Bill Maher on Who Makes Health Care Decisions

Without a new episode of Lost I got around to watching last Friday’s episode of Real Time with Bill Maher tonight. From his New Rules:

Republicans always frame the health care debate by saying, “Health care decisions should be made by doctors and patients, not government bureaucrats,” leaving out the fact that health decisions aren’t made by doctors, patients or bureaucrats. They’re made by insurance companies.

Insurance companies, which are a lot like hospital gowns: chances are your ass isn’t covered.


  1. 1
    Ahsholay says:

    Health care decisions are made by doctors and patients.  What Mr. Maher should have said is that in some instances the insurance company decides a procedure is not covered under the patient’s policy.  The patient is free to get the procedure, however, it’s just not going to be paid for through insurance.

    In some versions of  health care reform, the government will, in fact, determine that the procedure will not, under any circumstances, be done, such as the case in Great Britain where rationing is commonplace for older citizens in need of expensive procedures.  Those people must leave their country to get the procedure, even though they can afford to pay for it.

  2. 2
    Ron Chusid says:

    Maher is correct in his commentary on the conservative argument. The conservative argument against health care reform in the United States based upon medical decisions being made by doctors and patients is ridiculous because at present insurance companies intrude far more upon medical decisions than Medicare does.

    Your comment on Great Britain is incorrect. About 10% in Great Britain have private insurance to cover things which the government program will not cover. It is also irrelevant as a government-run plan such as in Great Britain is not on the table in the United States.

  3. 3
    Ahsholay says:

    I am 62 years old, and no one in my extended family has ever had an insurance company prevent them from obtaining a medical procedure they and their physician determined necessary.  There have been arguments about payment, but not about the basic decision on the treatment.

    Secondly, if one can believe published excerpts from Tom Daschle’s book, it is clear he envisions circumstances under government supervised healthcare where old people will just have to get used to the “conditions” old people suffer from. 

    And what about the other  90% in Great Britain?  

  4. 4
    Ron Chusid says:

    You are lucky. I see patients every day who have problems because of insurance company restrictions.

    “Secondly, if one can believe…”

    No, you cannot believe the spin from right wingers who cherry pick statements and often outright misquote to make their arguments.

    “And what about the other 90% in Great Britain?”

    They either get what is in the government plan or pay on their own. At least everyone has coverage–and while there are problems with their system this is not under consideration here. What about the millions in this country who are uninsured or under-insured? What about all the people who wind up in bankruptcy because of health care expenses? That doesn’t happen elsewhere in the industrialized world.

  5. 5
    Ahsholay says:

    While I can sympathize with someone whose medical needs result in financial hardship, that does not lead me to accept the European model of a socialistic approach.  I accept full responsibility for my own and my families expenses, medical and otherwise, and expect others to abide by the basic principle of individual responsibility upon which this country was founded.  How many of the millions who are uninsured are so because of conscious decisions along the way to spend their income in other ways, or not get an education, or make poor health-related lifestyle choices, etc.?

    A thorough reading of Daschle’s book will illustrate his belief that the system he espouses would, indeed, ration care for the elderly.  I have a basic, unshakable disagreement with that model.

  6. 6
    Ron Chusid says:

    Nobody is recommending a “European model of a socialistic approach.”

    Many are uninsured because they have lost their jobs. Others are working but cannot afford coverage due to the high cost of individual plans in this country. This is especially the case if they have any preexisting medical problems.

    You are also misrepresenting Daschle’s views.

  7. 7
    Eclectic Radical says:

    I’m recommending a socialistic approach on a European model, preferably the Scandinavian model. It’s hard to argue with long life spans, high quality of living among senior citizens, and the lack of any economic drag of the kind we create by our system of forcing business to subsidize the national system. In this one area, socialism would be extremely good for private business.

    That said, Ron is right. No one in Washington and very few people outside of Washington are advocating such a radical policy. The most ‘socialist’ plan I am aware of is the Ralph Nader idea that Medicare/Medicaid should be extended to cover every citizen.

    And let’s be frank Ahsholay: unless you have no insurance and pay for your family’s health care costs entirely out of pocket, in cash or by credit card, you do not accept full responsibility for your medical expenses or your family’s. If you have medical insurance, you are sharing responsibility for your medical expenses with every other customer of the company with which you do business and the executives who run the company. The company and your fellow customers pay far more of your health care costs than you do. If you acquired your coverage through work, your health care is also subsidized by your employer. In a personal sense, you are responsible for very little of it, either way. This is the whole point of health insurance in the modern sense: to share responsibility for medical costs to lower individual costs. All of the possibilities for health care reform are based on the same principle as private insurance, up to the most radical socialized medicine.

