Universal Health Care & Personal Health Concerns
| July 8th, 2007On a pandagon thread about socialized medicine, a commenter called Catty writes, “I know 2 die-hard libertarians that are now universal health care supporters. Funny how problems like multiple sclerosis and cancer can change people’s minds.”
I have always supported universal health care, but jesus fuck she’s right.
A couple weeks ago, I started having some strange symptoms. Last week, I went to the ER to speak to a physician, and she said the things I didn’t want to hear — namely, that my symptoms were consonant with two bad diagnoses: diabetic neuropathy and multiple sclerosis.
I have since been to my regular physician who is not nearly so concerned. I am still being checked for diabetes, but she’s holding off on the MRI to diagnose for multiple sclerosis for now. We’re first looking into other possible causes which are much more benign, such as hypothyroidism, advanced anemia, migraine, and anxiety.
I am an incredibly privileged woman. I’ve never been without health care. My health insurance is incredibly good. I pay $5 for doctor visits, and $5 for medications. I’ve always known that my health insurance was great, but I don’t think it’s ever really hit home for me how much uninsured people have to pay for their health care — not just going into debt, but going bankrupt, becoming homeless, and sometimes having to make the difficult decision to let themselves or their loved ones die from treatable illnesses.
Another commenter called Jodie relates the following story, “My 27 year old brother in law developed an intense headache on a Thursday, dx’d as brain tumor after an MRI, had surgery, went to intensive care, had chemo, and died prior to the next Thursday. Cost after insurance: $280,000 (at last count, I don’t think all the bills are in yet)… That bill was amassed in less than a week.”
Note: After insurance.
Other commenters discuss surgery for marrow transplants coming in at $250,000, refills for cancer drugs being in the thousands of dollars, a course of treatment for a major illness costing hundreds of thousands. Canadian commenters relate how relieved they are to live in Canada, after considering the ramifications of the major illnesses in their lives should they happen to have been American and uninsured. When a parent, a sibling, and another close relative are sick, often the whole family can’t find enough money to fund health care for all of them, even when they go into debt. They must choose bankruptcy or death.
Treatment for uninsured people is abominable. Uninsured people often have no choice but to obtain their health care through emergency room visits, which are phenomenally expensive. Pandagon commenters report paying $300-1,200 for emergency room visits, for things as routine as obtaining antibiotics for a bladder infection. One commenter notes that his $320 physical meant that he had to put off paying his bills for a month.
Facing debt, uninsured people often put off going to the doctor until their dieases have progressed beyond treatment. Worse, if they do go, they may be ignored. Pandagon recently reported incidents of uninsured people being left to die in hospital emergency rooms.
In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.
“Thanks a lot, officers,” an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. “This is her third time here.”
The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She’d been given prescription medication and a doctor’s appointment.
Turning to Rodriguez, the nurse said, “You have already been seen, and there is nothing we can do,” according to a report by the county office of public safety, which provides security at the hospital.
Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.
Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone’s apparent indifference.
Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.
Alerted to the “disturbance” in the lobby, police stepped in — by running Rodriguez’s record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.
At the same hospital, in 2003, “20-year-old Oluchi Oliver waited hours to be admitted to the hospital with crippling stomach pains, according to his family. After 10 hours, he collapsed dead on the floor. No one noticed, his father, Akilah Oliver, said.”
I had a brief hiccup with my insurance coverage the day I decided to go into the ER, and it looked like I might not be covered at all. (Now, I’m covered by two health care plans.) I almost didn’t go in. My mother told me I had to go in, that they’d find a way to fund it if I were sick. We are extremely well-off for the United States, but I doubt that even we could find a way to pay $250,000 if I didn’t have insurance and needed a marrow transplant.
I’m watching my reactions as I read this Pandagon thread. I am so scared. I probably don’t have MS. I’m repeating this to myself as a mantra. My other mantra involves facts about MS. If I do have MS, I have all the indicators of a good prognosis. I am young, white, and female. If I do have MS, it’s extremely likely that I have the type that remits, instead of the type that progresses until you die. Hell, 15% of people who have MS never suffer a second attack.
And there are drugs! One of my fiance’s professors told him about two people she knows with MS, who were diagnosed in their thirties, and who now, in their fifties, have been kept symptom-free with drugs. I called one of my friends who is in medical school, and he told me to remember that both MS and diabetic neuropathy require lifestyle changes, but may not affect life quality.
Even in the worst case scenario, I’ll be okay. That’s not enough to keep me from worrying or being depressed, but it’s good news. Nevertheless, I’m a basket case as I wait for my blood test results.
