Socialized medicine: WSJ plays the ol' "Canada card"

[Aeschines]

Cites are from The Wall Street Journal, “Canada’s “Free” Health Care Has Hidden Costs” (editorial), Pierre Lemieux, 2004/4/23.

Every year Time, Newsweek, or one of the major “news” mags does a story along the lines of “Who Was the Real Jesus,” and every now and then a conservative organ like the WSJ does the “Canada’s Healthcare System Sucks, So Socialized Medicine is Bad and Can Never Work” story. Today’s WSJ dished up this plate of tripe.

You’ve heard/read this garbage so many times now that I hardly have to quote much from the story, but here’s the key quote I think:

Socialist systems are notoriously oblivious to anguish, discomfort, humiliation and other subjective factors which bureaucrats cannot measure or don’t value the same way as the patient does.

How do we know? Canada’s healthcare system has long waiting periods, etc.

Lemieux’s argument is at best poor, at worst dishonest and disingenuous. First, the United States already has socialized medicine: it’s called Medicare, Medicaid, veterans’ benefits, etc. In fact, Lemieux says,

The Canadian government pays about 71% of total Canadian health care expenditures, compared to 44% paid by the government in the U.S.

Lemieux is guilty of a very subtle logical fallacy, which I call “arguing the total while accepting the partial.” That is, Lemieux argues against adopting socialized medicine in the US, while failing to recognize the socialized medicine we already have and apparently having no problem with it.

Second, he is guilty of the straw man fallacy. There are many countries in the world that have socialized medicine that offers excellent care without waiting periods. Whereas the systems of Canada, Britain, and Australia are typically cited as poor, those of France and Germany are said to be excellent. I myself have lived for years under the Japanese system. The standard of care is very high, you can choose your doctors and hospitals, and my wife, my f-i-l, and I myself have never had to wait at all for treatment. If you want to argue that socialized medicine is bad, you at least have to look at the big picture of practices around the world.

Third, Lemieux talks about “hidden costs.” Very well, there are 40+ million persons in the United States who have no health insurance at all, the majority of whom simply can’t afford it (I know there are many young people who choose not to pay for it). This is a “cost” of the system in the United States, and it is not the only one. Preventive care is excellent in Japan, where most company workers get a free checkup once a year through their companies. The uninsured are simply ignored—so, for example, cancers that could have been treated in their early stages or prevented altogether end up being treated in emergency rooms and costing the system that much more.

Further, health insurance in the US is hideously expensive. My mother right now is paying $700 a month—just for herself, through COBRA. She also said that that is what we used to pay for our whole family back in the 1980s through the CPA Society (quite high then, too). I also heard a statistic on the news recently that on average health benefits for an employee cost a company about $7000 a year. When you figure that people still have to pay over $100 themselves each month, that’s about $8200 a year minimum for health insurance. (I understand that socialized medicine doesn’t solve this problem; I’m just pointing it out.)

The WSJ seems to be getting flakier and flakier on the editorial page, but this piece was unworthy of even its low standards. My overall take on the matter is that healthcare is a tricky matter, and there are many approaches. Healthcare is expensive no matter what you do. I am not saying that bam! we need more socialized medicine tomorrow—but we do need to improve our system one way or another. It needs to be fair, everyone should be covered, it needs to be solvent, and the level of care must stay high. Is that tough to do? Yes. But if the US wants to prate about being the greatest country on the planet, it needs to beat France and Germany in the healthcare area.

For those who would like to argue in this thread that socialized medicine is not the way to go, please address the following when responding:

1. The US already has quite a bit of socialized medicine, as per the above statistic.
2. Some socialized systems are said to perform quite well.
3. The US system is failing in certain areas (lack of coverage for all, etc.).

[jshore]

@Aeschines

The WSJ seems to be getting flakier and flakier on the editorial page, but this piece was unworthy of even its low standards.

Yeah, I keep thinking I have read a WSJ editorial or op-ed piece that has sunk to a new low…And, then I go and read another piece a few days later. Sort of reminds me of the joke about the physics job market when I was a postdoc: "How’s the job market this year? "Oh, about average …

Worse than last year but better than next year!"

