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January 08, 2004

HEALTHCARE IN AMERICA....Healthcare costs continue to skyrocket, but there's an interesting twist to the statistics:

Health spending accounts for nearly 15 percent of the nation's economy, the largest share on record, the Bush administration said on Thursday.

....Public spending on health care accounts for 45 percent of all health spending in the United States, compared with a 72 percent average in O.E.C.D. countries. But health spending has outpaced economic growth in most of those countries, putting pressure on government budgets.

The government already pays for 45% of healthcare costs in America, which means that public healthcare spending accounts for 45% of 15% of GDP, or 6.75%.

In other western countries healthcare costs are about 10% of GDP, which means that public spending accounts for about 72% of 10%, or 7.2%. That's barely more than we spend in percentage terms and less than we spend in actual dollars per person. And by most conventional measures they deliver care that's as good or better than ours. For everyone.

Now, our higher costs are partly due to the fact that we're richer than most other countries and choose to spend more of our income on healthcare. But that's not the whole story, and these figures suggest that if we had a rational public healthcare system in the United States we could fund it for barely more than we spend now.

Think about that: it wouldn't cost much more than it does now; if it were decently designed it would almost certainly do a better job of holding down costs than the ridiculous patchwork that we have now; corporations could largely get out of the healthcare business; everyone would be covered; and judging by the experience of European systems it would deliver care about as good as we get now. Hell, maybe better if my doctor is anything to go by.

And of course private care would still be available for anyone who wanted to pay extra to get it. So what's not to like?

Yeah, yeah, I know, it's socialism. But wouldn't it be nice if we could put the scary namecalling aside and instead just work together on building a real healthcare system to replace the creaky, dysfunctional, and out of control one we have now?

Posted by Kevin Drum at January 8, 2004 10:23 PM | TrackBack


Comments

Umm... why is it socialism? Why not ditch any talk of 'isms' and use it if it works?

Posted by: floopmeister at January 8, 2004 10:26 PM | PERMALINK

Dunno. You'll have to ask the folks who call it "socialized medicine" and flee in terror.

Posted by: Kevin Drum at January 8, 2004 10:29 PM | PERMALINK

Good point...

Posted by: floopmeister at January 8, 2004 10:29 PM | PERMALINK

Don't worry, though, I'm sure they'll be along soon enough to enlighten us.

Posted by: Kevin Drum at January 8, 2004 10:36 PM | PERMALINK

"if we had a rational public healthcare system in the United States we could fund it for barely more than we spend now"

Uh, yeah, haven't some of the Dems been saying that at virtually every debate. For sure Kucinich has been saying this.

Posted by: David Montgomery at January 8, 2004 10:37 PM | PERMALINK

"they deliver care that's as good or better than ours. For everyone."

What planet are you on? Do you know about the 6-month waits for MRIs in Canada? The debacle than National Health Care is in England? The thousands of elderly who died for lack of adequate health care during a heat wave in France? God, the ignorance here is astonishing.

Posted by: Al at January 8, 2004 10:39 PM | PERMALINK

My Aussie sister-in-law is conservative in many ways, but she thinks that the absence of "Public Health" in America is sheer lunacy.

If even the AMA is leaning this way... what's to stop it?

Posted by: bad Jim at January 8, 2004 10:40 PM | PERMALINK

Dear Al, do you have numbers for American deaths due to the variable availability of medical care here? You could start with comparative infant mortality rates.

Posted by: bad Jim at January 8, 2004 10:42 PM | PERMALINK

He said as good as our's.

People die in Chicago every time we hit temperatures above 90. That is not unusual for Illinois, it happens yearly, and yet people still die.

The French get hit with unpredicted heat wave, and many die. The French health minister or whatever the hell they're called over there took the blame for it and resigned.

People dying to a regular occurance vs people dying to a mistake and an oddity are about equal, yah?

Furthermore, where do you get that number on the Canadian medical system? I have a Canadian friend, he says despite some underfunding problems their healthcare is pretty good and wonders why the hell we haven't done our system up like their's.

Posted by: Quain at January 8, 2004 10:45 PM | PERMALINK

Why won't it work? Because the Conservatives are going to respond with arguments like this this and this.

If Clinton's Democratic party couldn't effectively respond to that type of crap ("1/8 Americans will lose their jobs!"), what makes you think that today's DNC could do any better?

I honestly don't understand how a national health plan advocate group just can NOT connect with mainstream voters. The elderly Bush supporters in my family are already demanding that the government pay for a good share of their medical bills, and most seem like they would actually challenge the devil to a fiddle contest if they could get the gov't to foot the whole bill.

Posted by: Frugal Liberal at January 8, 2004 10:47 PM | PERMALINK

And have you tried to get an appointment with a specialist through your HMO in California? My kids have various issues that send them to Childrens Hospital in Oakland. A 6 month wait for certain services is not unheard of.

But of course we can't rationalize the healthcare delivery system. That would be Soshalizm. And you can't have that! Nope.

Looks like my uncle Herman, the retired pediatric cardiologist, is correct. He says medical care will soon become unavailable to large numbers of middle class people - the system is collapsing around our ears. When it finally, irrevocably falls apart, then Congress may do something.

Until then, try not to get too sick, okay?

Posted by: Leila at January 8, 2004 10:49 PM | PERMALINK

bad Jim - You're missing the point. I don't dispute that the "variable availability" of health care means that some people get somewhat inferior healthcare (Although I doubt that our emergency room system of health care is much worse than Euro-style socialist health care). What I dispute is Kevin's ludicrous statement that Eurosocialist health care is approximately equal to that received by the majority of us who have private health insurance.

Posted by: Al at January 8, 2004 10:50 PM | PERMALINK

The other health care systems are free riders off of our research and development. They don't pay the costs, but they nevertheless reap the benefits. If our system also went socialistic, no one would be paying the costs and medical advancement rates would drop quickly.

Posted by: Sebastian Holsclaw at January 8, 2004 10:54 PM | PERMALINK

Well, Germany is going the other way because the public costs are unaffordable:

http://www.findarticles.com/cf_dls/m0KGK/8_9/107277133/p1/article.jhtml

German news media reported last month that the center-left government headed by Chancellor Gerhard Schroeder and the conservative Christian Democrat opposition had reached agreement on a wide-ranging plan to cut healthcare costs in the country that currently are said to be among the highest in the world. The agreement apparently paves the way for the legislative approvals needed to start implementing the reforms as of Jan. 1 of next year.

The agreed-upon reforms are aimed at cutting just under EUR 10 billion in costs next year, with annual savings rising to more than EUR 23 billion by 2007. State-paid healthcare contributions are currently around EUR 142 billion a year, but costs exceeded that by about EUR 2.5 billion last year. Because of persistent high unemployment, the German government has been forced to increase mandatory contributions from workers to subsidize the healthcare system.

Health Minister Ulla Schmidt said the proposed reforms "aim at spending every euro efficiently." She added: "We will get rid of many outdated structures." The planned reforms also focus on what many have cited as antiquated rules that are protective of the traditional high margins for pharmaceutical companies. Among the changes are anticipated expansion of the retail pharmacy market, with pharmacies being allowed to have up to three subsidiaries rather than current rules that allow ownership of only a single drug store. It also would enforce price controls on certain patented drugs and would permit German residents to order medicines by phone or Internet, giving them access to lower prices in other European Union countries. Mail-order drug purchases are prohibited at present.

The cost burden on patients also will increase under the reform plan, to EUR 10 for quarterly doctor visits, and EUR 10 per day for hospital stays for a maximum 28 days per year. Under the reform plan, patients will have to pay the full amount of private insurance for dental prostheses beginning in 2005, and beginning in 2007 will have to cover their own sick pay insurance.

Posted by: Matt Young at January 8, 2004 10:57 PM | PERMALINK

MRI's are not that hard to come by in Spain, from what I hear (second hand information; I only saw the x-rays myself).

As a former employer, I would welcome something better than constantly rising costs and dwindling services from health care providers.

Posted by: bad Jim at January 8, 2004 10:59 PM | PERMALINK

Hey Al

Canada's MRI/CAT/PET shortages are caused by a lack of equipment and technicians. We have no such problem here. We have the resources in the US to treat the majority of patients, Canada doesn't. That's the big difference.

The thousands who died in France's heat wave died for lack of air conditioning, not a faulty health care system. I'm sure that several people die in Canada from exposure every year, and that has nothing to do with a lack of MRI. That's just nature v. man.

My suggestion? Invest in air conditioning, because it's only gonna get hotter.

Posted by: Frugal Liberal at January 8, 2004 10:59 PM | PERMALINK

Is where the monthly blogosphere argument about benefits/detriments of socialized medicine is going to be? I've seen so many that they're boring already. OTOH, I did find Kevin's statement about the quality of care elsewhere quite humorous though!

Posted by: Al at January 8, 2004 11:01 PM | PERMALINK

rational public healthcare system

did you say "rational"??

rational ???

i nearly threw up laughing and crying simultaneously...

honey, if it were possible to have a rational public system for anything, the commies woulda succeeded...

and talk to a few europeans.. they hate their healthcare systems... u have to wait for years in line to get a heart operation... or even a dentist's appointment... ever heard about the brits' dental health? you think they don't brush their teeth, that's why they have that reputation??

Patient: Doctor, I'm pregnant, I need an abortion..

Doctor: I'm putting you on the waiting list, come back after 9 months...

Posted by: bentley driving pimp at January 8, 2004 11:03 PM | PERMALINK

And France's deficit concernes with healthcare are forcing movement toward partial privatization:

http://www.eiro.eurofound.ie/2003/06/feature/fr0306106f.html

Worsening financial situation and tense industrial relations
The drive to reform the system has undoubtedly been strengthened by the worsening financial position of the sickness insurance funds (which are jointly managed by the social partners). The general scheme, which covers all employees and three-quarters of sickness insurance spending, is in the red. In 2002, healthcare spending rose by 7.2%, whereas the target increase approved by parliament was only 3.8% (FR0112153F). The sickness insurance fund deficit for 2002 stood at EUR 6.1 billion. At a recent meeting, the Social Security Accounts Commission (Commission des comptes de la sécurité sociale) forecast a 5.9% rise in healthcare spending for 2003, while the target increase endorsed by parliament was 5.3% (FR0302112F). The forecast deficit for the sickness insurance scheme in 2003 is EUR 9.7 billion. The worsening situation is due to a slowdown in revenue growth on account of a drop in pay-roll growth - the basis on which social security contributions are calculated - from 3.3% in 2002 to a forecast 2.7% in 2003. It is also the result of spending increases, particularly due to doctors' fee increases implemented in the spring of 2002.

In January 2003, a draft agreement struck by the sickness insurance funds and almost all trade unions representing general practitioners was hailed as evidence of an improving relationship between the funds and healthcare professionals (FR0302110F). However, disagreement over fee-related issues between the funds and healthcare professionals subsequently led to a breakdown in talks. Even more serious still was the fact that département-level doctors' action committees, which are demanding `free pricing´, have urged, with some success, specialists to pull out of agreements - ie to cut all ties with the sickness insurance funds, thus making it impossible for patients to recover their healthcare costs. The general practitioner sector is not the only area experiencing tension. In hospitals, a shortage of staff (both doctors and nurses) needed to implement the 35-hour working week and pressures in emergency services have fuelled persistent industrial relations unrest (FR0302106N).

Possible directions for reform
While the exact shape of the reform package is not yet known, the official reports that have already been published and the stated position of supplementary insurers provide a clue to the main thrust. In particular, the government-commissioned `Chadelat report´on the `respective roles of compulsory and supplementary sickness insurance in healthcare expenditure´(Rapport sur la répartition des interventions entre les assurances maladies obligatoires et complémentaires en matière de dépenses de santé), published in April 2003, advocates a three-tier structure. According to this model, the government would identify a `basket of [healthcare] goods and services´covered by compulsory sickness insurance (level one) and by supplementary insurance (level two). Individuals and families would be able to take out totally optional insurance for those goods and services not covered (level three).

Posted by: Matt Young at January 8, 2004 11:05 PM | PERMALINK

I dunno, I'm of two minds about this.

On the one hand, single-payer does make perfect sense, and since I'm working in the US right now, I'd surely feel a lot more comfortable if I didn't have to watch my health care coverage deteriorate every year as my employer tries to control costs.

But I'm planning to retire back to Canada, and I want there to be a real health care system when I go back. The last time you guys tried to fix your health care, the opponents made a real point of holding up Canada as a *horrid example*.

Lies, of course, but the trouble was, Canadians overhear everything you yell, true or not, in your political infights. By the time the dust had settled, a lot of Canadians, especially in Alberta where they're more credulous about such things, had been convinced that our health care system was in desperate trouble and needed to be "fixed" in all the wrong directions. Did a fair bit of damage, that did, and we're not really over it yet.

So while, sure, I'd like the US to get a better system, I really cringe at the thought of having to go through all that again.

Posted by: Canadian Reader at January 8, 2004 11:06 PM | PERMALINK

And those damn British waiting lists:

http://12.31.13.73/HealthNews/reuters/NewsStory0305200315.htm

British hospitals caught doctoring waiting lists
--------------------------------------------------------------------------------


Last Updated: 2003-03-05 4:21:15 -0400 (Reuters Health)

LONDON (Reuters) - More than half Britain's hospitals have incorrectly reported waiting list figures and some have deliberately doctored their figures, an Audit Commission report published on Wednesday said.

The revelations of widespread waiting list 'fiddling' add to the Labour government's problems with the National Health Service (NHS), which it is struggling to reform in the face of opposition from doctors and many within its own party.

More than 100 Labour MPs voted on Tuesday to oppose government plans for so-called foundation hospitals, which will operate more independently.

The government has pledged to spend 40 billion pounds building new hospitals and employing new doctors and nurses to keep its promises to reduce waiting lists, which have over one million patients on them.

Posted by: Matt Young at January 8, 2004 11:16 PM | PERMALINK

According to the World Health Organization,

Japan spends 7.8% of GDP and provides one of the best national health care programs in the world, not to mention some of the healthiest residents in the world.

Posted by: Frugal Liberal at January 8, 2004 11:19 PM | PERMALINK

ANd the Spanish system is suffering with spiraling costs and declining revenue as young taxpayers disappear:

http://www.tradepartners.gov.uk/healthcare/spain/profile/overview.shtml

The Government is faced with spiralling costs in the provision of health services which are increasing at a higher rate than budget forecasts. Some of the reasons for rising costs are: (i) As life expectancy increases, the percentage of the population over 65 years of age also rises and the demands this segment makes on the public health system are four times greater than the rest of the population, particularly in the area of 100% reimbursement for pensioner’s prescription drugs. (ii) The recent wave of a new immigrant population is now also covered under this universal health system. (iii) Although decreasing, Spain still has the highest proportion of AIDS cases in Europe and this together with drug addiction presents problems for the public health system. (iv) Spain is reported to spend twice as much treating patients from other countries, who may come as tourists, as it costs other countries to treat Spanish patients. (v) The incorporation of more expensive high technology equipment to detect and treat illnesses is another factor increasing expenditure.

The Government wants to introduce higher levels of budgetary discipline and is giving public hospitals and health centres more financial autonomy. An attempt has been made to set up hospitals as “Trusts” or “Foundations” but this has met with limited success and only in the case of where a new hospital has been built. So far only a few “Foundations” have been set up as the subject is politically very controversial. Reducing waiting lists is another priority. There are some plans to build new hospitals in some Regions although up until now the PFI (Private Finance Initiative) has not been used to build public hospitals. The current emphasis is to continue with improvements and provision of services at primary health care centres.

Private

About 6 million of the Spanish population are subscribers to private health insurance schemes and this figure has remained stable in the past few years. 2 million of these subscribers are civil servants and due to agreements negotiated with their employer, these subscribers pay reduced premiums to these health insurance companies. Private health insurance in Spain is a complex area and is not confined to the simple reimbursement principle. The UK firm BUPA has a significant market share in this area through their Spanish subsidiary, SANITAS. These health insurance firms either administer their own clinics or determine the level of fees to be paid to Doctors on their panel or hospitals under their schemes.

Posted by: Matt Young at January 8, 2004 11:21 PM | PERMALINK

Strange last sentence: But conservatives trace much of the difference to the fact that private insurers have provided more generous benefits.

If anyone knows which insurers are providing "more generous benefits" let me know, I'd like to switch plans.

Posted by: TomF at January 8, 2004 11:23 PM | PERMALINK

Um, Al, ever been to Canada? I happen to know more than one nurse who worked in both systems. They all agree, the Canadian system is as good or better, and the less money you have, the better a deal it is. I didn't think that was quite true mysef, until I got down here.

In fact, as far as I can see, I am now paying $400/month for my wife and child for the exact same service I recieved in Canada- save there are endless non-covered services, and even when a service is covered, it generally takes three tries, by phone and e-mail, to get the company to pay the bill. Oh, and they can drop us if we get too sick. Oh, and the bill goes up 18% per year. Oh, and they just closed the trauma center at the local public hospital, leaving 1 trauma center for 1,000,000 people over the bottom half of my immense western state. Oh, and 1 HMO leaves the market a year.

As for the argument that the rest of the world 'free rides' on the good ole US of A cuz we're paying for all the research, let me just ask you-how do you know this? Do you have some numbers to back up this claim? I'm no research scientists, but I know a few, and the picture I get of research from them doesn't support this view at all.

Paying a premium to the big pharma companies can be spun as putting in more than your share, but in reality it's just boneheaded. The big conglomerates are truly global, and the US, while a giant market, will hardly play that big a role in their R&D decisions if you suddenly get sane and start to negotiate a decent price for your drugs, like every other western nation already does, may I add. Besides, the relationship between the R&D budgets of the big pharma companies and actual advances in medice is not all that clear. They spend alot of time researching and producing 'me-too' copies of popular drugs, and they generally only put money into a drug after public research has demonstrated its promise (check out the lineage of AZT if you want a taste of this sort of thing). They also devote a ton of time to 'lifestyle' drugs, for baldness and such. Do these sound like the sorts of firms that are putting all they can into important drug research, such that if they lost any income, it'd have to come out of that budget? I don't think so.

Posted by: epist at January 8, 2004 11:27 PM | PERMALINK

"Think about that: it wouldn't cost much more than it does now"

If I had a dime for each time I heard this about some new big government proposal.

Which bring us to the other point, if our government currently pays nearly the same percentage as Europe, then there is no need to tinker with it, unless you plan to take some of that "nearly the same percentage" from seniors and give it to me for optional medical procedures.

Posted by: Matt Young at January 8, 2004 11:30 PM | PERMALINK

What I dispute is Kevin's ludicrous statement that Eurosocialist health care is approximately equal to that received by the majority of us who have private health insurance.

Yes, Al, but the point is that a large minority in the US don't have private health insurance. Since WHO looks at the whole picture, pointing at a privileged group and saying "But they get better health care (more expensively) than in Europe!" doesn't change the argument that the US has a health care system overall worse than any in Europe. (WHO stats put the US at 37th in the world.) As Kevin points out, this could be changed: the US has the capacity to rise to 1st in the world for health care, and it needn't cost any more.