I can’t imagine how much worse it would be if I didn’t know how I was going to pay for the medical expenses of my doctor visits, my blood tests, my MRIs, my visits with the neurologist and/or dietician. Without insurance, would I be able to afford those drugs that could keep the multiple sclerosis in check, preventing me from losing the use of my limbs, my speech, and my brain?
I don’t understand how anyone can oppose universal health care. A libertarian in that thread is spouting off strange talking points. Some are demonstrably false. Countries with socialized health care do not have more bureacracy than we do; they have less, because hospitals don’t have to deal with insurance claims. They don’t have longer wait times than we do. They don’t force patients into predetermined courses of treatment. The cost in taxes is more, but studies have shown that while taxes are higher in many countries with socialized medicine, the American middle class ends up screwed with their lower tax rate — because we have pay not only our taxes, but we also have to pay through the nose to privately fund things that countries like Sweden provide for free. We end up paying a huge amount more, just so we can claim that we have lower taxes.
One of his talking points is that he doesn’t feel he should be forced to help people who are less fortunate. Does he understand that he’s talking about people who will die without his help? Help that he will benefit from, because he as a middle class American would pay less if taxes were higher but provided more services? Someday, he may have a medical emergency, and god forbid he should be denied his insurance. He may bankrupt himself and his whole family. If he chooses to finish treatment, he might lose his home. We might force him, as we force others, to choose between the basic necessity of shelter, and death.
Meanwhile, he can’t even imagine those scenarios. Over and over again, he talks about the undue burden that would be placed on him if he had to help other people. He can’t imagine himself in their shoes. If he can imagine their pain, he doesn’t care. What a strange, frightening lack of empathy. What a limited view of the world.
My empathy is heightened right now, because of course this medical issue has me sensitized to issues of my own mortality. It’s odd to move from the life in which I thought of myself as healthy, to the life a few days later when I realize that I could have a progressive and debilitating illness.
I don’t want to be going through this. I want to feel safe and well again. Hopefully, my diagnosis will be benign, and soon I will be feeling safe and well again. Even if I have MS, I am sure that eventually my sense of weakness, fear and vulnerability would dull, and my illness would become just another part of my life. That’s another thing I’ve been repeating to myself for the past couple weeks. Studies show that paraplegics are just as happy one year after their injury as they were before it occured. People are amazingly adaptive; anything can become ordinary. If they are equally happy after that, then I will surely be equally happy even if my diagnosis is MS.
I am so amazingly lucky to be worrying only about my health. If I were worried that I was about to bankrupt my loved ones, and that I wouldn’t be able to afford life-saving care, this painful experience would become a constant waking nightmare. Any person who would wish that on other people is both monstrous and lacking in empathy.
July 8th, 2007 at 2:59 pm
My wife has begun writing about her experience with health care after breaking both of her elbows here. She has yet to get to our visit to L. A. County Hospital when we were desperately trying to get her physical therapy for her broken elbows. I suspect she’ll put off writing about that until after our book tour, because remembering that part is especially traumatic.
I pray you have nothing to be concerned about. But when you say, “I am young, white, and female,” the only thing there that will help you is your youth. In the US health care system, class trumps race and gender. Either you have the money, or you do not.
Oh, something that will help a USan: the state you live in. Emma’s accident was in Minneapolis; her immediate care was excellent, and when they learned we had no money, the matter was written off. True hell began for us when she returned to Los Angeles with both arms broken and we began hunting the resources for what to do next.
This comment was written by will shetterly.Report this comment to the moderators
July 8th, 2007 at 2:59 pm
The Lord and Lady watch over you and bless you.
MS has many variations. I have two aunts, two cousins, a friend and a co-worker who had and have MS. Each one has a different type. Only one aunt had an exteremly aggressive one. The other 5 travel, work, have families and do live good lives with some modifications and care.
I’ll keep you in my prayers.
This comment was written by Silver Owl.Report this comment to the moderators
July 8th, 2007 at 3:13 pm
Owl and Will,
Thank you both.
Will — when I say young, white and female, I mean specifically that those are good markers in regard to MS. Young people tend to have milder cases than older people, females than males, and white people than black people (who tend to contract MS at older ages than white people).
This comment was written by Mandolin.Report this comment to the moderators
July 8th, 2007 at 3:25 pm
(Will,
By the way, I’m in California. I’ve talked with you a little bit — I’m a SFWAn, and I’m on LJ. I sent you an email the other day which may have been quite confusing. It’s good to see you ’round these parts. Just waving hello.
Hello!
~Mandolin)
This comment was written by Mandolin.Report this comment to the moderators
July 8th, 2007 at 4:12 pm
(Mandolin, howdy! I’ve decided I’m an old fogie in one aspect, at least: all the different internet handles and icons are too much to remember, so on the internet, I assume everyone is a dog I haven’t met.
