislature took advantage of a modest increase in federal aid to hospitals for indigent care to cut state spending.
We never hear of what if anything is happening in terms of treatment, unlike in Ohio and West Virginia.
Senator Rubio has led attacks on Obamacare. I expect Florida looks much more like the American future than, say, Ohio, which has a relatively decent and humane governor.
We never hear of what if anything is happening in terms of treatment, unlike in Ohio and West Virginia.
Senator Rubio has led attacks on Obamacare. I expect Florida looks much more like the American future than, say, Ohio, which has a relatively decent and humane governor.
4
Americans, including politicians, have been brain washed. We often hear politicians say that America has the best health care in the world! However, you rarely hear Americans speak in terms of outcomes such as life expectancy, infant mortality or rates of diabetes. The fact that the cost of US's health care system is much greater than others wealthy nation's is also not acknowledged or discussed.
Other countries have real health care systems that are followed. In the US we have a patch work where hundreds or thousands of systems are followed based on the dictates of insurance companies, pharmaceutical providers, Doctors and patients.
My family experienced the health care systems of England and France. In France an expectant Mother is given a Carnet de Sante (health booklet) when she becomes pregnant. This Carnet details what needs to be done and includes a schedule and scorecard that tracks every doctor visit, vaccination, etc for a child up to adulthood. It is followed religiously and questions are asked when it is not. This system results in better health care outcomes at a lower cost.
Unfortunately, we in the United States refuse to consider implementing an efficient health care system. However,. I truly believe that one day we as a country will figure this out and establish a much more effective system.
Other countries have real health care systems that are followed. In the US we have a patch work where hundreds or thousands of systems are followed based on the dictates of insurance companies, pharmaceutical providers, Doctors and patients.
My family experienced the health care systems of England and France. In France an expectant Mother is given a Carnet de Sante (health booklet) when she becomes pregnant. This Carnet details what needs to be done and includes a schedule and scorecard that tracks every doctor visit, vaccination, etc for a child up to adulthood. It is followed religiously and questions are asked when it is not. This system results in better health care outcomes at a lower cost.
Unfortunately, we in the United States refuse to consider implementing an efficient health care system. However,. I truly believe that one day we as a country will figure this out and establish a much more effective system.
17
Mr Kristof,
First, yours is not an absurd proposal. It makes eminent sense. Pay for performance is exactly what we should task our legislators. Perhaps they should have a reduction in base salary, some public housing to cover their residence and a good leverage plan for over achievement.
Second, the editors should take your proposal seriously. In every editorial roundtable it should be discussed among them and their peers. It should be brought up in every press conference held by any elected official and the press. This is a reasonable, fiscally conservative proposal that will enforce pragmatic legislation.
Third, an independent assessment of their performance with a public baseline of metrics should be maintained. The key issue is that the metrics be tied to good health outcomes, attainable in earth time by earth people, and compared across state lines, demographics and international performance.
The big problem of course is that the GOP like to mouth platitudes about market forces and pay for performance. They really don't want market metrics applied to their own (lack of) accomplishments.
First, yours is not an absurd proposal. It makes eminent sense. Pay for performance is exactly what we should task our legislators. Perhaps they should have a reduction in base salary, some public housing to cover their residence and a good leverage plan for over achievement.
Second, the editors should take your proposal seriously. In every editorial roundtable it should be discussed among them and their peers. It should be brought up in every press conference held by any elected official and the press. This is a reasonable, fiscally conservative proposal that will enforce pragmatic legislation.
Third, an independent assessment of their performance with a public baseline of metrics should be maintained. The key issue is that the metrics be tied to good health outcomes, attainable in earth time by earth people, and compared across state lines, demographics and international performance.
The big problem of course is that the GOP like to mouth platitudes about market forces and pay for performance. They really don't want market metrics applied to their own (lack of) accomplishments.
15
We still pretend that the war on women and Planned Parenthood is because of the sanctity of life, although only selected lives are sacred and even those aren't as sacred as profits.
24
Our infant mortality rate is 2 1/2 times that of Japan and compares unfavorably to wealthier Asian countries-- we're well behind in life expectancy of Japan, Macau, South Korea, Singapore, etc.
We don't do well in our own hemisphere - infant mortality rate is 5.08 per thousand while Cuba's is 4.07. Cuban life Expectancy overall is very close to our own - tobacco consumption us reckoned to be the cause.
Our infant mortality rate in some Southern states is astronomically higher than our national average - as low as impoverished nations. Black babies don't seem to count. Compare ourselves to nations like Japan, Switzerland, France,Germany, Canada, etc. and our numbers are appalling and regionally worse. State's rights for dying early.
Congress needs to deal with public spending that funnels too much from our largest, most important economic States - whether it is the Western concentration focused on California or the Northeast which is constantly robbed of funds for critical infrastructure.
What rationale can there be for the disproportionate spending in states with lots of acres and small populations. What stops us from constant upgrading of our transportation system that provides good jobs. Others do.
"Self-reliant" federal sponge Alaska lives on federal money. Montana receives four times more per capita for roads than densely populated states and nothing is done to expedite Northeast High Speed rail and in California.
Acres are winning over people.
We don't do well in our own hemisphere - infant mortality rate is 5.08 per thousand while Cuba's is 4.07. Cuban life Expectancy overall is very close to our own - tobacco consumption us reckoned to be the cause.
Our infant mortality rate in some Southern states is astronomically higher than our national average - as low as impoverished nations. Black babies don't seem to count. Compare ourselves to nations like Japan, Switzerland, France,Germany, Canada, etc. and our numbers are appalling and regionally worse. State's rights for dying early.
Congress needs to deal with public spending that funnels too much from our largest, most important economic States - whether it is the Western concentration focused on California or the Northeast which is constantly robbed of funds for critical infrastructure.
What rationale can there be for the disproportionate spending in states with lots of acres and small populations. What stops us from constant upgrading of our transportation system that provides good jobs. Others do.
"Self-reliant" federal sponge Alaska lives on federal money. Montana receives four times more per capita for roads than densely populated states and nothing is done to expedite Northeast High Speed rail and in California.
Acres are winning over people.
15
You cannot meaningfully compare apples and oranges! Japan is hugely unlike the States. If you were to select all those of Japanese ethnicity in the States and compare their health outcomes to those of Japan, you would see very little difference. Differences in infant mortality are almost entirely due to low birthweights and the fact that hospitals in the States care for a much larger number of very-low-birthweight babies than hospitals in any other country, whose poor outcomes skew the statistics.
The simplistic throwing around of cherry-picked statistics purely to support a partisan point of view is not helpful.
The simplistic throwing around of cherry-picked statistics purely to support a partisan point of view is not helpful.
2
But what causes the low birth weights? Poverty and lack of access to prenatal care? Isn't that precisely what we are discussing?
Are you suggesting there is something about the U.S. other than lack of access to healthcare or support that drives low birth weights?
I don't believe that folks whose ethnicity is Japanese but live in America with our bad diet and exercise habits would perform the same as the folks in Japan.
Are you suggesting there is something about the U.S. other than lack of access to healthcare or support that drives low birth weights?
I don't believe that folks whose ethnicity is Japanese but live in America with our bad diet and exercise habits would perform the same as the folks in Japan.
4
Your figures are deeply flawed because you are comparing apples and oranges. Poland, with a homogeneous culture and ethnicity, is not comparable to the States. An example: In Norway, a very homogeneous culture, healthcare officials concluded decades ago that breastfeeding was better; a national conversation took place among women, and within two years, the breastfeeding for six months rate was at 95%! This could never happen in a large heterogeneous country like the States.
In a similar vein, poor maternity and infant mortality rates in the States are concentrated in populations with low birthweights. These low birthweights have nothing to do with the healthcare system and do not occur in Poland or Norway. The astonishing rate of obesity in the States contributes greatly to poor health outcomes but has nothing to do with the healthcare system.
Simplistic approaches by journalists to extremely complicated problems are not at all helpful and are in fact harmful. A single-payer system will do absolutely nothing on its own to improve health outcomes or reduce costs. A prime example is the NHS which has declining outcomes and increasing costs. The NHS does not provide integrated care, cares not a whit for patient satisfaction, and has no economic incentive to improve either; the Centre simply throws money at it, and since it has no competition there is no incentive to improve.
Only by moving away from fee-for-service and towards the Kaiser model can healthcare be reformed.
In a similar vein, poor maternity and infant mortality rates in the States are concentrated in populations with low birthweights. These low birthweights have nothing to do with the healthcare system and do not occur in Poland or Norway. The astonishing rate of obesity in the States contributes greatly to poor health outcomes but has nothing to do with the healthcare system.
Simplistic approaches by journalists to extremely complicated problems are not at all helpful and are in fact harmful. A single-payer system will do absolutely nothing on its own to improve health outcomes or reduce costs. A prime example is the NHS which has declining outcomes and increasing costs. The NHS does not provide integrated care, cares not a whit for patient satisfaction, and has no economic incentive to improve either; the Centre simply throws money at it, and since it has no competition there is no incentive to improve.
Only by moving away from fee-for-service and towards the Kaiser model can healthcare be reformed.
There are several points on which Charles is simply wrong. It is an established fact that the incidence of prematurity, especially extreme prematurity, relates to the provision (or not) of quality prenatal care. That includes guidance on nutrition, smoking cessation which can be carried out by nurse practitioners. Similarly, obesity, and consequent Type II diabetes can be influenced by appropriate intervention. Wouldn't be better and cheaper to control a diabetic's sugars, rather than have him presenting at ER with a gangrenous foot, blind and in renal failure, requiring expensive care and rehab?
As to funding for the UK NHS it has relatively recently risen from just over 6% of GDP to 9%, which is less than half of US spending. It is good value for money, and it is offensive to imply they "do not give a whit".
Patient satisfaction is not necessarily a measure of success. A large clinic in the US found that patient satisfaction in their chronic pain centre did not equate with objective evidence of improved function.
As to funding for the UK NHS it has relatively recently risen from just over 6% of GDP to 9%, which is less than half of US spending. It is good value for money, and it is offensive to imply they "do not give a whit".
Patient satisfaction is not necessarily a measure of success. A large clinic in the US found that patient satisfaction in their chronic pain centre did not equate with objective evidence of improved function.
1
Sweden has a higher percentage of foreign born than the US.
Surely birth rates depend on the health care system particularly on pre-natal care which is terrible in the US.
Here are the per capita figures for total health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
The WHO using a formula developed by The Harvard School of Public Health ranks our system as 38th in the world. (France & Italy are 1 & 2). This formula doesn't include costs. Bloomberg ranked countries' systems on efficiency which does include costs. We came out as 50th out of 55.
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
Surely birth rates depend on the health care system particularly on pre-natal care which is terrible in the US.
Here are the per capita figures for total health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
The WHO using a formula developed by The Harvard School of Public Health ranks our system as 38th in the world. (France & Italy are 1 & 2). This formula doesn't include costs. Bloomberg ranked countries' systems on efficiency which does include costs. We came out as 50th out of 55.
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
1
Most American Physicians support a single payer health insurance for all with quality affordable healthcare for all regardless of age, income, net worth, preexisting illnesses and location.
Listen to your doctor, not your politician, insurance company, pharmaceutical company, med mal attorney, hospital or electronic medical records company.
www.pnhp.org
Listen to your doctor, not your politician, insurance company, pharmaceutical company, med mal attorney, hospital or electronic medical records company.
www.pnhp.org
9
Your doctor works for a for profit insurance company or health car conglomerate.
You forget, ~$170,000+ is incorrect. Factor in health benefits, pensions, etc and I would be surprised if it did not gross out to >$250,000. Further, with their lack of productivity they appear to work part time for perhaps 1,000 hrs. per year. i.e. Total compensation then becomes a minimum of $250/hr. So much for minimum wage!
Add to this the donations they receive from interested parties, they do not suffer.
Add to this the donations they receive from interested parties, they do not suffer.
20
Members of Congress don't actually get paid only $174,000 per year. They are also routinely enriched by the bribes paid them by lobbyists, PACs, SuperPACs, and other influence peddlers. In our Supreme Court's understanding of the Constitution, public service is about opportunities to fatten bank accounts.
If you want Congress to care about the public interest, disconnect members of Congress from the gravy train they now enjoy.
If you want Congress to care about the public interest, disconnect members of Congress from the gravy train they now enjoy.
13
If you put it into the right context, 'Murica looks only half as bad: Compared with other corrupt oligarchies (like Russia) and other threshold countries with nuclear weapons (North Korea) I guess your doing fine.
4
The first 2 paragraphs are bogus.
We pay more than Poland to avoid people trying to bribe our congressmen. I'd advocate even more money if we could stop their corruption.
I'm a dreamer.
We pay more than Poland to avoid people trying to bribe our congressmen. I'd advocate even more money if we could stop their corruption.
I'm a dreamer.
2
Let's tie journalists' salaries to being truthful and objective. They would all die paupers.
2
the gold plated healthcare the congress receives at taxpayers expense should stop & they should be mandated to have whatever the average citizen has.
over half of them are millionaires and monthly premiums probably do not figure very high in their budgets. they do not need the free care we pay for them. maybe they would be more careful with our lives if theirs depended on the same system.
https://www.nytimes.com/2014/01/10/us/politics/more-than-half-the-member...
over half of them are millionaires and monthly premiums probably do not figure very high in their budgets. they do not need the free care we pay for them. maybe they would be more careful with our lives if theirs depended on the same system.
https://www.nytimes.com/2014/01/10/us/politics/more-than-half-the-member...
15
Members of Congress are on Obamacare through the District of Columbia exchange. They're compensated for the cost.
1
They are only compensated 75% and as you remark they cannot get a group policy. They are treated worse than other employees of large institution or corporations.
because the basic premise of the health care debate is false you could reduce the pay of congress to zero and they still would not be able to solve the health care coverage, cost and quality of care problems we have. the basic premise of the debate is that the health care market is a free marked that merely needs some tinkering to perform properly. that is completely false. the health care market is composed of government sanctioned interlocking monopolies that will never be fixed by free market solutions that do nothing to break up the monopolies enjoyed by doctors, pharmacists, insurance companies, hospitals, and pharmaceutical companies. the monopoly power enjoyed by these entities virtually guarantees that health care costs will continue to rise at double digit rates, and health care quality will continue to fall. we have to either get rid of their monopoly power or create the government institutions necessary to control it.
3
While I laud you for this column and agree almost totally with what you write, there is one sentence I find fault with:
"...I’m not really in favor of slashing congressional pay; we should pay officials well to attract the best talent."
$174,000+ a year hasn't gotten us much. I doubt if raising congressional pay would make much of a difference. We'd still be stuck with the stuff that rises to the top of a cesspool.
"...I’m not really in favor of slashing congressional pay; we should pay officials well to attract the best talent."
$174,000+ a year hasn't gotten us much. I doubt if raising congressional pay would make much of a difference. We'd still be stuck with the stuff that rises to the top of a cesspool.
6
Let's change the employment status of Congress from full time employee with full benefits to "independent contractor" with no benefits. After all the Founding Fathers who so often invoked by Congress were men of free enterprise and rugged individualism. Perhaps with benefits we can simply say to Congress, "pull yourself up by your bootstraps ! "
13
Those who haven't tried to learn about how most people live in civilized countries, or haven't traveled, have no idea how different our standard of living is in the US. I'm sure they would love to live in a civilized country if given the chance. The US demonstrates daily that it is uncivilized. The few manipulate the many in order to steal from them, and the many have proved that they don't mind being manipulated as long as they're sedated (with cheap food, drugs, alcohol, and/or having their prejudices bolstered) and that they have no appreciation for the long term ramifications of the current system.
9
The NYT and op-ed columnists need to clearly and frequently--starting immediately--detail the Congressional health plan: A health care plan that most Americans can only dream of. Kelly Anne's obnoxious comment that people should find a job to secure health insurance is a reflection of her arrogance and ignorance of those outside her immediate working/social circles. The working poor--emphasis on working--rarely have employer sponsored health plans. Ask the many Walmart employees who need food stamps to feed their families each month. With the decline and loss of manufacturing, coal mining, and other reliable jobs that offered a slice economic security, in their place retail opportunities offered some financial help, but did not offer sufficient salary replacement, are now disappearing every day. Where are the jobs with good pay and health benefits, Kelly Anne and GOP cronies? The media must make Trump supporters and all Americans fully aware of Congressional and WH health benefits. Where are the progressive PACs and the DNC in spreading this information to Trump supporters and others who may not be fully informed? Don't our elected officials work for us as at will employees? Writing a health care plan in secrecy demands illumination and transparency of how congress will not suffer the same fate as what they propose for so many of their constituents.
14
The health care plan of Congress and its staff is actually worse than the employees of any other large institution or corporation since they cannot get a group policy, but must get individual policies on the exchange.
Oh come on Nick, who are you fooling? We all know America is the best at everything. Right?
We not only have the best healthcare system, but we also have the best measurement system (Imperial instead of Metric), the best primary schools, the least demand for illicit drugs, the best electoral system (and the best democracy), the most awesome president (sorry Trudeau and Macron), the highest paid teachers, the safest cities, great equality in income distribution, the most harmonious race relations, the smartest set of foreign policies, the best food in the world, and the only language that is worth learning.
Why should we ever think there's something important to learn beyond our borders?
If only we did. We could improve so much. We should study healthcare systems all around the world and benchmark against them. Borrow a little here and a little there so we can put together the best system possible.
But for some reason, closed minded Americans can't imagine that there are people who are doing things better than we are.
And unfortunately, that hubris, arrogance, ignorance, and myopia is likely to continue to cause further decline of our country. Or at least not prevent it.
P.S. We have great police officers and firefighters (and emergency response systems). Their professionalism and dedication are second to none. Our universities are excellent. We do have many things other countries can learn from us, but we are selling ourselves short if it's not a two-way street.
We not only have the best healthcare system, but we also have the best measurement system (Imperial instead of Metric), the best primary schools, the least demand for illicit drugs, the best electoral system (and the best democracy), the most awesome president (sorry Trudeau and Macron), the highest paid teachers, the safest cities, great equality in income distribution, the most harmonious race relations, the smartest set of foreign policies, the best food in the world, and the only language that is worth learning.
Why should we ever think there's something important to learn beyond our borders?
If only we did. We could improve so much. We should study healthcare systems all around the world and benchmark against them. Borrow a little here and a little there so we can put together the best system possible.
But for some reason, closed minded Americans can't imagine that there are people who are doing things better than we are.
And unfortunately, that hubris, arrogance, ignorance, and myopia is likely to continue to cause further decline of our country. Or at least not prevent it.
P.S. We have great police officers and firefighters (and emergency response systems). Their professionalism and dedication are second to none. Our universities are excellent. We do have many things other countries can learn from us, but we are selling ourselves short if it's not a two-way street.
14
We would have had universal healthcare long ago if the right didn't continue to vilify minorities as "takers" and people aren't really American.
8
The problem is that Congressman are not working for the voters anymore... I imagine they view the salary paid to them out of our tax dollars as chump change. They are working for the lobbyists and for the lavish, but delayed, compensation they will receive from the lobbyists once they leave office.
12
I love you.
2
"O.K., I’m not really in favor of slashing congressional pay; we should pay officials well to attract the best talent."
There is no guarantee that the generous pay at the end of the stick is going to attract the best talent. In fact, you may just get those who think a seat in Congress is a big payoff. Shall we consider that not only do they earn more than most Americans, but their income from corporate lobbyists and various bribes afford them luxuries many of us can't afford like multiple homes. AND they get health care that half of them want to take away from us. It's time to pay them like many of Americans are paid: by the clock and by the quality of their work. It's time for all of us to act like the bosses we are instead of the dirt under their shoes.
There is no guarantee that the generous pay at the end of the stick is going to attract the best talent. In fact, you may just get those who think a seat in Congress is a big payoff. Shall we consider that not only do they earn more than most Americans, but their income from corporate lobbyists and various bribes afford them luxuries many of us can't afford like multiple homes. AND they get health care that half of them want to take away from us. It's time to pay them like many of Americans are paid: by the clock and by the quality of their work. It's time for all of us to act like the bosses we are instead of the dirt under their shoes.
9
Not such an absurd proposal. If we evaluate teachers based on student outcomes, why not do it for politicians based on policy outcomes like mortality/morbidity statistics, carbon containment, murder rates, etc? Surely there is a better way to judge which policies are best for the nation - perhaps emphasizing data over diatribe?
Oh wait, I don't live in Canada.
Oh wait, I don't live in Canada.
12
News flash to America's pro-life party. . ."If we had Italy’s child mortality rate, we would save 12,000 American babies’ lives each year — that’s 33 children’s lives saved every day." -Nicholas Kristof
7
Given how inefficient our health care system is it is hard not to sympathize with those that want to bring a single payer system here to the US.
My concern though is that given the money in politics in the US we’re almost sure to botch the implementation of universal health care so that instead of paying $10,000 per person we’ll instead be paying $20,000 to $30,000 in order to line the pockets of the myriad special interests in the health care industry.
As exhibit A for this concern I give the monumentally stupid law that prevents the government from negotiating for lower prescription drug prices for Medicare patients. Republicans often like to say government should behave more like a business, but then at the urging of drug industry lobbyists make up this rule that prevents the government from doing exactly that. What large corporation wouldn’t use its size to negotiate lower per unit cost of anything?
Now imagine how expensive this could all become of the government pays for the health care of all Americans.
My concern though is that given the money in politics in the US we’re almost sure to botch the implementation of universal health care so that instead of paying $10,000 per person we’ll instead be paying $20,000 to $30,000 in order to line the pockets of the myriad special interests in the health care industry.
As exhibit A for this concern I give the monumentally stupid law that prevents the government from negotiating for lower prescription drug prices for Medicare patients. Republicans often like to say government should behave more like a business, but then at the urging of drug industry lobbyists make up this rule that prevents the government from doing exactly that. What large corporation wouldn’t use its size to negotiate lower per unit cost of anything?
Now imagine how expensive this could all become of the government pays for the health care of all Americans.
39
I assume that law would disappear in the creation of a universal healthcare system. The whole thing needs to be re-thought, not just bits and pieces. The lobbyists need to go.
6
"we’re almost sure to botch the implementation of universal health care". For crying out loud, we already have single-payer, universal health care (>65 folks) that works extremely efficiently. This kind of ill-informed hedging is what the insurers and republicans love to exploit.
8
The Democrats already have a great health care bill. HR676 introduced in 2003 and reintroduced every year since.. As of June 22, 2017, it had 113 cosponsors, which amounts to a majority of the Democratic caucus in the House of Representatives.
The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, most medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought.
The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs. An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year. Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care.
The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, most medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought.
The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs. An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year. Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care.
Brilliant column! I wonder if there are current economic statistics to support health care for the poor, specifically addressing lower infant mortality, better prenatal care, less crime among the poor who have access to free, good health care. If rich people who do not want to subsidise poor people's health costs could be convinced that crime would decrease, maybe that could appeal and convince (at least start to) those who think that 'lazy' people without jobs don't deserve good health care. Their Darwinian attitude is repugnant and angers me ethically and should be enough to support and improve the ACA but the argument now seems only to be won by appealing to sound economics, assuming the statistics bear this out.
30
The taxpayers should have the same type of health care coverage as those in Congress. No more. No less.
12
Congress members wages, benefits including medical insurance, pension and staff expenses allowance, and days on duty in Washington, DC ought to be posted on the US house and Senate websites' home page. That way tax payers would know how much overpaid some members of congress are. No wonder, almost everyone of them does not want to leave the job or retire voluntarily!
Their medical insurance benefits should be exactly same as that allowed by BCRA since they are short term, part time employees.
Their medical insurance benefits should be exactly same as that allowed by BCRA since they are short term, part time employees.
5
"Members of Congress are paid $174,000 a year, while members of Poland’s lower house of Parliament are paid $32,300 a year. Hmm. It looks as if we're getting ripped off"
Excellent and so well stated! Thank you Mr. Kristof!
Excellent and so well stated! Thank you Mr. Kristof!
12
Agree, Bravo Mr. Kristof!
2
And now some of them are whining for additional "housing allowance". Let them live in a cardboard box over a heating grate.
4
Overhead for private insurance in the USA is 20-25%. In Europe it is regulated to 3-5% and executives do not get paid millions to deny payment. Medicaid and Medicare have 3% overhead and do better than than the private sector with spends $6 billion on lobbying.
Another 20-25% of health costs are for overtreatment and overdiqgnosis because doctor are afraid of malpractice which is encouraged only in the US and because patients demand only the best.
