American freedom of choice? What a bunch of BS. Here in the US I have to have insurance through my work because of preexisting conditions. So I can’t quit my job without serious health care repercussions. My employer chooses my health plan. My health plan designates the doctors in the network. So I have a very limited choice of which OB/Gyn’s I can go to. And I was damn lucky that my doctor was part of both plans when my employer suddenly changed providers this spring, or my choice of doctor would have been negated on the spot. My sister-in-law in Canada can work where she chooses, change jobs when she wants, has more doctors to choose from, and never has to worry about not being covered by her health insurance. I get only 12 weeks of unpaid FMLA for maternity leave. She gets 6 months paid maternity leave, and a choice of 6 months more unpaid (or at reduced pay) if she wants it. Who has more freedom, really?
No point in arguing. From experience, to many, it’s axiomatic that non-socialised medicine implies “freedom” (presumably the freedom to stand by and watch others rot). Any appeal to experience or logic is met with a dubious claim to the dismal science. For instance:
Presumably, granting the poor the right to state of the art treatment is a social engineering project.
You’re factually wrong even though I understand the emotions behind it. You’re entitled by law to continuing coverage by COBRA, and as long as you maintain continuous coverage you can’t be denied new coverage for pre-existing conditions. So you can switch jobs and so on. Strictly speaking, it’s the ultimate freedom of choice.
Just because it sounds like a pejorative term doesn’t mean that it is one. After all, if this doesn’t qualify as a social engineering project, then what does? Do you think that social engineering projects of necessity must be bad, and therefore we shouldn’t label something as such?
Labelling a project a “social engineering project” is understood as being perjorative:
The only thing relevant is what bob_co intended to imply by labelling socialised health care as being a social engineering project - not what I think of the term.
Moved to Great Debates.
Gfactor, General Questions Moderator
How does a national health care plan place an additional step between “the patient’s hand and the physician’s pocket”?
Exactly which rights have Canadians lost to their government?
COBRA grants you temporary coverage (18 months, for most cases), so it’s not a cure-all for the pre-existing conditions problem that rivulus brought up. And it certainly isn’t going to help much with the switching employers (and subsequently having to choose a different doctor) either.
I kind of expected the “ultimate freedom of choice” to be a little more “ultimate”…
LilShieste
Even though I asked for this move, I’m hoping that we can stick to the OP here and:
-
Concentrate on a comparison of the US and Canada specifically.
-
Not get bogged down in a political debate about the goodness or badness of "universal healthcare’, but stick to what we know about the systems that make them different and why the cost structures end up the way they do.
Do you have a cite for that? I looked up our local drug pusher (Allergan) and they only break down SGA vs. R&D. While R&D is less than SG&A, SG&A includes a LOT more than just marketing.
see post 53
I saw it (after (I posted), and it makes the same mistake.
SG&A is much more than marketing costs.
http://financial-dictionary.thefreedictionary.com/Selling,+General+&+Administrative+Expense+-+SGA
Using SG&A to claim that firms spend more on marketing than on R&D is an accounting mistake.
I just looked up some numbers. In 2003, the Alberta Government spent 7 billion dollars on health care, about 5% of GDP. That’s a per-capita amount of about $3,300. This does not include private health care services like dentistry, OTC drugs, eyeglasses, LASIK, etc. We actually spend a lower amount on health care relative to GDP than other provinces - New Brunswick spends almost 9%.
I’m a person that is very sympathic to the free market and libertarianism, but it seems to me that the American health care system would be far better if it were like the “socialized” systems elsewhere. A major problem is that insurance based systems have most of the disadvantages of socialism built into them anyway with additional disadvantages added, so we might as get the benefits of a government run system.
The major problem with socialism is the waste that results when somebody else is picking up the tab other than the one receiving the services. Of course this applies to insurance based services as well. This is not as bad in health care as it would be for consumer products since few people want health care they don’t actually need. However doctors and drug companies and medical equipment suppliers will happily encourage use of unneeded tests and supplies so they can make more money, and consumers doesn’t balk since the cost isn’t coming out of there own pockets.
Alas our insurance based system has these problems and more. Every company has a different plan with different rules and restrictions. If you move or change jobs or need care when on vacation there are lots of problems that wouldn’t occur in a nationalized system. While in theory insurance companies would compete to provide the best service, the plans are complex enough and involve low-probability high-payout situations that are virtually impossible for the consumer to evaluate fairly. To make it worse, they sell to employers rather than the consumer directly. The ability of the user to select the best service for the best price, the cornerstone of the free market, is virtually non-existent. To make things worse, they lose the economies of scale the government would have, they have waste trying to get other companies to pay when people are multiply insured, and they spend a lot in marketing.
