Your 401k Should Stop Free Falling

The bill was heralded as a way to calm the markets following the 778-point mini-crash the day after the original bill failed. That plan hasn't exactly worked. But! If the bill does eventually succeed in stabilizing the markets, everyone with a 401k, IRA, mutual fund, or plain old stocks will directly benefit.

New And Improved FDIC Insurance Limits

The FDIC has upped its insurance limits from $100,000 to $250,000. A couple can now stash half a million dollars in the bank, fully insured by the federal government. The new limits even apply to credit unions.

Technically, the FDIC insurance limits are only extended through 2009 to prevent banks from contributing added billions to the insurance fund that they need in their coffers. Congress will almost definitely make the increase permanent next year, giving banks plenty of time to save up cash to contribute to the reserve fund.

AMT Extension

The dreaded AMT—the parallel tax system designed to snag at least a few tax dollars from the wealthiest Americans—will no longer impact almost 20 million Americans. Couples are now exempt up to $69,950 (an extra $3,700!), while singles are exempt up to $44,350 (an $1,850 increase!) The benefit fades out at $150,000 and $112,500, respectively.

A true fix would have involved indexing the AMT for inflation. Maybe next time.

Other Tax Credits

These apply to smaller subsets, possibly you!

• $8 billion in tax breaks for victims of natural disasters;
• $5 billion for college tuition deductions;
• $400 million to help teachers buy their own school supplies;
• $3 billion in deductions for residents who pay state and local taxes in states that don't have an income tax.

The bailout essentially doubles as an energy policy expanding and extending for eight years several energy credits that were set to expire.

• Homeowners can now claim a 30% tax credit for putting solar panels on their roofs without any limit;
• The same 30% credit applies to wind turbines and geothermal heat pumps;
• A one-year extension of breaks for energy efficient home improvements;
• Plus, the first 250,000 buyers of plug-in electric vehicles are eligible for a $7,500 tax credit.

The energy portions of the bill also throw a lot of money at companies looking to invest in clean, renewable energy, but this is about you, not them.

The bill almost failed again in the House because members of both parties wanted to pay for the tax breaks upfront. The Senate, however, only offset the energy portions of the bill. Remember to one day thank your grandkids for the tax breaks.

Mental Parity

Health insurers are now required to treat mental health issues the same as they would any physical illness. It also prevents health insurers from making their mental health benefits any more restrictive than other covered illness.

Most importantly, without mental parity, we wouldn't have a bailout bill at all. The Senate couldn't introduce a new bailout bill from scratch, so they cut and paste the bailout bill into the relatively uncontroversial mental parity bill. Creative, isn't it?

Homeowners

This is a housing bill, after all. The heart of the bill is the Troubled Asset Relief Program, or TARP. A team of mortgage specialists—possibly the people who got us into this mess but can now benefit from hindsight—will scoop up questionable mortgages held by banks. Toss out the skunk and the room won't stink anymore, right? Presumably, the theory goes, this will allow everybody to calm down and get back to business as usual. Banks will once again lend to businesses so they can meet payroll, consumers will be able to borrow money for cars, homes, and school.

Beyond buying up securitized mortgage, the government may also buy whole mortgages on a case-by-case basis. Even if the government doesn't own your home, the Treasury and other federal agencies have been empowered to modify loans to minimize foreclosures.

Many House members wanted to empower bankruptcy judges to rewrite predatory mortgages altogether, a proposal that was rejected by the Senate.

Homeowners who are able to reduce their mortgages won't owe tax on the difference, as they normally would. And if you're a renter living in foreclosed home, you can stay, so long as you stick to the terms of your lease.

If you are at risk of foreclosure, the Department of Housing and Urban Development has several tips for staying out of foreclosure:

1. Don't ignore the problem!
2. Immediately call your lender and try to work out a solution.
3. Open mail from your lender because it may contain useful information to help avoid foreclosure.
4. Start reading up on your rights and foreclosure laws.
5. You have options to help avoid foreclosure. Study them.
6. Call (800) 569-4287 to find a HUD-approved housing counselor.
7. Spend more on your mortgage, less on everything else.
8. Sell-off assets that you don't need, like that spare car or jewelry.
9. Don't pay anyone to help you avoid foreclosure. They are scammers.
10. Watch out for anyone promising to save your home if you sign a document. You are signing away your house to scammers.

