Our health care system is not the greatest on the planet because of private health insurance. It is the greatest on the planet because of a great educational system. None of the great health care advancements to come out of this country came from the private sector. NONE!

(1) a “great educational system”? Yeah.
(2) I would wager that MOST great health care advancements of any note came from the private sector. In general, by overcoming a crapload of interference from bureaucracies and plaintiff lawyers.

You got a bug up your butt about insurance companies. Fine. I’m not overly fond of them myself, but the environment created by ambulance-chasers and an insane bureaucracy is what made the costs of the whole health care industry so off-the-planet.

Government takeover of the industry will obviously make the situation worse, not better.

You clearly have no idea how to read this document. A person would not be denied and appendectomy over a person with “tobacco dependency.” If that were the case then EVERY case of appendicitis covered by Oregon in the state would be fatal. It is not a “wait and see” issue.

As I clearly stated in the column, the prioritization of covered treatments (by the way, 503 is a pretty low number of coverable conditions, wouldn’t you agree?) comes into play when the state is judging what to do with its finite amount of dollars. If there’s only enough money to provide tobacco addiction assistance OR to fund an appendectomy, the former gets the coverage. Period, dot, end of story.

Next, I’ll give you $1,000 if you can proved that your own health insurance doesn’t have the same type of issue where they deny you care if there is a < 5% chance of 5 year survival. They ALL do.

Playing the game of equivalence between Obamacare/”public” coverage and private insurance is a non-starter. The entire rationale for a government-centric health overhaul — and for a “public option,” like the one in Oregon I wrote about here — is that it provides better, more accessible, and more humane coverage than those eeeeevil private insurers. When called on that fallacy, though, you and those like you want to slip from an argument of superiority to one of equivalence. I’ll thank you to leave the goal posts on this field buried right where you first put them.

Additionally, most people are dropped by their group coverage long before it even comes to this.

Looking for your citation….oh, right, you don’t have one, do you?

Getting back to that superiority vs. equivalence argument, is the point of that comment to say “look how humane this program is — they’ll keep you on even while not doing anything to :prolong your life” or “alter disease progression” (read: cure you)”?

Here is what happens: you have group coverage through your employer and become very sick with, say , cancer. Once you move into the companies defined “long term disability” you are force into COBRA. COBRA benefits means that you pay “full price” for your health insurance (usually 3-4 times your previous coverage payment). But because you are not on 40-60% of your base salary you can’t afford the $900+ for health insurance and you’re dropped.

Hm. My wife is on COBRA, and based on the checks I write each month, your numbers are BS.

Moving on from that, though, are you (again) trying to make the case that this “public option” program is superior to private coverage because it allows you to die while being able to say you had some form of “coverage” up to the (accelerated, based on public option rationing policy) end? Is that really the best argument you have to make?

Our health care system is not Cbecause of private health insurance. It is the greatest on the planet because of a great educational system. None of the great health care advancements to come out of this country came from the private sector. NONE!

First off, I’d love to see you try to explain (with citable facts) your claim that our health care system is the “greatest on the planet” (which it is — thanks for acknowledging that, and please explain to me why we’re supposed to support trading it in for a lesser model) “because of a great educational system.” Really, something that shows that correlation would be great. Anything.

Second, nobody said private health insurance was the reason our health care system was “the greatest on the planet.” In fact, I’d argue that we’re held back in large part because of our dependence on insurance. If doctor visits and small medical expenses were paid out-of-pocket, instead of through a third party, then costs would come tumbling down, both because we’d be cutting out the middle man and because folks would actually know what things cost and, through the power of the consumer’s purse in a free market, effectively demand that those prices drop to a level they could — and were willing to — pay. Insurance shouldn’t be the payor for every expense; rather, it should be insurance against catastrophic events.

You don’t go through your homeowner’s insurance underwriter to purchase a new light bulb for the front porch, screen for your window, or doorknob for your bedroom door. Doing so would be ludicrous, because it would jack up your premiums, cause the price of those goods to rise as a result of administrative and middle-man-salary costs, and give you less control over your home repair dollars. So, you pay those minor expenses out-of-pocket and rely on insurance to back you up in case of unaffordable catastrophe.

