Devil's advocate: saving America from socialized medicine.

[RickJay]

@curlcoat

She also really glossed over the issue of rural Canadians living rather far from anything other than basic medical care, and the differences between the provences.

“Provinces.” The reason she glossed over this is that it’s obviously irrelevant. It doesn’t matter what kind of health care system you have; if you live in the boondocks you will have less medical care nearby. Upper Assgrab, Baffin Island, Population 275 is not going to have a full service hospital with an advanced oncology department the way Toronto or Calgary do, whether or not you have private health insurance. The Province of Ontario has as many doctors as Yukon Territory has people. This will be true of the United States, China, Australia, or any other country in the world.

@Martin_Hyde

But given those truths someone pointing out that “ooh, ooh, look how efficient Canada’s system is compared to ours!” doesn’t really inspire much confidence. Most educated people understand a free market system will be more efficient than a socialized system.

I’m sorry, MH, I found your post really confusing. You conceded that most countries are more efficient in this regard, and then say most educated people understand exactly the opposite.

Usually the arguments for socialization ignore the matter of economic efficiency, for example if you feel that health care should be a public service and not a standard service that should be subject to the whims of a free market then you aren’t really too interested in economic efficiency in the first place.

Actually, one of the reasons Canadians are so protective of the single-payer system IS economic efficiency; the perception, which is generally correct, is that Americans pay far, far more than we do. I’ve also heard a lot of American proponents of single-payer health care point this out as a potential benefit. Health costs are a very big political issue in Canada; by no stretch of the imagination is the attitude here “The heck with efficiency, health care at any cost.”

So the fact that our mixed-free market health care system (I say mixed because many of the best hospitals receive large influxes of funding from the State and Federal government every year as well as receiving hundreds of millions from private donors and such every year–this is why many major public hospitals employ people like Michelle Obama) is actually less efficient than socialized systems suggests to me that a fully socialized system done in the United States would quickly establish itself as the least efficient of any such system in the world.

I suppose that’s possible, but I don’t see why it would have to be so. The potential pitfalls you cite for the USA - large country, federal system of government, very mixed backgrounds - are all true here. They’d also be true of Australia, which also has a single-payer system.

We ostensibly have “single payer” primary and secondary education (State and Local governments, and to a lesser degree the Federal government) and it’s not created equality of result.

Well, here’s the thing; Canada’s health care system hasn’t created equality of result, either. There is simply no denying that the rich get better care than the poor; there are, after all, a lot of things that are not covered by our health care system (prescriptions, dentistry, elective procedures, some physio, counselling, eye care, etc.) and a lot of extras are pay-as-you-go. I get medical benefits from my employer that people in crappier jobs do not get that are worth very substantial amopunts of money, if you consider what the out-of-pocket would be. Private care is available for a price.

The idea behind the health care system was to ensure an equality in implementing a baseline of basic, necessary preventive and emergency medicine. The same is essentially true of education, which is a very good analogy, by the way.

[Ocean_Annie]

@Martin_Hyde

Usually the arguments for socialization ignore the matter of economic efficiency, for example if you feel that health care should be a public service and not a standard service that should be subject to the whims of a free market then you aren’t really too interested in economic efficiency in the first place.

Is there a health care market? It is not a commodity bought and sold at a market price on any given day. Doctors prescribe based on the unique needs of each patient, and most patients defer to the doctor’s knowledge. You can get a second opinion and avoid incompetence, but cost is determined by professional norms and industry standards. Cost isn’t negotiated between doctor and patient.
Not all markets respond to market forces. The free market is used politically to oppose any taxes or government regulation. If it isn’t a free market, it must be socialism.

[Ocean_Annie]

@Martin_Hyde

We ostensibly have “single payer” primary and secondary education (State and Local governments, and to a lesser degree the Federal government) and it’s not created equality of result.

The public schools are not funded like single payer health care. There is no federal education tax. Public schools are funded with property taxes, which is why the better public schools are generally located in higher income neighborhoods and states with higher incomes and property values.

Private and public universities receive federal grants and student loans. The cost difference between institutions are not necessarily due to educational quality. Universities in the U.S. are valued for stature and status. High status universities are more likely to receive generous financial donations and attract the best students.

[Voyager]

@Ocean_Annie

The public schools are not funded like single payer health care. There is no federal education tax. Public schools are funded with property taxes, which is why the better public schools are generally located in higher income neighborhoods and states with higher incomes and property values.