We've written many posts expanding on these topics, including:
4 Things To Try Before Foreclosure
Consumers Are "Unaware" That Lenders Can Help Them Avoid Foreclosure
Lenders Freeze Mortgages Rates For Some
What To Do When Rental Gets Foreclosed?
Mother Saves Family From WaMu Foreclosure With Consumerist's Executive Contact Info
Halt Foreclosure Proceedings By Challenging Your Bank's Claim To Your House
New Ruling Means Banks Could Have Tough Time Foreclosing
32 More Foreclosures Dismissed For Lack Of Documentation
Freddie Mac: Don't Let Fraudsters Steal Your Home
Watch Out For Equity Stripping Scams
How To Save Your Home from Foreclosure
Beware The "Fannie Mae" Prize Draw Scam

HUD also has a new program that can help people transition from predatory mortgages to FHA-insured 30-year fixed mortgages. You qualify if:

• Your troubled home is your primary residence and you don't own a summer home.
• Your mortgage was born before 2008, and you have made at least six payments.
• You need help paying your existing mortgage.
• As of March 2008, the mortgage costs more than 31% of your gross monthly income.
• You haven't been convicted of fraud in the past 10 years or lied on your mortgage application.

Yes, This Affects You

There's been a lot written about the bailout and whether it will work. One article in particular from the New York Times captured poignantly the potential price of apathy and inaction:

In 1929, Meyer Mishkin owned a shop in New York that sold silk shirts to workingmen. When the stock market crashed that October, he turned to his son, then a student at City College, and offered a version of this sentiment: It serves those rich scoundrels right.

A year later, as Wall Street’s problems were starting to spill into the broader economy, Mr. Mishkin’s store went out of business. He no longer had enough customers. His son had to go to work to support the family, and Mr. Mishkin never held a steady job again.

Frederic Mishkin — Meyer’s grandson and, until he stepped down a month ago, an ally of Ben Bernanke’s on the Federal Reserve Board — told me this story the other day, and its moral is obvious enough. Many people in Washington fear that the country is starting to spiral into a terrible downturn. And to their horror, they see the public, and many members of Congress, turning into modern-day Meyer Mishkins, more interested in punishing Wall Street than saving the economy.

Let's hope this thing works.

Lesson From a Crisis: When Trust Vanishes, Worry [The New York Times]
Rescue Sweetened With Tax Incentives [The Washington Post]
Bailout Brings With It Diverse Perks [The New York Times]
Details about the Bailout Plan [Daily Kos]
Tips for Avoiding Foreclosure [HUD]
Hope For Homeowners [HUD]

(Photo: Getty)

The NYT has an interesting article about the movement to standardize the bracelets:

The goal is to prevent potentially dangerous mistakes, like giving the wrong food to an allergic child, or allowing a patient with balance problems to walk unescorted down a freshly waxed hallway. The drive was spurred, in part, by a notorious 2005 Pennsylvania case in which a patient nearly died because a nurse used a yellow band thinking it meant “restricted extremity” (don’t draw blood from that arm), as it did at another hospital where the nurse sometimes worked, when at this hospital it meant D.N.R.

While the new color-coding has been quickly embraced by at least 20 states and endorsed by the American Hospital Association, the purple bands, typically embossed with the letters D.N.R. to reinforce the message, are meeting with some resistance.

The nation’s leading hospital-accreditation agency, known as the Joint Commission, has expressed caution about the new system, citing concerns about branding patients by their end-of-life choices, or inadvertently broadcasting those choices to family and friends who have not been consulted.

The commission also said that children who do not understand the system had been prone to trade the wristbands like baseball cards.

Awwwwkkwaaarrrdd. The main takeaway for the consumer is that hospitals make mistakes, so it's a good idea to ask questions about the bracelets that they put on you and make sure that everything is as it should be. If something doesn't seem right, speak up for yourself or for your family.