The other health care systems are free riders off of our research and development. They don't pay the costs, but they nevertheless reap the benefits.

Sebastian, that's nonsense. Medical research and development happens all over the world. It's funded primarily by governments. Privatised medicine and the big companies that profit so hugely off it are the free riders, seeking profit from research funded by taxpayers.

It is a standard fantasy of introverted Americans that nothing useful happens anywhere else in the world, but this goes along with the fantasy that scientific researchers do their best work for profit rather than for love of their subject. As just one example, it was the Pasteur Institute (government-funded) in France that discovered HIV in 1983: shall we then deride all US researchers whose work is dependent on that discovery as free riders on the French?

Posted by: Jesurgislac at January 8, 2004 11:34 PM | PERMALINK

I'm living in the UK right now, so I get to see the NHS (the British single payer health care system) in action. There are a lot of problems with it, basically all having to do with the fact that it is badly underfunded.

But...

Having participated in both, I have to say that the British system is in principle vastly superior to the US one and that if the UK devoted the same percentage of their (much smaller) GDP to health care as we do then there is no question of which healthcare system would provide better and more efficient care.

The thing that boggles my mind, though, is why a single payer system is referred to as socialism. Although this seems to be a handy rhetorical trick, it seems to me that people who do this are either being intellectually dishonest or have a poor grasp of what socialism is. A single payer healthcare system is not socialistic in that the government is not providing the health care, nor is it controlling how health care is provided. Rather, it is merely acting as a huge consortium of healthcare consumers and negotiating with doctors as to fees and levels of services. Much like a huge HMO.

Given how unpopular HMOs are, it is hard to grasp how this would be an improvement, but there are a few key differences. First, there is no profit motive. Thus, the primary incentive is not to lower costs as much as possible, but rather provide the most and best care as efficiently as possible. Second, the level of care provided is a matter of public policy. The officials who set this policy are overseen by elected representatives, so if a local area wants some particular type of service and is willing to fund it then this service gets provided, as opposed to HMOs, which are subject mostly to their shareholders.

There are a couple of other things that are worth pointing out. The first is that in a single payer system there is nothing to prevent people from paying for health care for other means, such as their own funds or private insurance. In fact, in the UK this often happens. There are doctors who are not NHS doctors and hospitals that are not NHS hospitals and if you want some types of care that are elective or severely rationed, this is often the way to go.

The other thing I have noticed said about single payer systems is that they are inefficient. This could not be more wrong. In fact, the administrative costs of health care in the UK are under 5%, whereas in the US they are running over 20%. This makes sense when you think about it, because there is one set of forms and one type of reimbursement process for the NHS, whereas anyone who has tried working out insurance arrangements with their doctor in the US knows full well what a nightmare that can be.

Posted by: Jay at January 8, 2004 11:36 PM | PERMALINK

Pinko! You sound like Harry S. Truman.

Posted by: Frederick at January 8, 2004 11:41 PM | PERMALINK

Even more striking than the unwillingness to discuss the lower life expectancy and higher infant mortality in the U.S. is the assumption that we can't do any better, or worse, that because costs are rising we need to find ways to cut back on care.

We can contemplate missions to Mars and a permanent presence on the moon but we adamantly insist that we couldn't possibly devise a better approach to public health?

Posted by: bad Jim at January 8, 2004 11:43 PM | PERMALINK

Jay: excellent.

Posted by: bad Jim at January 8, 2004 11:45 PM | PERMALINK
In other western countries healthcare costs are about 10% of GDP, which means that public spending accounts for about 72% of 10%, or 7.2%. That's barely more than we spend in percentage terms and less than we spend in actual dollars per person. And by most conventional measures they deliver care that's as good or better than ours. For everyone.

And you base this on what exactly? Oh yeah, nothing.

Posted by: Steve at January 8, 2004 11:54 PM | PERMALINK

And another thing:

Why aren't small business owners behind a single payer health care system? It seems to me that they are at a huge competitive disadvantage as regards attracting and retaining skilled employees, who would be more likely to go to work for a large corporation who can negotiate cheap(er) large(r) scale health care for its employees.

It seems to me that if one wanted to push a single payer system, making this case to small business owners would be a good first step.

Posted by: Jay at January 9, 2004 12:00 AM | PERMALINK

Jay, I agree, and I think one of our Democratic contenders ought to be doing that. This simply makes good sense.

Posted by: bad Jim at January 9, 2004 12:05 AM | PERMALINK

Jay,

Having participated in both, I have to say that the British system is in principle vastly superior to the US one and that if the UK devoted the same percentage of their (much smaller) GDP to health care as we do then there is no question of which healthcare system would provide better and more efficient care.

One of the reasons people say that we need a single payer system is to control for costs. What you are saying points out the fallacy with this position.

The thing that boggles my mind, though, is why a single payer system is referred to as socialism. Although this seems to be a handy rhetorical trick, it seems to me that people who do this are either being intellectually dishonest or have a poor grasp of what socialism is. A single payer healthcare system is not socialistic in that the government is not providing the health care, nor is it controlling how health care is provided. Rather, it is merely acting as a huge consortium of healthcare consumers and negotiating with doctors as to fees and levels of services. Much like a huge HMO.

It is socialism because it prices and decisions are not made via the market process, but instead by collective decision making. In other words, if you are a doctor and want don't want to play the government's game you are basically out of luck. ClintonCare was specifically designed this way. One of the parts of the legislation held that if any health care provider provided health services that duplicated the care provided by the Clinton plan said health care professional would be either fined, jailed or both.

You see, the problem is one of incentives. There cannot be any pooling of people of different risk catagories as the lower risk people will be lured away by better structured premiums/plans. In the insurance field this is called "cream skimming".

Given how unpopular HMOs are, it is hard to grasp how this would be an improvement, but there are a few key differences. First, there is no profit motive.

Kaiser is an HMO and is not for profit. Its great if you are healthy and sucks if you aren't.

Thus, the primary incentive is not to lower costs as much as possible, but rather provide the most and best care as efficiently as possible.

Actually I disagree with this. The system you have in the U.K. is underfunded. Fine, then what happened to this desire to provide the most and best care as efficiently as possible? Politics? Did people start getting upset at continually increasing costs? How come Canada has such a low number of MRIs?

The problem with the single payer system is that the decision is now a political decision, and democracy is a crappy allocator of resources.

There are a couple of other things that are worth pointing out. The first is that in a single payer system there is nothing to prevent people from paying for health care for other means, such as their own funds or private insurance.

Well if the government only wants to be covering those who are high risk (i.e., have pre-existing conditions, congential conditions, etc.) then yeah. Otherwise, there is the incentive problem.

Even more striking than the unwillingness to discuss the lower life expectancy and higher infant mortality in the U.S. is the assumption that we can't do any better, or worse, that because costs are rising we need to find ways to cut back on care.

A couple of problems with this.

1. Infant mortality and life expectancy are connected. Life expectancy is sensitive to changes in infant mortality. So by pumping resources into lowering infant mortality, you could see a higher life expextancy, which is somewhat misleading.

2. Life expectancy is not solely a function of the health care system. For example, Americans are more violent than many other industrialized countries.

Ignoring these factors can give a misleading impression.

Posted by: Steve at January 9, 2004 12:20 AM | PERMALINK

Obligatory coda: national health care would also obviate much of the tort reform issue and reduce product liability costs, since it would take one of the major issues off the table. No one would need to sue just to pay for medical care.

This is not to say that defects, negligence or malpractice would be ignored; since they would fall into the category of public costs, they might get more attention, and perhaps better attention than they get in court.

Posted by: bad Jim at January 9, 2004 12:20 AM | PERMALINK

Rather than compare anecdotes and scare stories, why not look at outcomes? From the World Life Expectancy Chart, below is a rank-ordered list of the 41 nations with national life expectancy at birth in the year 2000 exceeding 75 years.

To cut to the chase, the United States is tied for 27th place, behind such nations as Greece, Malta, and even Jordan. Not to mention Canada, the United Kingdom, Germany, and of course France. But take heart! We're still ahead of Cyprus, Cuba, Libya, Panama, and Jamaica.

1) Andorra 83.5
2) San Marino 81.1
3) Japan 80.7
4) Singapore 80.1
5) Australia 79.8
6t) Sweden 79.6
6t) Switzerland 79.6
8t) Canada 79.4
8t) Iceland 79.4
10) Italy 79.0
11t) France 78.8
11t) Liechtenstein 78.8
11t) Monaco 78.8
11t) Spain 78.8
15) Norway 78.7
16) Israel 78.6
17) Greece 78.4
18) Netherlands 78.3
19) Malta 77.9
20t) Belgium 77.8
20t) New Zealand 77.8
22t) Austria 77.7
22t) United Kingdom 77.7
24t) Finland 77.4
24t) Germany 77.4
24t) Jordan 77.4
27t) Luxembourg 77.1
27t) United States 77.1
29) Ireland 76.8
30) Cyprus 76.7
31) Denmark 76.5
32) Taiwan 76.4
33) Cuba 76.2
34t) Costa Rica 75.8
34t) Portugal 75.8
36) Chile 75.7
37t) Libya 75.5
37t) Panama 75.5
39t) Jamaica 75.2
39t) Uruguay 75.2
41) Argentina 75.1

Another point is that greater prevalence of high technology is not at all related to higher life expectancy. Jack Wennberg at Dartmouth Medical School has demonstrated in numerous national studies in the US that, while the presence of MRI machines, bypass surgery teams, and such is strongly and positively related to the cost of health care, it is in no way associated with better quality of care or better health outcomes or better health status. In many settings, more high tech is associated with worse (but much more expensive) overall health.

The American healthcare system is demonstrably not better than those of numerous other countries. It's demonstrably less equitable than any other non-Third World healthcare system (and also less equitable than some in the Third World). Those inequities are our national shame.

Posted by: N in Seattle at January 9, 2004 12:25 AM | PERMALINK

Your numbers are out of date, Kevin.

The Woolhandler study I linked takes into account decreased tax revenues from employers being able to write-off health insurance costs as well as the Fed and State costs for government employees' health insurance (like the FEHBP). So the government already pays for almost 60% of the industry, not just 45.

Posted by: Graham at January 9, 2004 12:26 AM | PERMALINK

"Don't worry, though, I'm sure they'll be along soon enough to enlighten us."

Yep, Kevin, that didn't take long before the Als and Sebastions came along with the same ol tired arguments as the health care costs go up about 1% of GDP every 6-7 years. Speaking as an employer, I can tell you to take heart, as Atrios said in another comment section: It will be the corporate sector that will finally drive the stake in the heart of our particular blood sucking unhealthcare vampire. We have tried a particularly bold experiment with this segment of society that we are all ultimately vulnerable to. We have turned it over to the insurance and pharmaceutical industries. (In that order) and it has been a failure.

But that will never stop Al from citing mythical tales of 6 month waits for MRIs in Canada, or Sebastion from telling us how the rest of the world is stealing the mighty intellects of the pharmaceutical industry blind, while we are only supporting their noble efforts at fair market value. (State funded basic research at university institutions anybody?) Nope, you are right, that socialist strawman is about 100' tall and 2 inches wide.

Posted by: Another Bruce at January 9, 2004 12:27 AM | PERMALINK

May I be shrill?

Earth to conservatives: we're already rationing health care!

If you don't have insurance, all you've got is the emergency room - where, at least in California, they can't turn you away.

This is good, right? This is the best we can do in the best country of the best of all possible worlds?

Many of us think this could be done better.

Posted by: bad Jim at January 9, 2004 12:43 AM | PERMALINK

I can't afford to visit Hawaii every month; Does that mean that "they" are rationing Hawaian vacations? "Rationing" generally refers to a system where somebody isn't permitted to buy something, even though they can afford it. Not to the simple fact that poor people can't afford to buy everything they want.

You want everyone in a single health care system? I thought "liberals" hated monopolies. Oh, wait, that's only when they don't expect to run them.

Posted by: Brett Bellmore at January 9, 2004 03:09 AM | PERMALINK

Bentley Driving Pimp: Speaking as a Brit, I can assure you that the reason why our teeth are as notorious as they are is because the Dental service is private. Got that? The NHS will pay for basic treatment for the poor, and that's it. Middle-class folks like me have to pay for ourselves. Hence, crap dental work.

As for the hospital waiting lists, the one fact that American conservatives always miss is that the waiting lists are generally for minor chronic conditions. Acute or serious conditions are prioritized; there's no waiting list for cancer treatment or an ambulance if you have a heart attack, and the only reason there's a waiting list for transplants is the scarcity of donor organs. But when healthcare is free at the point of delivery, people want more of it -- which is why you get queues for minor conditions that, in a private system such as the US one, many people would grit their teeth and live with.

Nor is a single-payer system bad for capitalism. Look at the health of the British pharmaceutical industry as an indicator; it's one of the country's largest R&D led export industries.

Posted by: Charlie Stross at January 9, 2004 03:19 AM | PERMALINK

Why is it that whenever I advance simple solutions to the organ shortage by suggesting obvious donors (prez, veep) people view me as unhinged?

Posted by: bad Jim at January 9, 2004 03:34 AM | PERMALINK

The other interesting point in there is that the US pays 15% of GDP for health care. The EU countries pay less than half that, at 7.2% of GDP. And their GDP/capita is less, so spending per capita is even less than half of our in the US. What do we get again? The US has higher infant mortality than all of them, and less life expectancy than about half of them. Huh?

And yes, I am a communist. I helped to bury millions of people in Siberia, China and Cambodia.

Or worse, I'm French.

Posted by: andrew at January 9, 2004 04:04 AM | PERMALINK

Catch a clue: You think Andorra heads that list because their health care system is better than our's? Yeah, right.

After you've stopped the epidemics, taught doctors to wash between autopsies and deliveries, and generally picked all the low hanging medical fruit, the chief cause of longevity differences is lifestyle. We don't have a shorter life expectancy than Andorra because our health care system isn't government run, it's because we're lazy slobs who eat cheeseburgers while vegging out in front of the tube. And too many of our children are born to irresponsible single teen mothers.

So, what's your single payer system going to do about that?

Posted by: Brett Bellmore at January 9, 2004 04:20 AM | PERMALINK

Steve,

Given the dishonesty/ignorance in your comment, it is probably a waste of time and effort to respond in a civil and rational manner, but I'll give it a try anyway:

You say

It is socialism because it prices and decisions are not made via the market process, but instead by collective decision making. In other words, if you are a doctor and want don't want to play the government's game you are basically out of luck. ClintonCare was specifically designed this way. One of the parts of the legislation held that if any health care provider provided health services that duplicated the care provided by the Clinton plan said health care professional would be either fined, jailed or both.

Do you have a literacy problem or are you deliberately misreading what I wrote? Where do I mention the hypothetical, never implemented, more than 10 years out of date Clinton plan? I was talking about the actual living, breathing NHS. And in the NHS, as I said there are many not-affiliated-with-the-NHS doctors that offer private FFS services. Including, as Charlie Stross mentioned a couple of posts above, most dentists. There are no laws whatsoever preventing private duplication of services.

You then say

You see, the problem is one of incentives. There cannot be any pooling of people of different risk catagories as the lower risk people will be lured away by better structured premiums/plans. In the insurance field this is called "cream skimming".

No. Actually that is what insurance companies in the US do. Everyone in the UK is eligible for the NHS and everyone pays for it through their taxes. Do not talk of that which you don't understand.

You then ask

Actually I disagree with this. The system you have in the U.K. is underfunded. Fine, then what happened to this desire to provide the most and best care as efficiently as possible? Politics? Did people start getting upset at continually increasing costs? How come Canada has such a low number of MRIs?

I thought I had addressed this implicitly and that others had addressed it explicitly. I'll try again and maybe you will be able to read now what you were unable to read before. To answer your last question first, I don't know. I'm just an American living in the UK for a while and know next to nothing about the Canadian health care system, how many MRIs it administers, how it prioritizes between that service and others, or whether this is indeed a problem. If you want an answer to that you should probably ask a Canadian. To answer your other question, though, the reason that the NHS is underfunded (at least in comparison with the US) is that the UK spends a lower percentage of GDP on health care than the US and far less in terms of dollars per capita. You get what you pay for and there is now doubt in my mind that if the UK funded its health care system to the level that the US does, it would be far superior.

Posted by: Jay at January 9, 2004 04:27 AM | PERMALINK

You (and these trolls) are missing something else, here, Kevin: our health insurance program leaves some 45 million people uninsured. These people do not get basic preventive care, which is one reason that our life expectancy is lower here. When they do get such care, they pay more for drugs and services than the insurance companies do, because the insurance companies bargain. So, all things even equal between the British or French system, the American system socks those who can afford it least with the higher costs.

And rationed vacations to Hawaii my ass. I may never go to Hawaii, but I damned well am going to need a doctor.

Posted by: Brian C.B. at January 9, 2004 05:11 AM | PERMALINK

Actually, Brett, the single biggest difference in health care outcomes, as far as I can tell, come from two sources:

1) Reporting. When a baby is born five months premature in Cuba, it's stillborn. When it's born five months premature in the United States, it's given heroic measures. If it dies three hours later, it goes into the statistics as an infant mortality

2) Immigration. Immigrants, who grew up in subpar conditions, have drastically lower life expectancies adn health outcomes than the native born. If you take immigrants out of the sample, a lot of those horrific American comparisons disappear; our poverty rate starts looking good compared to Europe, and our health statistics look even better. Gregg Easterbrook talks a lot about this in his new book, The Progress Paradox. And before you ask, yes, we have even higher rates of immigration than Canada.

There's no question that we spend too much on heroic intervention at both ends of life. But is that really so bad? Should we cut that 15% of GDP to take Grandma off the ventilator because she's only going to live another month anyway? In some cases, we're clearly giving people care that decreases, rather than increases, the quality of their end-of-life experience. But I'm damn uncomfortable with either a government bureaucrat, or an insurance company, giving orders to pull the plug, which is the only way to substantially trim those costs.

(I know someone is going to bring up Medicare's much vaunted lower administrative costs. But Medicare achieves those costs by forcing much of its administrative burden onto doctors. Economically, it is not a net positive to have expensively educated doctors spend hours each week doing work that could be done by a high-school educated file clerk. Areas other than cutting care turn out to offer few opportunities for costless saving -- for example, it can cost more to sell to the government than the consumer sector, which may eat up the marketing savings single-payer advocates expect. Theoretically, we could get a government procurement reform that would mitigate this -- but theoretically, we could invent a single pill that would allow us all to live forever. In the real world, when building a functional single-payer system requires also revamping the procurement structure, and the civil service, and peoples' health care expectations, it's a pretty sure bet that it isn't going to work.)

Posted by: Jane Galt at January 9, 2004 05:19 AM | PERMALINK

The problem with preventive care also turns out to be one of immigration: the poor using the emergency rooms turn out to be disproportionately composed of illegal immigrants, who refuse to use clinics and so on, even when they are free, because they are afraid of La Migra. The experience of free clinics, as far as I know, is that they have little impact on emergency room usage or patient outcomes.