So, my advice: Keep reading. You’ll find worse.

[clayton_e]

@Aeschines

Canada’s healthcare system has long waiting periods, etc.

From what I’ve heard from Canadians is that only minor surgery has a waiting period and its usually only days to a couple weeks. One Canadian I talked to said she’d heard that insurance has PACs lobbying with propaganda saying Canada’s system has unbearable waits, though I don’t know if this is true.

[matt_mcl]

1. Maybe if people who agreed with him hadn’t spent the last twenty years hacking our health care system to pieces, it would be better now.

2. The question is, Is our health care system worse than a private health care system? Frankly, I think the fact that I, personally, can get health care at any time for no out of pocket expense is sufficient to demonstrate that, but I’ll let everyone else argue about it for the nonce.

3. Of course the government pays a greater proportion of health care bills. That’s why it’s called socialized medicine, duh. That’s only bad if you think the government shouldn’t spend any money. The question is how much the society spends on it in in total:

Americans certainly spend a lot more on health care than Canadians do, or, for that matter, than anyone else in the world. One-seventh of U.S. national income, 13.6 percent, goes to health care, compared with 9.3 percent in Canada and 8 to 10 percent in most developed countries. Thus, Americans’ yearly expenditure on medical care works out to be $4,090 per capita, compared with $2,095 (U.S.) spent by Canadians. It is not that Canada spends so little-Canada has long been counted among the countries that spend the most (in 1997 only Switzerland, at $2,547, Germany, at $32,339, and Luxembourg, at $2,340, spent more), but that the United States spends so much. To match these levels, Canada would have to add $45 billion a year to its health care spending. cite

[Apos]

It’s next to impossible to generalize about different health care systems by looking at just outcomes or even outputs and inputs.

Here’s just ONE reason why.

Consider: what happens when a health care system is really, really effective? You’d think, of course, that you’d have better health outcomes, correct? But if health care can save people from ailments that would have claimed their lives before, then people are going to be a lot less wary about risk. If they can just take lipitor or whatever, why worry as much about cholesterol? Why watch what you eat as closely if heart attacks aren’t as deadly as they once were?

Americans as a people tend to be very susceptible to moral hazard: if you make some fun activity safer, insure us against potential harmful outcomes from various things, then we tend to consume much more of them at a higher rate. So one explanation for why so much money is spent on health care in America is that Americans are in general more likely to use advances in health care technology as a means to live riskier, unhealthier lives which are more pleasureable. This difference in behavior, then, is one reason it’s so difficult to compare American health care to some other system. And undoubtedly other countries have differences in consumption preferences along the same lines.

[cmason32]

@jshore

Yeah, I keep thinking I have read a WSJ editorial or op-ed piece that has sunk to a new low…

I haven’t seen many that beat “the lucky duckies” editorial.

[Abbie_Carmichael]

1. The US already has quite a bit of socialized medicine, as per the above statistic.

This is true.

Chew on this: an MRI will run you about $800. Pretend you’re uninsured but you’ve GOT to have an MRI. I don’t know about the whole country, but where I live you’re gonna get your MRI even if you tell them up front that you can’t pay.

I don’t believe an MRI actually costs $800. Yes, I know the equipment is expensive. And you’ve gotta pay whoever runs the machine, electricity, etc. But $800 a pop? No way.

I suspect that the $800 not only covers the cost of your MRI, but the cost (at least partially) of someone else’s as well. The medical community sure as hell isn’t going to operate without the promise of big profits (not that I expect them to, don’t get me wrong), so they jack up the prices to make up for the people that can’t pay. So yeah, we kinda do have socialized medicine. Those with health insurance pay outrageous costs, and those who can’t pay, don’t, yet still get the same treatment. (Yes I realize this may not totally be the case in some parts of the country. I’m generalizing and oversimplifying.)

2. Some socialized systems are said to perform quite well.

Eh. I guess this is debatable. I’m sure even people in Japan may have a horror story or two.

