# Shooting for Sweden, Hitting Venezuela **URL:** \ **Category:** Great Debates\ **Created:** [September 7, 2018, 4:46pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952 "2018-09-07T16:46:14Z")\ **Posts on this page:** 20\ **Page:** 9
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [September 16, 2018, 12:46am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/161 "2018-09-16T00:46:21Z")
> [@Carryon](#): > > Venezuela has 31 million people compared to Scandinavia + Finland + Iceland’s 26 million. > > To be short you have to compare apples to apples not apples to oranges. Small countries can skim the cream and profit. This is why a state like Delaware does fine. They found a niche in chemicals and corporations and skim the cream which is enough for their small population. You can’t apply what Delaware does to California, nor can you compare Venezuela to the Nordic countries. But you can compare Canada (4.72 million more people than Venezuela) to Nordic countries – you know, that Canada – the Canada that the USA has declared to be a security risk and launched a trade war against – the Canada where people live longer, live in a healthier state longer, pay less out of their pockets for health care and pay less through their taxes for health care than Americans – [the Canada that you should aspire to be](https://www.macleans.ca/news/canada/99-reasons-why-its-better-to-be-canadian/), starting with first world health care for all rather than [the highest incarceration rate in the world](https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate). Try being a bit more caring. A bit more social. Or just admit that your country has stopped advancing because of your maga-maga-me-me-maga-maga-me-me, it’s-all-about-me, so-fuck-you-now attitude toward your fellow people as well as toward foreigners. The first world has health care for all, that is all the first world but the USA. It is not because you can’t. It is because you won’t. You chose not to have health care for all just as you chose not do deal with your gun death problem despite the rest of the first world having dealt with it. There is nothing holding you back from picking up your socks other than your own unwillingness. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [September 16, 2018, 4:15am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/162 "2018-09-16T04:15:52Z")
> [@Budget\_Player\_Cadet](#): > > Like, seriously. We keep talking about things like oil reserves and cultural homogeneity and population and all these factors that might help us figure out whether implementing socialism in the US would lead to this outcome… > > Guys. > > **Venezuela is a kleptocracy**. I tried to make this point earlier, but it was ignored. Anyone who thinks the problem with Venezuela is socialism knows nothing about Venezuela. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [September 16, 2018, 5:46am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/163 "2018-09-16T05:46:56Z")
> [@Miller](#): > > It may be nonsense, but you’re going to need better anecdotes to prove it. Because what you just described is a fucking dream compared to US health care. Jesus, they gave you a free aspirin at the hospital! Do you have any idea how much that would cost someone in the US? If they had a vending machine, probably $1.50. My point was that single payer doesn’t get you away from bureaucracy and the overhead of it. It’s just more hidden behind the scenes here. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [September 16, 2018, 8:06am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/164 "2018-09-16T08:06:35Z")
> [@wolfpup](#): > > I didn’t say the costs would be identical. I said that if the US achieved substantially the same system as the Canadian provinces, one could expect costs to be roughly similar. And there is no evidence for that. America is not Canada. It’s ten times larger, it has a different demographic composition, a different political structure, etc. I already pointed out that our education systems are roughly the same, but Americans pay 30% more with a significantly worse outcome. Prices in Canada vs the U.S. also change based on our relative standards of living. In terms of PPP, the U.S. has a GDP per capita of $59,500. Canada is $48,300. That affects the price of everything. The U.S. also has a much less healthy population, which is why it lags in life expectancy and other health measures. This is why it’s not meaningful to use arguments like, “The U.S. has the most expensive health care system, but lags in life expectancy” to make a claim about the quality of U.S. health care. Instead, you need to look at outcomes _of people in the health care system_, after controlling for things like prior physical condition. When you do that, the U.S. typically skyrockets to the top or near it. For example, the U.S. typically has the highest survival rates for cancer. > [@](#): > > The interesting thing about the education analogy is that despite some significant differences in how the systems are run, their fundamental structural similarity (taxpayer-funded public schools) results in costs that are remarkably similar, whereas US health care costs are a complete outlier, pretty much off the chart compared to Canada or any other country in the world. I wouldn’t call it ‘remarkably similar’. In Education, in 2014 Canada spent $10,300 while the U.S. spent $12,700, but the U.S had significantly worse outcomes. I mean, really significantly. What would it cost you to bring all those schools up to Canada’s standards? In healthcare Canada pays $4,753 per capita, and Americans pay $9,892. They pay more but get equal or better outcomes. The fact you consider one to be a disaster and the other to be an insignificant difference sounds to me like cognitive bias. I suspect that if the U.S. kept the current education system but spent the money on it needed to get up to our standards, they might easily be paying as big a difference as they do in health care. > [@](#): > > And incidentally, touching more directly on the OP and the original subject of this thread, [the reason Canadian students do so much better than American ones](https://www.bbc.com/news/business-40708421) is the (socialistic) emphasis on equality across schools and equality of opportunity within them, including for immigrants, minorities, and the poor – and particularly with respect to equality of opportunity for the underprivileged, so that students’ test scores are not dragged down by a long tail of underachievers. And you know how that is achieved? By allowing parents to choose their kid’s school. Our neighborhood school wasn’t very good, so we simply chose to send our kid to a different one. If a school is terrible, no one sends their kids there. My city has shut down our inner city schools for lack of students because they sucked. The teacher’s unions in the U.S. are partially to blame, because they are the ones who have fought tooth and nail to prevent parental choice in the public school system, which is why the charter school movement is growing in strength - which the teacher’s unions also oppose. > [@](#): > > In fact the point I’ve made several times, though not in this thread, is that for optimum flexibility UHC systems should be managed by the individual states under general federal guidelines, as they are in Canada by the provinces. I totally agree with you. If you are going to have a government run system, at least have many of them. That way they can still try different things and learn from each other, and a screw-up in one of them doesn’t doom everyone. But here’s the thing - That’s not what would happen. A universal health care system in the U.S. would be run out of Washington. If it was currently in place, it would be run by the Trump administration. Do you still want it? You want to put your medical care in the hands of the clowns in Washington DC? With their track record? > [@](#): > > No, we know already. We know because UHC is far less costly than the US system in every single country in the world, without exception, and we know