While that is true, there is evidence that the cause is not better funding. In my district there are five high schools with highly varying quality. One is one of the best in the state, and is indeed located in an area of high income. However, it gets no more money than the other schools, in fact less than the second best school, the one my kids went to, which has the advantage of being the oldest and the alma mater of the bigwigs in our town. The teachers in the best school are no better than the teachers in ours, and the facilities are actually worse. I was involved in a district wide GATE parents program, so I had a lot of contact with parents in all the schools.

In our district, anyhow, test scores for elementary schools are strongly correlated with the percentage of students on the subsidized lunch and breakfast program.
In California funding per pupil varies wildly across districts, because it is frozen where it was when the state took over collection of property taxes. LA gets a lot and the large number of legislators from LA won’t allow the funding to be better equalized. Our district was far more rural when this got frozen, so we are badly ripped off compared to a neighboring district.

I suspect that there will still be differences across hospitals after UHC based on the competence of the administration and the income level of the population the hospital serves, just like there is in schools now, so I agree with your larger point.

[Voyager]

@Martin_Hyde

The “underclass” is a sweeping term that holds little meaning. Generally speaking the types of people who would be prone to abusing a single payer system are the chronically homeless (who already cost us from anywhere to $20,000-$150,000 a year per transient) and the urban poor who have a high incidence of drug addiction and a general feeling of entitlement.

How about the working poor? The nonworking poor get Medicaid. The homeless are not a real good benchmark, since there is a high incidence of mental illness there.
So, does the guy who works two jobs, neither with health benefits, and stands to lose everything if anyone in his family gets sick merit your disdain? How about the guy who gets laid off and loses his coverage, or who can no longer afford private coverage?

[The_Tao_s_Revenge]

@brazil84

There are other things which happen in the United States but not in Canada. For example, our murder rate is roughly triple yours, mainly because we have a big underclass which is pretty good at causing social problems.

Instead of crying like little ignorant helpless babies wouldn’t it be a better solution to look at why we have a crime problem?

Maybe it’s because we have more people who feel like their in hopeless situations and desperate people do desperate things?

In otherwords I’d like better proof of your assertion that we can’t afford safety nets because we have crime. You may be confusing cause in effect. Maybe western Europe and Canada do better then US crime wise because they have less desperation and better educated people?

@Ocean_Annie

Without government subsidies, the U.S. health care system would collapse. It is unsustainable as an inefficient, expensive corporate structure that pays out billions in executive compensation to maximize profits by denying care. The U.S. health care business needs a nanny state to maintain its existence.

The question is who should benefit from public funds, the American people or corporate executives and investors. Is the government using public funds for public service or at the expense of the public ?

This was a very good post and I find it very telling of weakness of the antiUHC side that they choose to ignore it.

@Grumman

Personally, I see a difference between forcing people to not do “bad” things, and forcing people to do “good” things. Driving recklessly and thereby risking other people’s lives is “bad” in a way that failing to subsidise people’s healthcare isn’t.

You’d rather they die and suffer from treatable conditions? Cause either that or you’ll have to subsidized other people’s health care. If not through taxes then increased fees for health care. The question is do you want to fund people’s healthcare plus a huge tangled network of bill collectors, lawyers, and baskin robins 31 claims forms tangle, or do you want to just fund the healthcare?

[brazil84]

@The_Tao_s_Revenge

In otherwords I’d like better proof of your assertion that we can’t afford safety nets because we have crime.

And I’d like you to either show me where I made such an assertion or admit that I said no such thing.

Your choice.

[MemoryLeak]

Why do so many Canadians go to the USA for medical treatments (joint replacements, heart procedures, plastic surgery, eye surgeries, …)?

[Lobohan]

@MemoryLeak

Why do so many Canadians go to the USA for medical treatments (joint replacements, heart procedures, plastic surgery, eye surgeries, …)?

How many is “so many”? Do a million of them a year do it? Or a thousand? Or a hundred? Is it just a bunch of rich people who want to bump the queue and not wait for poor people’s hearts to get bypassed before they can get a facelift?

[The_Tao_s_Revenge]

@brazil84

And I’d like you to either show me where I made such an assertion or admit that I said no such thing.

Your choice.

Delivered.

@brazil84

There are other things which happen in the United States but not in Canada. For example, our murder rate is roughly triple yours, mainly because we have a big underclass which is pretty good at causing social problems.