Another 20-25% of health costs are for overtreatment and overdiqgnosis because doctor are afraid of malpractice which is encouraged only in the US and because patients demand only the best.
13
States that have instituted "reforms" that have substantially reduced the number of malpractice suits have not reduced the cost of health nor the frequency of tests and treatments. Defensive medicine is a myth. In fact, in a letter to Senator Hatch, the CBO wrote that an ideal system of tort reform would not lower costs by any more than 0.5%, 0.3% of which would be due to less "defensive medicine,"
http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf,
Here is the relevant paragraph from the letter to Senator Hatch:
"CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services."
To see where the real waste is read the Time series "Paying Til It Hurts" by Eliszabeth Rosenthal.
http://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html...®ion=Header&pgtype=article
http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf,
Here is the relevant paragraph from the letter to Senator Hatch:
"CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services."
To see where the real waste is read the Time series "Paying Til It Hurts" by Eliszabeth Rosenthal.
http://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html...®ion=Header&pgtype=article
1
The US is the only country that allows contingency fees for lawyers who can make millions a year. Many doctors pay 10-40% of their net for insurance and Canadian doctors pay 1/4 as much as Amercans There are 2-3 times as many C-sections in the US to play it safe, etc.
Great column. Despite widely available facts many Americans don't know (or care) that we are lagging behind other countries in the statistics you cite on infant mortality, etc. I'm a Kristof fan because your columns show your passion and concerns for the difficulties experienced by the average person. Your suggestions are also so practical that one wonders why we haven't already adopted them. Keep up the good work.
13
Dick Cheney, long time Federal employee and retiree has been treated for heart ailments for about twenty years or more. Can the CBO generate a public report on how much of his care was paid by our government (taxes) and the amount paid out of pocket ?
13
This statistics should be available publicly for all politicians.
1
Single payer, government run health insurance removes the profit motive from health care through private insurers. Everyone will need health care at some point so insurance companies will always set up the system to minimize their losses. With single payer - everyone is in the pool so costs are spread. I am a senior citizen, made a middle class wage, never in 4 decades paid more than $450 per year for my government health insurance. Employers match the contributions; your premium is calculated on your income tax form on a sliding scale based on your income. Thank God I live in Canada and don't have to think twice before going to a doctor or hospital when needed. And by the way, my seriously disabled brother received every care in hospital right to the natural end of his life, and premature babies receive best medical care here too - there are no "death committees". My sympathy goes out to citizens of U.S. over this. Health care is a human right.
31
Facts, hard, cold facts do not matter to the extremist ideologues to whom this column is addressed. The only facts that they, and their millionaire/billionaire paymasters are attentive to are the figures on the latest polling in their gerrymandered districts, the size of campaign war chests, and the number of zeros appearing on their net worth statements. They are impervious to any rational arguments to advance the common good as self-interest is the only God these "people" worship.
12
With the advent of Chief Justice John Roberts four Republican Justices all who voted in favor of Citizens United and McCutcheon it is most probably impossible to achieve reducing health care cost and Medicare for all. It is obvious to me that me no longer select our candidates to run for congress money does that for us. What decent person would run and face the barrage of money opposing him. As to candidates today it is a race to the bottom.
9
You are absolutely right on the impact of Citizens United. Just look at the list of donors to Mitch McConnell's reelection campaigns. They are health insurance companies giving hundreds of thousands of dollars to Mitch to insure that they never go out of business to keep health care expensive for all. Democracy demands a level playing field where the rich and poor have equal power but Citizens United gives corporations power to advance their interests with their money power. Corporations are not individual citizens: therein lies the distortion of democracy. Cutizens United must be overturned.
14
Citizens United had no bearing on campaign contributions. You have no idea on what you are talking about.
Apart from a more rational healthcare delivery (any system is more rational than what we have here), there are social issues that make America sick. The US is no 19 in the global ranking of obesity and no 1 among the industrialized nations, while Poland is no 57 (http://obesity.procon.org/view.resource.php?resourceID=006032). The Polish diet is not inherently healthier that the American meat-and-potatoes, so if Poles are slimmer, it is due to greater self-discipline. The rate of teenage pregnancy/birth in the US is highest in the industrialized world, despite the fact that Poland, a Catholic country, has strong restrictions on abortions. No single-payer medical system can be expected to cash out unlimited funds for irresponsible breeding without going bankrupt. Conservatives emphasize cultural issues and individual behavior, while liberals blame social and economic factors. The truth is that both are correct.
7
It is unfortunate that Trump simply can't just tell our 435 Representatives and 100 Senators that they are fired. We have no Democracy anyway, why not? Then after redistricting every district we could hold new elections. The only two prerequisites to run would be that the candidates would have to prove they are smarter than a fifth grader and that they are not on more than 5 times the normal dose of ritalin. Oh, one other thing. To be able to register to vote each registrant would also have to meet the same 2 criteria. It seems likey we would have far fewer candidates or voters. The Republicans want smaller government right? Think of all the money we would save. We could elimnate most all government agencies. Just let King Trump run everything and give him a raise of course, he needs it.
2
In a democracy, Congress indeed is independent from the Executive branch of power (= the president). So a president can't fire Congress.
But that doesn't mean that a president doesn't have any real power. He has.
He could hire a competent Sec. of HHS for instance, rather than the Sec. we have today and who's a complete RINO who's fully supporting Ryan and McConnell.
And most of all, he could use the bully pulpit of the presidency to tell Congress that he will immediately veto a bill that does the EXACT opposite of what he promised to do on healthcare, as Ryancare does, and tell them to start all over again.
He could also engage in real, tough negotiations with Congress, so that the result is at least a compromise between what he campaigned on and what the RINO Congress wants.
Instead, he's doing the exact opposite, since he entered the White House: when Ryancare passed in the House, he even threw a party in the Rose Garden (= something that normally only happens when a bill is signed into law, not already when it merely passed the House, so doing this sent a very strong signal to the Senate, telling them to act swiftly and pass Ryancare).
And today, he's threatening Senators who don't support Ryancare to support a challenger during the next elections. In other words, just like what he did with Ryancare in the House, he's threatening those Republicans who want to go further and those who still remember his campaign promises to try to fire them if they don't fall in line.
But that doesn't mean that a president doesn't have any real power. He has.
He could hire a competent Sec. of HHS for instance, rather than the Sec. we have today and who's a complete RINO who's fully supporting Ryan and McConnell.
And most of all, he could use the bully pulpit of the presidency to tell Congress that he will immediately veto a bill that does the EXACT opposite of what he promised to do on healthcare, as Ryancare does, and tell them to start all over again.
He could also engage in real, tough negotiations with Congress, so that the result is at least a compromise between what he campaigned on and what the RINO Congress wants.
Instead, he's doing the exact opposite, since he entered the White House: when Ryancare passed in the House, he even threw a party in the Rose Garden (= something that normally only happens when a bill is signed into law, not already when it merely passed the House, so doing this sent a very strong signal to the Senate, telling them to act swiftly and pass Ryancare).
And today, he's threatening Senators who don't support Ryancare to support a challenger during the next elections. In other words, just like what he did with Ryancare in the House, he's threatening those Republicans who want to go further and those who still remember his campaign promises to try to fire them if they don't fall in line.
Hear, hear :)
2
Nick, Nick, Nick, You naive idealist.
Sure, "American babies are one-third more likely to die in their first year of life than Polish children." But dig deeper! Whose American babies are more likely to die early in America? After you check that out, you'll know why that is so and why Republicans are indifferent to that statistic.
Sure, "American babies are one-third more likely to die in their first year of life than Polish children." But dig deeper! Whose American babies are more likely to die early in America? After you check that out, you'll know why that is so and why Republicans are indifferent to that statistic.
14
If only the Times hadn't bashed Bernie Sanders so badly.......
7
Actually they should get what their constituents get as a base salary - Medicaid (no private insurance), SSI (no private pension) and minimum wage. To suggest this is not being farcical. If they want to earn more then they should get a quarterly "bonus" for results, using the metrics you discussed.
Annual performance reviews should be done by constituent survey and published publicly. And all those days off? Nope, you need to be in D.C. more than half the year and vote on topics at least 85% of the time in order to qualify for your bonus.
All of my suggestions are the same suggestions put in place for many public school teachers. These guys are also public employees and should be held to the same standard if not a higher one.
Over 85% of the congress and house already have wealth, they don't need this salary. Their salaries need to be an honorarium; a payment given for professional services that are rendered nominally without charge (mid 17th century: from Latin, denoting a gift made on being admitted to public office, from honorarius).
Basically my point is this; when you hit folks in their pockets they get an immediate and clear understanding of issues, especially when they have to deal with the economic realities of the rest of the country. I know it will never happen but damn it, it should.
Annual performance reviews should be done by constituent survey and published publicly. And all those days off? Nope, you need to be in D.C. more than half the year and vote on topics at least 85% of the time in order to qualify for your bonus.
All of my suggestions are the same suggestions put in place for many public school teachers. These guys are also public employees and should be held to the same standard if not a higher one.
Over 85% of the congress and house already have wealth, they don't need this salary. Their salaries need to be an honorarium; a payment given for professional services that are rendered nominally without charge (mid 17th century: from Latin, denoting a gift made on being admitted to public office, from honorarius).
Basically my point is this; when you hit folks in their pockets they get an immediate and clear understanding of issues, especially when they have to deal with the economic realities of the rest of the country. I know it will never happen but damn it, it should.
17
We have top talent and treatment for rare and challenging medical diseases, but we fail miserably at the day-to-day management of common ailments.
But don't be overly impressed by the statistical data- one reason our infant mortality looks so bad here in the US is that we do EVERYTHING possible to save hopeless premature babies whereas in other countries they perish at delivery due to rationed care and do not contribute to the statistics.
Until the US can have a reasonable and rational conversation about NOT doing everything for dying 95 year-old grandma without the GOP screaming "Death panels!!" we will continue to overspend on healthcare. The general public thoroughly believes that more is better when it comes to healthcare and they are total wimps when it comes to making end of life care decisions.
But don't be overly impressed by the statistical data- one reason our infant mortality looks so bad here in the US is that we do EVERYTHING possible to save hopeless premature babies whereas in other countries they perish at delivery due to rationed care and do not contribute to the statistics.
Until the US can have a reasonable and rational conversation about NOT doing everything for dying 95 year-old grandma without the GOP screaming "Death panels!!" we will continue to overspend on healthcare. The general public thoroughly believes that more is better when it comes to healthcare and they are total wimps when it comes to making end of life care decisions.
9
I don't know where you got that information from. They don't do anything to save premature babies? Maybe they do a little less.
Pandora, do you have a grandma?
Do/did you love her?
Do/did you love her?
1
Yes, Mr. Kristof, you make some valid points here. But you left out one "yuuuuge" reason that we lag behind other countries in healthcare. Greed. Insurance companies, being the sharks that they are, don't want the feeding frenzy that they've had for years upset.
10
If the US senate and congress didn't have their 24k gold plated health care provided and paid for by us taxpayers, and had to actually go out and find coverage, then pay for it themselves... they would have a vastly different opinion on "making health care great again."
It's "sad" that the US has by far the most costly healthcare system and one that discriminates against low income individuals. Now this discrepancy will increase more under the "fake" claimed improvements in the republican plan.
What a bunch of "lying liars" as Al Franken cited in his book, which under trump is due for a major updating and reissue.
It's "sad" that the US has by far the most costly healthcare system and one that discriminates against low income individuals. Now this discrepancy will increase more under the "fake" claimed improvements in the republican plan.
What a bunch of "lying liars" as Al Franken cited in his book, which under trump is due for a major updating and reissue.
9
I don't know about paying well and attracting talent. Usally paying well results in hiring white conservative men with few if any new ideas. In my organization this week, the most talented individual, bright and outspoken young woman, was paid about the least and just got summarily sacked by one of the safe old guard. My experience has been that there is NO correlation between pay and competence. Your column implies that there is a negative correlation between these variables in Congress. Maybe so, someone should do the study.
7
The problem with American health care is that it's run FOR PROFIT. We need to get the health insurance companies out of the health care business and we need to have tort reform to stop frivilous law suits. (not where real litigation is warranted for serious errors resulting in damage or death) Our system encourages greed, corruption, duplication, mismanagement, etc. Europe is years ahead of us in Health care, protecting their environment, wages, etc., and most Americans don't even know it because they don't travel. Travel is an enemy of ignorance and we have plenty of it.
19
Never thought I'd live to see the day you'd come out in favor of National Health Insurance/Medicare for all! Good for you! And those stats on how poorly we Americans do in contrast to other countries are so important to share. If only more people would pay attention.
7
Harsh it may sound but the members of Congress are little more than high-priced bums. They get paid a frankly astronomical sum to deliver to the American people PEANUTS. Peanuts in the healthcare, education, the environment, etc. People always point to places like Africa as the epicenter of political corruption but that epicenter is here in the U.S: politicians taking out tax dollars and not delivering anything. Americans are struggling and miserable and what is our government doing to alleviate the pain? Helping the rich.
10
well, we have a lot of military people and weapons. that's all they care about besides enriching the top 1% and corporate america.
4
After reading, a sampling of letters, I was suprised that none of the letters addressed the potential costs of:single payer plan, and a comparison of ACA VS GOP OPTIONS, in terms of costs.I'm curious, because cost is the ultimate driver of which ever plan is adapted. Associated with cost,is reduction of medical costs by means of: wearable medical sensors that will make available the instantious medical state of someone.Presently,of the self devices are available: oxygen,blood pressure,diabetic symtoms,etc. What we need is some
One like a Apples's Job.
technology,
One like a Apples's Job.
technology,
2
see, here's the thing...how in god's name can anybody who has LIFETIME excellent health coverage for themselves and their families, even begin to imagine what it is like to not have any.
in the same vein when you have a GUARANTEED, performance not withstanding base salary of $175K ...then heck...who needs to concern themselves with well, much of anything...
paying high only works if there are performance standards like you know in the REAL world.
in the same vein when you have a GUARANTEED, performance not withstanding base salary of $175K ...then heck...who needs to concern themselves with well, much of anything...
paying high only works if there are performance standards like you know in the REAL world.
Although the path to this New Gilded Age in the US started circa the '80s, what really opened the floodgates was Citizens United. To start chipping away....democratically...at the vast inequality we see now, we must clean out the swamp by VOTING.....along with public resistance. OR, as people become totally disenfranchised, we may be pushed to the streets just like a century ago...just to get the attention of a Washington blinded by greed. And, finally, Medicare for all!
4
First, of all, we need to operate on facts. Real facts like those presented in this column, not alternative facts. Maybe we could deduct $1,000 from a Congressperson's salary for every policy-related lie or misleading statement he/she makes.
Congress should have their salary cut because of their performance, or lack of it, in a lot of areas. We should have defeated both Al Qaeda and ISIS by now. Our roads and bridges should be fixed. As far as health care goes, they should have done something about the cost of medicines. A pill that ten years ago cost $0.06 now cost over $150 in the U.S. In Europe it cost $0.02 a pill. That is just one medication. Most people are not in hospitals that often. They do go to the pharmacies. A pill that prevents stroke for those with Afib can cost over $500 for 90 days even with insurance. Many cannot pay that co-pay. We have all heard of the cost of Epi Pen. Ridiculous!!! Medical insurance has to include medication in most policies. These outrageous prices get thrown into the cost of policies and hospital costs. Congress isn't even trying to address medication costs. Much of their failure is on their own shoulders, They want to destroy the president from the other party and neither side will work work in a bipartisan way to develop important legislation. We could start monetary limitation by not giving them tax breaks like health insurance. Make them pay for their own health insurance until a health bill is passed that serves all of us equally and not just them with their huge benefits.
7
In 2015, the pharmaceutical industry alone, spent over 300 million dollars lobbying in Washington. The chance of Kristoffs proposal seeing the light of day has two chances and SLIM is out of town.
8
Just think of what good that $300 million could have done, had it been invested in better health care for ordinary people!
3
They spend more on marketing than they do on R&D.
You'll find it difficult to outmaneuver the insurance lobby without campaign finance reform first. The insurance industry works very hard to keep themselves entrenched and essential in the health care system. They're like a burrowing tick. Obamacare is the most recent example. They wouldn't even allow a public option. We'll need to weaken the industry over time before we can successfully convert to efficient and socially equitable health care. Without taking the money out of elections, you'll never amass the 60 votes need to unequivocally introduce universal coverage. Citizens United nailed that coffin shut.
11
At a minimum, Congress should have to sign up for whatever they pass.
I agree, but I'm sorry it will never change. Simply because its the babies of poor people and people of color that we'd be saving. Sad but unfortunately true.
There is a Paradigm Shift that took place about 10 years ago. Unnoticed. We stepped with both feet OUT of the old Industrial, New Deal, Federal Era.....and INTO the yet undefined Electronic, Global Communications, Segmented Trading Block Era.
Our Congress and Senate refuse to acknowledge that this has happened.
The US Senate is notoriously anti-progress. Their most recent accomplishment has been the retrograde ObamaCare Legislation....which is a sad attempt to recreate the good ole days of the New Deal....it effectively mimics the concept behind another great New Deal idea.....Social Security......which everyone sees as a TAX on their paycheck. If you still arent clear on this....I'll spell it out......ObamaCare is a TAX, created with little insight, by the Senate, in blatant violation of the US Constitution.
The Failure of ObamaCare isnt in providing universal insurance(not "health care" but "insurance")...it does that..........no.......ObamaCare has FAILED to cover-up the destitution of the Social Security Fund.
Now the Repubs attempt to one-up the Dems, by using the same obsolete, non-progressive tactic.....a re-write of a useless tax law that does nothing to help Finance a dang thing.
Our Congress and Senate refuse to acknowledge that this has happened.
The US Senate is notoriously anti-progress. Their most recent accomplishment has been the retrograde ObamaCare Legislation....which is a sad attempt to recreate the good ole days of the New Deal....it effectively mimics the concept behind another great New Deal idea.....Social Security......which everyone sees as a TAX on their paycheck. If you still arent clear on this....I'll spell it out......ObamaCare is a TAX, created with little insight, by the Senate, in blatant violation of the US Constitution.
The Failure of ObamaCare isnt in providing universal insurance(not "health care" but "insurance")...it does that..........no.......ObamaCare has FAILED to cover-up the destitution of the Social Security Fund.
Now the Repubs attempt to one-up the Dems, by using the same obsolete, non-progressive tactic.....a re-write of a useless tax law that does nothing to help Finance a dang thing.
MEDICARE For ALL. Please help, SIR.
1
Unwieldiness, inefficiency, and high cost are reasonable enough arguments for single-payer. Extravagant claims beyond that are unnecessary.
3
What sort of Health Care do Congressmen receive ?
Do they have options on what plans they pay for - do they pay for them ?
What happens when they retire from Congress or are voted out -
Do the Taxpayers pay for their continual Medical Insurance ?
Why is this country so backward on the necessities of life ?
Do they have options on what plans they pay for - do they pay for them ?
What happens when they retire from Congress or are voted out -
Do the Taxpayers pay for their continual Medical Insurance ?
Why is this country so backward on the necessities of life ?
7
Great idea! It should be law.
Many in DC have said this and I agree, why not extend federal employee's insurance to everyone. There's already 200,000+ people on that plan. It's good, it's affordable. And give people the ability to buy into this plan as a "public option". Problem solved (for now). If McConnell or any republicans were smart they'd do this. So there's something going on here, the question is how many more lies will we suffer? How long will these shenanigans drag out until they do the right thing?
Many in DC have said this and I agree, why not extend federal employee's insurance to everyone. There's already 200,000+ people on that plan. It's good, it's affordable. And give people the ability to buy into this plan as a "public option". Problem solved (for now). If McConnell or any republicans were smart they'd do this. So there's something going on here, the question is how many more lies will we suffer? How long will these shenanigans drag out until they do the right thing?
4
Poland was totally bankrupt only 20 years ago, in the aftermath of the 'fall of Communism' in 1990 after 45 years during which all resources were devoted to making armaments for Russia. effectively Poland's occupier. Under the 1945 - 1990 regime, Polish doctors were paid one-half as much as Polish steelworkers and coal miners (I know this first-hand) who produced armaments for the Russian-controlled military. This makes health care system in the United States, which experienced nothing comparable, all the more shameful.
A factor in Poland and elsewhere in which should be taken into account: Polish doctors do not graduate from medical school with a mountain of debt, as they often do in America. Entrance to medical school in Poland is based purely on academic qualifications, not on ability to pay tuition.
The extremely high cost of medical studies in the US, which the US government does not support as other countries do, so that US doctors have to pay off debt by charging high fees, may be a factor in high costs with poor results in the US.
A factor in Poland and elsewhere in which should be taken into account: Polish doctors do not graduate from medical school with a mountain of debt, as they often do in America. Entrance to medical school in Poland is based purely on academic qualifications, not on ability to pay tuition.
The extremely high cost of medical studies in the US, which the US government does not support as other countries do, so that US doctors have to pay off debt by charging high fees, may be a factor in high costs with poor results in the US.
21
Congress makes healthcare expensive by giving big Medicine and big Pharma leverage in charging whatever they want. The explosive rise in costs of medicine in the US arises because there is no negotiating power for consumers to keep costs down. The very same drugs we pay an arm and a leg for cost less in Europe and Canada! Why?
Congress whines about the cost of medical care and their "solution" is to cut medical care for the poor rather than go to the source and control what Medicare and Medicaid is willing to pay. Single payer, Medicare for all would be even better. Congress, worshiping at the shrine of big business, letting them make decisions is virtually always bad for the consumer particularly in virtual monopolies like healthcare.
Congress whines about the cost of medical care and their "solution" is to cut medical care for the poor rather than go to the source and control what Medicare and Medicaid is willing to pay. Single payer, Medicare for all would be even better. Congress, worshiping at the shrine of big business, letting them make decisions is virtually always bad for the consumer particularly in virtual monopolies like healthcare.
8
I also like Bernie's bill that would have cut Congress pay to that of Mexico. Since members of Congress think US workers should compete with Mexican workers shouldn't they too compete? Only fair. Mexican Congress makes about $30K/yr. - sounds about right.
6
All we hear about is the high cost of health care and how we can't afford it. Ask people if they want higher taxes to pay for health care and they say no.
But the real question is, if we are the richest country on the planet -- that means every other nation is poorer than we -- then how do they all afford universal health care when we can't?
Even in deep blue California, people are afraid of the $400 billion cost for single payer. But they don't discuss the $200 billion employer contribution or the inherent savings of universal coverage or the inherited wealth of families whose grandparents did not give all their money to a doctor.
We can afford it. If we can afford Mitt Romney's tax rate and Donald's 20 years of tax credits, we can afford universal health coverage.
But the real question is, if we are the richest country on the planet -- that means every other nation is poorer than we -- then how do they all afford universal health care when we can't?
Even in deep blue California, people are afraid of the $400 billion cost for single payer. But they don't discuss the $200 billion employer contribution or the inherent savings of universal coverage or the inherited wealth of families whose grandparents did not give all their money to a doctor.
We can afford it. If we can afford Mitt Romney's tax rate and Donald's 20 years of tax credits, we can afford universal health coverage.
10
This time I can agree with Mr. Kristof. Base the pay on health improvement. Krostof fails to point out that we have had ACA for 6 years and it has failed to improve the health of Americans as measured by any statistic. ACA costs lots of money and hasn't improved health of Americans. I doubt the Republican bill will do any better, or any worse for that matter.
1
Very fine argument. Congress breaks too often. We would substantially save by paying their wages per diem, only on days they show up with no overtime in a Congressional version of minimum wage.
5
Close, but the threat to their checks is not a sufficient motivator. Most of them are already pretty wealthy by most standards. Instead they should face the same threat they so blithely impose on others... they should face threats to their healthcare.
Let them KEEP their $174k dollar salary, but propose a rule that they AND members of their households may only use insurance plans that could be obtained by someone earning the national median income. If whatever ailments they might develop are not covered by such a plan, they may spend up to $50k out of pocket on procedures, medicines, etc. to try to preserve their lives of the lives of their spouses and relatives.
Thus, they can keep the cars, vacations, private schools and all that... but if they or their loved ones become ill, they will be forced to contemplate the same terrifying reality as the masses of people for whom they have so little regard. Let people like Ted Cruz see the kind of "freedom" he has been pushing. Within 3 years, we would have some of the most robust healthcare protections in the world. It's just a question of properly motivating them. "Oh wait... IT'S MY family's life that might be endangered? Well, that's different!" The clarity of vision would be astounding. All the logistics would somehow be overcome; the money found. The howling of special interests would fall on utterly deaf ears if they were counter to the interests of these Congressman's wellbeing.
