Federal inspectors announced today that they are pulling the plug on $200 million in federal funding for Martin Luther King-Harbor Hospital.
It’s over.
The fat lady ain’t officially sung yet; the decision ultimately lies with the Los Angeles County Department of Health Services (DHS), which answers to the LA County Board of Supervisors. But that fat lady is warming up.
The hospital’s emergency room will shut down as of 7 pm Friday night
DHS director, Bruce Chernof has announced that he is requesting a “voluntary suspension of the hospital license.”
All of this has to be formally approved when the Board of Sups meets in special session on Monday. But it’s a done deal.
The cynical among us wondered if Dr. Chernof would actually pull the plug on MLK—if and when the feds pulled the money. There was the worry that political correctness and factional pressures would continue to win out. And that once more there would be a series of last ditch efforts and promises….
….but then, as has happened over and over, the fundamental changes needed would not be made.
(To illustrate, here is the LA Times timeline on MLK’s history.)
Nobody wanted to see it come to this. It’s tragic for the community, a failure for the city and county. But when 27 percent of all patients walking into MLK’s emergency room are considered at risk, it’s time to clear the table and start again fresh.
We can’t afford more horror stories like those of Juan Ponce and Edith Rodriguez.
Now the question is, where do we go from here.
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UPDATE:
NOTE: I’m working an analysis of all this for the LA Weekly, trying to make sense out of what we should take away from this, and where we DO go from here, and have been chatting with some of those involved in order to sort out some thoughts. Not that anyone in the entire town, as yet, has an answer.
Mike Antonovich, not usually among the most enlightened of men, was—of the County Sups—the most forthright in pointing the finger at his own board, himself, and some others in this city, for allowing the failures to go on unchecked for so long.
Chernof, in his official statement said that MLK will eventually reopen. “… the department is committed to reopening King-Harbor as a full-service hospital as soon as possible,” he said, “and is working to identify potential private operators, or options for County operation under a reconfigured model….”
Well, okay. Good luck. In the past, DHS has tried to find private operators with no cheerful takers. I’m not sure what exactly makes the prospect MORE attractive for private companies now that the situation has gotten worse, not better.
It’s a heartbreaker. But, so, so much money has been poured into a place where the clean-up job that was promised over and over again, was simply never done. The staff that was supposed to be fired….wasn’t. The people who definitely, positively, we swear on our mothers lives, were going to be retrained….weren’t. UCLA-Harbor, which was supposed to provide new management, never took over.
And so the awful mistakes continued, and the lies, the excuses, and the prevaricating….
And yet……
“It’s a very personal relationship this hospital and the community have,” a sobbing Lark Galloway-Gilliam, executive director of Community Health Councils, said to the LA Times. “People fought to have this place built, and it’s been employment for some people. It’s been a symbol that our community is somewhat whole, that the resources are there that you need when you want them.”
Well, not anymore.
***************
PS: This somewhat bumped the wild and woolly school story I promised today. Look for it early Monday morning.
Ouch! Had to happen… was bound to happen. Now, you’ll find out what the various community leaders are really made of, because they’re ether going to go on a sincere hunt for alternatives, or they’re going to stand on the curb, wring their hands, and keen.
You’re absolutely right that this fiasco was kept afloat only by political correctness. Yvonne Burke (who doesn’t live anywhere near there and wouldn’t be caught dead there), Maxine Waters, the AME pastors and I think even the ubiquitous Jesse Jackson and Al Sharpton weighed in on this as a racial issue.
Meanwhile, at other hospitals, when the JCAHO (Hospital accreditation agency) consistently give a it failing grades in even one or two areas, there is a major, immediate overhaul. Lay people can’t understand how irregular it was to keep this hospital open under the circumstances.
Wish we had a good solution, but as I’m sure Woody will jump in to point out, with so many immigrants and poor blacks using the ER as clinics and leaving it with huge bills unpaid, the problem will ricochet onto other hospitals.
Seven have already been closed in recent years, including those with much better, even good, track records.
Maybe some clinics offering lower-cost routing care from nurses and nurse practioners, with doctors as needed, would cut a lot of this overuse of expensive ER’s. I know there are such places in Hispanic areas, but are there around MLK?
This is what happens when do-good liberals are left in charge of something important. As usual, the liberals are the mommies of the world, and the conservatives are the daddies, who have to come to the rescue to solve problems. This decline is more than just about hospitals, it can be seen in cities and all areas of government where financial accountability comes no where near that of private enterprise. I can hardly wait for Hillary-Care.
Woody, with any luck at all, the WORLD will never know the extent of harm that Hillary-Care will bring about.
As a health care professional, however, I can state clearly that I’ve seen major damage done by both conservatives and Libers (though usually more oftn by libs). Governor Good Hair of Texas (Rick Perry for those not picking up on my sarcasm) cut mental health funding for medicaid several years ago and the Tex legislature had to restore it. In the mean time, the only ones who could offer help to those on medicaid were psychiatrists who were singularly unequipped to do more than write scripts for meds. No counseling, no nada! Now, at least we can.
The sole guilty party in the health care fiasco is people… those who care more about turf than care, those protecting their jobs and those of their friends and family and who do things their way and those who just flat out don’t give a damn. I have been lucky to have pvt. insurance and it has come through in my cancer treatments (well, I’m still here and that counts for something I guess) but I’ve seen what happens to those that don’t, some by their own stupidity and some by the bureaucrats who’s job it is to do something. Unfortunately, all they often do is sit on their asses.
We do NOT have a health care crisis, we have an insurance problem that won’t be solved by single payer (look at all the other countries problems that have tried that) but that won’t be solved by means other than taking a hard look at the problem and coming up with answers that do not involve going to the ER for a cold, do not involve clerks and nurses authorizing care, that do not involve docs ordering tests not because they think they are needed but because of the cover your ass litigousness of today’s trial lawyers chasing ambulances and owing fealty to the Democrats. Ahhh sh*t, I’m beginning to sound like a liberal… I need to get back on my meds 😉
Ok, Rant over…
Of course the Board isa responsible. For too many people this place was a source of patronage and employment. Not a medical center.