Posted by: Jane Galt at January 9, 2004 05:22 AM | PERMALINK

I tend to agree with the overall point, although I'm a bit leery of going to a single system. Lack of R&D incentives being just one problem.

But one major flaw that most of the comparisons with the US and Europe have is they don't account for the vast difference in population density. (The same is true, incidentally, with the public transportation argument.) We've got a little over 30 people per square kilometer, compared to 110 for France, 154 for Finland, etc. It's going to be more expensive as a portion of GDP to provide equivalent health care regardless of the system.

Posted by: James Joyner at January 9, 2004 05:24 AM | PERMALINK

My wife and I run a micro-sized business. The business carries a health insurance policy (Blue Cross, MA). The premium was adjusted last year partly because of our ages and partly it hadn't been adjusted for a year or two. The monthly premium for me and my wife went from roughly $550 to $950. On my wife's last visit to her gynecologist she learned that Blue X no longer covered the routine ultrasound. Cost: $300.

Posted by: Joe Betsin at January 9, 2004 05:35 AM | PERMALINK

It might be instructive to do an investigation to find out why amounts that are put onto medical bills in the US are oftentimes, oh, say 5 to 10 times what they are for private-pay patients in, say Germany. For equivalent procedures.

It is becoming increasingly clear that medical billing in the US is something of a scam.

Posted by: raj at January 9, 2004 06:01 AM | PERMALINK

Frugal Liberal says
Canada's MRI/CAT/PET shortages are caused by a lack of equipment and technicians. We have no such problem here. We have the resources in the US to treat the majority of patients, Canada doesn't.
And one of the reasons for this would be our "high" cost of medical care. We can afford it.

And has everyone forgotten that the hated HMOs were a first step toward socialized medicine? Your argument is that if a little socialization is bad, a lot is good?

My final point was raised by James Joyner: what about R&D funding? Our R&D efforts are rolled out to the rest of the world, where's your compassion for other countries?

In theory, socialized medicine is a wonderful concept. But the practicality is extremely low.

Posted by: Ron at January 9, 2004 06:16 AM | PERMALINK

Sebastian (and others),
I've heard the argument that we (US taxpayers) need to subsidize medical and pharmaceutical research because the other countries are getting a free ride.

Your scare quote is that if we don't do it, it will go away.

I say the proper conservative response is 'let the market work.'

Is it fair to charge rich people more for milk because otherwise the farmer will cut down on the number of cows and the price will go up?? Is that what libertarians and conservatives are saying?

Sheesh. We should compete in the global market like all the other countries. Maybe our prices go down, and their prices go up. Let he market work!

If we want to subsidize research then let's do it directly, where we can control it, and not indirectly through higher prices.

I don't want my research dollar used for advertising and finding another way to patent another frigging 'Gastric Reflux Disease' pill!

Marketing dweeb one: Heartburn just doesn't sell.

Marketing dweeb two: Yeah, but what about Gastric Reflux DISEASE?!

one: Ooooh, you're good.

two: Thank you, US taxpayer.

Posted by: Tripp at January 9, 2004 06:29 AM | PERMALINK

Tripp
I'm not sure I'm following you. Is your suggestion to 1)do socialized healthcare 2)fund R&D 3)charge other countries their "fair share" for our R&D?

Because otherwise, the market is working. The US has the money, the US companies can charge more here; but they still do overseas business.

Posted by: Ron at January 9, 2004 06:48 AM | PERMALINK

Tripp -- I find it hard to imagine how you think that implementing socialized medicine is "letting the market work".

The definition of letting the market work is allowing hte equilibriating mechanisms of individual decisions about supply in demand, in reponse to price signals, set a price at which the market "clears": the amount of goods people are willing to supply at a given price matches the amount of goods people demand at that price.

The chief objection liberals have to the health care system comes not when the market is broken, but when it is working: when it efficiently sets a price on medical goods. When that happens, some people cannot consume as much medical care as they would like to, if the price were lower. Single payer advocates therefore want to break the clearing mechanism so that the demand-side price is artificially low. Of course, if you do this without subsidizing the supply side, the result is shortages and rationing, and if you do it with subsidies, the result is spiralling costs. But that's an argument for another day.

What equilibriating mechanism are you proposing between nations, once you have broken teh price mechanism that attracts dollars to research? As current research priorities will show, government fiat seems to be a poor substitute.

Posted by: Jane Galt at January 9, 2004 06:58 AM | PERMALINK

Jane,
I think you are getting stuck on labels.

In the global market for (some) products, 'countries' are 'individuals.' Can't you take the market paradigm to the next level of abstraction?

Imagine the following Monty Python skit:

Shopkeeper: That will be 100p for the milk.
Customer: But you just charged HIM 50p.
S: Well, you're richer than him, aren't you?
C: So?!
S: I have to charge you more.
C: Why?
S: So I can research a better chocolate milk.
C: But I don't want chocolate milk.
S: Well you like healthy milk, don't you?
C: I suppose . . .
S: So you must pay more so I can research a healthier milk.
C: But I don't want to!
S: You must!
C: If I want want bloody healthier milk then I'll hire someone to research it myself, and probably get a better job of it, to!
S: Oh, you can't do that!
C: Why not?
S: Why that's socialism, isn't it?
C: (pause) Well, all right then. (walks away)

Posted by: Tripp at January 9, 2004 07:06 AM | PERMALINK

Today's Bob Herbert column illuminates just one shortcoming of our foundering healthcare system:

A new report by the Center on Budget and Policy Priorities shows that 34 states have made potentially devastating cuts over the past two years in public health insurance programs, including Medicaid and the very successful children's health insurance programs known as CHIPS. More cuts are expected this year.

"Almost half of those losing health coverage (490,000 to 650,000 people) are children," the report said. "Substantial numbers of low-income parents, seniors, people with disabilities, childless adults and immigrants are also losing coverage. Cutbacks of this depth in health insurance coverage for low-income families and individuals are unprecedented."

The worst of the cuts are in Texas. "The Lone Star State has adopted deep cutbacks in its State Children's Health Insurance Program that will cause about 160,000 children — one-third of its SCHIP caseload — to lose coverage," the report said.

Leave no child behind . . . yeah, right.

Posted by: Bragan at January 9, 2004 07:20 AM | PERMALINK

I'd have more sympathy for the anti-UHC point of view, if there was actually an alternative. Like it or not, the HMO system won't last much longer. Maybe a decade. Eventually, it'll become too expensive for people to afford. Companies will be unwilling to lower prices, as that will affect their stock prices.

As it is right now, it's a HUGE parasite on the economy at large. It really could be argued that it alone is killing the economic recovery..

NHC in the UK was basically crippled by the Thatcher government, from what I know. The Canadian system has a few HUGE problems, that frankly can't be fixed (Look at a map) but are worked around pretty nicely. Not too familiar with other plans.

Like it or not, there really is no other option. The free market, in this case, has been shown to not work. It happens sometimes. Get over it. It doesn't mean that "communism" is better, or that everything should be nationalized. Just that in some industries, competition is unrealistic.

Posted by: Karmakin at January 9, 2004 07:25 AM | PERMALINK

There are already too many comments on this thread, so I'm not going to jump in.

My health plan, like most others, was great until I got sick. Then the insurance company seemed sort of stunned and befuddled about what to do when receiving a bill from the doctors and testing firms.

And I never used to believe those claims that 100,000 people per year died because of drug mishaps in hospitals until I actually saw it happen.

I guess I should be happy that in America, some rich guy, somewhere, is receiving great health care, better than he could find in Canada. I toast you, rich guy!

Posted by: Constantine at January 9, 2004 07:34 AM | PERMALINK

If you don't like HMO's, blame Ted Kennedy. He was instrumental in crafting the legislation that produced them.

Why is it that nobody here EVER considers actual private insurance (for the individual), like we all have for our homes and cars, when this debates comes up? Somehow the only solution is Government.

And don't give me any bunk about "red-lining" and "Adverse Selection" as those can be eliminated through laws.

Posted by: Black Oak at January 9, 2004 07:34 AM | PERMALINK

As usual, this topic produces the most useless and depressing thread. Platoons of straw-men are sent forth to be slain in titanic battles by people who set up a dichotomy of either the current U.S. system (which one side of the debate tends to defend, for some unfathomable reason) , which has only the most tenuous relationship to a decentralized, market-based regime, or a centrally-planned regime, which of course will the first centrally planned regime in human history which will not have the defects of central planing because, well, just because.

In other words, the same American political processes that produced those paragons of optimum resource usage, the Department of Defense and NASA, will wither away when applied to health care technology (and make no mistake, modern health care IS a technology enterprise) because, well, because we REALLY, REALLY, would like them to wither away. All the while, of course, hardly anybody in this debate is willing to acknowledge the ugly little fact that what this debate is about is how to deny people care, for no regime will ever be able to deliver the all the care that people would prefer to have, and cultural expectations play a huge role in how rationing is achieved. The same people who yelp when medicare cutbacks are proposed, or try to win votes with tales of medicare cutbacks, tend to be those who speak favorably of regimes in which a 75 year old who would benefit from a bypass would be better off in the U.S.

I'm open to any suggestions regarding this most unpleasant lesson in scarcity, but it would be nice if people could stop pretending that rationing will not occur, or that the current regime isn't terribly distorted, and that it wouldn't be preferable to have a functioning health insurance market. It would be equally nice if people would acknowledge that the more political bodies are involved in the production and distribution of health care goods and services, the more the effect political processes have on that production and distribution will mimic the effect they have on other types of goods and services in which political bodies are the ultimaite arbiters of production and distribution. All of this, however, would require treating one's ideological opponents with respect, operating in good faith, and admitting that one's proposal (literally, any proposed regime) will inevitably have drawbacks which entail denying care to people who would benefit from having it. This, of course, would require intellectual honesty, and we wouldn't want that.

Posted by: Will Allen at January 9, 2004 07:42 AM | PERMALINK

James Joyner:

But one major flaw that most of the comparisons with the US and Europe have is they don't account for the vast difference in population density. (The same is true, incidentally, with the public transportation argument.) We've got a little over 30 people per square kilometer, compared to 110 for France, 154 for Finland, etc. It's going to be more expensive as a portion of GDP to provide equivalent health care regardless of the system.

Uh huh...

Country..........Popul/km^2.....Life expectancy

United States.......29.4.............77.1

Australia............2.5.............79.8
Canada...............3.1.............79.4
Iceland..............2.7.............79.4
Sweden..............19.7.............79.4
Norway..............13.9.............78.7
New Zealand.........14.3.............77.8

Sources:
life expectancy
population density

Oh, and you got Finland wrong by an order of magnitude; its population density is 15.3 per square kilometer.

Next strawman?

Posted by: N in Seattle at January 9, 2004 07:48 AM | PERMALINK

"Countries" are not Individuals. We say that the US imports cars from Japan and the US exports grain to Japan, but what actually happens is that Joe Farmer buys a Mazda3 from Irv Forktongue, a car dealer in Iowa, who buys from Mazda Corporation, who manufactured the car in Hiroshima, Japan. Meanwhile, Yoshi Hamamoto, a Mazda factory worker in Hiroshima,purchases cereal bars, to munch on the train, from his local grocer, who in turn purchased them from a wholesaler who bought them from Archer-Daniels Midland, who employs Joe Farmer to run one of their properties. The "US", and "Japan" are only involved, and only relevant, to the customs process. It really isn't any different than if Jeff Kozlowski, a factory worker in Detroit were buying the cereal, and Joe bought his car from Ford, except that Joe likes the Mazda better, and Jeff prefers Columbian coffee for breakfast.

Medicine is different because it IS socialized - Dieter in Hamburg doesn't buy medicine, he petitions the government doctor to give it to him. (Government doctor because the doc gets paid, ultimately, but the government.) Thus the market distribution is determined by government officials, not individual demand at market prices.

Posted by: rvman at January 9, 2004 07:53 AM | PERMALINK

I'm sorry you feel that way. I would like to continue being able to spend my money for private health insurance and not subject myself to a strictly government funded system.

Having lived in Germany I would contest your comments about it (or other government funded systems) as being equal or better based on my own experience. I'd say our government funded healthcare system (the 45%) may be equal but the private system is far better than what these government funded systems provide. Ultimately the private or capitalist (sorry for the namecalling) healthcare in our country is by far the best in the world.

Posted by: Stephen Filkoski at January 9, 2004 07:57 AM | PERMALINK

After reading all the comments here, the consenus seems to be, liberal; try to help everyone. Conservative; If you can't afford it do without. Typical responses.

Debak

Posted by: Debak at January 9, 2004 07:58 AM | PERMALINK

"I'm living in the UK right now, so I get to see the NHS (the British single payer health care system) in action. There are a lot of problems with it, basically all having to do with the fact that it is badly underfunded."

But this cuts right to the heart of Kevin's argument that Euro-style universal health care delivers equal care for less money. It doesn't. European (and Canadian) systems deliver worse care for less money.

I simply think that there is no way getting around the basic axiom that you get what you pay for. The US delivers, as a whole, better health care for more money. And while left-wing has a legitimate argument about the distribution of care among various segment of our society, it is ludicrous to assert (as Kevin does) that overall level of care in places like Canada, Britain, or France is equivalent to that here.

Posted by: Al at January 9, 2004 08:04 AM | PERMALINK

N:

Almost all the people in Australia live in about 3 cities. Almost all of the Norwegians live on the coast. Almost all Canadians live in a little strip along the US border. Iceland? One little area. Americans? All over the place. It isn't overall averages that matters, it is the actual density. If virtually all Americans lived in New England, and the entire west and south were virtually empty, then overall density of population comparisons between the US and Australia might be relevant. Personally I think our medical system is expensive because employer provision is failing, not density, but just comparing averages doesn't work if the populations are variably clumped.

Posted by: rvman at January 9, 2004 08:05 AM | PERMALINK

Speaking of straw-men, could people stop citing life expectancy as a measure of the quality of health care delivered? If you're morbidly obese, and lead an entirely sedentary lifestyle (and American are by a good margin the most obese and sedentary people in the idustrialized world) you just ain't going to live as long, on average, and there isn't a damned thing your doctor can do about it, and it won't make a damned bit of difference how your medical expenses are paid. Toss in the differences in how premature birth results are recorded, differences in homicide rates among the young, and other cultural differences, and statistics trotted out to "prove" something about the quality of health care delivery tend to be just another exercise in intellectual dishonesty.

Posted by: Will Allen at January 9, 2004 08:05 AM | PERMALINK

Ultimately the private or capitalist (sorry for the namecalling) healthcare in our country is by far the best in the world.

For the umpteenth time: Only for those that can afford it (and that group of people is steadily eroding).


Posted by: Bragan at January 9, 2004 08:08 AM | PERMALINK

Why is it that nobody here EVER considers actual private insurance (for the individual), like we all have for our homes and cars, when this debates comes up? Somehow the only solution is Government.

Because private insurance companies exist to make money, Black Oak. That may have escaped your attention? As a result, if you have a chronic health condition, they won't want to insure you, because you will end up costing them money. Nor will they want to insure the elderly. Nor will they want to go on paying out health care costs to someone who needs expensive long-term care. All of that cuts into their profits, and as private companies, their first duty is to their shareholders, not to the people who have bought medical insurance from them. If they have no legal obligation to insure people who are bad risks, which in a completely free market they would not, they would insure only healthy people under 65. Everyone else would end up paying for health care on a one-off basis, or dying if they couldn't afford it.

Possibly you could calmly walk past a homeless person* on the street screaming in agony as he died of cancer, unable to afford treatment or painkillers, but I gladly admit it would affect me. So we assume some degree of government involvement, because there is a general feeling among most people with an ordinary degree of human compassion that it's wrong to allow people to die in agony on the street - and while charities can do a good deal, they cannot do everything. As the Europeans have long-ago discovered, publicly-funded health care is far more efficient and effective than the American patchwork system.

*And anyone without medical insurance who was required to pay for long-term medical treatment would have a very good chance of becoming homeless.

Posted by: Jesurgislac at January 9, 2004 08:13 AM | PERMALINK

"As usual, this topic produces the most useless and depressing thread."

Yep, this topic should be on Vol I of the "Greatest Hits of the Blogospere". I'll bet that Jane Galt has a dozen similar threads in her archives. It would be easier for the hosts if they save the long-winded posts and just said "Universal Health Care: Discuss", wouldn't it? Nobody's changing anybody else's mind here.

Posted by: Al at January 9, 2004 08:14 AM | PERMALINK

Furthermore, that obese, sedentary lifestyle greatly drives us medical cost. I'm too lazy to look it up, if accurate, honestly derived, statistical measures are even available, but it would be interesting to know what the U.S. spends per capita (compared to other industrialized nations) on diabetes, heart disease, hip and knee replacements (among other orthpeadic procedures), etc., and other maladies closely related to obesity and a sedentary lifestyle.

Posted by: Will Allen at January 9, 2004 08:17 AM | PERMALINK

rvman,
Can't you get your head around another level of abstraction?

Sure, governments aren't individuals (duh), but if Govnerments aren't individuals then Corporations aren't, either. so why is it okay for the non-individual Corporation to negotiate prices with suppliers?

The only reason the citizens of the US don't have a 'Prescription Drug Buyers Club, Inc' to negotiate lower prices (or import drugs from other countries) is because the US govt won't allow it, and they won't set one up.

I say you and Jane Galt are hamstringing market forces and are distorting the capitalist system!

Posted by: Tripp at January 9, 2004 08:22 AM | PERMALINK

"I can't afford to visit Hawaii every month; Does that mean that "they" are rationing Hawaian vacations? "Rationing" generally refers to a system where somebody isn't permitted to buy something, even though they can afford it. Not to the simple fact that poor people can't afford to buy everything they want."

The above definition of rationing is deceptive in this context. When a 75 year old in England with end stage renal disease is denied chronic dialysis by the healthcare system conservatives in the US call that rationing. The individual could pay out of pocket for the service. Calling attention to the "rationing" of healthcare in the US is appropriate because it uses the same definition for rationing as the conservative critics of single payor or nationalized healthcare systems. When a service is so expensive that almost noone could afford it out of pocket, it is reasonable to call it rationing.

Posted by: Mark at January 9, 2004 08:31 AM | PERMALINK
And while left-wing has a legitimate argument about the distribution of care among various segment of our society, it is ludicrous to assert (as Kevin does) that overall level of care in places like Canada, Britain, or France is equivalent to that here.

That depends what you mean by "overall". If you mean what the median individual in the society gets, for instance, its probably not ludicrous at all.

Posted by: cmdicely at January 9, 2004 08:34 AM | PERMALINK

Instead of arguing about the worse care for less money in the single-payer systems that exist (and that's debatable, depending on whether you look at the 15% or so of the US population that does not have health insurance), think about what 15% of our GDP we spend on healthcare could do if we had a European-like system funded with 10% of GDP (with 5% of GDP being spent by people who wanted private service), if they're taking reasonable care of EVERYONE in their societies on 7-8% of their GDPs...