As someone who grew up poor and law abiding I ask you to stop blaming things on me. Poor comes from ignorance, not divine prejudgement, and the way you fix ignorance isn’t be telling them to fuck off and die cause I’ve got mine.
The way you fix it is you give people the tools to survive, and you put them in a place to use the tools for a better life. I’d certainly turn to crime too rather then be poor the rest of my life. Not everyone is in a situation to escape so readily. College requires a semistable life situation, or you can’t your stuff together, fail, and loose your financial aid. I’d rather a few people abuse the system if meant many more got help.

[Bookkeeper]

@Krokodil

I was bankrupted by a kidney stone a few years ago, and I had Blue Cross. That would never happen in any other industrialized nation. I can do without the exotic geegaws of House, M.D. if I can just get the treatment for illnesses I’m likelier to get.

Single Payer? Where can I sign up?

I have had three separate kidney stone attacks. I was NOT bankrupted as I paid $0 under the Canadian system. My mother in Florida had a kidney stone attack just this month. She has a good insurance plan and still had to pay $2500 up front before the hospital started treatment (and this was a non-profit hospital), with the final total bill likely to be 10-20 times that.

I had to wait 24 hours for my treatment - Mum got treated the same day. I still like my system much better, thanks!

[curlcoat]

@Hilarity_N.Suze

Meanwhile, a friend of mine and her husband were doing great 10 years ago. They both had good jobs, they had a couple of kids, they had two rental houses and one they lived in. Then he had a heart problem, which has resulted in a bypass, some kind of implant that has to be tested once a year, and severely cut back hours. He just can’t do what he used to do. And she had a brain tumor. They did have insurance, but nonetheless, after the heart problems and the brain tumor, they had to sell all their houses to pay the medical bills, one of them is now 100% disabled and the other 50% disabled, and they’re renting. No savings and nothing to fall back on and no vacations ever again.

I’m not getting how this applies. You think that we should have a UHC that would have allowed them to keep three houses and go on vacations? Or, you think that somehow a UHC would mean that the real costs of that sort of care would be less? Or, that this is a typical example?

And not only that, but health care costs are sneaky. You can’t ask, “How much is this going to cost?” because the only people who know are the insurance companies. For instance I went in and had a physical this year, because it had been a long time, and my doctor wanted to make sure I was healthy enough to take Fosamax. (Ha; they give this to people in nursing homes, how healthy do you have to be?) I asked how much it would cost, the receptionist looked at my insurance card and said, “Oh, just the copay.” $20. Okay, fine.

It isn’t like your insurance benefits are a secret. Did you check to see if the insurance company had considered the lab bills at all?

I think the first thing I’d do to fix healthcare would be to get rid of all insurance companies, period. Of course this would throw a lot of people out of work. A hell of a lot of people. There would be opposition, and there would be lobbying. But I think we can’t even see what’s wrong with health care until we cut through some of the weeds, and by weeds, I mean insurance companies.

I continue to be amazed at the number of people who trust the government more than they trust insurance companies. Particularly considering how much the government sticks their nose into how the insurance companies run.

Why do there have to be codes? Why can’t a person be told the cost of an office visit with lab work, up front? Why do insurance companies pay more if it’s one kind of diagnosis and less if it’s another? It’s a total mess.

Well, actually, here is an example of the government dictating something to the insurance companies. The ICD-9 (it’s probably -10 now) are for standardization purposes. As for why a person can’t be told the costs up front, the cost of an office visit depends on how long you are with the doctor, and whether the doctor is a specialtist or a GP. The cost of lab work depends on what you get done of course!

[curlcoat]

@Ocean_Annie

The only people benefiting from the system we have now are lobbyists, corporate insurance, executives, drug companies, and bribed lawmakers. Patients and health care providers are the losers. It doesn’t seem rational to fund a health care system that profits people who undermine its viability.

And yet, somehow, I get health care without having to claim bankrupcy. With UHC, the only people that you think are benefitting now that would be dropped, might be dropped, are the insurance CEOs. All the rest would still need to be involved, since the government will need people from the private sector to run the UHC, they will still need the drug companies and the companies that make medical equipment, and we will always have lobbyists and bribed lawmakers.

If the government nationalizes health care, it will remove profit. This will eliminate the administrative costs for screening, challenging claims and harassing providers. It also eliminates highly paid lobbyists and astronomical executive compensation. The government can negotiate drug prices –unlike Bush –and eliminate pharmaceutical advertising.