Woody, do you ever use that grey matter between your ears or just regurgitate that papblum you hear on hate radio? If “Do Good Liberals” screw things up then please tell me why the trauma center at County-USC is so highly rated (best place in the county to be sent to if you’ve been in an auto-accident or shot. In fact the military sent physicians there to learn how to treat gunshot wounds)
And Harbor General is also OK. Same board ran those. Course I can’t speak for the facilties in Dogpatch – er, Atlanta.
Roper’s analysis is so perverse that it would take more time than I have the will to spend here now. Yes, it is an insurance crisis – a crisis caused by relying on a FOR-PROFIT system. Why do you think people go to the ER for primary care? HINT: they lack the financial means to see a doc at the office.
Learn about other systems – then we’ll talk. The last place I’d go for a health care system is Texas!
I once worked in a psychiatric hospital in a transition coordinator capacity to help patients move from an inpatient to outpatient status. There was one unit of the hospital that was a disaster. No management intervention seemed to work. The staff were unskilled, unethical, and/or cynical, and the patients were out of control on an individual level, and fully in control on functional level. Observing from the outside, you’d have been hard pressed to distinguish the patients from the staff. It really was Bedlam, Inc. The hospital director, in a fit of utter frustration, shut that unit down. Dispersed the staff and patients to other areas of the hospital and locked the doors to the unit for two years. Time went by, there was staff turnover in the hospital, patients were discharged, and things settled. The director then reopened the unit. It was amazing. Within a year, the unit had re-established itself with all of the original staff, and most of the original patients, and it was every bit as dysfunctional as before. How does this relate to MLK-Harbor?
It’s important to remember that even though MLK-Harbor closes, the people who “lived” there aren’t going away. The people who were patients will not move. The staff may disperse for awhile, but likely not stray too far from the geographic area. When a re-enactment happens, all of the same actors will be primed to take the stage once again. And, you’ll get a do-over, but it’ll be all the same people doing it all over again.
NY Times: Los Angles Hospital to Close After Failing Tests and Losing Financing (not behind a paywall; registration probably required) http://tinyurl.com/22ssqg
My answer to:
is, Nowhere. And, while that’s the problem, it also suggests aspects of a necessary solution.
Knowing that this will be the case, and wanting to avoid a repeat of the current outcome (which might be too hopeful on my part), the management team – from the very top, down to the supervisors of the custodial staff – will have to be pretty darned talented. The supervisors of the supervisors will have to be new. It is unavoidable that many of the same line staff will be re-hired, and without a doubt, they will come with just peachy-keen previous performance records. Ergo, you’re going to need people who can watch ’em like a hawk, document the hell out of their inadequacies, and fire ’em – while at the same time rewarding and reinforcing those capable of delivering good patient care – simultaneously, bracing and preparing for the first round of discrimination lawsuits. The whole culture of the place will need to be rebuilt. Dealing with the soft discrimination of low expectations won’t be a painless process. If the same supervisors – from the county level through the hospital’s upper management team – are allowed back to their former positions, it’ll be second verse, same as the first. At the level of the front line, you’re actually going to begin where you left off and build from there. That’s going to take an array of really talented management folks, who are fully supported from the top, with sufficient resources ($$$) to overcome the inefficiencies imposed by the inevitable churn in the front line.
If that can’t be done, because the personnel and the financial resources aren’t forthcoming, it would be better to hold MLK-Harbor to its critical care only framework and send the rest to other hospitals for emergency and inpatient needs. LA County will have to decide where its dollar resources are best spent. Infuse those resources into existing hospitals that meet JCAH accreditation standards to beef up their existing facilities, or resurrect a renewed MLK-Harbor? Either way, it won’t be cheap. The alternative, of course, is to simply decide that folks in the surrounding community are simply not deserving of decent hospital services, and offer nothing at all. Or, isn’t that really the decision that was really made by allowing King-Harbor to deteriorate as it did – until it got too embarrassing for those who were supposed to be in charge?
I’m curious. If MLK-Harbor began as a teaching hospital, what happened to that medical school affiliation? Medical professionals who have trained at institutions in areas like this frequently cite it as the best possible training they could receive. That has value. Why did that relationship fail?
rlc,I’ve stated in another comment somewhere that I would choose to go to the inner city charity emergency room in the event of being in an auto accident. Those doctors have opportunities to gain experience in trauma care more than the ones in the suburbs. That doesn’t make the hospital better. It just means that those doctors are more specialized in workinig with knife and gunshot wounds.
Woody, County-USC is excellent, and not just for trauma care. You can’t legitimately make the generalizations you’re trying to make. They don’t hold up.
Celeste this might be connected in a way with your “Wild and Wooley” School story. For what did we have at MLK/Harbor if not their very own “Dance of the Lemons” with staff that didn’t give a damn and a board that went along.
Has anyone given though to how patients in Watts/Willowbrook will get to these surrounding facilities by public transit?
Well, several people seem to agree that finding a way to fund and staff clinics that can serve the uninsured with cheap care for routine problems like colds, ear infections and URI’s — among the most common complaints, and easily treated with antibiotics — would take a lot of the burden off hospitals. Plus routine checkups and shots for kids, blood tests for adults, lots of stuff can be and is handled by nurses and even nurse assistants at medical offices today. Nurses and doctors would refer people with more serious problems to county hospitals for free care. If people were required to start at these clinics and get a referral to the ER or hospital — unless of course, there was a real emergency — that would make sense.
