by Eric Martin
Sarah Palin during a speech before a Canadian audience:
PALIN: We used to hustle over the border for health care we received in Canada. And I think now, isn’t that ironic?
Haha. Irony! Apparently, that whole socialism thing didn't look so bad after all – even for someone with access to the Best Health Care Evar! As Wonk Room points out, this isn't the first time that Palin accidentally let the truth slip in between the cracks in her death panels:
This isn’t the first time Palin highlighted the difficulty of obtaining affordable health care in America. During the presidential campaign, Palin discussed how her and husband Todd had “gone though periods of our life here with paying out-of-pocket for health coverage until Todd and I both landed a couple of good union jobs.” At the Vice Presidential debate, Palin recalled “about times and Todd and our marriage in our past where we didn’t have health insurance and we know what other Americans are going through as they sit around the kitchen table and try to figure out how are they going to pay out-of-pocket for health care?”
Also, ironic.
Isn’t it also being reported there is an alternate version of this story where she’s traveling to Juneau instead?
Speaking of ironies, the Canadian PM recently flew to Florida for heart surgery because the Canadian procedure, being a bit outdated, involved breaking bones and he didn’t want to undergo that particular procedure.
Speaking of ironies, the Canadian PM recently flew to Florida for heart surgery because the Canadian procedure, being a bit outdated, involved breaking bones and he didn’t want to undergo that particular procedure.
Not ironic at all. If you’ve got the loot, the US health care system usually offers great, state of the art treatments (amongst the best in the world, if not the best – depending on the particulars).
But if you don’t have the money, you’re usually sh*t out of luck (hence Grayson’s crude depiction of the defenders of the status quo as the “Don’t get sick” plan).
This is why you don’t see a lot of working class and middle class Canadians crossing the border to the US. They either can’t afford the treatments, or at least would prefer to be treated for free in country.
However, you do see a lot of Sarah Palin types (before her recent fame/fortunes) going north.
You betcha!
i never understood how a brain could come to that argument. “oh our health care system is so awesome that australian ministers are coming HERE!”
no. our doctors are awesome. our facilities are awesome. our system, which they don’t use, is not.
McKinney, a couple of problems with your comment:
1. The Canadian PM did not fly down to Florida for heart surgery, it was the Premier of Newfoundland, and,
2. It seems that the American procedure, like the Canadian procedure you refer to is a bit outdated when compared to the Miami Method pioneered by Dr. Lamelas of the Mt. Sinai Medical Center in Miami. Dr. Lamelas has even designed some of his own implements and has better outcomes than any other surgeon in the world for this procedure.
3. I think it would only be ironic if you can find quotes of Danny Williams banging on and on about how the Newfoundland health system is the best in the world and then choosing to go to the US himself.
Yukoner–you are correct, it was the Newfoundland guy.
Eric–the reason why our system is so far superior (and is much more widely used by Canadians than you’d concede, although I don’t know where to go for stats) is that it is market-driven, which is the polar opposite of what you get in a nationalized system, where the economic burden is so great there is no money left over for innovation much less a reasonable degree of surplus capacity (so that patients don’t wait months for surgery, etc.).
McKinneyTexas’s comments on health care always remind me of that Eddie Murphy ice cream skit from Delirious.
Except in health care today your ice cream drops you.
Eric–the reason why our system is so far superior (and is much more widely used by Canadians than you’d concede, although I don’t know where to go for stats)is that it is market-driven, which is the polar opposite of what you get in a nationalized system
Well, where do you go for stats? The links in this post detail American use of Canadian medical facilities. Why don’t you provide other links?
Otherwise, you seem confused. The purpose of health care reform as proposed is not to “nationalize” the system. In fact, Canada hasn’t even really “nationalized the system.” A public option would more closely model reform on the French model, where INSURANCE not actual health care is provided by the government.
However, we’re not even going that far. We’re basing our reform on the Swiss model, where not even is CARE not nationalized, but insurance is left to the private market, with certain restrictions.
But even still, through medicare and medicaid, the US government provides a lot of “nationalized” insurance.
where the economic burden is so great there is no money left over for innovation much less a reasonable degree of surplus capacity (so that patients don’t wait months for surgery, etc.).
But this is belied, again, by facts. Doctors in “nationalized” systems like the UK pioneer innovations all the time. In the US, many if not most of the more useful innovations and drug breakthroughs are made under government funded studies (less rogaine and cialis, and more disease treatment).
As for wait times, how long do you wait for a procedure if you don’t have insurance, and can’t afford the procedure out of pocket?
Hell, even with insurance, there are often wait times in the States.
Eric–the reason why our system is so far superior (and is much more widely used by Canadians than you’d concede, although I don’t know where to go for stats) is that it is market-driven, which is the polar opposite of what you get in a nationalized system, where the economic burden is so great there is no money left over for innovation much less a reasonable degree of surplus capacity (so that patients don’t wait months for surgery, etc.).
Which is why the US system pays more money for poorer results.
Sorry, but try doing research and not using ideology for arguments. (Don’t wait for months for surgery. Heh. Heh heh heh. That’s a good one).
“Hell, even with insurance, there are often wait times in the States.”
There is a certain amount of denial of facts in some of this discussion. No one said NO innovation comes from the UK, no one said you NEVER have to wait in line in the US.
However, every analysis says that the US has the most ADVANCED medicine in the world (not all of the advanced medicine). The most and latest of techniques and equipment available to the broadest set of patients.
The analysis also says that Canadians have longer wait times for less advanced technology and techniques.
Measured by outcome this isn’t always a bad thing, but lets not make the rational arguments for other potential systems seem less valid by denying the facts.
Cite, Marty. The comparisons I’m familiar with do not always compare apples to apples.
“(Don’t wait for months for surgery. Heh. Heh heh heh. That’s a good one).”
Why is that funny? Except for purely cosmetic surgery, and certainly for critical surgery, the wait times in the US shorter than Canada.
To be clearer, we should be specifying best outcomes and so forth. Such behavioral outcomes such as bankruptcy from medical conditions and lack of coverage entirely can be excluded from measurement, but they most certainly skews the overall picture.
“Cite, Marty.”
Google wait times and read any article on the first three screens. Every one will be about Canadian wait times. Some things are just true. In fact, the UK has even moved its wait times ahead of Canada since the turn of the century.
However, every analysis says that the US has the most ADVANCED medicine in the world (not all of the advanced medicine). The most and latest of techniques and equipment available to the broadest set of patients.
“Every analysis” is a pretty high bar, I’m going to assume you meant something more like “many studies”, or even “some studies”.
Can you show us some studies that demonstrate that the most and latest techniques and equipment are available to the broadest set of patients in the US as compared to other, similar nations?
In what measures of health care is the US superior to, frex, all other OECD nations?
And, how did US superiority come to be?
And, can a useful correlation be drawn between that superiority and how it came to be, and our relatively more market-based approach to providing and paying for health care? As opposed to any of the other possible causes.
All of that’s many steps short of your claim, but I’d settle for it as a starting point.
Thanks –
If I have no health insurance in the U.S., or even if I do, and little money, and I suffer from the same heart problem our Canadian friend has, will this Florida hospital let me through the door.
I suspect the U.S, to its credit, also builds the most advanced sailing yachts in the world. I’m glad sailing yachts aren’t the cure for expensive, life-threatening diseases.
Or are all commodities alike in their importance?
Could the Canadian also go to France or Switzerland for these procedures? I ask that question sincerely; I don’t know the answer.
I hope our Canadian friend recovers fully and returns to Canada and proposes that the Canadian medical insurance system be upgraded and funded adequately so that next time he can stay close to home.
It would have been funny if the airline he flew to Florida demanded a fee to pee. Imagine the poor guy’s added discomfort if he’d forgotten his wallet.
Yet another great idea from privately financed air travel.
Marty: Wait times differ for procedure. Some are actually longer in the US.
But I see you don’t want to answer this question:
Further, and most importantly, how long do you wait for a procedure if you don’t have insurance, and can’t afford the procedure out of pocket?
Meaning: some amount of wait time is due to the fact that there is not a class of Canadians that are denied access to these treatments.
“wait times” and “market driven” are red herrings.
Herring is good for you. The fat in herring prevents heart disease.
The most and latest of techniques and equipment available to the broadest set of patients.
Really? Broadest set? I’d like the link to that study.
“Meaning: some amount of wait time is due to the fact that there is not a class of Canadians that are denied access to these treatments.”
Absolutely true. See I knew someone would quit trying to argue the facts and recognize the obvious. In the US we spend all of our time talking about the cost of healthcare. In Canada we spend all of our time talking about wait times. They are the symptoms of the same problem reflected in the two solutions.
I made no claims as to which was preferable, for people with time to wait and no way to pay Canada is much better.
People with no way to pay and in a hurry are caught between the rock and the hard place, although both systems provide excellent emergency life saving care for these people.
People with money and in a hurry may go to the US, or get private care in Canada.
Don’t be surprised if McKinneyTX and Marty come back with a link to some Fraser Institute report that extols the endless virtues of for-profit health care delivery while completely (and intentionally) misrepresenting the pros and cons of Canada’s current universal program. The org is a right-wing/neoliberal think tank dedicated to furthering the complete unravelling Canada’s social safety net and the establishment of a free market paradise here in the Great White North. Opponents of US health reform tend to zero in on their handy repository of pro-market propaganda in order to denigrate the virtues of socialized medicine.
(Also, plz to be not allowing derailers to derail this thread until it becomes an ignorance-infused referendum on my country’s extremely popular health care system. Oh, and belated thanks for the blogrolling. I heart ObWi forever.)
Marty:
Except for purely cosmetic surgery, and certainly for critical surgery, the wait times in the US shorter than Canada.
Cite? Especially a cite that actually compares apples to apples please. Specifically comparing the average wait times for the ENTIRE population of the US versus Canada. I’ve seen some that conveniently do not include the uninsured in the US and/or those on Medicaid. Funny eh?
Google wait times and read any article on the first three screens. Every one will be about Canadian wait times. Some things are just true.
Yes, some things are just true, like that you will get a lot of articles about Canadian wait times. This does not mean that surgery wait times in Canada are longer than in the US for the population as a whole.
OK, I took the Marty challenge. I Googled “wait time medical procedure”.
And he is correct, many of the top hits are about wait times for medical procedures in CA. Apparently Canadians are pissed because they believe they have to wait too long for medical procedures.
So, how long is too long? From one of the top hits, the Wiki page on Canadian health care:
Life-threatening: immediate.
Specialist physician: median time four weeks.
Diagnostic tests like MRIs or CAT scans: median time two weeks.
Surgery: median time *four weeks*.
24% waited four hours or more in the ER, which I assume implies that 76% waited less than four hours.
This information is filed under “criticisms”.
Feel free to compare and contrast with US experience. Feel free to confine your comparison to people in the US with insurance, because if we include folks who are not insured at all, the US doesn’t have a freaking chance.
And, of course, what stands out in all of the hits I read was that the links were to pages sponsored by Canadian government health agencies, providing benchmarks and guidelines for bringing wait times down, describing the funds that have been spent to do so ($5.5 billion since 2002), and describing what measures are being put in place to improve the situation.
In Canada, the dialogue is about the nature of the problem and how to solve it.
In the US, the dialogue is about death panels and socialism.
Show me the studies that show how the *most and latest techniques and equipment* are available to the *broadest set of patients* in the US as compared to other, similar nations.
Don’t forget the broadest set of patients part, please.
Show me one.
I’m not saying they aren’t out there. I just want you to bring the homework if you’re going to make the claim.
Show me *one freaking study*.
thanks –
Oh, now, mattt, you have to admit that Canadians are hoping for Obama’s plan to succeed just so they can come south and get even better care than they’ve previously gotten south of the border. Just ask Google.
Mattbastard,
Perhaps I could link to that and any number of other studies (some by the provinces themselves, e-health in Ontario or the Alberta Health system). I actually, as evidenced here, try to avoid linking to studies that can be interpreted as trashing Canada or the US. Challenges exist in both systems. I have been treated in both and had issues and good things in both. But my associates in Canada spend a lot of time bemoaning the lack of ability to be as innovative as their US peers, sometimes people they went to school with in Canada.
Adorn that last with winking smileys as needed.
Marty,
Given your acknowledgement of the fact that the 45 million uninsured are left out completely, and the fact that even for millions of the already insured, their insurance won’t cover certain procedures, how do you justify this asked by Russell again:
the most and latest techniques and equipment* are available to the *broadest set of patients* in the US as compared to other, similar nations
In Canada we spend all of our time talking about wait times.
What you mean “we”, kimosabe?
Canadians have longer wait times? Canadians have less advanced procedures and equipment? Easy answer: spend 50% more money per capita in their health care system. They’d still be spending less than the US does per capita. Their “system” would still be cheaper — and no Canadian would have to wait for any medical care, not even the most sophisticated kind.
Cheaper, just as prompt and sophisticated, and accessible to everybody. But oh noes: socialist!
–TP
Marty: Why is that funny? Except for purely cosmetic surgery, and certainly for critical surgery, the wait times in the US shorter than Canada.
It’s funny because there is no systematic collection of data on wait times in the US, so you really have no idea what you’re talking about and couldn’t cite any evidence to back up your claim, anyway.
Other countries with national health care systems have systematic national and local recording of wait times, and make that information public. So mad patriots in the US who want to believe your godawful health care system isn’t lingering down there in the Third World basement, pick out bad examples and compare with what self-serving advertising is made available in the US. Naturally the advertising figures come out looking better than the clear and systematic data.
But I get better health care and pay less for it than you do, Marty: just as Canadians do.
Why is it a kneejerk reaction by right-wingers to fake out a pride in your awful system, rather than actually want to improve it?
Perhaps I could link to that and any number of other studies
Yes, perhaps you could. Your choice.
“In Canada we spend all of our time talking about wait times.
What you mean “we”, kimosabe?”
I live in both places
Slarti: But my associates in Canada spend a lot of time bemoaning the lack of ability to be as innovative as their US peers, sometimes people they went to school with in Canada.
It’s amazing how people who live in countries with national health care systems feel free to complain about how their health care system could be improved.
Oddly enough, national health care systems tend to respond well to complaints by their owners/users about how they ought to be improved.
Whereas notably, McKinneyTexas, Marty, and you yourself, don’t feel at all free to complain about the really horrific failures of your own health care system, or speculate about how this failing system could be improved. Now why would that be?
Tony makes an excellent point as well.
Canadians spend a lot less on their health care. So if they spent more, they could probably cut down on the wait times. We, on the other hand, spend much more and have interminable wait times for the un- and under-insured.
“It’s funny because there is no systematic collection of data on wait times in the US, so you really have no idea what you’re talking about and couldn’t cite any evidence to back up your claim, anyway.”
It is true that the only places collecting wait times today are the most sophisticated IDN’s.
The reason is that it hasn’t been necessary until the last ten years as the IDN’s and hospital networks have begun to evaluate whether it would be better to actually have wait times rather than an oversupply of advanced equipment.
Interesting. It’s almost as if someone else said that.
The fact is, the US system will continue to offer the extremely expensive state-of-the-art procedures and drugs that it always has done. America is full of wealthy people willing to pay for those kinds of things, and they will continue to pay for them. Nothing about that situation is touched by any of the health-care reforms. There is no government takeover. There is no prohibition on private practice. There is no law against having health insurance that covers expensive interventions.
And that’s basically a good thing. What is an expensive intervention available to a few wealthy people today becomes a commonplace available to everyone in a decade or two – once the patents run out, experience with the technique or drug drives cost-saving innovations, cheaper alternatives are derived, mass-production of the equipment involved takes off, etc. Your free market at work. It’s great.
I’m all for tiers of health insurance, all for doctors making available new kinds of interventions on a fee-for-service basis, all that stuff.
The problem we have right now is not a lack of expensive interventions. The problem we have now is that, 1) the products on offer are getting more and more expensive without offering much more in the way of benefits, and lack of standardization, lack of competition, and barriers to market entry mean that no low-cost entrants are coming along, so the whole “tiered offerings” thing isn’t working, and 2) a lot of people and in particular, a lot of people who really need healthcare, just can’t afford the bottom tier of health insurance anyway, because of certain unavoidable aspects of the current health insurance market, in particular the adverse selection problem, which is related to the ability to deny coverage based on pre-existing conditions, and changing that requires a healthcare mandate to avoid adverse selection death spirals.
Even if you’re inclined to do so, saying to the uninsured “You can’t afford it, tough luck” doesn’t work because we all wind up paying anyway, and in really stupid, inefficient ways – reducing someone to poverty so they can go on Medicaid is a lot less efficient than just making sure they had healthcare so they didn’t go broke in the first place; treating someone in the ER when something minor becomes a crisis is a lot more expensive than treating them in a doctor’s office in the first place.
None of that has anything to do with high-end care in this country. A lot of the people who currently have no health insurance are going to get coverage under the reforms that will not be gold-plated health insurance, and will not cover a lot of expensive interventions. That’s okay because right now they have nothing at all. But that change will not affect existing plans that cover expensive interventions, and it will not in any way affect the ability of wealthy Americans to pay for those on a fee-for-service basis.
Of course, the claim that it will reduce you to negotiating with a government bureaucrat about what is covered is a crowd-pleaser. Not true, but good ‘n’ scary. What would be good is if the people who find that kind of thing scary took a good look at what the bill actually does, at which point they should realize that the claim that it’s a government takeover is a load of crap, and the resistance to it has a lot more to do with the insurance industry’s lack of desire to be properly regulated and wealthy people’s desire not to pay even a little bit more tax.
No government takeover. I mean, there isn’t even a continuation of the precedent set by Medicare and Medicaid that the government can be the insurance provider when it’s providing the funding, as it will be with the subsidies. This is as market-friendly a reform as any market fan could wish for. I’d prefer a bit more government intervention (like a public option), but I think the market-driven approach will work extremely well even without it.
That moderate Republicans are voting against something that takes the most market-friendly possible approach to insuring the uninsured ought to ensure electoral doom for them for the foreseeable future once the things gets rolling. To me it’s bizarre that they are fighting this tooth-and-claw to get a minor advantage in the next election instead of taking the long-term view. This thing is going to be as beloved as Social Security within 10 years. People love their universal healthcare in other countries and severely punish parties that threaten them.
Why is it a kneejerk reaction by right-wingers to fake out a pride in your awful system, rather than actually want to improve it?
‘Tis a puzzlement, isn’t it, Jes? But the longer the debate drags on, the more I keep coming back to John Holbo’s excellent insights into the nature of contemporary American conservatism. And especially to this passage:
The thing that makes capitalism good, apparently, is not that it generates wealth more efficiently than other known economic engines. No, the thing that makes capitalism good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave ‘conservatively’. Of course, crouching to protect themselves and their loved ones from the eternal lash of risk precisely won’t preserve these workers from risk. But the point isn’t to induce a society-wide conformist crouch by way of making the workers safe and happy. The point is to induce a society-wide conformist crouch. Period. A solid foundaton is hereby laid for a desirable social order.
Seen this way, those 45 million-plus Americans with no health insurance whatsoever aren’t a bug, but a feature (albeit a feature to be extolled only in certain very limited venues). Fear of falling keeps people* in line, and keeps them from getting too soft, too comfortable, and too demanding.
That’s as good an answer to Jes’ question as any I can come up with.
*Other people, that is; you know, the kind who need to be kept in line. As Holbo points out in the linked essay, the conservative is always serenely certain that s/he already has the right stuff and doesn’t need any further toughening up, thank you very much.
I’m curious — which province do you live in when you are in Canada, Marty? And what is your official citizenship/residency status?
“The thing that makes
capitalismgovernment control good, apparently, is not that it generates wealth more efficiently than other known economic engines. No, the thing that makescapitalismgovernment control good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave‘conservatively’gratefully.”Thus providing the government further leverage to control their lives.
Slarti, sorry to have confused you with Marty.
Marty: It is true that the only places collecting wait times today are the most sophisticated IDN’s.
So you did realize your claim that wait times in the US are shorter than in Canada was completely meaningless? Good to know. Why, then, did you persist in defending what you knew all along was a completely meaningless assertion?
Indeed, given that you knew what you were saying was meaningless, why bother saying it in the first place?
Marty: “I made no claims as to which was preferable….” Nonsense. The implication was unambiguously clear.
Marty again: “People with no way to pay and in a hurry are caught between the rock and the hard place…” Absurd. This is essentially true everywhere unless you are so filthy rich that you can have your own fully staffed private hospital nearby at your beck and call.
Mattt, the answer to the first is Ontario. The second is, its been a number of years and close to having to renew but I couldn’t tell you exactly. I get to live here to work basically.
It seems that the American procedure, like the Canadian procedure you refer to is a bit outdated when compared to the Miami Method pioneered by Dr. Lamelas of the Mt. Sinai Medical Center in Miami
Specifically, similar procedures are done in Toronto and Ottawa, but not in Newfoundland (nb Newfoundland is a very rural place, this is like someone going from Montana to LA for healthcare). I don’t know if the exact same procedure is done in Canada tho.
the reason why our system is so far superior (and is much more widely used by Canadians than you’d concede, although I don’t know where to go for stats)
So you don’t *know* it in the sense of having the information, you *just know* it because it fits in with your preconceptions. This virtually guarantees that you’re immunized from new information changing your viewpoint- after all, you already *just know*.
There’s a good wikipedia article comparing the two systems, including a section on cancer. Of course, there are also groups dedicated to skewing the stats, so if you prefer to reinforce your preconceptions rather than challenging them Im sure you can google for those as well.
“Indeed, given that you knew what you were saying was meaningless, why bother saying it in the first place?”
Because outside this blog it is a pretty unquestioned and uncontested statement. Even in Canadian and US medical circles. Sorry for the lack of cites. You could find me a cite that questions it as common information and I will quit saying it.
Marty: No, the thing that makes capitalism government control good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave ‘conservatively’ gratefully.”
I’ve tried to respond to this, but all I can really think to say is: Marty clearly doesn’t know anyone in the US who has clung to a job they hate for fear of losing the health benefits keeping them alive (I live outside the US, and I know several); and he doesn’t know anyone at all in the UK, if he thinks we adopt a “cowed and subservient posture” either to the government of the day, or to the NHS.
“Thus providing the government further leverage to control their lives.”
That post was nothing but an insulting descent into baseless propaganda and bespeaks an obscurantism that would make any Trotskyite proud.
“Marty clearly doesn’t know anyone in the US who has clung to a job they hate for fear of losing the health benefits keeping them alive ”
Sure I have, and am a fan of having HCR, but people cling to jobs they hate for lots of reasons, I suspect even in the UK.
Marty: Because outside this blog it is a pretty unquestioned and uncontested statement.
“Outside this blog”? You mean, in your own little world?
It’s a meaningless statement, Marty, as you yourself acknowledged, because the US does not collect systematic data on wait times.
You may not hear this meaningless claim challenged or contested, but that would be because you appear (outside this blog) to move in very limited circles.
It’s still meaningless. To make a comparison of wait times, you need to collect data – and the US simply doesn’t do it.
So basically, you made a claim you knew was meaningless because you usually get away with doing so?
Marty, I’m sure you thought that was a devastatingly clever take-down, but come on. You could at least make a minimal effort here.
Holbo’s comment was germane to the discussion at hand precisely because living without health insurance is living “precariously.” And one of the benefits of reform is that it will make many people’s lives less precarious, because whereas they didn’t have health insurance of any kind, now they will. The lives of people with health insurance are less precarious than the lives of people without it. Are we at least in agreement on that?
And yet some people seem to find the very notion of making people’s lives less precarious objectionable. (Or they take your tack, which is to simply ignore the existence of those 45 million people entirely.) Why could that be?
And you come back with a “response” worthy of a high school freshman with a poster of Ronald Reagan on his bedroom wall. Please.
Thus providing the government further leverage to control their lives.
By that token, a massive, faceless health insurance company “controls my life” right now, in order to make money off me. And that’s preferable to you because…well, because someone’s making money off me, apparently.
Oops, Marty. Didn’t see uncle K’s post. Long live the permanent revolution.
On another matter, where is the highly praised competition in our healthcare? Insurance companies don’t compete and are exempt from anti-trust; drug and medical device firms get absurd and socially expensive patent protection; the AMA and our immigration authorities restrict the supply of doctors; and they don’t compete on price….where are the TV ads? Further, a great deal of the public health infrastructure (physical plant) is built with public funds or with the aid of public financing.