Let them KEEP their $174k dollar salary, but propose a rule that they AND members of their households may only use insurance plans that could be obtained by someone earning the national median income. If whatever ailments they might develop are not covered by such a plan, they may spend up to $50k out of pocket on procedures, medicines, etc. to try to preserve their lives of the lives of their spouses and relatives.
Thus, they can keep the cars, vacations, private schools and all that... but if they or their loved ones become ill, they will be forced to contemplate the same terrifying reality as the masses of people for whom they have so little regard. Let people like Ted Cruz see the kind of "freedom" he has been pushing. Within 3 years, we would have some of the most robust healthcare protections in the world. It's just a question of properly motivating them. "Oh wait... IT'S MY family's life that might be endangered? Well, that's different!" The clarity of vision would be astounding. All the logistics would somehow be overcome; the money found. The howling of special interests would fall on utterly deaf ears if they were counter to the interests of these Congressman's wellbeing.
14
Thank you for this column educating your readers about the US health care problem and how we compare to the rest of the world.
Now you have to walk over and talk to the NYT Business section office and ask them what they think we should do about run-away investing in Health care delivery. This part of the puzzle rarely gets any attention but we all know it's part of the excessive costs of health care.
Taxpayers and consumers of health care are subsidizing the health industrial complex as they shovel dividends and capital gains to their investors in Health.
Under the Affordable Care Act, the Market Cap for Health has doubled from $750B to $1.5 Trillion. That represents all the shares in Health x their share price (Insurance, Pharma, hospitals/nursing homes, biotech, Medical supplies, etc)
Once you've done this, can you get back to us with a Part II of the discussion?
Now you have to walk over and talk to the NYT Business section office and ask them what they think we should do about run-away investing in Health care delivery. This part of the puzzle rarely gets any attention but we all know it's part of the excessive costs of health care.
Taxpayers and consumers of health care are subsidizing the health industrial complex as they shovel dividends and capital gains to their investors in Health.
Under the Affordable Care Act, the Market Cap for Health has doubled from $750B to $1.5 Trillion. That represents all the shares in Health x their share price (Insurance, Pharma, hospitals/nursing homes, biotech, Medical supplies, etc)
Once you've done this, can you get back to us with a Part II of the discussion?
3
What is the "Market Cap for Health"?
The value of the healthcare financial marketplace --goods and services--has indeed grown.
Many sub sectors of healthcare would indeed continue to grow in expenditures with ACA or single payer. More patients receiving care means more healthcare workers, more of certain healthcare supplies, etc.
But some trends become noticeable if we break down the drivers of those costs--and look at what drives up the revenues/costs, plus what the actual costs versus benefits are to individual taxpayers/citizens.
One mistake is to ignore the insurance industry and pretend their profits belong to a different sector of the economy. In fact, insurance has been the actual client--not patients--selecting what care is available and at what cost to what citizen. Insurance drives much of the requirement for tests, too.
Because the insurance industry sometimes is unfair on how they discount too deeply some parts of healthcare, hospitals try to make up the shortfall through the pocketbooks of patients who don't qualify for the group discounts of Medicaid/Medicare/group insurance.
The for profit sector of the hospital industry has created expensive redundancies. Lots of details to look at there for certain!
And we can go on and on. Bottom line, though: a single payer system is the only thing that will rein in the combo of costs from for profit sectors, pharmaceuticals, cost to consumer to be a member of the healthcare system, plus the cost of the care.
Many sub sectors of healthcare would indeed continue to grow in expenditures with ACA or single payer. More patients receiving care means more healthcare workers, more of certain healthcare supplies, etc.
But some trends become noticeable if we break down the drivers of those costs--and look at what drives up the revenues/costs, plus what the actual costs versus benefits are to individual taxpayers/citizens.
One mistake is to ignore the insurance industry and pretend their profits belong to a different sector of the economy. In fact, insurance has been the actual client--not patients--selecting what care is available and at what cost to what citizen. Insurance drives much of the requirement for tests, too.
Because the insurance industry sometimes is unfair on how they discount too deeply some parts of healthcare, hospitals try to make up the shortfall through the pocketbooks of patients who don't qualify for the group discounts of Medicaid/Medicare/group insurance.
The for profit sector of the hospital industry has created expensive redundancies. Lots of details to look at there for certain!
And we can go on and on. Bottom line, though: a single payer system is the only thing that will rein in the combo of costs from for profit sectors, pharmaceuticals, cost to consumer to be a member of the healthcare system, plus the cost of the care.
1
Healthcare capitalization...healthcare expenditures
The only fair and just solution is that all Americans be enrolled in the same plan that Congress enjoys.
Of course that requires a Congress and President who believe in fairness and justness. Oh well.
Of course that requires a Congress and President who believe in fairness and justness. Oh well.
4
I considered a fact recently reported, but not elaborated upon, as a vital clue about what is going on. Why, when the facts are so clear do we insist on maintaining our failing healthcare system?
That's because the people with the power, the rich, have a life expectancy that is over 10 years longer than the rest of us. They can afford good healthcare so they get it. Then they don't see why others are having trouble.
In the same vein, Congress has good healthcare coverage and they earn enough to be able to afford the best care available. So again, what's the problem? Medicaid? Oh, that's for those losers the poor.
Make all of Congress get their healthcare through Medicaid, don't allow them to up the ante by adding supplemental coverage and I would wager everything I own, that Medicaid would quickly become, by law, a so called Cadillac plan.
That's because the people with the power, the rich, have a life expectancy that is over 10 years longer than the rest of us. They can afford good healthcare so they get it. Then they don't see why others are having trouble.
In the same vein, Congress has good healthcare coverage and they earn enough to be able to afford the best care available. So again, what's the problem? Medicaid? Oh, that's for those losers the poor.
Make all of Congress get their healthcare through Medicaid, don't allow them to up the ante by adding supplemental coverage and I would wager everything I own, that Medicaid would quickly become, by law, a so called Cadillac plan.
7
Cui bono or who benefits seems a good place to start for any investigation. In this case the average $10,000 per person mentioned that's spent in America on healthcare doesn't seem, from the article, to benefit ordinary Americans in comparison to other countries who spend far less. So who does it benefit?
No healthcare coverage or services for members of Congress until all Americans have universal healthcare coverage.
8
Right Mr. Kristof.
A constitutional amendment tying Congressional benefits to the level possessed by ordinary Americans.
That would be a key to good government.
A constitutional amendment tying Congressional benefits to the level possessed by ordinary Americans.
That would be a key to good government.
3
Medicare, they should get Medicare.
3
There's a cute idea behind this column, especially for a reason Mr. Kristof doesn't state: Congress (and Administrations) keep trying to institute "pay for performance" schemes for government employees. They should do the same for themselves. It's only fair, isn't it? (What's fairness got to do with anything?).
Beyond "fairness," an additional benefit of Congress trying to institute "pay for performance" would be that it would force them to confront the inherent trickiness of defining "performance" and value, and intelligently establishing quantitative links to compensation. I think Congresspeople will settle, instead, for sloganeering and posturing.
Beyond "fairness," an additional benefit of Congress trying to institute "pay for performance" would be that it would force them to confront the inherent trickiness of defining "performance" and value, and intelligently establishing quantitative links to compensation. I think Congresspeople will settle, instead, for sloganeering and posturing.
7
Mitch McConnell and Paul Ryan routinely argue that patients don't have enough "skin in the game." Let's go further than your proposal. How about a pound of flesh out of everyone voting for the Republican Bill if it doesn't deliver more people better healthcare at less cost than the ACA? I'm sure Tom Price could recruit his surgical buddies to handle the details for the right price.
3
The statistics you cite have little effect on those reluctant to adopt a national healthcare plan, constituents and elected officials alike. Those closer to the top of the income ladder, those with employer provided plans, assume they are getting better care than those lower down the scale. There is the assumption that were the same dollars and care - like a pie - spread out over everyone, they would lose. Proponents of single payer should address this unspoken belief.
3
BRILLIANT!! As a physician I have long favored a single-payer system and believed that provider compensation should be tied to patient outcomes. Furthermore, I accepted years ago that elected officials are my bosses' bosses and any protestation that they are not or wish they were not is simply annoying. Governmental oversight of public resources and services is intrinsic to a civilized society. I only mind that our democracy allows the bosses of our elected officials to be well-heeled lobbyists for whom patient outcomes are an incidental consideration at best. It's too bad we can't tie their compensation to patient outcomes as well.
7
I would tie Congress not only to performance, but also to having to use ONLY the health care program they wish to provide for American taxpayers.
10
In the health care debate one crucial component, that is often not mentioned, are the drug companies. Merck, Pfizer and others are publicly traded companies that are in the business of making money. While I agree that Congress needs a pay cut, how can we rationalize that Pfizer CEO received over 16 million dollars in compensation last year? At an earlier press conference this year, Trump commented that "pharma is getting away with murder". Ian Read, the CEO at Pfizer, in response to Trumps' comments said "what Trump and others don't understand is that good drugs cost a lot of money to make". Drug prices also have to cover Mr. Read's salary.
3
Pharma spends more for marketing than they do for R&D. This has been the situation for years.
1
Tie Congress’s Paychecks to Our Good Health As Soon As We Get Off Alcohol And Drugs
Why do the congresswomen and men that are promoting this egregious healthcare bill care? They have their healthcare for life paid by us. O.K. says the Ryans, McConnell's et al. We've got ours now the rest of you swing in the wind.
This goes for the man-child Trump too.
This goes for the man-child Trump too.
6
Nicholas, your proposal is not at all absurd. It makes total sense out of the nonsense we are watching. "It’s time to apply the discipline of markets. For the sake of our senators’ own characters, we should pay for work.
If we now pay almost six times as much per capita on health care as Poles do, and get outcomes that are far worse, hmm, what do you think? Maybe we pay our representatives one-tenth what the Poles get? That would be $3,200 a year for a member of Congress. THANK YOU FOR BROACHING THIS!
If we now pay almost six times as much per capita on health care as Poles do, and get outcomes that are far worse, hmm, what do you think? Maybe we pay our representatives one-tenth what the Poles get? That would be $3,200 a year for a member of Congress. THANK YOU FOR BROACHING THIS!
Please with the $174k salary. They use that to buy suits. Everything for them is covered. Once they are elected, they start making millions. Doesn't matter if your benefactor has cured cancer or gone to jail or has been accused of sexual assault. They pay them and they'll do whatever they want
1
Two simple points: First, much of all of this crap from Trump and the Republicans is Trump's vile hatred of former president Obama and the Republican Party's skilled appeal to racism/bigotry. Second, as most of the rest of the world has already realized, medical care is simply not a marketable "product," it is the epitome of a public good. As such, it can only be effectively managed by the public, like everyone else in the world knows.
12
'Cheated'? 'a stain'?? (ya think???)
Problem is senators aren't in it for the salary & benefits.
In the USA political public 'service' seems to be most often a manifestation of a narcissistic power disorder exacerbated by campaignfunditis. Certainly there are more lucrative careers that don't require getting palms so greasy & the overactive selfadulation gland. Lawmakers generally aren't in it to benefit their constituents any more than attorneys are in it for a love of justice. You'd need an involved electorate to keep congress in line.
Problem is senators aren't in it for the salary & benefits.
In the USA political public 'service' seems to be most often a manifestation of a narcissistic power disorder exacerbated by campaignfunditis. Certainly there are more lucrative careers that don't require getting palms so greasy & the overactive selfadulation gland. Lawmakers generally aren't in it to benefit their constituents any more than attorneys are in it for a love of justice. You'd need an involved electorate to keep congress in line.
4
I just wish there were an actual, effective way of getting this kind of information to the folks that are hidebound MAGAs. Or are in the thrall of what highly slanted, parsed info they get via FB, FOX etc.
Right now the "fake news" slogan is too effective at drowning out facts.
Right now the "fake news" slogan is too effective at drowning out facts.
4
Why is it the government's responsibility for a citizen's health care? Governments are responsible for pubic and common goods. Health care is not on that list, it is a personal responsibility.
1
Everyone benefits when people are healthy, it is a public good. In the simple and crassest case, healthy people are more resistant to epidemics making the risk to the entire population less. Slightly more subtle is infant and childhood health. A healthy child can learn and become a productive adult far more easily than an ill one. These are just the really, really obvious public goods of health.
7
For why health is a public good, please see the Spanish influenza epidemic of 1918-20 when nearly 50 million people died internationally because of dismal health care. We all benefit when people around us are healthy, just like we all benefit from safe, modern roads that transport people and goods efficiently, and building codes that prevent people from being immolated in high-rise buildings. And I think you meant public good, not pubic.
I'm pretty sure there's something in the Constitution about promoting the general welfare.
1
Mr. Christoph, please keep in mind that Poland does not have our high-powered, and highly-paid, lobbyist fraternity to support. Likewise, it doesn't have the super-duper health insurance executives, as demonstrated by their ova-the-top salaries and egregious bonuses. Oh, and hey, let's not forget the wonder drugs which, once the patent expires, are bought for a song and, then the cost is subjected to the hocus-pokus multiplier effect, when sold to the public.
Hey, is America a great country, or...WHAT?
https://thetruthoncommonsense.com
Hey, is America a great country, or...WHAT?
https://thetruthoncommonsense.com
3
Subsidized health care for members of Congress should be the hill to die on (metaphorically speaking). I understand the notion that serving members should get good health care, but why should they get to keep it once they leave? Force them into the market place and, fingers crossed, it might lead a few more to legislate for their constituents, rather than big money donors, since said constituents have the power to kick them off the government dole.
3
It is so frustrating that essentially 100% of our current discussion focuses on how to contain costs (and shift that savings to the wealthy) and accept the fact that we live with restricted access. The discussion should be about exactly those points raised so succinctly within your editorial, Nick. IMHO, our spending 18% of our GDP would be an appropriate use of our fiscal resources if we were to rank at the top of all first world countries in our national health metrics. But to spend essentially double what the global first-world average is to achieve 37th position is simply a terrible ROI, and should be a national embarrassment.
8
Want to offer better health care to the American people?
Simply put Congress on the same health plan they vote for the rest of us.
Simply put Congress on the same health plan they vote for the rest of us.
8
This article is very much on point. A single payer system is the only viable alternative we can expect. Obamacare was but a bandaid to avoid universal health care but has since proven to be economically untenable. So would any "fix" to Obamacare. Indeed, the only alternative to fixing an un-fixable system has been a single payer concept. But Democrats have, as always, been too cowardly to embrace reality. And of course Republicans warn of a doomsday single payer system if their ridiculous sham doesn't become the law of the land. Everyone, it seems, understands universal health care should be the right of everyone.
4
There has to be some discrimination law that has me paying for McConnell's, but he doesn't pay for mine? Nothing in the constitution states I should provide him with healthcare, why am I? He gets universal, but I'm from Mars?
6
Let's do it!!! Or let's promote a House Bill that will force Congress to use the same healthcare they will force on all of us!!
4
A few years ago I took my husband to the emergency room. The first person to come in to see him, pushed a cart with a computer. My husband thought she was a nurse and started explaining why he was there. I stopped him. "She doesn't care. She's from billing." This is our "health care" system.
3
Thanks for the informative comparisons. Great idea, but I doubt the Republicans will like the idea, or worse the reality of becoming responsible legislators. They are starting to look like Trump himself. That is to say unaware of what is required to be something other than obstructionists. It's so easy to destroy, but difficult to build lasting meaningful accomplishments. Are they up to it at any price?
Heh, I like the idea. It's an amusing thought experiment.
Something I wonder though, a potential cost savings from universal healthcare that I never see mentioned is that if all kids have access to mental health care and medications, we can reduce the number who go on to commit criminal acts. Untreated ADHD, for instance, makes kids much more likely to fail to graduate or get good grades, it also makes them more impulsive (likely to do something stupid) and to take illegal drugs. If you can keep them off that track in the first place, that would be a great savings for the criminal justice system later on.
Read an article on Vox this morning about our maternal mortality rate, Texas, where they didn't expand Medicaid and closed PP is the worst in the nation. California, where they've applied science to the issue is as good as most of Europe and five times better than Texas.
Something I wonder though, a potential cost savings from universal healthcare that I never see mentioned is that if all kids have access to mental health care and medications, we can reduce the number who go on to commit criminal acts. Untreated ADHD, for instance, makes kids much more likely to fail to graduate or get good grades, it also makes them more impulsive (likely to do something stupid) and to take illegal drugs. If you can keep them off that track in the first place, that would be a great savings for the criminal justice system later on.
Read an article on Vox this morning about our maternal mortality rate, Texas, where they didn't expand Medicaid and closed PP is the worst in the nation. California, where they've applied science to the issue is as good as most of Europe and five times better than Texas.
Kristoff says: "O.K., I’m not really in favor of slashing congressional pay..."
Why not? These are the folks who claim that market forces are the solution for every problem. Everybody else in America realizes that Congress is broken. Why should we pay them for performance that would get any other American fired?
Why not? These are the folks who claim that market forces are the solution for every problem. Everybody else in America realizes that Congress is broken. Why should we pay them for performance that would get any other American fired?
7
Re "... we should pay officials well to attract the best talent."
Well, that's certainly been working out, hasn't it?
Well, that's certainly been working out, hasn't it?
4
Great column- we need the same health car plan as Congress.
8
If universal health care is going to work in the US, it will require pharmaceutical industries, medical supply companies, medical device companies, and hospital upper management to all take some cuts to their bottom line. We cannot have, for example, common medications that cost $700 per month. If the charges continue in their current form, we will have "access" to the medical system with compromised or rationed care.
1
If there is only one payer, that payer has immense negotiating power for things like pharmaceuticals and DME. That would drive down the current pricing structure. This is exactly how some countries have lower costs of care. And, when there is only one payer who is responsible for the entirety of lives, there is more incentive to focus on public policy that improves health, thus preventing the need for health-care n the first place. Something that is absent from the current system.
4
Great column - we all need to push this idea constantly. Alas it is very difficult to get folks to understand something - even the glaringly obvious - if understanding it is ideologically uncomfortable.
7
I love the concept of holding politicians accountable by meaningful metrics, but in this particular case of health insurance and managing the "care" cartel, the government is not primarily responsible for the health of us people, even if it pretends to be. We the people are.
3
Thanks for providing the $10,000 annual per capita cost of health care. A random set of four people would have an expected $40,000 annual cost. A working family of husband-wife-two kids would have an expected cost well below this, as they are likely to be young and healthy. Let's say it's $25,000 -- which would then be the fair market cost of insurance. How is this situation sustainable?
Elizabeth Rosenthal's book "An American Sickness" shows the many ways in which care providers, hospitals, pharma companies, device manufacturers have gamed the system to extract our money. Medicare is a single-payer system for senior citizens, and it too has been financially compromised.
A single-payer system will be a great simplification over what we have now, but it will not solve the cost problem. Until we figure out how to prevent manipulation, we are not going to solve health care with a single payer system.
Elizabeth Rosenthal's book "An American Sickness" shows the many ways in which care providers, hospitals, pharma companies, device manufacturers have gamed the system to extract our money. Medicare is a single-payer system for senior citizens, and it too has been financially compromised.
A single-payer system will be a great simplification over what we have now, but it will not solve the cost problem. Until we figure out how to prevent manipulation, we are not going to solve health care with a single payer system.
4
And what do you do when after making this marvelous switch to a single payer system many find themselves with either less coverage for the same amount paid (assuming paid for by taxes) prior to the switch or having to pay extra for the same coverage?
I know what the NY Times will do. They will label them as liars. They did this in the early days of Obamacare. Krugman was especially good at it.
Let's not pretend this won't happen, ok?
I know what the NY Times will do. They will label them as liars. They did this in the early days of Obamacare. Krugman was especially good at it.
Let's not pretend this won't happen, ok?
Let's just say for the sake of argument that Trumpcare is wonderful and that all the gloom and doom predictions of the CBO and such are totally wrong and we'll have everyone happy and smiling about the new arrangements.
But will such a plan answer the big question: why do Americans pay so much more for health care than others, and have to live with second rate results? A recent article in the NYRB points out that whatever the strong points of Obamacare, and there are many, cost containment is not one of them. And that's largely because Obama and his congress, in order to get their plan across, caved into the powerful lobbies: e.g., Big Pharma (so drug prices go up up up); the insurance industry (so premiums go up up up); the lawyers, trembling at the thought of tort reform.
Does Trumpcare address any of those issues? Perhaps, but I doubt it. Can they be addressed as long as we see healthcare not as a national right but as a private profit-making enterprise, whose ultimate responsibility is to stockholders?
But will such a plan answer the big question: why do Americans pay so much more for health care than others, and have to live with second rate results? A recent article in the NYRB points out that whatever the strong points of Obamacare, and there are many, cost containment is not one of them. And that's largely because Obama and his congress, in order to get their plan across, caved into the powerful lobbies: e.g., Big Pharma (so drug prices go up up up); the insurance industry (so premiums go up up up); the lawyers, trembling at the thought of tort reform.
Does Trumpcare address any of those issues? Perhaps, but I doubt it. Can they be addressed as long as we see healthcare not as a national right but as a private profit-making enterprise, whose ultimate responsibility is to stockholders?
5
The Congressional Oath of Office begins with, “I do solemnly swear (or affirm) that I will support and defend the Constitution of the United States”.
Perhaps it’s time to amend the oath and have members of congress adopt one of the promises stated within the Hippocratic Oath. The Hippocratic Oath is a promise that medical students must take before becoming a licensed medical doctor. One of the many covenants within that oath is, “first, do no harm”. It would appear that when it comes to health care in the United States, the Republican’s proposal is predicated on, “do no harm to the healthy and the wealthy”.
As a Canadian who benefits immensely from a wonderful health care system, it’s unconscionable to think that 22 million more Americans will be without health insurance by the year 2026 according to the Congressional Budget Office’s latest analysis. Moreover, it’s predicted that 15 million fewer people would be enrolled in Medicaid by 2026. How can Republicans be so merciless to Americans who need health care the most?
The current Republican regime only cares about the healthy and the wealthy. Maybe behind their closed door meetings they pledged an oath to a Darwinian health care system that is founded on survival of the fittest and the richest.
Perhaps it’s time to amend the oath and have members of congress adopt one of the promises stated within the Hippocratic Oath. The Hippocratic Oath is a promise that medical students must take before becoming a licensed medical doctor. One of the many covenants within that oath is, “first, do no harm”. It would appear that when it comes to health care in the United States, the Republican’s proposal is predicated on, “do no harm to the healthy and the wealthy”.
As a Canadian who benefits immensely from a wonderful health care system, it’s unconscionable to think that 22 million more Americans will be without health insurance by the year 2026 according to the Congressional Budget Office’s latest analysis. Moreover, it’s predicted that 15 million fewer people would be enrolled in Medicaid by 2026. How can Republicans be so merciless to Americans who need health care the most?
The current Republican regime only cares about the healthy and the wealthy. Maybe behind their closed door meetings they pledged an oath to a Darwinian health care system that is founded on survival of the fittest and the richest.
8
It's normal to see the healthcare debate based on personal perspectives.
As the daughter of a woman who died of cancer and a man who survived cancer to now be diagnosed with Parkinson's, I ache for a focus on innovative research into cures. As the mother of a healthy 26-year-old, I want due focus given to preventive care. As a CCHI Certified Healthcare Interpreter for Spanish, quiero igualdad para todos los pacientes. As a former patient advocate, I demand that lawmakers be held accountable for their serious dereliction of duty.
The U.S. is in the unique position of being the solitary OECD country that doesn’t provide universal coverage. This gives the U.S. the unique position of being able to examine all of those other systems in order to pick and choose a universal system that would work best for our population.
Elected officials must be held accountable for failing to do the research and writing necessary to formulate a plan. They must be held accountable for holding the U.S. back from achieving for its citizens what so many other countries have done, to the benefit of their economies. Their ongoing refusal to examine the issue with open eyes and then proceed with a plan that covers all at the most reasonable price possible is despicable. We CAN have healthcare that is handled in a smart, fair, and economically responsible way - but it requires legislative leaders who are decent human beings.
As the daughter of a woman who died of cancer and a man who survived cancer to now be diagnosed with Parkinson's, I ache for a focus on innovative research into cures. As the mother of a healthy 26-year-old, I want due focus given to preventive care. As a CCHI Certified Healthcare Interpreter for Spanish, quiero igualdad para todos los pacientes. As a former patient advocate, I demand that lawmakers be held accountable for their serious dereliction of duty.
