I don’t see where he says making it optional couldn’t work. He explains why it wouldn’t work for a private insurer, but the federal government isn’t a private insurer. It could take the costs of everyone who enrolls, less the premiums collected from everyone, and make up the difference with tax revenue.

Kinda like public education: You don’t have to attend, but your taxes will pay for them whether you attend or not. That said, feel free to go elsewhere if you can afford it.

It works for everybody only if everybody has a stake in it.

The problem of adverse selection arises when people can opt out of PAYING, not when people can opt out of RECEIVING. So Robert’s proposal seems consistent with Krugman’s concerns.

But Lu identifies a more complicated political dynamic: How can the public health system ensure support from the Powers That Be if the Powers That Be go get their health care elsewhere? Again, consider the example of public education.

This problem seems intractable to me because I don’t know of any practical way to keep the Powers That Be from going elsewhere. Over time, this dynamic would likely result is a two-tiered system, with a bear-bones overworked public system struggling for resources to serve the masses, while rich people who lack any stake in the system stymy political efforts to secure additional funding.

Yet I suspect a two-tiered system would still produce greater life expectancy and lower infant mortality than the current system.

But a system where those outside the “insurance plan” still have to pay for it through their taxes isn’t really optional, so that really doesn’t refute Krugman’s assertion.

I agree with you, which got cut out from my last post.

as for the SOM, whichever you decide, to send it tomorrow or not, just shoot me an email.

and thank you every one for this way-off topic exchange.!

but….I agree that dental care as a low-priority is whacky and just bad healthcare.

There’s an implied comprehensiveness to this model that I’m uncomfortable with. As Jay pointed out, there are a lot of treatments–and therefore a lot of sick people–who are left out of this model entirely. The free market enables HMOs to leave out treatments that are not profitable, and to ignore people with no market clout–generally the most vulnerable and needy.

And you could choose to switch carriers on your birthday, if you wanted to (important for allowing some market forces in).

This isn’t perfect, but I would prefer a model that is closer to free market (choose your insurer, pay what you can or choose to) than one that rations care, which a lot of the socialized medical systems do (at least, they appear to do so, to me).

I had to have surgery the first year I was here. We paid almost nothing for the entire procedure, including the doctors visits both before and after, the hospital stay and the tests.

I am a socialist I think in this regard. I think certain things; basic food, clothing, shelter, education and health care, ought to be free or nearly free.

agreed.

and now I understand why you say you are late. do you want to send me what you have or wait?

And: exactly.

what i’m learning reading your words is that one’s experiences color one’s expectations.>>

Please don’t assume that I’ve been insulated from transphobic healthcare because I’m fortunate enough to have trans-friendly providers–and to be in a privileged position vis-a-vis care, period–right now.

I’m not saying that single-payer healthcare would not be vulnerable to the same transphobic lacunae as the HMO system; merely that it wouldn’t necessarily be so. There are single-payer examples that take relatively good care of transpeople, and they are more accepting and more comprehensive than even the most transfriendly HMOs here. Kaiser SF is the best of the best, but it’s much worse than the Canadian system: under _no_ circumstances, no set of requirements, will it provide anything other than hormones and hysterectomies. Odious certainly isn’t acceptable, but the Canadian system isn’t denying SRS-related care to absolutely everyone.

piny,
SF is unusual and, unfortunately, not representative of other cities and towns. Access to care for non-insured trans folks is a huge issue in my college town here in the midwest.

what i’m learning reading your words is that one’s experiences color one’s expectations.

Where I live, I’m with Robert: little or no coverage for transfolks even with universal access (and the requirements for folks in Canada are odius, at least to my way of thinking.). Perhaps SF will lead the way, if we ever do achieve universal access.

And btw, your submission isn’t late. Tomorrow is the deadline.

Robert,

Cheap and free clinics with which I am familiar turn away TS folks because they can. Having said that, providers within the clinic claim that transsexualism (and the taking of hormones) represents such a complex medical condition that said healthcare providers cannot possible treat TS folks with colds, herpes, asthma, etc. They then state that all healthcare must be coordinated through a doctor experienced in treating TS clients, which is akin to saying that a low-cost or freebie clinic doctor can’t treat a diabetic with the flu. Only the diabetics endrocrinologist can do it.