But no. You demand, yes DEMAND, the instant alleviation of your health problems and/or fears.
Thanks, Marty — I figured it was probably Ontario. Wait times for certain elective procedures tend to be a particular nuisence here, thanks to cuts/’reforms’ made in the mid-90s under the Harris provincial govt (following transfer payment cuts from the then-Liberal federal govt that slashed health care funding to the provinces by a substantial amount).
No one said NO innovation comes from the UK, no one said you NEVER have to wait in line in the US.
Actually, the former is EXACTLY what McKTX said: the economic burden is so great there is no money left over for innovation
“No money” means “no money,” unless there’s some ambiguity I’m failing to see.
Of note: Among the last ten years’ worth of Nobel Laureates in Medicine, fully half come from outside the US. But I’m sure their American colleagues are doing all the REAL work.
Because outside this blog it is a pretty unquestioned and uncontested statement. Even in Canadian and US medical circles. Sorry for the lack of cites. You could find me a cite that questions it as common information and I will quit saying it.
You know what? This is horsesh*t. Lazy-ass horsesh*t.
I could find you a cite, and I did. Handed it to you on a platter. After exactly one minute of googling I provided a cite that gives actual wait times for Canadian medicine.
Here they are:
Life-threatening: immediate.
Specialist physician: median 4 weeks.
MRI or CAT scan: median 2 weeks.
Surgery: median 4 weeks.
ER: 76% less than 4 hours.
Those are the wait times that Canadians are b*tching about. They would be absolutely normal, if not delightful, to most Americans. They’d be like heaven to the 15% of us who have no f**king health insurance at all.
Yes, there are lots of links, because there’s a lot of discussion in Canadian press and government about how to improve them.
I wish to god the public discussion in this country was one tenth as substantive.
If you want to google the conversation about American health care, you have to google for “death panel”.
Seriously, you’re bringing nothing to the table here other than your own prejudices and parochial opinions.
Why the hell should any of us care what you have to say on the topic?
Thus providing the government further leverage to control their lives.
Tell it to the freaking 46 million people who have no health insurance at all, or the almost 1 million people who have been bankrupted by medical bills, or the 45,000 people a year who die unnecessarily because of lack of access to medical care.
Give you liberty or give them death.
Seriously, from here:
every analysis says that the US has the most ADVANCED medicine in the world (not all of the advanced medicine). The most and latest of techniques and equipment available to the broadest set of patients.
The analysis also says that Canadians have longer wait times for less advanced technology and techniques.
To here:
You could find me a cite that questions it as common information and I will quit saying it.
In what, a half dozen comments?
We could put 100 cites in front of you and you wouldn’t quit saying it. You’ll say it again in this thread, you’ll say it again the next fifty times the topic comes up.
And it’ll all be your freaking opinion, based on what your buddies all say.
Meanwhile people in this country have *no freaking health insurance at all*, all so folks like you and McKinney don’t have to wait as long as a Canadian for a CAT scan.
No, the thing that makes government control good is that, by forcing people to live precarious lives …
Yup, there’s nothing like free primary and secondary education, workplace safety standards, federally insured bank deposits, unemployment insurance, and all the other things libertarians whine about to make my life feel precarious.
How bout we all pony up for her retroactive abortion
Sarah Palin Admits She Used To Hustle Across The Border To Take Advantage Of Canadas Socialized Medicine
Palin: Socialized Medicine Leads To Death Panels But It Worked So Well For My Family And I, We Used To Take Advantage Of It Over Americas Privatized System Ironic? Hypocritical? The former governor of Alaska, a.k.a., The Barracuda…
“Seriously, you’re bringing nothing to the table here other than your own prejudices and parochial opinions.
Why the hell should any of us care what you have to say on the topic?”
You don’t have to care about my opinion at all, but you can’t refute my personal knowledge and experience that forms my opinion with median times that you don’t seem to understand.
Lets see, “The median wait time for diagnostic services such as MRI and CAT scans [53] is two weeks with 86.4% waiting less than 3 months.[52]”.
Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn’t sound as good that way, huh?
And, in Ontario, they also work the system by making anyone the doctor wants to have one within the two weeks stay in the hospital until they have it, that is their prioritization scheme. Makes you feel better that they are prioritized, but still doen’t seem like a great system.
I am not the one bashing a system here, you are. Your stats are good with me, as I pointed out in the beginning. I have read all of them, by LHIN, by hospital, by doctor. The MRI and CAT scan machines in Canada are on average x years or more older than in the US, they have fewer per capita, etc.
You say you went and got the stats, great, because they should tell you that in government supplied healthcare you don’t measure cost, you measure wait times based on the budget limitations the government imposes.
No matter how many of the variations of the F-word Russell throws in, it doesn’t change the facts, the ones he posted.
It also doesn’t change my informed opinion that a significant number of medical professionals would tell you that doing research, or even working in the research hospitals, in the US is better than in Canada, because the medicine is more advanced.
It also doesn’t mean anyone forgot that many in the US aren’t covered by insurance, there wait times for non life threatening care is infinite, that wouldn’t change the median but would certainly lower the percentage to get treatment within 3 months.
I don’t qualify for all your vitriol Russell, ease up.
You don’t have to care about my opinion at all, but you can’t refute my personal knowledge and experience
The plural of anecdote isn’t data.
It also doesn’t change my informed opinion that a significant number of medical professionals would tell you that…
And neither is that.
Well, and a certain percentage of people waiting a while for a CT scan does not necessarily indicate anything that would affect quality of care at all. I had a CT scan of my head a couple of years ago, and even though I was able to get an appointment within a few weeks (this is with Kaiser Permanente), it really wasn’t that urgent, and waiting a couple of months would’ve been fine. I was about 30, I was just having some severe headaches, there were no other indications, it was purely precautionary. What’s the evidence that people who really need a CT scan have to wait a long time in Canada? If their system for prioritizing puts off people who aren’t urgent in favor of fitting in all the people who are urgent, what’s the problem?
And while I appreciate we’re talking about Canada vs. the US here, the actual healthcare bill under consideration wouldn’t grant the government the sort of control that would affect whether CT scans were available. It’s nothing like the Canadian system.
It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it.
The word “might” carries an awful lot of freight in that sentence.
–TP
Uncle K, after that great Holbo quote”: Seen this way, those 45 million-plus Americans with no health insurance whatsoever aren’t a bug, but a feature (albeit a feature to be extolled only in certain very limited venues).”
See also the GOP on how unemployment benefits are bad, (After all, they let folks look for a half-decent job, sometimes, briefly, rather than having to grab the first one that comes along, however low-paying & crappy.
Also – Marty, re your reworking of said quote . . . just FAIL. Now, with more strikeouts and replacements you could have at least made the standard conservative argument about how gov’t providing valuable services to make people’s lives more secure makes them gratefully dependent on gov’t . . . which sounds pretty good right around now. But yeah, as it stands, no.
Marty: It also doesn’t change my informed opinion that a significant number of medical professionals would tell you that doing research, or even working in the research hospitals, in the US is better than in Canada, because the medicine is more advanced.
Perhaps, but that’s not even remotely what you were originally claiming.
Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn’t sound as good that way, huh?
About eight years ago I was diagnosed as potentially having a irreversible neurodegenerative disorder. I had excellent insurance — thanks to my then-union — so that wasn’t the problem. The one teensy problem was the wait time: nine f***ing months.
Doesn’t sound as good that way, huh?
Thank god the diagnosis was in error and I was able to regain my equanimity and (arguably) intellect. Because if it had been, that would have been nine months of irreversible brain damage given to me by the squanderings of the Best Healthcare System In The World(tm).
Finally:
Because outside this blog it is a pretty unquestioned and uncontested statement. Even in Canadian and US medical circles.
I work in healthcare IT and I’ve never heard anything of the sort. What I’ve heard is that the high-end care in the US is the best in the world, a statement with which no-one disagrees. Beyond that, your remark is utter crap; while there are a few who will make the claim that the US system has the best care in toto, a) they’re generally referring only to the insured (where the question becomes much more complex), and b) to say the claim is controversial is an understatement.
[It’s also false, fwiw, but that sadly seems not to be germane to the present conversation.]
I have read all of them, by LHIN, by hospital, by doctor.
Where do you come by that information? Not because I’m calling you out on it, just because I’d like to see it.
There isn’t a lot around for US quality of care, and I’d like something better than anecdote to work with.
The best thing I’ve found is this, which puts the American system on average better than the Canadian system for wait times, but with such weird outlying data (average wait time to see a GP in Boston MA — 63 days) that it’s hard to say what “on average” means.
The wait time for hip replacement surgery in CA was particularly crappy, with 50% of CA hospital admins saying someone over 65 had a 50% chance of waiting more than six months.
That sucks.
From other stuff I’ve read, as regards wait times, both the US and CA appear to be more or less equally sucky when compared to France, Germany, or some other EU nations.
The bottom line, to me, is the number of people in this country who have no insurance at all, or insurance that is inadequate to address any significant illness.
This country is astoundingly, prodigally rich, unbelievably rich, and there are people who live here who don’t go to the doctor when they’re sick, because they can’t afford to. Or who are driven into bankruptcy when they do get sick, even when they have insurance. And a lot of those folks are working folks.
I’m not talking about marginal down-and-out types, I’m talking about people with jobs and kids.
I appreciate that we have some of the best, most state of the art medical technology and practice in this country. I also appreciate that that is inaccessible to millions upon millions of us.
It should not be that way.
I don’t qualify for all your vitriol Russell, ease up.
Fair enough, my apologies.
Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn’t sound as good that way, huh??
Uh . . . there’s an awful lot that needs to be unpacked here before you can hang your hat on this. I’d imagine that where MRI or CAT scan: median 2 weeks intersects with Life-threatening: immediate, the latter might get you bumped up the queue.
Some more points of view:
Should Canada privatize?
A Canadian doctor looks at American health care.
Analysis of wait times for elective surgery in OECD countries
If you live in Canada and you want a hip replacement, it kinda sucks.
If you live in the US and you have really good health insurance, Bob’s your uncle.
If you live in Canada and you plain old get sick, you have no worries.
If you live in the US and you don’t happen to have good health insurance, or health insurance at all, you’re likely screwed.
Calling all cleek! Italics in aisle 8!!
You certainly seemed to be forgetting it earlier in your comments, Marty. What percentage of Americans do you think are in that infinite-wait category for MRI/CAT scans, and how does that affect the comparison to the Canadian waits you’re so concerned about?
“Where do you come by that information? Not because I’m calling you out on it, just because I’d like to see it.”
I don’t get it that way, but the Ministry of Health has a website with most of this info on it here. Like most, i am not sure how frequently the stats are updated.
You don’t have to care about my opinion at all, but you can’t refute my personal knowledge and experience that forms my opinion with median times that you don’t seem to understand.
One doesn’t refute an opinion. However, I think that your opinions would do well to try to adjust themselves to fit around facts rather than vice-versa. And if you’ve got something to add other than insults that will expand our collective understanding of “median times”, just jump right in.
The same thing happened on the cap gains thread- you have an opinion, some numbers etc don’t jive with that opinion, you call the numbers crap and say that your opinion is (touchy-feely time) just as valid as everyone elses.
Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn’t sound as good that way, huh?
If they use a system that’s blind to the need of the patient, then that would be true. But as someone with extensive family in Canada, I know that this is not true.
As someone with *claimed* experience with the Canadian medical system, you ought to know that this is not true as well.
“The same thing happened on the cap gains thread- you have an opinion, some numbers etc don’t jive with that opinion, you call the numbers crap and say that your opinion is (touchy-feely time) just as valid as everyone elses. ”
Funny, Thats exactly how I feel this went, what is odd is that the discussion, mine and Russells was about whether the numbers were good or not. That requires interpretation or, opinion.
50% greater than 2 weeks with 14% still not done at 3 months doesn’t sound great to me. Some number of those under two weeks were life threatening (meaning diagnosed immediately life threatening) so some number over 50% of diagnostic tests were schedule out over the next 3 months plus. Seems long to me and longer than my experience in the US, but consistent with my experience in Canada.
I am not sure what your objection to my opinion is other than you disagree.
The combination of citing healthcare availability statistics with a refusal to acknowledge the problem of the uninsured strikes me a bit like this:
REPUBLICANS: Behold, the Edumatron 9000 mechanical educator! It graduates high school students in the top 30% of the country and only costs twice as much as human teachers!
EVERYONE ELSE: Cool! But wait.. it appears to feed the poorest 10% of students directly into a wood chipper. And then uses them to make hamburgers for lunch for the others. That seems … I don’t know … bad?
REPUBLICANS: You won’t find results like these in any other country, nosirree! This machine is state of the art all-American engineering and it’s going to give our kids the boost they need for the future!
EVERYONE ELSE: …but the woodchipper?
REPUBLICANS: 22% of students get a 1500 or better SAT score, and 4% get a perfect 1600!
EVERYONE ELSE: That’s great, really, but does it have to kill quite so many poor people?
REPUBLICANS: No other country has an education system like this!
…
And so on. I mean, I’m all for neato stuff in healthcare that deliver good results. I just don’t see why this has to involve letting so many people die, here in the richest country on the planet.
Can whoever fixes the italics also post the magic incantation [1], so the rest of us can learn it?
1. Escaped, of course.
Did that really work?
Apparently so.
OK, I ended my comment with
[/i][/i][/i][/p][/i][/i]
(=where the square brackets should be replaced by angle brackets.
Marty: Your stats are good with me, as I pointed out in the beginning. I have read all of them, by LHIN, by hospital, by doctor.
But then you tried to claim that the Canadian stats were worse by comparison with US stats. And that claim was meaningless, because there are no equivalent US stats. The US government doesn’t collect data on how long each person in the US seeking care has to wait for it.
And you know it was meaningless. And your only defense so far for your making a statement you knew was meaningless was that, outside of this blog, you mostly don’t get contradicted when you make that kind of meaningless claim.
Is that all you got?
50% greater than 2 weeks with 14% still not done at 3 months doesn’t sound great to me.
I don’t disagree with this, my issue was whether that’s significantly better than in the US.
From what I can find, the answer seems to be “it depends”. Even leaving the uninsured folks in the US out of it.
And both CA and the US appear to have poor wait times when compared with some other, similar countries.
Greater government involvement in ensuring the availability of health care does not appear to inevitably lead to scarcity of care, poorer quality of care, or longer wait times.
And it does appear to create greater transparency and responsiveness in addressing problems in the large. The Canadian national and provincial governments’ responses to wait times being an example.
American market-driven health stuff excels at providing stuff that has high profit margins.
And last but not least, 45+ million people in the US will spend at least part of this year with no insurance at all, and over half of the personal bankruptcies in the US will be due to medical costs.
45 million people is more than the entire population of Canada. It’s a lot of people.
And, we pay something like twice what most other OECD nations pay.
That’s what I take away from the information I’ve seen. So, I don’t think what we’re doing is working well.
So Sarah Palin’s parents, when she was a youngster may have taken her brother to the closest medical treatment center for emergency medical care, creating some international incident forty years later…
As one wise person said:
“Is that all you got?”
Posted by: Jesurgislac | March 09, 2010 at 05:11 AM
“Is that all you got?”
Sadly, no.
About 44,000 people die each year in the US because they don’t have health insurance. cite. Sarah Palin’s “solution” to the deaths of thousands of Americans is to talk gibberish about “death panels” .
The US health care system is renowned throughout the world as the most expensive system providing the worst care of any developed country.
Yet the response to this, from patriotic right-wingers like McKinneyTex and Marty, is not “how do we do better?” but to make mindnumbingly stupid claims about how their rotten system is already better, providing you use the right metric… which entails a lot of complicated mental juggling, such as Marty holding up real Canadian national figures against imaginary US national figures and pretending he can see that the imaginary ones are better than the real ones.
Now which side of the line do you fall, Blogbuds? Too patriotic to care how many people the US health care system lets die each year?
About 44,000 people die each year in the US because they don’t have health insurance.
Really! Don’t more than that die that do have health insurance?
“…talk gibberish about “death panels” Don’t you have “death panels”? I thought I read somewhere…
“…providing the worst care of any developed country.” Jes, come on, you’re better than that.
“Now which side of the line do you fall, Blogbuds?”
Most of whatever is wrong with our health system is caused by government manipulation – so obviously I’m not going to support further manipulation – especially where there is no indication that it is intended to improve ‘health care’. Health care, by the way, that is the best in the universe – without a doubt.
It’s sad to see the quality of argument has diminished here since hilzoy bailed.
“Is that all you got?”
No, that was all the Palins had. Jes has the NHS, although I would prefer the French system.
Not to mention them cushy commie union jobs later, and let’s not forget that gummint-provided moocher-care while she was nanny of the nannystate.
Speaking of prayer, what are we going to do about the religious couple who are going to jail because they didn’t seek medical care for their now-dead children, preferring prayer to their Creator instead of consulting those pointy-headed elite doctors who went to universities on either Left Coast?
Why didn’t the Palins, all generations of that illustrious family, go this route?
The religious couple relied on their faith and prayer. Check. They were self-sufficient. Check. They didn’t over-utilize the healthcare system, which so many believe is the reason costs are so high. Check. They didn’t rely on gummint. Check. They weren’t subsidized by anyone, like say, Stalin’s haircuts were subsidized, which by the way, were just like Medicare, which shouldn’t be cut by Democrats, but should be abolished by Republicans. Check.
What am I missing? Why aren’t these parents testifying in front of Jim Demint against the demon Obamacare and in favor of the Republican healthcare plan, which by golly these parents have been living.
Would Jim Demint try to sneak them into his subsidized doctor’s office (under the Federal Employees Healthcare Plan) or would he hustle them out the backdoor after testifying, perhaps with a monopoly voucher for their future childrens’ appointment with the coroner.
If their children could speak, they would be the end of Obamacare. In fact, I expect Sean Hannity, that brilliantined bug smiling like Kali, will have their exhumed corpses (man, I hope it was a private cemetery, not one of them gummint collective jobs) appear on his show and stick a microphone in their faces while providing their answers in funny voices and not moving his poisonous lips.
The modern day Republican Party is a zombie psychopath abroad in the land.
I thinking right now of the end-of-life care I would like to provide Hannity, DeMint, and any number of fascist blonde Palins on FOX.
It would be cheap.
Check.
Don’t more than that die that do have health insurance?
the mind reels.
Health care, by the way, that is the best in the universe – without a doubt.
Except for the 45 million uninsured. And the millions more that are underinsured. Other than that.
Most of whatever is wrong with our health system is caused by government manipulation – so obviously I’m not going to support further manipulation
Yeah, if it weren’t for that government manipulation through Medicare and Medicaid, we wouldn’t have 45 million uninsured and millions more underinsured.
No, we’d have more.
It’s sad to see the quality of argument has diminished here since hilzoy bailed.
Yes, hilzoy was vehemently opposed to health care reform, and tended to view the problems with our health care system as derivative of government manipulation.
Riiiiigggghhhht.
Jes, come on, you’re better than that.
Well, not right now – I’m coughing and sneezing and trying to get over a cold which is sitting in my nose and throat before I have an operation inside of my nose. I rang the practice I’m registered with this morning at 8am and got an appointment for 10:30: the doctor listened to me coughing, checked my sinuses for any sign of infection, and signed me off work for two weeks to make sure I get over this cold before I have the operation, and after which I’ll be on sick leave, during all of which period I’m still on full pay.
I picked this practice to register with because it’s an easy 10 minute walk away (actually, I can get there in less than 3 minutes when I’m feeling fit…) and has an excellent appointments system: if I had felt unable to walk that far, I would have explained that to the practice receptionist, who would have arranged a home visit from the doctor on call.
So right now I’m feeling pretty ill. But that I get better care than I would in the US, and pay less for it – without a doubt.
As do people in every other developed country in the world, Blogbuds. We take for granted a standard of care that you don’t.
I picked this practice to register with because it’s an easy 10 minute walk away (actually, I can get there in less than 3 minutes when I’m feeling fit…) and has an excellent appointments system
Seems as good a time as any to note that under the NHS, Jes can choose just about any primary care provider she likes. And she can continue to see that provider as long as she damn well pleases.
Whereas I, as a beneficiary of The Greatest Healthcare System in the World (OO-RAH!), have to choose a provider who’s in my insurance company’s network. There may be GPs who are closer, or who I would prefer to see, but if they’re not in the network, tough sh!t.
And of course if I change jobs next year and end up with a new insurance plan, I may have to go find a new GP, whether I like my current one or not.
And I’m one of the lucky ones.
And of course if I change jobs next year and end up with a new insurance plan, I may have to go find a new GP, whether I like my current one or not.
Look on the bright side: if your new job doesn’t come with health benefits, you can choose an GP you like.
Except for the 45 million uninsured.
Posted by: Eric Martin | March 09, 2010 at 09:51 AM
Uh, 45 million … ? Are there some Americans included in that number?
…and Jes, I’m glad you’re being taken care of. If it gets serious and requires special attention – we’ll gladly take care of you. We’re use to being the world’s safety net – at least at the moment.
Uncle Kvetch…again, most of your concerns are created by gov’mint, and certainly will not be solved by them.
Some of our challenges revolve around corporations being forced to provide health care for their workers. We need to work on changing that in the future.
Thanks for the cup of coffee.
If it gets serious and requires special attention
…then I’ll be taken care of by some of the best in the world, at no extra cost.
Wouldn’t want to put your crummy system under any Jesurgislac strains…
I’m glad you’re being taken care of.
Thanks for your good wishes. I wish you the same – though with less confidence that it will be the case.
Some of our challenges revolve around corporations being forced to provide health care for their workers. We need to work on changing that in the future.
Simple: adopt our NHS system. No corporations are forced to provide health care for their workers: when an employer provides access to private health insurance, not only is it of better quality – our private health care providers get real competition, unlike yours – but it’s done as an additional benefit, a luxury extra, not life or death.
It would be nice to think, on behalf of my American friends, that you will be changing to something better in the future…
Uh, 45 million … ? Are there some Americans included in that number?
Don’t get xenophobic on us. From a public health standpoint, it’s bad policy and just plain stupid for everyone to allow a large pool of untreated individuals to exist.
Uh, 45 million … ? Are there some Americans included in that number?
Yeah, tens of millions. Why?
Tens of millions underinsured too.
Why?
Blogbuds: Uh, 45 million … ? Are there some Americans included in that number?
“According to the 2000 United States Census, whereas the number of naturalised citizens had increased by 71% (6.2 million to 10.6 million), the number of non-citizens had increased by 401% (3.5 million to 17.8 million) in the preceding three decades (Schmidley 2001). In 1998, about 63% of foreign-born individuals (or approximately 16.5 million) were non-citizens (Carrasquillo et al 2000).” cite It’s estimated that about 45% of the non-citizens didn’t have health insurance.
Yet: “In 2006, 46.6 million Americans were without health insurance. Most had incomes above the poverty level, and thus, did not qualify for government entitlement programs. More than 80 percent of the uninsured were employed or came from working families.” cite
So while over half of non-Americans have the same health insurance you do, the number of uninsured Americans is greater than the number of uninsured non-Americans.
(Plus, what Gwangung said.)
… untreated individuals to exist.
Posted by: gwangung | March 09, 2010 at 11:04 AM
Uninsured, not untreated. Different subject.
Forgiven. To a certain extent, it’s an understandable error.
Uninsured, not untreated. Different subject.
Uh-huh. Not sure you can elucidate the differences in a quantifiable way, particularly when it pertains to public health. Public health experts certainly seem to think that such a large population of uninsured is a problem for them.
Uninsured, not untreated. Different subject.
Would be in any other developed country in the world: in the US, of course, uninsured is how your system ensures people with comparitively minor ailments go untreated until their ailments get so bad they have to seek help – at which point, their treatment is much more expensive.
That’s how the US manages to have the most expensive system delivering the worst care of any developed country.
Yet: “In 2006, 46.6 million Americans were without health insurance.
Posted by: Jesurgislac | March 09, 2010 at 11:17 AM
You have been misinformed. Truly, I hope you get better. Glad you have access to good treatment.
It is true that more people with health insurance die every year than die without health insurance.
This should be looked into.
It is also true that everyone on Medicare dies.
Everyone in countries with decent health care systems of one kind and another, croak willy-nilly.
And yet folks in underdeveloped countries with no insurance and dilapidated healthcare systems seem to thrive, if you look at population growth.
It turns out that the “death” tax prevents all death because folks just refuse to die and give all of their money to the gummint.
