# Is American health-care amazing? **URL:** \ **Category:** Great Debates\ **Created:** [May 17, 2009, 5:44pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764 "2009-05-17T17:44:53Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 18, 2009, 2:25am UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/21 "2009-05-18T02:25:40Z")
> [@athelas](#): > > Why does it have to be a government plan? Why don’t we get rid of employer health insurance tax credits, so that they won’t have an incentive to cover their employees, and people will have their pick of private insurers? Well, I would had expected that solution to appear a long time ago, but IMHO private insurers and corporations just do not have the interests of the people in mind. They had plenty of time to show their effectiveness in relation to the health care that other developed nations have. ---
**Author:** ![SenorBeef](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senorbeef/32/2220_2.png) [@SenorBeef](https://boards.straightdope.com/u/SenorBeef)\ **Post date:** [May 18, 2009, 5:46am UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/22 "2009-05-18T05:46:27Z")
> [@riker1384](#): > > Why is it that people get health insurance through employers in America, anyway? I don’t understand that. We don’t have to buy food from a company store. We get money, and we spend that where we want. I’ve read that during WW2 there were government-mandated wage freezes that dictated what employers could pay employees. So to attract the best and brightest, they tried to offer other benefits than better wages - including covering their health insurance, and it stuck. Sort of a quirk of history. It’s sort of ironic that the current system that small government advocates (of which I am one, but I’m coming to change my mind on our current health care system because it’s not set up to respond to free market pressures) advocate maintaining the status quo which was originally created by obtrusive government intervention into the markets. ---
**Author:** ![Attack\_from\_the\_3rd\_dimension](https://avatars.discourse-cdn.com/v4/letter/a/b38774/32.png) [@Attack\_from\_the\_3rd\_dimension](https://boards.straightdope.com/u/Attack_from_the_3rd_dimension)\ **Post date:** [May 18, 2009, 6:00am UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/23 "2009-05-18T06:00:55Z")
> [@caligulashorse](#): > > What a bunch of garbage. No one with a functioning brain cell would have read that beyond the first “myth”: > > \*\* > > 1. Canada’s health care system is “socialized medicine.” > False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.\*\* > > This guy failed economics and basic logic. “I’m not a thief. I stole nothing. I was just borrowing that money. I even left an IOU.” Don’t see where you’re going here. Canadian doctors see patients, and bill the provincial health authority for the service they provide. For instance, a radiologist reads a chest X-ray, dictates a report, and drops the requisition for the x-ray in a tray. A secretarial person picks up the requisition and bills the provincial health authority for 1 chest x-ray interpretation for patient Jane Smith, ID number 123456789. The province then coughs up the money and the radiologist pockets it. A family doc does the same thing and bills the province for a physical examination, or whatever, and gets paid a fee for the examination. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [May 18, 2009, 7:29am UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/24 "2009-05-18T07:29:00Z")
> [@athelas](#): > > Why does it have to be a government plan? Why don’t we get rid of employer health insurance tax credits, so that they won’t have an incentive to cover their employees, and people will have their pick of private insurers? One problem is the profit motive of the private insurers make them decide not to cover people that might need to use the insurance. I am self-employed and have a pre-existing condition. Thus, I have been declined by every insurer licensed in my state. I moved overseas 7 years ago to get insurance. ---
**Author:** ![tetranz](https://avatars.discourse-cdn.com/v4/letter/t/a587f6/32.png) [@tetranz](https://boards.straightdope.com/u/tetranz)\ **Post date:** [May 18, 2009, 12:05pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/25 "2009-05-18T12:05:29Z")
> [@Declan](#): > > I cant speak for the other 9 provinces, but its never been nessasary in Ontario to have a private clinic and pay per visit. It sounds like something that just doesn’t happen but if a Canadian doctor wanted to open a private clinic which does not participate in the public health system and only treats paying patients, is he legally allowed to do that? Somehow I got the impression that it was not permitted which rather surprised me but … I might have heard it from an unreliable source. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [May 18, 2009, 12:17pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/26 "2009-05-18T12:17:14Z")