    In a sense, you’ve never been responsible for your own health care costs. Ever. In another sense, you’ve always been responsible for those of others. Either way you care to look at it, health care reform is not going to change that.

  8. 8
    Ron Chusid says:

    Electic Radical,

    To nitpick one point–we cannot necessarily say that the health care system in Scandinavian countries is better based upon their long life spans as the Scandinavian countries have a more homogeneous society without many of the life style and socioeconomic problems we have here. Even if we had a comparable system of universal health care, I bet they would still beat us in such measures.

  9. 9
    Ahsholay says:

    Ron and Eclectic,

    You both make some excellent points, however I am concerned about any reforms based upon the premise that healthcare is a right–that the Government is the guarantor for all citizens.  I would strongly support reforms leading towards more portability, more tiered-coverage options, and greater shared buying power.

    I still want the national focus to be on the premise that one’s healthcare is no different from any other product/service required to get through life.  It is an individual responsibility.  Constitutionally, it may be difficult to pursue some of the meaningful changes, such as limiting states’ mandates on coverage ( I can’t believe I just wrote that–since I am an ardent States Rights supporter!!)  But in this one area, some national guidelines are appropriate in view of the critical nature of healthcare and the mobility of us citizens.


    I understand how insurance spreads the risk.  But my bank statements over the years are good evidence of the fact that I am paying–whether it be for me, my family, or some guy down the street.  My point was that I have made a conscious decision to put off buying “stuff” to pay the premiums and out-of-pocket expenses.  I have not asked my neighbor to do it for me.

    Thanks for the lively discussion!!

  10. 10
    nomoreGOP says:

    “that does not lead me to accept the European model of a socialistic approach. ”

    wait wait.. let me guess.. GOP talking point #7?? no.. wait.. #8?

    gotta find a way to throw in some “scary” words like socialism.. are you going to claim that obama is getting ready to “redistribute the wealth” by stealing it from the rich and giving it to the poor..

    where do you people get this absolute non-sense? no one is talking about adopting any sort of european and/or socialist policy.. quit being such a sheep.. dont let the same people that have been telling you how to think for the past 20 years fool you.. none of the conservatives have ever shown in any form at all while governing that they have any intention AT ALL of upholding the very principles they were elected to office lying about..

  11. 11
    Eclectic Radical says:

    Well, we have fewer bears and wolves, and our temperatures are a lot warmer in the winter in most states. 🙂

    More seriously, you are probably right, yes. That said, even if one cannot completely equate longer lifespans with universally available health care one cannot completely remove that factor from the picture either. So I concede, but only partially.

    Ahsholay, that’s exactly the problem. Health care is different from other products/services traded on the market. First and foremost, it is exceedingly difficult to make a profit by providing health care services. One makes a profit by taking payment from as many people as possible and paying it out for as few people as possible. The more health care one actually has to provide, the less profit one makes. Currently, the health care industry’s profits are subsidized by business because most individuals working a 40 hour week cannot afford health care otherwise, because of the increase in private insurance costs.

    Portability is only a problem because of the three-payer system uses now. Because the employer has a share in paying health care costs, the employer naturally only wants to pay for current and retired employees and not the people they fire or who quit. Hence the portability issue. So the only just way to make health care portable is to eliminate the employer-subsidized system. The alternative is to force employers to pay for all their former employees plans, a financial nightmare, until they find new work and then force the new employer to manage ten or twelve different programs their employees have brought from previous jobs, an administrative nightmare.

    If we have to eliminate the three-payer system, wse are left with a need to pick up the slack. The government doing so is the best solution for the most obvious reason: a tax-supported government health plan shares the risk of health costs far more efficiently than fifty to a hundred private companies, thus lowering provider costs, and only needs to meet its costs, thus lowering consumer costs.

    The only differences between a single government provider and umpteen private providers are beneficial. The system is still the same system of shared responsibility that existed before.

    And yes: you have asked your neighbor to do it for you. By buying private health insurance you enter into an agreement where you and your neighbor agree to help each other pay for health care, and your premiums and out of pocket expenses do not change that. There is no difference, in that sense, between the most socialist government health care policy imaginable and private insurance.

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