Canadians complain loudly and often about our health care, but the complaints are almost always about the need for detail improvements to the current single payer system. I can count the number of people I have heard say that we need to go back to a system more like the US on the fingers of one foot. Pretty much anyone who lives in a UHC country looks on the US system as something to seriously avoid, not emulate.
Of course. Like I said, our system evolved, it wasn’t created. No one would or probably even COULD emulate our system as it stands today, since they don’t have the historical links to why our system is what it is.
Your friend needs to do some reading on the economics of insurance and the concept of market failures and adverse selection. He’s trying to come up with solutions to a problem he just doesn’t understand.
To answer your Question 1; the problem is that health insurance is a market failure due to adverse selection. Completely free health insurance does not work unless you have a large group of people buying it together - as happens with an employment benefits plan, which is why people talk of Americans being stuck to their jobs to keep health insurance. The Wikipedia articles on those concepts explain them pretty well.
Conversely, things like food and clothing are not market failures. The market allocates food and clothing very efficiently.
It’s nice that your friend is a Libertarian, and in many ways I am too, but the fact of the matter is that market failures do exist, and a libertarian should be able to see that and account for it in a realistic worldview, the same way libertarians can account for market failures like how to deal with pollution or how to fund the armed forces.
- Canada has no laws I am aware of forcing health care rationing, and if it did it would be a national outrage.
All things are rationed, except breathable air, I guess. It’s certainly true that access to health care is not always instant in Canada. Of course, it never could be, under any system, because no matter how you structure it there are only so many doctors, so many nurses, and so much money. The only question is HOW you want to ration things. Not if.
- I have heard of Canadians using the US health care system to speed up select processes, usually if they’re rich and impatient. It’s a pretty rare thing, though, I’ve only met a few people who ever did that and one was pretty clearly a hypochondriac. You have to consider that it would be awfully expensive and inconvenient to go to another country for most health care needs just to maybe speed the process up. And of course for most things it wouldn’t speed the process up at all.
So it seems that there are some valid criticisms when it comes to healthcare rationing, and longer waiting periods of health care for certain procedures in countries that have UHC, but this is better than having lots of people go without the care they need (as is the case in the USA).
Is that a fair point?
The UK does have private health care, actually. If for some reason the socialized system isn’t enough for you, you can hire a private doctor. But the basic infrastructure is publicly funded.
Think of the UK as using a public system for most care, and letting private practice doctors fill in the gaps. The USA tries to use a private system for most (really about half) of the health care market, and then fill in the gaps with public “patches”–without going all the way to socialized medicine for fear of putting private health insurers out of work or something. The UK’s track record for providing care is better.
This is why the PPACA (“Obamacare,” or “BenNelsonCare”) is such a disappointment to many reformers. It was designed to expand private health insurance instead of replacing it with a more efficient public system. So it’s still bad at filling the cracks.
Yes, I think it is.
I’ve made the point before about how hard it is for the people I talk to in the UK to get and keep getting psychotherapy, and putting an arbritary hard limit on what’s covered leads to some odd decisions, like the since backed off policy of covering the (fantastically expensive but sight-saving) Avastin treatment for one eye but not both, but overall I’d have to agree socialized medicine is a better model than the US system.
Also, for the most part it’s not the insurance companies in the US rationing care, it’s the HR managers at companies that buy the insurance dictating what benefits they want there employees not to have. Right not the big thing in the private insurance industry is requiring prior authorizations for MRIs, CT, and such, this is being driven at the request of the companies wanting to control premiums for their employees.
I work in the Canadian health care system and want to make a couple of points.
In Canada, many of the “debates” about the Canadian health care system are really just about straw men. They assume, usually without explicit mention, that it’s either/or: the Canadian system OR the US one. You almost never hear discussed, let alone debated, the merits/liabilities of non-US, non- Canadian systems. In fact, I doubt that many Canadians could even tell you any salient points of any other health care system. In any case, when the question is confined to ‘Canadian versus US systems’, no honest person can argue (IMO); the Canadian is superior.
With respect to the OP, yes, there is a huge amount of rationing of health care in Canada (it’s not called that, of course). For one, health care as a whole is rationed by the amount of funding available for it and, in many, maybe most, Canadians’ opinions, there’s never enough funding made available.
