Conservatives: explain to Europeans/Canadians why their health care should be more like the U.S.'s

[VarlosZ]

@Sage_Rat

I’ll get back to the UK in a moment, but to continue talking about Cuba, let’s also note that Cuba reportedly has some of the best-trained doctors in the world. But what medications has Cuba invented? What medical techniques were found and proved by the Cuban medical industry? None. If the US and Europe weren’t pioneering science, Cuban medical knowledge would almost certainly stay exactly the same from decade to decade. Their doctors are only any good, because we discovered new things and were willing to let them leach that knowledge off of us.

Leaving aside the larger argument, this is not exactly a fair analysis. First, the discrepancy between US medical innovation and Cuban medical innovation has primarily to do with the fact that we are huge and rich while they are small and poor. Try running this comparison instead with some Western European country that has a form of socialized medicine and the difference would be a lot less impressive.

Second, and more abstractly, it’s true that running a largely for-profit health care system and pumping staggering sums of money into it often drives innovation, and that this is in fact a benefit of the ad hoc jumble we’ve arrived at. However, just because we often get there first does *not *mean that innovation would be at a standstill in other countries if we quit the game. Government-directed, not-for-profit research is perfectly capable of advancing medical science; we should know, since we do quite a bit of that even in the United States.

[bump]

I think that among the conservative rank-and-file, there are a few ideas that have taken hold.

1. The vast majority have employer-provided health care that’s pretty decent, and fear that government-operated single-payer healthcare would cause their standard of care to go down.

2. They view it as the government intruding on their personal lives and telling them what they can and can’t be treated for.

3. There’s a fear of raised taxes to pay for this single-payer health care. Along with the tax-raising, there’s a certain concept that they don’t want to be forced to pay for a large segment of the population’s health care, i.e. the poor, who in their view, don’t shoulder their fair share of the tax burden, AND behave in ways that would drive up costs.

Now I don’t necessarily adhere to these views, but that’s what I hear from relatives and friends who are conservative.

I think the real problems with these thoughts are that the raised taxes would necessarily cost more than insurance premiums already do, and that somehow the government mandating the standard of care would be worse than letting private companies that your employer picks do the same exact thing.

At least the government isn’t trying to make a buck by nickel and diming me, I figure.

I think they’d argue that the ability to choose your own providers and treatments is the big advantage vs. the European systems, but then again, that’s an illusion, because insurance companies control that for everyone but the truly rich who can pay out of pocket for whatever they want.

[wolfpup]

@Qin_Shi_Huangdi

Not all European health care systems are single-payer: France and Germany do not among others. And the problems aren’t just those but the vastly higher spending as percentage of GDP on healthcare.

First of all, while technically there may not be a “single payer”, the public system(s) are so tightly regulated that they are effectively the same and are de facto single-payer. And the optional private insurance systems are such a small proportion of the overall market (and also tightly regulated as to participation and operation) that they make no effective performance difference in the overall system.

“Vastly more”? Utter bullshit. For 2009-2013, to take the specific examples mentioned, Canada spent 10.9% of its GDP on health care, France 11.7%, Germany 11.3% – and all of those countries achieved universal, unconditional public coverage and the percentage of GDP spent was declining. The US spent 17.9% of its GDP on a broken system that was very far from being even close to universal, and percentage of GDP spent was increasing.

@bump

I think that among the conservative rank-and-file, there are a few ideas that have taken hold.

1. The vast majority have employer-provided health care that’s pretty decent, and fear that government-operated single-payer healthcare would cause their standard of care to go down.

This is, in theory, a valid concern, because, in theory, a grossly mismanaged government program could be worse than what people have today, especially for the wealthy. In practice, de facto single-payer systems work just fine, and are effectively the only viable system of health care in which costs don’t quickly become unmanageable.

@bump

2. They view it as the government intruding on their personal lives and telling them what they can and can’t be treated for.

This is supremely ironic, since Americans are fully conditioned to having profit-incentivized insurance bureaucrats telling them what they can and can’t be treated for, while I, as a lifelong participant in single-payer, have never in my life had anyone question any treatment, nor that of anyone I know, nor in fact is there even a mechanism for doing do. What single-payer can do is nickel-and-dime you by excluding certain coverages across the board, like the fact that I have to pay for my own eyeglasses (exceptions are made for the poor). But if I need a heart transplant that might cost a million dollars, no problem. The whole cost-control model is completely different, and it’s a lot more rational because no clinical judgments are made by self-serving bureaucrats against your and your doctor’s wishes.

