by hilzoy
"We pulled up to the main entrance of the hospital after the two-hour drive from our home near Gettysburg, Pennsylvania. My husband opened his door, grabbed the roof of the car and began to pull himself out as I walked around to help him. I was too late. In an instant–time slowed enough for me to see the danger but raced ahead too fast for me to reach him–he lost his grip and fell to the concrete, shattering his hip, breaking his femur and causing internal bleeding that kept him in the hospital for months.
My husband is a retired college professor, and what the teaching profession lacks in salary it often makes up for with generous benefits. His health insurance would cover most of the emergency costs related to the fall–the surgeries, the hospitalization, the drugs. But in the astronomical sums the cost of medical care often entails, "most" is not a reassuring word. Months later, as his discharge from the hospital drew near, I sat in my living room looking at the bills piling up on the table. The co-pays, uncovered care and other costs had already reached $8,000, and we had virtually nothing left. (…)
The fraying financial thread by which we were already hanging was now certain to snap. When I heard the awful sound of my husband's body hitting the concrete outside the hospital, I knew the modicum of independence to which he had clung for so long was gone. He was discharged into an assisted-living facility, where most of the cost was excluded from both his private long-term-care insurance and Medicare. At $9,000 a month, the bills accumulated quickly.
Recently, we decided to bring him home, although the doctors would have preferred that he stay at a facility with full-time supervision. But this was a mathematical decision, not a medical one: we do not have the money it costs to keep him there. I had already stopped working, to care for him; our savings are nearly depleted; and his pension is not nearly large enough to pay the bills.
Today he needs nearly round-the-clock professional help at home–less than the cost of the assisted-living facility but still far more than we have. I have spent recent weeks looking for a job that can add at least enough to my husband's pension and our Social Security benefits to cover the cost of his care. It is a dilemma familiar to so many women–finding work that can pay for care but also leave time for providing it.
The time is drawing near when, job or no job, the expenses will simply be more than we have."
Ms. Michelman might want to change the gender reference in that paragraph you clipped: I’m male, have been caring for my mother for 10 years, and am about out of money. I too am looking for a job; in my case, one that will pay my health care and auto insurance premiums so I can continue to care for her.
It’s a situation which plays no gender favorites.
Well, I guess if everyone agrees the US needs universal health insurance, the best argument to have is whether a journalist on another publication should have been allowed to say “so many women” when some men are full-time carers too….
I have never understood why Republicans are not behind universal health insurance.
Their argument for doing so seems to go a little something like, “Blah, blah, blah…Europe…blah…blah…blah…Taxes…blah…blah…blah…keep off my lawn you damned teenagers.”
Jesurgislac,
Oh, never mind. The point I was trying to make was that Michelman’s problem is widespread and goes beyond stereotypes.
I have never understood why Republicans are not behind universal health insurance.
1. their leaders are too heavily invested in the existing structures;
2. they don’t actually believe that bad stuff is going to happen to them;
3. a significant minority of them are sociopathic whackjobs.
But you knew that, didn’t you?
Link: The point I was trying to make was that Michelman’s problem is widespread and goes beyond stereotypes.
True. But there’s not a lot Hilzoy or anyone on this blog can do about Michelman’s choice of phrasing, is there? Which is my point.
There are more women functioning as unpaid carers than men (this is true in the UK, at least): but obviously no one, regardless of gender, should be in the position of going broke trying to keep up with the cost of medical bills while providing full-time care.
I have never understood why Republicans are not behind universal health insurance.
Because universal health insurance gives people more independence from their employers and encourages adventurous small-business entrepreneurs, which are both things Republican policies oppose, favoring employer control over employee welfare, and favoring large-scale corporations over small independent businesses. Plus, traditionally most Republicans care for the problems of the very wealthy far more than they do their own problems, and the very wealthy tend to have good health insurance and not to have the same difficulties over co-pays.
“I have never understood why Republicans are not behind universal health insurance.”
Start with this: What is the good of being rich if the poor have what you have? Phones, TVs, homes, cars, retirement money, healthcare.
End with this: Why work for IBM, Xerox, GE, et al, if you can have the same benefits and a more satisfying job working for your local grocery store, food pantry, newspaper,or auto body shop?
The Republicans believe that healthcare is a luxury reserved for those who can afford it. It is not for those who need it.
“Because universal health insurance gives people more independence from their employers and encourages adventurous small-business entrepreneurs,” at the expense of robbing them of independence from the government, which in the long run is a much more serious thing to be dependent on. Private businesses at least don’t routinely threaten to shoot people who cross them.
Liberals get all upset about ‘big business’, and your answer is always the biggest, nastiest business around.
I mean, let’s be serious: Health care is a finite resource, and people are mortal. Even in a perfectly run system, people are going to die due to that latter fact, and people who could have been saved are going to die due to the former.
If you’re upset about the fact that sometimes poorer people die when a treatment wealthier people could have afforded would have saved them, you know what? You could bankrupt the entire world trying to provide everybody the best care, and still not succeed, so the only way to prevent that is to deny people health care they can afford to pay for.
That’s pretty nasty, wanting people to die who could pay for the life saving treatment out of their own pocket. But it happens in countries with nationalized health care.
You really care, you ought to be more concerned about the factors that make health care more expensive for everyone, like an FDA approval process that’s slower than other nations’, but not any more effective. Or the regulatory bias against preventative medicine. Or the way concern about ‘doping’ denies people who aren’t involved in competitive sports treatments which would vastly improve their quality of life.
But that would involve the government intervening less, not more, wouldn’t it? And it’s pretty hard for you guys to admit the government is frequently the problem, not the solution.
“But it happens in countries with nationalized health care.”
Cite?
“Private businesses at least don’t routinely threaten to shoot people who cross them.”
Somebody’s not up on their past & present labor movement history (although to be fair, that often – for example, Shell in Nigeria – involves government threatening or outright killing people on behalf of/with the assistance of private businesses).
“I’m from the health insurance company, and I’m here to help you” – it would be absolutely terrifying, if it wasn’t so utterly unbelievable.
Brett: at the expense of robbing them of independence from the government, which in the long run is a much more serious thing to be dependent on. Private businesses at least don’t routinely threaten to shoot people who cross them.
Huh. You know, we’ve had the National Health Service in the UK since 1948. 61 years. If the provision of universal health insurance led directly to the government routinely threatening to shoot people, I think we’d have noticed by now.
That’s pretty nasty, wanting people to die who could pay for the life saving treatment out of their own pocket. But it happens in countries with nationalized health care.
No, Brett, it doesn’t.
Or the regulatory bias against preventative medicine.
The chief bias against preventative health care in the US system is the sheer quantity of people for whom their only access to health care is the If you think preventative health care would be a good idea, you should be shouting for a national health care system… that’s how you’ll get it.
for whom their only access to health care is the ER.
(I guess Brett showing up to flail about guns and government and how the government wants TO KILL EVERYONE but benevolent corporations don’t, is the Republican defense.)
“ . . .is the Republican defense.”
It’s pretty offensive, that’s for sure.
“You could bankrupt the entire world trying to provide everybody the best care,
I’m not sure best is the goal. Decent care, perhaps. World, tradeoffs, etc.
“ I mean, let’s be serious: Health care is a finite resource, and people are mortal. Even in a perfectly run system, people are going to die due to that latter fact, and people who could have been saved are going to die due to the former.”
Yes, so let’s not do anything to make the situation somewhat better, because status quo and unreachable perfection are the only two possible options.
“ . . . at the expense of robbing them of independence from the government”
Well, I’d agree that the Michelman family is radically freer under the current system, at least according to the definition put forward by Joplin (1971). Why don’t you try to contact Mrs. Michelman and share your argument with her? I’m sure it will provide her with much-needed comfort.
The entire Federal Government, all State governments, and many of the municipal governments have paid healthcare. I don’t hear them complaining.Why is government healthcare so bad, hmmm?
Jes, it’s an article of faith among Republican opponents of UHC that you cannot get private medicine/insurance in countries which have it. You can show them the evidence, but you can’t get them to believe otherwise, in the same way that you can’t get a similar constituency to believe that Iraq had nothing to do with 9/11.
If you’re upset about the fact that sometimes poorer people die when a treatment wealthier people could have afforded would have saved them, you know what? You could bankrupt the entire world trying to provide everybody the best care, and still not succeed, so the only way to prevent that is to deny people health care they can afford to pay for.
The UK has a national health service. It also has private health insurance and the option for anyone to buy any kind of private healthcare they want (here or overseas). So you are simply wrong on that.
If you read someone like Andrew Sullivan, he will admit that there is always healthcare rationing in any system. He just wants it to be done by the market rather than the government. Why? Because he and Brett think that it’s better that poor people die of curable diseases (in a free market system) than that there is the smaller possibility that prosperous people (like Sullivan, I don’t know about Brett) die of curable diseases because of NHS rationing.
I would accept that there are a small percentage of people who do better with US healthcare than universal equivalents: those with the best forms of private insurance and no really expensive diseases. 90% or more of the rest of the population are worse off. But when the 10% include so many of those in positions of influence, it’s not surprising that nothing much changes.
All of us, including Ms. Michelman and her unfortunate family, should gird our loins for the rancid ugly bile that is going to erupt from the some on the Right against her in the coming weeks.
chris y: Jes, it’s an article of faith among Republican opponents of UHC that you cannot get private medicine/insurance in countries which have it. You can show them the evidence, but you can’t get them to believe otherwise
So basically, Brett will continue to believe that it’s impossible to get private health care in the UK even if I link to sites like http://www.BUPA.co.uk and http://www.lookforhealth.co.uk? Interesting.
in the same way that you can’t get a similar constituency to believe that Iraq had nothing to do with 9/11.
Well, the difference is that “Iraq had nothing to do with 9/11” is a concept requiring a little bit of thought and understanding to follow. But “Britain has private health care/private health insurance” doesn’t require any thought or any understanding beyond the effort to click on the link and believe that people wouldn’t just make those sites up just for a spoof.
Indeed, private health insurance is much better (according to comparisons I have read) in the UK than in the US, because in the UK, private health care competes with the NHS: it has to be distinctly better than the NHS in order to convince people to pay up – and where Brett’s fear just falls over and looks stupid, is that private health care is generally only able to offer the “better than the NHS” tag if it’s not anything major, not life-threatening or disabling, because it’s the awkward zone where it won’t kill you to wait but it will be uncomfortable while you wait, that people do tend to make use of private health care if they can afford it.
What I *really* don’t understand is why the Small Business Association and similar groups aren’t totally on the UHC bandwagon. Speaking as someone who’s been part of a very small business for 8 years now, the need for affordable health insurance is a constant worry, and one of the biggest barriers to starting a business. It would be completely to small businesspeople’s advantage for access to health care to be separated from employment, so why aren’t they for it?
I mean, let’s be serious: Health care is a finite resource, and people are mortal.
Granted. So why are you backing the single most inefficient system in the developed world? A system on which your government(s) spends more per head than the British government spends to run the NHS. A system that is more bureaucratic than any nationalised system anywhere. And a system that is simultaniously the most expensive in the world and only the thirty-seventh best?
Even in a perfectly run system, people are going to die due to that latter fact, and people who could have been saved are going to die due to the former.
No one is arguing with you. But when your argument is “We can’t have a vast improvement because it’s perfection or nothing” you might as well give up now.
If you’re upset about the fact that sometimes poorer people die when a treatment wealthier people could have afforded would have saved them, you know what? You could bankrupt the entire world trying to provide everybody the best care, and still not succeed, so the only way to prevent that is to deny people health care they can afford to pay for.
But what we are worried about is that people die from diseases in America when every single civilised country in the world (and on this subject you are not civilised) has
That’s pretty nasty, wanting people to die who could pay for the life saving treatment out of their own pocket. But it happens in countries with nationalized health care.
Depends on the implementation. Not in Britain it doesn’t. (The closest you can find to it happening is where people can afford topups but not the entire treatment can’t get the treatment they can’t afford).
You really care, you ought to be more concerned about the factors that make health care more expensive for everyone,
Yes. Take the insurance companies out and pull all their charters. They are nothing but a pointless level of bureaucracy that no sane system has. The NHS’s administrative overheads are paltry compared to the great lumbering behemoth of red tape that is private provision of healthcare using a
like an FDA approval process that’s slower than other nations’, but not any more effective.
If that’s to do with drug approval, that will actually lower costs.
Or the regulatory bias against preventative medicine.
If that’s true it’s a major factor. But given how knowledgable the rest of your post demonstrates itself to be I’m going to have to demand a source for this claim.
But that would involve the government intervening less, not more, wouldn’t it?
No. It would involve less pointless private sector bureaucrats. It would involve block negotiations with pharmaceutical companies (which really bring drug prices down for the NHS).
And it’s pretty hard for you guys to admit the government is frequently the problem, not the solution.
Oh, government is frequently the problem. In this case the government’s unwillingness to kick the private sector and say that it will either provide a civilised standard of care nationally (which shouldn’t be hard given the resources put into it) or it will be nationalised.
But it seems impossible for you to admit when the private sector is running demonstrably the single most inefficient system anywhere in the world. It is hard for you to admit that every single medical system in North West Europe (and for that matter many other places) are cheaper and better than the US system. In part because they have more (and more useful) government intervention. It seems impossible for you to admit that no government anywhere has managed to come up with a more bureaucratic system and one more focussed on denial of treatment to patients than the existing insurance based model of healthcare in the US.
And until you admit that you are continuing to deny reality.
If there was a way of ensuring that black people didn’t get it, we’d have had national health care by 1970. In discussing politics with conservatives, I’ve seen more pure naked racism on this subject than perhaps all others combined.
At first John Thullen’s 8:24 seemed like a non-sequitur, but I think I get it:
He means people will claim her grief is divine punishment for her NARAL activities
I have never understood why Republicans are not behind universal health insurance
Really? Guess what? There’s gambling going on in the backroom at Rick’s Café Américain. Shhhh.
Could it be the campaign funding by the health insurance lobbies?