> [@athelas](#): > > Why does it have to be a government plan? Why don’t we get rid of employer health insurance tax credits, so that they won’t have an incentive to cover their employees, and people will have their pick of private insurers? Because, unless something changes, private insurers are tremendously expensive, and won’t cover you if you had a cold within the last five years (hyperbole). The problem isn’t the market, but the fact that the market has been usurped by massive government intervention via Medicare, Medicaid, CHIP, VA, etc. I generally like the market solution, but here is my big criticism of it. Let’s say that we had a pure market system and it worked like we hope it would. Then you have a 7 year old girl with cancer. Her parents either didn’t buy insurance, can’t afford the operation, or whatever. The operation costs $XXXX and her family can’t afford it. It seems as if efforts to raise the money in the community are falling short. This operation has a 100% chance of curing her if she gets it, but she will definitely die if she doesn’t get it. What does the market say to this little girl? ---
**Author:** ![sishoch](https://avatars.discourse-cdn.com/v4/letter/s/3e96dc/32.png) [@sishoch](https://boards.straightdope.com/u/sishoch)\ **Post date:** [May 18, 2009, 3:40pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/27 "2009-05-18T15:40:31Z")
Here’s an example of the wonderful American health car system. My doctor’s office exists to maximize profits for their investors. The doctors are scheduled weeks in advance, to maximize the throughput of the office. To get care, I have to call and schedule an appointment, typically 3 or more weeks in advance. So if I need treatment right away, I am directed to the ER at the local hospital and I’m treated by the ER staff, that does not have access to my medical history. This is for any immediate treatment, even during office hours. So any acute care costs me $150 for the ER plus $75 for each doctor I see, unless they are out of my PPO, in which I’m completely responsible. The cost to my insurance company is probably on the order of $1000 to $3000, depending upon the service. So, if you feel sick in America, please have the courtesy of scheduling it well in advance. ---
**Author:** ![Attack\_from\_the\_3rd\_dimension](https://avatars.discourse-cdn.com/v4/letter/a/b38774/32.png) [@Attack\_from\_the\_3rd\_dimension](https://boards.straightdope.com/u/Attack_from_the_3rd_dimension)\ **Post date:** [May 18, 2009, 3:50pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/28 "2009-05-18T15:50:50Z")
> [@tetranz](#): > > It sounds like something that just doesn’t happen but if a Canadian doctor wanted to open a private clinic which does not participate in the public health system and only treats paying patients, is he legally allowed to do that? Somehow I got the impression that it was not permitted which rather surprised me but … I might have heard it from an unreliable source. From wikipedia on Canadian Healthcare: > **[Healthcare in Canada](https://en.wikipedia.org/wiki/Health_care_in_Canada)** > > Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal.: 81  The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country". Canadian M... " The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service.[1] According to Dr. Albert Schumacher, former president of the Canadian Medical Association, an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly. " "Frontline practitioners whether they’re GPs or specialists by and large are not salaried. They’re small hardware stores. Same thing with labs and radiology clinics…(snip) The Canada Health Act of 1984 “does not directly bar private delivery or private insurance for publicly insured services,” but provides financial disincentives for doing so. " You open your own shop. People come, you treat them, you charge their insurance company. Everyone has the same insurance company, which is from the province. Most people have some additional insurance to cover dental and glasses. It would be tough to set up as a private for-cash provider, since the exact same service is offered essentially for free everywhere else. The other benefit is that anybody and everybody is covered, to include homeless, drug addicts and other non-mainstream groups. In all the places where I have worked the homeless guy is in the next bed to the professor in the ER. ---