@bump

3. There’s a fear of raised taxes to pay for this single-payer health care. Along with the tax-raising, there’s a certain concept that they don’t want to be forced to pay for a large segment of the population’s health care, i.e. the poor, who in their view, don’t shoulder their fair share of the tax burden, AND behave in ways that would drive up costs.

The fear can be shown to be misplaced simply by looking at other countries’ per-capita costs. It’s not the tax burden that is important, but what you have to pay in total to get health care. In order to show costs in the US, you literally have to extend the scale of the Y-axis on such graphs in order to accommodate that towering huge bar! But yes, the business about “shouldering fair share of the tax burden”, if interpreted as code for “dark-skinned people getting something for nothing”, is definitely part of the mythos – and they don’t care that such a system would actually cost them less because of efficiencies and cost controls.

[VarlosZ]

@wolfpup

But yes, the business about “shouldering fair share of the tax burden”, if interpreted as code for “dark-skinned people getting something for nothing”, is definitely part of the mythos – and they don’t care that such a system would actually cost them less because of efficiencies and cost controls.

Just an observation: it’s funny how statements about one’s country that wouldn’t be irksome in general can be offensive when coming from a foreigner. I mean, it would be regrettably reductionist no matter the source, but I wouldn’t say something like that about Canada even if I felt it was largely true.

It’s not rational, but I assume I’m hardly the only one.

[wolfpup]

@VarlosZ

Just an observation: it’s funny how statements about one’s country that wouldn’t be irksome in general can be offensive when coming from a foreigner. I mean, it would be regrettably reductionist no matter the source, but I wouldn’t say something like that about Canada even if I felt it was largely true.

It’s not rational, but I assume I’m hardly the only one.

I know, and I thank you for your observation, sincerely. I assumed that the words “Europeans/Canadians” and an invitation to health care comparisons in the title would give me some leeway to do just that. But the main point is that I do hope that you understand that these criticisms aren’t directed against a nation, but against a particular irrational ideological contingent there: not to put too fine a point on it, the current crop of Republicans. And when it comes to the racism that I implied (which, in retrospect, was insensitive on my part) it’s really only a small minority of them. The statement that you quoted was certainly meant that way.

FWIW, I have many close relations in the US who feel just as I do, but obviously love the place overall, since they are still there and doing fine, and have been grateful for the exceptional opportunities that it’s afforded them. If it makes you feel any better to have my comments sourced to them, voting US citizens, in one case a major contributor to the Obama campaign, then you may do so. The words would be the same.

[bump]

@wolfpup

The fear can be shown to be misplaced simply by looking at other countries’ per-capita costs. It’s not the tax burden that is important, but what you have to pay in total to get health care. In order to show costs in the US, you literally have to extend the scale of the Y-axis on such graphs in order to accommodate that towering huge bar! But yes, the business about “shouldering fair share of the tax burden”, if interpreted as code for “dark-skinned people getting something for nothing”, is definitely part of the mythos – and they don’t care that such a system would actually cost them less because of efficiencies and cost controls.

From what I can tell, there’s a misplaced faith that you get what you pay for, and that somehow any government run scheme that’s actually cheaper would prima facie have worse coverage as well. Essentially the concept that if they’re paying X for Y service, how can they pay less than X and still get Y service or better? The concepts of economies of scale and the colossal bargaining power a US single-payer system would have don’t really register in their heads.

I don’t even think it’s a racist thing as far as the paying for others idea is concerned; it’s based on behavior, although with the really tight race/socioeconomic class coupling in the US, it seems like it is based on race.

They don’t begrudge the poor black family that just can’t make ends meet; they begrudge the single mothers with multiple kids by different fathers, regardless of the color. They begrudge the poor families with 6 kids, yet the mother makes minimum wage, and the father makes scarcely more. They begrudge people who do things like eat a high fat diet and smoke, yet can’t afford to pay for their own healthcare. I can guarantee that the conservatives of my acquaintance would be just as annoyed at having to pay for lung cancer treatments for some white Tennessee hillbilly who smokes 2 packs a day as they would for some black man from Baltimore.

[Velocity]

Both American and European health care systems are deeply flawed.

[Martin_Hyde]

I’m a fan of the German healthcare system, and think it’s far better than the Canadian or British systems. The German system is actually not crazy-different from the American system, it’s kind of like our system if it made sure everyone was covered and was administered sanely instead of giving hospitals carte blanche to charge $500 for a pair of latex gloves used in a surgery.

[Mijin]

@Velocity

Both American and European health care systems are deeply flawed.

Care to elaborate? The stats seem to imply most european countries (particularly in the west and north of europe) have comparable care to good US hospitals for a fraction of the cost.