The same should be true of health care. Unfortunately, not only do we honor (and pay for) the Unholy Trinity of Insurer-Doctor-Patient (with each leg of the triangle only being able to communicate and exchange resources with one other) in every medical transaction, but anti-private industry zealots like yourself and government-control advocates like the President, the Speaker, and others are working hard to permanently enshrine us in an even more inviolable version of such a system with your “single payer” advocacy.

The middle man needs to be cut out, not to have an impassable wall built around him by government.

And that brings me to your final “point”: that the private sector has never made a medical advancement. I’d say you must be joking, but you’re clearly incapable of such a thing. So, let me just rattle off a few private sector health care advancements for you: the diphtheria antitoxin, the smallpox vaccine (the only one on this list that wasn’t made in this country), the discovery of DNA structure, discovery of the genetic structure of viruses, penicillin (both discovery and development), and vaccines for polio and pneumonia.

I’m sure you’ll ignore this last, though, as you appear to be a true believer. In fact, I hear that if you cover your ears and shout “the private sector has never accomplished ANYTHING!” and “government is the best, most efficient, and most productive producer of everything ANYWHERE!” enough times, it can actually come true.

Don’t let me stop you trying that. Just remember, you have to keep saying it until it happens. No stopping and no quitting allowed, or your wish just won’t come true — and that would make us all sad, wouldn’t it?

Unfortunately, the higher number doesn’t indicate more weight in the system — in indicates a lower priority.

The state made a very big deal about this year’s rankings at their release, playing up the fact that “prevention” (tobacco cessation, obesity treatment, abortion, etc.) was the new focus and highest priority of the State (and of the rationing council).

It’s illogical, counterintuitive, and perverse…but it’s right (it’s government).

That fact is borne out on the Oregon Health Services Commission’s website, which explains both the mindset and methodology behind the rankings.

In part, it says:

[T]he rankings of the Prioritized List of Health Services included in this report are based on the first revision of the prioritization methodology since the Oregon Health Plan’s implementation in 1994. This methodology places a new emphasis on preventive care and chronic disease management in the recognition that the utilization of these services can lead to a reduction in more expensive and often less effective treatments provided in the crisis stages of disease. The methodology also reflects a better account of clinical effectiveness and cost-effectiveness into the ranking of health services as directed by Section 8 of House Bill 3624 (2003) and codified in ORS 414.720(4b).

Further, on the methodology page, it says:

In the summer of 2005, as the HSC began to prepare for the biennial review of the list. The Commission was encouraged to ask themselves whether the basic structure of the list represented what they truly considered to be the most important to the least important. It was suggested that a higher emphasis on preventive services and chronic disease management would ensure a benefit package that provides the services necessary to best keep a population healthy, not waiting until an individual gets sick before higher cost services are offered to try to restore good health again.

The HSC believed that placing a higher value on prevention and chronic disease management was a good idea on its face and could be crucial in maintaining a sustainable program as we face an aging population. …Some of the services moving towards the top of the list as a result of this reprioritization include maternity care and newborn services, preventive services found to be effective by the US Preventive Services Task Force, and treatments for chronic diseases such as diabetes, major depression, asthma, and hypertension

By the way, the reason the covered conditions list dropped from 680 to 503 is because people were dropping out of the program (enrollment went from “over 100,000 to under 24,000…over the last three years,” according to the OHSC) and the powers that be decided that cutting coverage for those who were still enrolled was a worthwhile trade-off to be able to afford to bring more people back into the program with expanded eligibility requirements — despite several Commission members’ disagreement that drastic coverage cuts were worth the mere 4,000-enrollee increase those cuts would bring about.

Again, according to OHSC’s website:

To note, the present cost of covering the much reduced OHP Standard population is currently higher at a per-person level due to higher chronic disease prevalence and service utilization[Ed: This was supposed to save big bucks, remember?]. …Health Services Commission members continue to believe that it is preferable to provide a reduced benefit package focused on preventive services and chronic disease management to the OHP Standard population and encourage the legislature to consider ways to use the new Prioritized List as a means to achieve expanded access.

It’s very, very ugly when seen up close — as are most things when government is involved.