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Saturday, August 08, 2009

Learning from France

France's health care system is often held up as a model of how successful a single-payer, universal health care plan could be. However, France is waking up to the costs of having such a plan.
The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul.

French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it. France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.

The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.

France's woes provide grist to critics of Mr. Obama and the Democrats' vision of a new public health plan to compete with private health insurers. Republicans argue that tens of millions of Americans would leave their employer-provided coverage for the cheaper, public option, bankrupting the federal government.

Despite the structural differences between the U.S. and French systems, both face similar root problems: rising drug costs, aging populations and growing unemployment, albeit for slightly different reasons. In the U.S., being unemployed means you might lose your coverage; in France, it means less tax money flowing into Assurance Maladie's coffers.

France faces a major obstacle to its reforms: French people consider access to health care a societal right, and any effort to cut coverage can lead to a big fight.
With Medicare, our universal health care plan for the elderly, facing an practically insurmountable shortfall, is there any reason to think that we would have fewer problems if we took in the entire nation into a Medicare-like plan?

And once we start down that road, we'll find that, like France, it becomes politically impossible for a democracy to cut costs. Too many people will become accustomed, as the French have, to seeing low-cost health care as their right and scream bloody murder if politicians try to trim costs. Nicolas Sarkozy is finding that out.
For instance, in France, people with long-term diseases get 100% coverage (similar to, say, Medicare for patients with end-stage kidney diseases). The government proposed trimming coverage not directly related to a patient's primary illness -- a sore throat for someone with diabetes, for example. The proposal created such public outcry that French Health Minister Roselyne Bachelot later said the 100% coverage rule was "set in stone."

"French people are so attached to their health-insurance system that they almost never support changes," says Frédéric Van Roekeghem, Assurance Maladie's director.
That's all well and good for the recipients of that 100% coverage, but it is not economically feasible in the long run. And you know that is what will happen here. Just think of how state governments have run into problems by mandating all sorts of coverage for treatments that might seem worthwhile on an individual basis such as prescriptions for Viagra or plastic surgery, but have driven up the cost of health insurance to pay for such gold-plated policies. Will politicians ignore the special interest groups demanding such coverage? Doubtful. And thus we will just be compounding the financial liabilities that we already can't pay for with Medicare.

Before we rush through some poorly cobbled together plan designed to satisfy interest groups and recalcitrant politicians, wouldn't it make sense to study more carefully the problems faced by countries and U.S. states such as Massachusetts, Maine, and Tennessee, that have adopted similar plans and are now finding out that they just can't afford such policies? That is the benefit of federalism - learning from the experimentation tried in individual states and even from other countries before applying such policies to the country at large. But there seems to be no indication that the Democrats in Congress have truly studied the problems such states have run into or the problems France is facing before plunging right in to repeat those problems. This is why the rush to pass this plan is so detrimental to sound health policy.

31 comments:

Bill B. said...

"Medicare, our universal health care plan for the elderly, facing an practically insurmountable shortfall"

Wow! How large is that projected shortfall? (I.e it hasn't happened yet, but some people think it will.

Is it less than the cost of the Iraq failure? Because you cheered just fine for that for 6 years. I think we can afford at least the same invested in Americans.

tfhr said...

Way to go Betsy, you've almost certainly provoked a gran mal from Biddle.

Wet clean up on aisle four!

tfhr said...

11 minutes late!

Wilson said...

So, trillion dollar wars and multi- trillion dollar bailouts of bankers and Wall Street by the Bush Administration is hunky dory, but god forbid we rush into actually helping those less fortunate than ourselves without insurance by emulating the highest rated health care provider in the world while the US is rated 37th, just behind Costa Rica...which is known for it's superb health care too. I would like to sum up Betsy's entire post as "I got mine, screw you!" because as she cautions us to slow down and study the issues, 50,000 families are going into bankruptcy this month due to health care in the US. How many people are going bankrupt in France this month??? NONE, Betsy, nada, zilch.

Pat Patterson said...

The French system, though admirable in several ways, does currently have two things going against it that Americans might not be particularly in love with. Illegal aliens and recently some legal aliens are not eligible for state coverage, they can purchase only very expensive private coverage, but are taxed as if covered nonetheless. The other is that this current emergency subsidy increases the cost of health care in France to 16% of GDP which is not much different than the US. Add in the discrepancies in the quality of care and the difference in the collection of the quality of care indicators and there simply isn't much difference.