Beyond the financial rationing, though, is the rationing done all the time by doctors within the system. Sure, it’s done under the guise of ‘what’s best for society overall’ and ‘what is the evidence for X or Y’, but it’s done nonetheless. Things like dialysis, high-tech devices, ICU stays, major surgery, etc., etc., are rarely offered to certain segments of the patient population, if at all. In most cases, I actually agree with that type of thing (do you really want to provide dialysis for a 93-year-old end-stage dementia patient) but, at the end of the day, these are value judgments and not based on evidence or what’s best for the patient (or what the patient would have wanted). My sense is that in the US such treatments are more often offered to those types of patients because “the insurance will cover it” and, unlike in Canada, there’s much less societal benefit in withholding them (i.e. in Canada, it’s a zero-sum game - limited funding means that there are only so many dialysis slots available. If you use one up on one person, another may not get his).
Rationing occurs because of price in our healthcare system. And I’m sure at a much greater rate than the NHS. Probably 100% of doctors in the US, if they were honest, would say they know people who died because they were turned away by our hospitals and insurance companies.
In fact, rationing is the whole point of prices in the first place. So if your friend is afraid of rationing, he should be demanding UHC.
KarlGuass, That’s true.
I do think in the US Obamacare or no costs are eventually going to get to the point we have to do the same kind of cost/benefit analysis that the UK, Canada, et all do. Rationing in the US as done by insurance companies/insurance purchasers is more the kind "You get X number of therapy visits, you need a prior authorization for a MRI, you need to see a (cheaper ) in-network doctor instead of an out-of-network. Putting a set cost on people isn’t a novel concept, state highway departments do it all the time to figure out what highway projects have merit. (In Minnesota the cost of a fatal accident is $7.2 million, your time stuck in traffic is worth $13.93 an hour)
I really don’t know if it matters. America is a plutocracy with a very anti-statist political atmosphere, so either way I don’t know if you can get a good fix to our health care problem. Private and public systems will have problems here.
Nations can and do have functioning health care systems based on either private insurance or private providers of care. But in the US we are so plutocratic that the laws are going to be written to benefit the providers, not the people who buy insurance. The Netherlands can be trusted to regulate private health insurance companies in the public interest. The US, not so much.
If you get a public system you end up with something like medicaid, which is so underfunded that only about 10-20% of doctors and dentists accept it and lots of patients have trouble finding care. Plus the anti-statists are constantly trying to cut reimbursement for medicaid/medicare too, partly as a back door effort to destroy those programs by making it so no doctors want to partake in it.
I think Obamacare was a good start. If politics ever changes in this country and who knows how likely that is, it can be amended later.
Adding comparative effectiveness to control costs (MA just added this today to Romneycare)
Adding a public option tied to medicare
Allowing Rx negotiations
Offering a medicare buy-in
Pricing isn’t rationing. It is a way to balance supply and demand, but rationing and prices are two different ways to do that. Rationing is what a government does when it doesn’t like the price signals, so they impose controls and then as a result end up with a shortage, and that shortage in turn is addressed through rationing.
The fundamental issue is, do you trust the government to say no, or the private insurance companies to say no? And if you get a no, what are the chances of getting that no changed to a yes? Patients have successfully gone to regulators or the media to get insurance companies to relent. Do people beat the NHS?
A couple of points
Food: Many countries where there is a large population of the poor have subsidized staples like wheat. Yes, socialized bread. In the US food prices are mostly stable and we have food stamps to act like Medicaid, though with the strain on food banks we could probably do more. People did starve here before the Great Society programs to fix the problem.
Clothing. An analogy to healthcare today is if there were no ads for clothes, and when you went to Macy’s to buy a t-shirt you were told that you actually need to get a $1,000 suit. Right then.
Rationing of healthcare in the US is primarily by income. I’m not rationed at all, the person who can’t really afford a doctor’s visit is severely rationed. While we talk about rationing for the very old, what the HCA does and what is smartest is rationing on the basis of evidence based medicine. While we’re arguing about how close to death someone should be before we stop giving care, let’s stop paying for stuff that doesn’t work. Insurance companies do this already to some extent by not covering quack remedies. Why not select the least expensive of fairly equivalent choices? Our fee for service system discourages this to some extent, but that isn’t necessary. Yes, doctors who like doing stuff that doesn’t work will be put out (and they may feel these things do work) but we need to make hard choices to get the system under control.