Posted by: A Texan in Maryland at January 9, 2004 08:38 AM | PERMALINK

cmdicely:

Quick: you're a median income person (insured) who needs a quadruple bypass. Do you want to have it here, or in Britain, where a friend's uncle was placed on an open ward eight hours after his surgery?

The uninsured arguably get worse care. (It's surprisingly arguable for all except the very poor). But the middle class indisputably receive better care here than the middle class in Europe or Canada.

Posted by: Jane Galt at January 9, 2004 08:41 AM | PERMALINK

I can deal with abstraction. For the purposes of discussions of economics:

CORPORATIONS.ARE.INDIVIDUALS. GOVERNMENTS.ARE.INDIVIDUALS.
Thus the behavior of corporations and governments, like human economic behavior, are the province of microeconomics.

COUNTRIES.ARE.COLLECTIONS.OF.INDIVIDUALS. To say the US and Japan do something is in the field of macroeconomics - the economics of aggregates.

Ultimately, what you are trying to do when you ask that the government negotiate on our behalf with the drug companies is use monopoly market power for your own benefit. In other words, you are trying to create a monopsony - a situation where there is functionally a single demander for a product or service. Monopoly produces an unfair, inefficient market outcome whether it is imposed by the supplier or the demander. Further, government monopolies are backed by the use of force - backing up the negotiations is the possibility that, if the pharma company decides not to sell for the price government offers, government will send in the cops and MAKE them produce. (What if the pharma behind AZT decides that the government offer isn't good enough? They will lose their patent or be ordered to produce at the low price. At this point we get real socialism - government de facto ownership of the means of production.) Monopolies backed by guns are not Good Things.
(If you think Microsoft is some kind of bad monopolist now, give them an army and see what happens. Even most libertarians wouldn't be thrilled by the Monsanto Militia enforcing sales, but now you want your medical purchases backed by the threat of the US Army kicking butt if you aren't satisfied with the terms of trade. Isn't this what the kookier liberals claim evilBush is doing in Iraq?)

Posted by: rvman at January 9, 2004 08:44 AM | PERMALINK

Will Allen: What would you use as a determinant, then? Anecdotes? You can complain about life expectancy but it is at least a place to start.

And by the way, being a sendentary lard ass IS part of medical care. When doctors, excuse me...primary care providers...aren't herding people through the system like cattle, they take the time to advise on nutrition and exercise.

And will someone PUH-LEEZE drive a stake through the heart of the long wait for service theme? Unless blood is shooting out of a major artery, the lines are quite long in the good ol' U.S. of A., thank you very much. Enough of the bullshit.

Posted by: chris at January 9, 2004 08:55 AM | PERMALINK

Jane

In Canada my father needed radiation treatment not available in the local hospital. He was flown to a larger city by air ambulance (jet). He was charged for the flight - at the price of a seat on a commercial flight. And of course he was flown back after the treatment.

The type of ward does not matter as much as the quality of nursing care. In fact the open ward might be better because the patient is not off in a private room with the nurse watching monitor screens at the nursing station.

Posted by: ____league at January 9, 2004 08:55 AM | PERMALINK
Almost all the people in Australia live in about 3 cities

Population of Australia - ~20m Population of 6 biggest cities - ~8.5m Posted by: keith at January 9, 2004 09:10 AM | PERMALINK

Jane Galt: your comment only makes sense if you honestly feel that the 45 million people in the US who don't have medical insurance deserve to die.

Frankly, that is the message I'm getting from those who are anti- the efficient European health care systems: "I'm certain I will always have medical insurance! Let the proles die, because I will never be one of them!"

Personally, that's why I've always preferred socialism: the attitude that all human lives are equally valuable.

I wonder how many of those who have so vehemently declared that they don't care if the uninsured die on the streets, so long as they themselves get medical care, are also "pro-life"? If so, how do you manage to reconcile your belief that a foetus is a human life and all human life is valuable with the belief that the uninsured deserve to die if they can't afford medical care? Do you believe that it would be okay (and desirable, in fact) to abort uninsured foetuses? Or if foetuses are sacred, how about infanticide of uninsured babies, would that be okay?

Kevin, I apologise in advance for the screaming responses from right-wing pro-lifers to this comment: anyone who just wants to insult me because of my opinions should come do it on my livejournal, okay? Thanks.

Posted by: Jesurgislac at January 9, 2004 09:20 AM | PERMALINK

chris, if you think that people need a doctor to know that being a sedentary lard-ass is unhealthy, you must believe that the people of this country don't consume much mass media, with it's constant messages sbout the health benfits of losing weight. Of course there are lots of other messages in the mass media, and consuming lots of mass media leads to a sedentary lifestyle, but you are entirely off-base in thinking that people are fat in this country because their doctors aren't taking time to tell them to lose weight.

People didn't stop smoking in this country becasue all of a sudden their doctors told them to; they stopped because of a cultural change in many areas of society, along with the fact that nobody needs to smoke to survive. In contrast, everybody needs to eat every day, fat and sugar taste better, and a good many people are genetically predispositioned to gain weight rapidly when eating such a diet, and many,many, people have to go out of their way to expend calories, as compared to our ancestors only a few decades ago, when people expended lots of calories in their everyday lives. This process is further along in the U.S, because the U.S. got rich first, but obesity and sedentary lifestyle are on the rise elsewhere now, despite the difference in health care delivery. People are not fat because of the relationshp with their doctor.

Measuring quality of health care is a very, very, difficult thing precisely because of the myriad of variable at play, so no, I don't consider crude measures which don't actually gauge the phenomena, but rather allow people with an axe to grind to sell their political agenda , "a good start".

Posted by: Will Allen at January 9, 2004 09:35 AM | PERMALINK

sorry, Chris, I didn't mean to misquote you, but I don't value crude misleading measures as a place to start; I view such measures as inadequate, so I ignore them and attempt to find better measures.

Posted by: Will Allen at January 9, 2004 09:43 AM | PERMALINK

Pardon me if someone already posted this. I haven't read throught all the comments.

A national single-payer system, which Kucinich and Mosely-Braun have been pushing, is NOT socialized medicine. Health care providers would still be private operations and not owned by the government.

With a national single-payer system, all health care premiums (yes, taxes) go into a single pool, from which patients costs are paid. Health insurance companies (and therefore costs) are eliminated, and pharmaceuticals and durable medical equipment are purchased in bulk.

With a single-payer system, which insures everybody, other costs, such as emergency room visits will vastly decrease because those who are uninsured tend to use emergency rooms as primary care providers.

I've read lots of different statistics about savings and costs as a percentage of total health care dollars, so I won't throw any out here. But it has been shown consistently that costs would decrease, not increase.

Posted by: Adrienne at January 9, 2004 09:49 AM | PERMALINK

Universal Single Payer is not a perfect system. It's just the best thing anyone has thought of to get health care to the most people who need it, instead of just the people who can afford it. Simple utilitarianism: trying to increase happiness for the greatest number of people.

Posted by: Bill Nazzaro at January 9, 2004 09:52 AM | PERMALINK

Al,

Wow. Illiterate or intellectually dishonest? Which one are you? Those are the only two choices when you infer the following from my quote:

"I'm living in the UK right now, so I get to see the NHS (the British single payer health care system) in action. There are a lot of problems with it, basically all having to do with the fact that it is badly underfunded."

But this cuts right to the heart of Kevin's argument that Euro-style universal health care delivers equal care for less money. It doesn't. European (and Canadian) systems deliver worse care for less money.

Really I meant the opposite from what you infer. In fact, my point was that it delivers care which is almost as good for far less money, which you could figure out for yourself if you only bothered to read the next paragraph:

Having participated in both, I have to say that the British system is in principle vastly superior to the US one and that if the UK devoted the same percentage of their (much smaller) GDP to health care as we do then there is no question of which healthcare system would provide better and more efficient care.

Posted by: Jay at January 9, 2004 09:53 AM | PERMALINK

I've known a lot of Europeans living in the US, and have talked to them at length about differences in the health care systems. The main thing I've come away with is that you can get good care in either system, just as you can get lousy care in either system. But the rules for manuvering within the systems are very different, and you have to take this into account.

The political issue with gov't run health care in the US is that people don't trust the government. The old line, "Do you want the people at the DMV to run your health care?" hits home pretty hard to anyone who's had to deal with the DMV themselves, especially if you have a problem. Sure, HMOs can be just as bad, but at least you can sue an HMO, and they will pay attention if you threaten to sue or hire a lawyer. Tried to get the DMV's attention lately? Good luck. (Note - this is the pitch that works. You may agree or not, but it does work.)

Posted by: rhinoman at January 9, 2004 09:55 AM | PERMALINK

Man, it took me ony 10 posts before my eyes started to bleed.

For anyone interested is this 2000 World Health Report from the WHO:

http://www.who.int/health-systems-performance/whr2000.htm

If you read it you'll soon discover that the US in fact does not have substantially better healthcare than the European nations, in fact in terms of cost/benefit ratios we rank below some nations you'd never expect.

One big reason is because in the US healthcare stops at the hospital. In European nations there is much more focus on prevetative care and it pays off in the long run.

But hey, ya'll feel free to never, ever challenge your assumptions and measure healthcare only in terms of frequency of surgery and fantasies of medical breakthroughs our "market" is developing at every turn (even though most medial research, be it drugs or surgery or what have you, is government subsidized).

It's probably easier to live in a fantasy world.

Posted by: Tim at January 9, 2004 09:57 AM | PERMALINK

People seem to be overestimating the kind of care indigent people receive at emergency rooms. In Colorado, at least, emergency rooms are only obligated to provide treatment to those without insurance if they are not "stable." I.e. bleeding heavily right now.

The Denver Post did a series on this a while back. One story I remember was a guy with a broken jaw who had to go to three emergency rooms before he was treated. If you can't count on your broken jaw being treated at the emergency room, it is hard for me to call that "health care".

Posted by: Emma Anne at January 9, 2004 10:07 AM | PERMALINK

OK, you want a more precise description of Australia's population? Most of the people in Australia live in a a rough arc along the coast from Brisbane to Adalaide, with one population center at Perth accounting for much of the rest.

The largest city not in the Brisbane/Sydney/Melbourne/Adalaide megalopolis other than Perth is the thriving metropolis of Hobart, Tasmania, population 126,048. Darwin, the primary city in the Northern Territories, has a population of less than 80,000. The largest inland city west of the mountains along the east coast probably has 30,000 people.

Australia is a vast empty clump with no people to speak of, with a couple of large metropolitan areas on one coast, and one on the other. Think of LA and the Richmond-Boston corridor with the populations they have now, but Chicago the size of Omaha, Houston the size of Corpus Christi, Dallas the size of Waco, and KC, Denver, etc. being trivially small. Spread the population density of Kenedy County, Texas (pop. 413, area 1392 square miles) over the remaining 85% of the country. Then you have Australia.

Posted by: rvman at January 9, 2004 10:09 AM | PERMALINK

European (and Canadian) systems deliver worse care for less money.

The US system delivers no care, or the next-best-thing to no care, for tens of millions, for nothing.

This is better how?

Posted by: Davis X. Machina at January 9, 2004 10:15 AM | PERMALINK

"The US system delivers no care, or the next-best-thing to no care, for tens of millions, for nothing.

This is better how?"

This is simple. tens of millions are actually younger and healthier, and financially better off by opting out of an insurance system. Remember a managed care system provides services to spcific groups who need the care, but collects money from all who pay it.

Posted by: Matt Young at January 9, 2004 10:26 AM | PERMALINK

How, pray tell, does government not functionally control the means of production in single payer if government is buying "in bulk" the equipment and pharmaceuticals? It takes a breathtaking lack of analytic thought to believe that, just because some private individual, company, or non-profit nominally "owns" the hospital, and the doc is in nominally "private" practice, that government doesn't still control those entities. Is my local McDonald's part of the great McDonald's entity? It is owned by a local franchisee, isn't it?

Single Payer is socialism, and subject to all of Mises', Hayek's, Friedman's, and all the rest's critiques of the failures of socialism. It WILL be highly inefficient. It WILL deliver a mismatch between needed and delivered services. It WILL deliver better service to politically favored places over politically disfavored ones. (Quick question, blue staters. If the Republicans run the House, who will get the new hospitals and best equipment, San Francisco or Houston? If the Dems do, will it be rich, well-served DC or Boston, or poverty stricken Mobile, Alabama?) We have to compare the reality of what a USCare would actually do to the reality now, not an ideal to our current system. The reality is that the Byrd Hospital in West Virginia will have 12 MRI machines, while there will be 1 for the whole state of Hawaii. That is just how our political system is.

Posted by: rvman at January 9, 2004 10:30 AM | PERMALINK

"Sebastian, that's nonsense. Medical research and development happens all over the world. It's funded primarily by governments. Privatised medicine and the big companies that profit so hugely off it are the free riders, seeking profit from research funded by taxpayers."

Ok, then please refer me to the top 20 medical advances in the past 20 years discovered by governments?

Advances in diabetes? No. Advances in Alzheimer's research? No. Angioplasty advances? Ha! Imaging innovations? Maybe on the margins. Cholesterol control? Please. Blood pressure control? Nope.

Your rhetoric hasn't led to actual advances. Governments are notoriously poor at creating useful drugs from their medical research. How many friends do you have in medical research? I know 30 full time doctors who have worked in private research for more than 15 years each. None of them have ever been involved with a drug that made it to market. That is 30 doctor salaries for 15 years with no product for their companies. That research is NOT funded by unit costs level payments by the Canadian government for drugs.

Posted by: Sebastian Holsclaw at January 9, 2004 10:31 AM | PERMALINK

Matt

Yes there are some young and healthy who decline insurance. Who pays when they crash their motorcyles etc.?

However, most of the uninsured are not uninsured by choice. There are millions working full time who would have to pay 20% or more of their income for insurance. Since you are sure to get sick if you not eat and you have to live some place they choose food and rent over insurance.

Posted by: ____league at January 9, 2004 10:46 AM | PERMALINK

""they deliver care that's as good or better than ours. For everyone."

The average is better. We do better in high tech areas and have less frank rationing.

"What planet are you on? Do you know about the 6-month waits for MRIs in Canada?'

The problems of Canada are products of an error in the design of the system and overspending by Trudeau for years on other things. They insisted on first dollar coverage which is very wasteful. Co-pays keep out the "worried well" who clog Canadian GPs waiting rooms because it's free. A $10 co-pay would have solved a lot of their problems. They chose to spend all the money on this primary care and skimp on hospitals and technology.

"The debacle than National Health Care is in England?"

The NHS has reformed quite a bit in the past 15 years. The fund-holding practice reform let GPs keep better control of their patients' care and reduced the arrogance of hospital based specialists considerably. The NHS does a much better job with home care for the elderly but the English are much more willing to accept rationing than Americans would be. The average level of care is good although docs are overworked. Lots of foreign medical students now but that's true here too.

"The thousands of elderly who died for lack of adequate health care during a heat wave in France? God, the ignorance here is astonishing."

The French are another trip altogether. About 15 years ago they had a scandal when the health minister allowed old stocks of blood products to be used up before ordering new, heat-treated, stocks. This allowed HIV infection of hemophiliacs to continue for several years after other countries had eradicated it from blood supplies. A French lab actually discovered the HIV virus and French medical care is excellent (they invented laparoscopy gallbladder surgery, for example). The heat wave deaths were because everyone goes on vacation in August, doctors and nurses too. It had nothing to do with the payment system.

Posted by: Mike K at January 9, 2004 10:50 AM | PERMALINK

Is it plausible to think that, with a profit motive, maybe some docs might have stuck around to treat patients in August while their colleagues whooped it up on the Riviera, and maybe Grandma just might have had someone to call for help? August month-long vacations are a symptom of France's socialism, not a pure benefit.

Posted by: rvman at January 9, 2004 10:57 AM | PERMALINK

A private market for health insurance will NOT work...the adverse selection problem is much deeper than the libertarians here seem to realize. You have to group people together somehow and make purchasing mandatory, which is what we try to do here through the workplace/insurance connection. Which has its own set of irrationalities and problems.

The adverse selection problem means a huge amount of time, money, and energy is spent in squabbles between insurance companies, patients, and hospitals about who is going to pick up the tab for who and for what. It's like an endless argument between a bunch of people about who is going to pay for dinner. Most of that is a waste.

We already have what is essentially a government health care system here, it's just extremely badly designed and inequitable, and leaves private parties to that endless squabbling referred to above. If I walk out of here and get rear-ended by a drunk driver and badly injured, how much of the next five years am I going to spend arguing with my insurance company? What is my chance of personal bankruptcy if my insurance is anything but gold-plated? Why should I go bankrupt or spend endless hours quarreling over who pays for bills if a drunk driver hits me? The latter is a waste and the former unfair.

A single payer system does not have to eliminate competition between providers for patients, or between technology suppliers for the providers dollars. It changes the financing on the patient end.

Posted by: MQ at January 9, 2004 10:59 AM | PERMALINK

Mike K -- great post. Unlike many you seem to appreciate that there are lots of different ways to design a national health care system, and different nations have different strengths and weaknesses. It's not a blanket up/down decision but a question of design. I think the best way to go is a reasonably large copay for most things and very good catastrophic coverage -- that keeps good market incentives for minor conditions and focuses the subsidies on areas where it is unfair to make people pay the costs of major disasters in their lives.

Americans would not tolerate the insularity and arrogance of the French medical community. For example, we would want to set things up here in such a way that physicians could continue to be sued for malpractice -- which is enormously difficult to do in France. If the right had their way, of course, it would also be enormously difficult to do here.

Posted by: MQ at January 9, 2004 11:04 AM | PERMALINK

"Who pays when they crash their motorcyles etc.?"

Taxpayers do, except those that avoid work or work in the underground economy.

Actually emergency services has become the focus of California's government medicine system, with budget cuts happening to all the ancillary services.

The way to avoid this cost is to move your business out of California, generally to another country.

Dunno what to tell you, except, that financially, the best strategy for drug users, reckless drivers, and violence prone individuals is to rely on the California taxpayer rather than pay their own costs.

Which brings us back to the central point, right?

The California socialized medical system favors the reckless, in sort of a reverse darwinianism. The best return on your investment is to avoid high productivity jobs that might be taxed, live on part time work, and rely on government for all emergency needs.


Posted by: Matt Young at January 9, 2004 11:09 AM | PERMALINK

I have a challenge for all the conservatives, libertarians and others (Matt, Jane, Sebastian, et al) who have been arguing here that the US health care is preferable to any other system.

I am willing to accept your premise without any argument. Fine, all the other systems, in every other country in the world, are inferior for all the reasons you articulated. I accept you evidence, I accept your arguments, and I accept your conclusions. You're obviously knowledgeable experts in the filed of medical care and insurance -- if I were to judge by the reams of information you seem to have ready at the click of a mouse.