Except we, if we emulate the French system, will end up paying more and eventually end up with the same decades old technology and care that Europeans seem unrealistically proud of. And a few unwary Americans as well.

tfhr said...

Wilson/Biddle,

Thanks for taking my suggestion and adopting the volleyball's name from Castaway as your latest nom de sock. Fittingly orb-like in appearance, somewhat deflated but still capable of expressing a few wheezing gasps of hot air, but nothing more than a toy to be batted around, it is a perfect symbol for you. It will also be a fresh breath of air from the stinky, thread worn, loner sock in the lint trap, master.of.biddle.

How do we know it's Biddle? A total failure to provide sourcing for the following claims:

"50,000 families are going into bankruptcy this month due to health care in the US. How many people are going bankrupt in France this month??? NONE, Betsy, nada, zilch."

Link? Nope.

The Constitution does not provide for government any obligation to pay for anybody's health care but it does require that the Congress raise and maintain the Armed Forces. If you're angry with your Congressmen, then ask them why they continue to fund operations in Iraq, Afghanistan, and around the globe? Are you bitter that Barack Obama is continuing in George Bush's footsteps in his conduct of this war? Contact him at flag@whitehouse.gov. I hear he is taking names. But most of all, calm down and stop maligning the host of this site with remarks like, "I got mine, screw you!"

You sound unhinged and maybe even less than capable of understanding the content of her post. You should calm down, take two aspirins and rest.

Bill B. said...

Pat throws some sand in everyone's eyes with vague reference to illegal immigrants.

Here's an idea Pat - we just don't cover them. Or we cover them and charge them the same as everyone else. You pick. It's a complete non issue.

Everyone else who thinks we can't do at least as well as the French, please leave the room now.

Bill B. said...

Quitter Palin has published this on her facebook page "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil."

I'm changing my voter registration to Republican, so I can vote her through in the primaries. Raw imagination like Palin's deserves to be rewarded.

tfhr said...

Biddle,

WE AMERICANS prefer America to France. Why would we want to do "as well as the French"? We could move to France (Oui, You could move to France) where the hospitals lag behind ours and where there are shortages of doctors in many rural areas, but it isn't the model of perfection that you claim.

Your definition of "well" conveniently overlooks the fact that the French system is headed to bankruptcy, much like our current Medicare system, and that it too has its segments of the population that are uninsured. You seem completely oblivious to the added complication that the French system is a significant contributing factor to the high unemployment rate in France. Not to mention that the French legal system does not advance the interest of tort hungry lawyers. (As always, legal reform is completely absent from your comments here thus betraying your desire to put the interest of a powerful political lobby like trial lawyers ahead of helping people with more affordable health care.)

There isn't a perfect government system for health care. The free market holds the solution for affordable health care and much of the high costs we see today are a result of the harmful effects of current government intrusion. To regulate to protect and enforce standards is fine but to subsidize, bureaucratize, and politicize health care drives up costs.

tfhr said...

Biddle,

As for your typically childish attack on Palin, go to the link:

THE DESTRUCTION OF SARAH PALIN
http://pajamasmedia.com/ejectejecteject/

If you are too lazy to read the essay, then just use the link provided by the author, Bill Whittle (huh, rhymes with Biddle - look at me, I'm rapping).
http://www.pjtv.com/video/Afterburner_with_Bill_Whittle/___The_Media%2C_The_Left_and_GOP_Elitists_vs_Sarah_Palin%3A_A_Lesson_on_How_to_Destroy_a_Leader/2235/;jsessionid=abchQdEncexhj_NKWX_ks

Pat Patterson said...

No bankruptcies in France? Hardly, there are currently almost 1 million people in the first stage of bankruptcy, before what is called a debt commission who are charged with trying to find all the assets, investigate any criminal charges and work out a payment schedule if possible.

The bulk of this group, around 65%, will be eventually declared bankrupt and lose all their possessions, I don't know if some assets are protected as in the US. And like the US over 60% of these are credit problems.