why. That is not true. Switzerland spends more per capita than the U.S. Norway is a couple of thousand behind. Neither of them have outcomes as good as the U.S. But this numbers game is stupid anyway. Countries are not fungible. For example, if you want to see who wins that game, it’s easily Singapore. Singapore spends less than $3,000 per capita on health care, but is perpetually ranked near the top for health outcomes. So why is Canada your model for America instead of Singapore? Canada spends more than double that of Singapore, and yet the WHO ranked us at 30th. Maybe Canada’s system is the disaster and we should all adopt what Singapore has done, and then we’d all have the same outcomes, right? > [@](#): > > Because the staggering bureaucratic overhead has been eliminated, and because there is generally a central authority to regulate provider fees and services. Centrally regulating prices is the worst thing about a public system. Prices are information. One of the worst ways a government can interfere in the marketplace is to fix prices. > [@](#): > > Everything that you’ve said here about availability of doctors, quality, etc. applies to the US, too, and in many cases the issues are worse. At least Canada doesn’t need to have [charities like this one](https://www.ramusa.org/) providing free medical care to its own poor citizens, something that should be considered a travesty in the richest country in the world. It’s a fair point. I’m not actually trying to make excuses for the U.S. system. I’ve already said that it’s so broken that going to some kind of single payer might actually be better. But what would be even better would be to fix it without going that route. > [@](#): > > I’m very sorry to hear about the health care issues you’ve described. But on the matter of misdiagnosis, you surely are not trying to imply that doctors made mistakes because they’re not paid enough, or because they’re paid by a public health care plan? There is a chronic shortage of doctors because of fixed prices. If the price of the doctor is not allowed to reach the market clearing price, you will have a shortage. Basic economics. These shortages are worst in places like native reservations, rural farming areas, places that are very expensive or difficult to live in like the oil towns up north, etc. If we had a free market, prices for doctors would rise and fall with those differences. When prices are set by fiat and the regulators get it wrong, you get gluts and shortages. And they always get it wrong. So one of the ways they compensate is to go doctor shopping around the world, and not look too hard at the credentials if someone is willing to work at a certain price. > [@](#): > > If the argument is that the system discourages doctors from spending adequate time with their patients, I acknowledge that that can sometimes be the case, although fortunately that has not typically been my experience – but these stresses happen regardless of the system of health care coverage, and indeed may be even worse with private insurance. It’s hard to do worse than ‘fee for service’ rates when it comes to shortening the amount of time a doctor spends with a patient. If a doctor is paid a flat fee for a visit, he has every incentive to get you out the door as fast as he or she can. Especially when the low fee structure means the doctors have to have a queue of patients lined up and run an assembly line type operation. There is actual data on this. From here: [Amount of time U.S. primary care physicians spent with each patient](https://www.statista.com/statistics/250219/us-physicians-opinion-about-their-compensation/), 33% of U.S. primary care doctors spent an average of 17-24 minutes per patient. Another 29% spent 13-16 minutes on average. In my experience, I’m lucky to get 5-10 minutes with my family doctor. And when you look at how fee for service works, it’s not hard to see why. In 2015, Ontario paid a doctor $32.64 for a patient visit. Out of that money, the doctor has to pay for the overhead of his practice. And the time for each visit is only partially spent with the patient - there’s also writing prescriptions, checking lab work, ordering lab work, and other stuff. So just how many patients per hour do you think that doctor needs to see to pay the bills and make a doctor’s income? I’m sure you know the drill - you show up, and a nurse takes you to an exam room. The doctor blows in 5-10 minutes later, briefly asks you what’s wrong, then tells you to take off whatever you need to take off. Then he or she goes out the door, and shows up 5-10 minutes later again. Now there’s a quick exam, maybe a few questions about anything that might be ailing you, a quick diagnosis, and you are told to get dressed. The doctor vanishes again, then shows up a while later with a prescription or whatever, and you’re done. What you didn’t see was the row of similar exam rooms, and the doctor is actually seeing four or five patients at the same time. That’s the only way to make enough income to survive. It’s also a recipe for poor patient care. The system of fixed prices drives this behavior. The only way a doctor can make more is to cut the amount of effort spent on each patient and feed more of them through the practice per hour. But then once the doctors are making more, the government uses the rise in billings as an excuse to cut doctor fees… That’s one of the reasons for long waiting lists, and also for the lower standard of Care that Canadians are now getting as compared to 29 other countries in the world. The waiting lists become the actual regulatory signal. If the lists get short enough that the public takes pressure off the government, the government will cut doctor’s fees again. Waiting lists grow or treatment gets worse until the government relents and pays a little more, etc. Waiting lists are an endemic feature of public health care, because when you can’t control demand because the cost to the customer is zero, you have to control it by instituting some form of implicit or explicit rationing. In 2015, Ontario cut doctor fees again, and some primary doctors responded by putting a CAP of 15 minutes on the time spent with any single patient. You think a few diagnoses might have fallen through the cracks? > [@](#): > > This is why in the US some practices have been moving to so-called [concierge services](https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html), high-end medical clinics where the payment of high annual enrollment fees gets you access to a doctor who can give his wealthy patients much more personalized attention and referrals to the best specialists. This sort of exclusivity in my view takes health care in the wrong direction, making it even more money-focused and weakening the system for everybody else. But such is the mercenary nature of US health care. And it wouldn’t be necessary if people didn’t perceive problems with mainstream medical care. So under your UHC system, would that arrangement be illegal, even if the customers were willing to pay full freight for the service? Because that’s the slippery slope of UHC, and how Canada wound up essentially forbidding wealthy people to pay for private health care in Canada (except for those things government doesn’t cover). The same argument was used that you just used - the private system would take all the best doctors and leave the dregs for everyone else. So no private medicine allowed. > [@](#): > > This business of wait times is a tired old canard that is constantly being over-hyped and exaggerated. Medical need in my experience has always been competently triaged and (again, in my experience) when there are significant wait times it’s always been because it just doesn’t matter. Why does your experience trump mine, especially when mine is much closer to the whole population statistics? There is significant variance in wait times across Canada. It varies by province, and withing provinces by city and region. You may be one of the lucky ones. But the statistics are clear that Canada’s wait times are very long by the standards of other