Then you should be able to resolve this simple puzzle for me:

I am close to 50, married for 20 years, and I have two young children. All of us are quite healthy. Both my wife and I are self-employed and work hard for a living. We net about $3,000 a year. We're very frugal, we live in a small house and drive a 1989 car. We have simple tastes and as far as we're concerned we're doing fine. We haven't been on vacation for a decade, and we don't eat out much and wear cheap clothes. But we have no complaints. We're quite happy.

There's only one problem: Our insurance premium for our family just went up to $700 a month. That was the cheapest one we could find. We had to cancel. Not out of choice but because we do have to eat from time to time. We're obviously very nervous, especially since we're getting older and we're bound to face more health challenges in the future, but also for our kids. They are healthy now, but accidents happen and even the healthiest kid can get a serious disease.

What do you think we should do?

Making more money is not an option. Who wouldn't like to make more money? But how? We cannot work any harder or longer. I did get a job a few years ago to increase our income, but even with the extra salary our finances did not improve in any meaningful way. And because I worked for a small company, our health care premium was only marginally lower than it is now. In any case, that's a moot point: the company went out of business two years ago. My prospects of starting another career right now are miniscule.

Besides, at a certain point in one's life one has to come to terms with one's limitations. Neither myself nor my wife are exceptional in any way. Like most people in this world we're quite ordinary. I'd like to think that we're relatively intelligent, and we're good parents, investing all our free time on our kids. We're both college graduates (I have an MA) but we don't have any special talents. Our youthful ambitions apparently exceeded out abilities. Improving our situation by sheer will power ain't gonna happen. Pulling one up from the shoestrings doesn't work if the shoestrings are old and frayed.

So, what do you think we should do? In practical terms, please. No slogans, or imperatives, or admonitions, or clichés. Give me a practical solution on how we can afford the unaffordable.

And please, please, none of the silliness about health care being an elective commodity. It most certainly it is not. Without health care we can get sick and die. So we must have it. But how? The current system is prohibitive.

So, what do you think we should do?

Posted by: James Rockford at January 9, 2004 11:22 AM | PERMALINK

James: you should get out there and work hard to elect a Democratic president.

Posted by: MQ at January 9, 2004 11:27 AM | PERMALINK

rvman,
I'm glad to see we agree that monopoly power is bad whether it is on the part of the producer or consumer.

From where I sit the US government has set up monopoly power for big pharma's in the distribution of drugs within the US. Otherwise people would be free to, for example, go to Canada for their prescription meds.

From where you sit the Gov't could become a monopoly consumer if it negotiated over block purchases.

In the past we regulated necessary monopolies like electric service, allowing the monopoly but regulating the price, but then those things got privatized. Why is it that the pharmacy industry is only half privatized - we enforce the monopoly but don't regulate the price? That is a very, very sweet deal for the pharmas, no? Enough that they can afford 6 lobbyists for every member of congress. Don't you feel even a little guilty siding with those people?

Posted by: Tripp at January 9, 2004 11:28 AM | PERMALINK

I'm very curious to see how Matt, Galt, and their ilk will address James Rockford's question.

Every time there's a discussion on health care conservatives do nothing but spread lies about how horrible things are in the EU and Canada (yes, they're are lies; I lived all over Europe and with few exceptions every industrialized country has a far more efficient and equitable sustem than ours). But they never, ever, offer any constructive suggestion on how to improve our system. Do they actually think it's perfect, with so many uninsured people?

Posted by: vacmaster at January 9, 2004 12:06 PM | PERMALINK

Jane Galt wrote: "The uninsured arguably get worse care. (It's surprisingly arguable for all except the very poor)."

If it's arguable, then by all means, argue it. To me, it's self-evident. If you have any studies or statistics that make your case, please cite them.

"But the middle class indisputably receive better care here than the middle class in Europe or Canada."

If it's indisputable, then surely you have the facts and figures to back this up, right? And you can post them here so that we can all see them and be convinced? Because right now, I don't see it.

Posted by: PaulB at January 9, 2004 12:21 PM | PERMALINK

N in Seattle:

You're right on Finland--an entry error in the calculator.

As to the population density-life expectancy correlation, I'm not sure why that's germaine to the argument here? We're talking about cost, not life expectancy. The latter varies with a lot of factors, not the least of which is, as Megan notes, differences in reporting.

Posted by: James Joyner at January 9, 2004 12:26 PM | PERMALINK

it is ludicrous to assert (as Kevin does) that overall level of care in places like Canada, Britain, or France is equivalent to that here.

No, it's not. It's a stupid argument, anyway, because on a strictly human level, you can't say:

'She didn't get care and died; he got fifteen MRIs and a plush private room'

and then say it averages out as '7.5 MRIs and treated pretty well'. Because that's what you're doing. The test of a healthcare system should be how it treats those at the bottom end of the scale, not those at the top. It's like saying that Paris Hilton's lifestyle reflects the overall lifestyle of Americans.

Governments are notoriously poor at creating useful drugs from their medical research.

That's simplistic bullshit, of course, but what are we to expect from Sebastian?

Government funding (i.e. funding to universities) is not directed towards money-spinning drugs. Instead, it does all the crappy groundwork: the foundational analysis that allows Big Pharma to piggy-back with its particular interest in creating consumer products. It's like saying that steel mills are notoriously poor at creating SUVs.

Finally: Jane Galt is doing well out of her middle-class healthcare plan, because it obviously includes an op diem prescription of LSD.

Posted by: ahem at January 9, 2004 12:27 PM | PERMALINK

vacmaster,
I know. It is so easy to BS people when they are ignorant.

For my little anectdotal piece, I worked 6 months in England with my family and found the healthcare just fine for my average, middle class problems (ear infections, broken bone.)

Granted the neighborhood clinic had cheap paneling instead of the imported marble they have at the Mayo Clinic, but what do you want to pay for, service or style?

On the other hand I heard incredible BS about the US while there, so they can be just as ignorant.

Posted by: Tripp at January 9, 2004 12:40 PM | PERMALINK

I'm also interested to see how the anti-efficient health-care people will answer James's question. (But I suspect they'll simply ignore it.)

Sebastian, you asked: Ok, then please refer me to the top 20 medical advances in the past 20 years discovered by governments?

Actually, this is more research than I really want to do on a Friday night, so I'm just going to pick out a few important medical advances secured over the past 20 years by government-funded research. (I'm aware that this is re-writing your question slightly, Sebastian, but the thought of trying to work out what the "top 20 medical advances of the past 20 years are" makes me tired already.

Well, to begin with, the identification of HIV, in the Pasteur Institute, government-funded, in France in 1983. Without that significant discovery, all medical research into AIDS health would be completely moot.

In 1998, government-funded research at Johns Hopkins university and other universities world-wide provided the first reliable evidence of genetic susceptibility to schizophrenia, within a stretch of DNA on human chromosome 13. I'd call this a significant medical advance.

Between 1979 and 1999, government-funded research at Johns Hopkins University established a chemopreventive agent for liver cancer in humans.

In 2000, government-funded research at Johns Hopkins university demonstrated that a specific enzyme in the brain is essential for nerve cells to form a hallmark of Alzheimer's disease (AD), beta-secretase. This is a key discovery that may lead to prevention or at least slowing-down of AD.

In 2001, government-funded research at the Walter and Eliza Hall Institute of Medical Research in Melbourne discovered that people with a particular variant of a gene, called interleukin 12, are likely to develop type 1 diabetes when this gene interacts with other genes and environmental factors. This was the first new type 1 diabetes-related gene to be discovered anywhere in the world since 1981, and, yes, Sebastian: government-funded.

Finally, the UK stem cell bank, government-funded by the Medical Research Council, is a world first: providing cells for researchers seeking ways to repair diseased and damaged body parts. It was founded in September 2002, and I am unable to link you to any major discoveries from this government-funded research, but I think it highly likely that they will occur, and, yes, Sebastian: when they do, we can credit the UK government for funding the research.

Posted by: Jesurgislac at January 9, 2004 12:44 PM | PERMALINK

By the way, James - you have all my sympathy for your situation, and I sincerely hope things get better for you in time.

Posted by: Jesurgislac at January 9, 2004 12:47 PM | PERMALINK

Jane Galt says: And before you ask, yes, we have even higher rates of immigration than Canada

Perhaps it's a nit, but this site says Canada has 1.7 times the rate of immigration as the United States, per capita. The highest rate in the world, actually. They also take in many of the world's refugees from humanitarian disasters, who are very poor, so it can't be argued that the quality of Canada's immigrants is different than the US (To preempt the brown people charge). Immigrants are also less likely to utilize govt. services, a fact that has been known for some time to all but the more committed xenophobes and Rush Limbaugh listeners.

Posted by: andrew at January 9, 2004 12:57 PM | PERMALINK

Jesurgislac, thank you for your kind sentiments, but apart from this situation with our health insurance our circumstances are fine. As I mentioned in my note above, I'm content with my life. My major pleasure is spending time with my kids and that doesn't cost anything. A certain lack of vanity, general frugality, and smart shopping (dollar stores, discounters, etc) mean that we can make ends meet quite nicely.

But our health insurance...that's the only thing that keeps me up at night. Unless I am magically transformed into a different person -- smarter, more talented, etc. -- or get an inheritance I don't see how our finances will improve. Hence, the only thing that can solve our problem is affordable health care. I have no problem paying for it, but it has to be affordable. Right now it would be more than I pay for housing.

I'm still waiting for a solution from Matt, Jane, Sebastian, etc. They're so knowledgeable and smart and eloquent arguing against the EU and Canadian systems. I hope thy can be as effective in telling me how to find affordable health care under our own glorious system.

Posted by: James Rockford at January 9, 2004 01:09 PM | PERMALINK

Rather than compare anecdotes and scare stories, why not look at outcomes? From the World Life Expectancy Chart, below is a rank-ordered list of the 41 nations with national life expectancy at birth in the year 2000 exceeding 75 years.To cut to the chase, the United States is tied for 27th place, behind such nations as Greece, Malta, and even Jordan. Not to mention Canada, the United Kingdom, Germany, and of course France. But take heart! We're still ahead of Cyprus, Cuba, Libya, Panama, and Jamaica.

Personally I favor some sort of mandatory universal healthcare coverage. But when we get it, we shouldn't expect to leap to the top of the life expectancy or infant mortality tables. The United States has a much more unequal distribution of wealth than most of the other rich countries that are "ahead" of us on health rankings tables. Poverty is more widespread, along with attendant problems like poor nutrition, violent crime (we have a lot more murder, for instance), hard drug consumption, etc. We also tend to have a lot more premature deaths due to auto accidents. The best "evidence" of the poor value we get for the 15 points of GDP we pony up is simply the fact that millions of us don't have any meaningful access to the healthcare delivery system.

Posted by: P. B. Almeida at January 9, 2004 01:19 PM | PERMALINK

"Rather than compare anecdotes and scare stories, why not look at outcomes?"

OK, you are on.

Europe, average fertility rate of 1.5, 25% below replacement. And it's not planned population reduction because the lower birthrate is more than made up for in immigration from the Middle East.

Italy, the model of modern socialism, along with Spain, host the worste of the Western Eurpoeans at a fertilty rate of 1.2, which means the Italy will be at 1/5 of its current population in 50 years.

If socialized medicine cannot stop the certain, violuntary death of a nation, then a) what good is it? and b) Why bother since the nation will be dead within a few generations anyway?

Posted by: Matt Young at January 9, 2004 01:25 PM | PERMALINK

Sorry. Italy is the model of modern socialism? Italy? IS that some strange code word for Sweden? Or the Netherlands? Or Denmark? or just about any Eurpoean country other than Italy? Who on earth looks to Italy as the model of modern socialism? Spain? Matt, what world, or Europe, do you live in? You have extremely eccentric socialist acquaintances and should immediately stop taking their views as representative of anything.

Incidentally, the French got their fertility rate up recently. Go figure out how.

Posted by: harry at January 9, 2004 01:34 PM | PERMALINK

James - not sure that Matt, Jane, et al were arguing that the current system is wonderful as much as arguing that getting the government even more involved in it won't make it better. I don't have any advice that you seem to sarcastically be asking for, as I'm not privy to your own situation, but I have two questions:
1. How many kids do you have?
2. If it costs X dollars a month to get health care insurance, and you have trouble paying that X dollars per month for whatever reason, do you feel that reducing X by forcing some other person or group of persons to pay for part of X is a justifiable action?

Posted by: Haplo at January 9, 2004 01:38 PM | PERMALINK

Matt Young is apparently still reading and posting here, but he'd rather go on and on about imaginary connections between fertility rates and health care systems (!) but will not answer Rockford's question. Wonder why...

Posted by: vacmaster at January 9, 2004 01:42 PM | PERMALINK

Perhaps it's a nit, but this site says Canada has 1.7 times the rate of immigration as the United States, per capita. The highest rate in the world, actually. They also take in many of the world's refugees from humanitarian disasters, who are very poor, so it can't be argued that the quality of Canada's immigrants is different than the US (To preempt the brown people charge).

Andrew: your numbers sound right. I believe both Australia and Canada take in more immigrants than the U.S. on a per capita basis. The source I usually go to is the world facts section of the CIA: http://www.cia.gov/cia/publications/factbook/index.html

Net/net is the CIA gives the same figure as yours. I'm not sure if that includes illegals or not. If it does not, then the large number of illegal immigrants into the U.S. could actually push America's per capita immigration numbers higher than Canada's (making Jane Galt correct).

In any event, I would strongly suspect that average immigrant wealth and education is nonetheless lower in the U.S. than in Canada (or Australia). Canada gets lots of immigrants from poorer countries, I'm sure, but so does the U.S. And unlike the U.S., Canada doesn't share a land border with the developing world. The United States is simply closer in geographic terms to the heart of the southern (and poorer) half of the Western Hemisphere. I'm guessing the socioeconomic makeup of its immigrants reflects this fact.

We've got a little over 30 people per square kilometer, compared to 110 for France, 154 for Finland, etc. It's going to be more expensive as a portion of GDP to provide equivalent health care regardless of the system.

James: This sounds dubious. We have invented cars, after all. They tend to make it possible to access healthcare that's a bit inconveniently far away at not much extra cost. Furthermore, much of the U.S. population is increasingly living in urban areas or megalopolises (as in say, the Northeast Corridor, or Coastal California) with Europe-like population densities.

Posted by: P. B. Almeida at January 9, 2004 01:47 PM | PERMALINK

"I am close to 50, married for 20 years, and I have two young children"

My advice is to sleep well and hope nothing changes with Medicare between now and the time you are 65. Also, I would look for a very high deductable insurance policy, and be prepared to dump $20,000 grand if you get sick. Another option is to move to a state where socialized medicine starts at at 55 or 60.

Another option is to mentally prepare for death at age 55-60 for an untreated heart condition. You know, lots of folks at your age, some rich and famous, are starting to die off (with and without health insurance)

Now the liberals will tell me I am cruel, but to tell you the truth, liberals are more likely to kill more of us in our life span with their reckless government policies.

Posted by: Matt Young at January 9, 2004 01:48 PM | PERMALINK

"From where I sit the US government has set up monopoly power for big pharma's in the distribution of drugs within the US. Otherwise people would be free to, for example, go to Canada for their prescription meds."

I get my expensive drugs from Canada now. If they tried to prevent it, and the drug companies may try to apply pressure on Canadian pharmacies, it would lead to a political explosion. There are large pharmacies in Mexico that obviously cater to Americans, as well.

The drug companies have contributed worthwhile research but the really big discoveries tend to come from basic research that is government funded. Unfortunately, the amount is declining.

The national life expectancy figures are not good indices of health care because we have two major factors that lower our figure. One-we report all infant deaths including stillborns and most countries don't. That makes infant mortality seem higher than it is. Two-we have a large inner city population with racial and life-style problems that affect that segment of the population. The countries that rank ahead of us either don't have the same problems or don't report them as thoroughly as we do.

James, I hope when you said you net $3000 per year, that was a typo and meant per month. Your problem is one reason why I support a national health plan in spite of considerably more conservative views than many here on other subjects. Health care has gotten too important to leave as a commodity that we purchase. It should be a public utility like fire and police. However, I hope we avoid the errors made by Canada and allow some private practice as a safety valve and use co-pays to take some of the heat off the system.

Posted by: Mike K at January 9, 2004 01:51 PM | PERMALINK

James, my apologies - I missed the portion of your first post that said you have two young children. (Ignore my first question)

Posted by: Haplo at January 9, 2004 01:53 PM | PERMALINK

James -- I am more sympathetic to your situation than you think. I was uninsured for two years. I have several rather expensive conditions that required a couple hundred dollars worth of drugs every month. I was a freelancer. Hundreds of dollars a month meant less of things I like to consume, like food and clothes and an apartment that wasn't in my parents' house.

What you really want me to say is "What you should do is vote in a politician who will take money from other people so you can consume all the health care you desire."

I'm sympathetic, as I say. But the tradeoff is not costless.

Government rations health care. It imposes price controls. It in other ways prevents the market from signalling optimal demand for services. It completely fucks up research priorities, and it has proven virtually useless at producing new usable innovations.

There are a lot of diseases we can't cure yet -- but that we will be able to, if we have a robust research establishment. I know that the current setup is not some ideal vision in which all research dollars are allocated perfectly. But from observing government contracting in action, I am confident to the point of certainty that whatever the inefficiencies of the current system, they will pale in contrast to the inefficiencies of a government-run system. In particular, I just don't see how the political environment will support research at current levels, when taxes could be cut by implementing price controls and slashing research budgets. As anyone who looks at the budget deficit can see, government is at its absolute worst, relative to the free market, when it is attempting to balance priorities between current and future consumption. Interest rates and rate of return provide incentives for future consumption. But politicians are never elected by anyone but current voters.

The problem is, the uninsured and the sick are here RIGHT NOW. We can see their pain. We cannot see and hear about the pain of the larger number of people who will sicken and die needlessly because the government, in order to procure health care for current voters, has strangled the market that produced the innovations that later groups needs to survive.

I will probably be one of those people, if we don't get better medical treatments. I sense that you're seeking to shame me by asking what you should do. I turn the question around: what should I do, or patients with cystic fibrosis, or Huntingdons, or colon cancer, or any of a long list of currently incurable diseases? Where should they turn when the government has destroyed their last hope of living a long and healthy life? Will you visit them, when they are choking and dying, to explain that your need was greater than theirs?

Posted by: Jane Galt at January 9, 2004 02:03 PM | PERMALINK

"imaginary connections between fertility rates and health care systems "

Lunacy.

Population decline is the number one health crisis in Europe, ask the UN.

If not directly, which is my supposition, but certainly indirectly. Answer the question:

Why does Italy bother with frunding socialized health care if the natives are gone in 50 years?


Posted by: Matt Young at January 9, 2004 02:06 PM | PERMALINK

Low population densities increase the cost, and decrease the effectiveness, of health care provision. Modern medical care is capital intensive, giving it high fixed costs that are best amortized over as large a group as possible; it isn't, very, in places like rural Texas. People can't drive twelve hours for a doctor's appointment. And trauma care outcomes are dramatically affected by the speed with which the paramedics arrive, which is naturally much slower in areas where people live far apart.