As to the charge that medical bills are responsible for the bulk of bankruptcies we have been over that nonsense before when it was determined that if one owed $5k then it was wrongly considered the cause of the bankruptcy not the mortgage or car or tuition payments.

Bill, as usual, did not notice that I was referring to illegal immigrants in France not the US.

tfhr said...

Pat Patterson,

Take it easy on Biddle. He's confused and not getting much support in the way of talking points. These gems he keeps tossing up are like Blue Dots in a strong outbound breeze and they fly better than balloons!

Hey batter, batter, batter...link!
http://www.nextag.com/worth-super-blue-dot-softball/products-html

Tacitus Voltaire said...

France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.

i suppose betsy wants us to thank the republican party for saving us from this nightmare of medical efficiency and fiscal sanity

Pat Patterson said...

The US and France use completely different methadologies in tabulating infant mortality. The US counts any fetus that has a breath or hearbeat, regardless of gestation or weight, as a live birth. While France, using the WHO system and excluding illegal aliens from its tally counts those risky and not so risky births as live only if the baby lasts a full year. If it dies during that period it is reported as a miscarriage which the US would report as such if the baby was still born. Apples and oranges!

tfhr said...

TV,

I wouldn't suppose anything if I were you since you've failed to research your topic and you've been conspicuously absent from the debate going on in these threads.

Biddle showed up here in in French nurse's outfit a few days ago and got torn up. Here's why:

Financially Unsound

"...France's national health service, rated the best in the world by the World Health Organisation, will collapse within the next 15 years.".
http://www.guardian.co.uk/world/2004/jan/24/france.jonhenley

"France, like all countries, faces rising costs for health care. In a country that's so generous, it's even harder to get those expenses under control".

"Last year, the national health system ran nearly $9 billion in debt. Although it is a smaller deficit than in previous years, it forced the government of President Nicolas Sarkozy to start charging patients more for some drugs, ambulance costs and other services".
http://www.npr.org/templates/story/story.php?storyId=92419273

Unresponsive

"During an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died."
http://www.healthcarebs.com/2007/08/13/french-health-care-for-the-us-merci-non/

"Hospital facilities, although greatly expanded since World War II, are still considered inadequate. Doctors tend to be concentrated in the cities and are in short supply in some rural areas".
http://www.discoverfrance.net/France/DF_healthcare.shtml

Unemployment

"To fund universal health care in France, workers are required to pay about 21 percent of their income into the national health care system. Employers pick up a little more than half of that. (French employers say these high taxes constrain their ability to hire more people.)"
http://www.npr.org/templates/story/story.php?storyId=92419273

Unlike America

I told Biddle and I'll tell you too that French doctors earn much less than their American counterparts (and I suspect that is also true for French lawyers) BECAUSE:

"...the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a TORT-AVERSE LEGAL SYSTEM, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay MUCH LOWER MALPRACTICE INSURANCE PREMIUMS". http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/

The effect is lower cost for the government or other payer in an environment where tort law is so restricted but we never ever hear about tort reform from the Dems. I know you know why but isn't it amazing that this has gone on for so long? The boogie man label gets slapped on doctors, insurance companies, you name it, but some how the trial lawyers are under the radar!

Pat Patterson also pointed out the difference in the GDP expenditure shrinks to about 1% when you factor in that France does not care for their illegal alien population as we do.

All in all, TV, France is a nice place to visit, but I would not want to live there and I don't want their health care system here. The only French person I know came to this country for a variety of reasons but the one I think is most applicable here in this discussion is that she inherited a congenital heart condition that took the life of her mother (at birth) and her brother (some years later). She was from a rural area in the south and while she missed much of what that region is so famous for, she much preferred the medical care she receives in the United States.

Tacitus Voltaire said...

will collapse within the next 15 years.".

i heard many such overconfident predictions about the imminent collapse of western europe back in the 80s. i guess they were a liitle off...

the rest of what you cite impresses me not at all. guess what - our health insurance system is not perfect either - did your research uncover that obscure fact? as a matter of fact, our native horror stories are considerably worse

Tacitus Voltaire said...

"...the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a TORT-AVERSE LEGAL SYSTEM, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay MUCH LOWER MALPRACTICE INSURANCE PREMIUMS". http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/

somehow this is supposed to convince me that the french system is worse?

tfhr said...