I’d have to strongly weigh in against single-payer health care, though. Canada, Britain and France — not to mention Cuba and Latin American and Eastern bloc countries, which Moore is also enamored with — have closed many hospitals, and ration care so severely, with routine surgeries being scheduled months in advance and often arbitrarily denied to anyone over 60 or 65, that anyone with means goes to private doctors and hospitals or comes to America. In reality, in every country that has single-payer care, there is a two- tier system, where the rich and even wealthy foreigners are lured to the private hospitals. Countries from Hungary to India and Thailand, have deluxe private hospitals for the wealthy, who shun the public facilities. (And/or, pay the public doctors privately, to get ahead on the lists.)
What we need is more affordable and easily-gained insurance for everyone. We should all have the low rates that big companies get, and shouldn’t be dumped after any illness, at the discretion of the insurer. Insurance companies have to stop the current practice, especially in HMO’s, of paying doctors per procedure, which encourages unnecessary tests and operations at the expense of preventive care and facetime with their patients. We have the far highest rate of hysterectomies in the world, for example, because it’s commonly done even for fibroids, which can be simply removed or shrunk in many cases. (I won’t bore the guys with details here, but suffice it to say, it’s a horrific operation that ages a woman overnight by removing her hormones, and can have complications more severe than the cause.) But this is an easy surgery to perform, with a high rate of reimbursement comparable to complicated eye surgery.
Other serious abuses of the system include incarcerating mental patients or declaring them as such and forcing their incarceration, solely for the insurance money. Tenet was sued and I think had many hospitals closed down, because of an aggressive policy of forcibly putting patients who went in for mental consultation, into long-term in-patient care for months. Real life horror stories from the movies.
So, we need: clinics, private hospitals with government oversight but not management or single-payer, and reform of the insurance system to benefit the patient, not doctors.
Sorry Maggie you’re squaring the circle and your facts don’t match the reality. Any private, for profit , system by defintion will be more expensive and less efficient than a public system. We spend 50% more than the next most expensive system on a per capita basis and still have 47 million uninsured and worse health outcomes.
We ration care here. Its done by cost. Our pharmaceutical industry has failed in each and every year for the last decade to manufacture enough flu vaccine. But we produce three types of penile enhancement drugs.
Those operations to people over 65 that we do here are – of course – covered by Medicare which is, I hate to break this to you, a government run single payer system!
richard, you are buying the leftist/Moore P R, and obviously don’t know what you’re talking about from first-hand experience as I do. You don’t address any of my issues, but people like you see single-payer more as a religion than matter of logic, and so this is a discussion I won’t repeat.
One added fact I’ll throw in, though: none of the countries where single-payer is working even moderately well, as a first defense (until those who can afford it seek private care) makes it available to many millions of indigent immigrants and even illegals like we have here. In Scandinavia, where it’s among the most effective, they have an extremely high rate of taxation, higher overall level of education in their populace, and are homogenous in language and ethnicity, and have an overall healthy, active lifestyle.
Celeste & rlc, so County-USC is actually a university hospital. I presume that USC actually is in charge of it, and I’ve found that university run hospitals for training and experimentation to be better than just city or county run political units. I think that my generalization still holds. It’s just that rlc introduced a differently defined hospital into the discussion where it wasn’t being discussed as was MLK. Tsk tsk, rlc.
**sigh**
“this is a discussion I won’t repeat”
Please don’t – because you are utterly clueless, devoid of anything remotely resembling coherent, factual information and a transparent ideological windbag and on the issue. Your central arguments are rooted in falsehoods and outright deception – most likely self-deception because I doubt anyone’s paying you to spew blatant disinformation.
By the way, Richard, by using Medicare as an example of a government-run single payer system, you are making my point: piles of indecipherable paperwork and rules, so many people don’t take advantage of all their benefits. And, do you know how absurdly high negotiated rates can be when they’re billed to Medicare? But many needs and meds are not fully covered. So many of my friends have to help their parents sort this out that if the elderly don’t have someone to help, they’re lost.
That was a reference to you characterization of a system such as exists in France, which is half-truth at best and avoids any substantive comparison in either cost per capita, access, consumer satisfaction or outcomes. You’re probably right about hysterectomies. But you ain’t gonna get a solution to that by continuing the current system wherein profit drives treatment.
For starters, what are the relative administrative costs of Medicare compared to the insurance companies ?
And the U.S. government already spends per capita on healthcare as much as the French government does – for universal coverage and better overall outcomes (leaving expenditures for private insurance off the table).
As for wait times, the deadliest wait times among those in need of care in industrialised countries are experienced by the uninsured in the United States. None of the hyped anecdotes about wait times for certain surgeries in, say, Canada or France compare to what amounts to rationing by income within the US in extremity or in negative outcomes for the patient. This is a bogus argument that doesn’t hold up on examination.
It’s time for some honesty.
“In Scandinavia, where it’s among the most effective, they have an extremely high rate of taxation, higher overall level of education in their populace, and are homogenous in language and ethnicity, and have an overall healthy, active lifestyle.”
How, then, do you account for the superior outcomes and high-level of consumer satisfaction (empirical facts – not anecdotal hype) in France ?
That said, I’m outa here. These arguments tend to be a waste of time.
France is also a much more homogenous population in the same ways: I speak pretty decent French and even I face snobbery; and they also have far fewer immigrants/ “guest workers.” Hospitals in heavily immigrant neighborhoods are very poor, so any overall satisfaction is spotty. People might be happier with the clinic-level care, but not with specialized surgeries for which there are huge waits and rationing. And in case you haven’t heard, their economy is in trouble: the French are going to have to get used to working longer hours and getting fewer government benefits overall. Single-payer systems just spend until the money runs out, don’t have cost analyses per procedure, and then just deny care when the money runs out. I’ve said everyone needs access to cheaper insurance that isn’t easily cancelled. But you and ric are in the Roger Moore club of single-payer as religion: believe in the absence of proof.