Posted by: Jane Galt at January 9, 2004 02:09 PM | PERMALINK

Halpo: If getting the government involved won't make it better, what will? Nothing? Are conservatives saying that is this is the best possible system and therefore we cannot do anything to improve it? Or, perhaps for conservatives having millions of uninsured is not a problem requiring a solution? I don't mean these questions either sarcastically or rhetorically. I'm just trying to establish their position.

1. As I already stated, I have two children.

2. As I already stated, I'd like to pay for my own health care. I simply cannot afford it. The question remains: What should I do?

I'm not certain what you mean by saying you're not "privy" to my situation. I included as much information as I thought relevant in my first post. I believe I was quite detailed. If you need any other relevant information, I will provide it. But people like Matt et al who are obviously so knowledgeable about all the ills of all the non-US health insurance systems should have no problem offering some constructive advice to a poor US denizen based on the information I already provided.

Posted by: James Rockford at January 9, 2004 02:11 PM | PERMALINK

Oh yes, one other thing.

If population decline and socialized health care are not connected, then why are the German socialists reforming and partly privatizing socialized health care in response to their fertility crisis?

They seem to know something that we don't. If you ask them why are they reforming socialized medicine, they will answer: To relieve the pressure on young families and help stop the population decline. Which implies, of course, one of the causes of population decline in Germany, as the socialists view it, is socialized medicine.

Or to put it in words we can all understand, rampant German socialized medicine kills more than it cures.

Posted by: Matt Young at January 9, 2004 02:13 PM | PERMALINK

"Sebastion from telling us how the rest of the world is stealing the mighty intellects of the pharmaceutical industry blind, while we are only supporting their noble efforts at fair market value."

"I've heard the argument that we (US taxpayers) need to subsidize medical and pharmaceutical research because the other countries are getting a free ride.

Your scare quote is that if we don't do it, it will go away.

I say the proper conservative response is 'let the market work.'"

I don't think either of you understand how it works. A US company spends 10 years researching a drug and spends billions of dollars doing it. It doesn't work. Oops. Then they spend more time researching a different drug. This works. They need to cover the costs of both drugs. Next, they market the drug. Canada says we like your drug, but if you don't give it to us at near the unit cost (the cost of production not counting research) we will ignore your patent and let one of our companies make it. (Please note, Tripp, that this isn't exactly a free market move on Canada's part.) Rather than get zero money from sales in Canada, they make enough money to make a small profit on production, but not nearly enough to cover the research costs. See how that works? The company gave into the threat of having their patent broken. Meanwhile the only country that covers the research costs is the US. Now tell me, what happens if the US no longer covers research costs, but Canada continues to threaten to break the patent if prices shoot up? The research costs don't get covered.

"Jane Galt: your comment only makes sense if you honestly feel that the 45 million people in the US who don't have medical insurance deserve to die."

This rejoiner only makes sense in a hypothetical world where homeless people don't get medical treatment in emergency rooms. That isn't the US.

"Government funding (i.e. funding to universities) is not directed towards money-spinning drugs. Instead, it does all the crappy groundwork: the foundational analysis that allows Big Pharma to piggy-back with its particular interest in creating consumer products."

Ok, Mr. doesn't know anything about actual medical research. Riddle me this. Why doesn't the government make drugs out this research? It is so easy, right? And the government could make lots of money, right? So why doesn't France do this? Why doesn't Germany do this? Why doesn't one of the countries amenable to socializing things let their universities do most of the drug research.

Because it doesn't actually work that way. It isn't easy at all to take basic level research and turn it into drugs.

If you want to know about how drug research actually works may I suggest that you read Derek Lowe or talk to the hundreds of doctors who have spent entire careers working on drugs that never end up making it to a consumer.

Posted by: Sebastian Holsclaw at January 9, 2004 02:23 PM | PERMALINK

A comparison of the US healthcare system and European healthcare system is not quite a 1 for 1 comparison.

Population density is an important consideration when comparing US and Eureopean health care. Due to dispertion and response area, the US requires more hospitals, doctors, equipment, etc. per population than other industrialized countries.


Infant mortality rate figures are not as clear cut as they may seem. The US has a much higher number of attempted births than most other industrial countries. Using US and Germany as an example.

US population est 290,392,000
births 14.4/1000 population
infant mortality 6.75/1000 population

Germany population est 82,398,000
births 8.6/1000 population
infant mortality 4.23/1000 population

US est births 4,181,644
Germany est births 708,622

US est infant mortality 1,960,146
Germany est infant mortality 348,543

Even though Germany has a much lower infant mortality rate, the % of births are nearly the same. US 68.09% vs Germany 67.04%.


Some consider the US to be subsidizing other nations health care (and pharmaceutical research) due to the fact that the US is the largest source of prescription drug profit. If the world drug profit is reduced significantly by a reduction of profit in the US (via government price fixing), will the amount of funding into drug research remain the same? Probably not. If a person can not afford to purchase drugs at the current price, while they care? Probably not.

Its possible a single payer healthcare system is better. I would like to see how it more affordable before its created. Both the US and European healthcare systems are running into a money crunch. How doe a single payer plan reduce health care costs? Could these cost reductions be implemented in a non-Government run plan? Everyone wants quality health care at an affordable price. Are there any steps that can be taken to achieve this, even partially, without running into a Government vs. Private debate?

Posted by: james at January 9, 2004 02:42 PM | PERMALINK

This thread should be put out of it's misery, but...

Hey P.B.: "I would strongly suspect that average immigrant wealth and education is nonetheless lower in the U.S. than in Canada"

Yeah, Canada does take a bunch of poverty-striken refugees, but these do seem to be a small % of the whole...so that, ultimately, your point about the average immigrant into the US vs. Canada is probably correct. Canada's immigrants skew more Asian, and the US's more Latin American.

But, still, 18% of Canada's population was born in a foreign country, so the comparison of per/capita healthcare expenditure is probably about a wash, with respect to the contribution from the immigrant population.

Anyway, regarding population density and healthcare expenditure: couldn't a comparison be made between say, California or NY and an EU coutry of similar density? I don't really have the inclination personally, however.

Posted by: andrew at January 9, 2004 02:43 PM | PERMALINK

This rejoiner only makes sense in a hypothetical world where homeless people don't get medical treatment in emergency rooms. That isn't the US.

But Jane Galt is arguing that they shouldn't get medical treatment in emergency rooms if they can't afford to pay for it. They should suffer and die, because in the future, she might need resources that they're using up. As far as she is concerned, her possible future needs, as middle-class person with health insurance, outweigh their immediate needs as poor people without health insurance - as she was, with remarkable honesty if considerable lack of human feeling, telling James Rockford.

Posted by: Jesurgislac at January 9, 2004 03:02 PM | PERMALINK

As far as drug research is concerned, there are a number of stories about drug discovery that could be used as examples. Lithium was discovered by John Cade, in Australia in 1947. It didn't come into wide use, and was not FDA approved, until 1970. One big reason was that it was not patentable so no drug company was interested.

Henri Laborit, a French navy surgeon, discovered chlorpromazine's effect on psychosis. It was an anti-histamine. The drug was eventually imported here by Smith, Kline and French who had no research budget at all.

The first anti-depressant, Tofranil, was discovered by Roland Kuhn, a Swiss psychiatrist with a chemistry background. He asked Geigy to modify a chlorpromazine analogue by adding a side chain. That was 1955.

Those drugs were discovered by clinical research people who did not work for drug companies. They are the basis for most of the psychotropic drug industry and, except for the atypical antipsychotics, not much new in that field has been discovered. Most of the money is now spent on advertising, not research.

I lost all enthusiasm for drug companies when tamoxifen was discovered to be effective in breast cancer. That was about 1973. In spite of the fact that tamoxifen was a veterinary drug at the time, its price went up about 10 fold.

Read one of David Healey's books on psychopharmacology for the whole story. Yes, drug company research is expensive and important but I wish they would spend more on it and less on advertising.

Posted by: Mike K at January 9, 2004 03:06 PM | PERMALINK

James:

"Halpo: If getting the government involved won't make it better, what will? Nothing? Are conservatives saying that is this is the best possible system and therefore we cannot do anything to improve it? Or, perhaps for conservatives having millions of uninsured is not a problem requiring a solution?"

(Side note: everyone seems to read Haplo as Halpo, like the dog food with an H. Heh. :)

I'm not sure anyone has said that this is the best possible system. I would certainly agree that endlessly rising costs (rising well above inflation, that is) indicates that there is a problem. However, I'm deeply suspicious of the notion that getting the government more involved than it already is will lower costs. Do you feel as if we've exhausted the possibility of getting the government less involved in healthcare?

When I stated I was not privy to your situation, I meant along the lines of your day to day finances - ie when you are trying to meet a monthly payment for something, there are lot of other factors that come into play. For example, how much did your premium go up by, to 700 from what? Is your car paid off? House? Do you have a cell phone plan? Do you pay for internet access? Do you live an an expensive urban area? (ie Seattle or NYC) Is it easy or difficult for you and your wife to take your skills elsewhere and get paid the same amount (but in a cheaper locale)? Did you mean 30k a year instead of 3? Has that changed from what it was in the past? Ie did you have a higher income when you decided to have two kids? 30k a year seems rough to raise two kids on.

I suspect you weren't asking for advice on personal finance though. You want to know how to get healthcare costs to go down. From this thread, commentators have said that the government is either the savior or the destroyer of healthcare. Personally, I'd lean more towards destroyer; since I've never seen an example of the government entering a sector of the economy and making it better overall. Regardless, I suspect that we'll see fully socialized medicine before long because its not difficult to argue that the current system has problems, and politically, more government seems to be a much easier solution than less.

Posted by: Haplo at January 9, 2004 03:19 PM | PERMALINK

Mike - curious about this point:

"I lost all enthusiasm for drug companies when tamoxifen was discovered to be effective in breast cancer. That was about 1973. In spite of the fact that tamoxifen was a veterinary drug at the time, its price went up about 10 fold."

If tamoxifen was suddenly discovered to have life saving properties, wouldn't demand for the product have suddenly shot up? Which in turn would have driven the price up? What about that chain of events caused you to lose "enthusiasm"? (never thought of using that word in reference to drug companies, myself. :) Did the price never go down again?

Posted by: Haplo at January 9, 2004 03:24 PM | PERMALINK

I see Matt Young provided not one, but three proposed solutions to my predicament.

His first solution, that I should look for a very high deductible insurance policy, and be prepared to dump $20,000 if I get sick is not feasible. As I stated already, I did a lot of shopping around and found the lowest possible premium. It goes without saying that the deductible is very high. As to being prepared to pay $20,000, I may be prepared to pay $20 million but it makes no difference when you don't have it. And I don't have $20,000.

His other option is to move to a state where "socialized" medicine starts at at 55 or 60. Sorry, but I asked conservatives to proposed a solution that is obviously based on their ideas of what a health care system should look like. And this is what I get? A solution based on socialized medicine?
Matt's last option, that I mentally prepare for death at age 55-60 makes even less sense. As I stated quite clearly, I have two young children. Children get sick and have accidents. Should I prepare my kids for an early death, just in case? How about we just do away with all medical care? After all, we will all die eventually, sooner or later. Let's all prepare for death and treat nobody for disease or accidents. Imagine the money we'd save! Heck, let's do away with anything that prolongs or protects life. Let's disband the army! We'll save a bundle in taxes. More of us will die, and sooner, from bad guys and disease and other things, but, hey, who cares if we all die well prepared?

The question remains, and I'll rephrase it for those who don't seem to want to understand what I'm asking: Can any of the conservatives who post here, all these experts in health care who can compare and contrast and spew statistics with abandon, tell me how under the current system I can afford health care for my family of four?

Posted by: James Rockford at January 9, 2004 03:25 PM | PERMALINK

Two points: Single payer can be sold to the business community if it includes scraping the worker's compensation system. In a single payer system the source of the injury shouldn't matter. Secondly, the problem of health care costs rising will not change by changing who pays. Instead of business shifting costs to employees by cutting benefits or increasing premiums, government handles rising costs by capping payments or rationing care. This leads to either constant calls for increased funding and higher taxes or a general degrading of the system, and in the end does it matter whether you pay for health care in higher taxes or higher premiums? We need to face the fact that health care is very expensive, and always has been.

Posted by: Tassled Loafered Leech at January 9, 2004 03:28 PM | PERMALINK

I bet almost everyone agrees on the following:

Factual:
1. The US system is not perfect. No system is.
2. More health research is good.
3. The profit incentive increases research, price controls decrease it.
4. Lack of insurance does not mean lack of care
5. Insurance is most important for castastrophic events than for routine care.
6. People tend to consume more of things when they are free

Two moral points:
7. If you can pay for healthcare yourself, you should: just like food and housing.
8. It's bad when poor people don't get health care needed to live happy, productive lives.

Within this framework we should agree to:

1. Raising money (via taxes or charity) to buy/subsidize catastrophic insurance for poor people
2. Raising money to provide/subsidize cheap routine care to poor people

Within this framework we would not agree to:

1. Government price caps on drugs/health services
2. Non means-tested health benefits
3. Everyone getting as much care as they want for free

I am glad we are all friends again.

James Rockford: Sorry to learn that you're in dire straits. I think you are likely more worried about the danger of being bankrupted by a medical catastrophy than is really likely in the 15 years you have before Medicare. You do, however, have an asset: your house. If you are really worried, you should sell your house, move to a cheaper neighborhood, and use the difference to pay for catastrophic health care until you hit 65.

Posted by: let this be the end at January 9, 2004 03:32 PM | PERMALINK

Ok, Mr. doesn't know anything about actual medical research.

Actually, I know quite a bit.

One friend of mine is in charge of the intellectual property department of a major university, and is handling the process that now allows publically-funded research labs to file patents, and spin off companies to profit from their discoveries.

Another friend is working for one of those spin-offs, having done nearly a decade's ground-clearing work (all publically-funded) in protein crystallography. The stuff that private corporations tend not to touch with a bargepole until it offers something with a big-dollar return.

In the past, the problem was multifold: firstly, the problem of ascribing 'ownership' to discoveries that emerge from public funding; next, the issue of liability; finally, the economics of retaining broad-based funding. Publically-funded research labs create most of the research scientists of the next generation, through doctoral programs. Private corporations not only benefit from the process that creates Ph.Ds, but also don't have to think too much about that broad research base.

It's quite true that private corporations take on the heavy risk both of failure in clinical trials and the possibility of legal action should unintended side-effects occur; but public funds also go into that process (i.e. the FDA).

So. You still haven't commented on the undeniable truth that Big Pharma concentrates on pushing lifestyle drugs and 'me-too' patented products most fiercely in the US consumer market.

Posted by: ahem at January 9, 2004 03:44 PM | PERMALINK

James Rockford,

You are a liar or scoundrel.

If you have two young children at age 50, then something went wrong with your life much earlier. More likely, you concocted this story to fit some statistical situation that places you to young for medicare and your children too young for work; somehow leaving some other group to cover your costs.


One way or another, you will have to play the odds on your likely sickness. Do you want your children to go to work and solve your problem; or do you want your children to go to work and solve the medical problems of all folks like you? Either way, your children will have to go to work, because you claim that you won't, and there ain't nobody else, I am sorry.

We are certainly not going to print money just to support folks who happen to fit your imaginary situation, because printing money simply means that you and your children pay a hidden tax.

Or perhaps your untrue and statistically insignificant situation is supposed to convince us the 16-30 years old young workers should forestall their life just to solve your class of problems. Is that how you got into your situation? Did you forestall marraige and family until late in life because some nutase on some blog concocted a story like this?

I repeat, the rest of us would prefer you prepare to die a little earlier, this will evidently free the two children your wife gave birth to at the age of 42, because what? she was to busy enjoying the single life for 15 years?

Posted by: Matt Young at January 9, 2004 03:51 PM | PERMALINK

Haplo, sorry for changing your name.

And, as you gathered, I actually meant $3,000 a month, not a year. My error. $3,000 a year is of course a ridiculous amount.

I have no problem answering your questions. My premium went up by $100 a month. I have a cell phone on a Cingular pay-as-you go plan, for emergencies. I buy a pre-paid $20 every three months or so. My car is paid. I have no credit card debt. The only debt is a student loan for my MA ($80/month). Yes, I do pay for internet access, $12.95 a month. No, I live in Reading, Ohio, a rather inexpensive place. My rent is $725/month. As to taking my skills elsewhere for more money, if I could I would. I think we all need to accept the simple fact that not everybody can become successful and rich by merely relocating, or marketing their skills, or taking a motivational course, or some such nonsense. Yes, I did have a higher income when I decided to have kids.

The specifics of my circumstances make the $700 premium prohibitive. But even for someone who makes twice as much I make, a health care premium that high should make no sense. $700 is a large amount any which way you look at it. I don't understand how anybody can be happy with our current system. Even if you can easily afford a $700 premium, you're still out $700 a month and if you're unlucky enough not to get sick, it's $700 for nothing.

Posted by: James Rockford at January 9, 2004 04:04 PM | PERMALINK

"It's quite true that private corporations take on the heavy risk both of failure in clinical trials and the possibility of legal action should unintended side-effects occur; but public funds also go into that process (i.e. the FDA)."

How can you gloss over the risk of failure in clinical trials and the problem of legal action?

Those are the two major risks in pharmaceutical research.

Last I heard less than 1 in 200 drugs makes it from initial research to market. That is billions of dollars spent that will never make money for a pharma company. And legal action has bankrupted very healthy companies.

So your argument seems to be "they only take 90% of the risk, why should they make money?"

I also note that most of the examples you cite are not therapies. The closest you typically come is 'lead to therapies'. That lead to involved a minimum of millions of dollars of investment in the working therapies and millions more in 'promising therapies'. The governements didn't deal with any of that.

"Those drugs were discovered by clinical research people who did not work for drug companies. They are the basis for most of the psychotropic drug industry and, except for the atypical antipsychotics, not much new in that field has been discovered."

So what? In two of the cases they discovered useful side effects while investigating something else. That is great, but doesn't tell anyone a damn thing about the general costs of research. With that kind of argumentation you might as well posit that no one, governments included, should spend much money on research. Obviously it can be done nearly for free right? Sheesh.

Of course, you do act as if research can be done for free, so maybe you believe it too.

Posted by: Sebastian Holsclaw at January 9, 2004 04:26 PM | PERMALINK

I don't understand that question either; the FDA takes no risk. All it does is pay people to read and analyze the results, which it does regardless of the outcome. THe pharma companies take the risk of losing their investment.