I have a friend who lived in NZ and they literally let her fiance die. Don’t get her started, oy.

3. The US system is failing in certain areas (lack of coverage for all, etc.).

Absolutely.

Hell if I know the answer, though.

I think maybe we could start by not allowing hospitals to screw patients over so. If you are given Motrin at the hospital, you aren’t going to be billed for the 2 Motrin you took. They’re going to bill you for the entire box of Motrin. That shit’s gotta stop.

[Neurotik]

@matt_mcl

3. Of course the government pays a greater proportion of health care bills. That’s why it’s called socialized medicine, duh. That’s only bad if you think the government shouldn’t spend any money. The question is how much the society spends on it in in total:

Very true. I wonder if anyone has a breakdown in the costs, though. For instance, drugs are much more expensive here than in Canada, so that could contribute. And of course, I’m not sure about things like malpractice insurance rates, etc.

In other words, the difference in cost may not be caused by the system used but by differing circumstances.

[ElvisL1ves]

@cmason32

I haven’t seen many that beat “the lucky duckies” editorial.

I’d put that one up against the Juanita Broaddrick one, or Peggy Noonan’s Elian Gonzalez ones. It does make one wonder how the WSJ editorial staff can contain their own venom while remaining immune to it, like reptiles do.

[cmason32]

@ElvisL1ves

I’d put that one up against the Juanita Broaddrick one, or Peggy Noonan’s Elian Gonzalez ones. It does make one wonder how the WSJ editorial staff can contain their own venom while remaining immune to it, like reptiles do.

I don’t know the context of those - mind explaining them?

For those of you unaware of the lucky duckies editorial, the WSJ argued that those making the Kingly salary of $12,000 a year only paid 4% in income taxes. The WSJ wonder just “who are these lucky duckies?” Nevermind that the 4% doesn’t include payroll taxes, sales tax, etc.

[ElvisL1ves]

Broaddrick context. I’m sure you’ll recognize it when you read it.

The raw text of *the * classic Noonan column, so wigged-out as to require no further commentary.

[Jackmannii]

@Aeschines

The uninsured are simply ignored—so, for example, cancers that could have been treated in their early stages or prevented altogether end up being treated in emergency rooms and costing the system that much more.

I often hear this stated with confidence, to the point where it has become a sort of mantra.

It is hard to measure this sort of thing, but I can’t think of any cancer where the institution of massive screening has saved the system money.

Take cervical cancer screening - an outstanding success story. The death rate from cervical cancer has plummeted (in large measure due to the relatively cheap Pap smear) and much human misery has been averted. But if you add up all the various diagnostic and therapeutic interventions (including colposcopies and various therapies) a huge amount of money is being spent. Even the simple Pap has been gussied up with new technologies (which incrementally add to its accuracy), including a new automated screening device which will push the cost up by 2/3 or so.
If you get vastly greater participation in screening for other cancers (like colon cancer) we’ll be paying a fortune for those tests and procedures. Many lives will be saved. But I doubt we’ll be saving money.

Further, health insurance in the US is hideously expensive.

And when universal government health care is instituted, “hideous” won’t even begin to describe the costs. I would guarantee it. Those who currently have poor or no health coverage will naturally have a better deal. Those with good health insurance will not.

A true universal plan is probably inevitable in the next 5-10 years, and much good will come of it.

It would be nice, however, if we were prepared for how whoppingly, obscenely expensive it is going to be. Don’t trust anyone who blithely assures you otherwise.
I don’t suppose there are any direct links to the entire perfidious WSJ piece that launched the OP.

[emacknight]

I want to make a quick point on “waiting times in Canada.”

We have a system, that has imperfections, so we complain about it. The biggest complaint in Canada is that there are waiting lines, and this is constantly brought up in our news and by our politicians. But I find it similar to the way Americans comlain about their democracy, so foreign countries try to use that as a reason not to vote…

Waiting lists and line ups show something very significant, they represent maximum resourse usage. For those unfamiliar with queing theory let me explain a little further.