I’m not aware of any rationing or waiting periods in France, so it’s not an universal issue. I’m aware, though, of healthcare costs always rising, and obviously there will be an upper limit to what a society can/will pay for citizen’s health, so this might happen in the future.
Besides, even if you have a system with some kind of rationing (say, you must wait quite long for a surgery that would significantly improve your life but isn’t immediately necessary), you still can go to a private hospital and pay out of your pocket. At which point the rationing is done on the basis of how much money you have. Of course, you still will have to pay for the public healthcare system despite not using it, but at least it’s possible to bypass a possible state-mandated rationing if you have the means to do so.
My understanding of “rationing” is like in WW2 - you are entitled to a prescribed quantity because there is a limited amount available.
That is not in any way representative of UHC.
In UHC, people gets everything they need though - depending on funding (and it varies greatly between countries and during economic cycles) - they may/not need to wait.
It is, but it’s those at the bottom and the top who are the least rationed, which is kind of weird. The rich can afford the least restrictive (that is, the “least rationed”) policies, and the disabled and poor can get Medicare/aid, which is pretty unrestricted as well (if you can get a doctor to sign for it, Medicare/aid will cover it, with very few limits…I’ve got Medicare/aid patients I go see every single day in their homes to change their wound dressings, and it’s covered for weeks as long as the doctor signs the order. Most private policies aren’t so generous with skilled nursing care). It’s the vast middle that has only the options of cheaper insurance plans with lots of limits or the unofficial rationing that is simply not being able to get healthcare aside from life-stabilizing care at the ER.
So if you don’t want rationing, be very rich or very poor, those are both good options.
Not everything they need. In addition to effectiveness, countries also consider price when deciding whether to approve a drug for use. Herceptin, for example, is not available in every country due to cost concerns.
There’s also an information disparity. US insurance is perceived as awful because since no one knows what is covered and what is not, doctors and drug companies advertise freely. Whereas if a drug is denied to a whole country due to cost concerns, then the public of that country probably will never even find out about it. And doctors won’t recommend treatments or tests that aren’t covered.
So if a patient in a UHC system is getting everything available in the system, it seems like they are getting everything. But they aren’t. It’s just being hidden from them better.
When will it be licensed for use in early stage breast cancer?
The National Institute for Health and Clinical Excellence (NICE) has said that it will fast-track the review of the drug, but manufacturers Roche still have to submit an application to European licensing authorities before NICE can consider it.
In the meantime, women up-and-down the country are challenging their local NHS trusts when they refuse to fund the treatment.
Trusts can still fund drugs which are awaiting NICE approval, but they tend not to because they argue it is hard to justify the outlay when cash is tight in the health service.
Why did Ann Marie Rogers go to court?
She said she was prescribed the drug by her doctor but has been refused it by local health bosses, and has borrowed £5,000 to fund her treatment.
But she said she cannot pay anymore and accused Swindon Primary Care Trust of putting “money before life”.
The PCT denied the move is solely motivated by finances, pointing out the local strategic health authority, in charge of overseeing the trust, has said the drug should not be routinely funded until it is given the seal of approval by NHS advisers NICE.
Why did the High Court rule against Ms Rogers?
Mr Justice Bean ruled that Ms Rogers had not shown that Swindon PCT refusal to fund her treatment was contrary to guidance from the Health Secretary.
He said the PCT was within its rights to decide not to fund Herceptin treatment unless the individual case was exceptional.
The court’s task was not to judge the merits of that policy, he said, but to decide whether the policy was arbitrary or irrational, and thus unlawful.
“Accordingly, despite my sympathy with Ms Rogers’s plight, I must dismiss the claim for judicial review.”
It’s worse than you think. Part of the deception is providing better results at lower costs. Devious bastards.
Hm… difficult choice… 
If only we had a system in place where people could choose representatives that could make decisions on things like healthcare and could replace them if they were unhappy. I know that is just crazy talk though.
Luckily, in the private sector we are able to buy enough stock in a company so that we can get a voice. I figure if 100,000 of us on this board each put up $500 we can get a 1% share of CIGNA
Better results in areas that are influenced by things other than health care. bring up a statistic that is wholly due to health care, such as cancer survival rates, and the UHC systems suffer badly in comparison.