The U.S. is in the unique position of being the solitary OECD country that doesn’t provide universal coverage. This gives the U.S. the unique position of being able to examine all of those other systems in order to pick and choose a universal system that would work best for our population.
Elected officials must be held accountable for failing to do the research and writing necessary to formulate a plan. They must be held accountable for holding the U.S. back from achieving for its citizens what so many other countries have done, to the benefit of their economies. Their ongoing refusal to examine the issue with open eyes and then proceed with a plan that covers all at the most reasonable price possible is despicable. We CAN have healthcare that is handled in a smart, fair, and economically responsible way - but it requires legislative leaders who are decent human beings.
19
The cited research report wpublished in the Annals of Internal Medicine is excellent and thorough. The sample sizes are statistically large enough to be valid, and several types of populations were studied. Also that study looked at morbidity issues, not just mortality figures in a short span of years. (The other study did not consider the health findings such as high hypertension rates and other issues that are bound to lead to more and more health problems as years pass.)
Yes, the data is firm that populations all over the world do better with universal single payer systems.
Yes, the data is firm that populations all over the world do better with universal single payer systems.
8
The idea of tying Congressional performance to pay is intended to be humorous, which it is. However, members of Congress aren't in it for the $175k salary. The median worth of members of Congress is a little over $1MM, yet they "represent" Americans whose median income is about $50k a year. That, in and of itself, explains where their loyalties are. If we want change, challenge Citizens United, rid our political system of lobbyist influence, forbid ex-Congress people from becoming lobbyists for 10 years and consider term-limits. That's where members of Congress make their money - not salary.
A final note: the US child mortality rate compared to other countries is shocking. How can Republicans - many who identify as "Christian" - fight for the rights of unborn children, yet turn the other way the moment a child takes his or her first breath?
A final note: the US child mortality rate compared to other countries is shocking. How can Republicans - many who identify as "Christian" - fight for the rights of unborn children, yet turn the other way the moment a child takes his or her first breath?
23
The health statistics speak for themselves to a large extant. The cost figures, however, need to be adjusted for the cost of living in those countries in order to have any true validity. For example, the cost of living in the US is almost twice that of Poland, so the $1680 there equates to over $3,300 here. That is still quite a bit less expensive, true, but if one is going to compare prices accuracy is more important than shock value.
3
- I am an independent. I follow your activities and applaud you. I voted for you.
Now: We all know the ACA is unsustainable in its current form. (see below) Why are the Democrats letting the Republicans take over the issue? Why aren't Democrats meeting behind closed doors to come up with an alternative? Seems to me there's a lot of "Woe is me, It's not our fault, the ACA is just fine" going on. Get off your collective behinds and propose a fix. Propose a plan that will save lives. Propose an alternative and show the American People the Democrats are alive - WORKING - and ready for a fight.
Now: We all know the ACA is unsustainable in its current form. (see below) Why are the Democrats letting the Republicans take over the issue? Why aren't Democrats meeting behind closed doors to come up with an alternative? Seems to me there's a lot of "Woe is me, It's not our fault, the ACA is just fine" going on. Get off your collective behinds and propose a fix. Propose a plan that will save lives. Propose an alternative and show the American People the Democrats are alive - WORKING - and ready for a fight.
14
I have been advocating Medicare for all for years and writing to my senator and Democratic Party for years. Either the Democratic Party does not really exist (which I have suspected for years) or they are too much in the pay of big Pharm and health insurers, (another suspicion). I don't know anyone with Medicare who is unhappy with it. It is a life saver even for middle class people. P.S. I love your columns.
10
Mexico has universal health care. Seems like no one mentions our good neighbor Mexico in these lists of countries with universal health care. ¡Viva México!
https://www.hsph.harvard.edu/news/features/mexico-universal-health/
https://www.hsph.harvard.edu/news/features/mexico-universal-health/
1
Economies of scale and scope are beneficial to public utility services, such as health, water, gas and electricity. Fragmentation complicares regulation, and favors cherry picking....But if you are Republican, you do not care about the little things affecting the people. You are protected by birth, cronyism, and lobbies.
The people of Senators McConnell's and Paul's Kentucky, like so many in red states, again and again vote against their own best interests and elect the likes of the duplicitous and rule-bending Senators McConnell and Paul and their cohort of co-conspirators: those public "servants" who render the American dream inaccessible to so many who vote for them.
Just how far has this country moved to the right?
An extremely "conservative" GOP now controls both the legislative and executive branches of the government; nonetheless McConnell was forced to delay voting on the GOP healthcare bill.
Did McConnell announce this delay because he wishes to halt the hurt it would deal to "his own people"?
No.
Why? Because a few center-right Republican senators would not vote for it because it is too mean spirited. The large group comprising the current middle of the road GOP senators--those who support McConnell no matter what--would vote for it because it was just mean spirited enough. A few ultra-right regressive Republicans, like Senator Rand Paul, would not vote for it because it is not nearly mean spirited enough.
Too mean spirited. Just mean spirited enough. Not nearly mean spirited enough.
Shades of "Goldie Locks and the Three Bears."
To bad that so many Kentuckians who hated Obamacare, but loved their own Kynect Care, didn't know that Kynect was their state's version of Obamacare--and voted contrary to their own best interests.
Miseducation has consequences.
Just how far has this country moved to the right?
An extremely "conservative" GOP now controls both the legislative and executive branches of the government; nonetheless McConnell was forced to delay voting on the GOP healthcare bill.
Did McConnell announce this delay because he wishes to halt the hurt it would deal to "his own people"?
No.
Why? Because a few center-right Republican senators would not vote for it because it is too mean spirited. The large group comprising the current middle of the road GOP senators--those who support McConnell no matter what--would vote for it because it was just mean spirited enough. A few ultra-right regressive Republicans, like Senator Rand Paul, would not vote for it because it is not nearly mean spirited enough.
Too mean spirited. Just mean spirited enough. Not nearly mean spirited enough.
Shades of "Goldie Locks and the Three Bears."
To bad that so many Kentuckians who hated Obamacare, but loved their own Kynect Care, didn't know that Kynect was their state's version of Obamacare--and voted contrary to their own best interests.
Miseducation has consequences.
2
Economies of scale and scope are beneficial to public utility services, such as health, water, gas and electricity. These are the reasons for national insurance and health services. Fragmentation complicates regulation, and favours cherry picking.... It also increases costs per unit and transaction costs. Private companies understand this; therefore they organize in holdings and conglomerates. But if you are Republican, you do not care about the little things affecting the people. Birth, cronyism, and lobbies protect you. Welcome to France, 1750! Let the people (small p, please) eat cake!
3
We will need to tie good health to something Congress earns, like maybe their own healthcare, as many have shown they don't care a hill of beans about us. This is a mess!!!! How in the heck did the doctors turn into mongrels only after money? Insurance companies? And why are the insurance companies keeping Reps and Senators in cash? (And they accept it?) And who, even with universal healthcare, will watch over me? There are a crooks everywhere!
1
Yes!. As a recent convert to the idea of single payer you provide a great arguement for why we need to go single payer. Many of us former doubters are now in the Medicare for all camp. Its not perfect, Medicare needs to be updated to ensure providers aren't losing money every time they treat a patient, and supplemental plans and private plans need to be legal ( as shown by Britians infamous wait times decreasing when private plans became legal).
We have another issue that is of growing concern. There is a growing anti-science movement in this country that goes far beyond the flat-earth fools. People are buying into the idea that vaccines aren't needed any longer and swallowing the snake oil from charlatans like Mercola, Wakefield, Tennypenney, and Jenny McCarthy et al that vaccines do more harm than good or are responsible for autism or "vaccine Injuries" . These gullible folks are largely responsible for the resurgence of illnesses that had all but been wiped out and now threaten those who aren't vaccinated or, more importantly, those who legitimately can not be vaccinated. Look at money being wasted on psuedo-science practices such as naturopathy, chiropratic wellness, reikki, homeopathy, accupuncture and other worthless "alternative" or "complementary" crap that doesn't work beyond the placebo effect and we are throwing good money at bad practices to bad people who often encourge buying their worthless supplements rather than vaccines or real medicine.
We have another issue that is of growing concern. There is a growing anti-science movement in this country that goes far beyond the flat-earth fools. People are buying into the idea that vaccines aren't needed any longer and swallowing the snake oil from charlatans like Mercola, Wakefield, Tennypenney, and Jenny McCarthy et al that vaccines do more harm than good or are responsible for autism or "vaccine Injuries" . These gullible folks are largely responsible for the resurgence of illnesses that had all but been wiped out and now threaten those who aren't vaccinated or, more importantly, those who legitimately can not be vaccinated. Look at money being wasted on psuedo-science practices such as naturopathy, chiropratic wellness, reikki, homeopathy, accupuncture and other worthless "alternative" or "complementary" crap that doesn't work beyond the placebo effect and we are throwing good money at bad practices to bad people who often encourge buying their worthless supplements rather than vaccines or real medicine.
"We should pay officials well to attract the best talent". Well Nick there appears to be our first mistake. This is the theme used throughout the banking world, indeed through the capitalist system, but only for the higher ups, never the rank and file. We are by this time I hope aware of the results you get when paying bankers top dollar to " get and retain top talent", you attract people interested in making money not interested in doing anything worthwhile. This is especially true in business after C.E.O.S make one acquisitions costing shareholders billions, and rarely panning out. The one thing that always pans out though is the golden parachute the hierarchy receives when exiting the firms failing or not. No better example in healthcare than William McGuire of United Health who was paid over a Billion dollars are when leaving after a scandal involving back dating stock options. The banking and tech field is littered with players who failed to run the company well yet were paid enormous sums always based on " it's necessary to attract top talent". Dick Fuld @ Lehman paid five hundred million after the company was dissolved, Melissa Mayer Three hundred million or so for five years of dismantling a company and writing off a billion dollar acquisition. Nick our health care system is the worst and most expensive in the developed world for one simple reason, people are in it to make lots of money not provide good care, with the exception of nurses and some of the physicians.
7
Won't work while Billionaires and Corporations can bribe them with dark money.
2
I just don't see any real solution on the table! On one side, healthcare is a moral issue and universal healthcare is the solution. But realistically, we all know it is not going to happen at least in the forseeabl future. So can they just compromise for now and settle for something less? On the other side, even though they claim they believe market force, healthcare industry is run by crony capitalism instead! To cut cost, their only solution is to cut benefits and insure less people.
Seriously, how could a country with Harvard, MIT and Silicon Valley come to this point?! The real reason is the swamp in DC. The lobbist-politician complex is the root of dysfunction. This country is actually run by various interest groups and they are sucking away valuable resources and the vitality of this country.
Ironically, President Trump is likely the only savior left. Remember his promise of draining the swamp? As a businessman who had the vision to see the opportunity and opening, I really believe and hope he will have the same ability when dealing with healthcare. For Democrats, I have this message. Suck it up, move on and work with President Trump. President Trump is surrounded by people with "New York value". Do I need to say more?!
Seriously, how could a country with Harvard, MIT and Silicon Valley come to this point?! The real reason is the swamp in DC. The lobbist-politician complex is the root of dysfunction. This country is actually run by various interest groups and they are sucking away valuable resources and the vitality of this country.
Ironically, President Trump is likely the only savior left. Remember his promise of draining the swamp? As a businessman who had the vision to see the opportunity and opening, I really believe and hope he will have the same ability when dealing with healthcare. For Democrats, I have this message. Suck it up, move on and work with President Trump. President Trump is surrounded by people with "New York value". Do I need to say more?!
1
A little late no? Bernie was trying to explain this to children very effectively, but folks from nyt shut him down, their moms said no you have to vote for status quo. They did but there were many more who wanted to change status quo. (Shoulder shrug). Thanks for trying Nick. I suppose you are in the danger zone of being called the s word.
7
Socialized medicine is what we NEED! Cut the capitalist bull half measures. People are dying.
4
But Republicans are right : socialised medicine is a plot to impurify your precious bodily fluids
1
"First, many Americans, including politicians, just don’t understand how poorly our health care system actually performs by international standards." Yes indeed. What's more, when they are presented with the data, they don't want to believe it.
6
Who does well under the American"health care" system? Big pharma and especially the insurance companies and their beneficiaries (the legislators whom they support).
2
The first step is to give citizens health CARE not health INSURANCE. Insurance is a casino game that the house always wins. I daresay all other countries' governments are not run by insurance and pharmaceutical lobbies. Our plutocratic system is not likely to change through democratic means.
7
Whatever health care plan is enacted, make members of Congress subject to the plan. No more deferments from the ACA, ADA and other government mandated actions.
3
I can't truly recall the last time there was such a backlash regarding how Congress wants to disperse healthcare. I suppose it has to do with the ruling party, now in control of all levers including the last line of defense - the US Senate (now only 50 votes shy).
If I were a GOP uber-lord, I would have left out stupid tax cuts, not tried to gut Medicare, and chipped away at the ACA more slowly in order to take down the notion of the success of a single payer system (Medicare). Then the GOP might have had a moderate win.
Instead, McConnell happily went all-in. He shot for the moon and I for one am glad that at this first GOP shot at the ACA was so incredibly ridiculous and overreaching. It pissed off everyone enough to make this a national debate since the Senate Republican leadership seems so adverse to hold their own debates.
Frankly, this is the best possible thing to happen for Americans since the Supreme Court defended the ACA. Time has passed, people who never had coverage now do. Governors who shunned the expansion of Medicare in their states are facing the fact that the market place - private insurers - are less enthusiastic when it comes to working with that state. Surprise!
The fact is that the backbone of any realistic healthcare system - even a hybrid of private and government sponsored insurance, is going to be based on free-market forces. I say, that if a state has lost its last insurer, let Medicare step in. That will show them how it can be done.
If I were a GOP uber-lord, I would have left out stupid tax cuts, not tried to gut Medicare, and chipped away at the ACA more slowly in order to take down the notion of the success of a single payer system (Medicare). Then the GOP might have had a moderate win.
Instead, McConnell happily went all-in. He shot for the moon and I for one am glad that at this first GOP shot at the ACA was so incredibly ridiculous and overreaching. It pissed off everyone enough to make this a national debate since the Senate Republican leadership seems so adverse to hold their own debates.
Frankly, this is the best possible thing to happen for Americans since the Supreme Court defended the ACA. Time has passed, people who never had coverage now do. Governors who shunned the expansion of Medicare in their states are facing the fact that the market place - private insurers - are less enthusiastic when it comes to working with that state. Surprise!
The fact is that the backbone of any realistic healthcare system - even a hybrid of private and government sponsored insurance, is going to be based on free-market forces. I say, that if a state has lost its last insurer, let Medicare step in. That will show them how it can be done.
5
The rich in the Senate have no idea what the rest of us go through. Trump certainly does not.
5
Nicoloas...c'mon...you're a smart guy...WHO WOULD DO THIS? Certainly not Congress...expecting them to change their compensation package by suggesting it is about as do-able as shouting at the moon to make it change course.
IF ANY OF THIS WAS POSSIBLE I'd suggest that they get paid the "median income" of the US (wonder how long it would be before the working folks started getting a better deal from them if that happened)...and while we're talking fantasy why not another bill that would require them to participate in everything else they pass...including health care (I'd bet they would get that fixed too)...love fantasy...but c'mon
IF ANY OF THIS WAS POSSIBLE I'd suggest that they get paid the "median income" of the US (wonder how long it would be before the working folks started getting a better deal from them if that happened)...and while we're talking fantasy why not another bill that would require them to participate in everything else they pass...including health care (I'd bet they would get that fixed too)...love fantasy...but c'mon
Republicans hate government. They say everything government touches is a failure. They want to contract everything out to the private sector. They think government employees are lazy, incompetents. They may have a point.
Government at its highest level is the president and the Congress. These government employees are lazy, incompetents. The president plays golf while the country is in chaos. The Republicans in Congress obstructed everything for 8 years and now can't find the rumps with both hands.
So, instead of paying these slackers based on performance (which they are not capable of), lets contract out the presidency and the Congress. Poland might submit a reasonable bid to run Congress. They already have a proven record of accomplishment. Putin need not submit a bid for the presidency; his puppet is already in place. Perhaps Canada would share Justin Trudeau?
By contracting out our presidency and Congress we can expect vast improvement; they certainly could not be any worse.
Government at its highest level is the president and the Congress. These government employees are lazy, incompetents. The president plays golf while the country is in chaos. The Republicans in Congress obstructed everything for 8 years and now can't find the rumps with both hands.
So, instead of paying these slackers based on performance (which they are not capable of), lets contract out the presidency and the Congress. Poland might submit a reasonable bid to run Congress. They already have a proven record of accomplishment. Putin need not submit a bid for the presidency; his puppet is already in place. Perhaps Canada would share Justin Trudeau?
By contracting out our presidency and Congress we can expect vast improvement; they certainly could not be any worse.
2
And really, if healthcare managed by the government is so terrible, why does Congress accept it for themselves?
8
@ Elizabeth Martin: Why doesn't this comment merit two NYT picks. It says it all!
I wonder is USA so poor country that country cannot take care of their citizens' health? What about saying Health is Wealth?Why US does not have Govt/ Missionary/Trust's hospitals &/or Outpatient clinics or simply some dispensaries ( I do not know equivalent American English word) where a patient with minor ailments like fever or stomach trouble or someone waking crossing road gets minor cut wound etc walks/drives to nearest( i mean really nearest not just thirty miles drive) gets first aid, not asked about his insurance
2
Maybe congress needs to get paid for "piece work"... every piece of legislation they pass gives them a check. Their check will need to be based on "value added" as well..... "value added" to the health of the country, infrastructure, health care, etc etc etc ... they will have to be "independent contractors" too, so they get to pay 100% for their health care and both sides of their social security. Maybe we can put them up in hotels & give them a per diem for meals when they need to come into DC. I mean honestly how many days a year do they actually work and need to be in DC? Some of us have done this for decades once they get used to it they will find it is very rewarding.
It's because Republicans care more about protecting a fetus than protecting a baby.
I suggest you go further...
Tie Congress’s Paychecks to their good Governance.
Of course, that would be unlikely , given the fact it would be a gross act of cruelty to not pay so many Employees for decades....
It's a shame most people are fairer than they are, so it won't happen.
Sad.
Tie Congress’s Paychecks to their good Governance.
Of course, that would be unlikely , given the fact it would be a gross act of cruelty to not pay so many Employees for decades....
It's a shame most people are fairer than they are, so it won't happen.
Sad.
Term limits would solve a lot of this. For the sake of our senators’ own characters...
2
Sp,e years agp. the NYTimes had a series on the health care systems of many developed countries. The last item the reporter would get would be an interview with the cabinet-level person responsible for health care in that country. And one of the questions was, what percentage of your people suffer bankruptcy due to health care costs?
The NYTimes should update that series and publish it again!
The NYTimes should update that series and publish it again!
2
Time magazine also did an issue on this topic, comparing the cost for their reporter to have an injured shoulder treated in, I think, Japan, Germany, Switzerland, and the UK. Everywhere accessible and less expensive. The bottom line was that the countries would be ashamed if their citizens we're bankrupted by health care costs.
So where are the "Pro-Life" people on this?
Anyone? Anyone?
Where is all the moral indignation at unnecessary and untimely deaths of Americans due to lack of health care?
Where are the people willing to kill others to defend the rights of individuals to live?
Crickets.
Anyone? Anyone?
Where is all the moral indignation at unnecessary and untimely deaths of Americans due to lack of health care?
Where are the people willing to kill others to defend the rights of individuals to live?
Crickets.
3
I sincerely hope that Rep. Steve Scalise, Republican majority whip, makes a full recovery from the terrible gunshot injuries he suffered. I also hope that he will consider how lucky he was to have the quality, affordable healthcare available to members of Congress. He has received the best care possible and his family will not be bankrupted paying for it. The Trumpcare repeal of the ACA, which he supported, does not afford the same to the American people. I hope he has a change of heart.
Demand that all of Congress get the same health care package they are trying to ram down the throat of America's citizens...!!!
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Sure thing pal. How about we tax your income at 90% of every marginal dollar over $100K - just as in Eisenhower's day? Btw, it was the next President after him - a democrat from a liberal northeastern state with a father who was a nazi sympathizer - that cut income taxes on the wealthy. All you charlatans forget to mention the cost of your flights of fancy - so let's get real. Even the least generous single payer plan requires VERY HIGH TAXES on the upper 25% of earners - y'know, all those smarties in Boston, NYC, SF, DC who religiously mouth these platitudes. Best hope your cynical dreams don't come true.
Since the GOP would have vote to pass this fantasy, why propose the impossible?
You should be writing about the countless horrid GOP senators who are perfectly FINE will killing fellow Americans to gift another tax break to billionaires.
Write about something REAL, for God's sake!
You should be writing about the countless horrid GOP senators who are perfectly FINE will killing fellow Americans to gift another tax break to billionaires.
Write about something REAL, for God's sake!
You have to be careful about these comparisons. US legislators are paid about 5 times what Polish legislators are paid. However, the US GDP is about 38 times that of Poland, on which basis you could argue that the Poles are overpaid or the Americans are underpaid.
My inclination is to positively link the pay in both countries to a low infant mortality rate and negatively to attempts to interfere with a woman's right to choose to terminate her pregnancy. That latter desire is something that Republicans and Polish religious rubes have in common.
My inclination is to positively link the pay in both countries to a low infant mortality rate and negatively to attempts to interfere with a woman's right to choose to terminate her pregnancy. That latter desire is something that Republicans and Polish religious rubes have in common.
Not bad. Framing is so important. Alas, now the echo chamber is so loud, how to penetrate w/o enlisting VP's Troll Army?
Unfortunately, those in power got there using their influence and money and could care less about those they represent for if they did, they would not be trying to cram Trumpcare down our throats.
What we should require from ALL congressmen and women and including the president and his cabinet and vice president is to pick a family in poverty and go live with them for a week - see how these folks REALLY live and survive. Can you imagine Mitch McConnell or Orin Hatch living in poverty for a week? Better yet, maybe Trump could open up his hotels and let the poor folks live in them for a week gratis so they could see how the power hungry egomaniacs live.
I think we'd all see a vast improvement of their attitudes and priorities when in comes to governing.
What we should require from ALL congressmen and women and including the president and his cabinet and vice president is to pick a family in poverty and go live with them for a week - see how these folks REALLY live and survive. Can you imagine Mitch McConnell or Orin Hatch living in poverty for a week? Better yet, maybe Trump could open up his hotels and let the poor folks live in them for a week gratis so they could see how the power hungry egomaniacs live.
I think we'd all see a vast improvement of their attitudes and priorities when in comes to governing.
1
Could the American ego admit its failings with health care and take a cue from
Poland? Great Britain? Canada? France? Open your mouth and say...
Your line, Mr. Kristof, about six figure Congressional salaries made me chuckle,
"...to attract the best talent." Clearly that's no guarantee.
Poland? Great Britain? Canada? France? Open your mouth and say...
Your line, Mr. Kristof, about six figure Congressional salaries made me chuckle,
"...to attract the best talent." Clearly that's no guarantee.
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Republicans should be wildly in favor of this. If they succeed, this new meritocracy would economically reward them individually, and with their gerrymandered districts, they don't have to worry about a true free market democracy ever derailing them. All upside for them, only downside for us...now that's Republicanism!
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"This country has come to feel the same when Congress is in session as when the baby gets hold of a hammer. "
Will Rogers
Will Rogers
Most wrong-headed column you ever wrote -- if it's a joke it's a bad one. Attacks on congressional pay and benefits are just dumb. You want a Congress of Darrell Issas? You can get one. It won't be better. Moreover, these foolish attacks ignore the fact that the minority party can be effectively shut out of a process. Maybe this is a joke or satire. I don't know. It's not helpful and you're a better columnists than this.
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" O.K., I’m not really in favor of slashing congressional pay; we should pay officials well to attract the best talent."
Oh Dear!
I don't think the Budget Deficit could withstand the huge amount of extra money it would cost to fund congressional pay to attract the BEST talent. (let alone whether there is enough "best talent" to fill Congress)
I think the best America can both expect and afford in regards to the mettle, talent, skills and expertise they should expect of a Congressman is someone who it could be hoped would/could do a fairly decent job.
I'm just not sure people like that are easily found and wouldn't expect at least $2-3 million a year for that fairly decent role....
Given that it costs $176,000 ++ a year to get ones that will only murder you by denial of health, Jail you , fire you or starve you...and you should see how much worse they treat the Poor and Minorities for that salary....