Here’s some introductory reading material for you. Because, to put it bluntly, you don’t know what the hell you’re talking about.
http://www.prospect.org/cs/articles?articleId=12683
My former business was in software for hospital management and meeting criteria for accreditation agencies, and we traveled the world comparing systems and selling them OUR expertise on how to do cost-benefit analyses and perform quality control functions. You can read your own articles, pray to the S – P religion. But it’s a science, not a religion of faith.
With each bit of half-baked blather you counter with, I become even more convinced you don’t know what the hell you’re talking about. You’re “expertise” on comparative health care systems is analagous to Rudy Giuliani’s “expertise” on national security – steeped in hype, self-promotion, disinformation and delusion. Random proximity doesn’t equate with experience and knowledge. You’ve produced nothing that even remotely approaches coherent, empirical analysis using either quantitative or qualitative measures across systems. Your selective and scattershot anecdotes and assertions don’t square with any of the data that people who actually DO “travel the world comparing systems” have produced. My advice is to cut the crap about other people’s “religion” and put your beliefs to the test of something that approaches systematic investigation and the readily available data on costs, consumer satisfaction and outcomes. And it’s “Michael” Moore, not “Roger”. A better investigation of the issue is this:
http://tinyurl.com/yu46gd
I’d also recommend following Ezra Klein’s commentary, which I linked to and you apparently refuse to even read.
Suffice to say, I’d have to be a complete idiot to consider your alleged “expertise” surpassing either Dr. Relman’s (former editor of the New England Journal of Medicine), or even “mere journalist” Klein’s.
well, I return the complement: only a total idiot can make the comments you have. I’m not going to get specific as the point of these blogs is anonymity, and I was head of marketing and a co-owner, my partner was the tech person/software developer, and we had a dozen programmers/analysts on staff, plus numerous support personnel. Like a lot of writers, this was my bread and butter, so I could sell my share of the bus, and do what I want — it’s one of the top 5 in the country and clients include major hospitals in every city. And not one sane person in the industry doesn’t know that the U. S. level of care is the best in the world, because hospitals have these systems of quality control and cost analysis, not the tax- and spend mentality of your government programs. Their so- called measures of customer satisfaction are subjective; they haven’t had a need to quantify because they’re the only game around, and can just raise taxes some more. I find it curious you get so worked up without knowing what you’re talking about, but list all kinds of journals…anyone can find someone who offers a “validation” of his ideas. And doctors are actually among the worst offenders of qualitative measures: they don’t like anyone looking over their shoulders, but want total control.
If there’s any one major obstacle to improving accountability, it’s the AMA. They’re also the reason we’re the only country where you have to get an Rx for things like Retin-A, Limotol and antibiotics (though those are overused in many places and have created resistance) that are freely available at any drugstore anywhere, from the third world to Europe. This attitude on the part of doctors is precisely why insurers often take too-harsh a stance against them; you can quote your doctors, Ezra Klein all you want, I really don’t care. And I don’t care about convincing you or quoting facts: educate yourself on these basic issues first.
By the way, where I said everyone knows the U S has the best quality of care in the world, I neglected to add (because I’d said it before) that the problem is access, and we need to offer cheaper insurance to everyone. But your politicizing would destroy the quality of care that exists now, and the ability to manage hospitals to balance quality and cost in the way that only private enterprise can. Funny, when wealthy people from Europe need specialized care, they come here.
Great thread, guys. Vehement disagreements included.
Reg, thanks for the Ezra Klein link. And I see you’ve added to my summer reading list. (Damn, and I was so looking forward to settling in with that nice, new James Lee Burke mystery.)
Ms. Freemon, don’t bother with the Ezra Klein link this “reg” person is an idiot and doesn’t know enough to pull his head out so to speak.
Burke will likely give you more pleasure AND increase your knowledge.
rlc, you obviously don’t know enough about health care (overall) to intelligently discuss whether or not Texas has good health care, you and reg ought to consider going into the corner and playing with your mental blocks.
Just so you know wiseass, UTMB Galveston provides one of the best teaching hospitals in the world along with charity care that beats most major city hospitals. The Burn Unit at BAMC in San Antonio is world class and accepts burn victims from all over the world for one reason and one reason only, it is the BEST. M.D.Anderson has one of the very best cancer treatment centers anywhere in the world, Shriners Children’s Hosp is world class and helps kids from all over the world. Learn to think before you type, but then you’ve not been know for doing that.
Nice work, reg. It’s hard to hold a position when the definitions of apples and oranges keep changing. That seems to be the current rhetorical strategy of those opposed to thinking about a single payer system. Your recommendations were solid ones, but only those with a higher threshold for anxious fears can/will examine them. For the rest, any alternative, or combination of alternatives, is too bloody frightening to contemplate. *sigh*
“anon” contends that everything you need to know about delivery of contemporary health care was resolved in the writings of Edmund Burke. Why extend oneself all the way to Burke. Why not just stick with Genesis ?
Incidentally, anyone who says the problem in the United States isn’t the health care system itself, but access to it, AND THEN rejects single-payer as some sort of potential death blow to a great health care system doesn’t understand what’s being proposed. Because single payer IS NOT “socialization” of the health care system. It leaves the system in place, and in fact because it broadens access actually increases the competitive factor (poor people with health insurance options would not likely flock to some pit like the Drew-King facility). Single payer is “socialization” of a basic insurance package – while allowing in the French version, at least, for even more extensive insurance and “elite” consumption for those who can afford it.