On another level, GOPers tend to believethe value of a citizen is measured by his or her wealth. ‘Good’ citizens can afford adequate healthcare–‘bad’ citizens cannot.
This is something the military can do. A young person going in not only does close-order drill, learns how to read a map, etc, but can also visit shut-ins on a regular basis, or chronically ill people and perform basic nursing tasks. Four years of that will get you some sort of extra education gratis, along with health benefits and a sense of connection.
What’s not to like?
I mean, let’s be serious: Health care is a finite resource
Republican admits that some resources may be finite. Film at 11.
Granted. So why are you backing the single most inefficient system in the developed world? A system on which your government(s) spends more per head than the British government spends to run the NHS. A system that is more bureaucratic than any nationalised system anywhere. And a system that is simultaniously the most expensive in the world and only the thirty-seventh best?
It’s teh Capitalism. If there is a resource and there is a finite limit on it, then it is more efficient–it is more profitable– to let the ‘market’ to determine the price.
Profit, rather than public good, welfare, or conscience, is the dominant motif.
As long as the parasites of the Insurance Industry are in the equation, the health of the ‘people’ will be auctioned off to the highest bidder.
We do NOT “need” better insurance. We need full, cradle-to-grave, single-payer, public health care. Nothing else, nothing less, is morally permissible or should be acceptable…
When I run stories like this by my GOP/Fox News family members the answer is consistently, “That’s tragic of course. Life can be very unfair. These things can happen but that doesn’t mean I should have to pay for it through taxes. That’s why there are charities.”
Of course there are rejoinders. But the problem is it’s a circular discussion, complete sealed, and completely illogical when seen in its entirety.
But that is the mindset and it plays well with the corporate incentives to lawmakers – it’s exactly why the “Harry & Louise” ad played so well across so many voters.
Personally I cannot think of anything since fire, the wheel, the printing press, and the internet that could do more to boost human creativity and productivity than portable universal health care plan. Millions of insured as well as uninsured would be freed up to take more risks, leave dead end jobs, explore new sectors if they weren’t trapped.
ThisJohn: Yup. I’m surprised that someone hasn’t already claimed that Michelman is facing the wrath of God; they did the same when the grandchildren of someone associated with abortion clinics died in a plane crash.
We live in a country where our health care system is so barbaric that I can actually sit here and feel lucky that when my father was diagnosed with cancer we knew the diagnosis and the course was definitively terminal. As a result, we never had to choose between caring for him and staying solvent. I can’t believe we still allow this. My father died almost 15 years ago.
If we were talking about nationalized health care, I would agree with Brett. But national health insurance does not mean government-run health care, and would almost certainly be an improvement over our current system.
If there was a way of ensuring that black people didn’t get it, we’d have had national health care by 1970.
SS only got through Congress when originally passed (1935?) by excluding most domestics and agricultural workers.
Wonder who they were….
” . . . at the expense of robbing them of independence from the government”
This is a key point, and there are different meanings to the Inner and Outer Republican parties.
To the Outer Party, this is simply a slogan: “government” health care today, and it’s Borg implants tomorrow. I’ve lived in Canada and in the US for long periods of time, and as far as healthcare goes, I certainly feel far more free in Canada where you don’t have to worry about losing your coverage with your job and fighting with insurance companies who don’t want to pay. Americans accept a level of Kafka-esque healthcare bureaucracy that would send Europeans into the streets with rocks. In single-payer plans, you have a voice at the ballot box and in the streets: in a private plan, you’ve got nothing.
To the Republican Inner Party, Freedom simply means Nothing Left to Lose for the unwashed masses. The Republican leaders want to make sure that their followers expect nothing out of government, so they’ll be fine when that’s what they get. The leaders have made it clear that their vision of government is a mechanism for directing money and power to their elite circle, so any justification for giving nothing to the rest of the population will work.
“Independence from government” to the leadership means that the population can independently sink into poverty and misery while the government independently makes its friends rich.
Its interesting that I’m reading this post now. I am unemployed and looking for a job right now and of course uninsured. I had a previously scheduled appointment for a physical exam set for today. I had to weigh between paying full cost for the appointment versus husbanding my dwindling financial resources.
I postponed the appointment, of course, even though I have some problems that I know damned well that a doctor should look at.
Ms Michelman’s situation is uncommon (though not all that uncommon. I know that hundreds of thousands, if not mullions, of people made the decision I made and as a result, some will end up in emergency rooms next because their problems , initially easily treated, redevelop into life threatening illnesses.
Why do Republicans oppose national health care? pretty simple . They cannot plan further than their next contribution from AMA ands drug and insurance companies. I cannot see any other reason.
In the meantime, Singapore and Thailand( supposedly Third World countries) have national health insurance and the US doesn’t . Bizarre.
For those who care concerned about effficency, this is what Wikipedia says about SINGAPORE’s health care system:
Singapore has a universal health care system where government ensures affordability, largely through compulsory savings and price controls, while the private sector provides most care. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[42] Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[43] Singapore has “one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes,” according to an analysis by global consulting firm Watson Wyatt.[44]
http://en.wikipedia.org/wiki/Universal_health_care#Singapore
If frikkin’ Singapore ( a country not much bigger in size than Washington, DC) can get it right, then there ain’t no excuse for the big old USA to fail on this.
As I understand, Obama main emphasis in his own proposals are on reducing health care costs and increasing efficiency, in order to increase the profits of the insurance companies and corporate programs. I was not aware that Obama was seeking, or had any interest on a single-payer program or a “public option” in order to increase competition for the insurance companies.
Will what Obama has proposed, for instance, really help Ms Michelman to a significant degree? Please provide details. I also realize there may be more generous possiblities out of Congress, tho in the interest of controlling deficits, we may get a veto or another alliance with Blue dogs.
Of course, we might try to impeach the enabler of war criminals, the President for Goldman-Sachs.
There’s a lot of terms that get thrown around when talking about health care reform in this country — universal health care, socialized medicine, nationalized health care, government (run) health care, single payer — each meaning something different, but all too often get confused and blurred together, especially (but not solely!) by conservatives. (Brett being one example.)
What we need to is to make our health care system less expensive (for both the people and the government) and more accessible, while at least preserving our capacity for medical innovation and the like. If we can do this in a way that achieves universal health care, all the better, but if the pursuit of UHC compromises this basic goal of overall improvement to the system, it may be worth making it a longer term goal.
Which is a long way of saying, support the Obama Health Care Plan.
Hmmm…thought I fixed this.
You know, we’ve had the National Health Service in the UK since 1948. 61 years. If the provision of universal health insurance led directly to the government routinely threatening to shoot people, I think we’d have noticed by now.
Jes, when Brett talks about the government shooting people, he’s speaking Libertarian, wherein the government only exists as a method of coercion and blah blah blah Rand-cakes.
It is important to bear this in mind, because the evidence re: effectiveness of socialized medicine is so overwhelming at this point that truly dedicated libertarians have no other argument other than going to the Well Of Libertarian Principles (freedom, freedom, and more freedom on Sundays!) and pretending that the marginal harm caused by forcing people to pay for socialized medicine is greater than the marginal harm caused by letting people die of horrific diseases and maladies.
Which is idiotic, but, again – libertarians, et cetera.
Bob
Just so you know, Obama’s plan does provide for a public option in his insurance exchange program. There are two such options for how a plan would work.
http://blogs.tnr.com/tnr/blogs/the_treatment/archive/2009/04/16/deparle-two-options-for-public-plan.aspx
“Will what Obama has proposed, for instance, really help Ms Michelman to a significant degree? Please provide details.”
Mrs Michelman is being hurt financially by the burdensome co-pays accompanying her husband’s care. This is a confluence of two faults in America’s health care system — the inflationary cost of care, and the high level of underinsurance (what a plan with such high co-pays essentially constitutes) that comes with so much lack of coverage (itself resulting, in large measure, from high prices — it’s a cycle).
Obama’s HCP brings insurers into a regulated market, whereby they will compete with each other and a public plan, not to monopolize the healthy and the wealthy (as they do now) but to expand overall coverage. This will reduce both premiums (in conjunction with other reforms, like EHR) and co-pays (as a percentage).
ThirdGorchBro: If we were talking about nationalized health care, I would agree with Brett.
And you’d be just as wrong.
Look, the NHS is far from perfect. I’ve worked for it (briefly, some time ago) my brother worked for it, I have several friends who worked for it – and obviously, literally everyone I know in the UK has been treated by the NHS at some point in their lives. There are things the NHS could do better. But it is as far removed from Brett’s fantasies as it is far ahead in every measurable factor except cost from the US system.
bob mcmanus: As I understand, Obama main emphasis in his own proposals are on reducing health care costs and increasing efficiency, in order to increase the profits of the insurance companies and corporate programs. I was not aware that Obama was seeking, or had any interest on a single-payer program or a “public option” in order to increase competition for the insurance companies.
Correct. Obama is running scared on this. Either that, or he really is too right-wing to appreciate the benefits of a universal health care system.
mightygodking: when Brett talks about the government shooting people, he’s speaking Libertarian, wherein the government only exists as a method of coercion and blah blah blah Rand-cakes.
I understood that. I was mocking Brett.
The government DOES only exist as a method of coercion. It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector. Coercion might not be all the government does, but it’s all the government does that somebody else couldn’t do just as well.
Just so you know, Obama’s plan does provide for a public option …point,11:59
Two posts from Uwe Reinhardt (via Ezra Klein) at the NYT, revisited this morning to be sure my impressions were correct.
Defining Health Care Reform
“…helping low-income Americans” would not have helped Michelman so much. I see little else in Reinhardt’s description except vague goals and ideals toward IHC.
Health Reform without a Public Plan
…Reinhardt
All of us, including Ms. Michelman and her unfortunate family, should gird our loins for the rancid ugly bile that is going to erupt from the some on the Right against her in the coming weeks.
We’re going to find out she has really, really nice countertops in her kitchen?
The government DOES only exist as a method of coercion. It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector. Coercion might not be all the government does, but it’s all the government does that somebody else couldn’t do just as well.
Even if you accept Brett’s claim above (hint: it’s bollocks – see regulation, accountability, economies of scale, and other factors (including lack of bureaucracy in the case of healthcare)) then it’s irrelevant. Because the government does not bring one thing to the table that the private sector does: a positive incentive to screw every last cent out of the general population that it can get.
Your life is worth more to you than your money. Which gives healthcare providers an amazing amount of leeway to screw their clients using impliments such as a 6″ diameter drill tipped with a surgical steel bit. And if the insurance companies screw their clients in such a manner (as they do) they know they can externalise the costs as it’s either the government or the community that would have to pick up the pieces for the poor bastards who have been made destitute due to healthcare costs. On the other hand, the incentive for the government to screw the population on healthcare is only passive apathy not active profit (in which someone with a particularly steady hand with the drill gets more money) – the government is going to be one of the groups picking up the pieces and people with a steady hand with the drill certainly aren’t going to be directly rewarded.
The incentives for private healthcare (and private water supply and private roads and privatising quite a few other things done by the government) are quite simply perverse as far as the general population is concerned.
Brett: The government DOES only exist as a method of coercion. It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector. Coercion might not be all the government does, but it’s all the government does that somebody else couldn’t do just as well.
All right… all right… but apart from better sanitation and medicine and education and irrigation and public health and roads and a freshwater system and baths and public order… what has the government done for us?
In order: no, it’s not, and yes, but so what?
Health care is no more a finite resource than legal counsel, emissions checks or any other service that the government provides. It is finite in the sense that the service must be funded, like roads and the military and everything else, but it is not finite in the sense that we will run out of it. This is a red herring.
As for the observation that people are mortal… in earnest, is this even an argument of any sort? Reducing the mortality of its population is one of the first obligations of any government.
Brett, if you’re ever looking for a reason why so little of what you say gets taken seriously, comments like these are a good place to start. I don’t see any sign that you actually think things like this through as opposed to simply throwing them out there because they sound good as one-liners.
The aspects of “big business” that liberals tend to get up in arms about arise from the harm done by the unregulated pursuit of profit. This is especially toxic in the private health insurance industry, in that the business model of any insurance company is based on denying coverage whenever they can get away with it. It is inherently, by every imaginable definition, exploitative.
Government may be “big” (a vague, relative term at best), and it may share some structural and bureaucratic similarities with business, but they key point is that the government is not and should not be concerned with profit. Absent the driving need to deny claims in order to support the bottom line, the focus can be on providing the best care possible.
That’s entirely setting aside the benefits of free preventative care and checkups. There are a legion of conditions that are much cheaper and safer to deal with if caught early, and the uninsured or under-insured usually cannot afford this kind of preventative care–which costs us all more in the long run. But please don’t try to score cheap points with nonsensical comparisons between government and business.
At first John Thullen’s 8:24 seemed like a non-sequitur,
Huh. I thought it cut to the heart of the question at issue :
I have never understood why Republicans are not behind universal health insurance.
The Republican moral calculus is founded in the invariable conviction of the privileged Calvinist that people get what they deserve, and runs something like this:
1. ) I have paid healthcare.
2. ) Therefore, I can be certain that I, personally, morally deserve to have paid healthcare (othewise it wouldn’t have happened).
3. ) Those other people do not have paid health care.
4. ) Therefore, they must somehow not morally deserve to have paid health care. Had they been better, had they been more hard-working or foresighted (or more like my admirable and deserving self in some other way), they would have paid health care.
5. ) Therefore, efforts to provide those other people with health care [watch this part closely] are designs to provide healthcare to those who do not deserve it.
6. ) Which is a The Bad Thing — call it “socialized medicine” or call it “cadillac-drivin’ welfare queen”, but the anathema in the Republican moral calculus is someone who gets something they don’t deserve.
7. ) Which cannot possibly describe anyone has already demonstrated that they deserve privilege by having it.
The final link, the one that will make it morally OK for Republicans to target Ms. Michelman with spiteful remarks, goes like this :
8. ) Ms. Michelson must somehow deserve the bad things that have happened to her.
It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector.