My main concern about nationalized health care in the U.S. is that the plan we would come up with would be an absurd kludge involving wasteful provisions as the politicians sell out to the insurance, medical, and drug special interests, and could conceivably be even worse than the disaster we have now. I’d be delighted if we could simply adopt a system like the Canadians, British, or French.
In 1948 when the NHS was set up, the doctors had to be bought. They opposed the move to a nationalised healthcare system claiming that it would adversely affect them and they fought it every step of the way. So the government gave them extremely large salaries. The founder Aneurin Bevan said of the doctors “I stuffed their mouths with gold”.
So it was by no means an easy thing to do.
It seems that the US might have to stuff a fair few mouths before a universal system could be established. But, I’m sure that if the political will was there, the obstacles could be overcome. The worst thing that could be done would be to do it half-arsed with “kludges”, do that and it’ll serve no one’s interests and disintegrate.
This gives me hope that it can be done reasonably.
A number of years ago some states came up with no-fault auto insurance. I thought it was a great idea, but when it was implemented in Pennsylvania, where I was living at the time, the legislature had turned it into a hideously complex monster that was worse than no plan at all. So I’m skittish.
The cite did not give SG&A, it gave “marketing, advertising and administration.” I’ll see if I can find out what administration covers. If it is the administration of the marketing and advertising program, then it is legitimate. If it is the administration of the entire company, then you have a point. However, general selling expenses don’t seem to be included.
No one should be surprised that marketing is high. Marketing expenses are higher than R&D even for most established high tech companies, and for good reason. When I was involved in an attempt to sell high prices software from within a big company, we got creamed because our R&D was higher than marketing. Marketing wouldn’t go to 0 in a single payer system, but it should be less. I’m also not saying marketing is evil, since how else will you get information to doctors. We don’t need ads for restless foot syndrome, though, trying to create a need. Those few with it can see their doctors.
Duplication of things like MRI machines so that hospitals can compete with one another increases costs for everyone.
Because the Canadian dollar is only worth 96 cents in REAL money. Duh.
I really don’t understand why people go to the trouble to ask such stupid questions. 
Is the exchange rate really .96:1? Wasn’t it .66:1 just a couple years ago? I shoulda bought Loonies when I could. 
But how do you figure out, in advance, exactly how many are needed? You’re never going to get it exactly right, so you either overbuy and have too many or underbuy and make people wait. Which brings us back to the whole pay more/wait more dichotomy that people keep bringing up. So if the answer is that we pay more because we don’t want to wait for needed test, then that tells me which system I’d prefer.
I don’t think it’s quite that simple (re: just buy more machines). I know that here in Alberta I’ve heard many times that the main bottleneck that causes wait times for MRIs (and presumably other diagnostic imaging like CT) isn’t the number of machines, it’s the number of skilled technologists to operate them. Assuming they have the budget, a hospital can buy another MRI. But if there aren’t enough techs available, and the length of time to train them is several years, then you have to make do and/or try to recruit techs from elsewhere.
I looked it up online and, at my local tech school (Northern Alberta Institute of Technology), a Magnetic Resonance program is 20 months long. A total of 16 students are admitted in alternating years. Hopefully that is enough positions to supply the demand in Alberta and hopefully they’ll stay around after graduating instead of relocating - but I’ve heard before that we aren’t graduating enough doctors and nurses in the province to fill anticipated needs in the next five to ten years, so it wouldn’t surprise me if this is the case in other health related fields.
If you buy based on actual demand instead of buying to make sure that you don’t lose business to those guys down the street you’d tend to have a better guess.
A local small city had two hospitals about three blocks apart. They had duplicate everything. One bought the other and now they have very different facilities. One has an emergency room that’s solely for pediatrics and maternity. The other handles the rest of the emergency cases, and isn’t overrun. You go to one hospital for X, the other for Y. One for an MRI. The other for a CT scan. (I’m making up that last example. I’m not sure which hospital has what.)
They didn’t need figure out “in advance” exactly what they needed. They weren’t starting from scratch, with absolutely no idea. They had experience to draw from, just as the rest of the US already has. I’d bet someone could give you a very good idea just how many MRI machines are actually needed based on the data of how they are currently used. If two MRI machines are each in use 10% of the time, you have too damned many MRI machines.
If demand increases, you get another MRI machine. You just don’t do it so that your facility looks more inviting to a customer, because then you have to recoup those unnecessary costs somehow. And because you have a very captive customer base, you can recoup those costs eventually.
We have huge capacity in some fancy, expensive areas, and not nearly enough in some less glamorous ones.
Edited to add: By “areas” I meant medical areas, but geographic areas are in the same situation. Medical services are trying to go where the money is–the way all capitalistic systems work. But where the money is isn’t necessarily where the need is.