TV,

The part about the tort issue is to point out the apple and orange comparison between the two systems and also to show that real reform could be had if the Dems would only put the trial lawyer lobby at bay. Can you not understand this? Why are lawyers your sacred cow?!

Medicare is teetering due to outlays exceeding income. Do you dispute this? France is headed on the same path. Why must you wait for the bus with no brakes and no driver to go over the cliff before deciding that maybe it was a bad idea to get on it in the first place?

Tacitus Voltaire said...

The part about the tort issue is to point out the apple and orange comparison between the two systems and also to show that real reform could be had if the Dems would only put the trial lawyer lobby at bay. Can you not understand this? Why are lawyers your sacred cow?!

um, this part was where you bring in yet another part of the french system that is superior to the american, and ask me why i don't support making the american system as good as the french here. how do you know whether i agree with you or not?

i come from a family of doctors. my cousin is a surgeon. there are two separate issues here: so-called "tort reform", and the high cost of insurance premiums. the two issues are related, but not the same. i think any "tort reform" absolutely needs to be linked to a promise from the insurance companies that they radically reduce the premiums, which is the part that directly impacts doctors. otherwise, the doctors will be just as impeded financially as ever.

Medicare is teetering due to outlays exceeding income. Do you dispute this? France is headed on the same path. Why must you wait for the bus with no brakes and no driver to go over the cliff before deciding that maybe it was a bad idea to get on it in the first place?

after hearing for forty years about how social security, medicare and medicade, and western europe will definitely go bankrupt within (x) years, you will forgive me if i am a bit skeptical

Tacitus Voltaire said...

Pat Patterson said...
The US and France use completely different methadologies in tabulating infant mortality. The US counts any fetus that has a breath or hearbeat, regardless of gestation or weight, as a live birth. While France, using the WHO system and excluding illegal aliens from its tally counts those risky and not so risky births as live only if the baby lasts a full year. If it dies during that period it is reported as a miscarriage which the US would report as such if the baby was still born. Apples and oranges!


i'm afraid pat is a bit logic-challenged here if he wishes to cast doubt on the advantage that the french measure in terms of infant mortality, as what this shows is that the american system of tabulating live births would, if anything, tend to give a higher percentage than the french system

so what pat has demonstrated here is, actually, that the advantage that the french show, routinely outranks the U.S. in infant mortality, must be even greater than we might otherwise conclude if we don't factor in pat's information

i can't imagine what phenomenon it is that has caused betsy, tfhr, and pat all to bring up information demonstrating areas where the french system is superior

equitus said...

Logic and causation:
Tort reform => reduced medical costs => reduced outlays for insurance companies => reduced premiums.

TV:
Reduced insurance premiums => tort reform

As for infant mortality, I think TV needs help to understand. Infant mortality stats do not include still births - only live births. What I'm hearing is that the US is generous in counting live births, even very ill babies. So when a very ill baby dies, it adds to the infant mortality stats. On the other hand, it appears the French do not count these very sick babies as live births, so when they die in the first year they're never included in the IM stats. In short, the US includes cases of IM that the French would not.

Also, TV didn't address the illegal alien disparity either.

Tacitus Voltaire said...

Logic and causation:
Tort reform => reduced medical costs => reduced outlays for insurance companies => reduced premiums


this chain of events is highly suppositious. the problem is not the highly profitable insurance companies having to pay out a few million more, the problem is that the extremely high premium for doctors, who after all do not usually earn more than a half a mil per year. despite your naive faith in this chain of events, there is not the least guarantee that insurance executives will cease squeezing the life out of doctors because of reductions in awards

Tacitus Voltaire said...

In short, the US includes cases of IM that the French would not

nobody has cited any source for these definitions, and i don't find any sources for american births that define it any other way than the infant surviving for a year after delivery, or that describe any differences in the american or WHO definitions:

WHO website, http://www.who.int/whosis/indicators/compendium/2008/3mr5/en/

"Infant mortality rate is the probability of a child born in a specific year or period dying before reaching the age of one, if subject to age-specific mortality rates of that period...

...Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born."

i find no sources that support your contention of differences in methods of calculations

Dr Weevil said...