Not a single Republican, and even some Democrats, has died since the “death” tax was introduced.
If the “death tax” is abolished, all of them will keel over immediately, even and especially those on Medicare.
Those who do not seek medical care, but instead petition the Lord for appendectomies, are rewarded with life everlasting.
I hope this humble post raises the level of discourse to Hilzoy-levels.
What folks don’t know is that before posting, Hilzoy would practice by shooting fish in a barrel and then falling down laughing and holding her stomach at the ease with which she was going to vanguish her interculutors.
My personal theory is that Hilzoy died from a surfeit of health insurance.
But then I’m a paranoid dyslexic — I have a suspicious feeling that I’m following someone.
Uncle Kvetch…again, most of your concerns are created by gov’mint, and certainly will not be solved by them.
Yeah, so you keep saying. In the case of my specific concerns, the British government is doing better by Jes than our system is doing by me. She has more freedom to choose her health care providers than I do.
You have been misinformed.
Again, stated as fact, but not argued.
Carry on trolling; you’re clearly not worth responding to further.
Even though I completely disagree with most of what UK, Jesurgislac and some others want, politically, they’re winning the war of facts by virtue of having some at their disposal, and by requiring them as substantiation for argument.
If you’re just making assertions, then you are just another Internet Assertion Monkey. You’re not going to convince anyone here, including me, by resorting to I-believe arguments.
If the “death tax” is abolished, all of them will keel over immediately
Well, what are they waiting for?
Isn’t this the year that the Throw Momma From The Train Act of 2001
reaches fruition?
–TP
Carry on trolling; you’re clearly not worth responding to further.
Posted by: Uncle Kvetch | March 09, 2010 at 11:38 AM
But UK, I’m a very accomplished troll. You’ve misjudged again.
Posted by: Slartibartfast | March 09, 2010 at 11:42 AM
…you have always disappointed. I’ve always liked John Thullen better. Internet Assertion Monkey. How rude.
Blogbudsman: Yet: “In 2006, 46.6 million Americans were without health insurance.
Posted by: Jesurgislac | March 09, 2010 at 11:17 AM
You have been misinformed.
Oh noes! You’re right, Blogbudsman – according to the CDC, the figure for 2006 was actually 43.6 million – 14.6% of Americans. The figure I quoted to you was 3 million out.
I’ve always liked John Thullen better.
Everyone likes John Thullen better.
Internet Assertion Monkey.
That does have a nice, punchy ring to it.
Who the cap fit, brah.
Nice shout out to Otis on your blog page, blogbudsman. Respect where it’s due.
Jes: The figure I quoted to you was 3 million out.
That must be the three million that the Republican plan was going to cover.
I assert that Slartibartfast at 11:22 is correct.
The data clearly shows that the US health system (1)is by far the most expensive per capita in the world, (2) still manages to leave approximately 15% of the population uninsured, and (3) still manages to produce poorer overall health outcomes than most other OECD countries.
From what I’ve seen here and elsewhere, a common response from the US political right is:
(1) Costs are high because of government interference in the health insurance/health care market place. Stop the government interference (except when you need to increase it by limiting lawsuits) and costs will plunge.
(2) Tens of millions of people are uninsured (and tens of millions more under insured) because they are illegal immigrants or because of government interference in the market, or perhaps because they want to be.
(3) Data on health outcomes is meaningless because it is skewed by all those poor illegal immigrants and/or because Americans eat and drink more than anyone else in the world.
I can’t stand John Thullen
Sorry to disappoint, truly. But I don’t do this for you.
Me, too. Although it’s good to keep in mind that he’s either clinically insane, or a mad genius, or both. So comparisons would either be unflattering to one of us; possibly both.
I present a general garment, and you claim it is cut to your fit? Or some such.
Either you’re arguing by assertion, or you’re not. If you are, wear the label proudly, or quit doing it. If not, I’m not talking to you.
Slightly more nuanced, it‘s:
Even if you want to try and play with the at the time of the interview notion, there’s still the part where over 30 million had been uninsured for more than a year, prior to the survey.
Yukoner. The US health system is so expensive that the US government already spends just as per capita as the UK and Canada, but covers much less than all of the population.
Here are my thoughts, as of now, about the broader question of HCR in the US, based on whatever information I’ve stumbled across over the last year.
Regardless of who pays for it, or how, health care costs in the US are on track to basically cripple the economy.
What the various payers in the US mostly pay for are direct hospital care and physician visits, and (to a lesser but still significant degree) prescription pharma.
The folks who consume those services and meds are overwhelmingly people with chronic illnesses like diabetes, cancer, pulmonary and cardiac issues.
*Most of these illnesses are manageable*, to at least some useful degree, by fairly simple and fairly inexpensive lifestyle changes.
Don’t smoke.
Don’t drink too much.
Get some exercise.
Don’t eat overly processed food and/or stuff that’s loaded with corn syrup or other sugars.
It seems to me that *none* of the reforms on the table, from either side, do anything serious about addressing that basic reality.
Health care costs a lot in the US.
It costs a lot because a lot of people are sick.
A lot of people are sick because of preventable lifestyle issues.
And when I say “lifestyle” issues, I don’t mean that people should get off their lazy duffs and get with the program. I think there are some deep issues at the infrastructure level that make it suprisingly hard for folks to have access to good food and opportunities for simple, pleasant exercise.
So, to my eye, a rational way to go about this would look more like a public health outreach at a national level, to encourage the production and availability of healthy food, to help people understand how to buy and prepare it, and to help people get some exercise.
Public health services and education.
How does this strike the conservative mind?
Does it sound like a program for encouraging people to take responsibility for their health, and empowering them to do so?
Or does it sound like more liberal meddling of the “Obama is going to make me eat kale” variety?
Just curious.
Dunno. I’ve heard in various places that I’m not conservative, and also that I’m a rightwing wacko. But, speaking for myself: I think that attention to diet, exercise, and refraining from smoking are GOOD things.
But enforced attention rubs me the wrong way. Having a decent health program starting in elementary school, though, seems to me a decent way to lay the groundwork for informed choice.
Having a decent health program starting in elementary school,
indoctrination!
Funny, Thats exactly how I feel this went, what is odd is that the discussion, mine and Russells was about whether the numbers were good or not. That requires interpretation or, opinion….
50% greater than 2 weeks with 14% still not done at 3 months doesn’t sound great to me
That’s not what you said at all; you acted as if the 14% would be applied equally to all patients. Specifically, you said It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it.
That’s as dishonest as the people quoting the average wait for a voluntary hip replacement and pretending that grandma would be laid up with a broken hip for months.
I am not sure what your objection to my opinion is other than you disagree.
I object to the attempt to use the statistics in an obviously misleading way. And again, if you have all this direct experience with the Canadian medical system, that should have directly demonstrated to you that that eg people don’t regularly sit around for 3 months waiting to find out if they’ve got brain cancer.
Sebastian,
Yes I’ve seen the numbers that you are referring to. It seems that you have the worst of all worlds and that means the most expensive one by default. All health care systems are obviously subject to upward pressure on costs but in the US these pressures seem to be magnified greatly.
Where is the push back on that upward pressure in the US? Medicare Part D started paying for senior’s medications but the program was forbidden to use its buying power to negotiate better prices. The current effort at reform includes some plans to reduce Medicare expenditures and the political right pivots 180 degrees to attack any effort to reduce costs at all. Cost containment on the Medicaid program appears to be largely limited to dropping poor people off the rolls which is unlikely to result in actual cost savings but never mind. And the incentives of the private insurers are so mis-aligned with the goal of overall health care system efficiency and cost containment that looking to them for pressure to contain costs is a joke.
Two advantages of a single payer system in this context:
1. There are very real system-wide pressures to contain costs along with the pressures to maintain or increase services. Hence the ongoing issue of wait times in Canada for example.
2. But because everyone will be in the wider health care system from cradle to grave, some of those pressures to reduce costs are channeled into long-term efforts like public health programs and campaigns. One example among many is the on-going long-term multi-faceted effort to reduce the incidence of Type 2 diabetes that is particularly common among First Nation and Inuit people. Up front costs are considerable but it appears that long term savings will dwarf those costs.
Part of our cost overruns are attributable to our overuse of tests and procedures in general, but in particular, the excessive, unnecessary and, in some cases, unethical end of life care.
Sebastian is correct: the US government pays through the nose for the health care it buys, just like private insurers do and just like individual citizens do.
It’s a wonder (to some) where all the money goes. It doesn’t go into hiring more doctors per capita than, say, France or Germany do. But it goes somewhere because you can’t spend money without it becoming income for somebody.
The US healthcare “system” is a jobs program for lots and lots of people. Some of them spend their time creating forms; others spend their time filling out the forms. Some of them create ads for their company’s boner pills; others create ads for their company’s competing boner pills. They may be contributing nothing to anybody’s health, but at least they get a paycheck — which is no small thing in today’s economy. “Reducing health care costs” can ONLY mean pay cuts or outright lay-offs for at least some people who now earn their living in the US healthcare “system”. (Well, it could also mean lower profits for some stockholders, but those are too sacred to touch, as we know, and too small to matter, as Sebastian has told us in the past.) So, in light of 10% unemployment, “reducing health care costs” is not unalloyed goodness.
Rejiggering the “system” so that the same total spending (i.e. the same total wages and profits) results in medical care for the people who are now going without it WOULD BE unalloyed goodness.
Some romantics believe that we should rejigger the “system” towards that gauzy past that Ronald Reagan melifluously reminisced about in his famous hit single inveighing against Medicare. To such starry-eyed idealists, all I can say is: we tried it your way up to 1965. IT DIDN’T WORK. So we hard-nosed libruls stepped up and did something: old people don’t go uninsured any more. Medicare was not a commie plot against The Market; it was a solution to a problem that The Market could not (or would not) solve.
Yeah, it was socialism. But one thing you CANNOT say about it is that it stunted the growth of the “health care industry”. Socialism is good for business more often than you think.
Russell is correct, too: staying healthy is absolutely, positively better than getting medical treatment — no matter how “efficient” the health care “system” is.
One thing I’d add to his list is the possibility that some of our health problems are due to stress. But don’t tell the drug companies, or we will start seeing TV ads for a pill to relieve Insurance Anxiety Disorder.
–TP
But enforced attention rubs me the wrong way.
I guess I was thinking more along the line of carrots rather than sticks.
No pun intended.
“Reducing health care costs” can ONLY mean pay cuts or outright lay-offs for at least some people who now earn their living in the US healthcare “system”.
They could become small-scale organic farmers!!
Imagine their delight!
Or, maybe some would enjoy it.
But don’t tell the drug companies, or we will start seeing TV ads for a pill to relieve Insurance Anxiety Disorder.
I think that pill is called “Jack on the rocks, soda back”.
Person A and Person B are the same age.
Person A has good health insurance and Person B has none.
Person A gets regular check-ups, which are covered by insurance, requiring Person A to pay a $10 or $20 co-pay.
Person B does not get regular check-ups because of lack of coverage.
Person A’s doctor finds something unusual during a routine check-up and sends Person A for further tests, which are completed within a few weeks.
Person A is found to have a disease in an early and easily treatable stage.
Person A receives treatment within a few weeks and eventually recovers fully, going on to live for a number of years or decades into the future.
Person B has the same disease in the same early stage as Person A’s at the same point in time, but doesn’t know it.
Person B, several months later, begins to experience symptoms and treats those symptoms with over-the-counter medications.
Person B’s symptoms, a couple of months later, become bad enough that Person B goes to the ER.
Person B’s disease is found to be advanced and terminal.
Person B goes home and informs friends and family of these circumstances.
A few weeks later, Person B is rushed to the hospital by ambulance.
Person B lives another week in the ICU on morphine before dying.
How should we calculate Person A’s and Person B’s wait times for treatment? Person A’s is a few weeks. Person B’s is more complicated. One could argue that Person B’s wait time for treatment is infinite, having never received it. I don’t think that would be fair. One could argue that Person B’s wait time should be the number of months that Person B lived with the disease that killed Person B. I don’t think that would be fair, either. I think Person B’s wait time should be based on the number of years or decades Person B would have lived had Person B been treated as quickly as Person A, regardless of their respective citizenships.
End-of-life care makes me crazy. There are some difficult questions about assessing when “end of life” is actually occurring, but there is a particularly perverse combination of expensive, painful, invasive interventions, and overcautious, miserly use of heavy painkillers & anti-anxiety drugs because of the fear of theft of painkillers or accidentally killing someone who is already bound to die.
It’s screwed up even in the best cases, and it’s horrific in the worst.
I guess this is more fuel for “You want death panels for grandma!” but when I hear that kind of crap, I think about my actual grandmother (still alive): survived the Blitz in London, saw her husband die in his 60s, kept on going for several more decades; recently got a scan in the hospital for something else in which they noticed what might be kidney cancer; as the doctors began discussing biopsy and invasive treatment options, said something along the lines of “Are you kidding? I’m going to die of SOMETHING someday and I’d rather it not come at the end of a long series of painful surgeries.” I hope I have that much grace when someone comes to me with that kind of question.
And yes, I’ll be very sad when she dies. But we’re all going to die someday; all anyone can really hope for in the end is some dignity and relief from pain. The way we talk about death from old age or major disease is very warped in this country. There are no deranged bureaucrats bent on killing your grandmother: being confined to a hospital bed, drugged out of your mind, and having repeated surgeries and other interventions is not a good way to go out, even if cost never entered into it.
Answer:
If person A is Rush Limbaugh, he’s headed for Costa Rica to suck off their socialist healthcare paradise, if Obamacare is passed.
If person B is Rush Limbaugh, Glenn Back will quit his church if Limbaugh, heretofore known as person B, receives either a trip to the hospital via ambulance or a week’s worth of morphine in the name of social justice.
‘Person A and Person B are the same age’
Not enough information about Person B. If Person B can get the check-ups needed without insurance coverage, then why doesn’t that happen? The only situation I can think of with which I empathize is that Person A is destitute and cannot make the choice to pay for the regular check-ups. But this condition has been with us for a long time. I know lots of young people who forego health insurance coverage but rarely do the same for all the modern technology they view as integral to their modern existence. When they encounter a situation like that faced by Person B, it is very sad, but clearly from a perspective different from described in the posted scenario.
Jacob: I hope I have that much grace when someone comes to me with that kind of question.
Me too. I salute your grandmother, and you too for taking her decision like that.
My great-aunt had one bad heart attack, multi-infarct dementia causing short-term memory loss, and osteoparosis (several bad fractures). She was fragile, stubborn, damaged, and … well, stubborn: she was absolutely bloody determined that she was going to die in her own bed at home, not in a hospital or a care home, and she got her way to the end. (She died of a second heart attack just before the end of 2001: at home, in her own bed, just as she’d wanted.)
She got a fair amount of fairly expensive support from the NHS and from the local authority to be able to live in her own home, and help from her neighbours and her family. The cost of her stay in a care home would have been considerably greater to the local authority, possibly less to the NHS, but the choice was always hers. (She was quite clear about that, and made sure everyone else was, too.)
Um, what? That aside, where ya been, GOB?
‘where ya been, GOB?
All is well. Just taking care of things in Utah. Many posts here are on foreign relations and military actions that don’t interest me nearly as much as the domestic threats to American liberty. So, when I have a chance, I stop by to see if I can throw a wrench into the works.
GoodOleBoy: So, when I have a chance, I stop by to see if I can throw a wrench into the works.
As Slarti pointed out upthread: the trouble with all the right-wing defenders of the US’s p!ssspoor healthcare system, is that they are attempting to win an online argument without any facts on their side. When you have to claim you believe you have a wrench and if you did then you could throw it and you’re sure that if you threw the wrench you don’t have it would somehow land in the works…
Thullen can do better, and often does.
‘without any facts’
I rarely quarrel with you about the facts. Facts about results/outcomes dominate the world of the progressive. The fact I do pay attention to is the failure to acknowledge the meaning of the content of the U.S. Constitution and the notion of the separation of powers among the federal and state governments and the people. Most of the facts cited here drive progressives to advocate actions at the federal government level that diminish my opportunity to make my own choices, which, in my estimation, is the essence of my individual liberty. It’s very elementary and requires few facts.
But Jes, you are subject to a health care system that denies you your liberty, so why should we listen to anything you say? It’s obvious that if you were to write what you really thought of the NHS on this blog, MI5 would have you shipped off to the British version of the gulag faster than you can say “Bob’s yer uncle.”
Unless, of course, you’ve been so thoroughly brainwashed from spending your life under the jackbooted heel of socialism that you can’t see universal health care for what it really is: a boot stomping on a human face…forever.
Part of our cost overruns are attributable to our overuse of tests and procedures in general, but in particular, the excessive, unnecessary and, in some cases, unethical end of life care.
You forgot profitable.
Freedom’s just another word for dying a slow and painful death from a treatable disease that goes untreated due to a lack of health insurance.
Most of the facts cited here drive progressives to advocate actions at the federal government level that diminish my opportunity to make my own choices, which, in my estimation, is the essence of my individual liberty.
personal liberty is only affected by laws at the federal level ? fascinating!
how do “conservatives” explain the fact that i can only buy the brands of Scotch that the state of North Carolina approves of ? other than the number of people they effect, how would the laws governing this be any different if they were applied at the federal level ?
GOB,
Does MY liberty count? I want to be able to make “my own choice” to buy my health insurance from the federal government. Would it be any skin off your nose if I had that choice?
–TP
Many posts here are on foreign relations and military actions that don’t interest me nearly as much as the domestic threats to American liberty.
“Who cares about us killing more brown people? I’m more concerned that I’m not allowed to just do whatever I want all the time!” What a mature outlook.
Apropos of the thread, I’ll be offline for a few days due to having hernia repair surgery tomorrow. I’m glad I’m one of the people in the US with good coverage.
Good Ole Boy: Most of the facts cited here drive progressives to advocate actions at the federal government level that diminish my opportunity to make my own choices, which, in my estimation, is the essence of my individual liberty.
Then you should welcome the advent of the US’s NHS, which would vastly increase your opportunity to make your own choices, and thus your individual liberty.
Or do you actually value your individual liberty so little that you’d oppose increasing your personal choices – and everyone else’s, too – by having the NHS in the US?
I wonder how GOB feels about the Federal government taking away his choice to decide for himself whether to spend money on killing Iraqis? Or the state of Utah taking away the choice of bar owners to offer happy hour drink specials?
“The only situation I can think of with which I empathize is . . ”
That’s … interesting phrasing, Good Ole Boy . . .
Is the stop light I’m approaching at the busy intersection up ahead there because of local, State or Federal mandates, or some combination thereof?
I’m going 42 mph, so hurry up with the answer. Plus I’m texting (and making waffles on my car’s built-in waffle-making feature), which makes the ride even more fun.
My sense of individual liberty and its essence — my ability to choose — are at stake.
If there is any Federal money (my stolen tax dollars) in that stop light and the law that says I must obey, I think I’ll speed up and run it to make a statement about my liberty.
I had my liberty diminished once in Utah; some cop wouldn’t let me make my own choice about how fast I wanted to go.
Well, I could make my own choice, but I had to pay Utah for the privilege.
Here I go.
“Part of our cost overruns are attributable to our overuse of tests and procedures in general, but in particular, the excessive, unnecessary and, in some cases, unethical end of life care.”
I *think* you are probably right about this. But why hasn’t there ever been a good study on this? I’ve looked for years and never even seen a good try at it. Is there one somewhere?
If Person B can get the check-ups needed without insurance coverage, then why doesn’t that happen?
The problem is that Person B can quite often not get the check-ups and/or other care without insurance coverage.
If Person B could do so without insurance coverage, there wouldn’t be an issue.
The only situation I can think of with which I empathize is that Person A is destitute and cannot make the choice to pay for the regular check-ups.
I think you mean Person B here.
As it turns out, you have plenty of opportunity to exercise your capacity for empathy, because lots of folks are either already too poor to get the care they need, or they are bankrupted by getting the care they need.
But this condition has been with us for a long time.
Yes, it’s true, the poor and otherwise unlucky are with us always.
Is your argument that we should therefore do nothing about it?
I know lots of young people who forego health insurance coverage but rarely do the same for all the modern technology they view as integral to their modern existence.
Perhaps you may wish to compare the prices of, frex, privately purchased health insurance coverage, or the out-of-pocket cost of any medical procedure more complex than an office visit, with the prices of consumer electronics.
Of all of the arguments against doing something about the health care situation in this country, the one for which I have the least sympathy is the argument that any government action that limits anyone’s personal choice is an affront to their personal liberty.
You can’t drive above the speed limit. If you build a house, it has to be to code. If you’re a smoker, you can’t smoke in most confined public places. You can’t own a bazooka or a tank. You can’t dump your bodily wastes in a drinking water source.
And so on.
These are all limitations on your personal liberty. We accept them because it makes it possible for the 300 million of us who live in this country to get along. Or, in other cases, means that the requirements for a plainly decent life are broadly available to all.
I don’t see anything in the constitution that says the federal government cannot regulate the insurance industry, cannot directly provide insurance if that’s what we want to do, or cannot directly provide care if that’s what we want to do.
If you see it in there, kindly show it to me. Because I don’t see it.
What you’re saying, GOB, is that *you don’t like it*.
When tens of millions of people are totally uninsured, and half of all bankruptcies are due to medical costs, and tens of thousands of people a year die for lack of access to care, that is simply not a good enough reason for government not to act.
I *think* you are probably right about this. But why hasn’t there ever been a good study on this? I’ve looked for years and never even seen a good try at it. Is there one somewhere?
While not a comprehensive study this story on the costs of end-of-life care is hot off the presses.
It does cite a 2008 cost study showing large cost differences between different top-notch U.S. hospitals (end of life costs averaging $93k at UCLA Medical Center vs. $53k at Mayo in Rochester, MN).
Naturally, supporters of UCLA Medical Center suggest that the study is flawed.
The people I know who work in medicine have plenty of stories of hopelessly-ill elderly patients receiving expensive procedures unlikely to improve the patient’s quality of life because the patient and/or the patient’s family wanted them to “do everything”.
Over on the other side of the Pacific, I just had a lesson with my iaido teacher, and his older sister (she’s 87, he’s 80 or 81) had moved down from Tokyo to live with them. My lesson started an hour and a half late because the town they live in sent someone new to do the 3 month survey of her health issues/abilities in order to set the level of care that she is eligible to receive. Because the new person had to familiarize herself with all of the issues and get to know her, the meeting took more time than it usually does. After that, my teacher’s sister is then eligible for various benefits (transportation to the day care center, physical therapy, etc) and the case worker is familiar with the issues, so when the time comes, she will be able to help in making decisions.
End of life care is not going to be reduced by fiat, it is going to be reduced if systems are put in place to help deal with the issues that arise. In the US, death is often put off, and the end, when it comes often seems sudden because there is very little infrastructure in place to help people understand the cost/benefit ratio.
Furthermore, the structure of insurance encourages hospitals to make drastic interventions based on profits and volume. There was one of those infographs in Harpers maybe 7 or 8 years ago that took the medical bill of a person in the last week of their life and analyzed what was being paid for, why it was being prescribed, and what it meant. Unfortunately, it is not online, but the cost was mind boggling, all to keep someone ‘alive’. (I think that some of the prescribed procedures suggested that the person was not conscious when all this took place)
Unfortunately, that kind of infrastructure necessitates a systemic approach, but if it is argued that this is socialized medicine and therefore is unacceptable, I don’t see the US making much headway.
“Unfortunately, that kind of infrastructure necessitates a systemic approach, but if it is argued that this is socialized medicine and therefore is unacceptable, I don’t see the US making much headway.”
lj,
I am not sure the US, in this particular only, is that far behind. My father has regular checkups, a significant amount of similar benefits (transportation to daycare, physical therapy)and a case worker very familiar with his particular issues.
I am not sure what this means though:
Does the case worker decide how to end the life? Not commenting or complaining, just asking whether this is an active or advisory role in the decision process.
The problem is that Person B can quite often not get the check-ups and/or other care without insurance coverage.
Or, Person B realizes the futility of getting a diagnosis they can afford but not having the money to treat it.
Of course, anyone comparing the price of an iPod to the price of privately-purchased insurance (with exceptions for pre-existing conditions, of course) isn’t exactly dealing with the real world anyway.