countries, that they often exceed the government’s own guidelines for health outcomes, and that they have been getting worse over time. This is flatly undeniable, and it’s a big problem, and you are hand-waving it away. > [@](#): > > For instance, you mention your grandmother being “in excruciating pain for YEARS while on a waiting list for a knee replacement”. I’m very sorry to hear that, but I simply don’t understand, again from own experiences, how that can happen. Joint problems due to age don’t typically arise suddenly, and if they arise due to some accident then they’re triaged as emergencies. It doesn’t matter if you really don’t understand how it can happen, because it happens. In her case, her knees had bothered her for years, and they kept getting worse until she finally couldn’t easily get up the stairs. She was about 60 then. She went to a specialist, and she was put on a waiting list for an artificial knee. And she waited for it for years. This was in the 80’s. The situation is somewhat better today, but not great. Here’s a document from 2011 which shows wait times for knee replacements. The benchmark set by the government for the maximum allowable wait is 182 days. In Nova Scotia only 47% of patients received the knee in that period, and the 90th percentile goes out to 600 days. That means the rest waited longer than that. Saskatchewan, where my grandmother lived, has the 90th percentile out to 450 days still. IN 2011, not a single province is hitting the benchmark wait time. And it’s generally worse today. > [@](#): > > A friend had a gradually developing knee problem, his doctor scheduled elective knee-replacement surgery which was done a month or two later (actually, sooner than he would have liked, as he wasn’t looking forward to it), and that was the end of it. He saw a slowly developing problem and had it dealt with in plenty of time. Had he fallen and broken something it would have been handled as an emergency. The system working as it should. Then I’d suggest that either your friend got really lucky, or you live in Ontario, or both. Ontario has the best stats for knee replacements, with the median waiting time being about 70 days or so, and the 90th percentile just outside of the benchmark. Those of us in the rest of Canada are not so lucky. > [@](#): > > My experiences include acting as health care advocate for several elderly individuals, and I’ve never had issues with the timeliness or quality of their care. I’m not claiming the system is perfect, but I can’t think of any major issues, and I can think of some surprisingly positive ones, like the quality of home care that one of them received. Again, quality of care is extremely variable. If you live in a big city with lots of money, and you’re in Ontario, and you come from a privileged cohort, you may get pretty good care. If you live in a rural area of Nova Scotia, good luck to you. This also points out how wrong it is to simply assume that the U.S. would have the same outcome as Canada, because Canada itself doesn’t have one outcome. Among the provinces, health care quality varies by a tremendous amount. How come, since they all use essentially the same system? Because other factors like demographics, ease of finding doctors, how dispersed the population is, and the wealth of the population are a huge factor. > [@](#): > > One also needs to keep in mind with these horror stories about long waits for MRI or CT imaging that not only are waits bypassed for time-critical situations, but they only apply to outpatients. Once you’re in hospital all these resources are essentially instantly accessible. But you don’t get into the hospital until your wait on the list is up. You are talking about emergency use - and yes of course if an MRI is needed in an emergency it can be used. We’re talking about diagnostics for things like arthritis, or cancer tests, or liver function, etc. > [@](#): > > In addition to what I said just above, I disagree with many of those assessments. The main reason that a lot of medical innovation comes from the US is that a lot of technical innovation in general comes from the US, and there is a lot of public and private research money around. The reason there is so much private research money around is because the U.S. has people willing to pay for it. Ask yourself - if the government had said in 1990 that for fairness no cell phone could be sold for more than $200, do you think we’d have the cell phones we have today? Who would have invested in them, when the cost five times to make than what the government would allow them to be sold for? That’s what you get with single payer medicine. When the government says that a treatment can cost no more than what’s on the fee schedule, no one bothers to invent new treatments that will cost more than that, and therefore you never get the virtuous cycle of innovation and competition that actually does bring costs down to where everyone can actually afford the thing. If the government had said that no car can be more than $20,000, we’d still be driving around in tin crap boxes. We wouldn’t have ABS, or airbags, or direct fuel injection, or 8 speed transmissions, or electric cars for that matter. And that $20,000 car today would be a piece of junk compared to a $15,000 car you can now buy. > [@](#): > > Outside of sci-fi movies, it’s rarely because some billionaire funds an invention to let him live an extra month or year. The innovative technologies that Canada’s health care systems fund vary by province but the general requirement (at least in Ontario) is proven efficacy. If there is some procedure that is not available here, it’s probably still experimental or at least leading-edge and not yet mainstream, and available only in one or two places, perhaps research centers where it was developed. The few cases I’ve read about Canadian patients going to the US for medical treatment have involved such technology. In most cases the public health system will pay for it. So you just made my point that the U.S. system has generated more technology, but are you sure the public health care system will pay for it? There are limited cases where you are allowed to skip the queue in Canada and go to the U.S. and have the government pick up the tab - not ‘most cases’. > [@](#): > > In any case, while I’m sorry that you had these bad experiences, if one were to extrapolate from them and assume they are typical, then one would assume that Canada’s health care system is dysfunctional and systemically broken. You are surely not trying to imply that this is the case, and it certainly disagrees with all of my extensive direct experiences over many years. Actually, my experiences track more closely with the statistics than yours. > [@](#): > > Much of this is wrong or misleading. Cosmetic surgery is covered if it’s medically necessary (for instance, due to an accident). It’s not covered if you’re getting it done for reasons of vanity. In Ontario where I live, [vaccinations are covered](http://www.health.gov.on.ca/en/pro/programs/immunization/schedule.aspx). As of December, 2015, fertility treatments are covered under the Ontario Fertility Program. Gender assignment surgery is covered [as of March, 2016](http://www.health.gov.on.ca/en/pro/programs/srs/). Okay, so you live in Ontario, which is a big outlier when it comes to most measures of health care - probably because that’s where the federal government is. Again, every other province’s statistics are worse, and in a few of them, significantly worse. Certain forms of dental surgery are covered, though not most routine dentistry. Psychology is not covered, but psychiatry is. Prescription drugs are covered for seniors over 65, for the poor, for everyone while in hospital, and in cases of certain rare specialized drugs. Generally speaking the things that are not covered are common minor items like prescription drugs and optometry (eyeglasses) for those of working age which have minimal costs and are usually covered by routine employer supplemental insurance. [/quote] My wife and I both have private health