What I hear from most of the “conservatives” on this issue is a litany of complaint about what’s wrong. I hear nothing in terms of clear policy suggestions (“should be” isn’t a coherent solution). Liberals have proposed a variety of approaches – from Edwards-style mixed-bag reform that aims at universal coverage to single-payer which guarantees it as the standard. Conservatives give us stuff like “medical savings accounts” or “better technology” as the range of solutions. I know of no one who doesn’t advocate smarter use of technology – which offers maggie a business opportunity with which I wish her great success – but I’ve also seen no EVIDENCE that the rightwing, Cato-style bromides about “market driven solutions” actually address the issue except at the margins. The closest to a “conservative” solution I could see would be a voucher system – based on average cost of an insurance package equivalent to that provided members of Congress. I’d also want to be able to simply buy into the system that members of Congress participate in. Given the relative administrative costs of that particular government program versus the private insurers, the private insurers would be seen as an increasingly unattracive alternative. I’m a pragmatist on this issue. The charges about “religion” are total crap, aside from the issue of “free market” co-religionists feeling their heads explode when they start to analyze the actual data and any extensive studies comparing “socialized medicine” as practiced by “Surrender Monkeys” with “the greatest health care system in the world.” Thus the rush to pile on with anecdotes. The problem with that approach, of course, is that an anecdotal examination of the U.S. health system is incredibly damning – even more so than statistical comparisons – and provides even the most casual observer with snapshot after snapshot that would be considered ugly and unacceptable in any comparable country.
I’m waiting for some comprehensive approach to the very real problems discussed here to come from the right. Mitt Romney could have moved ahead of the GOP pack, as Schwarznegger has, by sticking with the Massachusetts reform. Not an efficient approach, because it’s totally political – as are most of these half-measures that bow to the primacy of profits for the incredibly inefficient insurance companies – but something that at least acknowledges the depth and breadth of the problem. But he’s run away from it – because the GOP base doesn’t give a shit about health care coverage for anyone but themselves. (These are the same people who refuse to tax themselves (or draft their children!) for a war in Iraq – remarkably ill-concieved and more than likely being lost – that they assert is the most important front in the World Historical Conflict of Our Era. What’s the thread that holds these cracked pots together ? The “religion” of tax cuts! It’s really that simple. Ultimately, there’s not much they care about more. Pathological and pathetic in my view.)
For the record, I agree entirely with reg. We should all be marching in the streets over this issue, frankly.
“The problem with that approach, of course, is that an anecdotal examination of the U.S. health system is incredibly damning – even more so than statistical comparisons – and provides even the most casual observer with snapshot after snapshot that would be considered ugly and unacceptable in any comparable country.”
Yeah, no kidding.
And by the way, having worked for years in some of the poorer neighborhoods in Los Angeles, I’ve long been struck by the fact that, under mediCal, the poor have much better access to a lot of the basics of health care than I do with Blue Shield PPO, unless I simply want to pay out of pocket all the time. Plus in Los Angeles, a lot of the better physicians simply have stopped taking insurance at all–or have stopped taking some of the big carriers, so one pays out of pocket to see them anyway.
I associate myself with Reg and would merely add that anyone that thinks that France is a “Homogeneous” society has not been paying attention. France has a very large minority population of North African Moslems and President Sarkosy made their assimilation into French society a key part of his platfoirm. If they were homogeneous then why the need for a “Ministry of Immigration and National Identity.”?
Yet despite this France rates first in the world in health care outcomes. High taxes? Yes, by American standards. But then you’re not paying premiums for private insurance – avg for a familiy of four now over a thousand a month.
reg: That said, I’m outa here. These arguments tend to be a waste of time.
Just someting else that reg lied about, because he come right back with his lengthy, boring, misleading comments.
Screw the French. Despite phony protests, their system allowed 15,000 people to die from in a heat wave–which is five times the number who died in our 9-11 attacks. Even the French Parliament agreed with that. Their system is full of flaws and hidden costs, that could be magnified here. Talk about us getting a system like the French is pure socialist bull and propaganda which steals even more money from taxpayers, and then they skew their results with a different set of benchmarks to look better.
rlc: Any private, for profit , system by defintion will be more expensive and less efficient than a public system.
What world do you guys live on?!
Celeste: For the record, I agree entirely with reg. We should all be marching in the streets over this issue….
I have an idea. If government can do such a better job than private enterprise, let us just march for the government to take over food production. After all, it worked so well in Russia.
As you say, ric, the North Africans have NOT been integrated into the French society very well, and hence the riots and hostility across the chasm: chasm precisely because the rest of France is very French. Historically, the black population has come from the Carribbean, which as French colonies, have received the same citizenship, French language and culture. “Assimilated” blacks have always been accepted and welcome, even more than in the U. S.
The current immigrant population, which doesn’t want to assimilate in culture or religion, alarms the French, and sets off a series of laws from no headscarves on, that would never fly in the U S. Precisely because the French ARE homogenous, except for these groups that they see as disrupters to the harmony. Sarkozy has named the first N. African, a woman, to his cabinet. And as I said before, hospitals in these immigrant enclaves reflect that demographic; as this foreign population grows, the French fear it will drag down their system, including hospitals and schools… France is just coming to terms with a new reality economically as well, and people don’t like the idea of working more than 35 hrs/week, cutbacks in their socialized system of government. Which is what Sarkozy is going to have to get to do. Many French subjectively rate their own satisfaction with their hospitals as high, because they’re there and offer comprehensive basic services: including family planning and birth control. But none of this has anything to do with the fact that it’s our system that can create and support the highest level of skilled surgeries and specialized care, to which everyone from Italian billionaire Prime Ministers to Saudi potentates to the TB guy, gravitate instead of the socialized care in Europe. All of this only supports my statements as to which societies/ countries do best with socialized/single-payer care. And don’t try to fudge that it can be run by the gov’t and not be socialized.
To whichever of you, ric or reg, has a wish list that includes everyone down to the indigent illegal immigrant getting the same level of care as U. S. Senators, well, that just reflects the economic realism of this line of thought.
Some new figures from the Census Bureau and National Centre for Health Statistics:
We are now 42nd in life expectancy. Down from 11th 20 years ago.
Infant Mortality – we’re 41st. That is below Cuba by the way.
Woody check the figures on Administrative costs. For Medicare its around 3.5% Private plans 15 -35%
Now which sounds more efficient to you? Oh wait. You’re an accountant so I guess you can stretch the numbers any old way.