Posted by: Jane Galt at January 9, 2004 04:32 PM | PERMALINK

Matt Young is a monomaniac. I remember other posts of his about how various countries full of Caucasians are "destroying themselves" by having lower-than-replacement birth rates. I don't quite see how he reconciles his terrors about the decline in the white population with his obvious lack of caring about actual, living people dying because they can't afford the health care given to the Bush, Trump, Rockefeller, etc. families. Nor do I understand why the decline of population in a country like Italy matters so much more than the rampant population growth worldwide. The planet is not suffering from a "decline" in numbers of people, Matt, and your obvious racism is getting really old. Or would you prefer to criminalize abortion for white women while making it mandatory for the lesser races? Why, then there wouldn't be any decline in the population of the people you care about, would there?

Posted by: Temperance at January 9, 2004 04:38 PM | PERMALINK

From Jane Galt, a bunch of unproven and mostly not very plausible assertions about government, based on no evidence at all that I can see.

"Government rations health care."

OK, that is true, but so does the market.

"It imposes price controls"

If that is what people vote for, yes.

"It in other ways prevents the market from signalling optimal demand for services."

Only if you think optimal demand for health care services is based on registering willingness to pay, which depends on ability to pay. If you think it should be based on need, then there are things government can do that will make demand more representative of need.

"It completely fucks up research priorities,"

Absolutely zero evidence for this. Since many of our basic research priorities (as opposed to commercialization decisions) are set by NIH, then if you like the output of the U.S. research system you should be grateful to government.

It's true that government might not be quite as invested in baldness cures and 47 me-too antidepressants than the private biomedical establishment.

"and it has proven virtually useless at producing new usable innovations."

Again, absolutely zero evidence for this (and much against it). Government does not bring innovations to market in our system. But a huge number of innovations that come to market are based on work that occurred outside the for-profit market system. How much biomedical research begins from the work of Watson and Crick in the 1950s? Did they work for a drug company? No, they did not. The AIDS virus was discovered in a government funded French lab. Another unimportant innovation, I guess.

Another thing: just because drug companies need to earn more than marginal production cost to fund research does not at all rule out the argument that current drug prices are too high.

The level of just unwillingness to think about the economics of technology and innovation is pretty striking on the part of conservatives in this thread.

Posted by: MP at January 9, 2004 04:43 PM | PERMALINK

If you have two young children at age 50, then something went wrong with your life much earlier.

I take exception to that comment. My father had three young children when he was 50 years old: my brother, born when he was 38, me, born when he was 40, and my sister, born when he was 43. When he was 50, his children were 12, 10, and 7. No, Matt, nothing had gone wrong in his life earlier: he simply never met the right woman until he was 35. (Mom is 8 years younger than Dad: a bit of an age gap, but since they've now been married for 41 years, the first marriage for both of them, who should quibble?)

I'm very grateful that my Dad and Mom are still alive and well at ages 77 and 69. If you think it wouldn't have mattered if I'd lost my Dad to a heart attack when I was 15, well, I've got news for you, Matt: yes, it damn well would.

Posted by: Jesurgislac at January 9, 2004 04:44 PM | PERMALINK

Temperance says:

"see how he reconciles his terrors about the decline in the white population "

And I say temperance is a racist scumbag of the worse sort.

No one has brought up race in this issue until Temperance jumps in and implies that a desire for population health is a signal of racist superiority. This is a very sad day for the radical left when a simple public health issue becomes a matter of racial preferences, and possibly signals a far darker and sinister motive behind the radical socialists.

If you fear genocide, then the folks to watch are the folks represented by Temperance and that ilk.


Posted by: Matt Young at January 9, 2004 04:44 PM | PERMALINK

Sebastian wrote:

"The other health care systems are free riders off of our research and development. They don't pay the costs, but they nevertheless reap the benefits. If our system also went socialistic, no one would be paying the costs and medical advancement rates would drop quickly."

Sebastian, as usual, you have no frigging idea what the numbers are. 9% of US healthcare costs are pharmaceuticals. Private R&D accounts for about 20-30% of that. So pharma R&D is about 2% of US medical costs. Try harder next time.

Also, the life-cycle of a pharmaceutical is becoming: (1) Researcher at elite medical school or university uses NIH grant to make a promising discovery; (2) Researcher runs off to Sand Hill Road or local equivalent to pitch idea to VCs (3) Researcher forms biotech startup to develop idea, licensing technology from University via the Bayh-Dole act (4) If development is successful, Big Pharma company buys out start-up or licenses the therapeutic from the start-up. So, there wouldn't be much fundamental medical innovation absent the NIH.

Posted by: Tom at January 9, 2004 04:49 PM | PERMALINK

"Kaiser is an HMO and is not for profit. Its great if you are healthy and sucks if you aren't."

I'm a Kaiser patient, and I've been greatly impressed with the care under their system. So I'm going to have to contradict you. Plus, Kaiser beats most other health plans in terms of patient satisfaction. So I suggest you're talking out of your arse.

Posted by: Tom at January 9, 2004 04:59 PM | PERMALINK

While many drugs fail, large pharmaceutical companies develop enough drugs at one time that drug R&D is a diversified risk, i.e. even if one drug fails, the risk of the entire portfolio can be reasonably assessed. Many observers think that PhRMA overstates the cost of drug development, especially when one takes into account tax credits and the like. After-tax cash outlay is generally estimated to be on the order of $100 million per average new drug brought to market (including failures), with some studies claiming closer to $70 million. It should also be noted that the NIH funds a lot of clinical trials. The profit margins of pharmaceuticals over the last 20 years should convince one that there is a lot of room to become more efficient.

PhRMA has been pushing (via lobbying and P.R.) the "we have to make obscene amounts of money in the U.S. to fund our R&D, otherwise that R&D wouldn't happen" line hard, to the point where the recent U.S. prescription drug bill doesn't allow negotiation of price. While there is probably some effect on R&D expenditure for the out-of-whack U.S. market, I'm not convinced that funding limitless private R&D on me-too drugs because consumers are price-insensitive (both doctors and patients) is a productive use of our money. If a foreign government is buying pharmaceuticals for less than I pay, they're being more efficient with their money than I am, end of story.

Drug costs are a big item, but they are not the largest part of healthcare--hospitals are. I think the system is going to collapse sooner rather than later. It already provides what I consider to be the largest impediment to entreprenership. If I wanted to start a company tomorrow rather that work in a corporate job, my biggest worry would be getting healthcare for my family and keeping healthcare if the venture tanked. A single-payer system in the U.S. would in my opinion vastly boost the garage-shop ventures that made this country great.

Posted by: psmacleod at January 9, 2004 05:04 PM | PERMALINK

"No, Matt, nothing had gone wrong in his life earlier: he simply never met the right woman until he was 35."

Well, that's fine and dandy, but do not then expect to put the burden of their medical care on the backs of 22-32 year olds who, themselves are trying to generate the surpluses to raise educated citizens.

Nor, should you put the burden of their medical cars on the backs of 35-40 years olds who are trying to raise families with the limited surpules they have generated.

Because, if you do, you are back to the situation of harming population health. Again, let me refer you back to the California case, where we dedicate socialized medicine to help only the young and reckless in emergency rooms. The result is that we have given a premium to the lifestyle of the young and reckless in California, and provided a liability to the young, educated families (who pay the costs).

If you give me the choice of adding to the burden of young educated Americans starting out in life, or shaving 5 years off the life of your parents; I will take the former. It's not a question of favoring the young over the old, its a question of balancing the burden so that national destruction is avoided. Because when populations decline, as in Italy, by nearly 50% each generation, it is both the young and the old who dissappear. I do not want the public health crisis in socialized Italy repeating itself here.

Posted by: Matt Young at January 9, 2004 05:30 PM | PERMALINK

Matt Young: "James Rockford, You are a liar or scoundrel."

Hey, why not both? If you're going to try and insult me instead of making an intelligent attempt at answering my question, why the conditional? Let's say I'm both and also a really bad dresser to boot.

But so what? Insulting me by invective, misrepresentation and insinuation obviously says nothing about how a conservative, market-based health care system is superior to a government-based one. Absolutely nothing. The only thing it reveals is your inability to provide an answer and your very bad manners.

And now that Matt dropped out, I'm still waiting for an answer from all the others conservative experts.

Posted by: James Rockford at January 9, 2004 05:42 PM | PERMALINK

Matt, that's interesting. (I give up on expecting an apology from your insulting comment earlier.) Despite your monomaniacal obsession with reproduction - your persistent (and entirely false) claims that Europeans are dying out because they are not reproducing enough) you appear to be convinced that no one ought to be permitted to have children once they're older than 32, and if they do then "something has gone seriously wrong with their life".

It's a strange yet bizarre inconsistency: I don't know how old you are, of course, but I confess I have this vision of you reproducing away madly in the span of 11 years that you have decided are the only 11 years in the human lifespan that it is okay to reproduce in.

Posted by: Jesurgislac at January 9, 2004 05:47 PM | PERMALINK

Matt, what difference does it make if Rockford is 50 with two kids instead of 22-32 with two kids or 35-40 with two kids? The insurance premium would be about the same, and equally unaffordable fro a family making $30,000 a year. The question remains, how can a family afford a monthly premium that's several hundred of dollars? There are millions of uninsured who are exactly in Rockford situation.

Posted by: vacmaster at January 9, 2004 05:48 PM | PERMALINK

Wow, this thread is nuts. I have to hand it too you Yanks, you guys really know how to have good ol' fashion ideological piss up.

Anyway, since I live in Soviet Canuckastan, I feel I should respond to the slights and misrepresentations that have unfairly soiled the reputation of this workers' paradise.

1) As pointed out earlier, yes we do indeed have a higher immigrant population stock that the US. Australia trumps us.

2) Yes, the system here rations health care along the line of health status instead of income/wealth. Shocking. (That's also why people who hurt their pinkies have to wait longer for a MRI scan.) BTW, the free market also rations goods. It's called a price.

3) Yes, we have less fewer imaging machines per capita than most OECD countries. Interestingly, we do better in terms of scan rates (scans/pop) than countries that beat us on the machine count. So things are not so simple. I'm of two minds on this issue: Our impure public good approach is likely to lead to congestion (think highways). On the other hand, I wouldn't be surprised if the US is overcapitalized in terms of medical M&E. BTW, all these indicators say nothing of health outcomes.

4) Matt Young finds it horrible that younger, working, healthy people should have to pay taxes to help subsidize the publicly delivered, single-payer health system. Well, you see Matt, when they get old then they will get the same benefits! Ultimately, most people will "get what they put in" if they die of natural causes. Look at it this way, instead of paying for all your health insurance at once and simply looking after yourself, you get to smooth the payments out over time and pool your resources with everyone else. As such, the government doesn't, strictly speaking, deliver health services. It funds them and acts a super-insurance company. The only difference is that since everyone qualifies, the Canadian system doesn't spend 1% of its economy filtering through applicants and rejecting sick and old people. (The US does, look at the work by Robert Evans at UBC.)

5) This stuff about "adverse selection being bunk" is astonishing. How? Seems to me James Rockford described it to a tee.

6) Sebastian. We free ride on drugs, eh? Did you know Canadian taxpayers subsidize US auto owners? Yup. It's called socialized medicine. It turns out GM, Ford and Daimler-Chrysler don't like paying for private drug benefits in Detroit. Why not have Canadian taxpayers pick up the tab? Have you noticed how many cars, and crucially, car parts are made in Canada? You're welcome.

7) This thing about reckless behaviour in a socialized system... what they hell is that about? I don't think people are willing to sick/hurt because someone else picks up the tab. It seems to me there are a lot of factors that impact the incidence of risky behaviour rather than the payments system for health care.

Look, there is no perfect system. However, the single payer system is efficient in that it precludes enormous monitoring costs and possibly overcapitalization of techno-whiz machine thingies that go ping. It may be less nimble, but provides pretty good service (by first-world standards) to everyone a lower cost. I'm a strong proponent of the free market, but this is one instance where I believe its failings overwhelm its strong points. From an economic point of view, I believe having a healthy population (young, old, rich, poor) is beneficial in terms of lifelong learning, educational attainment, reducing anti-social behaviour, etc. In other words, it contributes to social cohesion and reduces the costs of social fissures (private security and a whole whack of jails).

There is also a moral factor. We live in rich societies and I like to think the dark ages are behind us. Surely allowing people to be healthy as possible is a good thing. It's just that simple.


Posted by: Stephane at January 9, 2004 07:14 PM | PERMALINK

Stephane:

"Well, you see Matt, when they get old then they will get the same benefits!"

Dead wrong.

We can go back to Italy. For each generation of Italians 1/2 as many seniors get medical care, simply because 1/2 of the seniors have died off. Their population is dying from social welfare costs, industry subsidy costs, and labor restrictions; for one simple reason, the young and educated pay the bills, and everyone but the young and educated get the benefits. Hence, they half 1/2 the number of families they need to continue their civilization.

Do you get it? The issue here is public health, something single payer health advocates could carte less ab out, ensuring that a balance ensures each succeeding generation acutally survives. That is public health. Get it?

Dean would like us to be like Italy! What a nutcase, Italy is dying and Dean should know that, he is a doctor, obviously a very bad one.

The big governmentists will kill you, look no farther than their examples in Europe. Here is the solution.


Rather than give free medical care to the young and reckless, paid for by the young and educted, here is a better idea.

Start by going back to Clintonianism, tax the righ and cut government. Remember Clinton? The guy from your party that proved less government and tax the rich results in health, less poverty, responsible government, and environmentalism? Remember him? The only person from your party who managed to keep the White House for eight years.


Using this philosophy (in the California case), we can construe a negative income tax, and add to that a mandatory medical savings account. This savings account is available for emergency care in California, or may be used for catastrophic health insurance, but the money must be set aside by law.

The money may be partly returned back to the young and reckless if they meet some insurance actuary conditions; and the money must be replenished when they meet unfavorable actuary conditions.

Doing this, then, the young and reckless are incentivized to become young and educated. They actually get to keep some money, not lose it, if they behave in a way that results in a healthy population.

This is mostly, or partly privitization. It results in a healthier, wealthier, society.

If you want to kill the population in the fastest way possible, then do this:

Get into a spending constest with the right wing big governmentists, to see which group can socialize their favorite industries in the fastest way possible, billing the young and educated for the costs.


Do this, and you will kill off the American population in 50 years, just like Italy, the country that Dean wants to emulate

Posted by: Matt Young at January 9, 2004 07:34 PM | PERMALINK

"Matt, what difference does it make if Rockford is 50 with two kids instead of 22-32 with two kids or 35-40 with two kids? The insurance premium would be about the same, and equally unaffordable fro a family making $30,000 a year."

Not so at all.

By definition a population with a healthy balance among the young and old will have exactly the right amount of resources for medical care for everyone in the population.

How do I know this?

Because, unhealthy societies without the proper balance between the young and the old die off.

And this we know from the European experience, they do not have the proper balance, and they have a socialized insurance industry, and they are dying off.


Remember, the definition of a healthy population is one that survives, and the necessary condition for that is to balance the health care costs so the young can actually have families. We call that health, and I am simply amazed that leftists can sit here and intentionally upset that balance in the name of a single payer system.

Posted by: Matt Young at January 9, 2004 07:40 PM | PERMALINK

Dear James Rockford: You could sell that GTO to pay the premium (just kidding). You could purchase a big life insurance policy and pray for an early death, thus enhancing the chances of success of your progeny (assuming that's the goal here). You could shift your indifference curves such that everything is done to be able to afford that health insurance policy (i.e., sell the house as suggested by one poster). Or you could just take your chances, probably your only realistic choice.

In a situation of pure competition, the market price for health insurance or health "care" (in equilibrium, c.p.) would clear at the "optimal" price (at the margin). The fact that some people would go without insurance or care and die prematurely as a result not being able to pay the going price is irrelevant to the theoretical outcome. Morality, (i.e., doing the "right thing") has no role in the analysis.

In the real world, the inelasticities and locations of the supply and demand curves create situations where the market "clears" only at extremely high prices, and in some instances, does not clear at all. Some of this has to do with supply (artificially low number of physicians, for example) and demand (artificially high expectations). There is also the factor that we all die at some point even if our health care consumption was infinite irrespective of the price.

As a society, we are free to make a choice to intervene in this market if we so desire. The question is: Will this result in an "optimal" outcome? From a pure competition analysis, maybe not. But this assumes some approximation of pure competition exists to begin with.

If judged from a moral outcome standpoint(modicum of agreement needed here) maybe yes.

On the whole though, you have my sympathy. One no cost option is to vote Democratic in the upcoming election. This costs nothing, and if enough of us do this you may get health care coverage of some sort at a cost which you can live with (as it were).

Posted by: bobbyp at January 9, 2004 07:47 PM | PERMALINK

Actually, James Rockford, you're not a liar or a scoundrel. But you sure as hell aren't an adult.
You are 50 and have two young kids. And you can't afford to care for them, despite the fact that you have a masters degree. Because, according to you, you're too stupid to make money.
Look, I'm sorry if this sounds nasty, but Jesus Christ your self pity makes me sick. Didn't you ever think about this before hand? Didn't you ever think ahead? Why don't you stop whining on the Internet, shove your self-pity up your ass, and get a job? Not for you, mister "I'm not into vanity", but for those children you've brought into the world and now can't afford to care for. Nope, you paint yourself into a corner over the course of your life and now whine that someone else should solve your problems.
Well, sport, there are people in the world that I feel sorry for. I feel sorry for a black kid in the inner city, with little hope for themselves and no vision of a decent life. I feel sorry for children stuck in shantytowns in African or Latin American cities, whose parents would literally kill just to send their children to live in the US. And I feel sorry for your children. But I don't feel sorry for you. You, my friend, need a good swift kick in the ass.
So, do me a favor. Go get a job, OK? Even managing a McDonalds gives you the equivalent of catastrophic health insurance. Surely, that's not beneath you, now, is it?

Posted by: rhinoman at January 9, 2004 07:56 PM | PERMALINK

"you appear to be convinced that no one ought to be permitted to have children once they're older than 32,"

Never implied that.

I strongly implied that the cost of health care should be balanced so that the population can actually survive. It makes no sense to imbalance the distribution of health care costs so that society dies off, for this is not quite health care, especially health care as I know it.

This means, that if folks decide to take family planning actions that are out of balance, then they should cover the extra costs themselves or forego medical care.

We could take the opposite approach, as we do in California, which has the policy that only those who are reckless in their actions get access to medical care from the government. Now this doesn't make sense to me, but that is what has evolved. Maybe this fits the socialist model, and in Spain, as near as I can tell, they have quite a similiar problem.

If you tell me, as Calpundit proposes, that everybody gets free medical care, except those who don't need it; then very shortly you have a system, like we have in California, where exactly those who take responsible actions regarding maintaining surpluses and getting educated end up paying all the bills, but get none of the services, exactly like Italy, where exactly the young and educated cannot afford family, because they are stuck with the bills. The system becomes unstable, and the population dies off.

If you are going to talk public health, then please do not plan to kill us off.


You have a system to cure this problem, it came from your party, it is part of what Clark represents, it will get your man in the WHite House, it will make your life healthier and wealthier.