Except we don’t get to vote on who is and isn’t in charge of private sector companies.
The government DOES only exist as a method of coercion. It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector. Coercion might not be all the government does, but it’s all the government does that somebody else couldn’t do just as well.
Libertarians are like adult Goths; it’s a desperate cry for attention.
I really think Brett needs to calm down and reassess his views of government. I mean, I get that he’s a conservative and skeptical of government, but lately he’s been expressing a truly visceral loathing of government in terms that are at least metaphorically violent; in the last few days he stated that taxes are rape, a view that manages to be profoundly unfair to victims of rape, to acquiescent taxpayers, and to public servants, whatever Brett thinks of them; and in this thread he refers to government as being an operation that will “routinely threaten to shoot people who cross them.”
There are genuinely thuggish forms of government that take without consent and are not responsive to their publics and indeed use overwhelming levels of violence at little provocation. But even in these debased times, the American democracy is not such a government, and referring to it in these terms will only suggest that the person doing so is paranoid and unreasoning in their outlook, likely leading to the disregarding of any less extreme points they wish to make.
It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector.
It doesn’t have to make a profit.
The incentives for private healthcare (and private water supply and private roads and privatising quite a few other things done by the government) are quite simply perverse as far as the general population is concerned.
A private oxygen supply is the logical conclusion of all this. I’m sure it’s been a feature of a dystopian science fiction novel or two.
We must privatize government coercion and find the most efficient means to ration the sanctity of life.
I have never understood why Republicans are not behind universal health insurance.
There are ideologocial-ish reasons Republicans have always opposed uni health insurance (enumerated above), but the GOP is so ‘de-coupled’ these days from their own ideology that you can almost bank on the fact that if the dems were on the floor of the congress and on tv day and night railing against uni health insurance in the US, GOP pillars would be railing FOR it (disingenuously so, as ever, but still). Obama could come up with a school crosswalk safety initiative which cost $0, and the Opposition would figure out a way to be against it. The GOP – not to say all Republican voters – are simply not to be taken seriously, not even enough to wonder why they are not in favor of UHI.
Blackwater…I mean, Xe….
Seriously, I think folks should tease out what truly in inherent to government and what belongs to behavior of large collective. On a very local level, one can even VOTE one’s self into government and decision making powers. That’s not an option available in the private sector.
As someone who has experienced both the British and American healthcare systems, I’d like to make a couple of points to those of you singing the praises of the NHS. Don’t get me wrong – I think its an excellent system – but it could be improved and its drawbacks make and interesting contrast with those of the US.
The NHS is incredibly cost-effective, in terms of health outcomes per $ spent, but the total level of spending is low, and increasing the level of spending (as the labour government did over the last 10 years) has only improved health outcomes at the margins. If you’re at those margins (eg. you were on the waiting list for a hip replacement) the result is a fantastic improvement, but it hasn’t benefitted most of the people who were paying for it.
The US system in contrast is astonishingly, mind-bogglingly expensive. It cost nearly $3k for my brother to stay overnight in a hospital because he passed out in a bar, for the usual reason people pass out in bars, and they weren’t taking no for an answer. That’s damned expensive for “he’s drunk, put him in a room and we’ll keep an eye on him until someone sober comes to get him”. In the UK he’d have been triaged to the back of the line so many times he’d have sobered up before a doctor saw him, which would have been vastly more cost effective, really, wouldn’t it? Total cost, 10 minutes of a nurses time, around $200.
But, and this is the important but, for those who can afford it the US system does produce much higher levels of service and much better health outcomes. It was undoubtedly more pleasant for my brother to be put in a semi-private room to work off his hangover than to spend his evening in the emergency room waiting area. But more seriously, there are critical, potentially fatal conditions, especially in the elderly that are more survivable in the US than in the UK.
This is the key question, then – what counts as “value for money” in healthcare, especially value for government money? Because there’s really no way to compare the value of providing reasonable, but not necessarily pleasant and definitely not always state-of-the-art, care for everyone, versus provided excellent, hi-tech, pleasant care, for those who can afford it?
Because in neither system does the consumer really get to pick their service level. In the US the insurer will exclude various things, but what is covered is inevitabily provided at the highest possible standard, with all possible technology, because we’re in this crazy situation where it creates less liability for the insurer to deny coverage than it does for them to cover only a non-state-of-the-art treatment. In the UK no conditions are excluded from NHS treatment, but the care you get is (at least in theory) carefully calibrated for cost-effectiveness by an organization called NICE (yes really – National Institute for Clinical Excellence – somewhat like the NIH). While the standards on which this is done are public, its doubtful much of the public really understands them.
Some people mentioned the private insurance system in the UK. It exists mainly to cover things that the NHS won’t cover – some kinds of chronic care, some elective procedures, and so on. The level of service is usually much higher – private rooms versus a bed in a ward, more time with more expensive doctors etc. But its very much a luxury good and its purpose is to complement, not replace, the NHS. Most NHS hospitals also provide private care, and most NHS doctors also have private patients, so there’s a great deal of overlap between the 2 – they’re not really seperate systems, but a main core system and a “top up” system. If you have a heart attack in your nice room in the private hospital while recovering from elective surgery, you’ll quite rapidly find yourself back in an NHS ward, because the private system, such as it is, isn’t rigged up for acute care. In some cases you can even mix the two – for example you can have your baby delivered by an NHS doctor and/or midwife but pay the hospital for a private room. My point here is that you can’t actually compare the US private system with the private top-up system to the NHS in the UK – the UK has virtually no private acute care, and very few fully private hospitals or practitioners. The private system could not exist as it is without the NHS, but the NHS effectively “crowds out” the private system from certain lines of business.
But there is a place where the 2 systems have a lot in common, and its the key point of failure for almost any healthcare system, and that is long-term chronic care. Tragedies like the one hilzoy described occur everywhere – its only the exact consequences that differ. Here unexpected healthcare costs lead to financial ruin. In the UK the same medical condition would leave only the taxpayer out of pocket, but the health outcomes would almost certainly be less good. That means, when it comes down to it, shorter life expectancies for people with these conditions, either because of wait times, or simply lower-tech treatment methods. The truly staggering costs of the very best care for long-term but survivable chronic illnesses are a huge problem for everyone, and its a problem no system solves well.
Warren, I’ve always had a visceral loathing of government as an institution. If it’s coming out a bit more lately, it’s because it appears to me that our government is finally starting in on the transition from “occasionally symbiotic” to “open predation”, which even the best, (Least worst, anyway!) of governments are susceptable to.
Take the TARP fund: It’s now official, you don’t get to pay the funds back if the government would rather you remained in debt to it, and thus dancing to it’s tune. (And, remember, some of those institutions didn’t get to refuse the funds in the first place!)
I think we’ve passed the tipping point, where the power of government relative to the private sector has grown so much that there’s no effective countervailing force. Something is going to vanish in the next few years, that’s never coming back, and I mourn it.
“It doesn’t have to make a profit.”
Neither do private charities. For profit business isn’t the entire private sector.
Shorter Brett: “There’s just something about that boy Barack I don’t like.”
I think we’ve passed the tipping point, where the power of government relative to the private sector has grown so much that there’s no effective countervailing force.
Better tell the Goldman boys, ma; they’re gonna have to get out of the Treasury by nightfall!
Brett, I’m not sure I agree with you (and I am sure I don’t know enough about TARP to effectively disagree with your characterization), but I do think your most recent comment is massively more compelling than any of your previous metaphorically violent emotional outbursts.
Similarly, I do not approve of, or find rhetorically effective, Jes’s response to your recent comment (especially ascribing to you the use of the incendiary term “boy”), though – again – a more reasoned comment expressing a closely related position (explaining the similarities between the economic and government power policies of the current administration and those of its recent and its earlier predecessors, for example) might stand an excellent chance of convincing me.
“Private businesses at least don’t routinely threaten to shoot people who cross them.”
Private businesses aren’t run by people chosen through election, by the people, of the people, and for the people.
Why do you hate democracy, Brett?
Simon K: As someone who has experienced both the British and American healthcare systems, I’d like to make a couple of points to those of you singing the praises of the NHS. Don’t get me wrong – I think its an excellent system – but it could be improved and its drawbacks make and interesting contrast with those of the US.
That’s a very fair analysis, Simon (FWIW, my brother, who has worked as a doctor in several different European nations, reckons the French system is the best one, and the NHS is among the worst in Europe, speaking from the point of view of the ordinary doctor in the system).
ut there is a place where the 2 systems have a lot in common, and its the key point of failure for almost any healthcare system, and that is long-term chronic care.
My great-aunt died a few years ago (seven or eight years ago now): and one thing which impressed me about the system of care wasn’t so much the intensive care unit where she ended up after her first heart attack, six years before she died: it was the care and support she got from the NHS afterwards but also from various local authority services to help her stay in her own home until she died, so long as she kept saying that was what she wanted to do. Obviously she couldn’t have done it without family and neighbors, but we couldn’t have done it without the multiple local services that turned out to be provided at low or no cost, once you knew to look for them: the local authority where my great-aunt lived had figured that almost any level of at-home service was cheaper than round-the-clock care in a nursing home, if the person in need of care – and her family – wanted to stay out of a care facility and was able to do so with help. (As I said at her funeral: she was determined to die in her own home, and she got her way to the end: she was good at that.)
So I possibly have too shiny a view of the services available for long-term chronic care, simply because the only close experience I have had of them has been pretty good – complicated and emotionally difficult at the time, of course, but manageable. Then again: it was manageable because my great-aunt was pretty compos mentis almost to the end, and even at the end, she might not be able to remember what she had for lunch, or if she had had lunch, but she was still very much herself. We were all slightly dreading what would happen when/if she got to the point where she couldn’t function at home.
Since you insist on asking, because democracy is a sad, sad substitute for freedom. On a statistical basis, I suppose we might prefer that the majority oppress the minority, rather than the other way around, but shouldn’t we really prefer that nobody gets oppressed?
“I have never understood why Republicans are not behind universal health insurance.”
Can’t speak for Republicans but I can try for conservatives.
It depends on what you mean by ‘universal health insurance’. I’d prefer universal catastrophic health care insurance for instance.
First, there is the question of innovation in health care. Certain types of universal health insurance would squash it. I would want to avoid that for the most part. I would suggest that ‘universal health care’ pay for only treatments older than a certain number of years (7-10) unless the new treatment is cheaper than the old treatment.
Second, there is a question of what care will be paid for. If we want health care to be cheaper we are going to have to develop an ethos that doesn’t involve spending tens of thousands of dollars on lots of people’s last 6 months of life. That is going to be a very hard sell.
Third, and this is a slightly different topic, I’m becoming increasingly disenchanted with the “Shorter X” format. It is sort of ok when the shorter version really a non-ridiculous reduction of the argument. But, using it to not-very-cryptically Brett a racist is not acceptable.
I realize that it’s a tiny point, a little bit of trivia in the vast ocean of complexity that is a health system, but I was quite struck a few years back when my grandfather spent a couple of years dying of congestive heart failure and was sent home with a device I’d never heard of before, an oxygen generator. This was a (moderately noisy, unfortunately) bix heavy box that you plugged into the wall and that supplied an enriched flow of oxygen to a mask, so he could rest near it without having to worry about exhausting or changing oxygen tanks.
As I said, I’d never heard of such a machine, and so I Googled around a bit (not actually finding all that much). But one very small fact that I did find stuck with me: when a Briton is prescribed an oxygen generator on the NHS, they are also given a tiny stipend that pays for its (extremely modest) electricity usage, lest they feel financially burdened by this contribution of their treatment to their bottom line.
As I said, it’s a single little factoid, and it’s a negligible amount of money. But it also speaks to a philosophical outlook about how you try to provide medical help that is quite different from what we see here in the US.
I suppose we might prefer that the majority oppress the minority, rather than the other way around, but shouldn’t we really prefer that nobody gets oppressed?Of course, our democracy, as constituted, contains protections for the civil liberties of unpopular minorities and combined different forms of representation and some supermajority requirements that can together give larger minorities significant influence.
More importantly, the question is not whether “we really prefer that nobody gets oppressed”, wihch I hope we can agree on, but how to express that desire in a system of government. On this subject, I refer you to Churchill:Many forms of Government have been tried and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time.
But, and this is the important but, for those who can afford it the US system does produce much higher levels of service and much better health outcomes
Simon, thanks for your thoughtful comment.
What I’d like to say about the specific point I quote here is that, as I understand it, under Obama’s or any other imaginable plan, those who can afford it would still be able to buy a better level of service than whatever is offered as the universally or near-universally available standard.
In this country, it is quite common for people to forgo necessary care and die, or to be forced into bankruptcy by unexpected accident or illness. Quite common.
As far as I know, nobody is trying to take “cadillac care” away from wealthy people. If you have the money, live it up.
As I understand it, the goal folks are trying to accomplish is to make access to basic health care available to as near to everyone as we can manage.
If you’re rich, I’m sure you will still be able to buy excellent care for yourself, and I’m sure that enterprises looking to attract high-demand talent will continue to offer high-end health benefits as part of a deluxe compensation package.
We’re just trying to make it possible for pluggers to not, frex, lose their homes if, again frex, they get cancer, or a spouse or parent ends up needing 24/7 care. Those things happen everyday.
Are you seriously suggesting that any kind of private charity would be able to provide a functional and universal alternative to either for-profit or government-funded health care?
Really?
I will eat my words if you can describe for me a plausible way in which any nonprofit charity could sustainably provide even basic preventative health care–yearly checkups–for 300 million people. I defy you to even try. Please show your work; argument-by-assertion is not acceptable.
Hilzoy,
You are completely wrong here, economically speaking.
Of all the Medicare beneficiaries who receive coverage under the plan, diabetics -primarily Type II adult-onset – comprise about 10%
Yet of all the Medicare expenditures made as part of this coverage, diabetics account for nearly 40%!.
Do the math.
Type II diabetes is primarily caused by the patient, due to obesity (and old age). This is not lukemia, or Parkinson’s, or name-your-random disease.