By the way, ric’s comment above under the newer schools/ kids’ advice thread, staunchly insisting that schools should not be run “like a business” and cost should have nothing to do with what services are provided, further substantiates what I’ve been arguing here, re: health care: people who think schools, hospitals and other services should be run by the government without any regard for cost, live in a fantasy world that is wildly fiscally irresponsible.
Maggie, you seem to have a sense of costs. That’s nice. Now, tell me again, why is business in business? Oh, yeah. Profits, right? I mean if business is in business it’s making a profit, otherwise there’s no point in being in business. So, are you arguing that the providers of health insurance and education should be making a profit? What would be a reasonable return on their capital investments, do you think? And, have a concept of rent seeking?
That should have been: Have you a concept of rent seeking?
I realize asking Woody for a coherent, empirically-based argument is like trying to squeeze water from a stone, but…
Please show me an article that analyses the French system in any depth – at least comparable to the Klein article I linked – which substantiates the horseshit you perpetually inflict on us when you indict the French system, including those “hidden costs and flaws you assert.
If the best you can do is suggest I’m a “liar” because I didn’t quite responding to this crap when I probably should have, you’re exposing the weakness of your alleged “argument”. Actually, you don’t make any argument. Just taunts and random assertions you pull out of your butt.
As for the French heat deaths, anyone interested can go to this Wikipedia link and determine for yourself if Woody’s rant even remotely makes a case that indicts universal single payer health insurance –
http://en.wikipedia.org/wiki/2003_European_heat_wave
Woody’s bit about “different set of bench marks” refers to differences in assessing infant mortality – it’s argued by critics of the numbers that the US figure includes more stillbirths and premature births than most other countries. Although he doesn’t bother to subtantiate this and generalizes from this one possible variance in comparative data to claim all of the comparative statistics are skewed, I’ll give him this one, which would mean we have merely an equivalent outcome in infant mortality at a much higher cost per capita (although I’m certain – as a matter of simple logic – that differences in access to full health care between citizens of France and the U.S. are at least a part of the story.) Other outcomes wherein the U.S. lags are not in dispute.
But leaving that issue aside, try to explain the vast differences in cost vs. outcomes, assuming they’re merely equivalent. Justify the lack of coverage of huge portions of our population. And rationalize the huge difference in administrative costs between insurance companies and government programs like Medicare.
No one in this thread has advocated “socialized medicine”, but that’s the canard that keeps coming up. Maggie and Woody leap to the notion that someone’s advocating “socialism”, is a “leftist”, adheres to “single payer as a religion (!?!?)” ad nauseum, rather than address the arguments coherently. Maggie leaps to asserting that her critics believe health care should be “run by the government without regard to cost” – when I made the point that universal insurance would actually force the health care system to be more competitive because people’s ability to make choices wouldn’t be as circumscribed as it is presently. No response to that. Just bullshit cliches and false characterizations.
Very sad showing, folks.
so you agree with ric that school systems shouldn’t be bothered with trifles like budgets — and you guys want to add health care to that. Then what? Oh, yeah, what the left has always done: impose still more taxes, waste more money, and if people just won’t cough up any more money, you cut back service, because you have never had to figure out how to live within a budget. (That’s exactly what single-payer systems do.)
At least every school system, incl. the LAUSD, which hasn’t done a very good job of using our tax monies wisely, at least agrees with the concept of having and living within a budget! The fact that you guys can even argue that fiscal responsibility is wrong, is beyond common sense.
“so you agree with ric that school systems shouldn’t be bothered with trifles like budgets”
“you guys can even argue that fiscal responsibility is wrong”
What the hell are you talking about ?
You guys are really pathetic. As for “cutting back services”, that’s exactly what the insurance companies are doing.
Goddam, this was a total waste of time. When the budget-busting, tax-cuts-uper-alles, don’t-wanna-pay-for-our-war GOPers start lecturing Democrats on fiscal responsiblity, you know you’ve gone through the Looking Glass.
rlc and reg are so enamored with government control of everything, that they will not rely on a rational bone in their bodies. I’ve got more important things to do right now, but you guys keep finding your left-wing sources to pretend that they are authoritative and consider all variables. I know from experience that reg will reject any position that disagrees with his, even if it came from God himself.
People wanting national health care paid by the taxpayers are people who don’t want to apply themselves and be responsible for themselves. Don’t put your baggage on my back.
reg, if you actually read ric’s comment on the school thread of today, you’ll see “what the hell I’m talking about” in his own words. IF you can get out of your obfuscating attempts to get people to read misc. no-doubt fascinating articles from a bunch of left-wingers and socialists you have found as proof.
ric, you bring up again the old canard that the U. S. ranks below Cuba and a number of poorer countries in longevity, and indeed we are currently 41st. But if you look at today’s LAT article on this, it confirms common sense and what I’ve been saying: because we are not homogenous, it’s meaningless to refer to “average American” statistics this way, as one might in Japan or most anywhere. Black Americans, and even more so black males, have a shorter life expectancy, similar to continental Africa, and infant mortality in that community is twice the average for whites.
“But this is not as simple as saying, ‘we don’t have national health insurance,'” says an epidemiologist at McGill in Montreal. The main factors researchers cite are: obesity, smoking, high blood pressure and cholesterol and blood sugar. In other words, the kinds of lifestyle habits that go hand-in-hand with the poor blacks and Hispanics who are bringing down the national average dramatically. And same goes for lower socio-economic status whites, who eat a lot of sugar and fats and junk. (Now I suppose you’ll argue that it’s racist to cite these statistics.)
Again, a healthy lifestyle within a homogenous ethnic group (like Scandinavia or Japan) is the chief indicator and cause of greater overall health and longevity; in a country like ours, socialized (yes, reg, that’s what it is) single-payer health care would be bankrupting and lower the quality of care for those who do maintain responsible lifestyles. If people stopped eating so many fats and sugars, their weight, blood sugar and cholesterol would go down. Add exercise, and the change would be even more dramatic.