Hospital Bracelets Face Hurdles as They Fix Hazard [NYT]
(Photo:Chester Higgins Jr./The New York Times)

From the economist's perspective, the question of whether we are spending too much on health care cannot ultimately be answered by looking at total expenditures relative to GDP or the federal budget. Rather, the question, whatever we spend, is whether we are getting our money's worth.

He suggested that in our current system, decisions were made with the idea that "someone else will pay for it," either the government, or private insurance.

"The best way to reduce the fiscal burdens of health care is to deliver cost-effective health care throughout the entire system," Bernanke said.

You can read the full text of his remarks here.

Challenges for Health-Care Reform [FED]
(AP Photo/J. Scott Applewhite, File)

In this documentary, Frontline examines 5 capitalist democracies to see if there's anything that can be learned from how those countries run their health care. No system is perfect, but there are some interesting ideas being implemented all over the world.

Sick Around The World [Frontline]

Since 2004, UCSF said it provided the names and addresses of 30,590 patients to Target America, paying the company $12,000 a year.

Hospital officials said it contracted with the company to assist "with identifying names of individuals who could potentially receive communications from UCSF."

"Identification of potential donors who were active in the philanthropic community was one objective, along with identifying individuals who had corporate relationships, such as board service, or were affiliated with relevant community programs and health care biomedical organizations," Kaarlela said.

After the breach was discovered, the hospital said it required Target America to hire "an objective third-party firm" to investigate. UCSF received the forensic analysis report March 26. It showed that information was potentially accessible from July 1 to Oct. 9 last year "if a query for a specific name was made." Notification letters were mailed to patients April 4.

To Dixon, the expert on medical identity, the disclosure lag was far too long.

"In Internet years, that's a century," she said.

In January, California began requiring health care providers to alert consumers if their medical information is breached. Swift notification is considered important so consumers can monitor credit reports and bills.

According to Joanne McNabb, chief of the California Office of Privacy Protection, notice should be given "in the most expedient time possible, without unreasonable delay."

"It's a judgment call, the how and the when part," McNabb said. "The idea is to give early warning so that people can take defensive action. On the other hand, you don't want to needlessly worry people."

It's not the worst case of lost records we've seen, but mining for donors seems so much worse than "whoops, lost another laptop!" At least people's social security numbers weren't included with the data. People who think their identity may have been stolen should pour themselves a stiff drink before sitting down to read this comprehensive post.

6,000 UCSF patients' data got put online [San Francisco Chronicle] (Thanks to Paul!)
(Photo: Getty)

From the AP:

New Jersey Gov. Jon S. Corzine said Tuesday he's open to using a "sin tax" to help provide funding for struggling hospitals.

His comments came after Amy Mansue, of Children's Specialized Hospital, suggested a fast food tax during a meeting between Corzine and hospital leaders on proposed state hospital and health care aid cuts.

Corzine called it "a constructive suggestion."

"We would be happy to examine that and debate that with the Legislature," Corzine said.

But Senate President Richard J. Codey said he wouldn't favor a fast food tax.

"That's a tax on poorer people and people with kids," said Codey, D-Essex.

Detroit weighed a 2 percent tax on sales at fast-food establishments in 2005, but the plan didn't become law.

A fast food tax to help NJ hospitals? Corzine open to idea [NJ] (Thanks, Andrew!)
(Photo:Morton Fox)

Hi there - I'm really hoping you and your readers can help me with my problem. I had two procedures done in December 2005 (laprascopy and a hysteroscopy). Prior to the procedure I called United Healthcare (my provider) and asked them if the amount the doctor was charging was considered reasonable. I didn't want to have these procedures done by this particular doctor if insurance would not cover the cost (I had another ready to perform the procedure who was in-network). After being reassured by United Healthcare that the cost would be covered I decided to go with the out of network provider. A few weeks later I received almost the full amount for the procedure - they covered about 90%.

This week I received a letter from United Healthcare telling me that they made an administrative error and that they wanted me to send them a check or money order for 7700 dollars! This is almost three years later!!