If America wants to have Fairly Decent Congressmen leading the Country I think it's affordable and possible...but only if you can settle for say...6 Congresspeople in total...3 for each party and divided between the 2 houses.
However, if you scrap the F35 Fighter Program, 2 Aircraft Carriers and all those $800 nuts/bolts in the Pentagon Budget I can get you 2 MORE Congressmen but instead of being "Fairly Decent", can only promise "Fair to Middling"...C'mon!...you know how hard it is to get a Congressman that won't ruin you for a few Lobby Bucks , let alone do well!
Oh Dear!
I don't think the Budget Deficit could withstand the huge amount of extra money it would cost to fund congressional pay to attract the BEST talent. (let alone whether there is enough "best talent" to fill Congress)
I think the best America can both expect and afford in regards to the mettle, talent, skills and expertise they should expect of a Congressman is someone who it could be hoped would/could do a fairly decent job.
I'm just not sure people like that are easily found and wouldn't expect at least $2-3 million a year for that fairly decent role....
Given that it costs $176,000 ++ a year to get ones that will only murder you by denial of health, Jail you , fire you or starve you...and you should see how much worse they treat the Poor and Minorities for that salary....
If America wants to have Fairly Decent Congressmen leading the Country I think it's affordable and possible...but only if you can settle for say...6 Congresspeople in total...3 for each party and divided between the 2 houses.
However, if you scrap the F35 Fighter Program, 2 Aircraft Carriers and all those $800 nuts/bolts in the Pentagon Budget I can get you 2 MORE Congressmen but instead of being "Fairly Decent", can only promise "Fair to Middling"...C'mon!...you know how hard it is to get a Congressman that won't ruin you for a few Lobby Bucks , let alone do well!
You want some positive action Nick that would cut right though all this political bickering and inaction, pass a bill today that provides the following: Members of Congress lose all health benefits immediately. Let them go to emergency rooms and free clinics.
And the only way they can get back what they lost is to provide us with whatever they get for themselves going forward.
If there is one thing we can count on, Congress will always take care of themselves. And they will do so very quickly.
And the only way they can get back what they lost is to provide us with whatever they get for themselves going forward.
If there is one thing we can count on, Congress will always take care of themselves. And they will do so very quickly.
it would help if Congress didn't exempt itself from the American Healthcare Act and the Better Health Reconciliation Act. If Congress had to have the same health-care and health insurance as we do, then everybody would have much better health care. Congress has a hypocritical habit of exempting itself from the rules that everyone else is required to follow. I believe they've also Exempted themselves in the federal civil rights acts.
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"pay-for-performance"
An interesting idea Mr. Kristof. I was wondering how much op-ed columnists at the NYT make. According to "glass door" base pay for NYT journalists is $110,000. I can't imagine that senior journalists like you make the same.
But rating performance of journalists might be an interesting idea. How would one rate the performance of an op-ed columnist? Success in transferring to reality, i.e. influence? "LIkes" "recommendations" of columns? Peer review?
Your points re health care are well taken, but perhaps we should judge you on how effective your columns are re those points.
An interesting idea Mr. Kristof. I was wondering how much op-ed columnists at the NYT make. According to "glass door" base pay for NYT journalists is $110,000. I can't imagine that senior journalists like you make the same.
But rating performance of journalists might be an interesting idea. How would one rate the performance of an op-ed columnist? Success in transferring to reality, i.e. influence? "LIkes" "recommendations" of columns? Peer review?
Your points re health care are well taken, but perhaps we should judge you on how effective your columns are re those points.
1
Simple. If you don't like his columns, don't read them.
Hunter-gatherers living traditional lives in their clan social groups have NONE OF OUR "DISEASES OF CIVILIZATION". NONE. Numerous books have been written describing this health phenomenon, including those by Stefansson and Donnison, published in 1960 and 1938, respectively. Population density stress caused by our very recent "built" artificial environments, filled with stress inducing new technologies, our disrupted clan social groups, and estrangement from the natural environment, are the causes of ALL our ever increasing disease burdens. Our H-G ancestors 10,000 years ago were 6 million on earth, now we are 7.4 billion: 1233 times more. Welcome to our home-made "killing fields". Prevention is the answer to ALL our healthcare problems, which we choose not to face. Stress R Us
Nick, good idea but congress is not motivated by visible pay, instead they are driven by the murky gravy train they get on after their legislative career.
Case in point. In 2006, after Republican whip Billy Tauzin passed Medicare Part D that prevented the government from negotiating drug prices, he promptly quit to run the pharma lobby for $2 million per year.
We see this repeated today by the GOP in their new healthcare plan, where the clear goal is serving their primary constituents needs by reducing taxes for the well off and provide more profit opportunities for business through reduction of payouts to "losers" who can't hold a job. Health stats of the poor is not relevant to them.
I
Case in point. In 2006, after Republican whip Billy Tauzin passed Medicare Part D that prevented the government from negotiating drug prices, he promptly quit to run the pharma lobby for $2 million per year.
We see this repeated today by the GOP in their new healthcare plan, where the clear goal is serving their primary constituents needs by reducing taxes for the well off and provide more profit opportunities for business through reduction of payouts to "losers" who can't hold a job. Health stats of the poor is not relevant to them.
I
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I'd like Congress to try an experiment. They go buy their own insurance plans on their state exchanges. And use only that plan for say six months. Oh and only that member or their spouse can deal with the paperwork/calls/bills etc surrounding that insurance plan. Then come back to the table and honestly tell the country that healthcare is super duper fine and dandy. They are sheltered by their wealth, by their staffs and by their willful ignorance. Let them experience waiting 2 hours on hold with the insurance company only to be told you need to fill out a form and submit it to a department, and then maybe be considered for an exception to get a prescription filled. Or to navigate a hospital bill in which the lab costs somehow aren't covered because even though there are multiple labs at the hospital, oh gee, your insurance doesn't cover any of them. Or that doc who stopped in every morning to see you? Turns out he's out of network so you're on the hook for his whole fee.
None of these scenarios are the fault of the ACA/Obamacare. They are the fault of a poorly regulated industry and Congress doesn't notice or care because they get platinum coverage, and when there are issues they have the money and staff to sort it out.
None of these scenarios are the fault of the ACA/Obamacare. They are the fault of a poorly regulated industry and Congress doesn't notice or care because they get platinum coverage, and when there are issues they have the money and staff to sort it out.
2
Hear, hear. Term limits, lower salaries, no pensions, no health insurance, no perks and no lobbyists would perhaps attract real public servants to Congress, dedicated to serving the best interests of the American people as opposed to their own best interests topped by an insatiable desire to win re-election. Then maybe they will look around the world and discover what all other civilized countries discovered long ago: you cannot provide better and cheaper universal health care until you kick insurance companies out of the "business," stop calling sick people a "market" and institute a single-payer government run system that dictates costs and standards.
1
22 million fewer people having coverage in the USA as a result of Trumpcare, that's nearly population of Australia that would lose its universal health care. Even the staunchest conservatives or libertarians would not dream of touching our Medicare. And even the highest income earners would not suggest the system their taxes finance should be changed. Why the different attitude between the two countries? Could it be that American society has just become incredibly selfish and uncaring, not only to the rest of the world but especially to its members, and that's why such a system is reviled in the USA?
Nick, don't confuse the issues with logic.
1
I am still waiting for Congress to do what is right and good for all citizens to be the main focus of what they do. It's become all about money and cost. No wonder nothing works.
1
Then Congress would simply go to the Koch brothers' cookie jar.
In an oligarchy the "owners" call the shots.
In an oligarchy the "owners" call the shots.
Thank you. A blunt and bold analysis demonstrating why we should understand the Republican political philosophy reflects a narcissistic plutocratic neglect of the common good and the unique capabilities of governmental agency if not merely a passionate rationalized support for racism.
Has anyone ever heard of term limits?
I seriously doubt wealthy, fiscally conservative Americans want to "waste" tax dollars to provide viable education and humane health, dental and psychiatric care for the least advantaged among us. We long ago slipped our moral moorings, traded for promises of a shinning city on the hill. Never mind the city is gated.
3
You mean the Gated Cities on the San Francisco Peninsula, in LA, in The Hamptons, on Martha's. All those Gated Cities full of wealthy, fiscally progressive Globalists whose only contact with the Others is the landscaper, pool boy, au pair and plumber?
Forget the paychecks. Why don't all Americans get the same Healthcare plan ??? They must be really special, right????
1
I agree, Phyliss - I've said for the last several years that healthcare would look very different in the U.S. if members of Congress and their families had to use it too.
Your're not really for slashing thier pay? Why do you consider this absurd? On top of this is Rep Chaffetz asking for "housing subsidies" for these Many millionares because of high DC rentals?! Bah.
I think they should get a nice Congressional DORM where they can be housed when in session (which is barely a fraction of the real time folks spend in college Dorms per year) so that non-millionaires can run for seats and have a shot at that table (not trough) of government. Plus slash their wages & insurance benefits akin to something more realistic...not in keeping with the extravagant corporate CEO rates.
As you clearly and thoughtfully point out - "... we as taxpayers are getting cheated. Should we really be paying senators a base rate of $174,000 — Mitch McConnell as Senate majority leader gets more — to preside over such bad results?"
I think they should get a nice Congressional DORM where they can be housed when in session (which is barely a fraction of the real time folks spend in college Dorms per year) so that non-millionaires can run for seats and have a shot at that table (not trough) of government. Plus slash their wages & insurance benefits akin to something more realistic...not in keeping with the extravagant corporate CEO rates.
As you clearly and thoughtfully point out - "... we as taxpayers are getting cheated. Should we really be paying senators a base rate of $174,000 — Mitch McConnell as Senate majority leader gets more — to preside over such bad results?"
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Fire Congress and Take Away Their Benefits.
1
You can't force Americans to have good health care! That would be oppressive Big Government coercion. They would rather die than have anyone in government tell them how to care for themselves.
Finally some common sense in this sad debate. Few of our representatives have any scientific training, they often ignore blatant facts like this. Ideology and old mantras are the only things that matter in trump's United Republicans of Banana States.
While Congress is underworked and overpaid every American should have the right to same type of health care as Paul Ryan and Mitch McConnell.
Ryan has been on the government benefits welfare dole including health care ever since his father died when he was a teen. Ryan has perpetuated the myth that he is this deeply intellectual policy wonk.
McConnell has been on the governments welfare dole ever since he got health care despite a bout with polio. McConnell prances and preens and pretends to be the big bad Elephant Prince of political tactics of delay, defer and deny. But McConnell is the tiny mouse of strategic diabolical duplicity who can't get to any progressive yes.
We are all destined to die when, where and how we are supposed to with our universal pre-existing condition of a use-by mortality date.
Ryan has been on the government benefits welfare dole including health care ever since his father died when he was a teen. Ryan has perpetuated the myth that he is this deeply intellectual policy wonk.
McConnell has been on the governments welfare dole ever since he got health care despite a bout with polio. McConnell prances and preens and pretends to be the big bad Elephant Prince of political tactics of delay, defer and deny. But McConnell is the tiny mouse of strategic diabolical duplicity who can't get to any progressive yes.
We are all destined to die when, where and how we are supposed to with our universal pre-existing condition of a use-by mortality date.
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Another great column, thank you. Too bad you supported HRC, and not Senator Sanders.
1
You're living in the past, Nora. I take your point, but it isn't helpful.
Maybe we should require all senators and representatives to use the government plan. It would be interesting to see whether they'd choose Trumpcare or Obamacare.
3
Better yet, provide Congress with the same health care plan that they legislate for us through whatever "care" they pass. Perhaps that would make them think about those who have nonexistent to poor levels of care.
2
Right here is an argument that all the Senators and Representatives who really want to do something should be making. Hammering away every day. The same way the right wingers do when they want start a war with Iraq, or promote this insane tax cut health care bill. Or demonize Iran. They are out there constantly until people don't know up from down. Thank you Mr Kristof because these are facts that can not be disputed. And all the things that are spoke of here, among many others, is the truth that every American should know. Do you hear me Schumer, Pelosi, and almost all of you Democrats? The time is now. Nothing else will work when it comes to health care. No more insurance for profit.... Medicare For All.... The only discussion should be how fast to phase it in and how to finance it with the least amount of pain. It really is shameful to read these numbers on early child care.
Orange, NJ
Orange, NJ
3
The pay rate is outrageous but the truly outrageous piece is the cadillac health care they receive personally, while rallying to lower the health care that is delivered to their constituents. Maybe if congress members health care was tied to what the average American can afford, we'd see some action.
227
I think all of our representatives should get paid an average of what their constituents earn, from the state’s reps to the federal. Think of how this would help the people. And the more qualified representatives, those who cared about the people, would increase their own wage as they benefit others.
Their bill is not about health care but about a huge tax cut for their masters. Citizens United has made the party of Lincoln the party of big money.
Congressionals receive full pension on retiring age 62 with minimum 5 yrs service; 50 year olds can retire after 20 yrs service, or they can retire at any age after 25 years service. What an insult to every American struggling to save for retirement.
Interesting that during the debate on the ACA the fake news of the day was that it created "death panels".
Today 50 senators and one vice president will likely be the supreme death panel. This group will delegate their ongoing responsibility to the state legislatures to carry out the duties. To emphasize the mission, the states will be given minimal associated funding.
Where is all the outrage at this from those formerly so alert to governmental insensitivity?
Today 50 senators and one vice president will likely be the supreme death panel. This group will delegate their ongoing responsibility to the state legislatures to carry out the duties. To emphasize the mission, the states will be given minimal associated funding.
Where is all the outrage at this from those formerly so alert to governmental insensitivity?
Universal , single payer, would make our business and industry more competitive, when relieved of the burden of health care. Yes we would need to pay more taxes but there would be a net gain as real costs go down. And the real gain would be better care.
Women in particular would be big winners as we know they are being short changed now.
Women in particular would be big winners as we know they are being short changed now.
9
Nick - Thanks so much for the reminder about how little health Americans get for what they pay. I can't help but think of the psychological ramifications. While not quite the traveler that you are, I have frequent interactions with citizens of nations that have single-payer systems, and one thing that is remarkable is how little they worry about their ability to get care or to pay for it. In this way, they have much more freedom than Americans who, until their Medicare years, are constantly burdened by worry about not only their health but how to obtain care, even if they are well-insured, and how to pay for it. Dealing with the complexities of insurance and billing can be worrisome even for those who are exceptionally well-covered. It is looking like Congress will do nothing to minimize complexity, worry or cost, even though it is clear that they intend to minimize Americans' health.
8
Sad our Profit motive determines how health care is provided. when a CEO of an insurance company makes 100mil a year it is a death tax. that is the reality. we all get sick, we all die. Must a small group skim the life out of people in the name of profit. Bring on the single payer option. keep the ACA mandate for 80 % of premiums must go to patient care, not profit. What a thought- and oh Congressman and women should only get what the lowest level of care provides; not the best on the peoples dime.
1
whether one is insured or not when he/she needs he/she should get health care. I do not mean those high end diagnostics heart surgery etc but at least minor ailments care.
Last time I was in USA I had some fever with sneezing cough. I went to nearest hospital's clinic( No name can be typed here) They ask me have you got appointment "No, but give me the same now. No you have to phone or through internet please. ut some paramedic might have thought something are you insured- " No i pay cash , I may get or not from my insurers but I am miserable please treat me" He referred something on his computer and said we can accommodate you by next week. Well I shall get cured by that time without your treatment. Went to pharmacy purchased OTC Tylenol Luckily I was cured.
Years back I was in Saudi( yes those were not bomb and terrorist days) Due to some insect bite or whatever that may be on both legs i started getting reddish patches. My friend drove me to nearest govt clinic( It was actually SCECO 's clinic. He talks something in Arabic with security we are inside, I show it to paramedic without any word he applies some medicines what a relief then he questions me, That is what is called emergency treament
Last time I was in USA I had some fever with sneezing cough. I went to nearest hospital's clinic( No name can be typed here) They ask me have you got appointment "No, but give me the same now. No you have to phone or through internet please. ut some paramedic might have thought something are you insured- " No i pay cash , I may get or not from my insurers but I am miserable please treat me" He referred something on his computer and said we can accommodate you by next week. Well I shall get cured by that time without your treatment. Went to pharmacy purchased OTC Tylenol Luckily I was cured.
Years back I was in Saudi( yes those were not bomb and terrorist days) Due to some insect bite or whatever that may be on both legs i started getting reddish patches. My friend drove me to nearest govt clinic( It was actually SCECO 's clinic. He talks something in Arabic with security we are inside, I show it to paramedic without any word he applies some medicines what a relief then he questions me, That is what is called emergency treament
If congressmen were paid on performance they would all be on welfare.
7
They are on welfare.
Here's the thing Americans: your problem is much larger than just health care; it stems from a fundamental flaw in your socio-political assumptions.
Let's contrast with Canada as the closest and best example.
It's not your politicians' fault there is widespread resistance to it, it's part of your ethos: Americans suffer from the widely held belief that universal health care is socialistic and that anything socialistic is bad.
In fact, contributing together into a common pot to provide for all citizens' needs is the only way to achieve a just and civilized society. You want good roads? Pay taxes and maintain roads. You want good public transit? Pay taxes and build good public transit. You want a healthy environment, safe drinking water and air you can breathe? Empower government to enact and enforce environmental protections. You believe that all citizens deserve the same basic access to health care as a human right? Contribute to a single-payer system.
It's bizarre to we Canadians for the most part, but you seem to be labouring under the misconception that working together is akin to removing the right to own property. It's not communism guys, it's just cooperating.
Work towards a common good instead of personal profit and everything else falls into place. It's really not that difficult.
Let's contrast with Canada as the closest and best example.
It's not your politicians' fault there is widespread resistance to it, it's part of your ethos: Americans suffer from the widely held belief that universal health care is socialistic and that anything socialistic is bad.
In fact, contributing together into a common pot to provide for all citizens' needs is the only way to achieve a just and civilized society. You want good roads? Pay taxes and maintain roads. You want good public transit? Pay taxes and build good public transit. You want a healthy environment, safe drinking water and air you can breathe? Empower government to enact and enforce environmental protections. You believe that all citizens deserve the same basic access to health care as a human right? Contribute to a single-payer system.
It's bizarre to we Canadians for the most part, but you seem to be labouring under the misconception that working together is akin to removing the right to own property. It's not communism guys, it's just cooperating.
Work towards a common good instead of personal profit and everything else falls into place. It's really not that difficult.
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I agree with my fellow Canadian. The reason why the USA does not have health care for all its citizens is due in large part to the over riding ethos in the USA as compared to other countries - the ethos of "me, me, me". I lived and worked in NYC for eleven years and as much as I loved being in the Big Apple I did not like living in the USA. It always seemed to me that in the USA everybody is out for themselves first and foremost. This allegiance to the ethos of the individual over the good of the whole has made your country one of the least socially progressive societies in the Western world.
1
The American ethos, and particularly the Republican Party ethos, exalts individualism, such a degree that cooperation is becoming impossible.
Under the current price structure for health care costs in the US there is no way single payer medicare for all could make it. Cost per person would likely exceed the average $10,000 per person. In the other industrialized countries the costs of drugs, hospital stays, doctors visits and insurance are all regulated by the governments so that single payer can work. If the US does not do this, of course single payer will always fail and the GOP can crunch the numbers to prove it. All branches of the health care monster in this country must be regulated for single payer to succeed. This will likely never happen since congress is controlled by the biomedical-pharma-industrial complex.
7
You're misinformed.
In Canada, drugs for most people aren't covered under the provinces' health care plans (health care is nationally mandated but provincially administered) so it's up to individuals to pay or to have private insurance in place. Hospital stays and doctors; visits are not regulated by governments at all – if you think you're sick, you go to a doctor, whether that's your family doctor, a walk-in clinic or a hospital: no charge, no questions.
What could be described as being "regulated" is the use of diagnostics: Canadian doctors probably make use of expensive diagnostic equipment less than their American counterparts. A big part of the reason for this, of course, is because when a patient has private insurance the impetus will be towards using it. Why not use the fanciest test if you're paying fore coverage anyway?
Which brings us to why per capita healthcare costs are so much higher in the US: it's not because of regulation or a paucity of care, it's because of an overuse of unnecessary diagnostic testing. Also, US doctors do make more than Canadian doctors which is probably why the AMA has usually fought universal healthcare.
In Canada, drugs for most people aren't covered under the provinces' health care plans (health care is nationally mandated but provincially administered) so it's up to individuals to pay or to have private insurance in place. Hospital stays and doctors; visits are not regulated by governments at all – if you think you're sick, you go to a doctor, whether that's your family doctor, a walk-in clinic or a hospital: no charge, no questions.
What could be described as being "regulated" is the use of diagnostics: Canadian doctors probably make use of expensive diagnostic equipment less than their American counterparts. A big part of the reason for this, of course, is because when a patient has private insurance the impetus will be towards using it. Why not use the fanciest test if you're paying fore coverage anyway?
Which brings us to why per capita healthcare costs are so much higher in the US: it's not because of regulation or a paucity of care, it's because of an overuse of unnecessary diagnostic testing. Also, US doctors do make more than Canadian doctors which is probably why the AMA has usually fought universal healthcare.
4
Good idea Kristof. But you need to take this idea further.
Tie Congressional pay to crime rates and the quality of schools.
That'll make things interesting.
You could also hold Congress accountable for negative actions that occur as a result of their actions.
Fund a low income housing project? You are accountable for any increase or decrease in crime.
Excellent idea there Kristof.
Tie Congressional pay to crime rates and the quality of schools.
That'll make things interesting.
You could also hold Congress accountable for negative actions that occur as a result of their actions.
Fund a low income housing project? You are accountable for any increase or decrease in crime.
Excellent idea there Kristof.
8
We would have had health care for all 50 years ago if it had not been for the Republican Party.
13
50 years ago we wouldn't have had that little problem in SE Asia if it weren't for the Democratic Party. You know, the Party that gave us Jim Crow laws. The Party that fought desegregation.
It used to be a military tradition for an Officer to not eat until his men had been fed. That hallowed tradition inspired incredible respect and loyalty. Perhaps if we did not offer the best medical care to Congress until the least of us had full access, it would be better for the Nation.
After all, if I had the choice of seeing the money go to a treatment for a family member or the Senate Majority Leader, I would easily choose to save a grandchild. At least there would be the hope that the child could eventually be a credit to humanity.
After all, if I had the choice of seeing the money go to a treatment for a family member or the Senate Majority Leader, I would easily choose to save a grandchild. At least there would be the hope that the child could eventually be a credit to humanity.
16
Nick,
I enjoy your well-reasoned comments, but they will fall on deaf ears in Washington until we have a major health crisis that affects ALL. As a small business owner, I spend for a family of 5 about $36,000 a year (deductible included) on health care - and, Lordy, that is a high percentage of my net revenue. I would rather have Medicare for all, simply because it would be so much simpler and I wouldn't have to deal with insurance for employees. I think that health care for all actually would drive economic growth because it would free small business owners such as myself to hire more folks without worrying about how that "extra person in the group" would affect he company health plan's costs. Plus, there are a lot of would be entrepreneurs who would gladly leave their jobs to start something new except that "they need the health benefits."
I enjoy your well-reasoned comments, but they will fall on deaf ears in Washington until we have a major health crisis that affects ALL. As a small business owner, I spend for a family of 5 about $36,000 a year (deductible included) on health care - and, Lordy, that is a high percentage of my net revenue. I would rather have Medicare for all, simply because it would be so much simpler and I wouldn't have to deal with insurance for employees. I think that health care for all actually would drive economic growth because it would free small business owners such as myself to hire more folks without worrying about how that "extra person in the group" would affect he company health plan's costs. Plus, there are a lot of would be entrepreneurs who would gladly leave their jobs to start something new except that "they need the health benefits."
20
You have to go one layer below the $10,000 cost per person to understand the true problem underlying our health care "system": every care provider and insurer is in the system for profit. Countries which contain costs control payments to providers; doctors are employees, not entrepreneurs. Since there are so many financially interested stakeholders effective reform is nearly impossible to achieve. Only a meltdown or near collapse of our economy because of runaway costs will bring change. Maybe if the Republicans achieve their tax cut at the expense of the health and well being of tens of millions, a popular uprising can force change before the healthpocalypse. But I am not putting my money on it. The poorest Americans have lived with equally low expectations and fear losing what they have. Don't expect an American Revolution over inadequate health care. The GOP is putting their money on that.