insurance. And good thing for us, because without it those ‘common minor items’ would be costing us about $4000 per month. > [@](#): > > The public health plan likes to nickel-and-dime on trivia like that while paying unconditionally and in full for major procedures like major surgeries. Those are priorities that I can get on side with. Can you hear yourself? You just called prescription drugs, dentistry and optometry ‘nickel and dime trivia’. Prescription drugs are the single biggest cost in the Canadian health care system, and Canadians pay an average of $1086 per year for them. Doctors are the second biggest cost at $1014 per person. You just hand-waved away the fact that the government doesn’t pay for most of the biggest expense in the health care system. > [@](#): > > The first thing you’re describing there is the hospital internal bureaucracy involved in dispensing drugs. That’s completely irrelevant and has nothing to do with the bureaucracy involved in health care funding which is what I’m talking about. Because it’s a _different_ bureaucracy? Overhead is overhead. And much of the paperwork in the hospital is to meet the requirements of Alberta Health, not the hospital administration. The paperwork is how the doctors and the hospital get paid by the government. > [@](#): > > Second, what you say about your health care professional spouse having to do paperwork doesn’t change the fact that American doctors and hospitals have to maintain significant staff to deal with accounts receivable and specifically with insurance companies which constitutes an enormous bureaucratic burden because of its volume and complexity, costing, as I said, an estimated $500 billion a year. Conversely, I can tell you for a fact that my family doctor has on staff just a receptionist and a nurse/assistant who never seems very busy. If there is a lot of paperwork to be done, nobody is doing it. Instead of making these bizarre arguments, if you just listed the stats I would agree with you. I don’t disagree that Americans spend more on administration - they actually spend about double. I’m not defending the American system. I’m rejecting the nothing that single payer somehow magically eliminates bureaucracy and paperwork. Government IS bureaucracy. Unfortunately, the U.S. system just replaces one giant bureaucratic entity with a bunch of them, while keeping the giant one around anyway. And the hodge-podge of public and private care across so many different agencies is ridiculous. That does not mean the only answer is single-payer, Canadian style health care. The fact that Canada is currently 30th in the world in quality of care and falling should give Americans pause. > [@](#): > > Because it has to work within a structurally broken system, including the fact of high provider costs and high provider overhead that it can’t do anything about. I am continually astounded by the staggering complexity of the Medicare system and its different “parts” and options compared to the simplicity of the single-payer system I’m accustomed to that simply pays for everything without question and no money changes hands between me and the health care provider. No argument from me. The American system is a mess. ---
**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:** [September 16, 2018, 5:54pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/165 "2018-09-16T17:54:29Z")
> [@Sam\_Stone](#): > > That is not true. Switzerland spends more per capita than the U.S. Norway is a couple of thousand behind. Neither of them have outcomes as good as the U.S. > > But this numbers game is stupid anyway. Countries are not fungible. For example, if you want to see who wins that game, it’s easily Singapore. Singapore spends less than $3,000 per capita on health care, but is perpetually ranked near the top for health outcomes. So why is Canada your model for America instead of Singapore? Canada spends more than double that of Singapore, and yet the WHO ranked us at 30th. Maybe Canada’s system is the disaster and we should all adopt what Singapore has done, and then we’d all have the same outcomes, right? I notice that many times when the right comes with an argument that ends with a “Right?” it usually has a bit that undermines a lot of what the point was. 🙂 So, that bit about Switzerland spending more per capita than the U.S? That is not what the reports show. > **[Do American and Swiss patients get what they pay for?](https://www.swissinfo.ch/eng/business/us-swiss-health-series-costs_do-american-and-swiss-patients-get-what-they-pay-for/43680290)** > > Health care doesn’t come cheap in the US or Switzerland, and costs vary widely. Are Americans and the Swiss getting the best care for their money? > [@](#): > > US healthcare spending is a whopping 17% of GDP, or more than $[9,000 per capita.](https://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-global-perspective?redirect_source=/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective)([Some estimates put the cost per person over $10,000](https://www.pbs.org/newshour/health/new-peak-us-health-care-spending-10345-per-person)). By comparison, Switzerland spends about 12% of GDP, at more than $6,300 per capita. As for outcomes: > **[New 11-Country Study: U.S. Health Care System Has Widest Gap Between People...](https://www.commonwealthfund.org/press-release/2017/new-11-country-study-us-health-care-system-has-widest-gap-between-people-higher)** > > Your level of income defines the health care you receive far more in the United States than in other wealthy nations, according to the Commonwealth Fund’s new 11-country report. The study, the only to include survey data to measure and compare... > [@](#): > > Paying More for Less > > Despite having the most expensive health care, the United States ranks last overall among the 11 countries on measures of health system equity, access, administrative efficiency, care delivery, and health care outcomes. While there is room for improvement in every country, the U.S. has the highest costs and lowest overall performance of the nations in the study, which included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The U.S. spent $9,364 per person on health care in 2016, compared to $4,094 in the U.K., which ranked first on performance overall. As for Singapore’s health care system… too many socialistic bits and mandates in that to make it palatable for many conservatives, so, it could maybe be implemented when we get rid of all the Republican rascals in congress. > **[Is Singapore’s "miracle" health care system the answer for America?](https://www.vox.com/policy-and-politics/2017/4/25/15356118/singapore-health-care-system-explained)** > > The Singapore model shows how liberal and conservative ideas can fuse. > [@](#): > > Here’s what Singapore’s conservative admirers get right: Singapore really is the only truly universal health insurance system in the world based on the idea that patients, not insurers, should bear the costs of routine care. > > But Singapore isn’t a free market utopia. Quite the opposite, really. It’s a largely state-run health care system where the government designed the insurance products with a healthy appreciation for free market principles — the kind of policy Milton Friedman might have crafted if he’d been a socialist. > > Unlike in America, where the government’s main role is in managing insurance programs, Singapore’s government controls and pays for much of the medical system itself — hospitals are overwhelmingly public, a large portion of doctors work directly for the state, patients can only use their Medisave accounts to purchase preapproved drugs, and the government subsidizes many medical bills directly. > > What Singapore shows is that unusual fusions of conservative and liberal ideas in health care really are possible. Singapore is a place where the government acts to keep costs low and then uses those low costs to make a market-driven insurance system possible. One thing you quickly realize when studying their system is it would be a disaster if you tried to impose it in a country with America’s out-of-control medical prices. > > That speaks to the more depressing lesson of Singapore. As soon as you begin seriously comparing where they are, and how their system works, to where the US is, and how our system works, it becomes painfully clear how far America is from having the institutions or preconditions for truly radical health care reform. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [September 16, 2018, 6:25pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/166 "2018-09-16T18:25:03Z")