I'm shocked and plan to appeal. Can they do this? I mean, it is almost three years later!?!?

I know UnitedHealthcare is really horrible when it comes to claims/billing but this is insane.

Thanks for any help you can provide.

Suzanne

On March 15, my dad had triple-bypass heart surgery at Jewish Hospital in Louisville, Kentucky. My mother immediately started planning for his aftercare. My mother is disabled and uses a walker to get around; my father normally takes care of her.

My father's doctors, along with the hospital's case worker and my mother tried to get their health insurer, Anthem Blue Cross/Blue Shield to approve off-site cardiac rehab. They initially approved the request and made arrangements at an approved facility. The day before checkout, March 19, Anthem changed it's mind. My father's doctors kept him another day to execute an emergency appeal. But to no avail, Anthem determined my father was "too healthy" and would have to go home (and basically perform self-care). It pushed my mother to the verge of a nervous breakdown, but thanks to friends and neighbors they made it work. Anthem was kind enough to provide a visiting nurse, three times a week, even though daily care was recommended by the doctors.

Yesterday, they received the attached letter, approving the rehab stay. Well, great, right? Let's go to rehab! Well, no-no-no. The approval was only good until 3/24. So, he'll have to re-apply.

In a stunning development underscoring the plight of non-profit hospitals struggling with the increase in uninsured patients, the Catholic ownership of St. Francis Hospital & Health Center on Wednesday said it will shutter the hospital because nobody would buy it.

The religious order of nuns that oversees St. Louis-based SSM Health Care said it could not even give the hospital away to other health facilities "for free."

Saddled with tens of millions of dollars in losses from uninsured patients who could not pay their medical bills, St. Francis would be abandoning its core mission of caring "for the people of its communities regardless of their ability to pay." SSM will seek a closing application with the state, a process that could take several months.

The closing would erase a deeply established health-care facility in a struggling south suburban town, forcing residents to travel further from home and potentially stressing other facilities with an influx of thousands of patients, many with limited means.

"Unfortunately, in spite of St. Francis' outstanding clinical reputation, reimbursement from commercial insurers could not cover the cost of providing care to the growing number of Medicaid and uninsured patients," said Sister Mary Jean Ryan, SSM's chief executive officer.

Maybe a network needs a realistic set for a TV doctor show?

SSM to Close St. Francis Hospital & Health Center (Press Release) [St. Francis]
The hospital they just couldn't save [Chicago Tribune via WSJ Health Blog]

"We've gone from a handful of patients when we started 2-1/2 years ago to 150 new patients a month," said Joe Andel, an American who owns the Rio Dental clinic in Ciudad Juarez with his Mexican dentist wife, Jessica.

Rio Dental, which uses U.S. labs to make its crowns, picks patients up at the airport in El Paso, Texas, across the border and has treated people from as far away as Alaska and Hawaii.

"The Internet makes this possible. It allows patients to find us and research us and shows we can do dental work of equal or superior quality to the United States," Andel said.

RELATED
"Get Cheap Plastic Surgery In Buenos Aires"
(Photo: Getty)

Citibank's card is open to anyone, and offers prescription discounts through PrescriptionDiscountBenefit.com. "For a fee of $8.95 a month, you can add on a vision and dental discount program, with discounts of up to 60% on services and eyewear."

For all three cards, the interest rates are in the 10-11% variable range.

"Credit Cards Offer Discounts on Medical Expenses" [SmartMoney]
(Photo: Getty)

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

A large body of evidence gathered in recent years has revealed a profound failure by health-care professionals to follow basic steps proven to stop infection and other major complications. We now know that hundreds of thousands of Americans suffer serious complications or die as a result. It's not for lack of effort. People in health care work long, hard hours. They are struggling, however, to provide increasingly complex care in the absence of effective systematization.

Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results. There need to be as few barriers to such efforts as possible. Instead, the endeavor itself is treated as the danger.

RELATED
"The Checklist" [The New Yorker]
(Photo: Getty)

One reason the Times selected the book is that, unlike so many "problem" books, it provides a series of possible solutions at the end.