Having someone familiar with the issues, who is outside of the family, can make a big difference. I’m not sure what I wrote that suggests that care workers here do (or should) have that kind of decision power and I apologize if I left you with that notion. What I am suggesting is that if the situation faced by someone is only know by people who either have certain stakes in the issues (i.e. the family) and people who come in only at the very end (medical staff), it is going to be difficult to arrive at a decision that won’t be skewed in some way. A regular checkup has, it seems to me, a different purpose than a 4 times a year survey interview that attempts to determine the physical limits and challenges a elderly person faces. One is reminded of the old joke where the man says ‘doc, it hurts when I lift my arm’ and the doc says ‘well, don’t lift your arm’. The joke doesn’t work if you say ‘doc, my joints hurt cause I’m getting old’ and the doc replies ‘well, don’t get old’…
Marty: I am not sure the US, in this particular only, is that far behind.
I’m glad your dad’s getting good care.
You do realize that a single anecdote is meaningless, just as you did realize (but claimed it anyway) that comparing Canadian wait times with imaginary “US wait times” is meaningless?
…and you do realize that insofar as care for the elderly is covered by Medicare, older people in the US have a socialized health care system which would be a great advantage to them in bringing up their standard of care to the rest of the developed world, unlike the rest of the US falling far below it?
[…]
There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.
The Commonwealth survey did find that U.S. patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F. Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. “Their wait might be uncomfortable, but it makes very little clinical difference,” he says.
The Commonwealth study did find one area where the U.S. was first by a wide margin: 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close.
Few solutions have been proposed for lengthy waits in the U.S., in part, say policy experts, because the problem is rarely acknowledged. But the market is beginning to address the issue with the rise of walk-in medical clinics. Hundreds have sprung up in CVS, Wal-Mart, Pathmark, and other stores—so many that the American Medical Assn. just adopted a resolution urging state and federal agencies to investigate such clinics as a conflict of interest if housed in stores with pharmacies. These retail clinics promise rapid care for minor medical problems, usually getting patients in and out in 30 minutes. The slogan for CVS’s Minute Clinics says it all: “You’re sick. We’re quick.”
The Doctor Will See You—In Three Months (JULY 9, 2007)
[…]
The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.
[…]
Wait Times For Medical Care: How The US Actually Measures Up
Fred at Slacktivist explains the difference thusly: Marty, Blogbudsman, McKinneyTexas, and GOB are playing Family Feud. The rest of us are playing Jeopardy.
For other options there’s also QI, where you get klaxon’d by Stephen Fry if you give the dull/wrong answer (though even Alan Davies wouldn’t be as boring as “America has the best healthcare in the world!”), Have I Got News For You, where you get points for the right answer but get asked back more often if you’re funny (alumni include both the first and the present Mayors of London), Call My Bluff, where you can win points for inventing convincingly wrong definitions of unusual words, and The Price Is Right, where at least you get Bruce Forsyth to flirt with you, though it appears most right-wingers would be really bad at figuring out how to get the prize…
Fred at Slacktivist explains the difference thusly: Marty, Blogbudsman, McKinneyTexas, and GOB are playing Family Feud. The rest of us are playing Jeopardy.
That’s a brilliant (and very funny) analogy.
That does defy explanation. As do Texas’ dry districts, if they still exist.
My best wishes for a successful procedure and speedy recovery, Phil.
Just to be clear, it wasn’t right-wing defenders in general; just one or two in this thread. YKWYA, and so does everyone else.
Argument by assertion is just a giant waste of space, I assert.
For other options there’s also
You’re missing the radio choices. I can only wish that those playing Family Feud (Family Fortunes in the UK) were playing Just a Minute – that way we wouldn’t have to deal with continual repitition of false talking points, and regular deviation to irrelevance. But sometimes it seems more like the pre-scripted parody I’m Sorry I Haven’t A Clue with rounds such as One Song to the Tune of Another, Cheddar Gorge (where you avoid the last word in the sentence – or the last thought in the chain of reasoning), Pick Up Song, and Swannee Kazoo (where you play duets on the Swannee Whistle and the kazoo).
…slip in between the cracks in her death panels…
pedant
Stuff slips through cracks, not between them. What is between the cracks is the intact solid stuff, where there is no crack to slip though.
/pedant
I *think* you are probably right about this. But why hasn’t there ever been a good study on this? I’ve looked for years and never even seen a good try at it. Is there one somewhere?
Seb, there was a 60 Minutes segment a few months ago, and I believe it cited studies. Here is a write up that might provide some leads:
http://www.cbsnews.com/stories/2009/11/19/60minutes/main5711689.shtml
Let me try that again, with a proper link
Charles: Do you think those links help you? They may make a point about Canadian wait times, but they also make a point about US wait times vis-a-vis other nations with universal coverage (some with government run health CARE like the UK). From the link:
However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.
Further:
Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.
Right.
Francis D,
Or in the case of Rush Limbaugh, I think the old Hoosier Hotshots song “From the Indies to the Andes in his Undies” fits the bill.
I’m not looking for any help. I say let the truth, to the degree it can be determined, fall where it may. I’m just throwing wood on the fire. 🙂
OT, I had some kale last night that I’d just picked from my garden, and it was fanTAStic! Loads better than those bags of pre-cut and -cleaned kale that you get at the local supermarket (which I’d thought were pretty good, until). Also, some garden spinach of a variety I’d never had before: huge leaves, a slightly tart flavor, and none of that dry-teeth effect you get from conventional (uh: garden-variety?) spinach.
Another thing that is really a whole lot better fresh from your garden: cabbage. Which we have still about a dozen heads of. I go cut a head, strip off some of the exterior leaves, and then cut it up for cooking. It’s so crisp that a VERY sharp knife makes kind of a ripping, shattering noise when cutting it. Tastes like nothing you’re likely to get from the store, even from a farmer’s market.
Other stuff we’re growing: sugar snap peas (which don’t even make it to the sink, most times. We just eat them right off the plant), turnips, collards, broccoli, lettuce (all done, now; time to replant), kohlrabi, broccoli (also all done & time to replant), brussels sprouts (experimental; never done those before) and the aforementioned spinach and kale.
Plus, we’re still eating the sweet potatoes we harvested back in November.
OT, I had some kale last night that I’d just picked from my garden, and it was fanTAStic!
I prepare with olive oil and garlic and it’s as you say, amazing.
Another thing that is really a whole lot better fresh from your garden: cabbage
My favorite is arugala. When we grew in Vermont, it was spicy. Had a bite.
I’m not looking for any help. I say let the truth, to the degree it can be determined, fall where it may. I’m just throwing wood on the fire. 🙂
Well, good on you for that. Those links were illuminating.
Thanks for the link Eric. And that is the kind of reporting I’ve seen for decades which has made me suspect that we do spend too much at the end of life. But what it isn’t, and doesn’t seem to lead or allude to, is a study showing how Americans treat dying people differently than our counterparts in other countries, nor how much that difference costs.
I suspect that the answers are:
A) we refuse to give up much later;
and
B) it costs an enormous amount;
and further
C) neither US government nor US insurance companies are good at getting that to stop.
Suggesting: we need to have a serious nationwide conversation about when to give up.
BUT: I don’t know if we really KNOW any of the presuppositions, and telling people that we have to stop treating grandma without knowing the answers is just going to cause enormous problems.
(And it leads to answers neither side likes: i.e. that personal choice is likely bankrupting us, and that the fun rhetorical targets the left loves [pharma prices, insurance companies] aren’t really the useful focus)
Which is why I wish we had data. If pharma prices are 1% of the difference in cost of care and this overtreatment at death is 35% (which are half assed but IMO reasonable guesses) it instructs us where the discussion should focus.
But because this difference is much talked about, but so far as I can tell, not deeply studied, we flounder all over the place.
Where is my winning lotto ticket so I can fund a study?
That’s the way I prepare it. That, and a little bit of ham. Probably good pancini would be best, but we just use what’s in the fridge; sometimes it winds up being a few last scraps of tasso. Just enough to give it a little flavoring. Honestly, though, fresh-picked kale could probably do without the ham.
One advantage of the “Obama makes us eat kale world” is I would quickly starve to death. Growing up in the south I ate everything from polk salad to collards greens, I no longer eat bushes. You can’t force me to eat arugula.
The upside is that as I starved to death I am sure I would be able to find some black market Marlboros and start smoking again to pass the time.
I suspect that the answers are:
A) we refuse to give up much later;
and
B) it costs an enormous amount;
and further
C) neither US government nor US insurance companies are good at getting that to stop.
In addition to what you wrote (and in conjunction) I think part of the problem is actually Medicare – that is, Medicare’s willingness to pay for too much (stuff like hip replacement for terminally ill patients). Add to that a medical culture that views death as a defeat (even though it is inevitable) that applies a default judgment of “keep the patient alive at all costs.”
Suggesting: we need to have a serious nationwide conversation about when to give up.
What we should do is require people on Medicare to compile a living will, with specific instructions. What Palin mendaciously called “death panels.” The thing is, many, many people would rather not be kept alive under all circumstances. But outside valid instructions, or a suitable, knowledgable health proxy, the default is “keep alive.”
But, yeah, a conversation would be nice. Also nice: one side of the divide not using said conversation dishonestly as a cudgel.
I don’t know if we really KNOW any of the presuppositions, and telling people that we have to stop treating grandma without knowing the answers is just going to cause enormous problems.
Right, but we can go the living will path first, and that would be a positive step that would obviate that concern.
Jes, I am really tired of you twisting and kvetching at everything I say endlessly and needlessly with no point.
LJ told a story about arelative as an example of how people are treated, interested I responde with a story about my Dad.
Your reply was a rebuke that my example wasn’t worthy of consideration somehow, although no rebuke to lj for a similar story.
All that not to mwntion your story about choosing a doctor because he/she was in walking distance and provided you a doctors note to miss work for two weeks for a sinus infection.
Chill out or leave my posts out of your discussion. Whatever valid points you might make are certainly outweighed by the need to just find aomething wrong with anything I say.
Another thing that is really a whole lot better fresh from your garden: cabbage.
Dunno how you like to prepare it, but Cooks Illustrated has a recipe for cream-braised cabbage with lemons and shallots that’s heavenly (albeit a bit indulgent).
As a garlic loving Italian, I like my cabbage with garlic and olive oil. Although I also add red pepper to the cabbage. For variety’s sake.
Sebastian,
neither US government nor US insurance companies are good at getting that to stop.
This is what I was referring to up thread. It appears that the US system is such that there are no consistent pressures anywhere to contain costs. And, partly because end of life care appears to be a very strong profit center for hospitals and doctors, everything including the kitchen sink is thrown into the fray.
An anecdote. Several years ago a good friend of my mother had a recurrence of cancer (she had been more than 5 years free of it after an earlier bout). She very quickly saw the oncologist who had successfully treated her before. After some tests etc. he told her that this particular cancer could not be successfully treated, that all the radiation, chemo and so on in the world would do nothing but make her last few months a misery of nausea and so on. He wanted to refer her to a clinic specializing in pain control and palliative care. Not surprisingly she and her husband wanted a second opinion and quickly saw a second cancer specialist who agreed entirely with the first. Her husband demanded that the doctors give her the aggressive treatment anyway. “You have to do everything you can!” Both refused, saying that not only would the treatments do no good, they would actively harm her by destroying her quality of life over her last few months of life.
They were a wealthy couple and the husband insisted they go to the US for more tests and another opinion. And lo and behold at a private hospital in Los Angeles, they found a team of cancer specialists who were more than willing to offer a protracted course of very aggressive treatment. When my mother asked the husband later what the doctors had said about the prognosis at the time he recalled that they had not promised anything specific but had kept repeating that there was always hope. And this is what he wanted to hear, he was desperate.
The sick woman didn’t want the treatment, she believed the Canadian oncologists and knew from previous experience just how awful the treatment was. But she gave in to her desperate husband and entered the LA hospital. The treatment did not extend her life at all (she died within a couple of days of what had been originally forecast)and she died far from home without being able to spend time with her daughter and grandchildren.
The hospital offered her husband condolences and a bill for $750,000.
“What we should do is require people on Medicare to compile a living will, with specific instructions. What Palin mendaciously called “death panels.” The thing is, many, many people would rather not be kept alive under all circumstances. But outside valid instructions, or a suitable, knowledgable health proxy, the default is “keep alive.””
The problem with this is twofold:
1) That nasty tort reform issue, if one person who MAY have standing objects to end of life procedures the doctors and hospital always err on the side of maintaining life for fear of getting sued.
2) The basic mind set of Americans. No I don’t have a study. But we tend to think of end of life just like the doctors, as a defeat.
As long as there is a chance that we can score that last minute touchdown, get the onside kick, throw the hail mary, convert the two point conversion and push the game into overtime we are required to keep playing. In almost every cultural norm that is what we are taught. End of life happens only when it is the final option, meaning it happens against all attempts to delay it. It is the reason for many good things in our culture, this is one of the challenges it creates.
That nasty tort reform issue, if one person who MAY have standing objects to end of life procedures the doctors and hospital always err on the side of maintaining life for fear of getting sued.
This is true absent a living will or health proxy by written instrument. In such settings, hospitals will honor the wishes of the patient/proxy over objections because the patient’s/proxy’s word trumps.
But you are right absent a living will/proxy. That being said, the problem wouldn’t likely be solved by “tort reform” unless you mean a very drastic form of reform such as you would do away with most suits for negligence. But fear of valid lawsuits applies. And you’re right about the cultural norm.
But that’s why it is important to have the living wills and health proxies. Many will still opt for “keep alive at all costs” but many would not. Further, minds change when you’re in the midst of the pain/suffering.
My father had a massive heart attack 8 years ago (quad bypass followed) and they had to use a defib to resuscitate him and he was subjected to many painful procedures with a long recovery time. After that, he changed his mind, drafted a living will and pretty much asked for DNR (do not resuscitate) in a whole host of settings.
Adding, Marty, that disregarding a living will would open the hospital up to liability as well. And a living will, if drafted correctly, provides serious protection for the hospital to act without liability.
That nasty tort reform issue, if one person who MAY have standing objects to end of life procedures the doctors and hospital always err on the side of maintaining life for fear of getting sued.
Yes, but as you right-wing tort-reformers always ignore, the most effective form of tort reform is universal health care, free at point of access. That you don’t even want to consider this, tells me that you don’t want tort reform: on the US politics gameshow, it’s just another Call My Bluff word, for which you have made up your own definition to score points.
(I think for right-wingers the Call My Bluff definition of tort reform is: Poor people should not be able to get large sums of money by sueing rich people (including corporations) no matter how badly wronged or harmed the poor person has been.)
I am really tired of you twisting and kvetching at everything I say endlessly and needlessly with no point.
Well, Marty, you could try being honest and straightforward, citing facts instead of making wild assertions. For example, that you kept trying to build on a meaningless comparison of data about Canadian waiting times with your own imaginary US waiting times. But if you’re sorry you did that and you won’t do it again, well, I’ll await your next data-less assertion with interest…
And if you really just meant to share a story about your Dad, not try to make a point about US healthcare, you really needed to edit the words “I am not sure the US, in this particular only, is that far behind” out of your anecdote about the regular checkups your dad receives. But if you just forgot to hit preview and didn’t realize that line was still in there, well, we’ve all made that mistake once in a while.
“Adding, Marty, that disregarding a living will would open the hospital up to liability as well. And a living will, if drafted correctly, provides serious protection for the hospital to act without liability.”
It is true that it provides great protection and specificc guidance, I agree that it is an essential step forward. I watched as my grandfathers living will was ignored (so to speak) because a relative was vocal in questioning the interpretation. Which is a reason for specificity in living wills, not an argument against them. More difficult is medical proxy, which tends to provide for the person to work with the professionals to interpret the living will. I am not an expert but have had several occasions (father, mother, grandfather) over the last several years to watch the emotional drama of that decision making process. As an aside, both my mother and father have a great quality of life after being at the point where the doctors had to ask if they should be revived in the last few years. Neither wished that someone would have chosen differently. My grandfather probably lingered a year longer than he would have chosen because of the family’s emotional direction to the care providers.
It is not an easy area to discuss, I try to be very sensitive to peoples emotional responses while also trying to assimilate the more academic or intellectual responses.
“(I think for right-wingers the Call My Bluff definition of tort reform is: Poor people should not be able to get large sums of money by sueing rich people (including corporations) no matter how badly wronged or harmed the poor person has been.)”
I think the Call my bluff definition for jes is “can I disparage as many target people as possible by making inane and obviously untrue generalizations”.
Yeah, I agree Marty. More specificity, and clear instructions to the proxy are the best bet.
Not only does that serve the patient best, but also the next of kin who sure don’t want to be doing any guessing.
And as Seb said, in general we as a nation should be considering these issues more than we are.
“Yes, but as you right-wing tort-reformers always ignore, the most effective form of tort reform is universal health care, free at point of access. ”
And just so I am clear, are you for or against an NHS type health care system in the US? I wish you would be clearer about that.
It would be so much easier to have discussions about what could or might happen, the real alternatives on the table and the view of most Americans tha an NHS style system is not the right answer if only we understood better where you were coming from because starting and ending every conversation with “that would be solved in an NHS system” is not productive in the context of healthcare reform in the US.
It is a lot like Republicans saying that everything could be fixed by tax cuts(or eveen tort reform), even if its true it isn’t going to happen.
And
And I am extremely disappointed to hear that doctors can’t be sued for malpractice in the UK because it’s too bad that poor people can’t sue the government no matter how badly wronged they were. That is what you mean by tort reform being solved by NHS, right?
Marty: It would be so much easier to have discussions about what could or might happen
It would be so much easier to have discussions about what could or might happen if you, and your allies, would stick to citing facts rather than wishful thinking.
If you want to argue realistically about the US health care system, you first need to be able to base your realistic arguments on real data. Thus far, on this thread, you haven’t been able to do that.
I agree it’s unrealistic to suppose that a national health service could be set up in the US, because although it would clearly be extremely popular with the majority of voters, your system of government is to give priority to the needs of corporations over the will of voters or the needs of human beings.
But so long as you feel free to disrupt serious realistic discussion about health care with your own imaginative assertions without reference to the real world, you really have no high moral ground to complain that I’m disrupting discussion by pointing out how much better off Americans would be if you, like us, had adopted a universal socialist health care system in the wake of WWII.
That is what you mean by tort reform being solved by NHS, right?
A while ago when a Republican brought up the shibboleth of “tort reform”, I noted:
That is what I meant. Sorry you didn’t understand me.
Marty, please provide a citation for your assertion that people can’t sue for malpractice in the U.K. under the NHS?
This library of congress article suggests that the NHS accepts liability for negligence of its employees and will settle suits.
Furthermore this site describes the options, including litigation, open to U.K. residents for filing a malpractice or negligence claim with the NHS.
That sounds different! I’ll give it a try, if I can find it.
At the risk of being obvious, nothing is as good with cabbage as bacon. I’m still recovering from the first fried cabbage recipe I tried (which, believe it or not, called for a full pound of bacon per cabbage head, then you fry the cabbage in the grease). Last iteration I went to half a pound of bacon, and threw away about 3/4 of the grease; next time I think a quarter pound of bacon and even a bit less grease would work wonders. Oh, and red pepper flakes with a bit of Creole seasoning, just to give it a bit of zing.
I’m obviously not worrying about BMI, at present. The bacon does complement the cabbage quite nicely, though.
Another of my favorite recipes involves cutting turnips into thin wedges and sauteeing them in olive oil and fresh thyme, letting them braise for a while and then finishing them off with a little triple sec.
You’ll never want to do turnips any other way.
Another of my favorite recipes involves cutting turnips into thin wedges and sauteeing them in olive oil and fresh thyme, letting them braise for a while and then finishing them off with a little triple sec.
Okay, but first you have to define “turnip” – is it this or this or this?
“One reason why Americans are more litigious over things where a neutral point of view says no one is really “to blame” – because accidents happen – is because the US does not have a national health care system,……..”
So your point is that in Britain people just don’t sue for pain and suffering or lost wages? Since their healthcare is covered they simply don’t sue?
As a tort reform advocate I would never suggest limiting out of pocket medical expenses, lost wages or cost of medical insurance/care that can no longer be obtained. In fact, I would like to pass a law saying that is automatically awarded based on a formula so litigation is not necessary.
I would prefer that there be a cap on pain and suffering awards.
See, I am not sure how that translates to those right wingers wanting the poor to not be able to take money from those rich people.
“Marty, please provide a citation for your assertion that people can’t sue for malpractice in the U.K. under the NHS?”
I didn’t assert this
So your point is that in Britain people just don’t sue for pain and suffering or lost wages? Since their healthcare is covered they simply don’t sue?
No, Marty, that wasn’t my point.
In fact, I would like to pass a law saying that is automatically awarded based on a formula so litigation is not necessary.
Okay, so the best means of making sure that “out of pocket medical expenses … cost of medical insurance/care” can be obtained without litigation, would be… a national health care service.
And that was my point.
“It would be so much easier to have discussions about what could or might happen if you, and your allies, would stick to citing facts rather than wishful thinking”
You mean like “I wish we could have NHS and that people really wanted that?”
I am more and more intrigued by your exceptionalist view of the NHS. It is practically American in it’s zealous defense and constant reaffirmation of its superiority.
It is as if you don’t believe that, given anyone really cared, the internet is not full of the pros and cons of the system, its challenges and faults, and the discussions of privatizing it in every election cycle.
Of course the difference is i wouldn’t pretend it to be worth my while to try to tell you what Brits wanted or didn’t want.
It is funny also to read your defenses of the Canadian system that I clearly have more experience with than you.
What is most clear is that you need and want something, anything, to criticize the US about. Healthcare, the military, the very form of government. I believe this must be your reaction to your feelings of cultural inadequacy. This inadequacy makes it impossible for you to recognize any good or strength in the US and constantly harp on the samae issues over and over, calling people names and, in general, just being negative.
Or you just don’t like me, but from what I have observed, it isn’t that personal.
“Okay, so the best means of making sure that “out of pocket medical expenses … cost of medical insurance/care” can be obtained without litigation, would be… a national health care service.”
Which i suspect is not really the biggest issue to be resolved from a cost saving perspective, which is what I was saying.
I suggest purple-top turnips, of the kind that is (apparently) shown in the first of your links, but smaller if possible. Around 7cm diameter would be a better size, I think.
I haven’t tried any other kind of turnip; for all I know other varieties would prepare well this way.
If you want, I can get you the exact recipe. It’s in a Williams-Sonoma cookbook that we’ve had forever.
What is most clear is that you need and want something, anything, to criticize the US about. Healthcare, the military, the very form of government. I believe this must be your reaction to your feelings of cultural inadequacy.
This is good stuff, the wikipedia article on “projection” needed some new material.
I am more and more intrigued by your exceptionalist view of the NHS. It is practically American in it’s zealous defense and constant reaffirmation of its superiority.
This is even better- American exceptionalism so strong that just plain doesn’t grasp other countries’ citizens feeling the same way. “It’s so cute how you pretend to love your country as much as we Americans actually love America. You probably act that way because you’re jealous.”
It is funny also to read your defenses of the Canadian system that I clearly have more experience with than you.
So far, your ‘clear experience’ is demonstrated via some statistics from the internet that were interpreted badly (ie claiming that average wait times applied to the subset of people with serious conditions). Oh, and a couple of claims that you knew a lot about it.
Carleton,
I would prefer to deal with one troll at a time. I am happy to have any level of conversation or take any level of criticism, yours or anyone elses, if you want to disuss anything in good faith, even whether I am discussing things in good faith.
However, if i typed that the sky was blue today where I am, jes would find a way to tell me I am wrong, the solution is the NHS, the US government is a beta democracy and that I am a right wing (pick your epithet).
For months i just ignored her, but I shouldn’t have to ignore someone constantly calling me names just on the edge of the posting rules.
So ease up while I deal with a much longer standing problem.
Marty: I would prefer to deal with one troll at a time.
Physician, heal thyself.
“Physician, heal thyself.”
Well, I am disappointed yet not surprised at this response. I can go over and try to be the voice of reason at a place like RedState or I can try to have a moderate voice on a site like OBWi.
The problem is that in neither place doe sanyone want to see the world from the otherr sides point of view. Despite the histrionics of health care and the waars and essentilly everything we discuss there are two or more points of view.
It is interesting whether it is the pure vile of some websites or the constant drone of attack here that it is clear that everyone wants a nice side to come and just beat up the other guys.
I can sit at home and talk to myself if all I want is to trash the other side and then agree with myself so I feel better, and really smart.