It is called Clintonianism. The Clintonian health model would include government grants that individuals would keep in reserve, and which individuals would be allowed to keep after a periond in which they demonstrate, through actuarial models, they they have moved into away from young and reckless into young and educated.

Later, when they get older, they would again have to build up their surplus as they move into the senior actuarial model, but the negative income tax would be maintained.

The advantage is that folks are incentivized to actually move modern civilization forward, rather then self destruct.

This is the policy that Clinton would propose if Clinton did not have to contend with big government, minimal thinkers who believe they can when a spending contest with the Repulicans, a contest the Democrats have not won in 20 years.


Posted by: Matt Young at January 9, 2004 07:57 PM | PERMALINK

Well Matt, as far as your explanation is concerned... no, I don't get it. I find this reassuring.

Socialized medicine and big government are forms of birth control? Riiiiight. Umm, look up: "educated women".

Posted by: Stephane at January 9, 2004 08:46 PM | PERMALINK

"educated women".

Now this is another red herring I get quite a bit.

If I recall 1.5 million years of evolution created us, and part of that creation was that educated women actually enjoy children. Perhaps, it is only leftist education that has women ignore 1.5 million years of evolution.

But, I suspect, that women normally do enjoy children, and normally do enjoy the survival of population, but they have been mis-educated into believing that men will no longer like them if they actually express their enjoyment of children.

In particular, if I recall my college days correctly, it was in fact the leftist men, who convinced women that their enjoyment of children was un-modern. The same leftist men who created the Italian system that is systematically killing off the population.

This has nothing to do with the health of the nation, this is about big governmentism, and the power gained through big governmentism. If the big governmentists thought it would help their power grab, we would be discussing the socialization of the shoelace industry.


Posted by: Matt Young at January 9, 2004 09:35 PM | PERMALINK

Geez, gang -- over 160 messages, and not one of you has yet mentioned the homeland security hazard posed by having 45 million people running around this nation without access to doctors.

SARS, anthrax, typhus, super-tuberculosis, the next killer flu epidemic (which we are allegedly way past due for)...we're sitting ducks for whatever wayward microbe breezes through the population, whether it be the will of God or Al-Qaida. This is why any serious national security plan would have a national health plan at its core. If people could be seen immediately as symptoms emerge (instead of two weeks later, when they straggle half-dead into the ER after infecting hundreds of other people), and we had well-funded tracking mechanisms to spot trouble as it brews, we'd have a fighting chance to stop epidemics before they spread.

But we're ignoring this the same way we're ignoring our wide-open ports and underfunded first responders. As usual, if Halliburton can't make a buck off of it, it has no place in our Homeland Security efforts.

Other comments:

1) My doctor, who is the director of a large community clinic, says that Medicare is far and away the fastest, easiest, most responsive of the 35 insurance carriers her practice contracts with. So much for Jane Galt's assertion about its unreasonable administrative demands on doctors.

2) Galt also says that the US middle class gets health care that's as good as the European middle class. My dad, a distinguished California high school teacher with an MS degree, might have argued that -- he died last year of an aggressive cancer, which he couldn't afford to treat because he couldn't afford health insurance. My husband and I footed much of the bill for his treatment and final days out of our own pockets. Guess teachers no longer qualify as "middle class" for Jane's purposes.

3) I've spent the last three years nursing a bad back. It's gotten to where it keeps me awake nights, and no longer responds to OTC drugs. I'm in pain most of the time.

Perversely, I've never dared to mentioned this to my doctor, because the condition is potentially TOO serious. Insurance companies are turning people down for very minor health problems these days. Once I'm diagnosed with arthritis or a fried disk, I'll never get insurance again. So if I want my other health needs covered, I have to hide this one as long as I can.

I'm bemused by those of you who think that health care is a luxury due only to the rich. I'm a card-carrying member of the Gilded Class -- yet getting my back looked at is a luxury even I can't afford, because the long-term costs are just too high. There's no way you can defend a medical system where even the rich can't get necessary care. Admit it: this sucker's broken.

From where I sit (with my ice pack), the alleged six-month wait under the Canadian system looks pretty damned good. Fortunately, I'll get to find out for myself very soon now: the immigration papers are ready, and the truck comes Monday to move us to Vancouver.

See you on the other side.

Posted by: Mrs. Robinson at January 9, 2004 11:01 PM | PERMALINK

"Sebastian, as usual, you have no frigging idea what the numbers are. 9% of US healthcare costs are pharmaceuticals. Private R&D accounts for about 20-30% of that. So pharma R&D is about 2% of US medical costs. Try harder next time."

Whoa, I make a point about pharmaceuticals and suddenly I'm a liar because I wasn't talking about all of health care. Pharmaceutical questions were already mentioned in the thread. I was responding. I don't think I have to respond to everything simultaneously. On pharma costs the socialized medicine countires are definitely free riding. They do the same on medical procedures. Your 9% has nothing to do with it.

Posted by: Sebastian Holsclaw at January 10, 2004 12:14 AM | PERMALINK

Never implied that.

No, Matt, you didn't "imply" that people over 32 shouldn't have kids: you said it outright, twice, and said it damn rudely. Again, given your obsession with reproduction, I find this not a little bizarre.

As for educated women having fewer kids - yes, Matt, it's a known worldwide demographic fact. The more education a woman has the fewer kids she's likely to have and the better she looks after the ones she has. The difference is striking in a Third World village between a woman who had three years of elementary school and a woman who had none: it's barely visible in the US because we take for granted that everyone gets 12 years of education.

Posted by: Jesurgislac at January 10, 2004 02:03 AM | PERMALINK

Hmmm, a couple of random comments.

From the outside looking in, I would suggest that part of the reason the US pays so much for health care is that the system itself is massively inefficient. For instance, most government run health care schemes have administration costs around 2-4% of the total cost of the service (eg. Australia, France, Canada) while private health care administration costs run around 20%.

The cost of obtaining a medical education, and hence the cost which must be recouped later on, is also enormous. $100,000 and up, judging by the numbers for Johns Hopkins, UVA and Chicago. Wow.

Between those two numbers _alone_ it isn't surprising that it's as expensive as it is.

I hesitate to mention it, since I can't find the link (anyone?), but I remember reading that one of the best (in terms of availability and lowest overall cost) health care services available in the US was that offered by the Department of Veterans Affairs. Before the Iraq war at least. Its administration costs were very low, and it used its buying power to negotiate good deals with pharmaceutical companies.

Just the way things are supposed to work in an _efficient_ market. You know, economies of scale and all that.

Posted by: polychrome at January 10, 2004 08:27 AM | PERMALINK

Of all the totally bizarre assertions in the thread are the numerous statements by Matt Young about low Italian fertility rates are caused by "socialized" medicine. It seems that it doesn't matter what anyone says about any country or subject, his answer is that low Italian fertility rates are caused by "socialized" medicine. It's obviously a non-sequitur. But I'll play along since I know a little about the subject.

The fact is, nobody really knows exactly why women in Italy (and other EU countries ) are not having enough babies to replace the population. However, it's quite clear that government health care systems are not the cause. Sweden, for instance, which has a health care system that's much more centralized than Italy's, has a positive fertility rate rivaling that in the US. Studying the countries with negative fertility rates in both the EU (primarily Italy, Germany, Greece and Span) and outside (e.g. Japan) we can see no correlation between their health care systems. On the other hand, countries like the US and Sweden which have disparate health care systems, have positive fertility rates.

If anyone is interested the most interesting theory as to why was put forth by professor Atsushi Seike, of Keio University in Tokyo. He argues that the countries with the lowest birthrates in the world today (see above) have relatively conservative family structures which have been maintained regardless of the fact that both men and women now work. Women in these cultures stayed home and had babies until the '60s. Now they're expected to do all the household chores, and take care of the babies, as well as work. Something had to give. They simply cannot handle lots of babies and they're opting out since husbands and fathers are not helping.

You can accept or reject Dr. Seike's ideas. But what's unarguable is that health care systems have something to do with birthrates. That is an illogical assertion.

Posted by: AF at January 10, 2004 09:20 AM | PERMALINK

Yeah so I know this is buried at the bottom of the comments, but come on!:

What planet are you on? Do you know about the 6-month waits for MRIs in Canada? The debacle than National Health Care is in England? The thousands of elderly who died for lack of adequate health care during a heat wave in France? God, the ignorance here is astonishing.

I can't help wondering if waiting lists for MRI's in Canada are longer because everybody who needs one can get on the list. My impression is that many folks in the states may need one, but aren't able to afford them.

I'm willing to be proven wrong.

Posted by: Yermum at January 10, 2004 09:58 AM | PERMALINK

When I was in for emergency care, I liked being in an open ward at my local hospital. It was friendly and people looked after each other in addition to the nurses and support staff being able to see at a glance whether anyone of the group of us needed help.

And it was free.

That's in the NHS, which is both single-payer and single-provider. Yes, you can get private insurance and private medicine, but you don't have to, and that counts for a lot.

When I had my eye surgery I had a private room, but if I didn't have visitors I preferred to go hang out on the ward with other people most of the time.

The NHS does have problems, but they aren't inherent in the system and in fact did not exist before the conservatives started trying to hack the system away with "modernization" programs based on the commercial system of the United States.

As with Germany, every attempt to "cut costs" by "modernizing" creates new levels of expense and bureaucracy that reduces efficiency. And then they use it to "prove" that the system doesn't work.

I can't think of anything that was better in the United States - except, as I've said before, the furniture. But I really don't see the point of paying thousands of dollars just so you can have stupid prints on the wall and slightly newer chairs.

Posted by: Avedon at January 10, 2004 12:05 PM | PERMALINK

James Rockford,

You may well have long ago given up reading these comments, but I want to thank you for enlightening me on something about which I had an idle curiousity, the cost of self-insuring for the self-employed. (I too am self-employed with my wife as business partner and have two young children, but live in Canada).

If you are still reading, could you tell me what that $700/month actually provides? Doctor's visits, hospitalizations, prescriptions, dentists, chiropractors? And what is the deductable?

Yukoner

Posted by: Yukoner at January 10, 2004 03:27 PM | PERMALINK

rhinoman:

Leaving aside the hostility of your post to James Rockford, I am still at a loss about the advice for him to go get a job, any job and quit whining.

And here I thought in my innocence that the USA was the land where the self-employed were highly thought of. It seems not.

A further thought. Can anyone point me to research done on how much of a measurable disincentive providing one's own health insurance is to self-employment in the US?

Yukoner

Posted by: Yukoner at January 10, 2004 03:32 PM | PERMALINK

Yukoner, I am still monitoring this threat in the faint hope that one of these conservative geniuses who think that the US has the best possible health care system will at least try to answer my puzzle. I don't think it's going to happen, but I will continue until tomorrow.

To answer your question, here's the information below, right from the policy:

HOSPITAL & DOCTOR EXPENSE COVERAGES
Room and Board 80%/20% up to $5,000 in net *
Miscellaneous 80%/20% up to $5,000 in net *
Surgical Charges 80%/20% up to $5,000 in net *
In-Hospital Doctor Visits 80%/20% up to $5,000 in net *
Diagnostic X-Ray and Laboratory 80%/20% up to $5,000 in net *
Intensive Care 80%/20% up to $5,000 in net *
Spinal Manipulation 15 visit maximum **
Doctor's Office Visit 100% after $25 copay per visit
First-Dollar Accident Coverage See optional coverages
Prescription Coverage See optional coverages
Dental Coverage Not Available
Deductible/Annual Maximum
Diagnostic/Preventative
Basic Restorative
Major Restorative
Orthodontia
Maternity Coverage See optional coverages
Well Baby/Nursery Charges See optional coverages
MAJOR MEDICAL
Deductible $500 / 3 per family per year
Co-Insurance (Insurance Co. / Insured) 80%/20% up to $5,000 in net *
Maximum Out-of-Pocket per Insured $1,000 in net; $4,000 out
Plan Maximum $5,000,000 lifetime / insured
OPTIONAL (ADD'L COST) COVERAGES
First-Dollar Supplemental Accident Coverage Yes- $500 maximum per accident
Supplemental Prescription Coverage Yes-Drug card avail.w/copays**
Dental Coverage Not Available
Deductible/Annual Maximum
Diagnostic/Preventative
Basic Restorative
Major Restorative
Orthodontia
Maternity Coverage Not Available
Well Baby/Nursery Charges No / No

Posted by: James Rockford at January 10, 2004 04:07 PM | PERMALINK

Yukoner:
I have no problem with people who want to be self employed. The price of freedom, though (that is, the freedom to work for yourself) is responsibility for the consequences of your actions. In James Rockford I hear the voice of a guy who wants to be self employed so he doesn't have a boss, but doesn't really want to work all that hard, and challenges other people to provide solutions to the problems that result from this. That doesn't really bother me, although I think it's pathetic. What drives me to "hostility" is the fact that he's dragging his two young children into his personal mess. When it comes to children, I think parents are required to do whatever is necessary to provide for them. It wasn't their choice to come into this world, after all. It was James Rockford's choice to bring them. They are his responsibility.
So, he wants a solution? I gave him one. Get a job. Problem solved. The fact that he may hate it is irrelevant.

Posted by: rhinoman at January 10, 2004 04:21 PM | PERMALINK

rhinoman: I planned to wait until tomorrow before addressing your comments in detail. I don't mind telling you that I'm very thankful for your contributions. Your musings, more than any of the assorted contributions of your ideological comrades who posted here, have given me a rare understanding into the conservative mentality. I plan to explain fully tomorrow, since I'd like to give the opportunity to any other conservative who wants to offer a solution to my predicament to do so.

However, I could not resist correcting specific misconceptions you seem to have about my situation -- although it baffles me as to why you would have these misconceptions since I explained all in several posts above.

First of all, as I already said, both my wife and I are gainfully and happily employed and we make enough money to lead safe and productive lives. We take excellent care of our children and their needs, as well as ours. I already explained all that. I also said that I did work for a small company until a few years ago, until they went out of business. And I explained that because it was a small company I still had to pay a huge chunk for my health insurance. In the current employment -- or should I say under-employment? -- climate I am thankful everyday that I have profitable work. And, as I already mentioned, I don't want anybody paying for anything I get. I would like to pay for my own health insurance, the same way I pay for all our other expenses. As I already said, this is the only financial problem we're facing right now. And the reason we're facing it is because health insurance is extremely expensive. It is expensive in absolute terms -- $700 a month is a lot of money any which way you cut it -- and obviously in relative terms for middle class, middle income people like me.

I'm neither whining, nor complaining, nor asking for a hand out or anything else. I have merely asked all the conservative geniuses who are so quick to argue the supposed deficiencies of every government-sponsored system in the world to explain how a person in my situation (and there are millions of people like me) can survive under our own and oh-so-wonderful system. It seems to me that when an inelastic commodity, a commodity that is not based on elective consumption but on real need, is so expensive that it precludes consumption by millions of citizens, the system that distributes this commodity is grossly deficient. We're not talking about the price of soft drinks or sailing boats here. Health care is literally a matter of life and death.

Trying to insult me by making stuff up about my life, kids, or whatever shows neither intelligence nor wit. It only demonstrates bad reading skills. Please read my posts, and if you have any constructive suggestions please don't hesitate to share.

Posted by: James Rockford at January 10, 2004 05:16 PM | PERMALINK

Rhinoman, there are quite a few millions people in the USA that are unemployed. And US corporations are not creating enough jobs to place the young workers that enter the labor market. James would get more from lottery than from the US economy.

DSW

Posted by: Antoni Jaume at January 10, 2004 06:04 PM | PERMALINK

Mr. Rockford:
If you can't afford health insurance, you're not taking "excellent care" of your families' needs. Sure, it's expensive, I know that. I despise paying so much for it. But I know quite a few high school graduates that have no problem at all getting health insurance for their families. If they can do it, what's your excuse?
Look, has it occured to you that you might actually be doing something wrong? Maybe, just maybe, it's not society's problem.
You ask me to solve this problem for you. My solution is simple - either make more money, or get a job that provides health insurance. As I said, lots of high school graduates manage this. If you can't do it with a master's degree, you aren't worth your feed.
And, as I said before, there are people who I feel need the government's help. You ain't it.
OK, I got a bit steamed. But if you're going to lay your life out on the Internet and snarkily demand that other give you a solution, you should be prepared for straight answers that you may not want to hear.
I give up. Besides, the game's on.

Posted by: rhinoman at January 10, 2004 07:01 PM | PERMALINK

Friday's New York Times carries two related stories - "Health spending at record rate" and "Flu has killed 93 children, but comparisons are difficult." What's the connection? Two problems that could be better confronted with a universal single-payer health insurance system. The US spends twice as much per capita on healthcare as Canada, whose single-payer system eliminates the advertising and overhead associated with a system of multiple private insurers. Those convinced that the private sector is more efficient should keep in mind that overhead amounts to half of costs in US private healthcare, as compared to a couple percent of costs in Medicare. Countries with government health insurance also have higher rates of flu innoculation, which is to be expected given that demand for vaccine increases in a system designed to encourage, rather than discourage, visits to the Doctor, and supply increases when the government, which can absorb the costs of purchasing extra vaccine to make sure there's sufficient supply, is footing the bill.

Posted by: Josh at January 10, 2004 09:45 PM | PERMALINK

I'm on Blue Cross, and the cost of my medications just went from 150 dollars a month to over $400/month. That didn't help on a fixed income. Took two hours to get the scrips filled, as the pharmacists was busy explaining to everybody why their costs had gone up for all insurance plans, especially Medicare.

This should be an interesting year for the Administration, as people figure out what's going on.

As for waiting lists, I have good insurance, and am in a good university medical system, and still had to wait 4 months for a basic outpatients procedure. I frequently have to wait 3-4 months to see a specialist.

Tell me again how it's worse in Europe?

Posted by: lazarus at January 11, 2004 02:05 PM | PERMALINK

James Rockford;

Thanks for the response. I'm rather taken aback at what a $700/month premium does not cover, and how high the deductable is. Chalk it up to never having had to deal with overall health insurance.

On a practical note, is there a professional organization of some sort you can join that offers a better deal for insurance by pooling risk? Or even a local/state Chamber of Commerce. I ask because I looked at joining my local Chamber when they began offering self-employed members a dental plan (not covered under our general system) along with a couple of other bells and whistles such as limited pay indemnity. Turned out the savings on plan did not outweight the membership fee so I didn't sign up.

Yukoner

Posted by: Yukoner at January 11, 2004 03:00 PM | PERMALINK

The uk does not have a socialized healthcare sytem, It is a fair and moral healthcare system for all. Yes there are some waiting lists, but just a long as the waiting that you do in america. And the healthcare in the uk is just as good as in the u.s., im british I should know, And in the uk you have a choice if you want to get health insurance, and get faster treatment, or if you cant get insurance you can still get good treatment from the NHS. I lived in the u.s., you dont have that choice, you better pay big money or die. The medication cost in the uk is very cheap, Blood presure medication in the uk will cost you about 7.00 pounds about $14.00 dollars. In the u.s. the SAME medication will cost you about $90.00 Its not right. I feel sorry for you Yanks.

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