It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds.

Other solutions would be more difficult—because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think it's the other guy who's getting unnecessary treatment. These are the reasons that presidential candidates don't focus on wasteful treatment.

But models for reform are out there. Hospitals that don't use the fee-for-service model, like those run by the Veterans Health Administration, are already getting better results for less money. They closely track their performance—that is, the health of their patients—and motivate employees to improve it.

They suggest that for basic illnesses, it might be both faster and more effective to try a walk in clinic—there are about 460 across the country now, but that number will jump to 4,000 over the next two years.

Walk-in clinics are... run by nurse practitioners, who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice or referrals if the problem is beyond their scope. These clinics have caught on in part because they're fast and don't require an appointment, says Steven Cooley, a physician and CEO of SmartCare Family Medical Centers in Denver. They're also cheap — $40 to $60 a visit, versus $150 for a doctor or $300 for an ER visit — and many take insurance.

"It is fiscal suicide to go out there and say, 'I am a geriatrician,'" Robinson says. "You get the patients that require the most time that pay the worst."

Until its collapse, the Soviet Union provided Cuba with cheap oil and fuel. These resources gone, Cubans ate an average of 1,063 few calories, drove less, and walked and biked more. Obesity dropped from 14% to 7%. Deaths related to diabetes, heart disease, and stroke fell.

In other words, eat less, burn more.

Move over South Beach, here comes The Castro Diet! All it requires is 11 years of economic deprivation.

[Study Abstract]
Economic crisis in Cuba leads to dramatic health improvements [University of Michigan]
(Photo: The Real Cuba)

There is also a reason AARP's Medigap policies — sold to Medicare recipients to cover expenses that the federal program doesn't pick up — aren't the cheapest, Sohn said. AARP is a national organization and wants to offer the same product to residents of every state. But providing health insurance is more costly in some states than in others. These products are regulated on a state-by-state basis, which makes operating in some places considerably more expensive than in others. Because the organization offers the same product everywhere at the same price, policyholders in low-cost states essentially subsidize those in high-cost states.

And with long-term-care insurance and term life insurance, AARP offers group plans that allow members to enroll at a reasonable price, even if they're not in the best of health, Sohn said.

The flip side: People who are in great shape can find far less costly products. They'll be required to get a physical exam to prove their good health, but it's probably worth it. AARP life insurance policies can be more than twice the cost of policies you can find elsewhere, Tignanelli said.

Though AARP's medical and financial products may cost more for some seniors, to others, they represent an otherwise unattainable deal. The only way to know for sure if you can get a better price is to shop around.

AARP not always best deal for seniors [L.A. Times]
(AP Photo/Wilfredo Lee)

With health-care costs rising fast and insurers more closely scrutinizing potential clients, consumers need to pay closer attention to what is in their medical records.

Not only can incorrect medical information lead to ineffective or harmful treatment — the Institute of Medicine estimates that as many as 98,000 patients die each year in hospitals from medical errors — it can also affect your insurability.

"You need to make sure you know what's in your medical records and correct any errors before you apply for insurance," says Carolyn McClanahan, a certified financial planner in Jacksonville, Fla., and a former medical doctor.

Savvy consumers know to check their credit score before applying for a loan. What is less well known is that consumers can improve their chances of getting insured — and of paying lower premiums — by checking that medical information held by doctors, hospitals and pharmacies is accurate.

Errors in medical records aren't uncommon. "They happen all the time," says Joy Pritts, research associate professor at Georgetown University's Health Policy Institute.

Patient Records Need Reviews [WSJ via WSJ Health Blog]
(Photo:Getty)

Not knowing who the father of the fetus is couldn't be used as an excuse under the new law. Women would have to provide a list of potential fathers who would then be required to submit themselves to paternity testing until a father is found. It would also make it illegal for a man who isn't the father to provide the permission.

What about rape or incest? A woman seeking an abortion would have to provide "reasonable cause" for the doctor to believe the rape of incest occurred, which, in our estimation, would probably mean police reports and charges filed.