Or are you saying the quality of care in both regions is not up to snuff?

[wolfpup]

@Martin_Hyde

I’m a fan of the German healthcare system, and think it’s far better than the Canadian or British systems. The German system is actually not crazy-different from the American system, it’s kind of like our system if it made sure everyone was covered and was administered sanely instead of giving hospitals carte blanche to charge $500 for a pair of latex gloves used in a surgery.

The German system has many strong points and I’m a fan of it, too, though I’d argue that an assessment like “far better than the Canadian or British systems” is questionable and certainly depends on what you’re measuring – the Commonwealth Fund assessment quoted upthread rated Germany at about the midpoint and well below Britain.

I think an even stronger argument could be made against the idea that it’s not much different than the American system. There are similarities, to be sure – the majority of working Germans are covered by programs jointly funded by their employers and themselves, and not by general tax revenue. But those similarities are superficial. The German universal health care system is the oldest in the world and is based on a culture of social solidarity that goes back to the time of Bismarck in the late 19th century. The vast majority of German people (around 85%) are enrolled in the statutory community-rated public system of non-profit “sickness funds” that are tantamount to a single-payer system, and the private system is restricted to certain categories, most notably to high income levels, and offers only limited benefits over the public system. Moreover, the success of the entire system is critically dependent on tight control by the Ministry of Health and the Federal Joint Committee, which exercise regulatory control over all aspects of health care funding and service delivery.

So the German system is, in that sense, very much a “government-run” health care system. Even though the plethora of sickness funds makes the system in some ways almost as complex as the US system, the fact that everyone is covered and almost everyone pays the same community rates and gets the same benefits makes it closer to a single-payer model and substantially cuts administrative overhead, while a system of predetermined rate negotiations helps to control provider costs. In contrast, virtually the entire US system is based on private insurance and for-profit service delivery. Rates and benefits vary wildly, and there is no means of cost control except by adjudicating claims at the clinical level. It’s a hugely different model, one that largely relies on market-driven insurance rather than on a regulated system of common benefits and a fundamental principle of universality.

[2ManyTacos]

I would make the argument that, by & large, the US effectively has the WORST health care system in the Western world. Yes, the ACA goes to great lengths to remedy that analysis, but its final successes are bound to be so scatter-shot - as in, say, being wildly successful in CA & NY while simultaneously enjoying less success in TX - that it will still inevitably leave a number of holes & problems that’ll have to be addressed by the (left-leaning) millenial generation.

That said, there are SOME aspects of the US health care system which aren’t unequivocally terrible, although, ironically enough, they’re the same areas of the system which already stress universality & make an even stronger case for (GOP reviled) socialized medicine.

Before I get to them, though, I want to mention a couple of things: Obviously, the truly affluent won’t experience many headaches with US health care because they possess the financial resources to pay for everything out of pocket anyway, so good for them. Similarly, many middle class & upper middle class people are satisfied because they have high-end insurance through their jobs which mitigates any financial expenses that they might incur. Still, that just reinforces the stupidity of US health care because those same individuals’ access to medicine is dictated by where they fucking work, which is categorically one of the dumbest conventions in US society that continues to persist today.

That said, there are a handful of aspects about HC in this country that already are universal (to an extent), & if you’d ask anybody whose part of them whether those systems should be jettisoned you’d immediately be met with an angry oppositional response.

Obviously, the first one most Americans know about is Medicare, which covers virtually the entire elderly population. The ironic thing about it is that it’s universally cherished amongst the senior citizen community, & yet many of them don’t make the connection that their health insurance is run by the federal government. “Keep your government hands off my Medicare!” signs were rampant at anti-ACA rallies back in 2009 & 2010, and they were (and still are) enormously stupid. Similarly, Medicaid covers our poor, and in the wake of its expansion in ACA-compliant states it has proven to be the most crucial component of reducing the uninsured population.

Native Americans also enjoy a UHC system of sorts through the Indian Health Service, & although it might not be the best health care in the world it still provides for most of their HC needs. The VA, too, provides UHC for qualified veterans; although it has rightly been criticized lately for excessive wait times & mismanagement, the actual HC is universally applauded.

All of which is to say, the best components of HC in the US are the ones in which the government either directly administers (such as the VA) or otherwise finances (such as Medicare), so it’s enormously ironic that conservatives are so Gawddamn skeptical of government-facilitated health care writ large.

[wolfpup]

@2ManyTacos

All of which is to say, the best components of HC in the US are the ones in which the government either directly administers (such as the VA) or otherwise finances (such as Medicare), so it’s enormously ironic that conservatives are so Gawddamn skeptical of government-facilitated health care writ large.