Now I’m really finished, you can argue to yourselves.
“Reg, if you actually read ric’s comment on the school thread of today, you’ll see ‘what the hell I’m talking about’ in his own words.”
rlc’s comment isn’t even at issue. What the hell did I say that indicated I agree with your characterization of what he said ? Your response is more undadulterated, preening bullshit…
I’m sick of your crap.
“I’ve got more important things to do right now”
Go watch TV.
See, RLoC and reg? It’s just like those schools that counsel at risk kids into dropping out. If the poor performers just leave, then all the national test scores rise because they’re not included in the counts.
Now if those Black Americans, Hispanics, and other non-homogeneous groups, Teh Poor, Teh Obese, Teh Smokers, those with high blood pressure, diabetes, and high cholesterol would just get over themselves and deal with their sorry-assed issues, then the world would be ever so much better for the rest of us. AND, we could have socialized medicine like all them other countries. But, we can’t have it now, because we’re so different. You know, Amerikins are exceptional. So fer sure we caint be like dem others.
This whole framework is right in line with those folks who think that if the ILLEGALS would just go back to Mexico it would solve the subprime mortgage problem, global warming, the war in Iraq, outsourcing, and multinational mergers.
LOL. *sigh*
Oh, and while we’re at it, let’s get rid of the Republicans, too. They set a really poor healthy living example with those deep fried Twinkies and fried pork chops on a stick at the Iowa State Fair.
My IQ-ometer is blasting bigtime, warning me to stay away, but I reluctantly re-emerge only to point out that Bill Boyarsky, who you three may also therefore consider an idiot, has an editorial in L A Observed from a few days back, echoing what I’ve said re: the main reasons people go to MLK and the E R, and how basic health education can prevent a lot of the pblm right there. He does advocate uni ins., which is NOT single- payer, tax-funding socialism, by the way. Even Arnold wanted that. Au revoir, enjoy your trips to France.
Is this the LA Observed piece to which you’re referring?
National health insurance and a failed hospital
Bill Boyarsky
August 11, 2007
http://tinyurl.com/36jdja
If so, I won’t speak for reg or RLoC, it’s exactly what I’m referring to.
How is this,
not single payer?
Having access to basic insurance for all, at cheap rates, isn’t single payer, which is gov’t paid; and in any case, he’s more an expert on insurance/ the financial aspects of healthcare delivery than any layman. What I’m referring to is his personal observation of WHY most folk were at MLK, the preventable stuff like, yeah, obesity, eating fats and unrefined sugar which give you high b p, cholesterol, and the other good stuff…which they they have a lot less of in, sigh, France again — everyone’s been trying to figure out if it’s cuz of the wine benefits, or cuz they eat so slowly, whatever, but yeah, your dumb and facetious comment in 48 IS exactly right, except for the last point. But I’d add, if we remove stupid people, who are more likely to eat and encourage eating of fatty and nutrient-empty fatty and heavily sugared food, along with the fried twinkie eaters, we might have a shot at an improved version of a European system. Ain’t gonna happen though, is it, guys?
Meant to say, he’s NO more…an expert. But this exercise has been revealing in the sheer stupidity of single-payer advocates. so thanks, guys, for underscoring my points.
Keep in mind that, as Celeste has observed, in America the poor already receive better care than most HMO patients under Medicaid, and the elderly (if they can navigate the options and paperwork) get some basic care under Medicare. (Their Rx coverage is pretty inadequate, though.) So it’s the rest that need cheap, consistent coverage that isn’t easily cancelled.
Good god – I can’t believe the stupid. Of course “Medicare for everyone” IS single payer. You’ve just endorsed it.
As I said, I’ve been arguing with someone who, literally, didn’t know what the hell they were talking about. Apparently you didn’t even read my comments befor making crude characterizations. If you reaad this and convince yourself that you can explain to me how “Medicare for everyone” ISN’T single payer, please don’t bother. Go eat a bowl of cereal or take a walk.
Thanks listener for providing that column. One thing I agree with maggie on, we’d all be better off if we could “remove the stupid people”. Not advocating it as a matter of policy – just an observation in the wake of much of what we’ve seen passed off as “informed commentary” or “expertise” in this thread.
“the sheer stupidity of single-payer advocates”
Like Boyarsky…who you claimed WE would consider an idiot.
Just a couple of points. GOVT agencies can be efficient. They have controls and budgets and the like. It has nothing to do with the business model. Business model is there, as someone pointed out to make a profit. Do you want your police services to make a profit?
Oh, wait a minute. Instead of a “Socialized” Government run police force lets provide tax credits to all citizens that they can use to purchase “Security” services to protect them from burglars, rapists and firebugs. Why not try that idea out on the public and see how many takers you get. I’d be prepared for some laughs though.
No, reg. Sadly, Maggie might say we missed her point. She’s advocating privately provided basic insurance for all, at cheap rates which isn’t necessarily the same as single payer, gov’t underwritten insurance.
She cites Boyarsky for the single cherry picked line that if those who frequented MLK-Harbor’s ER practiced better self-help health, and took care of their problems sooner, they wouldn’t need emergency rooms. Of course their inability to seek earlier intervention could be tied to their inability to afford either health insurance, or health care.
The problem you and I had is Maggie’s inability to recognize two facts.
(1) Cheap rates wouldn’t meet the private business model requirement for generating a profit. Whether or not the insurance companies are wont to generate an economic profit is another discussion altogether. But sticking with only the notion of normal business returns on investment, Maggie seems to ignore that whole profit motive thing. I asked that question, albeit snidely, back in the beginning, but she ignored it. It wasn’t a particularly gentle warning on my part, but it was a warning nonetheless. Couple the profit motive with the likelihood the population she targets as teh problem is more prone to having pre-existing medical conditions, which any rational insurer would want to exclude, any insurance offered could not be cheap by definition. The payouts for services would exceed the premiums. If, the premium reflected the actuarially anticipated payout, the insurance could no longer be cheap.