I do this because I think having both sets of ideas in a thread is good for me, and possibly others. I get and give criticsm pretty well. What Jes does is not that, i certainly have waited a long time to exxpress that, I won’t again, but it is easy to read through this thread and find the classic example.
lj said “on this side of the Pacific” and then told an interesting anecdote that informed, I said :Iam not sure America is far behind in this instance” and told what I thought was interesting anecdote that was quite similar. Jes attacked me…not lj, not the discussion, she found a way to make what I said bad.
Its what she does.
Can I just call a timeout, and ask that everyone (myself included) try to take a breath and return to a more respectful tone.
Myself included – to reiterate.
Good with me
Can I just call a timeout, and ask that everyone (myself included) try to take a breath and return to a more respectful tone.
How about an open thread so Slarti can share his turnip recipe?
“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
Russell, this is a fairly broad restriction limiting the Federal Government to those powers enumerated in the Constitution which include, apparently to the chagrin of numerous commenters here, the authority to use military force to defend the United States against foreign enemies. But I cannot find anything that I could conceivably construe to include taking over the direct provision of medical insurance to all inhabitants of the U.S. or the direct provision of medical services to all its people.
If I were able to find such construction as allowed these matters, then I would be at a loss to find the point at which this separation of powers actually has meaning.
Of course, the Constitution includes provisions for amendments and that would represent an appropriate path for the efforts of those who think the federal government having these powers is the solution to our health care needs.
Marty,
Apologies for this pile on, but the purpose of my anecdote was to open a discussion of what is needed to improve end of life care and given that Japan has the most population that is most rapidly skewing towards the higher end of the scale, I thought that my anecdote might be useful. I, of course, don’t know the purpose of your anecdote, but it certainly seems as if you wanted to claim that the US had no problems. My anecdote pointed to a fully articulated system for all (or at least most, homelessness is becoming a problem here), whereas yours merely pointed to the fact that your father was in a position to get regular checkups. As such, it doesn’t really get at what I was trying to point up. If there is some sort of nationwide system, or even statewide system, for dealing with elderly, I would love to hear about it, but arguing that you were simply presenting an anecdote to my anecdote really seems to miss the point of presenting the anecdote. I, of course, take full responsibility for this, but I would futher observe that if you view this as like a snowball fight, and the person who throws the most anecdotes wins, discussions are going the descend in quality in a similar way. Again, this is just an observation, but I only bring it up because you gave my anecdote as an example and I was perhaps not clear about the purpose for bringing it up. Again, apologies for the misunderstanding.
Russell, this is a fairly broad restriction limiting the Federal Government to those powers enumerated in the Constitution which include, apparently to the chagrin of numerous commenters here, the authority to use military force to defend the United States against foreign enemies.
Wow. A few minutes after a call for respectful tone, and this? Really? I mean, which commenters exactly rue the fact that the Constitution gives the executive power to defend against foreign enemies?
But I cannot find anything that I could conceivably construe to include taking over the direct provision of medical insurance to all inhabitants of the U.S. or the direct provision of medical services to all its people.
Well, then, it’s a good thing that the Senate bill doesn’t actually do any of those things. Not even close.
Wow. A few minutes after a call for respectful tone, and this? Really? I mean, which commenters exactly rue the fact that the Constitution gives the executive power to defend against foreign enemies?
The same ones who hate teh capitalism and eat puppies (mmm, puppies *Homerdroolz*)?
‘But I cannot find anything that I could conceivably construe to include taking over the direct provision of medical insurance to all inhabitants of the U.S. or the direct provision of medical services to all its people.
Well, then, it’s a good thing that the Senate bill doesn’t actually do any of those things. Not even close.’
I was responding to Russell’s specific comments, to wit:
‘I don’t see anything in the constitution that says the federal government cannot regulate the insurance industry, cannot directly provide insurance if that’s what we want to do, or cannot directly provide care if that’s what we want to do.’
And I do believe what Russell says represents the ultimate objective of those pushing this legislative effort.
What’s wrong with the amendment process?
Actually we have a national system called Medicare through which all of the benefits I referenced are made available.
Sorry if I wasn’t clear, I certainly thought our anecdotes were comparing equivalent systems through example.
Last comment was for lj.
Actually we have a national system called Medicare through which all of the benefits I referenced are made available
Yes. And the practical and simple way of providing better-quality health care to all, would simply be to extend your socialist healthcare system (Medicare) to provide for all Americans, not just those over 65.
It’s good to know you appreciate good socialist health care when you see it, Marty…
Russell, this is a fairly broad restriction limiting the Federal Government to those powers enumerated in the Constitution
GOB, thanks for the reply.
Yes, I am aware of the 10th Amendment, and agree with what it expresses.
I’m also aware of Article I, Section 8, and of the long and often broadly stated set of powers and responsibilities it expressly grants to Congress.
Those begin:
The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States
“Provide for the … general welfare” is an extraordinarily broad mandate. It’s been interpreted, reasonably, to include a very long laundry list of things.
Most of those things are not explicitly named as a federal responsibility. They’re just useful things that can effectively be provided at the federal level, and so that’s what we do.
Inspection of food and drugs at the point of production. Establishment and enforcement of standards for weights and measures. Regulation of the financial industry. Workplace safety standards and enforcement. Support for local safety officers.
Standards and support for public schools. Investment in basic research in the sciences. Weather forecasting and analysis. Management of publicly owned land. Regulation and enforcement of standards for clean air and water.
The first 10 that popped into my head. There are probably 10,000 to pick from.
None of these things is explicitly named in the text of the Constitution as a responsibility of the federal government. If the standard is going to be that if it’s not named explicitly, then it’s out of bounds, then they all have to go.
Every one of them.
Some folks will be happy to see them all go. Some will be happy to see them all stay, and for another 1,000 to be added to them.
Most folks will find some they like, some they don’t, and some they kinda like but don’t like the way they’re implemented.
But a case can be made for all of them.
And unless you want to work from the absolute standard that *any responsibility not explicitly and specifically named in the text of the Constitution is to be forbidden to the federal government*, the case will be made on practical and political grounds, not on grounds of Constitutionality.
Because all of the things I’ve named above, and hundreds and thousands more, contribute to the general welfare of the United States of America.
So I think the burden is on you to explain what it is about paying for or providing medical care that is different in nature from any of the things I’ve named, or any of the hundreds of things I could name that the feds do now, every day. Often quite effectively.
I get the fact that lots of people object to the size of the federal government, object to the range of things it has taken on, and believe those things could be better handled at a more local level.
There are lots of points at which I agree with that opinion.
But that’s not a Constitutional question. It’s a question of pragmatics, and of political preference.
And in point of fact, the federal government today provides insurance for health care, and directly provides health care services, to subsets of the population. If the standard is “it must be explicitly named as a specific responsibility of the federal government”, all of that has to go.
All of it.
I don’t mind discussing the political or pragmatic aspects of health care reform, but IMO the question of whether the Constitution *forbids* the federal government from being involved in the regulation, funding, or direct provision of health care to Americans is a non-starter.
The Constitution is, I imagine by intent, just not that specific in its language.
Which brings it all back to a question, not of what is absolutely allowed or forbidden, but of what we *prefer*.
There are things that are expressly allowed, and things that are expressly forbidden, in the document. Those things do not include a laundry list of what Congress can legislate or fund in the interest of promoting the general welfare.
The first 10 that popped into my head. There are probably 10,000 to pick from.
The interstate highway system, perhaps?
How about an open thread so Slarti can share his turnip recipe?
Seconded. And I want to try it with parsnips. We love parsnips.
Jes,
It would not be simple or practical.
It would require a huge number of Americans to have less access to services. It would also have many of the advantages you espouse. It isn’t going to happen. You chirping here about it in every comment won’t make it happen, it doesn’t even make it a good solution to the problems in the US.
Me complaining about the Senate bill won’t make it not get passed by the House, so I just sit and wait for Pelosi to get the votes.
Every time I say there is something good, or even better, about US healthcare it certainly does not mean I am denying the issues with it.
I do find it interesting that some of those people from other countries seem to think their healthcare is perfect, and defend even other countries systems vehemently. And then accuse us of denying we have a problem even though we are actually in a national debate, no, an international debate over how to fix our healthcare.
We all know we have a problem, we got it.
GOB: And I do believe what Russell says represents the ultimate objective of those pushing this legislative effort.
I really do not think that is true. I think if that was the desire of those pushing this legislative effort, the end result would probably include some concrete measures towards that goal. I think it’s what a lot of them might want, but I’m not sure it’s a majority even of Democrats, and it is absolutely not a majority of members of Congress.
I honestly, sincerely think if one’s real nightmare is a government takeover of all healthcare, one should be thinking very hard about how to do something about the twin problems of American healthcare as it is now: the uninsured, and the cost problem.
Left untouched, with efforts to address them blocked, those two are going to one day cause the whole thing to explode, and what happens after the explosion is unlikely to be a return to laissez-fair free-market provision of healthcare, since that’s where the biggest problems are.
It’s one thing for poor people to be uninsured; they don’t vote much, their political impact is always limited. It’s another thing for middle-class people who are self-employed to be unable to find insurance, or for people temporarily unemployed to be unable to pay COBRA.
It’s one thing for costs for the federal government and your employer to rise a lot; it’s another thing if Medicare starts cutting back heavily on services provided and if your employer healthcare starts to look a lot more like “Go to Walgreens and good luck!”
I’m not sloganeering here, I’m saying that those two problems are growing and unless something is done to address them, they will cause a gigantic crisis. And when it comes, that crisis is likely to prompt a far, far more radical overhaul of the healthcare system in the US than the current health reform bill. That’s always how it goes when things are allowed to get really really bad. When things get really really bad, people turn to the government because – sarcasm aside – it really is the only thing that can act fast, tell people what to do, and spend vast amounts of money. The private sector just cannot do that in response to that kind of a crisis, because the incentives do not exist.
The best thing for getting the government out of healthcare generally is to allow the government to get into solving those specific healthcare problems mentioned, at least sufficiently to head off a major crisis.
That’s what I really believe is true. I personally would like more government involvement in healthcare, and I especially think that a public option is very desirable if there is going to be a mandate (and the cost problem requires there to be a mandate), but I’m willing to accept the current attempt to solve it without one, and if the day never came that public pressure was sufficient to get the government into providing healthcare for the sort of people – like me – currently covered under private plans, I would not shed a tear.
What matters to me is covering the uninsured and dealing with the cost problem before we go bankrupt with Medicare/Medicaid/low-income-subsidy spending. I do not have an ideological aversion to a mostly-private healthcare system like the one we have right now. (I say mostly-private because even though the government spends a lot of money on healthcare, most of the actual provision of services is still done in the private sector.)
I should say (russell just posted) that I also think that the provision of healthcare is clearly constitutional. The closest thing to a problem is the mandate, which as a matter of liberty actually troubles me a little, though not as a matter of practicality – and even as a matter of liberty, the trouble is fairly small because of the provision of subsidies to low-income people. And I don’t think it’s unconstitutional in any case.
Marty: I do find it interesting that some of those people from other countries seem to think their healthcare is perfect
Well, I’m from the UK, have lived in the US a long time, and think neither system is perfect. If I had to choose a system for myself without thinking about societal welfare, I’d pick the US system and cross my fingers that I didn’t get really sick in ways that would render me unable to receive care, as happened to a friend of mine with cancer who found herself stuck between “having a hard time keeping a job for long because of recurrences” and “not completely destitute and eligible for Medicaid”. (Part of the reason I don’t worry a huge amount about that is that I could always run away back to the UK anyway…)
But if I had to choose a system based on societal welfare – and when it comes to talking about public policy that’s the interest I try to have in mind – the imperfect (but much cheaper) NHS is a winner by a mile, because it simply does not have the problems of people worrying about losing coverage or having a huge number of people who are not insured for care. Everything else is trivial by comparison. The US has lots of cool, high-tech interventions if you have insurance, none of which remotely compensate in QALYs for the huge problem of the uninsured.
But that doesn’t mean I think the NHS is the model for the US. As I just posted, I think that a combination of regulation & subsidies will be sufficient to produce a healthcare system that works just as well or better than those in any other advanced country, once it gets rolling. In fact I think it’s possible that 30-50 years from now people will be looking at the post-reform US system as a model.
Russell, this is a fairly broad restriction limiting the Federal Government to those powers enumerated in the Constitution which include, apparently to the chagrin of numerous commenters here, the authority to use military force to defend the United States against foreign enemies.
Smear on our patriotism aside, I think the objection is to the clearly unconstitutional use of nebulous CIC powers to trump black-letter protections in the Constitution. It never ceases to amaze me how some people can be so jealous of their liberty to not have health care coverage, but have no concerns about the President locking up citizens or denying them basic Constitutional rights based on his edict.
And I do believe what Russell says represents the ultimate objective of those pushing this legislative effort.
It is a novel, mind-reading based standard of constitutional interpretation that ‘bars legislation which GOB suspects is being pushed by people with what he believes are unconstitutional aims’.
It would require a huge number of Americans to have less access to services.
There are two responses to this.
One: you appear to be forgetting (again) that a huge number of Americans (about 45 million) live without health insurance, and as a result they die when they could have lived (about 44 thousand a year).
Two: you have no explanation and no data for your assertion – once again. You are still chirping away without facts on your side. Whereas I can point to a nationwide system of universal health care which is proven to work better than the American system, at less cost.
You claim you know that the NHS wouldn’t work in the US. But you can’t provide any evidence that it won’t: you just assert it as if you know it’s true.
It’s one thing for poor people to be uninsured; they don’t vote much, their political impact is always limited.
Ah, the true face of the pro-lifer at last: let them die, who cares, they’re only poor people, they don’t matter…
Every time I say there is something good, or even better, about US healthcare it certainly does not mean I am denying the issues with it.
And yet, you can’t even back up what you claim to believe is “good” or “better” about US healthcare with any kind of data.
Seconded. And I want to try it with parsnips. We love parsnips.
Thirded.
As an added incentive, if we get the turnip open thread I’ll post my wife’s parsnip and poached pears recipe, which is both delicious and alliterative.
Turnips – we get tiny turnips early in the season at our farmer’s market. They’re about the size of a smallish red bliss potato. We just slice them thin, crisp’em up in a frying pan, and eat them like potato chips.
Farmer’s market opens in about 12 weeks. Not that we’re counting down or anything.
Jes: Ah, the true face of the pro-lifer at last: let them die, who cares, they’re only poor people, they don’t matter…
A. I posted that, and I am very, very pro-choice, my disagreement with your particular opinion notwithstanding. (You are not the arbiter of who is pro-choice and pro-life based on their absolute agreement with your position; those terms have particular meanings, and I clearly fall on the pro-choice side given that I think there should be no legal restrictions on abortion and subsidized access to abortion for the poor.)
B. I was describing how things are – that poor people genuinely have little political power and their plight is generally ignored – and (clearly!) not how I wish they were. Problems of the poor rarely appear in the popular consciousness as a crisis. I don’t like it, but that’s how it is everywhere.
It never ceases to amaze me how some people can be so jealous of their liberty to not have health care coverage, but have no concerns about the President locking up citizens or denying them basic Constitutional rights based on his edict.
Not saying that GOB suffers from this species of cognitive dissonance, but it sure as hell is common.
I file it under “if it ain’t my ox, I don’t care if it’s gored”.
I posted that, and I am very, very pro-choice, my disagreement with your particular opinion notwithstanding.
I apologize. It’s late at night where I am and clearly I should quit responding to threads, if I can’t tell whether it was you or Marty who said something.
Seriously. Stupid, late-night mistake, and I apologize for any offense caused.
No prob.
I file it under “if it ain’t my ox, I don’t care if it’s gored”.
Yeah, witness the reaction when you suggest that these sorts of methods be applied to domestic, right-wing terrorists.
Pre-emptively, we aren’t even supposed to call flying planes into symbolic buildings “terrorism” any more if performed by libertarian jihadis. Only brown people need apply.
Jes, I haven’t forgotten anyone, this is your trolling. Giving 40 M access by reducing access for 260M requires more thought than you give.
The quote on poor people was a snide comment from another poster, not mine, norany conservative poster, just another example of name calling.
Marty, I would be interested to know what facet of Medicare mirrors what I described, the 4 times a year interviews (at the patient’s home) to determine the level of care that elderly qualify for. This is the Health and Welfare Ministry’s page about the ‘Gold Plan’, a 10 year plan that was revised midway in 1994 to address systemic problems in care for the elderly. I’m not seeing how your father’s annual checkups provide an equivalent system.
There is certainly a measure of self interest for me, in that addressing questions that others might have about elderly care in Japan helps provide me with specific things to ask about and follow up on here for my own benefit, but since you have an aging parent, I might suggest that actually describing what the system offers and then comparing it to other places might be useful to you in the future. However, if you feel that your father’s once a year checkup sufficiently covers what he needs, and you feel that you can generalize that to the rest of the US population, that’s your call, not mine.
Jd,
I was doing this on my phone on a plane, rereading ot was not snide at all and a good point. Sorry.
Marty
It would require a huge number of Americans to have less access to services.
This seems contradictory to me; you’re praising the services Medicare offers. But also saying that rolling this out to more people would, in general, reduce access to services.
It sounds like rolling back Medicare from the current situation to zero ought to *increase* access to services for the affected population, if that’s your assessment.
Either that, or there’s some special reason why Medicare is good for one group, but harmful when applied to other groups. Because I don’t see any other reason for privileging the status quo like this.
It sounds like the calculus is something like:
There’s a finite supply of health care in the US. Some people do not have access to it, while some others do. Therefore, giving access to those who now do not have it will reduce what is left for those who now do. (Please forgive my beer-soaked grammar, as necessary.)
It’s a zero-sum scenario where more players come to the table without contributing to the pot, or something … I guess.
If you think states can’t violate our liberties just as well as the feds, check this travesty out. Is nothing sacred?
Health-care reform is zero-sum if we restrict the view to a short-term financial sense. That is, every penny that is spent on subsidies comes from somewhere else and doesn’t get spent there.
It is not zero-sum in a short-term welfare sense, because taxing the healthcare of someone who has a very comprehensive healthcare plan already does very little to affect their welfare, whereas providing healthcare to someone who has none gives them an enormous boost in basic welfare.
It is not zero-sum in a long-term financial sense, because people who are too sick to work contribute nothing to productivity, people who go bankrupt from medical bills suffer a major hit to financial stability and may need public-funded bailouts or transfer payments, and the reduction in use of ERs as primary-care facilities will save a lot of money in itself. The result will be higher productivity, less cost on medical spending for the same benefits, and in the end that means more money for everyone.
The thing that people are most concerned about is that it is zero-sum in terms of access to medical treatment. I am not convinced this is actually true. Yes, there will be increased demand for basic medical care, and if you think about the source of funding for those doctor’s visits being a tax on high-end medical plans, that means those plans will be somewhat less comprehensive for the same cost. (Although to some extent regulating medical loss ratios will help with that by reducing insurer profits. I do not believe reducing insurer profits to the levels appropriate to a regulated utility will cause a disaster; for one thing, insurance companies don’t do very much, so the potential for underinvestment with the prospect of lower profits is much less of a problem than with actual medical facilities, and for another thing, the proposed medical loss ratios are pretty low and any number of insurers have shown they can survive and run just fine at those levels.)
But it is true that some people with expensive plans will receive less comprehensive coverage. There are two things to say about that: the first is that the source of funding is the removal of the tax exemption for the truly gold-plated plans; that is, to some extent the recipients of those plans were getting a very large tax break from the government – they are paying much less tax than someone with the same income who has a less comprehensive health plan – which seems very unfair when other people are receiving nothing at all from the government to help with healthcare costs. The second is that there are sharply diminishing returns to healthcare spending on a single person (which is part of why subsidizing high-cost plans is so unfair). Yeah, you can have a plan that covers gym membership and massages and god knows what else, but in terms of actual health effect, beyond a certain level of spending additional spending does very little. (I believe this is well-documented but I have a squirming baby in my lap right now so I’m not in the mood for Google…)
So there will be a shift in demand to some extent from the kind of stuff covered by high-end plans to the provision of basic services. In the short-term that may demand some measures to control inflation, but in the medium-long term – as long as the AMA lets there be enough medical schools and immigration is loosened for doctors and nurses – there should be no problem. Demand breeds supply in most markets, including healthcare. In other countries that went universal, the feared instant medical inflation from a horde of new patients did not occur, and in a lot of those places there were far more uninsured than the 10% of the population that will be newly-covered under the reform. The size of the problem of the uninsured means that the actual shock to the system will be around 10%, which is manageable (and another reason to do it now before the problem & the shock get worse).
And of course as mentioned, there will be a reduction in the use of very expensive ERs as primary-care facilities which should free up some medical resources. A lot of the people who will be covered are, in truth, receiving medical care already, and we’re already paying for it, whether through hospital fees that have to be inflated to cover the uninsured who never pay, or through government payments for the same kind of thing. And if I’m going to pay for it, I’d rather pay for people to visit a community health clinic for 1/10 the cost of going to the ER, and the best part is, they’d rather do that too.
Government actions can be positive-sum. I think we should judge pretty cynically which ones actually are, but I think it is crazy to think that they cannot be in all cases, and I think that this one will not only be positive sum but not actually do anyone any meaningful harm whatsoever even in the short term.
And I know there are people who think that any government action with a redistributive effect – no matter the positive effect on welfare – is just out of the question. Even those people should not be so worried by this as by other redistributions (like many of those already enacted). The redistributive effect of this bill is pretty mild for the reasons listed above. It may even be nil because the costs of the uninsured will no longer be falling on the insured through ER visits and unpaid hospital bills.
And the effect on welfare for many people with very high-cost plans may even be positive. Conservatives don’t like unions for various reasons, but one of the reasons they give is that unions tend to negotiate very high fringe benefits which, they correctly assess, tend to come to some degree at the expense of salaries, and so individual union members are not offered a choice between Super Duper Healthcare or an extra $3,000 in salary, and so parochial interests – the older, sicker union leadership who are more interested in expensive healthcare, say – can drive more spending that way than most people would really care for.
Well, the big tax break for healthcare is one of the reasons that choice is rarely offered. Without the tax break on the last few thousand bucks of that benefit, unions and employers will be under pressure to negotiate a cheaper plan in exchange for more cash, which – if what conservatives say about the problem with collective bargaining is true – will make many of them happier than they were with the gold plated plan. I’m not saying that will be universal, but I think it will be a factor.
And if you don’t rule out redistribution altogether but just think the bar should be set high, this reform ought to easily clear it. The harms are great, the cost of the plan is low by comparison, and the amount of redistribution is very modest – $100bn annually, about 0.7% of GDP.
I don’t think there will be much pressure to raise the amount redistributed this way once the crisis of the uninsured is out of the way. In Britain, there is little pressure to raise the benefits offered by the public plan to sky-high levels, because most people think that if you want to get coverage that is very expensive with few benefits, you can pay for the damn thing yourself. The pressure to do so here, where most people won’t even be receiving the subsidies, will be vastly less.
Most of this – especially the cost of doing nothing – is very apparent to most on the left, partly because, duh, we’re on the left, we wouldn’t be if we didn’t think that there were not major unmet needs that require government action. But I think it’s worth explicating for those not on the left who have real concerns about cost and effect on the welfare of those redistributed-from.
I don’t know if this is persuasive to everyone, but it’s the best I can do.
Jacob,
I appreciate the depth of thought that goes into these comments. I disagree with some of what you say, obviously or I would be, well, on the left. This however is the summary of a reasonable position based on the sum of dataa available interpreted intelligently.
I can’t take the time tonight to walk through a similar overview of my, more conservative position, but it would disagree in two ways.
They would be the overall redistributive effect over time and the real impact of taxing “comprehensive” plans.
Thanks for the thoughts.
Thanks.
Of course my own belief goes quite a bit further. I believe it is a collective action problem, and that everyone will be happier when nobody has to go without healthcare. I also believe that everyone will be happier when they don’t have to worry about losing healthcare even if they have it now.
I think those effects are extremely strong, and that is partly based on my experience with the NHS. People love the NHS, not just as a system that delivers benefits to them, but they love the fact of it, they love living in a society that strives to provide healthcare to every one of its citizens. You see that with what might seem like over-the-top praise for it. But people are really proud of it; it’s something they all got done together, they grasped the nettle, and it ended up not stinging too badly, and the problem got solved.