Talk about the government getting all up in your private business. Proponents of the bill are saying it's a "men's rights" issue, but fail to mention a man's right not to be subjected to random paternity tests. This is real life, not the effing Maury Povich show.

Between the forced paternity testing of a random list of men to the "permission slips" and police reports... thank goodness this unconsumer-friendly hunk of crap is unlikely to pass.

Abortion law would give fathers a say State legislators propose change; opponents blast bill as 'extreme' [Record-Courier] (Thanks, Melinda!)
Text of The Bill [Ohio State Legislature]

Missouri doctors cited numerous objections to the pilot program, which was halted and is being redesigned. For example, most faculty members of the Washington University School of Medicine in St. Louis were initially excluded from the quality rankings because university-based care is generally more expensive. Doctors in major specialties were ranked by cost alone.

Tyler Mason, a spokesman for UnitedHealthcare, said the company had been meeting with the attorney general's staff. He said: "We share their commitment to looking at cost and quality. That's exactly what this is about. The assertion in the letter that sometimes higher cost equals higher quality is actually not what experts nationwide find. Sometimes lower cost means higher quality."

N.Y. Attorney General Objects to Insurer's Ranking of Doctors by Cost and Quality [NYT]
(Photo: Waldo Jaquith)

The intention of the clinic is to keep people out of the emergency room and inside the Walmart, according to the Daily Herald.

Ledlie [ senior director of Wal-Mart's health business development] said its in-store clinic operators found that more than half of the customers who used the clinics said they had no health insurance, and nearly 15 percent said they would have gone to an emergency room if the clinic was not there.

"That was the hypothesis, but to see that proven out in the data really, to us, felt like this was the right time to go forward in a bigger way," Ledlie said.

Hastings said keeping customers out of emergency rooms makes sense for Wal-Mart, whose lower-income shoppers are being squeezed by high gasoline prices and a slowing housing market.

An unexpected emergency room trip could drain a shopper of dollars they would otherwise spend at Wal-Mart, he said.

Ledlie said the clinics fit the idea of "one-stop shopping" — a customer who has been treated for a sore throat can then fill a prescription at a Wal-Mart pharmacy and buy everything from chicken soup to cough drops before leaving.

More complex and riskier than traditional health-care, these new plans have patients pay lower monthly premiums in exchange for higher annual deductibles.

If this sounds appealing, keep these questions in mind.

• What health care services am I likely to use?
• How much of my health care costs am I responsible for?
• What is covered?
• Can I save toward future health care costs?
• How can I learn more?

Get informed, because after all, you're essentially placing a bet that you won't get sick.

Rolling the Health Dice [NYT]

As if the injury weren't bad enough, he soon found himself under the fell gaze of Child Protective Services after the workers of the Hospital Corporation of America mistook his Asian wife's stoicism for not "being comforting enough."

Because of the inquiry by CPS, the setting of AppTechie's son's arm was delayed by two excruciating days.

AppTechie has inquired with malpractice lawyers but they have told him that, "because of riders on the new laws regarding a cap on what a person can win i a medical malpractice case, doctors, and especially ER doctors, are practically bulletproof for engaging in dangerous practices with patients and that we have no way to win a case like this one without extraordinary expenditure for experts and the like."

Do you agree? Does AppTechie have a case? Or should he just try and get on with his life? Read his story inside.

AppTechie writes:

Tip #1: Negotiate — If you don't have health insurance, as your doctor for a discount. Apparently only 13% of patients bother doing this but, when they do, the majority receive a discount.
Tip #4: Confirm that tests are necessary — In the interest of covering their butts, it's possible that doctors will order unnecessary medical tests.
Tip #7: Watch for double billing — It's not uncommon for hospitals to double bill for certain things. For example, they might charge a daily room rate as well as for sheets and pillows.

Basically, get everything itemized and question anything that seems out of sorts.