> [@puddleglum](#): > > This is wrong because it mixes up personalities and interests. If you replaced every congressman and Senator tomorrow, we would still not be any closer to a workable system because the interests the politicians represent would not go away. Doctors and nurses would still not want huge pay cuts. People who like their current insurance would not want it changed, patients would still want access to the latest drugs and technology. Middle class people would not want huge increases in their taxes. > The problem is that people want a system that is cheaper, covers more people, and doesn’t affect quality. These goals are in fundamental opposition to one another. It’s not about personalities. It’s about one political party. We need one of our political parties to actually try and govern again. That would get us closer to solving a lot of our problems on many issues, not just healthcare. Also, the way you present the choice, IMO, is more stark than the reality. We could get to full UHC without single-payer, without huge pay cuts to doctors, without huge tax increases for the middle class, and with most people’s insurance not changed. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [September 17, 2018, 1:13am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/167 "2018-09-17T01:13:59Z")
> [@senoy](#): > > The largest country in the world with a practical and functioning universal healthcare system is Russia. They have 140 million or so. Their healthcare is very cyclical. After the collapse of the USSR, it greatly privatized and the public healthcare became essentially a shell. When Putin took power, he re-socialized healthcare and turned it into a fairly well functioning system. Imagine that. _Nota bene,_ I hate Putin. But yes, socialized medicine works. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [September 17, 2018, 5:06am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/168 "2018-09-17T05:06:19Z")
I just want to briefly comment on the items that I think specifically require refutation. On the rest of them, my original points stand. > [@Sam\_Stone](#): > > This is why it’s not meaningful to use arguments like, “The U.S. has the most expensive health care system, but lags in life expectancy” to make a claim about the quality of U.S. health care. Instead, you need to look at outcomes _of people in the health care system_, after controlling for things like prior physical condition. When you do that, the U.S. typically skyrockets to the top or near it. For example, the U.S. typically has the highest survival rates for cancer. It’s absolutely meaningful. If you “control for” prior health condition, you’re automatically selecting the wealthier cohort that has always had top-tier health insurance. The problem is precisely that many people do not, because access to health care is not universal. And no, as per the article I previously cited, and hundreds of others just like it, the US does NOT have “the highest survival rates for cancer” – it has rates in line with other developed countries within the expected normal variations, including substandard performance for some cancers. > [@Sam\_Stone](#): > > That is not true. Switzerland spends more per capita than the U.S. As already noted by others, this is false, and also betrays a rather astonishing world view, because it’s well known that no country on earth has anywhere even close to the per-capita costs of the US. Switzerland spends far less – $5,260 per capita in 2010 compared to $8,233 for the US – and in my view, spends as much as it does because of an over-reliance on private health insurers. > [@Sam\_Stone](#): > > Centrally regulating prices is the worst thing about a public system. Prices are information. One of the worst ways a government can interfere in the marketplace is to fix prices. In a civilized society that seeks to offer quality health care for all, there is no “marketplace”, there is only the imperative of basic human decency and the compassion to recognize health care as a human right. Regarding access to health care as a business in a “free market” entitled to make a profit is where all the problems come from – the denial of care to those who can’t afford it, grossly inefficient hamfisted and inadequate attempts to try to make exceptions to avoid the appearance of complete barbarism, and the frequent denial of care even to those who can afford good insurance, when the insurance bureaucracy steps in to limit its medical payouts. As for “fixing” prices, that’s a deliberate choice of a rather hostile word; what the government actually does is negotiate fees with the physicians’ association much in the manner of a corporation negotiating with a union. > [@Sam\_Stone](#): > > Okay, so you live in Ontario, which is a big outlier when it comes to most measures of health care - probably because that’s where the federal government is. Again, every other province’s statistics are worse, and in a few of them, significantly worse. Ontario may be better in some respects, but some other provinces actually have better coverages. The point is, however, that ALL provinces must conform to the standards of the Canada Health Act, which guarantees a minimum set of standards. Unless a province wants to opt out of the system entirely, which they are entitled to do. Note that despite all the alleged problems you like to cite, presumably to allege the superiority of private insurance, no province has ever done so, or even remotely considered it. > [@Sam\_Stone](#): > > My wife and I both have private health insurance. And good thing for us, because without it those ‘common minor items’ would be costing us about $4000 per month. > > … Can you hear yourself? You just called prescription drugs, dentistry and optometry ‘nickel and dime trivia’. Prescription drugs are the single biggest cost in the Canadian health care system, and Canadians pay an average of $1086 per year for them. You do have a way of dredging up the most amazing horror stories and anecdotal outliers. But here are the actual facts. In my long life, supplementary health insurance has always been an automatic feature of any job I have ever had, considered so routine and of such minimal importance that it was never even mentioned as a real “benefit”. Indeed, during my time as a self-employed consultant, I never bothered with it, and sometimes had to pay for my own prescription drugs. It was never a problem and never amounted to more than a hill of beans. ETA: And I should add, now that I’m retired and more likely to need prescription drugs, they are fully covered by the Ontario drug plan for us oldsters. 🙂 Here are some actual numbers that prove this out. [According to this](http://creativeblueprint.ca/wp-content/uploads/2013/09/SampleMonthlyRates.pdf), basic Blue Cross supplemental coverage in Ontario for extended health care plus prescription drugs is around $50.55 per month for an individual and $85.23 for a couple. In keeping with your conservative mantra above that “prices are information”, this is information about what it’s worth, based on expected payout – and it’s worth less than typical cable TV service. If one generously assumes that 80% of their revenues go to medical payouts and their total overhead is only 20%, that means they expect to break even at a monthly payout of $40.44 per month or $485 a year – which is more or less in line with my personal experience with prescription drug costs, which on average have been much less than that. Kindly reconcile that with your claim that the average Canadian spends $1086 per year on prescription drugs, and tell me how Blue Cross manages to stay in business – let alone how they are pleased to pay you and your wife $4000 a month. I don’t doubt your extraordinary story, I’m just saying that once again your anecdotal experience is an extreme outlier, because if there were more than one or two Sam Stones in the land, Blue Cross would be bankrupt. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [September 17, 2018, 5:41am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/169 "2018-09-17T05:41:20Z")