Can't find a source? Should have kept looking. I have read this many times over the years, with the most detailed account in (I think) The Public Interest 15+ years ago. Here's something recent from IBD, which I found quoted on Random Jottings -- unfootnoted, but quite specific:

"Infant mortality rates are often cited as a reason socialized medicine and a single-payer system is supposed to be better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.

"As she points out, in the U.S., low birth-weight babies are still babies. In Canada, Germany and Austria, a premature baby weighing less than 500 grams is not considered a living child and is not counted in such statistics. They're considered 'unsalvageable' and therefore never alive.

"Norway boasts one of the lowest infant mortality rates in the world — until you factor in weight at birth, and then its rate is no better than in the U.S.

"In other countries babies that survive less than 24 hours are also excluded and are classified as 'stillborn.' In the U.S. any infant that shows any sign of life for any length of time is considered a live birth.

"A child born in Hong Kong or Japan that lives less than a day is reported as a 'miscarriage' and not counted. In Switzerland and other parts of Europe, a baby is not counted as a baby if it is less than 30 centimeters in length."

Pat Patterson said...

Wikipedia, sometimes accurate, ackowledges that the numbers are collected differently and an article from 2006 in US News and World Report goes into the differences by examining how the numbers are collected and the sizes of the samples.

http://tinyurl.com/22v5c5

The rest of the section referring to WHO also makes it quite clear that WHO is referring to live births after five years. But again the US lists all births as live if there is a pulse or breath while most European countries still wait one year, which is perfectly acceptable to WHO, as well as using weight and gestation as determinants to when to label the birth as live.

Another article by Nick Erberstadt also noted the discrepancy between how infant mortality rates are arrived at noting that some countries do not even keep statistics on some types of birth until the one year date approaches then counts them as a live birth without noting the actual birth date.

http://tinyurl.com/3589hc

Tacitus Voltaire said...

um, dr weevil, your quotes don't mention france, and directly contradict what is clearly stated on the official WHO website. now let's see, who is the best authority on WHO standards? WHO, or a policy advisor in the california state senate quoted in investor's business daily...

even so, i find this interesting metric: "Most infants are born at around 36 weeks and weigh about 3400 grams, or 7 lbs. Low birth weight infants are those who weigh 2500 or less grams, or about 5 ½ lbs. Very low birth weight infants weigh 1500 grams, or about 3.3 lbs. Extremely low birth weight infants weigh 1000 grams or less, or about 2.2 lbs" (http://www.expectantmothersguide.com/library/newjersey/lowbirthweight.htm)

how many babies in the unted states and europe would be born at half or less than the "extremely low birth weight"? looking here, http://www.healthsystem.virginia.edu/uvahealth/peds_hrnewborn/vlbw.cfm, we find that this is measured at 0.2 percent

therefore, using actual evidence, we can see that this factor that it cited only in a financial magazine, if true, would only have a 0.2 effect on the total statistics

tfhr said...

TV,

Are you suggesting wage and price controls when you say, "a promise from the insurance companies that they radically reduce the premiums,...."? It's funny that nobody has offered to dictate to lawyers what they can charge their clients.

No the insurance companies will not need to be told. They'll listen to a mysterious power...It's called competition. Often mistaken for a dirty word by liberals, competition is a natural component of the free market.

Here, I'll use it in a sentence. "If tort reform placed a limit on the size of medical malpractice awards, not only would doctors be inclined to practice less defensive medicine but could also take their business to insurance companies that offered lower premiums than their competition."

Hey, I have to give you credit because you are just about the only one here advocating for current health care "reform" plan(s) that is still open to the idea of tort reform. Why do you suppose it's absent from the current plan(s)? That is why I brought up "part of the french system that is superior to the american". How can a politician point to a health care system like the one in France and still blow off tort reform? (It makes me question their sincerity, competency, and intellectual honesty.)

And as long as I'm asking questions, how do your doctor/surgeon relatives feel about our Medicare system? Do they have to pass off to their non-Medicare customers the unpaid difference remaining from what they are reimbursed for patients with Medicare coverage versus their actual costs? Do they support the health care "reform plan", as it is currently configured?