The vast amount of expenditures does not go to antibiotics or guaze pads or scalpels. It goes to expensive cardiovascular and orthopedic interventions in our fat, old, and dying populace. Yet you want to spend more.
Given that most Republicans and conservatives are strong supporters of the military and its internal workings, you would think there would be a lot of opposition to the government-run Veterans Administration, which provides comprehensive health care to veterans.
I’m not trying to argue that the VA is an example of outstanding health care in all respects, but if universal care is good enough for our war heroes, how can it be so bad for the rest of Americans?
I don’t agree that that necessarily follows. What you’re describing is one possible balance of priorities. There are others.
First, the thing that bloats the cost of our current system the most is administrative overhead. Every serious plan I’ve seen addresses that in some fashion.
Second, I don’t see how it’s useful to start with the assumption that you’re going to have to provide worse care. Making health care cheaper is certainly a big priority, but I would argue that given the choice between making it cheaper and making it universal, the universal part wins. And again, I still think this is a false choice.
“Since you insist on asking, because democracy is a sad, sad substitute for freedom.”
I don’t mean to pile on, Brett, but if you really want to live in your ideal world you’re going to have to move to some other country. I’m not asking you to go, I’m just pointing out that whatever it is you’re looking for, you’re not likely to find it here.
Maybe somewhere back of beyond — the UP, somewhere up in the Idaho panhandle, out by the Four Corners somewhere, way up in some shaggy corner of the Appalachians.
If you go that way, bring your gun. You’ll want it.
If you want to live around other people, you’re going to have to accept limits on your own, personal freedom. There ain’t no way around it.
Good luck.
Doctor Science: What I *really* don’t understand is why the Small Business Association and similar groups aren’t totally on the UHC bandwagon. Speaking as someone who’s been part of a very small business for 8 years now, the need for affordable health insurance is a constant worry, and one of the biggest barriers to starting a business. It would be completely to small businesspeople’s advantage for access to health care to be separated from employment, so why aren’t they for it?
Good question. After a little digging on the National Small Business Association site, it seems like they want to make carrying health care mandatory but keep the industry private… give tax incentives. While the link above is broad talk of reform, it appears they are also specifically urging members of Congress to co-sponsor HR 1470.
To be honest, I don’t know how representative the NSBA is of anyone other than the most active of small business owners. Their claim that they represent 70 million people in the U.S. who are either small business owners or employees of small business owners seems, well, slightly self-aggrandizing. Forced to wager an answer to your question, I would guess that NSBA operates as a lobbying arm of, again, the most active small businesspeople, and their efforts only represent the interests of a small subset of those 70 million.
It should also be noted that they are coming out hard against EFCA.
Enforcement and recognition of those freedoms (particularly in this country) has been through the judicial process, which has engendered cries of judicial activism.
I’m not certain you’re putting two and two together and recognizing how connected freedom and prevention of the tyranny of the majority actually are.
“First, the thing that bloats the cost of our current system the most is administrative overhead. Every serious plan I’ve seen addresses that in some fashion.”
Are you certain? My understanding was the the two main price differences between our health system and most European ones is 1) doctor and nurse salaries, and 2) end of life care.
Catsby:
I don’t see how it’s useful to start with the assumption that you’re going to have to provide worse care.
A point that should be made over and over. There are a lot of interlocking sets of priorities and different balance points between them. One of the most obvious is targeting spending on preventative care. A lot of that spending pays long term financial and health dividends.
“The government DOES only exist as a method of coercion. It brings nothing else, AT ALL, to the table, when approaching a problem, which isn’t available to the private sector. Coercion might not be all the government does, but it’s all the government does that somebody else couldn’t do just as well.”
This is, of course, total nonsense. The government does countless things that are necessary to be done for the good of endless common people which can’t be done by private industry because there’s no profit in it.
See, for example, the history of rural electrification, rural postal service, supplying emergency room services for the uninsured, the food stamp program, Medicaid, providing an Air Force and military, giving police protection to the poor, running public schools for those who can’t afford tuition, etc., etc., etc.
Most of the point of government is to do that which other entities can’t/won’t do.
Can you actually cite doctor salaries in the US versus doctor salaries in (for example) France or the UK, nurse salaries ditto?
End-of-life care costs are likely so far dependent on a multitude of other factors that I’m not sure it’s reasonable to compare between France and the US: average life expectancy is noticeably better in France, which suggests that regardless of what the US spends in the last six months of life, France’s overall healthcare for the whole of a person’s life is better.
But first, I think you’d have to show that the entire monstrous addled bureaucracy of US healthcare is somehow cheaper to run than the more streamlined versions elsewhere…
Yeah, just as libertarianism is a sad, sad substitute for solipsism.
–TP
Sebastian:
I don’t see how administrative costs — especially the costs of dealing with insurance companies, and also their profits — can *not* be a major component of US medical costs, in excess of spending in civilized countries.
If we had single-payer, universal, no means test health care, we wouldn’t be spending money for:
1. people at insurance companies (including doctors) evaluating whether they’ll pay a given claim. Turning it down, arguing with patients, arguing with doctors.
2. people in doctor’s offices (including both nurses and doctors) arguing with insurance companies. The small family practice I go to — 3 MDs, a couple of physician’s assistants — has 3 full-time equivalent nurse admins solely for dealing with insurance companies. That’s not counting the people who work at the front desk and in the records room.
Hospitals have entire departments to do this. There are about 4 pharmacists at my local drug store, at least one is on the phone to an insurance company at any given moment.
3. Time spent by patients (like me) and human resources departments arguing with doctors and insurance companies, trying to get promised or implied coverage. Time spent by HR and business people debating what insurance coverage to get, on hold with insurance agents, writing letters, etc. Filling out forms, sending them in, filling them out *again*.
4. Insurance company profits.
“I really think Brett needs to calm down and reassess his views of government. I mean, I get that he’s a conservative and skeptical of government,”
Brett’s not a conservative; he’s a libertarian. He’s always used this language, which is typical of immoderate libertarians.
For the extreme libertarians, government is nothing but a jackbooted heel coming to shoot them and take away their freedoms. Weird, and blind, but that’s their view.
Regrettably, their noise and numbers swamps from view the relatively small number of sane libertarians (see, e.g., Jim Henley, Julian Sanchez, Radley Balko, etc.).
The great Catsby? 🙂
Are you certain? My understanding was the the two main price differences between our health system and most European ones is 1) doctor and nurse salaries, and 2) end of life care.
Pretty certain. I’ve seen data for this multiple places, but the only link I can find on short notice is this.
1. higher prices for the same health care goods and services than are paid in other countries for the same goods and services;
2. significantly higher administrative overhead costs than are incurred in other countries with simpler health-insurance systems;
3. more widespread use of high-cost, high-tech equipment and procedures than are used in other countries;
4. higher treatment costs triggered by our uniquely American tort laws, which in the context of medicine can lead to “defensive medicine” — that is, the application of tests and procedures mainly as a defense against possible malpractice litigation, rather than as a clinical imperative.
1. Salaries figure into this somewhat, but the real culprit here is bloat from drug company patent monopolies and kickbacks.
2. My point. Single payer would take a huge bite out of this, but our system is so abominably lousy with red tape that there are plenty of efficiency savings to be realized from solutions short of that.
3. I don’t view this as necessarily being a bad thing. Many high-tech treatments have value added that make their increased cost both reasonable and a good value. Some are bloat. Not everything that’s high tech and more expensive is wasteful.
4. A problem that has more to do with our legal system than it does with the method of providing health care per se. But again, not always a bad thing: I’m of the school of thought that when in doubt, it’s better to get checked and tested than not–as I pointed out upthread, many many conditions are more cheaply and effectively treated if caught early.
“A private oxygen supply is the logical conclusion of all this. I’m sure it’s been a feature of a dystopian science fiction novel or two.”
In The Moon Is A Harsh Mistress, prior to the revolution, you had to pay “air money” to the Lunar Authority. I don’t recall offhand if it was stated how this was handled after the revolution.
However, custom says you give air to anyone who can’t afford it, until they can pay you back:
TMIAHM is, for those unaware, generally extremely highly regarded by most libertarians. It’s also actually one of Heinlein’s best books.
Bah, blockquote got eaten. The following is quoted from the article I linked:
Speaking of blockquotes, how feasible (or desirable) would it be for the ObWi mods to add a bordered blockquote style to set it off from comment text a little better? I’m thinking of something like the one they use at DKos, which is both unobtrusive and effective.
I’ll be happy to provide the CSS if necessary.
“When acts of God ruin like hurricanes or earthquakes ruin people’s lives, we step in to help.”
You can step in all you like. You have no right to force me to pay for other people.
There are 2 ways to obtain medical care:
By voluntary means (paying for it yourself, insurance or charity) or by coercion.
Interesting that most liberals would never point a gun at someone to get something for themselves, but it’s okay if Barney Frank or Obama does it for them.
Why don’t you liberals be honest and admit that the government operates like the mafia? Pay up or bad things will happen to you.
Kindly tell me the distinction between taxation and theft. And spare me your ends justifies the means utilitariansim.
You, too? I thought I’d just managed to do something really dumb twice in one comment, above …
I’d really like to see how the fire department and the police operate in Mark’s world …
“I will eat my words if you can describe for me a plausible way in which any nonprofit charity could sustainably provide even basic preventative health care–yearly checkups–for 300 million people.”
Why would any charity have to provide basic preventative health care for 300 million people? Most Americans can afford to pay for it themselves. Low cost providers like Wal-Mart charge as low as $59 for a basic checkup. Also, yearly checkups are a waste of money for most young and healthy people.
And again, this is the liberal utilitarian argument. It’s okay to coerce people for a good cause.
Jes – thanks for your follow-up. I agree with your brother on the perspective of ordinary doctors. As I’ve seen it operate the NHS is hell on earth for junior doctors and nurses, and sadly there is almost no such thing as a senior nurse any more. There’s no job security, the hours are horrible, and the pay is terrible. Doctors, once they acquire seniority, have a much easier life, partly because they can then take private patients.
Local authority health services are distinct from the NHS, although obviously closely related. They can be excellent, and they can be terrible because there is still some difference between jurisdictions. The British don’t take well to federalism – it creates inequalities than people don’t like – so I’m not sure how long this will last. But that kind of care isn’t quite what I was thinking of – I was thinking more in terms of things that would require health professionals over long periods of time eg. degenerative illnesses, serious mental health problems, and so on.
russell – Although I may have sounded down on it, I actually think the trade-offs in the British system are made better than they are in the US one. But its very reflective of a difference in values between the two political systems – the British like equality of provision, Americans generally want the best for themselves. The tradeoffs in the NHS wouldn’t be sustainable here, which isn’t to say some kind of mostly-single-payer system wouldn’t be – it would just look different.
That said, the issues with state provision aren’t limited to Cadillac (or Rolls Royce) levels of care. That’s why I threw in the remarks about my brother’s bachelor party experience (my bachelor party, as it happens …). The difference permeates the whole system – the NHS will give anyone cost-effective treatment for anything, the US system will give those who can pay, or who are insured for whatever it is that’s wrong with them, the very best care available. The ethos is quite different, and it pervades the whole way healthcare is administered. In the US its impossible to get low-cost care even if your only problem is mildly excessive alcohol consumption. In the UK its impossible to get the very best care technically possible for certain conditions.
I should explain that last point because I wasn’t totally explicit about it before. When a single payer buys almost all healthcare based on a uniform assessment of its cost effectiveness, anything that it chooses not to pay for automatically has very few customers. It therefore becomes more expensive and in many cases totally unavailable. This doesn’t just mean cadillac levels of care for the rich and old, it means (for instance) certain malaria medications for travellers, certain vaccination regimes for children, and so on.
Its essential to see the tradeoff here clearly: The UK system achieves universal coverage very efficiently, at the expense of measurably poorer health outcomes for all patients, compared with the US system. Those poorer health outcomes are politically acceptable in the UK because they occur only at the margins – those who are extremely unwell, extremely old, extremely young or extremely rich have measureably smaller life expectancies.
I don’t think that particular tradeoff would work in the US. In particular the old and the rich (and the old and rich) have much more political clout here. I don’t know the details of the French system, but since it more freely allows mixed state/private payment for care, it might well be more politically acceptable in the US.
Simon K: Those poorer health outcomes are politically acceptable in the UK because they occur only at the margins – those who are extremely unwell, extremely old, extremely young or extremely rich have measureably smaller life expectancies.
Though FWIW, the UK does have better life expectancy on average than the US. (It’s not nearly as marked between the UK and the US as it is between the US and France, though – and I seem to remember it’s fairly recent.) The UK also has a lower infant mortality rate and a lower maternal mortality/morbidity rate than the US.
Warren,
Try reading some Murray Rothbard or Hans Hoppe. They describe in great detail how an anarcho-capitalist system would work.
We know how the police operate in our system already. Millions arrested for victimless crimes, people tasered to death, constant police lying, coverup of police crime, etc. Nice, huh?
Private fire departments could operate on a prepaid insurance basis or you could pay for services after the fact.
Just because something is not commonly done now, does not mean it is impossible. I’m sure people in the former Soviet union wondered how they could possibly eat if government run grocery stores were abolished.
Sure we do. There’s even a name for it. Starts with a T. I’m pretty sure there were some wild parties recently complaining about it. It’ll come to me.
I await your description of how we have no right to force you to pay for other people’s roads, other people’s defense, or other people’s schools, or other people’s public defense attorneys, or…
Tweeeet. False dichotomy, 10 yard penalty.
If you want to tilt at windmills by complaining that you have to pay taxes to fund FEMA and Interstate 5, that’s your hobby and it’s your right to waste your time and money on it. Mine is Legos. But when it comes to the right of the federal government to raise taxes to fund programs for the common good, that ship sailed a long time ago.
This question is so silly as to defy description. And responding to it is probably a waste of time. But for the sake of any would-be-libertarians out there who might think this sophistry clever: the difference is law.