> [@wolfpup](#): > > Switzerland spends far less – $5,260 per capita in 2010 compared to $8,233 for the US – and in my view, spends as much as it does because of an over-reliance on private health insurers. Still, my Swiss insurance did pay straight out (the system for outpatient care was “you pay, we reimburse”), without several rounds of me quoting chapter, verse and DNA of the people who wrote their own policy. That alone makes the Swiss system more cost-effective than the US’s, both in visible (insurance company workers) and hidden (patient time and stress) costs. One thing they do have is a large price differential with the neighbors; many clinics and hospitals which present themselves as very high-end, where everybody gets their own private… no, not room; suite. They also have a lot of people who go there for elective procedures in highly-discreet, highly-exclusive settings. I don’t think they offer monogrammed nip-and-tucks, but hey, offer enough money and they’ll ask if you want the thread to be gold or do you prefer a titanium-iridium alloy. If healthcare costs per capita are totaled without separating “elective and non”, then Switzerland has higher costs than any of its neighbors like an apartment overlooking Central Park has higher costs than one in Queens. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [September 17, 2018, 11:51am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/170 "2018-09-17T11:51:24Z")
> [@Sam\_Stone](#): > > I’m sure you know the drill - you show up, and a nurse takes you to an exam room. The doctor blows in 5-10 minutes later, briefly asks you what’s wrong, then tells you to take off whatever you need to take off. Then he or she goes out the door, and shows up 5-10 minutes later again. Now there’s a quick exam, maybe a few questions about anything that might be ailing you, a quick diagnosis, and you are told to get dressed. The doctor vanishes again, then shows up a while later with a prescription or whatever, and you’re done. Don’t be so sure that Americans “know the drill”. The weakness of our system isn’t in the care given to people who get medical care, that care is essentially as good as anywhere else in the world. It’s the people who don’t get care that are the problem. The person who hasn’t seen a doctor in 10 years because they wouldn’t be able to afford treating whatever illness the doc might find. The carpenter (from my circle of acquaintances) who needed knee surgery for years and didn’t get it because he couldn’t afford it. By the time I stopped having contact with him I think he was on 5 years of “not on a waiting list”. It’s ugly, and confusing, and stressful, even if you have insurance. I had surgery, covered by good insurance, and a year later I was getting invoices and wondering if I was going to have to pony up a few thousand out of pocket to make it go away. My wife had a test and I realized later that it cost us a couple thousand more (out of pocket, natch) because she chose to have the test in December instead of January, thanks to our deductible. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [September 17, 2018, 12:46pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/171 "2018-09-17T12:46:20Z")
> [@wolfpup](#): > > In a civilized society that seeks to offer quality health care for all, there is no “marketplace”, there is only the imperative of basic human decency and the compassion to recognize health care as a human right. Food is also a human right, but we allow the free market to distribute it. (Why we have public health care but not public grocery stores is a classic economics exam question.) I am a firm supporter of universal, single payer health coverage, but to say that there is no marketplace for health care is just ridiculous. Of course there is. The supply and demand of EVERYTHING is a marketplace. You cannot substitute high-horse moralizing and preening for logic and intelligence. Economics counts, and to deny that the laws of economics apply to health care is to deny reality. It is to doom ourselves to never improving anything and to burn money while people get sick. Canada’s health insurance system is at its root a very economically intelligent way of approaching what any economist will tell you is a fundamental problem of adverse selection - so to deny the value of economics in health care is to deny the very science that says the Canadian system is built on a foundation of good economics. It seems to me that acknowledging reality might also allow the structure atop that foundation to be incrementally improved. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [September 17, 2018, 1:53pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/172 "2018-09-17T13:53:57Z")
An amazing amount of wrong here, and me with so little time. I suppose I’ll do it in stages. > [@Sam\_Stone](#): > > This is why it’s not meaningful to use arguments like, “The U.S. has the most expensive health care system, but lags in life expectancy” to make a claim about the quality of U.S. health care. Instead, you need to look at outcomes _of people in the health care system_, after controlling for things like prior physical condition. When you do that, the U.S. typically skyrockets to the top or near it. For example, the U.S. typically has the highest survival rates for cancer. No really, no. In public health, when measuring the performance of healthcare systems, one looks at large, overarching measures. These include lifespan, but also years spent in good health (DALYs), healthy life expectancy, infant mortality, maternal mortality, amenable mortality, etc, etc. They US does pretty poorly for a developed country in all of them, and if you average it out, pretty poorly overall. The indicators are not that far apart either. What I think you mean is Healthy Life Expectancy at Birth. The US does pretty much like it does in other measurements. Pretty ok if it had been an eastern European nation and a bit better than the Maghreb, but lagging the first world such as western Europe, Australia, Canada and Japan. Cite. The US does do better than average in the limited area of health care that is cancer, that is true. A high rate of testing and highly expensive interventions play to the strengths of the system. However, many stats are based on 5-year survival rates where the US score can benefit from good surveillance even in the absence of any treatment. Also, cancer is a condition that increase with age. Due to the US low average lifespan, a considerable number of cancer cases in the rest of the developed world is diagnosed in people who have already outlived the US average lifespan. I believe cancer is the number 3 cause of death. So better than average for number 3. But thats an outlier. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [September 17, 2018, 2:18pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/173 "2018-09-17T14:18:41Z")
Cancer is number 2 in the USA as a cause of death, and will someday beat out heart disease for #1. They are far, far head of anything else, and you will find the same thing in any rich country. You can fix many causes of death but the death rate’s always 100%, and ultimately, even if you avoid everything else, heart disease or cancer will get you. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [September 17, 2018, 2:57pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/174 "2018-09-17T14:57:02Z")