That kind of effect is never doubted in other areas of national accomplishment in the US. Putting a man on the moon, having the world’s most powerful military, being the richest & most productive country on the planet, having a long-lived and thriving democracy – they’re all sources of individual happiness through pride and a sense of collective achievement. You don’t have to think that the economy should be collectivized – and I certainly do not think that – to think that there may be some other areas where at a relatively low cost, the US can collectively do something really significant, something that people will be proud of.
Giving 40 M access by reducing access for 260M requires more thought than you give.
You have yet to show how providing Medicare to all would reduce access to healthcare for any.
Seriously.
Quit trolling this thread if you can’t do more than assert right-wing talking points without even trying to justify them and then calling me a troll!
Marty,
The problem you point to isn’t British Exceptionalism. It’s that in this area America is exceptional. Exceptionally crap. There is no other first world country with 45 million people without healthcare. If you were to say to me you thought the French or German way was better than ours and should replace ours, I’d disagree unless you were prepared to raise taxes by a few percent of GDP to fund it. But in many ways they actually do have a better healthcare system than ours.
On the other hand if you were to propose replacing the workable if imperfect NHS with the murderously barbarous US system then I’d consider you a dangerous idiot at best. And that applies even if you are going to double the resources in healthcare in the UK for free to match US spending.
Praising the overall US healthcare system makes as much sense as praising the merits of fibreglass dragsters in a demolition derby. There are a few things it does well (the government funded NIH is wonderful). But it’s trivially the wrong car to do a good job on the course.
“there may be some other areas where at a relatively low cost, the US can collectively do something really significant, something that people will be proud of.”
Interesting that so many Americans have bought some kind of Republican talking point as conventional wisdom that government can’t do anything right. An example of this is that I was listening to a podcast of the program “This American Life” a recent episode about FDIC takeover of banks. The narrator of the story of a particular bank takeover, at some point, stated (paraphrasing): “and, surprisingly, the FDIC did this really well – not something people usually say about a government agency!”
But, in fact, most government agencies do things remarkably well. Profit motive doesn’t always yield better service, because most employees, whether of government or corporations, aren’t earning part of a profit – they’re working for a salary, so their motivation is neutral. It galls me to hear the “government does things worse than private industry” meme repeated. There might be examples of that being true, but very few, and I notice that one never hears specific examples.
The “market” works very well for luxury goods and services, but not for basic needs. I so wish we had an NHS.
That sounds good. It’ll have to wait another day or two, though, because I’ve got stuff going on. Training for a local tournament is just one of many.
I think I’d like to also include some of my other favorite recipes, too. These are mostly out of cookbooks, but few people can own every single decent cookbook on the planet.
Which is not to say you can’t try. What would you be if you didn’t even try? You have to try.
Oh, me too! Parsnips are right up there with beer on my favorite-food list.
Parsnip recipes would be most welcome. I’ve never had them other than steamed (with just a smidge of butter; really, they don’t need much of anything other than their own parsnippy goodness) or in the chicken (or vegetable, if you’re chicken-averse) soup.
Marty, I would be interested to know what facet of Medicare mirrors what I described, the 4 times a year interviews (at the patient’s home) to determine the level of care that elderly qualify for. This is the Health and Welfare Ministry’s page about the ‘Gold Plan’, a 10 year plan that was revised midway in 1994 to address systemic problems in care for the elderly. I’m not seeing how your father’s annual checkups provide an equivalent system.
LJ,
This sounds like a very positive aspect of the Japanese system. But I think it’s abundantly clear at this point that introducing something like those quarterly interviews is politically unthinkable in the US, for obvious political reasons. “Some socialist bureaucrat is going to come into your home and assess whether you’re still useful to society or can be dispensed with.”
We all have to bear in mind that in the “debate” currently taking place in Washington, one side has no intention of arguing in good faith. Their only intention is to defeat the President on his signature issue. Beyond that, they are more than comfortable with the status quo.
Maybe 50 years from now the Republican Party will have regained some semblance of sanity, and a moderate Republican president will be able to introduce something like that Japanese “Gold Plan,” Nixon-to-China style. For a Democrat to institute something like that successfully is simply not in the cards.
What a country.
Lj,
Funny what you read sometimes. I never said anything about annual checkups, I said, as referenced below, regular checkups. You assumed annual, but actually based on his age and other factors he does see his doctor about every three months regardless of whether he has a particular issue. I was very specific about the other benefits I was comparing in the parentheses, The availability of his case worker is due to the doctors practice he is associated with, I think the practice picks up that cost rather than charging back to Medicare. When hospitalized there is a separate Medicare paid case worker.
I am still unclear why any reference to some part of the US system as being ok brings such immediate negative response.
[…]
First, the battle for public opinion has been lost. Comprehensive health care has been lost. If it fails, as appears possible, Democrats will face the brunt of the electorate’s reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes.
Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats’ current health-care plan. Yes, most Americans believe, as we do, that real health-care reform is needed. And yes, certain proposals in the plan are supported by the public.
However, a solid majority of Americans opposes the massive health-reform plan. Four-fifths of those who oppose the plan strongly oppose it, according to Rasmussen polling this week, while only half of those who support the plan do so strongly. Many more Americans believe the legislation will worsen their health care, cost them more personally and add significantly to the national deficit. Never in our experience as pollsters can we recall such self-deluding misconstruction of survey data.
The White House document released Thursday arguing that reform is becoming more popular is in large part fighting the last war. This isn’t 1994; it’s 2010. And the bottom line is that the American public is overwhelmingly against this bill in its totality even if they like some of its parts.
The notion that once enactment is forced, the public will suddenly embrace health-care reform could not be further from the truth — and is likely to become a rallying cry for disaffected Republicans, independents and, yes, Democrats.
[…]
If Democrats ignore health-care polls, midterms will be costly
If it fails, as appears possible, Democrats will face the brunt of the electorate’s reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls.
My suspicion that this is not true is based on several things:
1)Many who oppose the bill have incorrect info on what it contains (eg that it adds to the deficit). When these don’t come to pass, they will not be as upset.
2)Many who oppose the bill oppose it for not going far enough, but it’s becoming increasingly clear that eg single payer isn’t going to happen, so I think they’ll come around by November.
3)There is no one in the electorate who will vote Dem for them trying to reform health care and failing. Having declared this as their intention they would suffer all of the consequences of their position with no possible upside. If 2010 is going to be bad, then it’s going to be bad.
4)But, if the bill does deal with healthcare successfully, even if 2010 doesn’t turn out well it will reflect well on the Dems in 2012 and beyond. And *this* is I suspect the real fear of the GOP. That and the hope that the Dems will self-destruct by listening to this bad advice from their politcal enemies.
Finally, in general I find this whole train of thought hilarious- bc it seems to come solely from Blue Dogs and conservatives. Funny that Patrick H. Caddell IDs himself as a ‘pollster to Jimmy Carter’ rather than as ‘guy who left the Democratic Party over 20 years ago and spends his time attacking the Dems using those old credentials’. It’s almost like he wants to fool people into thinking he has the best interests of the Democratic Party in mind with his advice.
Marty: I am still unclear why any reference to some part of the US system as being ok brings such immediate negative response.
Oh. Let me explain.
Because you appeared to be arguing that because you can point to an individual case of an elderly man in the US getting the health care he needs to stay well, this somehow proved that the whole US system wasn’t so bad.
National figures for how many people 60+ get regular checkups would be more convincing.
Further, bear in mind that in this thread you joined it with the apparent attention of contributing nothing more than arguments by assertion – for example, your assertion that you just knew US wait times were shorter than Canadian wait times – and complaining that in other circles this works and people don’t contradict you.
Further, it is more than a little disengenuous when you start claiming I’m a troll for stating my opinion – to then complain that you feel I’m taking offense at your comments.
Also; another American friend without health insurance just got diagnosed with chronic lymphedema. I have no idea how he’s going to pay for the tests that eventually established this or the days in hospital prior to this or what his not being able to stand or sit for very long without getting dizzy and keeling over is going to do to his earning capacity, but I tell you frankly, Marty, coming directly from reading his blog post to re-reading your smug little craptastics about how well you think of a health system that leaves 45 million people in the crap, makes me feel I need to quit writing right now before I say something
Jes, Just to be clear, I had no doubt why you were negative. I am just your trigger to complain. It makes absolutely no difference what I actually say.
I am very sorry about your friend, and you seem to constantly forget that I favor extending Medicare to the uninsured and uninsurable. That’s because then you couldn’t always just assume the worst intent from me.
I am just your trigger to complain. It makes absolutely no difference what I actually say.
Actually, it would if you tried offering reasoning from verifiable facts, as opposed to assertion from I-believe.
I am very sorry about your friend, and you seem to constantly forget that I favor extending Medicare to the uninsured and uninsurable.
Which is what I said earlier and you argued that giving everyone access to Medicare was going to result in diminished access to healthcare. You didn’t say how, you didn’t say why, and now it appears you actually think it ought to happen anyway.
That’s because then you couldn’t always just assume the worst intent from me.
Well, you are a pro-lifer. But I was trying to leave that aspect out of your character out of this discussion.
You were abusive, insulting, and silly. Now you’re trying to claim that I shouldn’t have expected you to be like that just because you were being like that.
Argue from facts and people can argue back. Make assertions of belief and call people “trolls” for pointing this out? Don’t complain when people then assume this is what you’re like.
I am very sorry about your friend
Thank you. Appreciated.
This thread makes my head hurt.
Part of the problem is that the national dialog on the topic conflates a few very separate issues: the extension of some basic level of health insurance to people who can’t afford it or otherwise access it and the fact that the US system(s) are much more expensive than most comparable systems elsewhere, and thirdly the issue of whether or not private or public healthcare payment is better.
The annoying thing to me about the debate is that arguments which clearly support or detract from only one of the three are used to support or attack all of the three as if they were exactly the same argument. And this happens on both sides.
For me, only the first one has immediate importance. Leaving a fairly large portion of the population without any kind of health insurance is either horribly immoral or horribly inefficient depending on what the society does when those people get sick/hurt. If it just lets them suffer, it is horribly immoral. If it treats them anyway, it is horribly inefficient because it ends up treating them in emergency rooms and with poor follow through.
On the second question–high costs in the US, there are lots of ideologically motivated assertions, and very little evidence. A huge portion of the things that people complain about and spend huge amounts of time on, as if they were a large part of the answer, clearly aren’t the big deal they are made out to be (tort reform and pharmacuetical costs are clear frontrunners in the overtalked about area). This is an important area, but analytically separate from the first issue. It is also much less understood than the first issue. Dealing with the uninsured isn’t the same as trying to fix everything else. I’m irritated with Democrats in Congress who seem more interested in changing the whole system without understanding why it is expensive and I’m even more irritated with Republicans in Congress who use (IMO justifiable) opposition to such wholesale changes as an excuse to avoid dealing with the problem of the uninsured.
On the third issue most people will be irritated to find out that evidence isn’t very clear. Lots of countries have mostly private systems, lots of countries have mostly public systems, and quite a few have interesting mixed systems. All of them seem to do very well. There is very little to show the advantage of any particular private/public blend over other ones. Though there seems to be vast evidence that our particular brand is wasting money *both* when privately and when publicly paid for.
Sebastian: I’m irritated with Democrats in Congress who seem more interested in changing the whole system without understanding why it is expensive
Can you say what kind of thing you’re concerned about here?
From what I can tell the current bill is relatively limited when it comes to attempts at cost control, which is why I’m not sure what you mean by changing the whole system.
The reform is primarily targeted at covering additional people, which means “subsidies, pre-existing conditions, mandates”, roughly. Everything else is pretty minor.
So I’m not sure how to reconcile what I quoted above with your (admirable) belief that the problem of the uninsured is paramount and cannot be ignored. To me that is exactly the big change to the system that the Democrats are pushing for, and it unavoidably touches on cost control to some degree, but in a fairly minor way.
Sorry if I wasn’t clear. It isn’t “all Democrats in Congress” it is “the Democrats in Congress who…”
The way the bill is shaping up in the end seems non-awful and mostly focused on the right things. The way things started and many of the things that critics-from-the-left seem to be focusing on, not as much. The original, pre-compromise House bill which was much talked about in say June and August (in the lets do this in three weeks rush days) exhibited much of that.
Leaving a fairly large portion of the population without any kind of health insurance is either horribly immoral or horribly inefficient depending on what the society does when those people get sick/hurt. If it just lets them suffer, it is horribly immoral. If it treats them anyway, it is horribly inefficient because it ends up treating them in emergency rooms and with poor follow through.
I think it’s actually both, if for no other reason than that people suffer needlessly before going to the emergency room, even if they ultimately end up being treated. And because I think that, I think the cost issue is partly tied to the issue of the uninsured. The inefficiency, itself, is costly. Primary and preventive care are much cheaper than treatment of advanced conditions. I think giving people better access to primary care (whether they’re insured or not) will bring down costs. But we need more primary-care physicians to do that effectively.
I still believe that giving everyone access to healthcare would reduce access for a significant number of people. I didn’t agree with you, I said what I have said for months. We should extend Medicare to cover all uninsured and uninsurable people. That is a full order of magnitude less complex than trying to convert the other 260 million.
No, I am anti-abortion and pro-choice, wrong again.
Abusive and insulting is what you do. You should read your self sometime.
As for facts, I believe that is a pretty common red herring for people who don’t want to hear the other side of an issue.
Somehow when people are saying what you want to hear you don’t demand stats to back up their opinion.
The example with lj was perfect. The sentence structure of our comments were practically identical,never once did I say the US system was superior, I was limited and specific in the areas that I thought were comparable but my comment was attacked.
But you just can’t admit you were wrong.
We should extend Medicare to cover all uninsured and uninsurable people.
Interesting thought. But why would I bother buying insurance if I can always get Medicare rates? I mean, I suppose some wealthy people might (like in the UK) get supplemental insurance for perks etc, but it seems like 95% of the people would settle for this.
So maybe Im not understanding your proposal.
“So maybe Im not understanding your proposal.”
No, you understand fine.
No, you understand fine.
So when Jes suggested expanding Medicare to all Americans, and you said
It would not be simple or practical. It would require a huge number of Americans to have less access to services.
your endorsement of the proposal was implied?
Marty,
I related my anecdote in response to the discussion moving to the question of end of life care, which, at the point when I discussed it, did not involve you or Jes. I would appreciate it if you didn’t invoke my name to try and address Jes’ points in this regard. I don’t want to be dragged into it, and the only reason that I related my anecdote was because it seemed to be a separate discussion from the exchanges between you and Jes. Thanks.
Marty: Somehow when people are saying what you want to hear you don’t demand stats to back up their opinion.
That’s childish, Marty, really childish. You’re the one who – in this thread – has tried to argue by assertion without reference to facts. I’m not the only one who pointed this out.
Now you seem to think I should have known you wanted to extend Medicare to all Americans even though the only thing you had actually said about it in this thread was that it wouldn’t work and would diminish access. You didn’t give any reason or backup for this, you just – argued by assertion.
Then you started throwing “troll” around, as if asserting I’m a troll would somehow invalidate the points I was making.
Try arguing by reference to fact. You’ll be amazed how well it can work – when you have facts to reference.
For me, only the first one has immediate importance.
Then we should just make Medicare available to anyone who doesn’t have, or can’t get, insurance through private means and call it a day.
On the second question–high costs in the US, there are lots of ideologically motivated assertions, and very little evidence.
The evidence I see tells me that what most of the money gets spent on is direct care in hospitals, doctor’s offices, and clinics, and that the overwhelming majority of that care goes to folks with chronic illnesses, many of which can be improved enormously with simple lifestyle changes.
So, my thought is that we should be focusing on prevention, and on changing people’s habits. Especially on changing people’s habits. And, ideally, doing so by offering specific public health outreaches to make better habits convenient and attractive.
Cheap and, while not easy, amazingly simple.
That’s my thought.
Lots of countries have mostly private systems, lots of countries have mostly public systems, and quite a few have interesting mixed systems. All of them seem to do very well.
I agree.
If we were starting from a clean slate, I’d say just do single payer with private providers. Because it lets government do the relatively low-value-added bean counting, actuarial, administrative grunt work that it’s actually pretty good at, and lets medical professionals provide care, which is what they’re very good at.
But we aren’t starting from a clean slate. So let’s just make it *better that it is now*, please, and then lather rinse and repeat as we see what works and what doesn’t.
So, you can put me down as one lefty who doesn’t particularly care what the mix of public and private is, as long as people get to go to the damned doctor when they need to.
A health care “system” should be about helping people get healthy, and stay healthy. It doesn’t much matter who does it, or what it costs, or whose sacred liberty freedom of choice prerogatives are preserved or trampled on, if tens of millions of people don’t have useful access to health care, and if tens of millions of people suffer from stupid, debilitating, preventable chronic illness.
Health care should help people get healthy and stay healthy. The rest is noise.
Jes, I included several facts in my last comment and you chose not to address any of them.
As far as others talking about whether I provided cited, I do sometimes and often feel whatever observation or assertion I am making is common knowledge. In the latter case the knee jerk “Cite” means we won’t be discussing it in good faith anyway so I am not inclined to waste more effort.
I was told specifically months ago to not insult people by providing cites for things that were common knowledge. I liked that thought process.
I included several facts in my last comment and you chose not to address any of them.
You included one fact in your last comment – that out of 305 million people in the US, 260 million are on some kind of health insurance.
I don’t dispute this fact, but I don’t see anything to “address”. Unless you’d like to get into how for want of any proper competition or regulation, private health insurance in the US is crappy compared with private health insurance in other countries?
I do sometimes and often feel whatever observation or assertion I am making is common knowledge.
People do make assertions from what they think is “common knowledge”. That’s Family Feud gameplay, as discussed earlier. That “common knowledge” isn’t necessarily true – as for example your “common knowledge” that wait times in the US are shorter than in Canada.
Your claim that when you’re asked to prove by reference what you just know is true means the argument isn’t being carried out in good faith? Maybe having it demonstrated to you that something you just knew was true – something you thought of as “common knowledge” was demonstrably false, will be an education to you.
Because you could have found out for yourself that your belief “US wait times are shorter” was false, quite quickly, had it ever occurred to you to check your “common knowledge” against the facts readily available on the Internet.
One advantage library research has over Internet research is that library research is much more likely to come up with answers to questions you didn’t have the knowledge to ask. Armed with only your false “common knowledge” that wait times in the US are shorter than in Canada, you didn’t have the knowledge that would have let you ask the Internet about national data on US wait times – and find out that there was none.
What you might want to ask yourself is why it didn’t occur to you to wonder how it could be true that the US has shorter wait times than Canada, when the US has 45 million uninsured.
The value of argument – on the Internet or anywhere – is that other people will ask questions that haven’t occurred to you. Your reaction to people asking questions that never occurred to you because the answer doesn’t fit your “common knowledge” seems to be that those people can’t be arguing in good faith because they’ve got answers you just know aren’t true, and when you claim that you know the answer and are asked to prove it and can’t because your “I just know it” answer isn’t true – you call your questioner a troll.
Jes, besides not recognizing a fact if it bit you, this is very boring. Your assertion that you found some fact somewhere that disproves anything I said is predictable and incorrect. So everyone starts throwing around statistics and sit back and smugly believe they have made some kind of point. When someone has a different assessment of those “facts” then you start name calling.
No one ever showed that US wait times were longer than Canada, and they can’t, because it isn’t true. You read, say, quote lots of things and then conclude what you like, which I think is fine. But your conclusions aren’t facts, as much as you want them to be.
No one ever showed that US wait times were longer than Canada, and they can’t, because it isn’t true.
Are you arguing that every patient in Canada waits longer than every American patient? Or that for every procedure the wait time averages are longer in Canada? And that this is the sort of common knowledge that everyone knows, so much so that asking you to produce a cite is an insult?
So everyone starts throwing around statistics and sit back and smugly believe they have made some kind of point.
Well, not everyone. To your credit, you did not make the mistake of trying to back up assertions with statistics. Man, you sure made everyone else look foolish there!
But your conclusions aren’t facts, as much as you want them to be.
Good to see that you’re starting to realize… oh, wait, you were talking to Jes, never mind.
I do agree that this is pretty boring. A debate where both sides are marshaling and contesting facts and theories is more interesting than one where one side claims that it’s conclusions are common knowledge and they cannot stoop to supporting them.
No one ever showed that US wait times were longer than Canada, and they can’t, because it isn’t true.
Oh really? E ancora muoiono…
“No one ever showed that US wait times were longer than Canada, and they can’t, because it isn’t true.
Oh really? E ancora muoiono…”
I couldn’t have asked for a better example of my point. The these two things have nothing to do with each other. Only through your interpretation do they have any relationship at all, which is fine. But it is just an opinion.
Carlton,
I am not insulted by a request for a cite. When I don’t have one that I think provides any more authority than me saying it then you should translate that as fact or opinion based on my explanation of how I know. I am good with either one you decide.
You can see the classic example of this in jes’s 9:26 pm.
I am very good with my conclusions being taken as my interpretation, conclusion or opinion, as for jes, see 9:26 pm again.
The these two things have nothing to do with each other.
You may see no connection between the 45,000 people who die each year in the US because they have no health insurance, and the myth you repeated that people in the US get treated faster than people in Canada, but…
But still they die.
[…]
Not to be outdone, the Physicians for a National Health Program (PNHP) repeated the exercise (with all its methodological sins) and boosted the tally to a 40% increase in the probability of dying for the uninsured. That produces a whopping 45,000 premature deaths every year…
As in the previous incarnations, the researchers interviewed the uninsured only once — and never saw them again. A decade later, the researchers assumed the participants were still uninsured and, if they died in the interim, lack of insurance is blamed as one of the causes.
Yet, like unemployment, uninsurance happens to many people for short periods of time. Most people who are uninsured regain insurance within one year. The authors of the study did not track what happened to the insurance status of the subjects over the decade examined, what medical care they received or even the causes of their deaths.
Also, before you go into mourning too quickly, be aware that when former Director of the Congressional Budget Office (CBO) June O’Neill and her husband Dave used a similar approach they found that the involuntarily uninsured (low-income people) were only 3% more likely to die over a 14-year period than those with health insurance. There was no statistically significant effect on the “voluntarily uninsured” (higher-income people).
That’s not too surprising in light of a RAND study finding. People are receiving appropriate care a little better than half the time when they see doctors. According to RAND, the care patients receive is not affected by whether they are insured or uninsured or by the type of insurance they have. People who are uninsured, of course, may delay seeing a doctor in the first place — because of their lack of insurance. But this problem is unlikely to be solved by enrolling them in Medicaid programs that routinely ration by waiting.
[…]
Does Lack of Insurance Cause Premature Death? Probably Not.
You’re citing John C Goodman, whose contribution to the health care reform debate in 2009 was that doctors needed to be more entrepreneurial or they risked losing custom to hospitals in India (Seriously.) and whose solution to the problem of the uninsured was (August 2008) “”So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care. So, there you have it. Voila! Problem solved.”
Citing John C. Goodman as an authority on how the uninsured get health care is kind of like citing Brett Bellmore as an authority on how minorities are affected by affirmative action.
Dr. Linda Lawrence, president of the American College of Emergency Physicians, about Goodman’s “solution”: “Emergency physicians can and do perform miracles every day, but taking on the full-time medical care for 46 million uninsured Americans is one miracle even we cannot perform. Access to care in the emergency department is no substitute for the comprehensive healthcare reform policy that should be at the heart of the platform of any presidential campaign.”
Or as someone else with recent experience of cancer treatment on Medicare pointed out: McCain and Goodman Know Nothing about Health Care.
The RAND report which Goodman cites is another example of how US healthcare sucks:
“The differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality of health care. Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care.”
The larger opportunity was identified in a UK study on “poor quality of data in general practice records, both in terms of its availability and accessibility, represents a significant obstacle to quality assessment in primary care”, and a solution: universal electronic medical records. (The practice I registered with in 2004 went online the week I registered, and there was a period of about 10 days during which everything seemed to take about twice as long as the staff and the patients were used to – but it’s been great ever since. For non-urgent appointments I really like being able to check the appointments calendar online and pick the time of day / GP / day that best suits me, but most conveniently, my medical records are now not a huge great folder of stuff that goes back to when I was a baby and has to be physically shipped from practice to practice wherever I go.)
Of course, when you have a national health care system you can do things like this… which the US can’t.
“Stop the government interference (except when you need to increase it by limiting lawsuits) and costs will plunge.”
Last time I looked, lawsuits took place in the legal system, which is part of the government. Therefore, limiting lawsuits, whatever you may think of the merits of it, IS limiting government interference.