Taxation and theft both constitute taking property or value from one person or entity, and giving it to another. In this they are similar, just as a cop shooting an armed suspect and the armed suspect shooting the cop both involve using a firearm to take the life of another. But few people would argue that the cop–assuming that this was a lawful shooting–committed murder. Even fewer would argue that the suspect shooting the cop was not.
The reason for this distinction is that one act falls within the boundaries of what we, as a society, have agreed is lawful, and one does not. One is an action that, while regrettable, generally makes us safer and more secure as a society, the other does the opposite. There are all sorts of things that are good when lawful, bad when not, even if on some level the underlying action is the same. Context–and law–matters.
Just so, while few people like paying taxes, and even fewer agree with everything their taxes pay for, there is near-universal agreement that taxation per se is a legitimate power of the state. I don’t like paying taxes, but I recognize that they pay for civilization. You might have heard of it. We live in one, and taxes make that–including the worldwide network on which you’re currently regurgitating this pseudo-Randian garbage–possible.
You don’t have to like it. But FFS, “how are taxes different than theft?” is on the intellectual level of “if God loves us, why is there evil?” Been there. Done that. Moved on.
Hilzoy: if you want to hear an anti-state argument on health care that doesn’t begin & end with “corporations YAAAAY!”, here’s one.
I’m actually fine w/ the general concept of collective provision for this type of stuff in principle. What I don’t get is why the discussion is limited to government vs mega-corporations, when they’re just two sides of the exact same coin. How ’bout neither?
Jes – You’re absolutely right that overall life expectancy, infant mortality and so on are better in the UK. I meant to emphasise that the UK acheives measureably lower health outcomes compared with the US *for those with access to the healthcare*. The qualifier is very important. Obviously the 50m Americans who don’t have routine access to healthcare, and the larger number whose access is constrained or intermittent, have a substantial impact on the overall statistics.
And why is this thread turning into another incarnation of the same discussion of anarchocapitalism that’s been flitting around the internet since the days of green screen terminals? We’re not going to reach any different conclusions this time …
Mark, there are excellent reasons why public services are charged to the entire public and not charged after the fact to those who use their services; for one thing, if you only paid the fire department after you had a fire not only would the fire department’s incentives be all fouled up but most likely you’d be unable to pay the costs of the fire. And If I am unwilling to pay the fire department, I guess my neighbors have got some problem, huh?
And I really don’t want to live in a world where people only go to the police if they’re wealthy or if they’re certain their situation is sufficiently bad to justify the additional expense incurred by contacting the police. It’s bad enough having the police we’ve got now, with all their problems, especially if you’re poor, or black, or gay; I don’t look forward to needing the police and being prevented by my own poverty or even directly outbid by the people who’ve wronged me.
P.S. I’ve helpfully hyperlinked the above word “neighbors” because exponents of libertarian philosophies so often seem to have trouble with the concept.
Catsy I’m more skeptical of your understanding now than I was at the beginning.
“Salaries figure into this somewhat, but the real culprit here is bloat from drug company patent monopolies and kickbacks.”
Even taking away 100% of the drug cost in our medical system saves you only like 10% of the cost. (See for example here And I don’t think you believe that drugs cost $0 even after the research has been paid for. So if we are only getting rid of the patent monopolies and kickbacks, I suspect that your mindset about where the real savings are is skewed.
It is kind of like Republicans saying that they are going to balance the budget by getting rid of earmarks. Either you don’t understand how big the budget is, or you don’t understand how big the earmarks are.
Quitter!
“Neither do private charities. For profit business isn’t the entire private sector.”
Setting aside that private charities can do relatively little compared to governments, due to their relatively tiny sizes, private charities can’t pay out more than they have coming in; government, on the other hand, can run various endeavors at a loss. (Yes, yes, by having jackbooted agents ruthless put guns to the heads of kittens and children of taxpayers, etc.)
“Since you insist on asking, because democracy is a sad, sad substitute for freedom.”
Freedom to be bankrupt and die from lack of health care, or merely suffer greatly, is a poor substitute for the benefits of democratic government.
Glossing the not-small distinctions between democracy, especially a democracy with various guarantees of individual rights, and dictatorship is an unbelievably huge gloss.
Really, Brett, if you feel so strongly that you lack “freedom” (and what is it, exactly, specifically, that you lack so badly that it compares to the lacks of hundreds of thousands, if not millions, of people in situations comparable to Kate Michelman’s?), why don’t you move to a more free country? Which one do you think is more free? If there is one, why not move? If there isn’t one, why do you think that is the case?
Kindly tell me the distinction between taxation and theft
Universal suffrage.
Because that’s the only way you can make any kind of meaningful comparison between the effectiveness of a charity providing universal health care vs. government providing the same? That was the topic under discussion, after all.
And yeah, I thought the idea was idiotic too.
Then again, so is this.
Surpassed only by this.
I can’t decide whether Mark is spoofing or just uninformed. Survey says?
Catsy just about said it all to Mark, and better than I could have. So let me make just one additional point.
If you can find 50% + 1 of the votes needed to enact your system of government, you win. Rural San Diego county, for example, has gone years without paying for region-wide fire coverage. Recent wildfires are causing friction (ahem) between the low-tax and the government-fire-response communities.
On health care, we as a country decided a long time ago that no one would be denied essential medical care due to lack of ability to pay.
If you want to change that decision, go find the votes.
“And again, this is the liberal utilitarian argument. It’s okay to coerce people for a good cause.”
Yes. America: love it, or leave it. Why do you hate America? Why not find a place where there are no taxes, and no government that imposes “laws”?
You’d obviously be happier. So, go find such a place.
Brett:
What I honestly don’t understand is why you’re more frightened of the government than you are of the medical insurance industry. I wrangle with some government agency maybe once a year, twice if you count taxes automatically; I wrangle with a medical insurance company or their effects at least once every six to eight weeks.
I have not been personally *afraid* of what the gov’t will do, even when we discovered we owed $2K for last year — they can cope, they’ll listen to reason. I have been *afraid* of insurance companies, I have had to experience direct physical pain because of their decisions — like, for instance, not approving a medication I need before a weekend. Or the time when my coverage lapsed for a month, and I had to cut back on my meds to skirt the edge of illness. Or my husband being in constant knee pain but the company not having agreed to surgery for him, because it hasn’t hurt *enough* yet.
You say the government works by coercion and the frequent threat of violence, but I honestly do not see that as realistic threat. The threat I feel from medical insurance companies is direct and personal, a matter of my daily health. What Kate Michelman is experiencing — what Gary Farber here is, for another — is closer to a literal life-and-death struggle.
Are you saying that this isn’t familiar to you, either personally or in people close to you?
I have no idea how this is being justified. Certainly I can’t think of any compelling reasons for why this would be the case.
Matt C — Type II diabetes is primarily caused by the patient, due to obesity (and old age)
??!
I’ve often said that conservatives really want to watch people starve to death in the gutters. Thank you for demonstrating this.
//If there was a way of ensuring that black people didn’t get it, we’d have had national health care by 1970.
SS only got through Congress when originally passed (1935?) by excluding most domestics and agricultural workers.
Wonder who they were….
Posted by: Davis X. Machina | April 20, 2009 at 10:48 AM//
It was southern democrats, according to wikipedia. “Some have suggested that this discrimination resulted from the powerful position of Southern Democrats on two of the committees pivotal for the Act’s creation, the Senate Finance Committee and the House Ways and Means Committee.[citation needed] Southern congressmen supported Social Security as a means to bring needed relief to areas in the South that were especially hurt by the Great Depression but wished to avoid legislation which might interfere with the racial status quo in the South. The solution to this dilemma was to pass a bill that both included exclusions and granted authority to the states rather than the national government (such as the states’ power in Aid to Dependent Children). Others have argued that exclusions of job categories such as agriculture were frequently left out of new social security systems worldwide because of the administrative difficulties in covering these workers.[20]”
Glad I could help you with that.
I’d like to point out that many republicans reject UHC because they don’t think it will work in America…not because they hate helping people who fall victim to acts of God.
Ddddave, surely you should have more self-respect than to bring up this whole “The Defenders Of Racism Before 1965 Were Democrats” story as if this sad legacy were the defining feature of the modern Democratic party?
Yup, racist Southern Democrats were scum (the hint is in that first adjective there). But the Democratic party rather emphatically broke with that legacy; that’s how LBJ famously “signed the South away for a generation or more”. And that’s how Nixon, and his heirs Atwater, Rove, and Bush picked up the South, which they largely hold to this day. Some of them even explained their strategy to do so in plain language.
It would be unfair to the modern GOP to say that it is defined by its embrace of Southern racism (or, these days, other rural intolerances, such as for homosexuals, Muslims, and Atheists), but it is far more true to say that the taint of Southern racism is a problem for the modern GOP than to say that it is a problem for the modern Democratic party.
“Glad I could help you with that.”
Do you know anyone unaware of the racism of the Dixicrats? Do you believe anyone here is unaware of the racism of the Dixicrats? If so, could you name such people, please? If not, what’s your point?
But there is apparently someone unaware of what happened to the Dixiecrats after the Democratic Party became less congenial for them — or at least someone who pretends to be unaware and hopes others are as well.
I don’t think it’s that hard to understand. Most philosophical conservatives (not to be confused with the ideological monstrosity that calls itself the GOP) don’t have a problem with inequity in society; they are more concerned with maximizing individual liberty and limiting the role of the state. Their opposition to universal health care flows naturally from those two premises. I don’t agree at all, but I don’t find it unfathomable either.
Well, I would prefer to call an argument like that something along the lines of “un-informed”, as opposed to dishonest or deceitful; I like to think the best of people…
Give me a break. When Davis X Machina asked “Wonder who they were….?”, do you really believe he was suggesting it was democrats? I was just responding to him.
Administrative costs are a large part of what we are buying. Most doctors are now in group practices or at large clinics. Those groups or clinics have a large staff of people whose only duty is to deal with insurance companies. Virtually every claim is refused when it is first presented, and some have to be sent back with minor (and I do mean minor) tweakings. This isn’t free, and ultimately our bills, regardless of how we pay, include the cost of these people’s salaries.
I was astonished to find this out. I had thought it was a problem faced only by “alternative” practitioners, like massage therapists, for instance. But my family doctor explained it to me.
“Give me a break. When Davis X Machina asked ‘Wonder who they were….?’, do you really believe he was suggesting it was democrats? I was just responding to him.”
No, I believe he was suggesting that “most domestics and agricultural workers” were African-Americans. That’s grammatically what his sentence says, given the antecedent of “they.”
Why you think he was referring to anyone else, I have no idea.
Actually, it’s pretty clear that Davis X Machina was asking who the domestics and agricultural workers were, and not who the lawmakers insistent on excluding them were.
The comment again:
Surely you agree that “they” there refers to the Workers, and not to Congress, especially as Davis doesn’t even refer to any faction within Congress?
Guys, if he doesn’t know what a double negative is, he surely doesn’t know what an antecedent is, which is why I suggested previously that he leave grammar to the grammarians.
[I haven’t been able to get this comment through for a while, so a few bits have already been said, and better, but at this point it’s a sunk cost issue, so . . .]
“That’s pretty nasty, wanting people to die who could pay for the life saving treatment out of their own pocket.”
Besides the not really true bit, one could also say, if responding in kind, ‘that’s pretty nasty, wanting people to die just because they can’t manage to pay for life saving treatment out of their own pocket?’ (And, of course, wanting people driven into bankruptcy, forgoing necessary care so they end up with much more serious (and costly) conditions, etc.)
“Since you insist on asking, because democracy is a sad, sad substitute for freedom.”
Sure. Likewise, capitalism or mixed economies are sad, sad substitutes for a utopian paradise where “from each according to [their] ability, to each according to [their] need” actually worked. But in the real world . . .
Which is where we live, almost all of us in extremely complex, densely interdependent, and quite crowded societies. Even hunter-gather societies aren’t “free”; it’s hard to imagine how we’d manage it at this point in time.
And, of course, it seems incomplete to only look at governmental constraints on freedom, as opposed to also considering those chains forged by any other kind of oppression, stemming from any other imbalance of power. Gov’t saying ‘pay taxes or go to jail’, etc. is a constraint on freedom, but so is being born into poverty, or as a despised minority, or facing megacorporations unrestrained by regulation, or facing certain kinds of widespread environmental problems, etc. (But of course, that’s why I’m a modern liberal).
“kindly tell me the distinction between taxation and theft. ”
Well, for starters (assuming we’re talking U.S.-style taxation), one usually doesn’t get a voice (to whatever limited degree, granted!), alongside ones neighbors, regarding who the thieves will be, how much they’re going to take, and how the money will be used & re-invested in one’s neighborhood. In fact, surprisingly enough, thieves rarely steal money in order to (granted, in part) improve the neighborhood, defend it against internal & external threats, aid commerce, and improve the general welfare; those few highly organized criminal organizations that make even the slightest gesture in this direction gain, I’ve always heard, a lot of (uneasy) support, because they’re in fact providing services that legitimate government can’t or won’t (even if because of their own actions).
Mark and Brett owe me money.
Every move they make costs me.
But, I’m a gonna let it go this time.
But there will come a day, and I will come to them and I will ask them for a favor, and they will do me that favor, because I have asked nicely.
Gary and Warren, I stand corrected.
Phil, I’m sure there are things you don’t do well.
“Stressed Americans postpone healthcare
“WASHINGTON (Reuters) – Twenty percent of Americans say they have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason, according to a survey released on Monday. . . . “We are seeing a positive correlation between Americans losing their access to employer-sponsored health insurance and deferral of healthcare.”
Why don’t you liberals be honest and admit that the government operates like the mafia?
Is there a Godwin analogue for mafia references?
I was going to respond to this by saying “agents of the government don’t remove your teeth with pliers”, but I’m not sure that’s true anymore.
Nice Info. I like it. It is very important to stay on top of your health and have a check up at least once a year to ensure that you remain healthy. Many health problems are curable but you need to catch them in time. Do not wait to go see a doctor because it may be too late.
Phil, I’m sure there are things you don’t do well.