**Author:** ![Speaker\_for\_the\_Dead](https://avatars.discourse-cdn.com/v4/letter/s/c77e96/32.png) [@Speaker\_for\_the\_Dead](https://boards.straightdope.com/u/Speaker_for_the_Dead)\ **Post date:** [May 18, 2009, 4:11pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/29 "2009-05-18T16:11:56Z")
> [@Attack\_from\_the\_3rd\_dimension](#): > > Don’t see where you’re going here. > > Canadian doctors see patients, and bill the provincial health authority for the service they provide. For instance, a radiologist reads a chest X-ray, dictates a report, and drops the requisition for the x-ray in a tray. A secretarial person picks up the requisition and bills the provincial health authority for 1 chest x-ray interpretation for patient Jane Smith, ID number 123456789. The province then coughs up the money and the radiologist pockets it. A family doc does the same thing and bills the province for a physical examination, or whatever, and gets paid a fee for the examination. I agree. While some of our doctors (especially our teaching ones) are salaried and paid directly by the provinces, the rest run things how they want to and get paid by what amounts to a government-run insurance company. As **Attack** says, it’s “fee for service.” ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [May 18, 2009, 4:26pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/30 "2009-05-18T16:26:49Z")
> [@](#): > > Now, I know next to nothing about the American system, which is the classic example of private health-care. Um…first off the American system isn’t a good example (classic or otherwise) of a private health-care system. Our system is a kludged up cluster fuck of a system half way between a quasi-private system and a government controlled system. Part of our problem is our system isn’t one thing or the other but sort of straddles the fence. > [@](#): > > Because I know so many people who want to move in that direction, it must be a pretty great set-up. Who want to move towards the American health care model? They are nuts then and should be locked away. Our system is a complete cluster fuck. The wonder is that it still functions as good as it does. > [@](#): > > What makes it great? We are a rich nation and so are able to attract top talent into our system. Also, our system pays doctors and such very well…which also tends to attract top talent. We also have a lot of money for some truly fine medical colleges and universities…again, which attracts top people from around the world. On the user side…if you have a job that gets you health care then our system is VERY good. For instance I am typing this from the doctors office atm. I hurt my shoulder yesterday when I fell at the air port lugging my stuff off the plane. I called my health care provider, told them I hurt my shoulder and asked to see a doctor. They told me to come right over. Doctor looked at the shoulder and sent me off for an X-Ray and an MRI (which I’m waiting for the results right now, freezing my backside off in one of these stupid hospital gown thingies). Total elapsed time since I called this morning…2 hours and 22 minutes. Prescription cost for the 3 I was given…probably something like $15. My out of pocket cost for the visit (co-pay)? $10. So…if you HAVE insurance in the US it’s usually (in my own experience) very good. If you don’t…well then it’s not so good. My sister has no medical insurance through a company, for instance. Nor does many of my relatives who are generally quite poor. For them it’s medicare and the emergency room. > [@](#): > > My goal isn’t to secretly have people realise flaws or anything. I’m genuinely curious what draws so many to privatisation, since I’ve never experienced private care. You’d need to look at some other country than the US if you want to compare Canada to a real privatized system. The US doesn’t have anything close to a privatized health care system. Honestly I don’t even know of a country that DOES have a true privatized health care system off the top of my head. -XT ---
**Author:** ![Speaker\_for\_the\_Dead](https://avatars.discourse-cdn.com/v4/letter/s/c77e96/32.png) [@Speaker\_for\_the\_Dead](https://boards.straightdope.com/u/Speaker_for_the_Dead)\ **Post date:** [May 18, 2009, 4:40pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/31 "2009-05-18T16:40:01Z")
> [@xtisme](#): > > Who want to move towards the American health care model? They are nuts then and should be locked away. Our system is a complete cluster fuck. The wonder is that it still functions as good as it does. I was inspired to ask this question after reading some recent threads in which a number of posters wrote in the most doom-and-gloom rhetoric about the losses the American health system would suffer if it were no longer private. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [May 18, 2009, 4:52pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/32 "2009-05-18T16:52:59Z")