Save on Medical Care - Part I, Part II, Part III, Part IV [FiveCentNickle]

• Is drinking mouthwash actually harmful to anything other than your social standing? [Link]

• I'm obsessed with trying different shampoos. Do you find that any of them actually do what they say, as far as making your hair shinier/straighter/less frizzy/less poufy etc?[Link]

• CarRepairFilter: Help me figure out what's going on with my usually well-behaved car, and what, if anything, it might have to do with a letter I got from Acura back in January... [Link]

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Doing some more reading on the subject, we were delighted to find this review of the American health care system in the New York Review of Books by Paul Krugman and Robin Wells. The summary is that the US Healthcare system spends more money on health care, yet the average American gets far worse care than comparable countries.

A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

Also interesting is this dissection post on Concurring Opinions, in which they talk about the enormous political status quo of healthcare's hopelessly fragmented system, which they believe would be a powerful adversary to any sort of universal health care / single payer situation. Just a fascinating problem.

Related: My Experience With Socialized Health Care

Link: Canadianizing the Golden State

I'm torn on this. Ireland has socialized medicine, and it sucks. When I first moved to Dublin, I took my Yamaha Superscooter out for a rush-hour drive and took a spill off it going around 55, breaking both my arms and one of my legs. Luckily, I was right around the corner from the hospital, so I got up from the mangled wreck of my bike, flagged down a taxi, and had him bring me here. When I got to the emergency ward, a scrolling sign chipperly announced that average waiting time was 8 hours. It was 9am on a Tuesday morning.

Near the door, a man with a board nailed to his face grumbled to his ashen-faced girlfriend that it was four hours since he'd arrived and he had a board nailed right through his fucking face, doesn't that take some kind of precedence? I didn't think I could compete with that. Thinking quickly, I hobbled back outside, flagged down another taxi, and had him drive me back to my superscooter accident. I propped myself up by the curb in a dramatic semblance of agony then called for an ambulance. When I got to the hospital, I bypassed the emergency room line entirely, was treated immediately — ambulances, apparently, don't go through queues.

Read the rest after the jump.

The entire experience was an odd admixture of abject incompetence and occasional excellence. The good news is that my bill at the end of the day was only 75. I met some cute nurses. On the other hand, if I were to see a doctor for fifteen minutes in a follow-up appointment, I would have to take the entire day off work, just because of the lines. When I eventually saw the doctor, more likely than not he would merely rattle my arm around in the cast, put his ear to it and rap upon it with his knuckles, as if testing the ripeness of a coconut. When my casts came off (which I actually had done with a serrated knife in my bathroom that morning, not wanting to have to wait in both the cast removal queue and the queue to see a doctor), the doctor told me that despite breaking 75% of my major appendages, there was "no need for rehab or exercises" and swatted me away when I began pointing out the fact that I could not bend my wrists or knees at all.

Maybe it's the American in me, but as nice as it was that the entire ordeal cost me only 75, I would have gladly paid just to be treated with some semblance of competence and sympathy. I've had my share of negative hospital experiences in the States too, but a long line in the States generally meant a couple hours waiting in the emergency room on a Friday night, not an eight-hour queue on a weekday morning. I never have had an experience in the privatized American healthcare system that can match the callous incompetence of my experience under Ireland's socialized medicine system.

The bottom line is that money talks. Whether we're talking about health care, cars or cellular phone coverage, you get better service the more money you pay. When no one's paying any money, you as an individual become a statistic and receive the base minimum of care, competence and attention to maintain the aggregate. So making private health care out-and-out illegal seems like a disastrous move for the consumers of health care.

I'm not sure what the solution to the problem is — the negative side of the American system is that, all too often, people without insurance get reamed, and I'm liberal enough to believe that every person has an unqualified right to be cured when they are sick. But that's a paradox: how can money talk when not having money guarantees you the same rights? Is the solution to make it the law that every company has to supply health insurance to their employees, regardless of full-time employee status and other mitigating factors? Those who are unemployed get taken under the umbrella of socialized medicine. But I can see that having extremely adverse economic drawbacks as well and I'm not nearly smart enough to know how to make that work.

Does anyone out there have any thoughts on the subject of universal health care, or know of any schemes that address the issues I've touched on here? I'd love to hear them. Drop us a line in the comments section below.