Countless things. I try not to open my mouth about them, lest I look dumb.
The government doesn’t remove your teeth with pliers? It prison rapes you, and then treats it as a joke; Is that good enough?
Look, democracy might indeed be the “least worst” form of government. And if we had a choice between the health care system being run by democracy, or a hereditary monarchy, the choice would be easy enough.
But democracy being the best of the worst doesn’t mean squat when the choice is not which form of government will do something, but whether a form of government will do it, or it will be done some other way.
So, I will say, among forms of government I prefer democracy, but I prefer freedom to democracy. Living in a democracy doesn’t mean you have to vote on EVERYTHING. In fact, the more you get to individually decide on, and the less you have to vote on, the better.
Im lucky enough to live in the UK where we have the NHS, although it is somewhat of a dated service i have chosen to taken the additional cover of health insurance providing me with shorter waiting times and the best medical facilities
Brett: So, I will say, among forms of government I prefer democracy, but I prefer freedom to democracy.
…okay, Brett, I’ve found the ideal place for you to live: Howland Island. You’ll still have to deal with the infringement on your freedom of a government department visiting briefly once every two years, but other than that, you can be as free as you wish. Bye bye, Brett.
“I was going to respond to this by saying “agents of the government don’t remove your teeth with pliers”, but I’m not sure that’s true anymore.”
But using regulation pliers, and not more than one tooth within a 24 hour period, to allow the subject to rest* in between sessions – so it’s all ok!
* well, not rest, but . . .
“ In fact, the more you get to individually decide on, and the less you have to vote on, the better.”
I’d say there are, at least, strong arguments for this. Personally, I’d like to decide to have reasonably safe and/or well-labeled food &medicine, a relatively clean environment, a basic safety net for my neighbors, fairly good public transit, some basic provisions against malfeasance in high places, and some limits on the ability for random folks to easily obtain rocket launchers and such.* Ok, so what do I do? Squeeze my eyes shut and concentrate really hard, like Hiro on Heroes?
(I am totally with you when it comes to yard care, though).
* YMMV
“a government department visiting briefly once every two years,”
Oppression!!! Guns being pointed at one’s head!!! Etc.
Brett:
In case you didn’t see it, I still have a question for you on the floor:
What about your *experiences* makes you more afraid of the gov’t than of the medical insurance industry? Do you actually deal with the latter without fear, without feeling a direct, personal threat?
The government doesn’t remove your teeth with pliers? It prison rapes you, and then treats it as a joke; Is that good enough?
It strikes me that you’ve lived under bad forms of government so long that you’ve forgotten the possibility of good government. Most western governments do not imprison the large proportion of their population that the US does, because most countries do not have the commercial prison-industrial complex that the US has. Most countries do not treat prison rape as a joke, instead they try to prevent it. I live in the UK, under a government that you would doubtless consider absurdly restrictive. I however like having a government providing a police force that helps to protect me, since I’m not sure I could afford my own private armed guards to do so. (And my eyesight’s bad enough that you really wouldn’t want me having a gun).
Mark:
Warren Terra pretty much covered this, but does anyone really need to point out the problems with paying people by the number of fires they put out or the number of burgled homes they investigate?
Also, how is old age a patient’s fault? Should we all step in front of buses at 60? Or perhaps we should be set adrift. I will agree that measures to prolong a life by a few weeks are often pointless, but using insulin to add many otherwise healthy years to a life isn’t.
The government doesn’t remove your teeth with pliers? It prison rapes you, and then treats it as a joke; Is that good enough?
Actually, that is among the places I was going with that comment.
But using regulation pliers, and not more than one tooth within a 24 hour period, to allow the subject to rest* in between sessions – so it’s all ok!
That’s another.
So, I will say, among forms of government I prefer democracy, but I prefer freedom to democracy.
Your argument here seems to assume that no government equals freedom, for some useful definition of freedom.
You might want to consider if that is actually so, and/or if there is any evidence that it might ever have been so, or could ever be so.
The only scenario in which I can imagine “no government” being equal to “freedom” is if there are either no other people around, or if you can solve the problem of other people being around by going someplace else.
Otherwise, “no government” generally means the guy with the biggest gun gets his way.
Unless you happen to be the guy with the biggest gun, that’s not really freedom in any meaningful sense. Even if you *are* the guy with the biggest gun, it’s probably not really freedom in any meaningful sense.
That’s not freedom, it’s organized crime. Real organized crime, not penny ante “they made me pay my taxes” organized crime.
Can you give me any example from the entire history of the human race where people lived together in populations greater than, say, 100, without some kind of government?
By “government” I mean some mutually agreed upon set of rules and institutions, where the price of participation meant submitting to those rules and institutions, and a refusal to do so meant you were either punished or had to leave.
I’m looking for one example.
If no such example from, let’s say, the entire Holocene can be found, maybe you should consider that you’re looking for a pony.
So have we abandoned the myth that drug prices are driving health care costs in the US? I mean I’m glad to, but I don’t want to take silence as assent.
I think drug prices end up being a flash point not because they are particularly important in the overall question, but because they are among the few places where average voters end up being exposed to anything like the real costs of health care. That captures the popular imagination, and then you get serious people suggesting that slaying drug companies is going to be a serious step toward saving costs in a national health care system.
We could cut drug profits to ZERO and still have dramatically more expensive US health care when compared to other nations.
The US government already spends about 4.7% of GDP for Medicare and Medicaid.
The US government already spends about 6.6% of GDP on public health care spending. See here
It already has public spending on health care comparable with Canada (6.7% of GDP, and very close to France (7.4% of GDP). It already spends more public money than the UK (6.4% of GDP). This looks even worse when you look per capita, because the US has a higher GDP per capita than almost all the comparable states.
The US government already spends more than enough to have the UK’s rather crappy universal health care system. What’s up with that?
Which is good, because all silence meant was that I went home for the day. Although in truth I don’t know how I can meaningfully respond to criticism of an argument I didn’t make–I never said drug prices were driving health care costs in the US, in fact I never said anything remotely close to that, so I don’t know what myth you’re talking about here. You just seized upon that one single data point and ran with it.
What I said was in specific response to this quoted line, which was one of four things that contribute to why we get less for what we spend on health care than other countries: “higher prices for the same health care goods and services than are paid in other countries for the same goods and services”
To which I pointed out that salaries “figure into this somewhat, but the real culprit here is bloat from drug company patent monopolies and kickbacks”.
Note there that I’m not saying drug companies are the reason health care in America costs so much. I’m saying that patent monopolies and the like are the main culprit in why we pay more for the same goods and services than in other countries. See, for example, the entire brouhaha over people ordering medications from Canada because it’s cheaper there. I’ll give you a hint: it’s not because of the exchange rate.
I would appreciate it if you would refrain from taking one small, specifically-targeted piece of my argument, inappropriately broadening its scope to turn it into the entire argument, and then using that straw man as a reason to disregard everything else I have to say.
Sebastian: The US government already spends more than enough to have the UK’s rather crappy universal health care system. What’s up with that?
As others have already pointed out to you, except you didn’t seem to be paying attention: the US is spending far more than the UK, considered both if you were spending this kind of money per person (which you’re not) and as a percentage of GNP.
There have been fairly subtle and detailed discussions about why this is, in this thread, which you do not seem to have been paying attention to and which I will not summarise for you. But yes: if the political will was there, which it is not, the US could run a universal health service at less cost than it now does, and provide a much better service than the UK.
“To which I pointed out that salaries “figure into this somewhat, but the real culprit here is bloat from drug company patent monopolies and kickbacks”.”
Maybe I don’t understand what ‘the real culprit here’ means in this context.
I was responding to the fact that the real culprit here is most definitely not drug costs.
“See, for example, the entire brouhaha over people ordering medications from Canada because it’s cheaper there. I’ll give you a hint: it’s not because of the exchange rate.”
I’m well aware of why people order medications from Canada. I’m beginning to suspect you don’t. They order it from Canada because Canada doesn’t pay a high enough price to pay for the research costs.
“I would appreciate it if you would refrain from taking one small, specifically-targeted piece of my argument, inappropriately broadening its scope to turn it into the entire argument, and then using that straw man as a reason to disregard everything else I have to say.”
Considering that you just reiterated the exact same argument again, I’m having trouble understanding what other argument I’m supposed to be responding to.
Drug costs are less than 10% of medical spending. US health spending is almost double that of say Canada. Cutting drug costs to ZERO (which surely you understand isn’t possible even in Canada) would still leave the US with about 180% of the Canadian costs.
You keep stressing good and services, without analyzing what the services component means.
You can spend more on services in two ways. First, you can use them more often. We do that in the US health care system. Second, you can pay the people providing the services much more money. We also do that in the US health care system.
That is the real culprit. I don’t know what we should do about it. But I do know that focusing on drug costs isn’t fixing it.
“Your argument here seems to assume that no government equals freedom, for some useful definition of freedom.”
Not at all.
We’re caught on the horns of a dillemna: Governments inherently limit freedom, but the absence of government is not a stable equilibrium. You get rid of one government, another will move in, or simply arise from petty thugs organizing. So anarchy is not feasible.
But that doesn’t imply that we can’t expand the portion of our lives which IS free. We live under a government now, but there are still portions of our lives which are neither constrained by government, nor coerced in other fashions.
We should seak to expand that portion, not contract it.
The key in understanding this has to do with two fundamental ideas.
The first is the term ‘entitlement’ vs. investment. It is cost effective for taxpayers to invest in government provided health care; private providers have been proven costly. In terms of the economy, investing in healthy workers and students means greater production; bankrupting swaths of our populace for their inability to afford health care has, by contrast, potentially catastrophically deleterious effects on the entire economy.
The second has to do with the left making this a moral issue. The moral issue actually is a preexisting, epochs long cultural imperitive of the medical profession contained in the Hippocratic Oath. It does not have to be the government’s moral imperitive that every citizen get health care; that’s the business of the medical profession; however, given that it is an essential tenet of the medical profession, the most effecient way to cover the costs incurred as a result is a very real concern of government and society. If conservatives and Republicans think emergency room socialism is the answer, they need to be held accountable for such Politburo thinking.
“As others have already pointed out to you, except you didn’t seem to be paying attention: the US is spending far more than the UK, considered both if you were spending this kind of money per person (which you’re not) and as a percentage of GNP.”
You quoted me, but didn’t see the distinction I made. “The US government already spends more than enough to have the UK’s rather crappy universal health care system.”
I’m well aware that the the US (both public and private expenditures combined) spend much more than the UK’s public system. My point is that the US government already spends more than the UK’s universal system.
Yet it isn’t a universal system. The US government can’t get universal health care out of spending at that level. I think it might be useful to analyze why the US government is ALREADY spending about enough money to get Canadian or UK universal health care but NEVERTHELESS only actually provides health care to about 1/3 of the population. (And that is a wild grope and remembering how many people the US government provides health care to. It might be lower.)
The US government [doesn’t want to] get universal health care out of spending at that level.
Fixed that for you. If the political will was there to cut bureaucracy and extend health care to all, the US could do it. It’s not, and so the US has an expensive and thoroughly crappy system which the NHS beats into a cocked hat.
I think it might be useful to analyze why the US government is ALREADY spending about enough money to get Canadian or UK universal health care but NEVERTHELESS only actually provides health care to about 1/3 of the population.
Certainly it would. But as you have already ignored all the analysis in the thread preceding, I’m thinking that, like the US government, the political will is not there.
Sebastian:
In case it escaped your attention, I had a question for you that rolled over to the previous page.
To take a specific example: Part of the cost of drugs in the US must be the costs of doctors and pharmacists wrangling with insurance companies, and the costs of the insurance company people doing the wrangling. If I were a Canadian, none of these expenses would be incurred, so how can drugs *not* costs more in the US? And isn’t all that effort and expense pretty much completely wasted? Its only purpose can be to let the insurance company hold onto my premiums longer — which is where they make their money, so as a for-profit business that *must* be their goal.
Here I am, asking again:
Brett, what in your experience makes you more afraid of the government than of medical insurance companies?
“If the political will was there to cut bureaucracy and extend health care to all, the US could do it. It’s not, and so the US has an expensive and thoroughly crappy system which the NHS beats into a cocked hat.”
What does that even mean? You are speaking too generally. Cut what bureaucracy? Medicaid bureaucracy? Medicare bureaucracy? And anticipating a possible rejoined–even if you think it is the insurance company bureaucracy, that doesn’t explain why Medicare can’t cover all the uninsured people in the US. It is already spending as much as the UK covers everybody with, why can’t the US cover current Medicare patients PLUS 100% of the currently uninsured–at a minimum?
What is ‘lack of political will’ in that context? The US government has ALREADY committed to spending as much as the UK does for universal health care. That suggests either that there is something else going on in the US, or that the US government is running a horrifically inefficient program (like on the order 1:3 ratio of useful spending to waste).
Doctor Science: “Part of the cost of drugs in the US must be the costs of doctors and pharmacists wrangling with insurance companies, and the costs of the insurance company people doing the wrangling. If I were a Canadian, none of these expenses would be incurred, so how can drugs *not* costs more in the US?”
You are confusing ‘part’ with ‘substantial part’. I’m fully confident that you have identified *an* area of increased costs. But again, it is just like Republicans saving the budget by attacking earmarks–you aren’t dealing with anything substantial.
Drug prices are less than 10% of US health expenditures. Even if you believed that the savings from cutting out insurance company wrangling was 100% (that you could make drugs and drug research free) we would still be roughly at 180% of the Canadian spending level. I suspect that you don’t actually believe that we could reduce drug costs to free, so the savings would be significantly less than that.
Further, you seem to be assuming in the rest of your question that there won’t be anyone wrangling with government denial of claims, and that the government won’t have people denying claims. Which seems a rather unreasonable assumption if you know Americans. 😉
For your point on profits, see also this
Insurance company profits make up about 0.5% of total US health care spending.
No, you really don’t, since you’ve insisted on misreading this line, completely absent its context, in exactly the same wrong way that I pointed out was wrong the first time you did it.