It hasn’t been private for a long time. My guess is they were talking about the losses if we went from what we actually have to a fully public system (UHC). There is a lot of debate as to what the conversion to such a system would cost, both in the initial costs and in the recurrent costs. There is also some discussion on the overall level of service we could expect…for instance, if everyone has access to the same care would that mean that a minority of people would get better care than today (especially those who get little or no care today) while the majority of people who DO have care today would get lesser care? There are only so many resources to go around and all that. But if they were lamenting the demise of private care in the US they were decades late. -XT ---
**Author:** ![tetranz](https://avatars.discourse-cdn.com/v4/letter/t/a587f6/32.png) [@tetranz](https://boards.straightdope.com/u/tetranz)\ **Post date:** [May 18, 2009, 5:04pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/33 "2009-05-18T17:04:39Z")
> [@Attack\_from\_the\_3rd\_dimension](#): > > From wikipedia on Canadian Healthcare: > [Healthcare in Canada - Wikipedia](http://en.wikipedia.org/wiki/Health_care_in_Canada) > > " The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service.[1] According to Dr. Albert Schumacher, former president of the Canadian Medical Association, an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly. > > " "Frontline practitioners whether they’re GPs or specialists by and large are not salaried. They’re small hardware stores. Same thing with labs and radiology clinics…(snip) > > The Canada Health Act of 1984 “does not directly bar private delivery or private insurance for publicly insured services,” but provides financial disincentives for doing so. " Thanks, that’s interesting. It’s a bit confusing but, after reading that Wikipedia page (and the discussion attached to the page), I think it’s true to say that a provider in Canada is prohibited from providing a service for a fee if the patient could get that same service through the government insurance system. It’s obviously a plan to stop someone with money jumping the queue. I’m not saying it’s a bad thing but it is different to what we have in New Zealand where someone with money or insurance can certainly get surgery quicker by “going private”. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [May 18, 2009, 5:32pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/34 "2009-05-18T17:32:16Z")
Quoth **athelas** : > [@](#): > > Blacks, for genetic reasons, have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics’ case collapses. Could we have a cite for this, please? Preferably one that controls for socioeconomic conditions? Because I suspect that all this comes down to is “American health care is great for the rich, and only sucks for poor people”. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [May 18, 2009, 8:29pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/35 "2009-05-18T20:29:58Z")
> [@Chronos](#): > > Quoth **athelas** :Could we have a cite for this, please? Preferably one that controls for socioeconomic conditions? Because I suspect that all this comes down to is “American health care is great for the rich, and only sucks for poor people”. Nope; covered it over in the [other UHC thread](http://boards.straightdope.com/sdmb/showpost.php?p=11151143&postcount=37), though I should have crossposted it for completeness. Among other reasons, blacks have a higher proportion of premature births, which contributes to infant mortality but is not obviously a result of medical incompetence. From the [March of Dimes PDF](http://www.marchofdimes.com/files/AA_PTB_Report_FINAL(1).pdf): > [@](#): > > Compared to non-U.S.-born, U.S.-born residents have been shown to have higher rates of preterm birth and low birthweight. While race is often discussed as proxy for socioeconomic status, differences in preterm birth by race/ethnicity cannot be attributed exclusively to differences in socioeconomic status. > > Black infants also have a greater chance of being born very preterm (less than 32 completed weeks of gestation) (Figure 2). In 2004, 4.1% of black infants were born very preterm, compared to 1.8% of Hispanic infants, 1.6% of white infants, 2.2% of Native American infants and 1.5% of Asian infants. This kind of thinking is a bit counterintuitive because many of us have been steeped in the whole “race is just skin deep” dogma, which does not allow for biological differences between races, or the existence of race in a scientific context. But in fact both forensic pathologists - who can detect race from skeletal morphology, and doctors, who see genetic differences in disease burden, have to actually grapple with such differences on a daily basis. Relevant to this debate, it means that we can’t compare countries’ disease burdens without comparing countries’ populations. (Otherwise people can cherry-pick facts, ie seeing Israel with crazy-high Tay-Sachs disease incidence and conclude it has crappier healthcare than Cambodia.) ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [May 19, 2009, 3:16am UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/36 "2009-05-19T03:16:44Z")