11
Michigan Blue Cross Blue Shield is a non-profit organization. They work for a paycheck. Which would probably go away for most of their employees is we went to a single payer system.
We talk about Medicare for all as a solution to our problems with health care. But we used Medicaid in the Affordable Care Act to address problems of lack of insurance for our most serious problems. Medicaid includes medicines, office visits, hospitalizations, nursing home care, etc. It would be an improvement over Medicare for all under certain circumstances.
Firstly, let's federalize Medicaid rather than leave it a state program. Then, let's set up a tax-funded system like social security to fund the new Medicaid program. Let's include everybody in the country in this national Medicaid system. Than, let our society, through our elected representatives, decide what health care services this new Medicaid will pay for. Let there be a market in Medicaid supplementary insurance as we now have for Medicare supplementary insurance.
This program will give us a medical safety net that includes everybody. It will be what our society, through its political process, decides every person, because each is human, gets what we think each person should get and what we are willing to pay for.
An objection may be that this would establish a two class medical care system. The importance of this objection depends on how restrictive or inclusive the Medicaid benefits are. This objection also ignores that no one is left out. This safety net includes everybody. There is no class of no care at all as we have now.
Firstly, let's federalize Medicaid rather than leave it a state program. Then, let's set up a tax-funded system like social security to fund the new Medicaid program. Let's include everybody in the country in this national Medicaid system. Than, let our society, through our elected representatives, decide what health care services this new Medicaid will pay for. Let there be a market in Medicaid supplementary insurance as we now have for Medicare supplementary insurance.
This program will give us a medical safety net that includes everybody. It will be what our society, through its political process, decides every person, because each is human, gets what we think each person should get and what we are willing to pay for.
An objection may be that this would establish a two class medical care system. The importance of this objection depends on how restrictive or inclusive the Medicaid benefits are. This objection also ignores that no one is left out. This safety net includes everybody. There is no class of no care at all as we have now.
6
Members of congress should be drug tested before they receive any benefits and their salaries should be changed to hourly work with a time clock. Representatives should receive the same healthcare that their states provide to their own citizens. There should be no federal stipend for living spaces. Each individual state should provide housing for their representatives and senators, in the same way that foreign countries have permanent embassies. Each state could buy houses or condos that their reps can use while in office and pay rent to the state.
62
Wow Jim, what a bunch of good ideas!
Jim--I'm for hourly wages for Congress, given how little work they actually do, and how much they suck from the government teat. They can hardly wait to take their 1 week vacation, in July, followed by their 4 week vacation, in August. Almost any hourly worker works harder than almost any Congressperson. Only trump takes more vacations or spends more of our money on their own entertainment, and leisure.
excellent! I'd vote for that!
Canadian members of parliament deal with complaints about the Canadian healthcare system constantly. During "town halls" or other public gatherings, questions and issues concerning the delivery of medical services are the most frequent.
That will happen to congressmen and women in the United States if the US Government is responsible for healthcare. Other public policy; infrastructure, criminal justice, defense, immigration reform or the economy will become secondary to healthcare. The public must understand that healthcare is not a "right." The only justifiable intervention in healthcare for the general public is for minor children who lack medical care because of incapacitated or incompetent parents. Adults without disabilities should be responsible for their own medical care.
That will happen to congressmen and women in the United States if the US Government is responsible for healthcare. Other public policy; infrastructure, criminal justice, defense, immigration reform or the economy will become secondary to healthcare. The public must understand that healthcare is not a "right." The only justifiable intervention in healthcare for the general public is for minor children who lack medical care because of incapacitated or incompetent parents. Adults without disabilities should be responsible for their own medical care.
1
Other countries' single-payer health care systems may not be perfect, but I sure don't see ANY of their citizens clamoring for US style insurance.
9
I'm not quite sure why you are upset about health care being the number one topic at "town hall" meetings, Health is our most basic consideration. And the issues that you see as being crowded out are of less urgency than in the US. Our justice system is not perfect but we do not have the off-the-charts incarceration rates of the US. Immigration is not really a hot topic because most Canadians realize that we need a steady inflow flow of skilled workers. And both the federal and provincial governments are heavily invested in infrastructure programs. As Nick points out, the rest of the industrialized world has managed to set up public health programs that allow citizens to live without fear of going bankrupt through illness. One day, I hope, the US will figure this out.
12
I once worked near the border and had many hiking and climbing adventures with my Canadian friends and colleagues. Even when we were in the mountains on the American side, they would always remind me that if something bad happens, to make sure that the emergency responders get them into the Canadian care system as quickly as possible.
2
HEALTH CARE Performance IS related to GOP Congressional salaries. The more they give the 1% in tax breaks and the more lives lost by the 99% (especially infants and new mothers), along with lives lost or shortened for other reasons, the more US Congressional salaries rise. I guess when they talk about the rising tide lifting all the boats on the shore, the GOP is referring to the Ship of State. The rest of us working outside of Congress are consigned to recycled rafts that carry refugees fleeing Africa to go to Europe. The only place where US citizens show dramatic increases in wellness are those who receive Medicare, a single payer system. Meanwhile, I think we out to put the GOP members in Congress on a salary diet, giving them the approximately $3,200 paid to members of Congress in Poland who produce far better results. It's only logical. Maybe if the US Members of Congress get the same salary as their Polish counterparts, the rest of us will get levels of healthcare that are the same as those of Poland.
13
How many days do Poland's legislators spend a year in Warsaw? My guess is: more than America's senators and representatives spend in Washington. If workdays are the standard by which we measure productivity, our legislators still come up short on positive results. In fact, the more they are there, the less they get done, and the more damage they cause with what they have "accomplished."
I'm not suggesting they cut their workload back. Far from it. I would lobby for our "leaders" to have to live in the same wooden barracks I and millions of my fellow veterans endured during the '40's, '50's and '60's. They should be subject to the same rigorous schedule of work that an Army Private E-1 endured, and held to the same standards of accomplishment. Pay for performance? That was called a promotion. The move from E-1 to E-2 was automatic, a function of time in service. After that, and the higher you went, the more it depended on performance and potential. By those standards, Mitch "Yertle the Turtle" McConnell would be on permanent KP.
I'm not suggesting they cut their workload back. Far from it. I would lobby for our "leaders" to have to live in the same wooden barracks I and millions of my fellow veterans endured during the '40's, '50's and '60's. They should be subject to the same rigorous schedule of work that an Army Private E-1 endured, and held to the same standards of accomplishment. Pay for performance? That was called a promotion. The move from E-1 to E-2 was automatic, a function of time in service. After that, and the higher you went, the more it depended on performance and potential. By those standards, Mitch "Yertle the Turtle" McConnell would be on permanent KP.
4
Given the circumstances outlined by Mr. Kristoff examples how our system of federal government isn't working: By the few, for the lesser-many.
The State of California, by comparison, appears to have figured out a lot.
The State of California, by comparison, appears to have figured out a lot.
7
Oh Mr. Kristoff, you don't think Congressmen and Senators are in it for the pay? Such trivial amounts, they would never care if you made it pay for performance. They live off the prospects of lucrative lobbying jobs and perks of fantastic trips, dinners and entertainment, not to mention toadying oligarchs. And the illusion that they are somehow powerful.
The way to get them to pay attention to healthcare is to make our coverage their coverage as well, and forbid donations to cover unexpected costs. By the way, how is Representative Scalise covering the hundreds of thousands of dollars of health care costs incurred as a result of his shooting? I bet he'll hit the $1 million lifetime cap as a result of this horrendous incident. No more for him after that. I assume that none of the costs will come out of his pocket. Why should the American public be treated differently? If you take Republican arguments for less health care at face value, over the entire course of our history and the numerous congressmen who have served, how many have incurred drastic medical costs? Very few. (although now the mentally ill can buy assault weapons. But congress now wants federal funds to pay for enhanced security, so they should be okay.) So why should we provide health insurance for congress at all, since most of them won't need it? Go figure.
The way to get them to pay attention to healthcare is to make our coverage their coverage as well, and forbid donations to cover unexpected costs. By the way, how is Representative Scalise covering the hundreds of thousands of dollars of health care costs incurred as a result of his shooting? I bet he'll hit the $1 million lifetime cap as a result of this horrendous incident. No more for him after that. I assume that none of the costs will come out of his pocket. Why should the American public be treated differently? If you take Republican arguments for less health care at face value, over the entire course of our history and the numerous congressmen who have served, how many have incurred drastic medical costs? Very few. (although now the mentally ill can buy assault weapons. But congress now wants federal funds to pay for enhanced security, so they should be okay.) So why should we provide health insurance for congress at all, since most of them won't need it? Go figure.
8
'Make our coverage their coverage as well.' That should be part of the embarrassing health-care mandate. If the big egos in DC had to subsist like the common man, maybe they'd wise up and go to single payer.
We have a near monopolistic gatekeeper between demand (those needing health care) and supply (Heath services). These for profit companies are mandated by law to maximize their profits without regard to our health. Until the ACA these insurance companies could have 30% overhead, now 20%, while Medicare has 2-5% overhead.
11
Given our global leading GDP and our ranking as the lone superpower in the world, there is a tendency to believe we are the best at everything. However, there are many areas where we are not close to a world leader and our reluctance to learn from others inhibits our improvement. As Nicholas points out we are far from a world leader in medical care despite having some of the best hospitals and surgeons in the entire world.
A hallmark of any first world country is that it is able to look after its sick. And we fail that test. Let's learn from our best friends and allies like Great Britain, Canada, France, Australia and Germany. They all do a much better job and at significantly lower cost than America. Are we too proud to learn from those who are better than us?
A hallmark of any first world country is that it is able to look after its sick. And we fail that test. Let's learn from our best friends and allies like Great Britain, Canada, France, Australia and Germany. They all do a much better job and at significantly lower cost than America. Are we too proud to learn from those who are better than us?
9
"The basic problem is that we’re spending almost $10,000 per person per year on health care, and somebody has to pay for it or else we ration care and people die."
This is a point that I do not see made enough. Too often, the right gets away with claiming rationing in single-payer systems as a reason for not going that route without ever noting the rationing inherent in our pay-to-play insurance system. Pricing people out of insurance, and therefore care, IS rationing.
This is a point that I do not see made enough. Too often, the right gets away with claiming rationing in single-payer systems as a reason for not going that route without ever noting the rationing inherent in our pay-to-play insurance system. Pricing people out of insurance, and therefore care, IS rationing.
13
Is it so expensive because they have built an industry around such and the way to pay them and keep it going is by making and keeping us all sick? And the team of doctors comes in, and respiratory, and radiology, and lab --- it's quite an industry, and they'll dry up without returning customers? An no one is healthier for the fact. And insurance skims off what they can. Someone has to start protecting the consumer. Our healthcare and well-being has been turned into a monster.
Chris,
Your last sentence is not that far from giving us the solution to the problem!
Instead of, as you say:
" Pricing people out of insurance, and therefore care, IS rationing."
America should follow this line of thinking:
Prising Insurance out of (health) care people, IS rational!
Eureka! I think that's it!
Your last sentence is not that far from giving us the solution to the problem!
Instead of, as you say:
" Pricing people out of insurance, and therefore care, IS rationing."
America should follow this line of thinking:
Prising Insurance out of (health) care people, IS rational!
Eureka! I think that's it!
I'm about to be unemployed thanks to Trump. I'm 58, single and female. I've made over the meager amount a single person is allowed to make to be eligible for subsidies on the ACA, at least in NY. I will not be able to afford an insurance policy. I fail to see the point in wasting my money on a policy that asks me (or anyone else for that matter) to pay an insurance company a monthly premium , deductibles, co-pays, out of narrow network fees, to switch doctors if mine aren't on the list, to tolerate claim denials as part of the process of getting health care, and that can change anything it wants while I'm stuck with it for an entire year.
What we have in America is not a health care system. It's a wealth care system that both parties have catered to. It's time that everyone in Congress and the cabinet but the president and vice president have to live with the choices they force upon us every day: pay monthly premiums, meet yearly deductibles, deal with unresponsive insurance companies, claim denials, no continuity of care, high co-pays, etc. And they should have to do it on salaries that do not keep pace with the rate of inflation and are not covering the actual costs of living.
My decision is clear. Like other Americans who have made enough to be ineligible for subsidies, I will have to risk going without insurance. I cannot stay afloat, pay my bills, pay a monthly premium, and survive. And at the age of 58 I can't count on finding a decent job.
What we have in America is not a health care system. It's a wealth care system that both parties have catered to. It's time that everyone in Congress and the cabinet but the president and vice president have to live with the choices they force upon us every day: pay monthly premiums, meet yearly deductibles, deal with unresponsive insurance companies, claim denials, no continuity of care, high co-pays, etc. And they should have to do it on salaries that do not keep pace with the rate of inflation and are not covering the actual costs of living.
My decision is clear. Like other Americans who have made enough to be ineligible for subsidies, I will have to risk going without insurance. I cannot stay afloat, pay my bills, pay a monthly premium, and survive. And at the age of 58 I can't count on finding a decent job.
93
I feel your pain- also 58, single, out of work and having a hard time finding a job. No one wants to take on such a person because we are too expensive to insure. But for now, I am fortunate because I live in a Medicaid expansion state. I have enrolled and it is wonderful coverage and I feel so very lucky to be able to get care for a chronic illness. I send you my best hope you will get Medicaid too (until the Repubs take it away...)
1
When I was very young, I realized the importance of having good health insurance from my mother, who had been a stay-at-home mom and returned to work in her 40s. Her job offered better insurance than my father's, and it helped them even in retirement (actually it saved them, I believe). I have always had insurance and took jobs that were not always the perfect fit, to ensure my own kids and husband were also protected (his jobs always offered insurance but here was a brief period when he was laid off and didn't have it). My question about single payer is, could our country ever agree on what it would cover and what it would not cover? That is, will it cover fertility treatments, reconstructive surgeries, etc. Or would it cover just the very basic, life-saving measures and preventive care, such as vaccinations? With debates raging about contraception, could we get agreement on that topic as well? I'm hopeful we could come together, but not convinced.
5
Most of the rest of the world handles this by providing basic and some not-so-basic services as part of national health insurance. If you want more, either you get a supplementary insurance package or you pay out of pocket. In London, for instance, "Harley Street" is synonymous with private practice doctors treating things the NHS does not cover.
Why in the world would anyone think the government can provide health care more efficiently? Nothing the government does is efficient. Nothing. Also, if single payer health care becomes a new entitlement, where does the money come from to pay for it? The nation can barely afford the entitlements we have.
1
So why is Govt in charge of the military? Let's privatize that completely. Maybe that will void wanton defense spending and wars?
13
Did you not read the article? We pay $10,000 per person per year on health insurance while in Poland it's just $1,680. Universal insurance would SAVE money.
8
Nope, we can't afford the entitlements dedicated to the military industrial complex, a stream of constant wars, more spending on arms than all other countries on the planet, a cycle of destroy and rebuild (ask the contractors who swoop in after the bombs to secure the reconstruction contracts about "entitlements"). Nope, no more entitlements to large ag operations, to prop up overproduction of cotton and corn and other commodities. Let the market decide the price, right? No? Hmm. Maybe, just maybe if we got the insurance companies out of the business of health care, it would be more like health care and less about the bottom line. Medicare (government run) has been the best thing to happen to me in years. Or, for another example, how about expanding the military health care model to everyone? It worked for me in my younger years. It would be far better than the mess we have now.
2
Universal Healthcare is not a panacea, and it is far from perfect. Live in Canada... need a knee replacement? Well good luck, line is 14 months long.
If you want a home grown example, look at the VA. We horribly fail our veterans everyday due to the pitfalls of universal care.
For profit healthcare has its flaws as well, but we live in a country that believes capitalism is a foundation to improvement, that financial freedom and incentives free of government interference drives innovation; take that away, well, you will just have to wait in line like everyone else in the world.
If you want a home grown example, look at the VA. We horribly fail our veterans everyday due to the pitfalls of universal care.
For profit healthcare has its flaws as well, but we live in a country that believes capitalism is a foundation to improvement, that financial freedom and incentives free of government interference drives innovation; take that away, well, you will just have to wait in line like everyone else in the world.
1
I'd rather wait in a 14-month line than not be able to get a knee replacement at all.
8
Well Jeremy, if what you say is so, then Nordic countries, Canada and many others should have failing health care-and they don't, contrary to your assertions. The failing is here, not there.
7
I'm a vet and benefit from VA healthcare. It is a myth that the VA is "horrible". That scenario is spread by those who are against any form of universal health care and want to buttress their case. Most vets recognize the VA as indispensable to their well being. Yes, it's not perfect, and, horrors, sometimes you wait for service, but if most Americans could enjoy the level of care that the VA offers they would march on congress to make it happen.
8
I propose that Congress gets the exact same health care plan as they legislate for "THE PEOPLE". Not one iota different. Not able to keep the safety net they vote for themselves. Exactly the same. See how fast they change their minds about what WE need.
100
It is now time for the Democrats in Congress to step up and fill the void and advocate for a single payer-insurance for all. They need to be all over the news and talk shows advocating for this. This column is more than enough evidence that our present system is a failure. I am speaking as a physician.
83
NIce idea. Problem is many (most?) of them don't see the salary as their main long-term source of income. Many are already wealthy when the enter the Senate. Others are looking to lucrative careers when they leave as lobbyists, think tank mouth pieces, public speakers, or consultants for industries related to committees on which they are currently serving. Reducing the tax burden on the wealthy is far more important to them, since they are either current members of that class, or aspire to be in the near future.
18
A single payer health care system would improve the health of Americans, too bad Obama and the Democrats refused to consider that option, and still do except for Sanders and the progressive left. Time to catch up with the rest of the world and provide Medicare for all.
13
Obama and the Democrats DID consider that option, at least partially, with the "public option" as part of the exchanges. It was torpedoed by the Republicans, and the Medicaid expansion requirement was later torpedoed by them and their supreme court. The Republicans torpedoed healthcare reform when Clinton was president, they torpedoed it again when Obama was president. When Reagan, Bush & Bush were president they ignored it, and now that Trump is in the WH they are nuking it. Put the blame where blame belongs - on Republican elected officials and the deluded masses who vote for them.
Universal Health Care is the way to go. Health should not be for profit. If it is managed by the government with the idea that our citizens should be able to expect the best health care in the world because as a nation we have the know how and the economic capability many of our difficulties could be addressed such as obesity, depression, other mental illnesses, addictions etc. To lower costs there would be attention given to healthy activities, prevention, monitoring of Child health, research for cures rather than emphasis on treating symptoms and to be sure there is the attention we deserve from health practitioners those who study to be our future doctors and nurses could be provided free schooling. It would cost a fraction of what we pay today. It would be better than what we have today. Let's support representatives that will really represent us and our concerns rather than corporate donors.
12
The reason that politicians want to privatize the government is that they imagine themselves as the CEOs of the country, deserving of all the perks of C-level executives. The healthcare crisis could be resolved quickly if members of Congress used public health services such as Medicaid or (if applicable) VA services.
13
This is a great idea. Politicians should be forced to utilize the VA system. Guarantee the VA would get a quick revamp to better serve our vets.
Maybe we should layout the case for improving healthcare in clearly objective terms. We already spend plenty for healthcare. We don't need to spend more, we just need to spend it in the right places. We could raise taxes to pay for it as long as most of those paying received compensating benefits. We currently spend over 3 trillion on healthcare. The government already over 40 per cent of Americans for about 1 trillion. Expanding that to all should cost less than 3 trillion. We just need to find a way to do it.
We also need to understand that health insurance isn't really like other insurance. Some people can't afford their healthcare. Everyone needs to be in the pool somehow.
We also need to understand that health insurance isn't really like other insurance. Some people can't afford their healthcare. Everyone needs to be in the pool somehow.
11
The number without health insurance as estimated by the CBO is 22 million less than under the ACA. The absolute number of uninsured however is 50 million.
This is the real number that has to be addressed and the number that should be mentioned in every conversation.
This is 15-20% of the US population.
What is our point of disgust at our politicians? When do they start to care about their constituents and not just their funders?
This is the real number that has to be addressed and the number that should be mentioned in every conversation.
This is 15-20% of the US population.
What is our point of disgust at our politicians? When do they start to care about their constituents and not just their funders?
10
Until there is a clear consensus as to the basic question of whether or not -- in the richest country the world has ever known -- citizens have a right to expect health care, we will just go round and round on the so-called "healthcare bill".
12
While you are at it...you might want to hope to expect a few other bit's and bob's as the richest country the world has ever known that many other nations long ago saw were a benefit and uplifting societal advances that helped more people and the nation prosper more and better by them.
Paid Sick Leave.
Paid Maternity Leave
4 Weeks Paid Holiday Leave
Health for Care , not Wealth not Share
People before Profits, Steeples and Prophets
More Equality and less Inequity.
Charity before Depravity
Help not Welts.
Unity not Annuities
Show less Greed, Follow fewer Creeds, Make more Freed
Pursue Happiness for All, so it has nowhere to hide.
In fact, if most people in all the other countries in the world were to ascribe to the the bulk of those suggestions above, it would go a long way to help make in all the ways it would, the world the richest world the world has ever known!
Paid Sick Leave.
Paid Maternity Leave
4 Weeks Paid Holiday Leave
Health for Care , not Wealth not Share
People before Profits, Steeples and Prophets
More Equality and less Inequity.
Charity before Depravity
Help not Welts.
Unity not Annuities
Show less Greed, Follow fewer Creeds, Make more Freed
Pursue Happiness for All, so it has nowhere to hide.
In fact, if most people in all the other countries in the world were to ascribe to the the bulk of those suggestions above, it would go a long way to help make in all the ways it would, the world the richest world the world has ever known!
3
Large observation studies consistently suggest that "medical care", i.e. hospitals, physicians, devices and drugs account for only about 10-15 % of any population's health, wellbeing and life longevity. About 10 % is genetic and the other 80% comes from non-medical socioeconomic factors such as levels of financial security, education, clean air, water, food safety, housing and personal lifestyle decisions. The Trump Administration is doing its best to decimate these socioeconomic conditions in America, so don't expect any improvement in our heath statistics anytime soon.
13
I read somewhere that Jason Chaffetz wanted a $2500/month living stipend. Heck, Mr. Chaffetz, so do I.
I'd be behind pay performance, if we had reasonable goals. But our goals have not been reasonable. "Shrink government until you can drown it in a bathtub" may not be the one we want to anchor pay on.
The GOP would give itself a raise based on the performance of the House and Senate. They are drowning healthcare in the bathtub. Actually making the nation healthier is not their goal.
As for comparisons to other nations? We don't have to do that. We are Americans. We have all the good ideas, and all the right answers. When you are as exceptional as we are, why even bother with benchmarks?
I'd be behind pay performance, if we had reasonable goals. But our goals have not been reasonable. "Shrink government until you can drown it in a bathtub" may not be the one we want to anchor pay on.
The GOP would give itself a raise based on the performance of the House and Senate. They are drowning healthcare in the bathtub. Actually making the nation healthier is not their goal.
As for comparisons to other nations? We don't have to do that. We are Americans. We have all the good ideas, and all the right answers. When you are as exceptional as we are, why even bother with benchmarks?
9
I'm all for performance metrics for Congress. Great idea.
9
I nominate Mr. Kristof for Health and Human Services Secretary!
A better solution would be to provide housing for Congress in D.C. nursing homes.
Chaffetz tells us apartments are unaffordable, and that members need a $30,000 stipend.
Okay.
That would provide for about 5 months in a low cost nursing home - $6,000 a month. After that, throw them out on the streets.
Treat them exactly the way they plan to treat Americans.
Kick them to the curb.
Chaffetz tells us apartments are unaffordable, and that members need a $30,000 stipend.
Okay.
That would provide for about 5 months in a low cost nursing home - $6,000 a month. After that, throw them out on the streets.
Treat them exactly the way they plan to treat Americans.
Kick them to the curb.
77
Make that a for profit nursing home.
I forgot which one of these overpaid members of Congress recently put forth the idea that members of Congress should also get a housing allowance for having to live in DC, but I think it speaks volumes as to their own belief that they are underpaid, which is ridiculous considering how little they get done and how what they are trying to get done would cause great harm to many of our citizens. Citizens United needs to be overturned, constituencies need to wake up and stop rewarding the most callous and least intelligent among them (Ryan in particular) with more terms.
You say: "American women are four times as likely to die in pregnancy and childbirth as Polish women,.." but you do not mention that statistics in Poland are incomplete and do not collect information on all maternal deaths.