If you need to see an orthopeadist because you busted up your thumb, there will be a wait. You might not get to see him/her right away. Why? Because that doctor has patients all day long. If there is NOT a waiting list, than that doctor spends a portion of his/her day doing nothing. Why is this significant? Let’s say for sake of argument that a doc in Canada and a doc in both make $100 a day and can see 10 people a day. In Canada each person would pay $10. If the doctor only sees 5 people a day each person will have to pay $20 in order to pay for the time the doctor isn’t seeing anyone.

So, if your doctor has plenty of openings, your costs include all those vacancies. If the government is paying, there is no point in having all that waste.

Moral of the story, waiting lists are not always that bad.

[jshore]

@clayton_e

One Canadian I talked to said she’d heard that insurance has PACs lobbying with propaganda saying Canada’s system has unbearable waits, though I don’t know if this is true.

You don’t know if it’s true?!?! Of course it is true! The propaganda about the Canadian system comes from a web of interests that include the insurance lobby and various libertarian think-tanks (which I wouldn’t be surprised to hear get some funding from the insurance lobby). Who, by the way, do you think sponsored all those folksy ads [“Harry and Louise” if I remember the names correctly] against Hillary Clinton’s health care plan?

@Neurotik

Very true. I wonder if anyone has a breakdown in the costs, though. For instance, drugs are much more expensive here than in Canada, so that could contribute. And of course, I’m not sure about things like malpractice insurance rates, etc.

In other words, the difference in cost may not be caused by the system used but by differing circumstances.

One of the biggest differences has to do with health care bureaucracy. People have dug up cites to studies on that in previous threads on the subject. Basically, health care reimbursement in the U.S. is an absolute nightmare for the medical offices because all the different insurance companies have different forms and procedures, etc. On the positive size, I suppose it creates lots of (fairly low paying) jobs.

[matt_mcl]

@Jackmannii

It would be nice, however, if we were prepared for how whoppingly, obscenely expensive it is going to be. Don’t trust anyone who blithely assures you otherwise.

I don’t claim to know enough about the US health care system to say otherwise, but I’d remind you to include the increase in efficiency that will be brought about by having one payer (or maybe 50 payers) rather than eight kajillion payers (individual insurance companies).

[clairobscur]

@jshore

One of the biggest differences has to do with health care bureaucracy. People have dug up cites to studies on that in previous threads on the subject. Basically, health care reimbursement in the U.S. is an absolute nightmare for the medical offices because all the different insurance companies have different forms and procedures, etc. On the positive size, I suppose it creates lots of (fairly low paying) jobs.

The high cost of liabily insurances for US healthcare providers has also been mentionned frequently.

[Jackmannii]

@matt_mcl

I don’t claim to know enough about the US health care system to say otherwise, but I’d remind you to include the increase in efficiency that will be brought about by having one payer (or maybe 50 payers) rather than eight kajillion payers (individual insurance companies).

Whatever the new system turns out to be, I have a funny feeling that efficiency will not be one of its strong points. Just a wild guess based on observing the implementation of U.S. social service programs.

[GingerOfTheNorth]

@Abbie Carmichael

**I think maybe we could start by not allowing hospitals to screw patients over so. If you are given Motrin at the hospital, you aren’t going to be billed for the 2 Motrin you took. They’re going to bill you for the entire box of Motrin. That shit’s gotta stop.

You are not billed like this in either of the three hospitals I work for. University of Maryland Medical Centre, Johns Hopkins Hospital, or GBMC. You are charged per pill.

Of course, I don’t have any idea how much per pill, but it’s not for an entire package of the drug.

[Dangerosa]

@jshore

You don’t know if it’s true?!?! On the positive size, I suppose it creates lots of (fairly low paying) jobs.

In India.

Dangerosa - former UnitedHealth Group business process contractor and healthcare industry insider

[MrFantsyPants]

As a Canadian with many friends and relatives that have been through the healthcare system here, I feel compelled to defend it.

From what I have seen, wait times are not an issue except for low priority surgeries. The quality of care has always been excellent. My only complaint would be that no matter how rich you are, you can’t buy you way to the front of the line.