It also eliminates competition. If you have ever been a member of a true HMO, you know what that means to medical care.

It will be a much more cost effective, efficient, and moral health care system that functions as a public service.

Run by the government???

[curlcoat]

@MichaelQReilly

This is just wrong. My brother works for a company that makes practice management software for doctors and surgery centers. Its a pretty small practice if an office only has one person that does billing.

Which isn’t what I said. I said that it isn’t true that all doctors have one or more people on staff that only do insurance billing, for example none of my doctors do. This may be because of the four doctors I see regularly, only one is in a big practice.

[The_Tao_s_Revenge]

@curlcoat

And yet, somehow, I get health care without having to claim bankrupcy. With UHC, the only people that you think are benefitting now that would be dropped, might be dropped, are the insurance CEOs. All the rest would still need to be involved, since the government will need people from the private sector to run the UHC, they will still need the drug companies and the companies that make medical equipment, and we will always have lobbyists and bribed lawmakers.

You neglected unpaid services for the poor that have to be made up in everyone else’s bill. You also neglected infrastructure for the insurance companies themselves. Health insurance is big business.

It also eliminates competition. If you have ever been a member of a true HMO, you know what that means to medical care.

Life expectancy, health, and infant mortality seem to be better in UHC countries.

Run by the government???

Canada gets better health care (as measured by health, life length, and infant mortality) for around half the dollar per person, and everyone is covered.

[brazil84]

@The_Tao_s_Revenge

Delivered.

The quote of mine you showed me does not say what you claimed it said. I don’t know if you are intentionally setting up a strawman or you just didn’t read my post carefully. Either way, there is no point in engaging any further.

Goodbye.

[The_Tao_s_Revenge]

@brazil84

The quote of mine you showed me does not say what you claimed it said. I don’t know if you are intentionally setting up a strawman or you just didn’t read my post carefully. Either way, there is no point in engaging any further.

Goodbye.

It’s not my fault you fail at communication. Your throwing out either made up or not very common terms.

Explain your use of the term “underclass”. If not the poor then who is the the “underclass”?

It’s a very poor debater who communicates badly then acts smug when he’s misunderstood.

I’ll just keep tearing apart your arguments in this thread btw.

[curlcoat]

@The_Tao_s_Revenge

You neglected unpaid services for the poor that have to be made up in everyone else’s bill. You also neglected infrastructure for the insurance companies themselves. Health insurance is big business.

I am already paying those unpaid services for the poor, thru my taxes. And the infrastructure that is currently there for the insurance companies would have to be duplicated by the government. Most likely, they would just contract it out to those companies as they have done with Medicare.

Life expectancy, health, and infant mortality seem to be better in UHC countries.

Cite? I’d also need to know what sort of UHC they have.

Canada gets better health care (as measured by health, life length, and infant mortality) for around half the dollar per person, and everyone is covered.

Again, Canada is not the US. If nothing else, they have huge areas that are only lightly populated, where a UHC type thing makes much more sense. Even in the populated areas, they don’t have the kind of masses of humanity that the US has. And they have had their UHC for, depending on when you want to count from, at least 40 years up to over 60 years, when they had an even smaller population. And they did it in pieces, not the whole nation all at once. If Massachusets works and continues to work, then maybe it can spread state by state. All at once I think is a bad idea.

[foolsguinea]

@MemoryLeak

Why do so many Canadians go to the USA for medical treatments (joint replacements, heart procedures, plastic surgery, eye surgeries, …)?

Well, it’s certain treatments that are harder to get, or harder to get quickly, in Canada. As complex & varied as modern medical care is, it’s not surprising that some services may have shorter waiting lists or be cheaper on each side of the border. It’s not baseline preventative care they’re coming into the USA for.

[gaffa]

@Voyager

How about the working poor? The nonworking poor get Medicaid. The homeless are not a real good benchmark, since there is a high incidence of mental illness there.

The New Yorker had an excellent article by Malcolm Gladwell in their Feburary 13, 2006 issue called “Million Dollar Murray”. Sadly, it’s not available to non-subscribers, but here’s the abstract.

The gist of the article is that the homeless alcoholic of the title was capable of being a useful member of society, and was whenever a social worker was able to get him into a program. But that every one of these programs had a time limit, and as soon as he “graduated” from the program, he’d wind up back on the street. It costs more to care for a homeless person on the streets than to get them a studio apartment and a full time assistant. Minor medical problems in an apartment balloon into life-threatening crises out on the streets.