(2) Cheap insurance (and, Maggie hasn’t defined what that actual dollar amount might be as a proportion of income or anything else) could only occur if the entity providing it was not looking to make a profit. The only available non-profit model out there big enough to take this on is the government. And, if the government got in the business of providing cheap insurance, that actually meant anything, the rational consumer would switch from privately provided to publicly provided health insurance.
Maggie may, or may not, understand health insurance, but what drove us both to the point of distraction is she doesn’t appear to understand the finance or economics of the health insurance industry. Which is why Woody and GM likely abandoned her to our sarcastic and mocking attacks.
The link that I think Maggie was trying to draw, but couldn’t articulate, is what about getting the providers of medical care to accept the cheap insurance? And, if reimbursements for services by the cheap rates were lower than what private insurance could pay with higher premiums, what happens to the quality of care? She assumes, I believe, that doctor’s incomes would fall so dramatically that only the dumbest among us would go to medical school, and the quality of care would deteriorate. As we both know, that’s a whole different set of assumptions and arguments. Although it is the chief Right Wing Noise Machine, fan the flames of fear, whip the masses into a shrieking frenzy tactic. *sigh*
I’ll quit here with the observation that I’d rather be treated by a veterinarian. The competition for vet school is greater than the competition for med school, ergo, the practitioners are exceptionally bright. And, they have to be good enough to get by without answers to the questions, Where does it hurt?, Tell me what’s wrong? or Describe your symptoms for me. My relatives who are medical school graduates have never argued with that assertion. And, if you want to have some fun, the next time you’re greeted with the request for your insurance information, respond with, You still accept cash, don’t you? and watch what happens. 😉
And since everyone loves to dump on the Post Office I’ll use them as an example of an Efficient Government Service. Efficient? YOU BET. Do you think a private postal service would deliver a letter anywhere in America – even the most remote rural outpost – for the same price? And redirect that letter to a changed address at no additional cost?
And provide a subsdiy to newspapers and magazines (we’ve been doing that since Ben Franklin set the system up) so that ideas could be promulgated at a lower cost to subscribers. That costs the postal service money but is considered a useful public service. A Private r Profit system would have no incentive to do that – without a government subsidy of its own.
Whoops – we must be thinking in tandem RLoC. I hate to point out, however, that put to a vote today many would argue that the single public rate for surface mail assigned to both population dense as well as population thin areas is a market aberration. It could be corrected by differential rates based on how far your mail delivery point is from a postal hub.
“privately provided basic insurance for all, at cheap rates ”
Personally, I’d like to see a privately provided good tweny-five cent cigar. My assumption, as an economically literate adult, is that market forces would be offering one up if it were feasible to make a profit doing such. Maggie isn’t just wishing for a pony, she’s wishing for ponies from strangers.
I’ll add for the benefit of clarity, that cigars are undoubtedly bad for you so having them more accessible would drive up our overall health care costs and, for the kids who are lucky enough, having a healthy pony demands that you feed it sensibly – no Snickers – and make sure it gets plenty of exercise.
Cigars are bad for you. Send as many as you can to reg.
Finally? For those who might wonder at the origins of the phrase wishing for a pony, or plus a pony, I recommend this:
If Wishes Were Horses, Beggars Would Ride — A Pony!
Posted by belle waring
March 06, 2004
http://tinyurl.com/2544z
Gosh, I didn’t realize the phrase was that old. Time flies when you’re having fun!
It really is sad watching you LAUSD grads — they do have social promotion, after all — make such fools of yourselves trying to impress each other. Which of you wants to vie for the job of principal at Santee, or were you already fired there? If so, there must be another school where stupidity and ineptitude, combined with lack of accountability, makes for the ideal qualifications. I agree with Woody, guys: take up smoking. In your case, it will be beneficial (to society).
What’s so pathetic is that the liberals can only see things as a choice of this or a choice of that–with “that” being government control. There are so many alternatives that they refuse to consider. Just some changes in the tax code to allow people full medical deductions or credits for healthcare would allow them to do what is best for themselves without a total takeover of the most important aspect of our economy. But, the left doesn’t want people to have their choices, because they can’t control the people then.
BTW, watching TV is more productive than arguing with reg, and it offers more intelligent information.
Killer king is closed now – call 1-800-LA.CO-SUP for help!
What a thread. Maggie’s arguments strike me as a bit all over the place, but I think that’s because any conservative sane enough to recognize that there exists an American healthcare problem is in for trouble.
I hear Maggie repeating that America has the best care in the world. But she also complains that other countries, like Canada, have a two-tiered system where wealthy patients receive better access and care. Isn’t that what we have here, Maggie? I don’t see the trade-off.
The other argument is about cost efficiency and here I think conservatives tend to get very dishonest. Emperical evidence shows that our current system spends more per capita and gets less care per capita than most single payer systems. If you’re gonna argue with this, I think it’s just a matter of parsing the data (and that may well require you to read “priests” like Ezra Klein, also known as “informed people who disagree with you”).
Maggie’s last argument is the most desperate: single payer won’t work here because we have a more diverse culture. In other words, black people prevent the system from working. I don’t really know how to respond to this except to say that it’s a load of hogwash. The specific problems she attributes to minority communites, poor excersize and diet, are treated best by single-payer insurance systems where investing in disease prevention saves insurers (the gov’t) money in the long run. As I believe Listner points out, those people are currently the least likely to have access to preventive care. Getting them good coverage should save money and prevent young boys from dying of infected toothaches: http://tinyurl.com/ywdshr
Do any of these responses remotely satisfy any of your points, Maggie? Do you have other essential objections that I’m missing? Do you have any solutions to the problem of healthcare in American? I’m late to the game and things got shouty, but I’d be interested to read your response.