You say: " American babies are one-third more likely to die in their first year of life than Polish children.." The same applies here. Datas from Poland again are incomplete, plus they do not even count as "babies" the very small newborns that we save here on a regular basis. In Poland these die much more often are not even counted as "births". Plus, there is a big difference between neonatal (first 28 days) and child (first year) mortality. That big difference defines the US. Our childhood mortality seems only higher because the higher neonatal mortality because of increased prematurity and counting many more of these really small babies as births. For a well-known journalist I would expect that you are better instead of rehashing wrong, incorrect, and incomplete data.
You say: " American babies are one-third more likely to die in their first year of life than Polish children.." The same applies here. Datas from Poland again are incomplete, plus they do not even count as "babies" the very small newborns that we save here on a regular basis. In Poland these die much more often are not even counted as "births". Plus, there is a big difference between neonatal (first 28 days) and child (first year) mortality. That big difference defines the US. Our childhood mortality seems only higher because the higher neonatal mortality because of increased prematurity and counting many more of these really small babies as births. For a well-known journalist I would expect that you are better instead of rehashing wrong, incorrect, and incomplete data.
2
Well, what's not up for debate is that maternal deaths in the US have risen 10.1 per 100,000 between 1987 and 2013.
10
Per 100,000 live births. Infant mortality is near the bottom of developed nations.
2
Why is there increased prematurity in the U.S?
And what about the greater numbers of Uninsured people giving births outside of Medically assisted births in hospital ? Didn't Health Insurers prior to Obamacare price Pregnancy/Childbirth as a preexisting Condition or a higher premium Health insurance cost/Requirement?
With so many Uninsured people in the U.S (especially prior to Obamacare) surely it would entail a large body of not only uncovered Mothers/Births but also very many less healthy and possibly very sick people with untreated conditions giving birth...
Those factors alone would go a long way in increasing the Mother and Child mortality rate than in countries with Universal Coverage.
And what about the greater numbers of Uninsured people giving births outside of Medically assisted births in hospital ? Didn't Health Insurers prior to Obamacare price Pregnancy/Childbirth as a preexisting Condition or a higher premium Health insurance cost/Requirement?
With so many Uninsured people in the U.S (especially prior to Obamacare) surely it would entail a large body of not only uncovered Mothers/Births but also very many less healthy and possibly very sick people with untreated conditions giving birth...
Those factors alone would go a long way in increasing the Mother and Child mortality rate than in countries with Universal Coverage.
I think it was Churchill who said that you can count on the Americans to do the right thing, but only after they have exhausted all other possibilities.
There is a front page story in todays Times about Mitch McConnell threatening to "go bipartisan" (gasp!) if he can't get out-lying Republicans to cooperate on his healthcare initiative. What a novel idea! Why didn't I think of that?
We claim progress, not perfection.
There is a front page story in todays Times about Mitch McConnell threatening to "go bipartisan" (gasp!) if he can't get out-lying Republicans to cooperate on his healthcare initiative. What a novel idea! Why didn't I think of that?
We claim progress, not perfection.
10
Pregnancy-related mortality in the US was 7.2 per 100,000 live births in 1987; by 2013, it was 17.3. That's over a 10-point jump--it's a disgrace.
10
Actually, it doesn't seem like an absurd proposal to me. Congress is not working, and clearly not working for our benefit. So, yes, tie their pay to their results. In addition, I'm sure that other readers will also point out the hypocrisy of creating an outrageously inadequate health care bill which they themselves will NEVER use. They should be required to use the same health care program that they are creating for the rest of us.
And, yes, we should have universal health care which ALL Americans use, including the fat cats in Congress and the round man sitting behind the oval desk in the White House. As my grandma, Katie Boyle, used to say, "If it's good enough for the goose, it should be good enough for the gander". Way to go, Katie!
And, yes, we should have universal health care which ALL Americans use, including the fat cats in Congress and the round man sitting behind the oval desk in the White House. As my grandma, Katie Boyle, used to say, "If it's good enough for the goose, it should be good enough for the gander". Way to go, Katie!
10
Longevity rates may very well change with reductions in Medicaid. Many poor seniors on Medicare rely on Medicaid to cover their part B and D. Then there is the gap insurance for part C. Healthcare is no picnic on Medicare. Coverage is just as spotty.
4
Here's the real question: Are we willing to kill off the health insurance industry in order to save money, have true universal access to healthcare, and have the return on investment that every other developed nation enjoys?
What is the insurance industry really giving us for the money?
Wouldn't the actuarials, economists, and other talented people employed by health insurance companies be better utilized pumping out real figures that directly lead to better allocated medicaid/medicare funding because they don't have to bother with kowtowing to shareholders, CEO's with 350X the average worker's pay, or cut deals with private hospital conglomerates and big pharma?
Just how much money would be freed up to do other things from actually providing health care to education, funding the arts, and other things associated with better mental health if we just let the health insurance industry die?
I want to see a number. I bet when I do see it I would be willing to make those other people find another job. Since I've already had to find another one several times now due to the Great Recession, I don't think that's such a big deal. It's their turn so we who've paid and waited have a turn.
What is the insurance industry really giving us for the money?
Wouldn't the actuarials, economists, and other talented people employed by health insurance companies be better utilized pumping out real figures that directly lead to better allocated medicaid/medicare funding because they don't have to bother with kowtowing to shareholders, CEO's with 350X the average worker's pay, or cut deals with private hospital conglomerates and big pharma?
Just how much money would be freed up to do other things from actually providing health care to education, funding the arts, and other things associated with better mental health if we just let the health insurance industry die?
I want to see a number. I bet when I do see it I would be willing to make those other people find another job. Since I've already had to find another one several times now due to the Great Recession, I don't think that's such a big deal. It's their turn so we who've paid and waited have a turn.
7
Come on Nick, it's just a feel-good thing to punish our legislators--they aren't really cut off from the experiences of their constituents so much as forced continually raise re-election funds and accept corporate lobby money to survive,
You muddy the waters of true reform of our system if you vilify people making a very nice but hardly lavish income.
Punishing them makes this a problem of personal virtue rather than a problem of systemic reform--much as requiring people who believe in global warming to ride bicycles would address that problem adequately.
You muddy the waters of true reform of our system if you vilify people making a very nice but hardly lavish income.
Punishing them makes this a problem of personal virtue rather than a problem of systemic reform--much as requiring people who believe in global warming to ride bicycles would address that problem adequately.
2
So much time is wasted and lives put at risk arguing for a "free market" system that has never been demonstrated to work anywhere. We need to wise up, look at what other countries do far better than we do and stop pretending that buying healthcare can or should be exactly the same as buying a car. This approach is both impractical and inhumane.
8
Their salary is the least of the remunerations. Getting rich, while making $174K/year, has become the modus operandi.
And then there's the lobbyist position waiting in the curtains.
And then there's the lobbyist position waiting in the curtains.
4
Why are you looking at pay for performance? We don't connect the two in the US. Bankrupt the nation? Destroy retirement incomes? Foreclose on millions of homeowners? Reward the bankers. Increase the price of medications required for life? Pay executives millions. Open bank accounts for customers that didn't ask for them? Give a golden parachute. This is a country that pays millions to baseball players that don't get on base 70-75% of the time. What's your beef?
3
"...we should pay officials well to attract the best talent."
This is a ridiculous statement as it pertains to government. We've seen what $174,000 attracts, and much too often it isn't "the best talent." Too often it has attracted gluttons of ignorance.
This is a ridiculous statement as it pertains to government. We've seen what $174,000 attracts, and much too often it isn't "the best talent." Too often it has attracted gluttons of ignorance.
I would gladly trade my health care plan for that enjoyed by our elected officials.
7
This is a market based policy suggestion I could actually support. Perhaps the specifics are a bit absurd, but not the principle. Thanks for pointing out to conservatives and liberals alike the facts about American health care n comparison to the world. I'll have to look more closely at Poland!
I think if we all had the healthcare benefits that congress has we would be happy and all of this healthcare fuss would end.
2
$174,900 is peanuts compared to what they get from donors, lobbyists and special interest groups. They do the congressman's work, writing legislation, telling them how to vote and what to say. Nice work if you can get it.
Thanks to Citizens United bribery is legal. The rest of us are suckers, with a birthrate of one every minute.
Thanks to Citizens United bribery is legal. The rest of us are suckers, with a birthrate of one every minute.
3
The whole setup is a mess --- keep us sick, so they can profit. As one wrote --- setup universal healthcare and you will cure cancer!
Exactly. Bernie warned us right.
1
Your proposal to support "pay-for-perfrormance, along with guaranteed, subsidized health insurance" is a great idea. I'll offer another. Kellyanne Conway says, "If they are able-bodied and they want to work, then they’ll have employer-sponsored benefits like you and I do.” Sounds good, Kellyanne. You get Congress to pass a bill demanding that all employers provide health insurance, and I'll vote Republican. Well, at least I would give it my full consideration.
Of course the biggest difference is that most countries view the health and well-being of its citizens as a basic right. In the US health care is a gigantic racket meant only to enrich the various players with their hands in the till. And there are many pigs snuffling up to the trough that has now reached an absurd $3.5 trillion.
Highly regulated single-payer is the only way. Replace the idiotic 2nd Amendment with the right as a citizen to quality health care.
Highly regulated single-payer is the only way. Replace the idiotic 2nd Amendment with the right as a citizen to quality health care.
2
You have proven once again that facts are stubborn little things. The problem is that most people can't read and understand the simplest of data.
3
I like the cut of your jib Mr. Kristof.
We could go one step further and have all members of government ( that are supposed to have OUR interests first and foremost at heart, regardless if we pay them anything ) be paid structured bonuses for how many tonnes of carbon\pollution less than the average that is spewed into the environment.
We could offer a whole host of things that bonuses could be paid for ;
~ voter participation
~ citizens above the poverty line
~ how many deaths related to gun_violence ( reduction )
~ how many citizens going to and getting a college degree
On and on ( scratching chin ..hmmmm ) I like this idea. Let's do it.
We could go one step further and have all members of government ( that are supposed to have OUR interests first and foremost at heart, regardless if we pay them anything ) be paid structured bonuses for how many tonnes of carbon\pollution less than the average that is spewed into the environment.
We could offer a whole host of things that bonuses could be paid for ;
~ voter participation
~ citizens above the poverty line
~ how many deaths related to gun_violence ( reduction )
~ how many citizens going to and getting a college degree
On and on ( scratching chin ..hmmmm ) I like this idea. Let's do it.
1
Put all members of Congress on the same health plan as the rest of us. Why are they afforded special privileges?
A nice sentiment, I doubt it will ever happen. It would be better at this point, to crumple up the mythical Constitution, throw it in the circular file, and start again.
Maybe turn to Jacques Frescoes teachings.
Maybe turn to Jacques Frescoes teachings.
As Jackie Mason once said "Congress hasn't had a winning season yet, put em' on commission".
Instead of pegging Congressional pay to performance, how about requiring them to enroll in the Trumpcare plan in their respective states?
5
When will GOP legislators realize that scads of American citizens have traveled abroad and have experienced "socialized medicine" first hand? Those who have done so realize that, even for non-citizens, office visits and pharmaceuticals cost far less outside the U.S. In my experience scheduling, wait times and paper work are also far less burdensome abroad.
My wife and I have received wonderful care in Canada, France and Italy. Care was delivered on the day needed and at a fraction of the cost for both office visits and pharmaceuticals.
Yet the GOP continue to offer their same old anti-socialist bilge--and their undereducated followers keep swallowing it--with incredibly ill effects for themselves and their families.
Why do Republican officials continue to insist that in the U.S. single-payer government healthcare would prove far less efficient than our current for-profit, opaque, cumbersome, and multi-layered public-private arrangement? Is it because the government here is run by ineffective politicians such as themselves? Because it is run by individualistic materialists who--even though so many of them masquerade as devout Christians--actually care ever so much more about their own self-interest, the survival of their Party and continued support from their plutocratic donors than they do about the Gospel message and the common good?
Or is it all about the "bribes" they receive from healthcare "industry" lobbyists?
My wife and I have received wonderful care in Canada, France and Italy. Care was delivered on the day needed and at a fraction of the cost for both office visits and pharmaceuticals.
Yet the GOP continue to offer their same old anti-socialist bilge--and their undereducated followers keep swallowing it--with incredibly ill effects for themselves and their families.
Why do Republican officials continue to insist that in the U.S. single-payer government healthcare would prove far less efficient than our current for-profit, opaque, cumbersome, and multi-layered public-private arrangement? Is it because the government here is run by ineffective politicians such as themselves? Because it is run by individualistic materialists who--even though so many of them masquerade as devout Christians--actually care ever so much more about their own self-interest, the survival of their Party and continued support from their plutocratic donors than they do about the Gospel message and the common good?
Or is it all about the "bribes" they receive from healthcare "industry" lobbyists?
383
I don't believe any of the GOP's concern is with "health care" or we would focus more on the care throughout a person's life, rather than once disease or old age has kicked in. We need "care" not insurance; "care" not concern with the donations from big Pharma.
1
I faily certain it's the latter, bribes pay to play.
All of the above. All of the above.
How dare you suggest that we learn anything from other countries! We're exceptional and have all the answers, and certainly don't need to look to all those socialist/communist countries in Europe and elsewhere. The statistics and data you quote about better outcomes at lower costs in other countries are obviously fake news. And why do we need more babies anyway? They'll just end up being welfare cases.
Let's just provide more profit for insurance and drug companies, and let millions of Americans, burdened with sloth and laziness, fend for themselves. And let's congratulate the many wealthy Republican Senators who would personally benefit from the tax cuts in the so-called health care bill for a job well done.
Let's just provide more profit for insurance and drug companies, and let millions of Americans, burdened with sloth and laziness, fend for themselves. And let's congratulate the many wealthy Republican Senators who would personally benefit from the tax cuts in the so-called health care bill for a job well done.
262
Great sense of humor.
2
OK Dean, good point. But, remember Churchill's quote (paraphrased) "the Americans will do the right thing after they have tried everything else".
What has struck me for years is how a congressman (woman) becomes a millionaire after a few years in congress. They start out with a normal net worth and end in the 10% class of donors. Ryan is a good one who is now a millionaire. They claim his wife has the net worth but that was not mentioned in the beginning. I smell a rat.
What has struck me for years is how a congressman (woman) becomes a millionaire after a few years in congress. They start out with a normal net worth and end in the 10% class of donors. Ryan is a good one who is now a millionaire. They claim his wife has the net worth but that was not mentioned in the beginning. I smell a rat.
1
Well, at least I know snark when I see it! Nicely done.
1
Mr. Kristof,
One of your best. Hopefully, a plan for phasing in Medicare for All and phasing out Medicaid will be Mr. Trump's big surprise.
I really like your suggested approach for international comparison of healthcare systems. I can envision a bipartisan "codel" forming up to take a study group and Congresspersons on a trip to other countries that are getting better results from their healthcare system.
I am personally interested in ways to improve highway safety. We are paying an enormous price in fatalities and injuries on our highways. In 2016, 40,000 Americans died on the highway and over 3 million were injured, with about 53,000 premature deaths from vehicle exhaust pollution. Drunk and drugged, and distracted driving can be enforced much better.
Mr. colleague, Dr. James Powell, and I believe that by 2027 we can cut highway deaths and injuries by a factor of 2. Powell is the inventor of the superconducting Maglev transport system. It is a remarkable intercity and commuter system. Cheaper fares, smoother and much faster. It carries trucks as well as passengers. See www.magneticglide.com for concept.
One of your best. Hopefully, a plan for phasing in Medicare for All and phasing out Medicaid will be Mr. Trump's big surprise.
I really like your suggested approach for international comparison of healthcare systems. I can envision a bipartisan "codel" forming up to take a study group and Congresspersons on a trip to other countries that are getting better results from their healthcare system.
I am personally interested in ways to improve highway safety. We are paying an enormous price in fatalities and injuries on our highways. In 2016, 40,000 Americans died on the highway and over 3 million were injured, with about 53,000 premature deaths from vehicle exhaust pollution. Drunk and drugged, and distracted driving can be enforced much better.
Mr. colleague, Dr. James Powell, and I believe that by 2027 we can cut highway deaths and injuries by a factor of 2. Powell is the inventor of the superconducting Maglev transport system. It is a remarkable intercity and commuter system. Cheaper fares, smoother and much faster. It carries trucks as well as passengers. See www.magneticglide.com for concept.
2
That WOULD be a surprise!
1
One contributor to the higher mortality rate in the US compared to other industrialized nations is deaths by guns. Another good reason for sensible gun control legislation!
2
Another fine article by Mr. Kristof but seemingly one of only a few advocating single payer system. When the idea is so appealing and used in almost all developed countries, one wonders why a single payer system is such an anathema here. But health care is far too important to leave to our
Congress, and may be better dealt with at the state level.
Congress, and may be better dealt with at the state level.
4
Let's require Congressmen and their families to buy insurance on the open market. The list of pre-existing conditions will disappear.
3
I agree, Medicare for all, and everyone insured. An investment in humanity, and in the American people. A workable investment.
Now that I know the rate of pay for our U.S. Congress, I completely understand why they are not worried about healthcare for themselves and their own. They can afford it, and at our cost.
Now that I know the rate of pay for our U.S. Congress, I completely understand why they are not worried about healthcare for themselves and their own. They can afford it, and at our cost.
6
The ACA's minimum quality benefits stipulation and its free preventative tests and procedures, especially pre-natal care, access to contraception and children's coverage has drastically increased Americans' wellness and saved countless lives. This is especially evident in states that extended Medicaid.
As a healthcare advocate, I know that the GOP legislation is an unmitigated disaster. We are fighting a losing battle against the prescription drug opioid epidemic, and need more services, not less. Prescription drugs have actually become a gateway to heroin. The Trump administration's answer is hire more police and build more jails, not help those addicted.
For the record, our clients dealing with addiction aren't poor. Most are wealthy. They got hooked after back surgery and dental work. They can afford access to expensive treatment facilities, often not covered or not covered completely by insurance. Millions of others don't have that ability. Secretary Sessions is enacting minimum sentencing guidelines which does nothing to stop the epidemic.
To say that the ACA and the expansion of Medicaid didn't save lives is a outright lie. What Congress should have been doing over the past several years is closing loopholes, regulating insurance costs and stopping over billing by healthcare providers. Instead, they sat on their hands and cried "foul".
If we are reincarnated, I suggest we all become politicians. You can do absolutely nothing and earn 6 figures a year.
As a healthcare advocate, I know that the GOP legislation is an unmitigated disaster. We are fighting a losing battle against the prescription drug opioid epidemic, and need more services, not less. Prescription drugs have actually become a gateway to heroin. The Trump administration's answer is hire more police and build more jails, not help those addicted.
For the record, our clients dealing with addiction aren't poor. Most are wealthy. They got hooked after back surgery and dental work. They can afford access to expensive treatment facilities, often not covered or not covered completely by insurance. Millions of others don't have that ability. Secretary Sessions is enacting minimum sentencing guidelines which does nothing to stop the epidemic.
To say that the ACA and the expansion of Medicaid didn't save lives is a outright lie. What Congress should have been doing over the past several years is closing loopholes, regulating insurance costs and stopping over billing by healthcare providers. Instead, they sat on their hands and cried "foul".
If we are reincarnated, I suggest we all become politicians. You can do absolutely nothing and earn 6 figures a year.
9
@Sarah
zinnnnnnnng. ( always love a biting\truth commentary )
I could and would only add that the whole idea of conservatism is to be ''fiscally responsible'' and that tax cuts solves everything. You can almost hear republicans doing their best doctor impression and saying; '' take two tax cuts and call me in the morn' ''
Alas, the hypocrisy is self evident ( too all but them ) when they want to enact any plan that is more costly, less efficient and happens to hurt\kill thousands and millions along the way.
Pity.
zinnnnnnnng. ( always love a biting\truth commentary )
I could and would only add that the whole idea of conservatism is to be ''fiscally responsible'' and that tax cuts solves everything. You can almost hear republicans doing their best doctor impression and saying; '' take two tax cuts and call me in the morn' ''
Alas, the hypocrisy is self evident ( too all but them ) when they want to enact any plan that is more costly, less efficient and happens to hurt\kill thousands and millions along the way.
Pity.
1
This article makes it sound like it is only the GOP that's at fault. A large number of issues would simply go away if the money in politics went away. Yet, here we are, both the centrist-democratic base built by the Clintons and the GOP really want the same thing--they want power, and their narrative is just different, and they both do not want the sort of money we see in politics go away. What we need to do is remove $ from politics asap. Then you will see that Congress thinks the constituents are us, the people, rather than those big name donors. You will then see how quickly problems like this go away.
4
The only way to remove money from politics is to first remove Republicans, otherwise, any attempt to redress the Citizens United disaster will be rejected. But I suspect that you know this and are just trotting out, if obtusely, the usual "thy're both the same" false equivalency.
We may in an ideal world get better health care and better health care insurance coverage, either through some new, evolved legislation, or through universal payer. But the overall health of the nation will not markedly improve unless we make a concerted, ongoing effort to reduce the toxins and disruptive chemicals and substances in air, land, water, food, industry. This by definition would require far more regulation, not less (do you hear that?, conservatives are now howling), and of course is completely contrary to every effort Big Government makes on behalf of its corporate benefactors. It would require virtually every agency and department--FDA, Energy, EPA, Ag, you name it--to do far more to get carcinogens, endocrine disruptors, particulate matter, etc. et al out of our environment. They eventually make millions of healthy people ill. Not to mention the concerted, massive effort to get many millions of us more educated, responsible, proactive, on better diets, exercising, and reducing our prescriptions. Hear the cacophony as every sector protests and screeches its unyielding resistance, or skepticism that such radical measures are even possible.
But one way to better collective health is a huge national and social effort to live more healthfully in a cleaner environment, not just spending ever increasing sums to treat an endless supply of ailing, failing bodies made so by natural systems that have been abused and broken.
But one way to better collective health is a huge national and social effort to live more healthfully in a cleaner environment, not just spending ever increasing sums to treat an endless supply of ailing, failing bodies made so by natural systems that have been abused and broken.
3
Insurance started with the British mercantile empire. 100 ships sailed out, and 99 came back. A shipowner had more than 100% of his or her net worth in the ship, and Lloyd's offered, for 2% of the value of the ship, to replace the ship if she was the one not to come back. Both the shipowner and Lloyd's did well.
But everyone gets sick, so insurance companies have to charge more than 100% of what they cover, so they mostly have policies that, if one reads the fine print, don't really cover anything. I can't afford the deductible and the co-pay, so my plan never costs my insurer anything, since they don't have to pay anything until I've proved that I've paid the full deductible and co-pay.
On the first day of the ACA, Obama brought out two photogenic young women who had serious health problems, and he said hat they were now fully covered for less than $100 a month, meaning they'd applied for Medicaid, been turned down because their incomes were very slightly too high, but now they'd been contacted since they could be covered by expanded Medicaid if they'd re-apply, and they had.
Employer 'insurance' isn't insurance. The adjuster agrees to negotiate huge discounts and to process claims, but the employer and employees pay 100% of all healthcare costs, plus the adjuster's fees. 50% of Americans get their healthcare paid for this way.
But everyone gets sick, so insurance companies have to charge more than 100% of what they cover, so they mostly have policies that, if one reads the fine print, don't really cover anything. I can't afford the deductible and the co-pay, so my plan never costs my insurer anything, since they don't have to pay anything until I've proved that I've paid the full deductible and co-pay.
On the first day of the ACA, Obama brought out two photogenic young women who had serious health problems, and he said hat they were now fully covered for less than $100 a month, meaning they'd applied for Medicaid, been turned down because their incomes were very slightly too high, but now they'd been contacted since they could be covered by expanded Medicaid if they'd re-apply, and they had.
Employer 'insurance' isn't insurance. The adjuster agrees to negotiate huge discounts and to process claims, but the employer and employees pay 100% of all healthcare costs, plus the adjuster's fees. 50% of Americans get their healthcare paid for this way.
1
All these articles about poor health in the USA miss the point about the reason medical care Is so expensive in the US. The USA health care is so expensive mainly because of salaries. Compare what an average doctor or a nurse makes in Poland to that in the US. About 7x more. No wonder US health care is so expensive, but why is this not acknowledged in so many articles about health care? This is an unsolvable problem because health care workers will never give up their perks.
2
The US has a much larger population than the countries mentioned. I have heard wait times in these single payer systems can end up harming people. Also, would quality of care diminish if doctors are reimbursed less on this single payer? That said if it would help increase competition and drive down prices that would help.