I only know two doctors and though they practice in relatively low risk fields, they have six figure insurance premiums. Neither has been the subject of a law suit but because of where they live, they really are stuck. I guess this would be a good place to segue into reform that would allow doctors and patients alike to purchase insurance from wherever they found the best deal, but I'll stop for now.

equitus said...

i can't imagine what phenomenon it is that has caused betsy, tfhr, and pat all to bring up information demonstrating areas where the french system is superior

Such phenomena be found in your faulty logic, TV. If you find yourself confused, reconsider your premises. It works wonders.

Tacitus Voltaire said...

take their business to insurance companies that offered lower premiums than their competition

the eternal naive faith in the goodwill of insurance companies, who, of course, couldn't already compete with each other, but just make huge profits and charge outrageous premiums because of the wonderful nature of the competetive system

the only people who will suffer restriction under the regimen of you devotees of freedom for all and lack of restrictions would be the evil sufferers of the malpractice of doctors, who have the temerity to get compensation in open court for the damage that has been done to them and their children - yes, they are the ones who deserve to not partake of freedom in open court, according to you

insurance companies, innocent victims - people who have been hurt, evil graspers - such is your value system!

Tacitus Voltaire said...

Do they support the health care "reform plan", as it is currently configured?

yes, because they understand the economics of health care, and know that treating people who do not contribute to health insurance make the system more expensive for us all. what you guys have against getting all americans to contribute to health insurance, i don't know

you might try talking to some doctors before forming your opinions, as you apparantly have not

your naive faith in the eventual pressure of the free market to cause insurance companies to lower their profits because patients will be restricted in lawsuits is touchingly naive

i'm sure the insurance company presidents who make, literally, $100,000 an hour, will get a nice feeling from it

tfhr said...

TV,

Wow!

"...the goodwill of insurance companies, who, of course, couldn't already compete with each other, but just make huge profits and charge outrageous premiums because of the wonderful nature of the competetive system"

You certainly hate the things you don't understand. Competition is a good thing, right? Can we agree on that?

Now, are you saying that there is collusion amongst medical malpractice insurers? Link please.

Are you suggesting that an insurance company's overhead does not include legal fees such as paying for staff, court costs, etc.?

Here is the concept: If an insurance company can perform its advertised services cheaper than another but with the same or superior quality of all other insurers, who do you think the doctor will contract for a policy?

Simplified: You have auto insurance, right? Did you take the first or most expensive policy you saw or did you shop it around to find the best price?

TV, doctors do the same. The two doctors I know certainly have sought to reduce the premiums they pay. (By the way, I have discussed the current debate over government medical care with them and well, I guess they don't have the same perspective as your family members, if I understood you correctly) Another sidebar: One of my friends donates a day each week at a free clinic. He tells me that the patients are notoriously unreliable about showing up for their scheduled appointments. Do you suppose that is because it's free? They've sacrificed nothing but tied up the doctor, blocked access for another person and created more work for the staff, but no skin off their nose (actually, eyes), they'll just reschedule.

Now back to the horrible people that provide insurance for us. I know they are the villain du jour because smarter Dems have figured out that people do get tired of hearing the left beat up on all of those "greedy" doctors out there, but if one company lowers its premiums the others will have to follow suit or provide more and better services or they will lose business.

There is another example that might help you and that is the cable business. It's a good example because it is heavily regulated and taxed by the government and does not offer as much competition as it should. There is a level of artificial competition between Verizon and Comcast where I live. Because of government restrictions, only Direct TV (actual television, not direct Tacitus Voltaire ) offers another choice. Obviously there are more cable providers out there in the United States but in this county in Maryland, just a few miles from Washington, DC, but hours by car at times, that is all you get. Naturally, the prices are amazingly similar so the debate comes down to services and special packages. The conditions are ripe for another competitor to come in here and undercut Verizon and Comcast but they cannot get past arrangements between local government and the aforementioned providers. This is amazingly like the restrictions on the health care industry that prevent customers from receiving their insurance from companies that operate outside of their states.

If the lack of competitors offering cable in your area isn't enough to make you understand why you pay so much for a simple service, take a look at the bill and add up the variety of taxes and fees scattered throughout it.

There is no denying that lowering insurance costs would help us all with lower medical care costs. I don't understand why so many on the left feel that the trial lawyer lobby is more important to protect than American consumers.