The real culprit here–where “here” specifically and exclusively refers to the issue that we regularly pay far higher prices in the US than people in other countries do for the exact same product–I noted as being patent monopolies, kickback schemes for prescribing name brands over generics, and other similar mechanisms that US drug companies use to jack up the price that domestic consumers have to pay.
Please note–and it’s annoying me greatly that I have to say this again, about as explicitly as I did the last time–that I am not making the argument that these factors are the primary driver behind the cost of health care in general in the US. I don’t know how you keep getting that meaning out of what I’ve written, especially since this entire exchange started with you challenging my assertion that the biggest culprit in the overall cost of US health care being administrative bloat.
No, people order it from Canada because the price is lower. The price is typically lower because of Canada’s Patented Medicine Prices Review Board, which sets caps on the prices that can be charged for patented drugs that have no generic alternative. This reduces the impact of price gouging by companies that have an effective monopoly on a product where being able to afford it can be the difference between life and death.
Arguing that they don’t “pay a high enough price to pay for the research costs” is a complaint from the pharma industry perspective, not any kind of factual cause of the price difference.
Then I really can’t help you. My initial argument was, and I quote: “the thing that bloats the cost of our current system the most is administrative overhead. Every serious plan I’ve seen addresses that in some fashion.”
You challenged me to support that. That’s fine. I cited one of the sources I had at hand, and unfortunately the link was eaten by along with my blockquotes in that comment, so the structure of my reply might not have been clear. The link was examining reasons why we pay more to get less, in terms of health care, and I quoted four of the data points it offered, then my thoughts on them in order.
This was offered in support of my argument about administrative costs. Drug costs were only one of the four data points, and the context of drug costs in that point wasn’t about the cost of health care in general, but in specific reference to the difference in price that US consumers pay for the same thing vs. other countries.
For reasons passing my understanding, you decided to take my side comment about drug costs being the biggest culprit in the context of the issue of prices for the same thing in the US being different than elsewhere, and turn that into my entire argument despite the fact that I started out talking about administrative costs, pretty much jettisoning everything else that I said in favor of zeroing in on this one comment that was the absolute beginning and end of anything I’d said about drug prices.
That’s nice, but I don’t care because I never once advanced the argument that cutting drug costs was the solution to the cost of health care in the US, nor do I think it’s so. You manufactured that out of one single tangential comment and I’m sick of going in circles trying to untangle what was really a very simple argument. You are arguing with yourself, not me.
This is going nowhere and I wash my hands of it.
Its more important to focus on a manageable system of universal health care, NOT universal health care INSURANCE. Those two concepts are not the same thing.
Universal health care INSURANCE implies that everyone will have access to products sold by private companies whose primary way of making profits is to deny you as much health care as possible in exchange for the premiums it takes in. It still remains an adversarial relationship at its core, which is not the best way to go as far as the health care issue goes.
Just my 2-cents.
Maybe it was the formatting of your 6:41 comment that made it look like a more important point than you meant. That was the one I quoted.
But if your point all along was that administrative costs are the main difference between the US and other countries, that isn’t correct either.
Now it isn’t an unimportant difference. But the difference in salaries is very striking see here for hospital doctors, or here for the more general ‘physician’ category. It suggests that hospital doctors in the US are paid about double that of their UK or French counterparts, and almost 5 times more than Germans. For the more general physician category, it appears that US doctors on average get paid about 35% more than their UK counterpars and just under 200% more than French doctors.
I would guess that at least part of what drives the high salaries of US hospital doctors is the need to pay back the debts incurred in getting to be a doctor. It’s part of why a universal health care system is just so much more practical than the US’s crappy system: when healthcare is profit-driven, becoming a doctor is an expensive investment which must therefore pay off to be worthwhile. In countries where the government must guarantee health care, the government must also ensure there are sufficient numbers of doctors to provide it…
The political will in question isn’t the will to spend money. The US has that. It’s the will to reform the system. The profits from the medical insurance industry may be fairly low – but almost every last person employed in medical insurance is a bureaucrat – and most of them are almost pointless. So it’s not the profits of the medical insurers that should be classed as waste – but the total costs.
The other part of political will in question is facing down the AARP. In Britain, national healthcare is rationed based on the QALY – the Quality Adjusted Life Year. (And then duly ignored by the doctors and paid up by the PCTs). We focus on the interventions that get the most improvement in life for the longest duration. In America public spending goes to the retired – those who are simultaniously the most expensive to treat and can gain the lowest absolute gain from healthcare.
And Brett, if you don’t want government go live in Somalia or the Congo. And if you think that someone who is diabetic and doesn’t have state healtcare is freeer than one who gets dialysis provided by the state, I’ve got a bridge you might be interested in buying.
Sebastian, part of my point is that you can’t neatly separate out “administrative costs” from the cost of US health care overall.
you seem to be assuming in the rest of your question that there won’t be anyone wrangling with government denial of claims, and that the government won’t have people denying claims. Which seems a rather unreasonable assumption if you know Americans. 😉
I’m not assuming that it will never happen, just that it won’t be such a huge part of the process. For the medical insurance industry, “deny, delay, confuse, refuse” is *policy*, it’s how they make their money. It is not incidental or occasional, it’s become the core element of their business.
The consequences of this policy pervade the US healthcare system. My meds cost more than in Canada in part because it costs more to get them to me, because the pharmacist has to hire someone to fight with the people the insurance hired to fight.
US doctors have to pay more for malpractice, in part because USans often *have* to sue to pay for long-term medical care that won’t be covered otherwise. A disproportionate number of the vaccine side-effects suits, for instance, were by farm families — because they tend to be self-insured, and can’t cover the costs of a long-term catastrophic illness in the family.
I think it might be useful to analyze why the US government is ALREADY spending about enough money to get Canadian or UK universal health care but NEVERTHELESS only actually provides health care to about 1/3 of the population.
IMVHO, this is a really good point.
rusell:
If that “1/3 of the population” that the US gov’t currently provides health care for means Medicare+Medicaid+VA, then the obvious answer is: it’s a less-healthy-than-average part of the population. Old people, poor (and therefor stressed, tired, and ill-nourished) people, and people much more likely than average to have physical and/or psychological injuries. How do the US gov’t rates compare to a matched population from other countries?
I’m as much for decreased health care costs as anyone. I max out my HSA every year and spend it all and more with a young, fairly healthy family. But I’m at a loss as to why we should take the NHS as a model or expect the government to be more efficient at providing comprehensive health care services. (BTW, besides hiring freezes and a few days of furloughs per month, has ANYONE in the government been laid off in this recession? And if so, was it federal government?).
If the facts and figures supporting Gammon’s Law of Bureaucratic Displacement are accurate, NHS has followed the way of most bureaucratic endeavors. In 1948, NHS had 480,000 hospital beds, shrinking to 186,000 in 2000, while staff went from 350,000 to 882,000, and the biggest increase in administrative staff.
And why is all the “admin time” imputed to private insurance companies? My friends and clients in the industry (including a hospital administrator) complain about: 1) government regulation driving business models and 2) the problem of E.R’s. When a huge portion of your patient base has the bills paid by the government subject to regulation, I don’t know how anyone can argue that the system that exists right now is privately run. It’s an amalgamation.
Do those advocating government-run universal health really believe that the government can be as efficient as private care and scoop up the profits in savings? And if so, for how long? Really?
Jes, how do you respond to Hanan? I realize he is politically opposite, but the articles he cites certainly give me pause.
Ezra Klein links to a report by the McKinsey Group examining the costs of care in the U.S. compared to similar countries:
A closer look at the study shows that 80% of the cost above ESAW is from hospital and outpatient care. Of that total above ESAW, 147B is operation expenses and support, 100B labor, 75B profits and taxes paid, 49B supplies.
Of the other costs above ESAW, 98B is admin and insurance, 57B outpatient drugs, 19B public investment.
Long term and in home care save 85B as Klein mentions.
Sebastian, IMHO, hit upon a few ideas I would like explored, namely 1) universal catastrophic health care insurance; 2) providing universal health care set at a level equal to cutting edge ten years ago (was the cutting edge really so bad in 1997?).
I’d also like to look harder at HSA’s. One earlier poster lauded Singapore’s system. Maybe the way to go isn’t towards socialist medicine, but a move Brett’s direction and a more libertarian approach (note to Brett: I use the term loosely; however, as the article notes, Singapore makes the U.S. look like Europe).
I wonder if we have really explored the private system. We hardly have a market and there is almost no transparency in the system where consumers can compare services and prices in any meaningful way. If you think to the contrary, you haven’t looked at a hospital bill recently.
I just don’t want our health care to go the way of the Department of Education. There is a market driven solution out there.
“If that “1/3 of the population” that the US gov’t currently provides health care for means Medicare+Medicaid+VA, then the obvious answer is: it’s a less-healthy-than-average part of the population. Old people, poor (and therefor stressed, tired, and ill-nourished) people, and people much more likely than average to have physical and/or psychological injuries.”
The 1/3 of the population is Medicare+Medicaid+VA+government provided health care to government workers (I’m not sure who exactly those are, I presume the military at least, and probably civilian members of the DOD, does it count lost of people in DC or do they negotiate for private insurance?)
So far as I can tell, by an enormous amount, Medicare is the largest part of that cost (at least double that of Medicaid)
But either way your answer doesn’t help us much unless old people in the US require about 3 times as much money to care for than old people in Canada, old people in the UK and old people in France. The government in Canada spends about as much in percentage of GDP and less in GDP per capita than the US government does. It does so while covering its old people AND covering everyone else in the country.
The fact that old people cost more for care would only be an explanatory factor if Canada, France and the UK didn’t cover them. But they actually cover old people and drug addicts and really everyone.
So a really important question in my mind is “Why does the US government already spend more per capita on health care than Canada but only covers about 1/3 of the population?”
I won’t even pretend to know the answer, but I don’t understand why the question is never framed like that. It seems like an important question.
“providing universal health care set at a level equal to cutting edge ten years ago (was the cutting edge really so bad in 1997?).”
Just to clarify, this proposal is qualified by ‘unless the cutting edge technology is cheaper than the 10 year old technology’. This would actually incentivize any company which is close to that price point to lower the price enough to get the much larger pool of government insured. It would also encourage the middle class to continue funding for technological advances by getting insurance that would cover the new stuff. Furthermore, similar concepts are how other countries operate in reality anyway, they just aren’t explicit about it.
I won’t even pretend to know the answer
Perhaps you should try reading the comments on this thread – reading them for the information they contain, rather than in order to defend the practices of the pharmaceutical industry? Just a thought.
I’ve read the entire thread, Jes. The suggestions I’ve seen thus far are either clearly wrong (like the one you cite, pharmaceuticals) or far too general to be helpful. If you have one in mind you could point it out explicitly rather than trolling.
Also there are many many suggestions that don’t bear on the question of why the government already spends Canadian health care amounts of money while only covering 1/3 of the population. Insurance paperwork/profit questions probably aren’t a very big issue in Medicare for example. (Now government paperwork might be a big deal, but that would be the fault of the government).
If the facts and figures supporting Gammon’s Law of Bureaucratic Displacement are accurate, NHS has followed the way of most bureaucratic endeavors. In 1948, NHS had 480,000 hospital beds, shrinking to 186,000 in 2000, while staff went from 350,000 to 882,000, and the biggest increase in administrative staff.
Yes. Granted. And the admin spend of the NHS still kicks the arse of any private healthcare model. As for hospital beds, the very nature of them has changed – you have a lot less long stay chronic condition (we’ve eliminated things like iron lungs) and doctors can treat much more rather than waiting for patients to get better.
And why is all the “admin time” imputed to private insurance companies?
Because as far as healthcare is concerned, insurance is nothing but distilled bureaucracy. Insurance companies themselves do not provide any patient care. They just push paper around. Bureaucracy, pure and simple.
Some bureaucracy is good (I’m an NHS bureaucrat) – without sufficient bureaucracy you end up with a paddling pool sized amount of saline and a year’s supply of unsterilized latex gloves but no sterilized latex gloves or basic pharmaceuticals on a ward. But when you are a separate company providing nothing other than bureaucracy and providing it on a continual full time basis then you can only be a parasite. At the very best the role of insurance companies in the healthcare sector should be that of regulator – but the regulator should not be on a commission.
Sebastian:
I can only think of two possible answers to your question. The opponents of universal health care would presumably argue that the United States does all the medical research for the world, and the rest of us free ride. You alluded to that argument in your comment about drug prices. Now, I know that as a universal rule, that doesn’t hold true; Canada and Britain both have distinguished records in medical research. Paul Tsongas, the conservative democratic politician, one commented that he didn’t know if he would have survived his bout with cancer if he had lived in Canada; it turned out the treatment that saved his life came from research done at Princess Margaret Hospital, the internationally renowned cancer treatment and research centre in Toronto. That leads us to the question, which I would like a cite for: how much of the world’s research does the US actually do? Can we even determine that? How does the amount of medical research that comes out of the US compare with (a) the proportion of the world’s population in the US, (b) the American portion of the Gross World Product, and (c)the proportion of health care spending in the US. My google search didn’t turn up much in the way of hard number; maybe someone else will have better luck.
The other possibility: the American system spends so much money because so many Americans seem to see economics, and in particular health care economics, as a morality play rather than a search for efficient solutions.
To our anarcho-capitalist contingent: once jack-booted government thugs™ can no longer enforce the medical monopoly rules, the economic issues around medicine will matter much less. Get last of the medieval craft guilds (aka self-governing professions) out of medicine, and the contest between the Free Medicine and Microsoft medicine will drive prices down far enough that we probably won’t need government involvement nearly as much.
Your research question isn’t well formed. The question is not “How much research is done by the US?” The proper question is “How much research is funded by patent price sales in the US?”. Discovering something in Switzerland that is paid for by profits from sales in the US implicates the same free riding problem.
“The opponents of universal health care would presumably argue that the United States does all the medical research for the world, and the rest of us free ride.”