> [@RickJay](#): > > Food is also a human right, but we allow the free market to distribute it. (Why we have public health care but not public grocery stores is a classic economics exam question.) > > I am a firm supporter of universal, single payer health coverage, but to say that there is no marketplace for health care is just ridiculous. Of course there is. The supply and demand of EVERYTHING is a marketplace. You cannot substitute high-horse moralizing and preening for logic and intelligence. Economics counts, and to deny that the laws of economics apply to health care is to deny reality. It is to doom ourselves to never improving anything and to burn money while people get sick. The differences between food and health care as necessities of life are at least twofold. One is that there is a very large variance in the type, quality, and convenience of different foods, with many luxury items, and as long as no one is starving or suffering from malnutrition, we consider price-based access to different foods to be a morally acceptable economic arrangement. The precondition to this acceptance is that any adult or child who would otherwise lack adequate food receives the appropriate level of public assistance. Medically necessary health care is completely different because – to take the Canadian model specifically – we reject the idea that there should be price-based access to different quality levels, and declare that there should be only one quality level for health care, and that is the best quality that it’s possible to offer. In Canada this is central to the philosophy of a just, egalitarian, and cohesive society. The second major difference is that food is by and large well within the means of most citizens, so that and the great variability across different foods makes it suitable to be a market-driven product. Whereas health care, in contrast, can unexpectedly run into extraordinarily high costs, and these costs are most likely to arise in connection with life-threatening emergencies. It therefore makes sense to have a public risk-sharing arrangement, both from a moral standpoint and from a purely practical economic one. There is nothing “ridiculous” about saying that there is no viable marketplace in providing access to health care, though I should have clarified that intended meaning more carefully. It’s a statement that I’ve made often before. This is distinct from the practice of health care by doctors and hospitals which is indeed a market of sorts, but certainly not a free market in most countries because it’s very tightly regulated. But access to health care in the form of funding health care coverage is not amenable to any market principles, and trying to make it so by running it as a business is directly and indirectly responsible for most of the problems with America’s health care system. Pointing out this basic fact of health care economics is not “high-horse moralizing and preening”, it’s just a fact. Insurance companies competing for health care coverage business introduce tremendous complexities and overhead into the system. Insurance companies meddling between the doctor and the patient, denying treatment or approving only cheaper alternatives, is immoral and fundamentally counterproductive, sometimes driving even well-insured patients into medical bankruptcy. The consequent emergence of a fragmented, unregulated system in which it’s impossible to control costs is also fundamentally counterproductive. Artificial patchwork solutions like Medicaid and EMTALA laws against patient dumping are inadequate, often ineffective, and extremely costly and inefficient, and seem to have more to do with appearances than a desire for real solutions. Every single one of these problems is the direct result of trying to treat health care coverage as a market-driven business instead of a basic human right and a public obligation. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [September 17, 2018, 6:35pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/175 "2018-09-17T18:35:28Z")
> [@wolfpup](#): > > The differences between food and health care as necessities of life are at least twofold. One is that there is a very large variance in the type, quality, and convenience of different foods, with many luxury items, and as long as no one is starving or suffering from malnutrition, we consider price-based access to different foods to be a morally acceptable economic arrangement. The precondition to this acceptance is that any adult or child who would otherwise lack adequate food receives the appropriate level of public assistance. No, that’s wrong. That actually isn’t the difference at all. It’s not a moral question, as evidenced by your admission that we’d still do something about it if someone had no food - it’s just that in the case of food we allow the market to continue distributing food and attack the problem on the demand side. Morality is a silly way to solve economic problems. Morality is a REASON to solve a problem. The reason the Canadian model essentially works is that health insurance is inescapably subject to market failure and food isn’t. Food, as a market, pretty much works. Health insurance simply does not, and it never will. Health insurance is inevitably subject to the problem of adverse selection; there just isn’t any way around that without some sort of interference. You can solve that problem in a variety of ways - universal healthcare, like the UK, universal health insurance, like Canada, or individual mandates, like Obamacare or Germany and a few others. But without it, adverse selection will always ruin the market for anyone who cannot (as through an employer plan) avoid the adverse selection trap. > [@](#): > > There is nothing “ridiculous” about saying that there is no viable marketplace in providing access to health care… I don’t think you grasp the meaning of “marketplace” here. There is a marketplace for everything, even things the government subsidizes. You cannot avoid its existence, and yes, it exists in Canada. There exists in Canada a supply and demand for health care, and associated prices and costs with that, whether you like it or not, and it doesn’t matter if we have the province interfere in that; it still exists, and that interference has both intended and unintended consequences, pros and cons. You can’t prevent reality, and if you want to improve the system - and it needs it - acknowledging the realities of the economics of health care will go a long way towards helping us do that. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [September 17, 2018, 10:30pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/176 "2018-09-17T22:30:06Z")
> [@RickJay](#): > > No, that’s wrong. That actually isn’t the difference at all. It’s not a moral question, as evidenced by your admission that we’d still do something about it if someone had no food - it’s just that in the case of food we allow the market to continue distributing food and attack the problem on the demand side. Morality is a silly way to solve economic problems. Morality is a REASON to solve a problem. If the food marketplace was like the health marketplace, you wouldn’t know the price of your groceries until after you had eaten your meal. Morality should set the boundaries of how the problem is solved, and so is part of the solution. Not the whole solution, of course. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [September 17, 2018, 10:43pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/177 "2018-09-17T22:43:25Z")
@ OP — While browsing another thread just now I came across this post from 5 months ago: > [@Trump sued by Stormy Daniels over hush payment](https://boards.straightdope.com/t/trump-sued-by-stormy-daniels-over-hush-payment/810163/679): > > The seeds for revolution have been planted. But, it’s not Trump Resisters that will revolt. It’s Trump fans. They will see an impeachment as an attack on the duly elected President. Hannity said last night (or was it Sebastian Gorka?), **“We won’t be the USA anymore – we’ll be Venezuela or something.”** Trumpists are primed to go to war over this. [my emphasis] Was this Hannity/(Gorka?) quote where you got your Venezuela meme from? ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [September 17, 2018, 11:54pm UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/178 "2018-09-17T23:54:28Z")