And if you are a transman (female to male transsexual) needing gynecologic care, deep things happen! Like good luck getting care if you live in a small town, don’t have access to Planned Parenthood clinics, or have healthcare insurance that excludes transsexualism treatments. Robert Eads, an FtM activist in the south (Georgia?) had to go through more than twenty doctors before he finally found one who would treat his ovarian cancer.

It happens here in my town in the Midwest too often for me to comment. I know activists in the DC area have worked to widen doctor knowledge at the freebie/low cost clinics there, for much the same reason.

Yes, Kaiser covers hormones and hysterectomies. So do the Blues. But employers are free to exclude such treatments if they desire it. And California’s forwarding thinking treatment of TS folks does not mean it will sway a federally administered program in any way.

I’m glad that SF exists for TS folks. Still, I’m with Robert on this one. If the U.S. ever achieved universal healthcare, I have every confidence that it will be poorly thought-out, capricious in its delivery and cheap in its motive.

Having said all that, I still think we ought to have universal healthcare. And the U.S. being the U.S., the rich will still get better care and better access.

And yet, the NHS does cover both hormones and surgeries.

Yep, and IVF. And birth control (of any kind) is free. You don’t even have to pay the prescription charge - which is £6.40 per item.

I heart the NHS.

And yet, the NHS does cover both hormones and surgeries. Some HMOs–Kaiser, for example–will also cover hormones and hysterectomies.

The point is to ensure that everyone has access to a minimum level of care, that people aren’t dying from TB because they can’t afford some penicillin. Any system of rationing health care is going to end up saying “no” to certain conditions; where surgeries and hormones for transsexuals will fall on that priority list is anyone’s guess (though like you, I’d be pessimistic.)

That said, I don’t understand why cheap/free clinics would turn away TS folk in Canada (I assume) or elsewhere for that matter. That’s an outrage. Details?

IIRC, trans-related medical treatments are covered in Canada, but subject to a lot of controls that transpeople find extremely burdensome. No worse, though, than the ones people have to deal with in nearly every city but mine. Since there are HMO models that treat transpeople very well, I see no reason to believe that single-payer holds any lesser potential. And since we’re disproportionately poor and unemployed, it seems like a boon.

This latter factoid is interesting. All the uninsured transpeople I know go to clinics that have a large number of transpeople as clients, but I don’t know if this is mandatory or because those places are more accepting or because SF has so many transpeople.

(I’m still working on the submission, btw–I know this is ridiculously late.)

In Ontario treatments related to transsexualism itself are excluded. Surgeries and hormones must be paid for out of pocket.

I don’t know if transsexuals with colds and such are turned away from health care clinics per se in Canada, as they are here in my city of residence. Transsexuals without insurance cannot receive treatment of any kind unless they are “managed” through a hospital gender clinic.

I have also heard from activists in the DC area that low cost clinics will also turn away trans folks.

What I don’t think people realize is that access to universal healthcare does not automatically mean everyone will get all the healthcare they need. Medicare used to pay for hormones and surgeries (back in the 70s). Now Medicare does not.

Why should universal healthcare be different?

Yeah, and I’m not required to have health insurance through my employer, either. Again, the problem is not that the government is providing the service, or that it is a “government program”. The problem is requiring participation.

Optional is OK. Mandatory is bad.

Pure free markets are also Eeeeeevil, because they don’t necessarily count all the costs at the time of the transaction, and they let sick people die in the street. I don’t think a free-market business model is applicable to health care anyway.

I like Lee’s suggestion, except that I would like to know what “basic” means (if it means you’re not covered if you get really sick, that’s a problem).

As a transsexual, I’m not convinced that I would suddenly receive access to care. Even with healthcare, doctors can deny me care because of diagnosis of transsexualism. Even if I break my arm or develop an aneurism, I can be denied care. You know, because transsexualism eclipses all other diagnoses.

(Btw: Canadian transsexuals are excluded from receiving certain types of treatments.)>>

What kinds of treatments?