Life expectancy has declined since Obamacare was introduced. Can we get a clawback of the pay from all those who voted for Obamacare?
Correlation is not causation.
5
That's actually a false and myopic statement. Life expectancy has risen in states that extended Medicaid. The ACA has improved patient outcomes, especially in the arena of chronic diseases such as diabetes and obesity. Unfortunately, Congress didn't close the loopholes that would have regulated the prices insurers could charge and didn't stop healthcare providers from over billing patients. This has caused a decrease in the number of patients who have access to care.
We also must consider the prescription drug opioid epidemic, which takes thousands of lives every day. Opioid deaths exceed car accidents, and overdoses kill more young people than anything else in our country. Gun related deaths, deaths from heart disease and cancer also add to these numbers. Obesity has been an epidemic in the U.S. for decades now, and it leads to countless deaths every year. It was around long before the ACA was enacted, and will take years to get under control if it is even possible.
We also must consider the prescription drug opioid epidemic, which takes thousands of lives every day. Opioid deaths exceed car accidents, and overdoses kill more young people than anything else in our country. Gun related deaths, deaths from heart disease and cancer also add to these numbers. Obesity has been an epidemic in the U.S. for decades now, and it leads to countless deaths every year. It was around long before the ACA was enacted, and will take years to get under control if it is even possible.
2
Cause and effect Phil. The insurance companies are still in the loop.
Republicans argue that the escalating cost of healthcare places US companies at a competitive disadvantage internationally. The obvious solution to the financial burden of health insurance costs to business is to follow Europe's example to adopt a single payer healthcare system, which has resulted in per capita health care costs being 50% less in Europe with better health outcomes.
18
I'm tremendously grateful to you for highlighting the per capita cost of healthcare in this country. It's a figure that the public doesn't hear enough about; and no one seems to be asking why healthcare in the USA costs so much while outcomes fall so far short of our peers. Instead, the Republicans in control of Congress have committed to further restricting access to care in order to fund unnecessary tax cuts for the few. The Constitution charges our leaders with promoting the general welfare (it's there in the Preamble, in between providing for the common defense and securing the blessings of liberty). Ensuring that everyone can get high-quality healthcare would seem to be basic to that obligation.
8
Members of Congress should be required to find and buy their own health insurance -- as so many millions of the rest of us are doing -- instead of getting the subsidized benefits of federal government health insurance -- as so many millions of the rest of us are not getting.
56
I have no problem with reducing congresses pay. I've always thought representatives should get the mean of their district, senators their states. I've always found it interesting that members of the House go into service with few assets and retire millionaires. Clearly the salary is neither an incentive nor a disincentive. Single payer is the way to go.
25
Congress pay? Let's look at their personal wealth. Most of them are independently wealthy.
https://en.m.wikipedia.org/wiki/List_of_current_members_of_the_United_St...
Are only people of means drawn to public service or do they acquire wealth because of their power? Are they genuinely interested in serving we the people or are they simply tools of the uber wealthy who post lobbyists in the corridors of the Capitol? Is our ciongess for sale?
https://en.m.wikipedia.org/wiki/List_of_current_members_of_the_United_St...
Are only people of means drawn to public service or do they acquire wealth because of their power? Are they genuinely interested in serving we the people or are they simply tools of the uber wealthy who post lobbyists in the corridors of the Capitol? Is our ciongess for sale?
2
Members of Congress have the best health care and it is paid for by the taxpayers. Why not require members of congress and their staff to get their health care coverage from the market/exchange in thee state they represent? Make them reap the fruits of their own labor.
127
I don't object to taxes but Americans don't get a good value for their tax monies.
Corporations are the true welfare Queens with 50 cents of every dollar going to Eisenhower's military industrial complex as Americans battle over a ever shrinking portion of the pie.
Corporations are the true welfare Queens with 50 cents of every dollar going to Eisenhower's military industrial complex as Americans battle over a ever shrinking portion of the pie.
12
Your numbers are off. Defense spending is about 16% of the budget. Social Security is 24%, health care (Medicare, Medicaid, etc.) is 25% of the budget, and other safety net programs are 10%. So entitlements are 59% of the US budget.
You can check my numbers if you don't believe them. Here's the source: http://www.cbpp.org/research/federal-budget/policy-basics-where-do-our-f...
You can check my numbers if you don't believe them. Here's the source: http://www.cbpp.org/research/federal-budget/policy-basics-where-do-our-f...
A hybrid solution—Affordable preventative care and catastrophic insurance coverage for everyone. Everything in between you can by on the market as suits your needs. While I support the ACA, but in its first year my premiums doubled and my deductible tripled. That is significant annual retirement savings I am no longer making. The ACA without revisions is not a viable long-term solution either despite the progress it represents.
2
Members of Congress do not investigate universal health care because big Pharma and insurance companies, their campaign donors, don't want it. It is no secret whose bidding "our" representatives and senators represent.
147
"Congress shall not authorize or permit the disbursement of government funding to offer or provide medical or therapeutic treatment for illness, disease, injury, or condition of disability at any quality, intensity, or expense not offered or provided to all citizens and residents of the United States of America.
No member of Congress shall accept for him or herself or any family member any provision or subsidy for the treatment, or prevention of injury or health related conditions.
These provisionsshall be enforced by adequate and regularly periodic public disclosures of information related to quality and expenditures by the establishment of at least two investigative authorities whose compensation and tenure are subject only to a three fourths majority of Congress over two subsequent sessions."
No member of Congress shall accept for him or herself or any family member any provision or subsidy for the treatment, or prevention of injury or health related conditions.
These provisionsshall be enforced by adequate and regularly periodic public disclosures of information related to quality and expenditures by the establishment of at least two investigative authorities whose compensation and tenure are subject only to a three fourths majority of Congress over two subsequent sessions."
9
The meme that members of Congress have "guaranteed, subsidized health insurance" will not die. The reality is less clear as discussed by Snopes: http://www.snopes.com/members-congress-health-care/
Special Congressional benefits do exist through the Office of the Attending Physician of the Congress and through the availability of the military health system in the National Capital Area, but the major benefits are through the DC based "SHOP" program, structured through the ACA. This program is very similar to employer-based insurance available in comparably sized businesses.
The biggest advantage is that, unlike a corporation which can pull its benefit package, the government is an ongoing entity less likely to cut benefits.
All that said, I am also in favor of single payer national coverage.
Special Congressional benefits do exist through the Office of the Attending Physician of the Congress and through the availability of the military health system in the National Capital Area, but the major benefits are through the DC based "SHOP" program, structured through the ACA. This program is very similar to employer-based insurance available in comparably sized businesses.
The biggest advantage is that, unlike a corporation which can pull its benefit package, the government is an ongoing entity less likely to cut benefits.
All that said, I am also in favor of single payer national coverage.
8
If we can't have a constitutional amendment guaranteeing equal access to healthcare for everyone, why can't we have one forbidding Congress to vote itself better healthcare than the most deprived citizens?
Notice this would not guarantee healthcare or any level of healthcare as a right. It only requires equity and fairness.
Notice this would not guarantee healthcare or any level of healthcare as a right. It only requires equity and fairness.
12
Kristof, as a fervent supporter of "free trade" pacts which put American workers in direct competition with their counterparts in China, Vietnam and Mexico, clearly does support "absurd" competitive pay proposals like the one he sets out here for members of Congress.
It would just appear that he's determined to spare the elites of the country the same treatment, while promoting fictions about how talented and competent they are.
And we wonder why Democrats can't win elections?
It would just appear that he's determined to spare the elites of the country the same treatment, while promoting fictions about how talented and competent they are.
And we wonder why Democrats can't win elections?
4
@jrd: Sometimes you come across a comment that is so sharp, so perceptive, that the author deserves a "chapeau" and a pat on the back, and this is one of them. Admire Mr. Kristof for his derring do, eagerness to venture into perilous regions of the world to bring us reports of human suffering, like the distress that every South Sudanese must feel who faces not only loss of life and limb from government sponsored Janjaweed militias, but from starvation and lack of adequate medical care, and NK's trek into the malaria ridden rural areas of Liberia makes him as susceptible to a bite from the anapholese mosquito, main carrier of malaria, or "paludisme" as it is sometimes called, as the residents.0nce bitten, its in your bloodstream for life, and lariam, main antidote and cheapest, can't cure it but only attenuate its effects.NK appears, no disrespect intended, somewhat like a middle aged boyscout, and you are right about the double standard.Suggest he also set the good example when he goes into these areas and adopt a family or two and sponsor them for visas. If you have the means, you should pitch in, not only by writing news reports, but materially, by helping at least 1 family to come states side.But all these overseas trade deals, NAFTA, TPP inter alia hurt the American worker and his standard of living. Advocates of these agreements always say that it will help American workers in the long term, but as JM Keynes wrote,"in the long term we'll all be dead!"
1
Do we want government making healthcare decisions for us, rather than insurance companies? Companies exist to make profit and government to provide services. Of course we prefer insurance companies, such as when I was hit by a truck, knocked unconscious, and the police called an ambulance to take me to the hospital. It's the American way for the insurance company to deny coverage and keep their money, as they point out, I did not acquire pre-authorization.
19
Even Medicare is not "universal single payer". Insurance payments or personal payments still have to cover quite a lot of the cost of it.
There are so many examples of decent medical care and payment across the globe. It is a mystery why members of the Congress refuse to even investigat them for possible emulation in this country.
Perhaps if members of Congress were in the same boat as the rest of us, medically speaking, some results would be had. I'd be for that 100 percent.
There are so many examples of decent medical care and payment across the globe. It is a mystery why members of the Congress refuse to even investigat them for possible emulation in this country.
Perhaps if members of Congress were in the same boat as the rest of us, medically speaking, some results would be had. I'd be for that 100 percent.
23
It is fun to fantasize about treating congressmen the way they treat Americans. Give them lower salaries and poor health plans. In reality, many congressmen are millionaires [ https://en.wikipedia.org/wiki/List_of_current_members_of_the_United_Stat... ]. They do not need their salaries and can easily afford any "platinum" plan. Now how about pegging their capital gains tax rates to their performance?
8
How about a per diem rate since in any given month, they seem to do the actual work of the people, maybe 10 days? Soon to go on to the 4th of July break, I'm quite sure many will be avoiding meeting their constituencies at home since they don't want to be badgered about their attempts to further strip the citizenry of their rights. I really want one of their jobs at an annual pay of $174k. I could live the rest of my life quite well on that. And I will work 20 days/month!
1
The GOP has discovered that once citizens become adjusted to a social program that is central to their well being, such as ACA (even with it's flaws), there's no snatching it back by brute force. If they do manage to sign into law their Draconian "health care" law they will suffer the loss of one, possibly both, houses of Congress. Liberals, on the other hand, will discover that the obvious answer to our health care, single payer, is an almost impossible goal. Why? Because the money needed would require that the wealthy once again pay their fare share in taxation, something we haven't seen since the 1950s. Since then, corporations and the rich have enjoyed a program of increasingly generous tax policies (beginning with the "Reagan revolution") and they, too, are convinced that those benefits are not only just but should be increased. They are not about to surrender any portion of their slice of the economic pie. Tax fairness will never happen in a country where the media (not to mention our elected representatives) are controlled by the wealthy.
14
Several commenters have pointed out that members of Congress are compensated for their so-called labor in enough tangible ways that slashing their salaries and benefits would do them no harm. I'd add that they are also paid with an "intangible" that they crave, perhaps above all other forms of payment: call it "the limelight" or fame or prestige - the equivalent of the "good name" or "good reputation" of a business or corporation, for which solid amounts of money are paid when a business or corporation is sold to another. It's a form of payment on which members of Congress quite literally "capitalize" both when still in office and after they retire from their public "service".
3
Medicare is the next entitlement program to go bust. The baby boomers are not in their 80's when they become expensive.
Nick, there is nothing absurd about your proposal to slash pay for Congress. In fact, not paying them at all until they actually do their job - single-payer system for healthcare modeled after far more effective and far more cost efficient systems around the world, invest in public health, true infrastructure investment (we spend far less in terms of percentage of GDP than most developed and developing countries, and far less than than historic levels), get money out of elections (the real way Congress gets paid - that would be the real pay cut), create national service jobs - mandatory for all 18-year olds for 2 years and open to all as jobs disappear to automation and globalization, deal with climate change by investing in green energy and technology and also on next generation nuclear - fully transitioning out of fossil fuels, stop supporting autocrats/dictators/kings/emirs/sheiks, improve human rights and civil rights for all - equal protection under the law.
31
Right on, MC! Time to reverse the neoliberal tide on all fronts.
1
But our political systems is such that you practically have to be rich in the first place before you become a politician.
Such that it wouldn't matter much to most of our politicians if we didn't pay them at all.
So the problem is much deeper, Nick, than you seem to be aware of.
Most of our problems in this country would vanish very quickly if congress weren't filled with rich people.
We would have universal, single-payer, Medicare for all tomorrow if congress weren't composed of rich people.
None of this is an accident either. It's no accident that you have to be rich to become a politician in America. This is by design.
The last thing the rich want is ordinary, non-rich people running the country.
Again, if we lived in anything that remotely approximated a real democracy, we would have had universal healthcare decades ago.
Fix the democracy deficit, and most of our problems disappear.
(Imagine that. It's the 21st Century and not only is there still a debate about whether democracy is the best form of government, but the anti-democracy forces in the US are stronger than ever.)
Such that it wouldn't matter much to most of our politicians if we didn't pay them at all.
So the problem is much deeper, Nick, than you seem to be aware of.
Most of our problems in this country would vanish very quickly if congress weren't filled with rich people.
We would have universal, single-payer, Medicare for all tomorrow if congress weren't composed of rich people.
None of this is an accident either. It's no accident that you have to be rich to become a politician in America. This is by design.
The last thing the rich want is ordinary, non-rich people running the country.
Again, if we lived in anything that remotely approximated a real democracy, we would have had universal healthcare decades ago.
Fix the democracy deficit, and most of our problems disappear.
(Imagine that. It's the 21st Century and not only is there still a debate about whether democracy is the best form of government, but the anti-democracy forces in the US are stronger than ever.)
66
Maybe if we paid our Senators and Representatives a few million dollars a year, they wouldn't be so eager to climb in bed with every lobbyist and bagman who crosses their path. They could also spend more time actually doing their job, instead of constantly "dialing for dollars" for the next reelection campaign. At least some of the time we would be spared from the shameful sight of former "public servants," ah, lending themselves out to anyone with money immediately upon retirement.
I think we would be well-served if we paid our elected officials more and our doctors less.
I think we would be well-served if we paid our elected officials more and our doctors less.
1
I don't know. My doctor works a lot harder than my Representatives.
46
I would rather do like they do in some other countries; have a limited campaign period and their election costs are covered by the government that is limited by a cap so everybody is playing on the same field with the same equipment. It increases the chances of "real people" getting elected not to mention women, people of color and younger people so there is always fresh blood in the mix of winners of elections. Oh, and of course, gerrymandering is replaced with non-partisan committees or computer generated districts drawn according to rules of shortest circumference to volume.
18
Your proposal sounds suspiciously like "trickle down" economics which as an illusion worthy of Houdini has transfixed the feckless GOP for the last 30 years. No matter the fact that it has never worked and never will.
Excellent. Yes, Medicare for all. Our national disgrace - the inequities and inefficiencies of our health-care system - has persisted long enough.
159
Congress has their own health care program. They aren't concerned since they are covered no matter what. Congress should be forced to participate in whatever health care program they devise. Then we would see them behave differently.
345
Bingo sdf. The goal of congress is to take care of themselves. Most do not have the ability to relate to the problems of their constituents. Shameful in deed.
1
This comment is incorrect.
Members of Congress and their senior staff members are covered under Obamacare -- that is, they must buy their insurance on the exchanges. Before the enactment of the ACA, members of Congress were covered under the FEHB (Federal Employees Health Benefits Program). However, Senator Grassley pushed to make Congress "eat its own cooking" (he probably also hoped to induce his colleagues to vote against the ACA). The employee subsidy that members of Congress formerly obtained on their FEHB plans is transferred to the policies they purchase on the exchange.
I have not seen any press coverage on how the latest House and Senate bills propose to handle insurance for members of Congress.
Members of Congress and their senior staff members are covered under Obamacare -- that is, they must buy their insurance on the exchanges. Before the enactment of the ACA, members of Congress were covered under the FEHB (Federal Employees Health Benefits Program). However, Senator Grassley pushed to make Congress "eat its own cooking" (he probably also hoped to induce his colleagues to vote against the ACA). The employee subsidy that members of Congress formerly obtained on their FEHB plans is transferred to the policies they purchase on the exchange.
I have not seen any press coverage on how the latest House and Senate bills propose to handle insurance for members of Congress.
1
Except, of course, that the new GOP "health care" legislation would work just fine for those with means. And from where I sit, $174,000 a year plus endless perks and bribes—oops, I mean gifts and dinners—from lobbyists counts as means.
1
Congress' base salary should also be indexed to median wages. They can get a raise when we get a raise.
189
Did Kristoff support Bernie? Bernie was, after all, the only candidate brace enough to call for universal health care coverage.
75
Universal health care has been called for by the Democratic Party for decades. Hillary Clinton worked on it in the 1990s. Other Democrats have introduced UHC bills. It's laughable to suggest Bernie Sanders was the only candidate pushing this issue.
41
Tristan: Nice misdirection. I clearly remember Hillary Clinton blasting Bernie Sander's proposal for a complete reworking of our healthcare system with her obfuscation that Obamacare was working so well and her pander that it was the outgoing president's signature accomplishment. Except, of course, that Obamacare wasn't working well and a significant proportion of the voting population was keenly aware that although there were some winners (most notably those on the expanded Medicaid rolls), they were actually losing ground in terms of rising premiums and deductibles. It's past time for Democrats to stand for something and they can start with universal healthcare paid for with a VAT. Once they start drawing distinctions with the Republicans in ways that actually matter to the middle class, perhaps they'll start winning elections again.
7
Hillary stated in the debate against Bernie, that it couldn't be done. It was one of those waffle statements on her part, as she initially fought for it like Bernie, but then came the donations from the healthcare industry.
4
The fundamental problem with healthcare in the US is the naïve assumption that capitalism, with its “magic of the marketplace” and “Laws of Supply and Demand” will work just as well for healthcare as it does for car manufacture, just listen to Rand Paul.
But there’s a problem here. The Laws of Supply and Demand don’t operate in healthcare the way they do in car manufacture, or other productive applications of capitalism, because the insurance industry (Supply) has a financial incentive not to provide that which is in Demand. This explains the bureaucracy. So, unlike the lean and efficient Mercedes corporation, the US healthcare industry combines the worst excesses of capitalistic greed with the worst excesses of inefficient socialistic bureaucracy. This bureaucracy is not only aggravating and extremely inefficient but also extremely expensive, hence the high cost of healthcare in the US.
This cost places a huge burden on American industry. Ironically, the government-financed insurance known as Medicare has only a minimal overhead, is still largely run by doctors, and is immensely popular (just ask any senior, Democrat or Republican). Making Medicare available to the general public would be a massive tax cut for industry, would raise standards across the board (as you point out people on Medicare survive very well), and might even make Trump’s reputation great again.
But there’s a problem here. The Laws of Supply and Demand don’t operate in healthcare the way they do in car manufacture, or other productive applications of capitalism, because the insurance industry (Supply) has a financial incentive not to provide that which is in Demand. This explains the bureaucracy. So, unlike the lean and efficient Mercedes corporation, the US healthcare industry combines the worst excesses of capitalistic greed with the worst excesses of inefficient socialistic bureaucracy. This bureaucracy is not only aggravating and extremely inefficient but also extremely expensive, hence the high cost of healthcare in the US.
This cost places a huge burden on American industry. Ironically, the government-financed insurance known as Medicare has only a minimal overhead, is still largely run by doctors, and is immensely popular (just ask any senior, Democrat or Republican). Making Medicare available to the general public would be a massive tax cut for industry, would raise standards across the board (as you point out people on Medicare survive very well), and might even make Trump’s reputation great again.
208
You had me until that last sentence. I don't think Trump's reputation was ever great. I guess he created an image of being great that some still buy. I don't and won't.
77
Excellent comment Michael. I recall years ago that a company located a plant in Canada with the main reason being Canada's single payer health insurance. Might also help explain why manufacturing has been disappearing from the US economy as well.
I hear from a friend retired to Mexico that health care there is very good. Years ago I spent a week in Lima, Peru and talked to an elderly person who told me that his health insurance was very affordable and good. He had health problems but was not worried about his care. An elderly couple that were home bound were provided with constant home care assistants who were charged with taking care of them always.
Lots of room for improvement here across the board.
I hear from a friend retired to Mexico that health care there is very good. Years ago I spent a week in Lima, Peru and talked to an elderly person who told me that his health insurance was very affordable and good. He had health problems but was not worried about his care. An elderly couple that were home bound were provided with constant home care assistants who were charged with taking care of them always.
Lots of room for improvement here across the board.
7
The reason for the high cost of care in the US is not quite as you describe. Here's a useful and detailed analysis based on first scaling expenditure by GDP:
http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-car...
For instance, Switzerland with a very high per capita GDP spends a lot on health care, though the US spends disproportionately more with worse outcomes. The above study examines the nature of this excess spending in the US.
A useful extensive comparison of costs and outcomes in health care systems internationally can be found here (free registration):
https://www.eiu.com/public/topical_report.aspx?campaignid=Healthoutcome2014
No country in the world has a health care system as expensive as than in the US.
A good summary of funding models for health care systems in the developed world is here:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/mod...
It illustrates how the US treats the health care of various classes of people differently whereas other countries treat everyone the same.
http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-car...
For instance, Switzerland with a very high per capita GDP spends a lot on health care, though the US spends disproportionately more with worse outcomes. The above study examines the nature of this excess spending in the US.
A useful extensive comparison of costs and outcomes in health care systems internationally can be found here (free registration):
https://www.eiu.com/public/topical_report.aspx?campaignid=Healthoutcome2014
No country in the world has a health care system as expensive as than in the US.
A good summary of funding models for health care systems in the developed world is here:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/mod...
It illustrates how the US treats the health care of various classes of people differently whereas other countries treat everyone the same.
3
We might also pro-rate the pay, and pay them only for the days that Congress is in session. That is not many. They don't bother to do their job, spending their time fawning over donors to get campaign funds.
305
So how about campaign finance reform?
71
Since they only work about 150 days of the year, at most, their effective pay is more like $278,000. And Jason Chafetz wants to give them more.
I don't think piece work would function well, they would just name more post offices.
Maybe their pay should be tied to their standing in public polls. Right now they are barely above used car salespeople.
I don't think piece work would function well, they would just name more post offices.
Maybe their pay should be tied to their standing in public polls. Right now they are barely above used car salespeople.
2
If speech = money, per SCOTUS, it will never happen.
2
Even Medicare has its limits. In 1985 I attended to my aunt's final illness where she spent about 10 days in intensive care in a hospital. Both her personal physician and the heart specialist accepted Medicare assignment without supplemental charges, there were no medical costs to pay. Today after being eligible for Medicare for some 20 years I am forced to pay over $5000.00 per year out of my personal pocketbook in supplemental expenses over and above what Medicare reimburses hospitals and physicians.
64
Mari, you are not alone. I too have been eligible for Medicare for a couple of decades. The out-of-pocket cost of my personal health insurance is over $10,000 per year, but I can't afford to drop it because I'm in the between-80-and-death range and fragile. Without my private insurance, serious illness or surgery would bankrupt me, and living on the streets is not exactly a tempting prospect.
2
I think people are calling for Medicaid for all because there is no annual deductible, but a monthly premium. It cares from pregnancy through nursing home.
2
That is because you bought an advantage plan and /or you did not realize those doctors chose to do the right thing when they did not charge at the end. Besides part of that $5k pays for services never part of the original Medicare, such as the MANDATE from Bush 43 that drug insurance must be purchased or suffer a penalty. I am betting that if you chose another advantage plan it might be more but not likely less. People don't seem to get that Medicare is still ADMINISTERED by insurance companies with rules established under MMS(Medicare and Medicaid). Every year those companies bid on the right to contractually administer those plans. It is likely that I'm the intervening years since your relative died that the rules were changed by Congress too.
BTW those changes and support of the underlying infrastructure of information services (computerized software) is big business for a whole host of government contractors. Those costs add to the overall cost of MMS.
BTW those changes and support of the underlying infrastructure of information services (computerized software) is big business for a whole host of government contractors. Those costs add to the overall cost of MMS.
1