I lived in Denmark for a short while and even though they were paying a 40% tax, they were so proud of their excellent health care system that they said that it was worth every penny. They did not have to worry about expensive treatments, how they would take care of themselves in their old age, the complications of having a child with disabilities and many other such problems. American made medicines were less expensive there than they are here in the USA! Also, products cost less because you were not paying the store owner or factory owner extra so that he could pay for his employees’ insurance. The government also mandates five weeks of paid vacation for every working citizen. There is a very strong work ethic there. I saw no poor people. None. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [May 19, 2009, 1:43pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/37 "2009-05-19T13:43:38Z")
> [@Zoe](#): > > I lived in Denmark for a short while and even though they were paying a 40% tax, they were so proud of their excellent health care system that they said that it was worth every penny. They did not have to worry about expensive treatments, how they would take care of themselves in their old age, the complications of having a child with disabilities and many other such problems. Agreed. At this very moment I am sitting at a US airport on my way to a doctor appointment in the Czech Republic. The cost to see my doctor there will be about $50, whereas in the US it’d be $2,000 or so. I just wish I could buy health insurance in the US so I didn’t have to fly to Europe every couple months when I am visiting the US… it’d be nice to be able to live in my own country again too without having to be worried about medical costs driving me into bankruptcy. ---
**Author:** ![QuanSu](https://avatars.discourse-cdn.com/v4/letter/q/c37758/32.png) [@QuanSu](https://boards.straightdope.com/u/QuanSu)\ **Post date:** [May 19, 2009, 11:04pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/38 "2009-05-19T23:04:43Z")
> [@caligulashorse](#): > > What a bunch of garbage. No one with a functioning brain cell would have read that beyond the first “myth”: > > This guy failed economics and basic logic. “I’m not a thief. I stole nothing. I was just borrowing that money. I even left an IOU.” I don’t follow your analogy. Would you mind explaining your logic? To Admin: How can a “banned” account get to continue to post? ---
**Author:** ![black\_rabbit](https://avatars.discourse-cdn.com/v4/letter/b/f19dbf/32.png) [@black\_rabbit](https://boards.straightdope.com/u/black_rabbit)\ **Post date:** [May 20, 2009, 1:42am UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/39 "2009-05-20T01:42:36Z")
> [@jtgain](#): > > What does the market say to this little girl? “Sucks to be you.” That’s the beauty of the market. ---
**Author:** ![Markxxx](https://avatars.discourse-cdn.com/v4/letter/m/5daacb/32.png) [@Markxxx](https://boards.straightdope.com/u/Markxxx)\ **Post date:** [May 20, 2009, 5:04pm UTC](https://boards.straightdope.com/t/is-american-health-care-amazing/496764/40 "2009-05-20T17:04:04Z")
Basically I have found through my readings and work with the U of Chicago hospitals (I complied and administered research questions for them), the American system is miles ahead of the world in areas of forefront research but lacking in everyday or “routine” procedures. For instance, routine transplants (such as kidney), or heart attacks or even everyday doctor visits, child immunization and chronic problems like high blood pressure, systems in place such as Canada and Europe and Aussie/NZ do a much better job. This is probably because people in those countries are able to get the treatments ASAP and don’t put things off. Obviously it’s easier to cure things when they are small. But for forefront medicine, and complex things, the American system just outshines the rest of the world. This is because there is a lot of incentive to go for these goals and they can use the everyday procedures that make money to fund these experimental and “offbeat” researches. The military research and military command has stated the biggest deficiency in American medicine isn’t practical but visional. They fail to see the danger in “tropical” disease or other such communiable illnesses that can be brought in by travelers to this country. In otherwords, if it doesn’t effect us now we won’t worry about it till later. [Previous page](https://boards.straightdope.com/t/is-american-health-care-amazing/496764.md?page=1) [Next page](https://boards.straightdope.com/t/is-american-health-care-amazing/496764.md?page=3)