I would say that, just as sanitation and hygiene were responsible for more lives saved than antibiotics, most of the difference in health care outcomes between nations of even roughly equivalent economic levels are due to culturally driven lifestyle differences. That’s not the sort of thing any government program is going to easily effect, short of measures that I would hope even the majority here would recognize as outrageous.
“But enforced attention rubs me the wrong way.
I guess I was thinking more along the line of carrots rather than sticks.”
It’s the government: It obtains it’s carrots by hitting people with sticks. So the distinction is only where the stick hitting occurs.
“2) The basic mind set of Americans. No I don’t have a study. But we tend to think of end of life just like the doctors, as a defeat.”
It IS a defeat. It may be an inevitable defeat in a universe with the laws of thermodynamics, but it’s no less a defeat for all that.
We’re not very intelligent about how we respond to that, but we’re quite right to recognize defeat when we see it, instead of pretending it’s some kind of twisted victory.
Just an anecdote; I just got my last chemo, probably, for my non-Hodgkins lymphoma. Almost certainly cured, according to my oncologist, because, although it’s an aggressive cancer, it was discovered quite early.
Why was it discovered early? Because it was picked up in the preoperative physical for my prostate cancer surgery, which I wouldn’t have gotten following the recent recommendations for treatment of early stage prostate cancer. I would have been put into “watchful waiting”, while it grew to the point where my prognosis was much worse, before being discovered.
So, I’m really quite happy those recommendations didn’t have the force of law behind them.
“”Provide for the … general welfare” is an extraordinarily broad mandate.”
No. Precisely no. It’s a freaking limit on the exercise of the enumerated powers: They can only be exercised for the general welfare, no “Cornhusker” deals. It doesn’t grant even the tiniest additional power.
I mean, think this through: What’s the point in enumerating powers, AND having a clause that lets the government do anything it thinks is a good idea? You must think the author of Article 1, Section 8, was a real idiot.
Therefore, limiting lawsuits, whatever you may think of the merits of it, IS limiting government interference.
Yes. The government-run legal system is simply in the way of the private court system we’d all rather use to bring law suits. Anything the government does is, by definition, interference.
It’s the government: It obtains it’s carrots by hitting people with sticks. So the distinction is only where the stick hitting occurs.
So where does the government get its sticks? There seems to be a chicken-egg problem here. Anyway, let’s take your characterization as a given for argument’s sake. Wouldn’t you rather the government use its sticks to get carrots rather than more sticks? And what if the carrots could be leveraged in such a way that fewer sticks would be needed down the road? (I’m starting to feel lost in a metaphorical forest.)
We’re not very intelligent about how we respond to that, but we’re quite right to recognize defeat when we see it, instead of pretending it’s some kind of twisted victory.
I don’t think anyone was suggesting that death was a victory. It was clear to me that people were discussing the inevitability you mentioned. Maybe the use of the word “defeat” didn’t quite capture it as well as it could have, but language has its limits.
I’m glad they caught your lymphoma early, Brett. Your circumstances illustrate part of the cost issue. Who wants to be the one out of 13,503 (or whatever) who dies under watchful waiting instead of early and aggressive testing and treatment? The statistics say that we’re wasting resources, because the 13,502 (or whatever) would have been fine. That’s cold comfort to the one who dies. It’s a tough nut, huh?
most of the difference in health care outcomes between nations of even roughly equivalent economic levels are due to culturally driven lifestyle differences. That’s not the sort of thing any government program is going to easily effect, short of measures that I would hope even the majority here would recognize as outrageous.
Actually, the easiest way a government program could affect people’s general level of health and wellbeing: change the crop subsidy. If the US government spent $7.3 billion a year on provision of fresh fruit and vegetables, locally grown, instead of corn to be fed to animals for cheap meat and dairy, or processed for other cheap, non-nutritious, fattening foods, would that really be “outrageous”? Well, maybe to you, Brett…
You must think the author of Article 1, Section 8, was a real idiot.
Is that better or worse than thinking he was a member of the Mafia?
“on provision of fresh fruit and vegetables, locally grown”
Why locally grown? So that they won’t be available in the winter?
” That’s cold comfort to the one who dies. It’s a tough nut, huh?”
Yeah, that’s why I was careful to label that an anecdote; I would have been screwed over under those recommendations, that doesn’t mean they would net out worse. OTOH, my doctor says that early detection of this cancer is almost always due to a chest X-ray done for an unrelated condition. Not that you want people getting frequent chest X-rays, of course. I’ve already gotten enough radiation from CT and PET scans to raise my lifetime chance of cancer several percent, in the course of this treatment.
Why locally grown?
To provide employment to local growers and local stores, rather than supermarkets.
So that they won’t be available in the winter?
You know, I’m sure there’s several solutions to this problem, and the US government came up with this terrific invention many years ago, called “an Internet”, on which you could find out answers to all sorts of things, if you had any interest at all.
But I guess you’ll just have to rot in curiosity, since you’re too much of a pure-hearted libertarian ever to go online.
Why, wait… what are you doing here?
(Sorry. I forget why there is no real point in trying to have a conversation with Brett.)
It’s the government: It obtains it’s carrots by hitting people with sticks.
Hey Brett –
First and foremost, very glad to hear your very good news. Excellent.
Re: your comment here, in 1965 a little over 40% of the US adult population smoked. Now it’s a little under 20%.
That’s a change in habit and lifestyle that will contribute a lot toward good health outcomes.
A lot of that change was driven by specific public policies. Education, tax incentives, prohibition on smoking in certain areas, legal action against tobacco companies for particularly egregious behavior.
You can either see that as an appropriate intervention by government on behalf of public health, or you can see it as tyrannical interference in people’s private lives.
No big surprise, I fall on the “appropriate intervention” side of the fence, and I think similar interventions in the areas of diet and exercise would be a great idea.
YMMV.
Why locally grown?
Fresher, more variety, less overhead in the supply chain. Depending on where you live, you might also add helps preserve open land in your area, makes farming a viable profession in your area. Quite often it’s better value for the food dollar, sometimes it’s even cheaper in absolute terms.
It’s obviously limited to what will grow in your area, but nobody’s saying it has to be the only thing available.
Freedom of choice, right?
No. Precisely no. It’s a freaking limit on the exercise of the enumerated powers
Based on a plain reading of the text, one reasonable meaning is that it is a limit on, specifically, the power to raise revenue. In other words, the only purposes for which Congress may raise revenue are to pay the nation’s debts, provide for the common defense, and provide for the general welfare.
Which leaves open the question of what “provide for the general welfare” means.
You could claim that the ability of the feds to act for the general welfare is limited only to those things specifically enumerated in the following clauses in Section 8. That’s not actually a reading that the text demands, or even lends itself to, but you could make the claim if you like. If so, you’re going to have to cut a lot deeper than whether single payer can be considered.
FAA, national weather service, food and drug inspection, building codes and standards, any civil engineering efforts at the national level other than building roads, and building roads is limited to post roads.
And on and on and on. And on.
None of that stuff is in there.
In for a penny, in for a pound.
I recently bought at a reasonable price some Ya pears from Hebei, China. Very good.
The “general welfare” clause was controversial even at it’s inception. However, it was generally taken as a limit on government until during the FDR administrations when the Supreme Court decided it meant just the opposite.
Russel, had it occurred to you that some of that could be done at the state level, which, per 10th amendment, isn’t limited to enumerated powers?
had it occurred to you that some of that could be done at the state level
I think that would be fine. I don’t really have a bias toward doing things at the federal level.
I don’t have much of a bias *away* from that either, though, and especially not when the thing in question is national in scope. And I think I’m just less suspicious of government at any level as an actor than you appear to be. At least, less suspicious of the governments we actually have, in the contexts we’re talking about.
Glad your chemo is done, and was successful. May you live long and prosper.
had it occurred to you that some of that could be done at the state level
Another comment, or maybe just observation, along this line:
Discussion of health care reform in the US most often compares our approach and outcomes to OECD nations.
The US has, by far, the largest population in the OECD. Japan’s next closest, and we have about three times their population. Most OECD nations have populations in millions to tens of millions. Some have less than a million.
In other words, in general they are comparable in population to a US state.
To the degree that scale is a complicating factor in making stuff like this work, IMO there is a reasonable argument to made for implementing reform at a state or regional level.
The counterargument is that this arguably might make care less accessible in some places.
Personally, I honestly don’t much care how it happens, as long as folks can go the doctor without going broke.
I recently bought at a reasonable price some Ya pears from Hebei, China. Very good.
Truly, an incontestable argument for growing all of our food on the other side of the world.
Well played Charles. Enjoy your pears!
No. Precisely no. It’s a freaking limit on the exercise of the enumerated powers: They can only be exercised for the general welfare, no “Cornhusker” deals. It doesn’t grant even the tiniest additional power.
Nope. It’s smack in the list of things “The Congress shall have power” do to. It’s closely tied to things which are clearly powers (ie “provide for the common defence and general welfare”).
But it’s inconvenient for you, so you use a bizarre reading, and then claim that that reading is the only possible one.
I mean, think this through: What’s the point in enumerating powers, AND having a clause that lets the government do anything it thinks is a good idea? You must think the author of Article 1, Section 8, was a real idiot.
*You* must think that. You have him making an explicit list of things Congress has the power to do, and throwing in a restriction without any attempt to distinguish it from the powers. And in such a way that it parses out as one member of that list rather than as an exception.
‘general welfare’ clause creates lots of disagreements. IMO, on the topic of health care, NIH research into possible causes and cures for cancer might fit, but the treatment of an individual cancer case would not. I can see the former falling into the general welfare category but not the latter.
Since many of those in opposition to current legislative proposals like much of the health care they now have and would like to continue to have those choices and those who favor a significant federal presence in health care favor the proposed legislation, why not go for both.
Keep the existing health care delivery system ( work on fixing individual problems with it as suggested many times by republicans.)
Create a second system (a public option?) where those who get service through that option would need a ticket to do so. We could have something like health care registration and classification similar to what was in place for the military draft, but it would work in a opposite manner. All the 1-A’s remain in the private health care system and some other classification is required in order to use the public option. Qualifying classifications could include such things as being unable to get private insurance due to pre-existing conditions, income insufficient to pay insurance premiums, veteran’s status, etc.
There could be some combination of Public Health Service. VA Hospitals, and NIH to constitute the public option infrastructure. The private option could be migrated away from being related to employment and premiums could be tax deductible for individuals. Health Savings Accounts could continue. Those qualifying and choosing to use the public option should not be able to do so without costs to the user, but those costs, be they premiums, deductibles, or co-payments should be financially reasonable to the user circumstances.
Good Ole Boy: IMO, on the topic of health care, NIH research into possible causes and cures for cancer might fit, but the treatment of an individual cancer case would not.
Each person’s health and wellbeing contributes to the general welfare.
Discarding the lives of individuals as unimportant is the corporate attitude: there are always more replacable workers, but each individual who lives or dies is part of a network of general welfare and support.
Or, put another way: letting an individual die of cancer because the wellbeing of individuals is unimportant to the general welfare of the nation seems profoundly backassward reasoning to me.
‘general welfare’ clause creates lots of disagreements.
I agree. And I think that those disagreements can be made in good faith.
Historically Brett does not agree with this position about disagreements; if you don’t agree with him about Constitutional interpretation, then you’re lying.
Create a second system (a public option?) where those who get service through that option would need a ticket to do so.
Why “need a ticket”? You’re a freedom-lover, GOB. Why would you restrict MY freedom to buy into a public option?
I asked you this earlier, and I ask again: why would my freedom to buy my health insurance from the federal government be any skin off YOUR nose?
–TP
“You have him making an explicit list of things Congress has the power to do, and throwing in a restriction without any attempt to distinguish it from the powers. And in such a way that it parses out as one member of that list rather than as an exception.”
Commerce Clause anyone? Yeah didn’t think so. 🙂
“Or, put another way: letting an individual die of cancer because the wellbeing of individuals is unimportant to the general welfare of the nation seems profoundly backassward reasoning to me.”
Yeah, kind of like the recent recommendations on breast cancer screening: Stop doing so much of it, it might be saving individual lives, but it’s costing too much. Since we have a private health care system here, that recommendation is just a suggestion. You guys win, eventually that sort of thing will be binding.
There’s a problem here: So long as Social Security is run the way it is, the government has a serious conflict of interest regulating health care: It costs the government money if the population lives longer.
I, for one, don’t like pretending the government isn’t effected by such conflicts of interest.
So long as Social Security is run the way it is, the government has a serious conflict of interest regulating health care: It costs the government money if the population lives longer
I, for one, don’t like pretending the government isn’t effected by such conflicts of interest.
ORLY ?
the US government is also the largest holder weapons in the country – weapons that could be used to get people off SS, so to speak. why don’t they ?
the US government is also in complete control of the delivery mechanism of SS checks. they could easily see to it that those checks are not delivered. why don’t they ?
the US government is also a large source of funding for road maintenance. it could reduce funding in areas where SS recipients live, thus encouraging fatal car accidents. why doesn’t it ?
the US government controls the drugs that are available for use. it could ban, or tax at a sufficiently-high level so as to make them unaffordable, the set of drugs which typical SS recipients are most likely to use. thus, encouraging people to get off SS, so to speak. why don’t they ?
the US government, being capable of passing laws, could outlaw old age. why don’t they ?
So long as Social Security is run the way it is, the government has a serious conflict of interest regulating health care: It costs the government money if the population lives longer.
SOCIAL SECURITY DOES NOT WORK THAT WAY.
NIH research into possible causes and cures for cancer might fit, but the treatment of an individual cancer case would not. I can see the former falling into the general welfare category but not the latter.
So the reason you are a socio-economically backward nation with systems that are an international disgrace is your narrow reading of your Constitution? Interesting.
And even if you acept your definitions, promoting the general welfare covers treating absolutely any infectious disease held by any person living within the United States of America. Becasue by treating them you are eliminating a method of spreading disease.
NIH research into possible causes and cures for cancer might fit, but the treatment of an individual cancer case would not. I can see the former falling into the general welfare category but not the latter.
I actually think GOB is right. Health care reform should not be limited to treating or providing insurance for the treatment of an individual cancer case. It should provide general coverage to the general population to qualify as promoting the general welfare. It would be wrong to pass a bill that would only allow coverage for Mary Smith on Maple St. in Bloomington, IL for her throat cancer. GOB’s right.
It’s sort of funny how conservatives on the one hand decry the environmental disaster scenarios of the 70s as ridiculous fantasy, and on the other, insist that plotlines about murdering the elderly from Soylent Green and Logan’s Run are not only plausible but an imminent threat under a Democratic administration.
‘Create a second system (a public option?) where those who get service through that option would need a ticket to do so.
Why “need a ticket”? You’re a freedom-lover, GOB. Why would you restrict MY freedom to buy into a public option?
I asked you this earlier, and I ask again: why would my freedom to buy my health insurance from the federal government be any skin off YOUR nose?
–TP’
My idea of individual freedom does not include providing taxpayer subsidies for services for those who are able to acquire needed services in the commercial marketplace. I know we already have such circumstances but this does not convince me. My interest is not so much keeping Tony from purchasing the service through the public option but rather to insure that the existing private service that many prefer will continue to be viable. So, if a ‘ticket’ is unacceptable, (this is how we do Medicare and Medicaid and VA Medical Services), then we could do the following two things:
1. Amend the Constitution to forbid the federal government from making any law that infringes the right of any individual or other legally organized entity to provide medical services (practitioners, procedures, treatments, facilities, health insurance, etc) or for any
legal residents to avail themselves of such medical services in the marketplace.
2. Require that anyone not qualifying under the criteria resulting in a ‘ticket’ for entry pay a premium with deductibles and co-pays equal to that prevalent in the commercial marketplace.
I also have some understanding that the existing marketplace, the collusion between state governments, the federal government, and the collective capitalists making up the insurance industry is NOT the competitive commercial marketplace I’m envisioning.
IMO, on the topic of health care, NIH research into possible causes and cures for cancer might fit, but the treatment of an individual cancer case would not.
What about federal efforts to procure and deliver H1N1 vaccinations?
Can the feds produce the vaccine?
Can they pay someone else to produce it?
Can they buy it and distribute it to hospitals and doctors, but federal employees may not actually do the innoculation?
Or can they participate in the whole supply chain from procurement to injection?
Note that *no form whatsoever* or procuring or delivering medical care, from basic scientific research to giving you an aspirin, is named as a power granted to any branch of government, anywhere in the US Constitution, either the original document or any of its amendments.
No form of medical research, no public health effort, no funding for or operation of hospitals or clinics, no support for medical education. Nothing. It’s not in there.
Neither is anything whatsoever to do with transportation other than post roads.
Neither is anything to do with any other kind of scientific research, other than securing copyrights and patents.
Neither is there anything about establishing, maintaining, or securing shipping ports, or about aids to navigation, or about weather forecasting.
Neither is there anything about ensuring that anyone has potable water, or electric power, or a sanitary way to get rid of their bodily wastes and household trash.
Really, I could go on all day.
The Constitution grants the feds *no power whatsoever* to participate in *any* of the those things, other than through a liberal reading of the phrase “promote the general welfare”.
And there’s nothing in that phrase to distinguish between funding research into cancer cures and direct delivery of cancer care to any individual patient.
You object because it will interfere with the free market. But there is not one word about the “free market” in the US Constitution either.
The feds can’t take private property without due process of law or just compensation. States can’t impair the obligation of contracts.
“Free market” per se, not a peep. It’s just not there.
If you don’t like the idea of government providing health care, that’s fine. It’s your privilege to get on the horn with your Senators and your Rep and let them know.
But there’s nothing in the Constitution that says your position is either necessary or correct.
‘And there’s nothing in that phrase to distinguish between funding research into cancer cures and direct delivery of cancer care to any individual patient.’
I was using this example with the intent to test whether any agreement would be forthcoming that certain provisions in the Constitution were written for the purpose of limiting the powers of the federal government, but if you believe there are no such limits, then no example will accomplish that intent.
GOB: My idea of individual freedom does not include providing taxpayer subsidies for services for those who are able to acquire needed services in the commercial marketplace
The commercial marketplace is the worst place in the world to have to buy healthcare.
Your idea of individual freedom may include dying for the worst health care service in the developed world, but again – why should others have to die, 45 000 a year, because you believe that health care ought to be run at massive expense to all so that the companies who provide it as a commercial service make their profits?
What is it about individual liberty that makes you think you’re not free unless, as a patient, you can go bankrupt paying for your healthcare, and as a taxpayer, you are required to subsidise the health corporations rather than the health care of your fellow citizens?
I can assure you, that among other benefits, the NHS is the best support a struggling entrepreneur could have. People in the UK don’t have to cling to their jobs for fear of dying if they strike out on their own. No wonder the corporations love your system – but it’s hardly your freedom they care for.
I was using this example with the intent to test whether any agreement would be forthcoming that certain provisions in the Constitution were written for the purpose of limiting the powers of the federal government
And I, in turn, was challenging your example, because it’s not a good example.
If the feds can fund cancer research, they can either fund or directly provide delivery of care. There’s nothing in the Constitution to give you a basis for distinguishing between the two.
There may be 1,000 political, practical, and even medical reasons for the feds to do either, both, or neither. But there is not a Constitutional reason for doing one, and not the other.
There are lots of things the feds, correctly, do not do, and which are reserved to the states. Charter corporations, for one.
And there are many, many limitations on federal power that I heartily endorse. The Bill of Rights is nothing but an enumeration of limits on federal power, and I completely support each every one.
The preference for a free market vs a public approach for delivering useful or necessary services is a political, social, pragmatic, and personal one. That’s fine, and those provide more than enough basis for having a strongly held position.
What it is not is a Constitutional question.
My interest is not so much keeping Tony from purchasing the service through the public option but rather to insure that the existing private service that many prefer will continue to be viable.
Why would private insurance not be “viable” in competition with a public option? Do you really have so little faith in private insurance companies?
Careful: don’t come back with something lame, like “subsidies”. The current bill provides for subsidies to (some) people so they can afford private health insurance. If you don’t approve of subsidies, you would deprive private insurers of customers.
–TP
Tony: Why would private insurance not be “viable” in competition with a public option?
Anyone in the UK who wants to can and does buy private health insurance.
Private health insurance in the UK, admittedly from strictly anecdotal evidence on either side, provides a far better-quality service in the UK than in the US: because private health insurance and private hospitals must compete with the NHS.
(I’ve never heard of anyone in the UK who bought private health insurance having to haggle with them to get them to pay up for a pre-agreed treatment, for example, which people in the US report as happening with alarming frequency.)
As seems frequently the case with Americans defending their own system, GOB just seems profoundly ignorant of the health care in other countries…
“Anyone in the UK who wants to can and does buy private health insurance.”
Less than 8%, primarily the very wealthy. The equivalent class of insurance and buyers in the US rarely have to negotiate for payment either.
As seems frequently the case with jes defending her own system, she just seems profoundly ignorant of the health care in other countries, particularly the US…”
Less than 8%, primarily the very wealthy.
They must have a really good public system, then.
Less than 8%, primarily the very wealthy.
Why is this even relevant? GOB worries about a public option interfering with people’s ability to choose private insurance. Jes points out that in the UK people are perfectly free to forgo the NHS and insure themselves in the private market. I fail to see whose “freedom” is being impinged upon, which was the actual topic under discussion.
I realize that the sparring with Jes is getting very personal for you, Marty, but still.
No uncle, the point was jes insulting GOB for no reason. In fact what the 8% represents is that very few people can afford the expensive and preferable private insurance. The publicly subsidized delivery has reduced competition foe the average person.
Marty, why does it represent that?
Perhaps it represents the fact that very few people find supplemental insurance attractive given the free provision of very adequate insurance, and only the wealthiest 8% spend on such luxury?
I mean, if people were truly upset that they couldn’t afford the preferable private insurance, one would expect that the UK’s health system would be wildly unpopular.
And yet the opposite is true.
I don’t think that logic works Eric. If the insurance you have is adequate, I have never questioned that, then knowing wealthy people have better insurance doesn’t necessarily trnslate to “wildly unpopular”. That is a big leap. It doesn’t change the dynamic of limiting the market choices.
The fact is that the NHS has provided good enough healthcare to keep any serious move for privitization. It is discussed though.
That is a big leap. It doesn’t change the dynamic of limiting the market choices.The fact is that the NHS has provided good enough healthcare to keep any serious move for privitization.
But what are you saying ultimately? That the NHS has delivered such a good product, that the only viable private options are for luxury level add-ons that interest roughly 8% of the population. That no one can compete with the NHS otherwise because it does such a good job at affordable rates?
This would not seem liks a negative, but rather a tremendous positive.
By the way, as it stands in the US, the market doesn’t provide much affordable private insurance either. Most people are either covered by the government (Medicare and Medicaid and SChip) or their employers aided by substantial government subsidies.
But there aren’t alot of attractive, affordable private plans – especially if you are a bit older or have a pre-existing condition (with the latter leaving you out entirely). Talk about market failure.
Marty,
Basically, that is why the privates are afraid of the public option. They will have a very hard time competing against a public plan that doesn’t have to pay astronomical executive compensation, dividends, advertising and costs of gauging who to cover and at what cost.
They fear that a public option will prove so attractive that people will choose it, over their plans.
That, of course, is the market talking.
The difference Eric is that the NHS actually delivers care, fixes prices and susidizes with taxes as long as you use their system. I doubt that executive pay is any substantial part of cost for 260M people covered, for example.
Having one adequate choice is better than nothing, thus my stance on Medicare for the uninsured. It isn’t the equivalent of creating truly competitive delivery choices.
Marty: Having one adequate choice is better than nothing
From an American living in the UK:
It isn’t the equivalent of creating truly competitive delivery choices.
Because obviously, when you’re ill, the first thing you want to think about is how much your treatment is going to cost and whether you should ask for paramedics from the nearest hospital or the cheapest one.
Seriously, Marty? You’re telling us that if you have internal bleeding in the middle of the night you want to visit pricecompare.com before you call 911?
“Because obviously, when you’re ill, the first thing you want to think about is how much your treatment is going to cost and whether you should ask for paramedics from the nearest hospital or the cheapest one.
Seriously, Marty? You’re telling us that if you have internal bleeding in the middle of the night you want to visit pricecompare.com before you call 911?”
Seriously? Thats your criticism of competitive healthcare? That I wouldn’t know who to call in an emergency? That competitive healthcare wouldn’t make sure I got appropriate emergency care?