Indeed. Which leads me to make a somewhat more pragmatic note to follow on to my previous one. Respected health care economists like Uwe Reinhardt have indeed suggested that there are important learnings in the German model that could be applied to the US system. But I think the lesson here – and the short version of my previous post – is that the only way it could be done is with the participation of the majority of the public in a community-rated system that provides uniform benefits to everyone, which is the centerpiece of the German system. That requires a substantial degree of government involvement and regulation, and it would most likely displace private insurers from the majority of their present market. Doing it right would be a reform of a significantly greater order than the original establishment of Medicare.

The rhetorical question to conservatives – in light of their opposition to the ACA and general dislike of government – is whether they’d be willing to accept a much greater degree of government involvement in return for a system that provides universal health care benefits at half the present cost and helps to hold down cost increases in the future. If they think not, then perhaps they should be challenged to provide evidence for why, fundamentally, the US couldn’t leverage its wealth to provide its citizens with the kind of universal health care that all other industrialized countries can manage, and why, in the US, the richest country in the world, such universal health care should not be the best health care in the world.

[KarlGauss]

As a physician, I would much rather practice in my system (Canadian) than that of the US.

By far the most important reason is I can’t imagine turning people down because they don’t have the bucks. That simply doesn’t happen here (except for various exceptional categories of people such as immigrants within three months of their arrival). In any case, in my career it has never been an issue. Not once. And that is very important to me. You come to my hospital, you’re gonna be treated. Treated all the way through, not just to be stabilized and then shown the door. And, you’re gonna be treated the same whether your net worth is 100 million or zero.

The second powerful incentive for me, as a doctor, to stay in Canada is that I spend precisely zero percent of my time trying to navigate the maze of providers and insurers that are the rule in the US. I don’t need any staff to help me in that regard because there is nothing to do in that regard. All my bills are paid. In full. Promptly. (Okay, maybe one in a hundred of my bills might get knocked down a notch if the powers that be think I invoked the wrong billing code). Likewise, except for a nominal fee to process my billings with the government, zero percent of my income goes to billing costs. Phrased differently, I can work as a physician all the time, and not spend any time negotiating, begging for okays to go ahead, etc.

I also earn about twice as much as my counterparts in the US (although the tax bite is probably twice as high for me). (To be fair, some high end specialists can earn much more in the US but most don’t regardless.)

Malpractice fees here are something like 3500 bucks a year (I honestly don’t know, that’s how insignificant they are in the grand scheme of things). And, although, yes, they are higher for the surgical specialties, they’re not outrageous and even then, the government reimburses the lion’s share back to the doc.

Speaking of malpractice, well, while we’re not free of lawsuits, there are a lot fewer in Canada per MD than in the US. The atmosphere is totally different (or so I’ve been told).

So, from a physician’s perspective, I think it’s a no brainer.

[Novelty_Bobble]

@KarlGauss

By far the most important reason is I can’t imagine turning people down because they don’t have the bucks. That simply doesn’t happen here (except for various exceptional categories of people such as immigrants within three months of their arrival). In any case, in my career it has never been an issue. Not once. And that is very important to me. You come to my hospital, you’re gonna be treated. Treated all the way through, not just to be stabilized and then shown the door. And, you’re gonna be treated the same whether your net worth is 100 million or zero.

Well said, this is exactly what a health system should be.

The detail of the funding model is not really the point as long as you can answer the following questions satisfactorily:

1. Regardless of contribution, does every citizen have access to the same, adequate level of care?
2. Is it allocated on the basis on medical need rather than ability to pay?
3. Are any bills low enough not to cause financial hardship?

Those seem like the bare minimum requirements to me.

[Red_Wiggler]

So, have our conservatives convinced any of you non-Yanks to adopt our system yet?

Wolfpup’s opinion a couple of posts back is the one that I share: not only should we have a system more in line with other western nations, but ours should also be among the very best. If so many of our citizens wish to continually trumpet what a great country we are, then perhaps we should prove it with a health care system that is the envy of the rest of the world.

[Evil_Captor]

@Red_Wiggler

So, have our conservatives convinced any of you non-Yanks to adopt our system yet?

Wolfpup’s opinion a couple of posts back is the one that I share: not only should we have a system more in line with other western nations, but ours should also be among the very best. If so many of our citizens wish to continually trumpet what a great country we are, then perhaps we should prove it with a health care system that is the envy of the rest of the world.

I read the whole thread and did not see a single instance of a conservative advocating for Europeans to adopt the American health system. It’s like they know they don’t have a prayer. Well, the ones on the Dope, anyway.