> [@RickJay](#): > > Morality is a silly way to solve economic problems. Morality is a REASON to solve a problem. I have never argued morality as some kind of methodology. I have argued that the moral imperative of health care is the REASON that government must ensure that access to medically necessary care is treated as an essential public service, not a commercial commodity available only to those with the means to pay for it. > [@RickJay](#): > > The reason the Canadian model essentially works is that health insurance is inescapably subject to market failure and food isn’t. Food, as a market, pretty much works. Health insurance simply does not, and it never will. Health insurance is inevitably subject to the problem of adverse selection; there just isn’t any way around that without some sort of interference. I strongly agree with the first part of that. To reiterate your third sentence, health insurance simply does not [work as a market], _ **and it never will** _. I’ve been saying this over and over again, for years. I don’t know how you can repeat this important point in full agreement with me, yet claim that health insurance IS a market, because everything is a market! I address this further at the end in response to your final point. However I also strongly disagree with the last sentence. The problem with health insurance as a market-oriented business goes far, far beyond just the problem of adverse selection. The fundamental problems are those I listed in the last paragraph of [post #174](https://boards.straightdope.com/sdmb/showpost.php?p=21212541&postcount=174). The essence of the problem is that ALL of the commercial business drivers in health insurance _ **are diametrically opposed** _ to the fundamental needs of health care. > [@RickJay](#): > > You can solve that problem in a variety of ways - universal healthcare, like the UK, universal health insurance, like Canada, or individual mandates, like Obamacare or Germany and a few others. But without it, adverse selection will always ruin the market for anyone who cannot (as through an employer plan) avoid the adverse selection trap. Again, adverse selection is only the tip of the iceberg. Access to health care is not amenable to being operated as a commercial enterprise, period. And the public health care system in Germany is nothing like Obamacare and to characterize it that way, as simply being an individual mandate for private insurance, is totally absurd. The public statutory system in Germany fundamentally represents the same sense of egalitarianism and social solidarity that we have in Canada. The fact that it has historically evolved as a network of non-governmental “sickness funds” is completely irrelevant; what is relevant is that the government is so closely involved in regulating it in the public interest that all the funds are essentially the same, offering essentially the same coverages at the same community-rated costs that are entirely decoupled from any concept of individual risk. What this means in practice is that all these funds basically operate as coordinated agents of a _de facto_ single-payer system. Obamacare is just a few strings and bandaids on a disastrously broken system based on unregulated freewheeling mercenary greed. To suggest any meaningful parallel is comically ridiculous. > [@RickJay](#): > > I don’t think you grasp the meaning of “marketplace” here. There is a marketplace for everything, even things the government subsidizes. You cannot avoid its existence, and yes, it exists in Canada. There exists in Canada a supply and demand for health care, and associated prices and costs with that, whether you like it or not, … No, I grasp it. The Oxford dictionary defines the applicable meaning of “marketplace” as “the arena of commercial dealings; e.g.- ‘the changing demands of the global marketplace’.” The word “market” itself has a similar but broader connotation – an area or arena in which commercial dealings are conducted; e.g. - ‘the labour market’; the free market; a demand for a particular commodity or service - e.g.- ‘there is a market for high-priced wine’. Now unless you’re just being hopelessly pedantic for the sake of being argumentative, one can readily see how health insurance doesn’t meet any of these criteria. You also appear to be muddling the very different issues of health insurance (access to health care) and the health care provider business (actually delivering health care services). When the government negotiates health care provider fees and establishes a health care budget, it might be said to be engaging in commercial dealings with the providers, but this is from the government’s point of view, not that of the patient. If this is considered a “market”, then so are welfare and disability payments and any other form of public assistance. But it’s ludicrous to think of them as market-driven commercial enterprises; we think of them as essential tax-funded public services. It’s also interesting to examine the issue from the standpoint of that last definition, “a demand for a particular commodity or service”. Is there a “demand” for health insurance? Intrinsically, no. There is a demand _ **for health care** _, not health insurance. No one has ever been rushed by ambulance to an insurance office. If a responsible government provides guaranteed and fully paid access to health care, there is zero market for a fundamentally immoral artificial commodity that promises to pay for it, sometimes, maybe, in part. So when I say that there is no market for this parasitical bullshit that does nothing but muck up the health care system with astronomical costs and bureaucracy, I mean just what I say. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [September 18, 2018, 3:54am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/179 "2018-09-18T03:54:55Z")
> [@](#): > > Again, adverse selection is only the tip of the iceberg. Access to health care is not amenable to being operated as a commercial enterprise, period. First of all, no, it IS the iceberg. As to your second statement, complete baloney. In Canada, drug stores are a private enterprise. Dentistry is wholly private. That’s part of health care access, and works just fine as a commercial enterprise… why, in fact, my family doctor (and pretty much all family doctors, too) is a commercial enterprise, and that works quite well. Did you think family doctors were state employees? > [@](#): > > When the government negotiates health care provider fees and establishes a health care budget, it might be said to be engaging in commercial dealings with the providers, but this is from the government’s point of view, not that of the patient. So? Health care is subject to market forces, like it or not. When the government determines a given price away from what the market clearing price is, there will be a gap between supply and demand. That can be made up through some other demand-oriented action, or people might sit on waiting lists. It’s all subject to market forces. That’s the world you live in. You seem to be now changing your argument to the notion that there is no market for health insurance, as opposed to your earlier claim that there is no market for health care, so that’s quite odd. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [September 18, 2018, 8:46am UTC](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952/180 "2018-09-18T08:46:36Z")
> [@RickJay](#): > > First of all, no, it IS the iceberg. Well. Healthcare is subject to a lot of externalities that can lead to market failure. Adverse selection is certainly one. Personally, I believe price elasticity, or the lack of it is a bigger one. Other issues include barriers to entry, non-constant demand, and for insurance models third party payee. [Previous page](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952.md?page=8) [Next page](https://boards.straightdope.com/t/shooting-for-sweden-hitting-venezuela/820952.md?page=10)