I certainly would say that the rest of the world pretty much free rides off of the profits created by pharma sales in the US. But that fact is not a good explanation for higher medical costs in the US because pharma products make a very small portion of total health costs. So proving or disproving that doesn’t get us anywhere with the question I’m interested in for the purposes of this thread: why does the US government already spend Canadian levels of money on health care yet only cover about 1/3 of the population.
“The other possibility: the American system spends so much money because so many Americans seem to see economics, and in particular health care economics, as a morality play rather than a search for efficient solutions.”
I’m not sure what “morality play rather than a search for efficient solutions” means. I especially don’t know what it means in the context of Medicare or other government run medical programs. Could you give a particular example in the context of Medicare that might illustrate what you mean?
Well, I think in part it’s because, instead of the government directly paying for indigent care, it’s instituted rules which funnel indigent care through our ICUs. A perhaps unintended effect of insisting that emergency rooms can’t turn people who can’t pay away.
This encourages the indigent to wait until their conditions get really serious, and then show up at the emergency room for treatment, instead of getting medical care at the cheap stage.
The hospitals then treat this expense as an overhead that they put on the bills of everyone who can pay.
Sebastian “I’m not sure what “morality play rather than a search for efficient solutions” means.”
The belief that people get the health care they deserve: so that if you are doing without health care, it is because you do not deserve it. (As the people who do without health care have usually been the very poor, who it is easy for conservatives to argue are obviously also undeserving, since if they were deserving they would have more money, this leads to denying health care to people who can’t afford it.)
It derives from the same kind of thinking that argues that if you are very poor, all you really need to do is buy a fifty-pound sack of brown rice and a rice cooker, and so anyone who is badly off and hungry is undoubtedly so because they are foolish and thus don’t deserve to be helped.
The NHS was, in a sense, also founded as a morality play: but an altogether different kind of morality play: a sense that we are all members each of one another, that the least should be helped without thought of whether they deserve it, only that they need it. The NHS wasn’t founded for efficiency’s sake, but for justice and kindness’s sake: it merely proved to be also a highly efficient system for delivering health care to all.
“The belief that people get the health care they deserve: so that if you are doing without health care, it is because you do not deserve it. (As the people who do without health care have usually been the very poor, who it is easy for conservatives to argue are obviously also undeserving, since if they were deserving they would have more money, this leads to denying health care to people who can’t afford it.)”
And this has to do with the US government spending Canada levels on health care while only being able to provide for 1/3 of the population how?
And this has to do with the US government spending Canada levels on health care while only being able to provide for 1/3 of the population how?
Maybe we could look to a system that covers more, or all, for less, for guidance, as opposed to sticking to what has failed here. And it looks like a public option, rather than a private mandate, helps get us there.
Ok, but if we can’t figure out what went wrong with Medicare et al. such that the government spends Canada levels for less than universal coverage, how do we know we will be able to avoid problems like that in the new system?
And this has to do with the US government spending Canada levels on health care while only being able to provide for 1/3 of the population how?
Well, you’ve ignored all the comments in this past thread about why US health care is so much more expensive, so I didn’t think it was worthwhile repeating or summarizing the explanations for you to ignore all over again.
But yes, it is quite expensive to have a system which ensures people who need healthcare don’t get it until they’re so sick they could die otherwise. And because denial of healthcare is regarded, by conservatives, as a system of morality, that’s your connection.
“But yes, it is quite expensive to have a system which ensures people who need healthcare don’t get it until they’re so sick they could die otherwise.”
Medicare is useable as a function of age, not ‘so sick they could die otherwise’.
You are talking about the unisured, I think. Which unless I’m confused, Medicare rarely pays for.
You know, Sebastian, it would probably help you to understand why the US health care system is so expensive if you didn’t just keep ignoring what people have to say about it. If, that is, you want to understand…
Let’s say you have 100 people, and you have a warehouse with 1000 items in it. Each one of those hundred people is going to need from 5 to 15 items from that warehouse. They themselves may not be absolutely sure exactly which items they need, or what is in the warehouse that they can have.
You can set up a system where each person gets 15 minutes with an expert guide to check out the items in the warehouse and take what items they need with the advice of their guide. This could take 3 or 4 days, if you have only one expert guide, or a single day, if you have four.
You can set up a system where each person has to respond to a battery of questions about their lifestyle and their job and their credit history, and provide means-test information about their income and their family, in order to prove they do need some items from the warehouse and can’t afford to buy them anywhere else, and then has to explain to a company representative exactly why they need what items they have listed, and then the company representative takes the list away to have it approved, and initially none of the items on the list are approved because that’s company policy, so the list gets brought back and gone over again and this time perhaps some of them are approved, and then someone goes to the warehouse and fetches out the items that have been approved, and then each person has to re-apply all over again for any items they still feel they need that weren’t approved.
The first system is a lot cheaper to run and makes sure everyone gets what they need. That’s the NHS.
The second system ensures that no one gets anything from the warehouse unless they’ve definitely proved they can’t pay for it and they really, really need it, no matter that some people die waiting and many more suffer slowly through the delays, no matter how much more it costs to make sure that undeserving people don’t get anything and that poor people really have to struggle to get what they need. That’s the US system.
How a paid up member of the human race sees it:
Jesurgislac, do you somehow believe that Medicare does not involve going to see a doctor and having him diagnose what is wrong?
Sebastian, I don’t believe that you have the political will to understand the answers to the questions you keep touting as “important”.
That is quite an answer.
Multiple people have already responded, in some detail, to the questions you were touting as “important”, in this very thread.
You don’t appear to have paid attention to what any of them had to say.
Hence my presumption that you do not have the political will to understand the answers to questions you claim you consider to be important: since if you did understand the answers – whether or not you agreed with them – you could at least respond to what people have been saying, with considered agreement or disagreement.
You say that multiple people have responded, point to neither the persons nor the arguments.
The question I pose is: why does the US government already spend as much as Canada, and more than the UK, but nevertheless not provide universal coverage considering that it is spending universal coverage-sized money?
The main specific responses I have seen have been: pharama prices, insurance profit and insurance administrative waste.
Pharma prices aren’t the answer. They aren’t even a big piece of an answer. They aren’t a large portion of overall costs even if the price could be reduced to zero, which it clearly can’t.
Insurance profit is likewise an incredibly small part of overall costs. Furthermore Medicare and the like doesn’t typically pay into insurance profits. So that can’t be the answer.
Insurance administrative waste may or may not be enormous, but again Medicare doesn’t pay it anyway. They may or may not be a huge part of the private component of US health spending, but they aren’t a huge part of the public spending. So that isn’t the answer.
The other answers seem to share the same problem, they want to blame the spending on insurance companies and private waste. That may very well explain why the PRIVATE portion of US health care spending is so high. But it does not explain why the PUBLIC portion of health care spending is already as high as Canada’s PUBLIC spending and higher than the UK’s PUBLIC spending yet NEVERTHELESS fails to give anything like universal health care.
Now some people (mostly you) have suggested philosophical generalities about conservatives not thinking that poor people deserve to have good health or whatever. That of course is a nice generality that does nothing whatsoever to explain why the US government already spends more money per capita than governments which provide universal health care. And I hate to repeat myself, but the US government doesn’t provide universal care despite spending that much. Also Medicare doesn’t target the poor. It is much more like Social Security.
Generally speaking, the arguments in the thread above are either so general as to be nearly useless, or specific but applicable to the PRIVATE portion of health care spending in the US.
If you would like to actually cite the many good arguments which pertain to public spending in the US (there are handy date codes at the bottom of each comment which facilitate that) please do so. Or you can merely assert without evidence yet a third time that I’ve overlooked the many obvious responses to that.
why does the US government already spend as much as Canada, and more than the UK, but nevertheless not provide universal coverage considering that it is spending universal coverage-sized money?
Yes. And, as I said, people have provided answers to that question, which you have – as you demonstrate in this comment! – not got the political will to understand, let alone respond to.
Or you can merely assert without evidence, yet again, that you did understand the answers, but that you’re sure they’re not the right answers, which is why you’re not bothering to respond: merely to deny.
Ok, if multiple people have answered that very specific question, Sebastian isn’t the only one who’s missed it, I have, too.
The government is spending more money per capita than other nations spend on universal health care, to provide health care to a comparatively small fraction of the population. Why exactly wouldn’t we anticipate that our government, were it to embark on universal care, wouldn’t end up spending hellishly more?
I can see increasing the number of the covered possibly reducing the expense per person covered, but actually reducing the total expense seems absurdly unlikely.
“The government is spending more money per capita than other nations spend on universal health care, to provide health care to a comparatively small fraction of the population.”
Is it the government spending that money, or people spending it, and isn’t much of the money people are spending going to insurance company and private health care overhead?
If so, that’s why.
Gary, Sebastian has, as far as I can read, made great pains to distinguish between health care spending by individuals in the private markets, and health care spending by government via the VA, Medicare, Medicaid and other such programs; and confined his repeated question to the latter type of spending. e.g., That may very well explain why the PRIVATE portion of US health care spending is so high. But it does not explain why the PUBLIC portion of health care spending is already as high as Canada’s PUBLIC spending and higher than the UK’s PUBLIC spending yet NEVERTHELESS fails to give anything like universal health care.
These are the same old typical arguments on why we should have socialized medicine. How about looking at some FACTS:
FACT: Medicare (which is already a form of socialized medicine) only pays 70% of medical expenses. Since doctors and hospitals are not payed the full value of their services, they make up the difference by charging other patients more. This is why hospitals charge twenty-five dollars for a band-aid. The Medicare program is another government program that loses money and therefore has to be subsidized.
And Medicare is broken and bankrupt. The only thing the government seems to be able to do is keep raising our taxes to fund a broken and failed program.
FACT: Socialized medicine has not worked in any country in which it has been adopted. It’s a money losing proposition and has to be subsidized by the government. This is the definition of negative economic growth. And doing something that has been repeatedly proven not to work and expecting it to work is the definition of insanity.
FACT: Medicine is a finite resource. In an economic environment of negative growth medicine will have to be rationed. Those that need health care will have to wait, sometimes for months or years, to get the care they need. If you are suffering from a terminal illness and they decide you can’t be saved, you will most likely be denied care. This is already happening in every country in the world that has socialized medicine. And this is why Canadians that have the financial resources are coming to the U.S. for health care.
FACT: One of the reasons health care is so expensive is because of excessive government regulation. If the government would get out of the way, market forces and competition would drive prices down. Consumers are the key to reforming health care. Not government. Not doctors and hospitals. Not insurance companies.
FACT: Health care is NOT a right. It is a privilege. Sorry people. As much as you would all like this to be a warm, fuzzy, Utopia, the fact is the world is a cruel place. Survival of the fittest is the way it is, both in the animal kingdom and also in human society. Get used to it.
FACT: ObamaCare is not about giving everyone equal access to health care. It’s about government control of your lives by taking away your freedoms guaranteed by the Bill of Rights.
Here are two short booklets that explain the real FACTS:
“Facts: Not Fiction: What really ails the US health care system”
By Greg Dattilo and Dave Racer
and
“Why health care costs so much: The Solution – Consumers”
By Dave Racer & Greg Dattilo, CEBS
These can be purchased for the paltry sum of $3.50 EACH by going to http://www.alethospress.com/hcbooks.htm. You have to admit, seven dollars is a small price to pay to get educated about the health care “crisis”. So how about it, people? I challenge you to put your money where your mouth is!
And if you think this is just a cheap come-on you should know that I am in no way connected to the publisher of these books. I’m only interested in getting the facts out in the open.
“And if you think this is just a cheap come-on”
I do, or otherwise you’d link to free information, which we can then duly ignore as the crap it is. After all, the fact is the world is a cruel place.
Socialized medicine has not worked in any country in which it has been adopted.
Wrong.
It’s a money losing proposition and has to be subsidized by the government.
Socialized medicine has to be subsidized the government? You don’t say!!
Health care is NOT a right. It is a privilege. Sorry people. As much as you would all like this to be a warm, fuzzy, Utopia, the fact is the world is a cruel place. Survival of the fittest is the way it is, both in the animal kingdom and also in human society. Get used to it.
Can someone explain the natural fallacy to this ‘tard? And also how “fittest” isn’t a synonym for “richest?”
Mr. Farber,
If you don’t wish to fork over a little pocket change to get educated, that’s your choice. In this country you still have the freedom to remain ignorant.
Phil,
Thanks for your infantile response. You can’t refute my argument so you attack me and call me a ‘tard. Then you even admit you can’t explain the “natural fallacy” in my argument.
If you have an opinion, then go ahead, express it. I challenge you to get over your temper tantrum and come up with some logical reasoning to refute my argument. Tell me where I’m wrong!
Oh, and by the way, Phil, what country can you name where socialized medicine has worked?
Thanks for your infantile response.
You’re welcome!
You can’t refute my argument so you attack me and call me a ‘tard.
You didn’t make an argument. An argument doesn’t consist of a series of unconnected bullet points.
Then you even admit you can’t explain the “natural fallacy” in my argument.
If you don’t know what the natural fallacy is, I can’t force you to Google it. Nonetheless, you’ve fallen right into its pointy little claws.
If you have an opinion, then go ahead, express it.
I did! I called you stupid. That’s my opinion.
I challenge you to get over your temper tantrum and come up with some logical reasoning to refute my argument.
“Temper tantrum?” Puh-leeze. I’m amused by you, not angered.
Oh, and by the way, Phil, what country can you name where socialized medicine has worked?
Oh, pretty much all of them, at least in terms of delivering longer life expectancy, lower infant mortality rates, better pre-natal and childhood health outcomes, etc. So long as we’re classifying those things as “working.”
No cites for you, though. Do your own homework.
What, he’s responding? I had this guy down as an advertising ‘bot and was thinking it’s amazing how realistic their posts can be. Not a bot but a troll, eh?
Trolls: do not feed them.
Please.
Aw, not even a fruit basket? Fruit is healthy!
Perhaps a nice banana? Time flies like an arrow. Fruit flies like a banana!