Seriously?
No, Marty, I’m being sarcastic.
Your sky-in-the-pie notion that the best way to get good healthcare is to apply market forces is too silly to deserve any serious response.
I’m sorry I didn’t make that clearer in my initial comment: I was mocking your foolishness.
But trying to explain what is wrong with the idea that the commercial market is a good place to buy healthcare, or the idea that competing to be more profitable will improve any healthcare service, would have taken a lot longer, and would have felt a bit like trying to explain in small words to a college student why it’s important to study for your exams and why you need to attend lectures and tutorials sober.
“But trying to explain what is wrong with the idea that the commercial market is a good place to buy healthcare, or the idea that competing to be more profitable will improve any healthcare service, would have taken a lot longer, and would have felt a bit like trying to explain in small words to a college student why it’s important to study for your exams and why you need to attend lectures and tutorials sober. ”
It would be great to interact with you if you could avoid that sarcasm, the intentional insult just at the edge of the posting rules and the direct name calling.
Some of the content you post is interesting and informative despite your pretentious and judgemental attitude in every comment where someone has disagreed with you.
I am going back to avoiding and ignoring you but I thought I would point out why.
It would be great to interact with you if you could avoid that sarcasm, the intentional insult just at the edge of the posting rules and the direct name calling.
I’m sorry I’m not patient enough to explain why you have to show up to lectures and tutorials sober and why it’s important to study.
But I’m also sorry you’re not smart enough to figure out that if you really feel you’d get better healthcare in a system where providers were competing for profit, you would do better in the hurly-burly of free argument if you were able to explain why and justify it with examples.
(You can’t do so, because there are no examples and no explanation: the only way to make such a silly argument is to assert it from personal faith, like a student claiming that he doesn’t need to study or stay sober to graduate with honors, he just will.)
I am going back to avoiding and ignoring you but I thought I would point out why.
You can’t cope with someone who insists you substantiate your assertions… and when you can’t do so, mocks you for continuing to assert them.
Yeah. Well, I can understand that. Of course, you could consider trying to substantiate your assertions with actual facts… but when you have no facts, I can see that’s hard to do.
” mocks you for continuing to assert them.”
And you do this with seeming impunity here at OBWi. I believe that the fact that you openly express that you do and will do this is a direct violation of the posting rules.
I can cope, I think the rules say i don’t have to.
Treat Me Like a Dog: What Human Health Care Can Learn from Pet Care
In fact what the 8% represents is that very few people can afford the expensive and preferable private insurance.
What percentage of Americans with employer-subsidized health insurance reject it and instead purchase more expensive but better coverage on the open market? I’ll bet it’s well under 8 percent.
“What percentage of Americans with employer-subsidized health insurance reject it and instead purchase more expensive but better coverage on the open market? I’ll bet it’s well under 8 percent.”
I think you are probably right for the same reasons the 92% don’t. It’s good enoough and the employer pays some percentage of the cost.
Yeah, kind of like the recent recommendations on breast cancer screening: Stop doing so much of it, it might be saving individual lives, but it’s costing too much
Actually, I believe that the real recommendations had to do with false positives. For example, with a low enough incidence, it’s actually possibly to do more harm with testing and initial treatment of false positives than the good that’s done with the screen.
I don’t have to agree with it, but that’s their rationale.
The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. source
But keep up the mindless demonization, it’s fun to watch.
It has been amusing to follow these comments. I have participated in the private American medical insurance system for over 50 years and my family members as well. And while, as I have noted on numerous occasions, there are many inadequate aspects in need of attention, I would not discard it for the one choice of a federally administered system. I like to choose my doctors, my treatments, the timing and the facilities where I go for treatment, and I have always been able to do this. I had aortic stenosis that required replacement of the aortic valve. The timing and the materials used to replace the valve have lifestyle effects (one should go as long as possible before surgery because it is desirable that it last and not have to be repeated and, in my case, since I am in otherwise excellent condition and like to continue athletics, I did not want a metal valve requiring blood thinners for life.) I had more than one medical opinion that the time for surgery had arrived and I chose to have it done in Arizona although I lived in Utah, since it was to be done in winter. My preference is for choice and I sense the potential to lose that as more and more of this process gets taken over by Washington. Would I have been able to do things this way in the NHS?
I believe that the fact that you openly express that you do and will do this is a direct violation of the posting rules.
And I believe that any forum in which sarcasm is a “direct violation of the posting rules” would be a miserable, wretched, wasteland of pious verbiage, dry of amusement though full of tempting mirages posing as shimmering puddles of cool reason.
A propos of nothing, I am reminded of the learned linguist who is lecturing on the various forms of negation in different languages. In some languages, he says, a double negative is a positive; in others a double negative is merely a more emphatic negative; in no language is a double positive anything but a positive. Some wiseguy in the audience yells out, “Yeah, yeah.”
–TP
Good Ole Boy: Would I have been able to do things this way in the NHS?
You would have been able to decide when you wanted the surgery – obviously: that’s a basic. (You would likely have received stronger and stronger advice that you really needed it now as the years passed, because they would have wanted to treat you as an elective rather than as an emergency patient.)
You would not have been able to pick out the specific date and time: you would have been told roughly how long you would have to wait for a date (which would correspond with how urgent your need for surgery was) and you would have been able to specify at the time what dates were impossible for you.
You would ordinarily have been operated on by the consultant surgeon to whom you were referred by the consultant who put you on the waiting list for surgery: you could have refused that specific surgeon, and yes, you could have asked to be referred out of region (the NHS phrase is “Out of Areas Treatments, OATS). There’s a NHS PDF outlining a typical NHS process for OATS.
The NHS works as effectively as it does because it’s much easier to assess and provide for needs in a large population. You may not know who’ll need a replacement of the aortic valve in the coming year, but you can pretty closely predict how many.
Any patient has a right to ask to be referred to any hospital or consultant capable of providing the treatment they need.
But, you’re more likely to get a sympathetic/helpful response from the various people involved in transferring you out of region if you have a medically valid reason for picking one region over another.
That reason could include “I have no support system in Utah, but if you refer me to Arizona, I can go stay with close family after the operation”.
If you had a really frivolous reason – “If you refer me to Arizona, I can go see the Grand Canyon while I’m recuperating!” – your local health care provider would be unlikely to be sympathetic.
But it partly depends on the treatment – if it’s sufficiently common that all NHS regions know they’ll have a large number of patients needing it and plan their resources accordingly, or if it’s sufficiently inexpensive that it doesn’t matter much where you have it, it’s a lot easier to get transferred.
If there’s exactly one surgeon in each region who can do the surgery and s/he plans the waiting list like a chess game with Deep Thought so that everyone who needs the treatment gets it in good time, you may just not be allowed to disrupt everyone else’s need for care.
…it occurs to me that (anecdotally) any time I’ve heard of someone who wanted to be treated outside of the region in which they live, they’ve always ultimately managed to get to be treated where they wanted.
Nut, the most likely reason for a NHS region refusing a transfer (the patient can always appeal) is that it’s “low volume, high cost” – not many people need the treatment in any one region, and most people find it most convenient just to be treated where they live. So there aren’t going to be that many people who wanted to be treated elsewhere and didn’t get their wish… and I have no idea if aortic valve replacement is one of those “low volume, high cost” treatments. (Though, ultimately, if a person really wants to be treated by a consultant in another region, I think the last-ditch strategy would be to physically go there, find somewhere to stay, and insist that you’e being treated there.)
Sorry to keep coming back to this – I’m wandering round the house finding things to put in the electrics box I’m throwing out, and thinking about my dad – the NHS has, in the past five years, saved his life, his eyesight, and his ability to be as active and fit as your average sixty-year-old (he’s eighty-one) – and about personal liberty.
What it boils down to is:
The NHS will, as far as the shared resources allow, let each individual determine the course of their own treatment and the quality of their own life. GOB would be free to decide he’d rather risk death waiting for a place to open up on the Utah waiting list than be operated on in a timely fashion in Arizona: he would be free to put his own personal whims ahead of his need to stay alive and healthy, if that was his choice.
What GOB would not be free to do, in the UK, is put his own personal preferences about where he was operated on (“I prefer Arizona in winter to Utah”) ahead of other people’s need to stay alive and healthy.
Which he would be able to do in the US, assuming he had more money/more health insurance than the other people who’d also like to be operated on in Arizona, not out of personal preference but just because that’s where they live.
I see that as a feature of the NHS system, not a bug, but that’s because I think that “Give me liberty or give me death!” is a noble statement only when you are referring to your own death, and not when you are referring to other people’s deaths.
YMMV. HTH. HAND.
I consider my penchant for liberty to be a product of the American tradition and it is difficult to cause me to have negative feelings about that since ancestors in all my family lines were here when the United States was formed and I came through the public school system before teaching such radicalism was extinguished.
Someone earlier suggested that it was merely an exercise of their freedom to partake of health services paid for by their fellow Americans. Since taxation is a form of coercion and that coercion diminishes the freedom of those being coerced, it really stretches my imagination trying to agree with that concept of freedom.
Oh, it’s James Madison’s birthday. Most people acknowledge that he had some on the spot understanding of the original meaning of the words in the Constitution.
“The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite”
–James Madison
Several states have groups active work to revive the long dormant Tenth Amendment. State governors and legislatures and federal senators have for a long time neglected their responsibilities in favor of receiving federal revenue sharing dollars and states’ sovereignty has suffered as a result. Walter Heller, who was Chairman of the Council Of Economic Advisors (I think that was the title) once said, when the debate over proposed federal revenue sharing was raging, that it would not likely hurt the states. I hope he’s looking down now. He was probably thinking only economically and not politically. That was also a time when the federal coffers were bulging due to a rapidly growing economy and a very progressive income tax was in place. Those circumstances were probably a big plus for the enactment of Medicare back then. Big economic difference today.
GOB: Are you as principled when it comes to war making powers?
it is not 1780. times have changed. the country, how it is run, and how it is structured have changed.
we can no more go back to Madison’s vision of the US government than we could go back to Madison’s vision of the borders of the US.
GOB: Several states have groups active work to revive the long dormant Tenth Amendment.
The problem with the tenth amendment is that it states, essentially, nothing. It provides that:
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
So, what are the powers that are delegated to the United States? Well, to find that out we have to look at the text of the Constitution and, if you think the text of the constitution delegates power X, that is the end of the matter, there is no reason to look to the 10th amendment.
I’ve said this before here (I think) that the 10th amendment is much like the useless savings clause in royalty contracts with respect to copyrights/patents, which typically states something “Any rights not granted to the licensee in this Agreement are reserved to the licensor.” Well, duh, as the licensor you retain all rights that you haven’t given away! But to determine what you have given away we need to look to the other provisions of the contract. If those other provisions indicate have given away right X, then the savings clause is meaningless, if those other provision indicate that you have not given away right X, then the savings clause is meaningless.
Such is the 10th amendment.
It has been amusing to follow these comments.
You can say that again, GOB. Why, just now you asked Jes a series of detailed questions about the NHS — I mean, for a minute there it was as if you were actually interested in the answers! Absolutely side-splitting.
Then when Jes goes to the trouble of answering your detailed questions with a series of even more detailed answers, you ignore her and go back to your tedious abstractions about your “penchant for liberty” and James Madison and “taxation is coercion.”
My sides are aching.
And that’s the health care reform “debate” in this country in a nutshell. Pure comedy gold, I tell ya.
Extra bonus points for this:
I consider my penchant for liberty to be a product of the American tradition and it is difficult to cause me to have negative feelings about that since ancestors in all my family lines were here when the United States was formed and I came through the public school system before teaching such radicalism was extinguished.
There’s never a wrong time to work in a little fact-free dig at public education. I hear in the public schools today all the kids have to sing “All Hail the Dear Leader Obama” in Swahili.
Anyway, your family history explains a lot. My grandfather came over on the boat from Calabria in 1904. He couldn’t possibly have understood liberty the way you do.
‘GOB: Are you as principled when it comes to war making powers?’
I say ‘yes’, with a caveat. Without acting as if I’m anything more than an average citizen, I feel more comfortable dealing with domestic governing issues. Foreign policy and military conflict are, to me, much more complicated. That is a reason again, for me, that federalism is such an important concept. The domestic matters that the federal government is deeply involved in, to the point of almost total distraction (witness the last 14 months and health care legislation), could be done by state governments. Then, a president and presidential advisors could devote themselves to matters for which the federal government has clear constitutional responsibility.
Yes, the “federal government” but actually with Congress taking much of the responsibility and control of war making. At least, if we’re quoting Madison.
But from your opening volley on this thread, I wonder where you stand on this?
‘The problem with the tenth amendment is that it states, essentially, nothing. It provides that:
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.’
Ugh, are you and Mr. Madison (who was there) saying the same thing?
“The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite”
–James Madison
“if those other provision indicate that you have not given away right X, then the savings clause is meaningless.
Such is the 10th amendment.”
I think this is accurate with one exception. The tenth amendment reminds us that it is the states ceding rights to the federal government, not the other way around, thus the states retaining all of them not specifically granted.
It seems to me, that is that portion of the contract that is the least broadly understood after 200 years. The people grant the states rights, then the states grant the federal government rights with a very specific set of rights and responsibilities for the fed originally articulated.
I consider my penchant for liberty to be a product of the American tradition
Your “penchant for liberty” and the particular ways it expresses itself are, in fact, solidly in the mainstream of an American tradition.
Government should first and foremost stay of out your hair and leave you the hell alone. If you need something you will get it for yourself, and everyone else should do the same.
It’s not, however, the *only* American tradition.
Other American traditions include the polity as commonwealth, where government exists to further the broad common good, rather than the good of a few.
Other American traditions include the “we’re all in this together” ethic that got my parents and grandparents through the great depression and WWII.
Your point of view represents a personal and cultural preference. It does not represent “the American tradition” because the American tradition is plural.
It is now, and it was when the Constitution was written. In fact, it was plural *before* the Constitution was written. Hence the annoying proliferation of squirrely, imprecise, non-specific language in that document.
You have a point of view. Noted. So does everyone else. Yours is not more “American” than any of the rest of us here who are posting from the US.
GOB: Ugh, are you and Mr. Madison (who was there) saying the same thing?
Consider me James Madison with an extra couple hundred years of history behind me. “Commerce,” among other things, is not what it once was. Nor are the “Indian Tribes.”
Marty: The tenth amendment reminds us that it is the states ceding rights to the federal government not the other way around, thus the states retaining all of them not specifically granted.
Right, but to figure out what rights have been given away we have to look to the other provisions of the constitution. If you think that the right to regulate “Commerce…among the several States” allows Congress to require people to buy health insurance, then no amount of pounding on the 10th Amendment will help, it’s been delegated to the United States!
Marty” The people grant the states rights…
I think you would find several votes on the current Supreme Court that, absent the 14th amendment, the states could do whatever they wanted to “the people” so long as it was allowed by state court judges.
Consider me James Madison with an extra couple hundred years of history behind me.
And an inferior haircut…
Anyway, your family history explains a lot. My grandfather came over on the boat from Calabria in 1904. He couldn’t possibly have understood liberty the way you do.
In my case, grandmother, and from Emilia Romagna. Her name’s on a plaque in Ellis, my uncles bought it for her.
My old man’s people were Border Scots, they came over much earlier, mid-18th C, to South Carolina, as indentured servants.
Hey, I’m a good old boy, too! Or at least, the son of a good old boy.
But clearly I don’t have the background to properly understand the concept of liberty.
I must have come through school after the radicalism was extinguished.
russell: the American tradition is plural
Something not said nearly often enough.
There are a few areas where you can cloak yourself in the Constitution and claim righteousness. The 10th Amendment is not really one of them, because it’s a matter of interpretation and not a plainly stated principle.
But what I find sort of funny about the idea that states should have more power is that we already have a great example of a large region with a weak federal government with limited revenue-gathering and -distribution powers and most powers devolved to the individual states.
It’s called Europe. Is that really the ideal model for the US? States squabbling over who has to bail out whom? Nationalist sentiments that prevent pragmatic actions to maintain economic stability? A very weak foreign policy because states cannot be made to agree on action. and the federal government lacks economic clout of its own? A largely unaccountable government because people pay no attention to federal elections?
Even Europe doesn’t like the European model. That this idea is being held up as an ideal by conservatives who are always talking about European inefficiency is bewildering.
GoodOleBoy: Since taxation is a form of coercion and that coercion diminishes the freedom of those being coerced
Ah. Folks, the moment this kind of mindless flaming garbage comes out of what passes for the mind in an Internet libertarian, you know you are in the presence of someone who isn’t worth trying to talk to because he hasn’t managed to get past the mental level of the six-year-old who reads Wind in the Willows and never wonders which brewer bottled beer in mole-sized bottles.
There, there, GOB. Someday you’ll grow up and then you will understand that things have to be paid for: that living in a country under government means, for the grown-ups, being willing to pay for the benefits you receive, not moan like a six-year-old who thinks it’s not fair his allowance got stopped to pay for the window he broke.
My maternal grandmother was Calabrese. We should share a plate of olives sometime, UK. Oh, and what’s liburty? Did I spell that right? Crap…I just don’t get it.
Jes,
You really have to try to express your opinions without insulting people. Enough already. Please. There are posting rules, and it’s exhausting.
Ummm, posting rules?
” If you think that the right to regulate “Commerce…among the several States” allows Congress to require people to buy health insurance, then no amount of pounding on the 10th Amendment will help, it’s been delegated to the United States!”
I agree with this completely, if you believe that then the 10th doesn’t apply.
Thus my consternation when many people don’t seem to grasp the concept of the states as individual entities with substantial rights that require representation.
(This also forms my basic disagreement with Eric over the makeup of the Senate. The Senate is designed to proportionally represent the rights of the states. They certainly were not all equal by population even when the country was formed or new states were admitted.)
My maternal grandmother was Calabrese. We should share a plate of olives sometime, UK.
Both my maternal grandparents were of Calabrese origin, as it happens, although my mother’s mother was born in the US.
Mmmmm…olives…
You really have to try to express your opinions without insulting people. Enough already. Please. There are posting rules, and it’s exhausting.
Eric, I understand what you’re doing and why, and it’s true Jes could have been a bit more restrained her language…but jeez. GOB’s schtick is getting awfully tedious, not to mention more than a little obnoxious. “I suppose as the only real American around here I shouldn’t be surprised that no one else understands what liberty really means…sigh….”
To be honest, when I read “I consider my penchant for liberty to be a product of the American tradition and it is difficult to cause me to have negative feelings about that since ancestors in all my family lines were here when the United States was formed” I was sorely tempted to ask GOB whether any of his sainted ancestors were slave-owners, and what this said about this whole “liberty” business.
Would that have violated the posting rules too?
There are times when I think that all the posting rules do is channel insults and rudeness into a more weasely, passive-aggressive form.
/meta-rant
Would that have violated the posting rules too?
No.
Look UK, I’m doing what I can in between a zillion other commitments. Jes’s comment was clearly over the line. I didn’t appreciate GOB’s tone, and called him out already once on this thread, but if it’s simply ignorance, better to have folks like russell and ugh dismantle than to cry foul.
Look UK, I’m doing what I can in between a zillion other commitments.
I understand and appreciate that, Eric, believe me. You’ve been churning out some damn good posts today.
That was more of a generalized rant than a criticism directed at you personally, and I’m sorry if it came out wrong. I’m agnostic on the whole posting-rules thing, for the reasons I outlined above, and GOB’s latest offerings pushed me a little too far.
Of course, ultimately it’s entirely up to you and the other owners of this here blog to make of it what you will.
Eric,
You run this blog (for which I am truly grateful) and you can make any rules you want to. If you feel that Jes@4:18 was over the line, then it’s appropriate for you to take the time to admonish her.
Can I just say, though, that we’re all adults here? Every one of us has been insulted, or at least felt insulted, many times — and not just on the internet, where nobody knows whether any of us is, in fact, a dog. Some of us react to insults by complaining about them; some by ignoring them; some by responding in kind. And our reaction, like the insult, gets judged by the wider audience.
As a member of the wider audience, I frankly find complaints about insults to be even more tiresome than the insults themselves. I don’t complain about the complaints because life is short. But my respect for the complainer does diminish a bit.
It may hurt somebody’s feelings to know that I lose respect for them when they complain about being insulted. For this, I apologize in advance.
–TP
I consider my penchant for liberty to be a product of the American tradition and it is difficult to cause me to have negative feelings about that since ancestors in all my family lines were here when the United States was formed and I came through the public school system before teaching such radicalism was extinguished.
My paternal grandparents were born near Naples and they each came through Ellis Island with their parents when they were maybe 10 or 12 years old, in 1902 and 1909 (?) respectively.
On my mother’s side, there is a record of Mathew Woodruff in Hartford in the 1640s. Counting my generation as #1, Mathew’s was the 11th backward.
Then there was “William Peck, born in or near London about 1601, married Elizabeth 1622, came to America 1637, one of the founders of New Haven spring 1638. Died 1694, 93 years old.” William Peck’s generation is the 12th backward, again counting mine as #1.
Disregarding possible crossing lines, I have 2^10 (roughly 1000) ancestors in Mathew Woodruff’s generation and 2^11th (roughly 2000) in William Peck’s. Of course, my Revolutionary War era ancestors are fewer generations back, so there are “only” about 128 of those lines.
GOB says: “since ancestors in all my family lines were here when the United States was formed.” If he can back this up — that is, if he has documentation for every one of his ancestors 230 or so years ago, that is one hell of a genealogical project that someone has completed, with a lot of luck thrown in as well, since it isn’t easy to get all that information accurately and reliably. Also remarkable is how pure the bloodlines have been kept. None of those dark-skinned Mediterranean Catholic or eastern European types mixing into the purity, nosirree. (True confessions: My family, being only human, isn’t immune from the phenomenon of “othering” the newcomers. I have a vivid image (from stories) of the fit my mother’s mother threw when her daughter informed her that she was marrying an Italian Catholic. She (my grandma) got over it, thank goodness, because otherwise I wouldn’t have had a chance to adore her throughout my childhood.)
I of course feel that my American story — a mixture of the bloodlines of people who were here 150 years before the beginning of the USA with the bloodlines of people I grew up with who had come over on the boat within living memory — is a far more truly American story than GOB’s.
No, I’m being sarcastic. Not very many things grind my butt more than people playing this stupid “more American than thou” game.
I just got back from 5 weeks in China. One of the blessings of that trip was that internet access was an on again off again thing, and I got well weaned away from daily blog-reading. Last time I checked in here from over there, there was a debate going on about tax brackets, in which someone was saying to Eric that his post was a populist rant and, patronizingly, that he could do better. This was only the umpteenth tax bracket debate — going nowhere every time — since I started reading ObWi 2 years ago.
And every other time I’ve checked in lately the discourse has been dominated by people perpetrating what UK (above) called GOB’s “schtick” — either the schtick itself, or everyone else drawn into responding to it.
Gah. I don’t have time for this crap.
A plate of olives sounds good, though. 😉
” If you think that the right to regulate “Commerce…among the several States” allows Congress to require people to buy health insurance, then no amount of pounding on the 10th Amendment will help, …”
Yeah, ’cause you’re somebody who doesn’t care what the words actually SAY.
TiO for all your travelogue needs!
Eric: You really have to try to express your opinions without insulting people. Enough already. Please. There are posting rules, and it’s exhausting.
Fair point, well made.
Whether it’s a correctly called a movement, a backlash or political theater, state declarations of their rights — or in some cases denunciations of federal authority, amounting to the same thing — are on a roll.
Gov. Mike Rounds of South Dakota, a Republican, signed a bill into law on Friday declaring that the federal regulation of firearms is invalid if a weapon is made and used in South Dakota.
On Thursday, Wyoming’s governor, Dave Freudenthal, a Democrat, signed a similar bill for that state. The same day, Oklahoma’s House of Representatives approved a resolution that Oklahomans should be able to vote on a state constitutional amendment allowing them to opt out of the federal health care overhaul.
In Utah, lawmakers embraced states’ rights with a vengeance in the final days of the legislative session last week. One measure said Congress and the federal government could not carry out health care reform, not in Utah anyway, without approval of the Legislature. Another bill declared state authority to take federal lands under the eminent domain process. A resolution asserted the “inviolable sovereignty of the State of Utah under the Tenth Amendment to the Constitution.”
[…]
States’ Rights Is Rallying Cry of Resistance for Lawmakers
You know, we already fought a war over this, and the Tenthers lost.