Will)
This comment was written by will shetterly.Report this comment to the moderators
July 8th, 2007 at 4:38 pm
I hope everything turns out ok for you.
Occam’s razor is a blunt tool when dealing with people, but I think the answer it provides to libertarianism is the one that makes the most sense. It’s just hatred. Pure misanthropy. There are other explanations. One of my favorites is the kid who has hir first jobs and gets hir first paycheck and discovers it’s for less than zie expected. “Who the hell is FICA?” zie says. Thus a libretarian is formed. Or they might beleive, as is popular with the dominant religion in the US, that people who have problems are being punished by God. Or, many folks are just full of hate. It’s possible to reach out to all of these people. FICA helps you. Job and Jesus both suffered. And the person who hates is deeply unhappy. Often they can be argued from their own self-interest (having a bunch of sick, hungry people around threatens public health and leads to plagues) or somebody can reach out to them. there’s also a very strong possibility of trolls. Alas, corporations are willing to pay people to go out and troll blog comments.
This comment was written by Les.Report this comment to the moderators
July 8th, 2007 at 5:41 pm
Does he understand that he’s talking about people who will die without his help?
Yes. He doesn’t care. I won’t say that Libertarians are selfish and evil, but selfish, evil people are attracted to Libertarianism because they perceive it as a philosophy that insures they are allowed to do whatever they please without being ‘forced’ to participate in the social community (except as takers, not givers).
A simple test for such persons is “If a single-payer health care system run by the government did not have the [parade of horribles], would you still oppose it?” And the answer will be yes. The practical issues are an excuse; the real driving force is their belief that they have no moral obligation to anybody.
This comment was written by mythago.Report this comment to the moderators
July 8th, 2007 at 6:41 pm
I think libertarian opposition to universal healthcare can be broken down:
1. Denial: It can never happen to me, so I don’t want to have to think about it.
This comment was written by emjaybee.2. Over-optimism: My insurance/savings are good enough.
3. Martyrism: If I didn’t save up for my cancer, then I deserve to die (as does anyone else). This one tends to crack at the time of diagnosis.
4. Fear of obligation: If I start caring about the needs of others, then they will demand so much there will be nothing left for me. Balancing other people’s needs against my own is hard, messy and unclear, and makes me uncomfortable. I like nice, pure, black and white systems where every obligation has to be spelled out beforehand, on paper, signed by lawyers; that way, I can avoid as many obligations as possible.
5. Misanthropy: I think most people are stupider than me, and that I would thrive in a libertarian society even if they bought it.
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July 8th, 2007 at 7:41 pm
rationing occurs in all health care systems, whether ‘universal’ or otherwise. either some ethnicities/cultures/classes just don’t get access, or certain procedures are capped at x many per y time period, or certain kinds of treatments just don’t get paid for unless they are privately funded.
all of the countries compared to the US have significantly smaller populations and much stricter requirements for citizenship (which often though not always translates into access to that much-vaunted ‘universal’ health care). additionally, every last one of these same countries is more ethnically and culturally homogeneous than the USA.
the guest workers and undocumented immigrants of most of the countries compared to the US do not tend to have access to the extensive government healthcare programs available.
even in america, states that are more ethnically and culturally homogeneous overwhemingly have better government-funded health care for their populations than more ethnically and culturally mixed states.
universal healthcare is a myth. this does not mean the libertarian view that it should all be ‘privately run’ is a good idea– it is a foolish and short-sighted one.
it does mean that like should be getting compared to like a sight more often than actually happens in these discussions about healthcare and how it should be changed for the better in the US. i mean, i don’t even honestly know how one would go about comparing 300 million people (US) to 30 million (Canada) and say ‘yep, that canadian system will scale just fine!’ and canada is right next door. but its population is far younger and far smaller– how can one reasonably extrapolate its healthcare system and policies as readily and suitably transferrable to america’s?
wikipedia’s overview of canadian healthcare is pretty interesting, and telling:
This comment was written by mari.http://en.wikipedia.org/wiki/Health_care_in_Canada
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July 8th, 2007 at 8:14 pm
[BB, I've asked you not to post on my threads. --Mandolin]
This comment was written by Brandon Berg.Report this comment to the moderators
July 8th, 2007 at 10:06 pm
Mari, talk to some Canadians—and not just rich ones. My parents and my sister became Canadians; the situation in Sicko is accurate.
Why capitalists think economies of scale will suddenly fail with universal health care but apply to everything else, I don’t know. If you like big business, you should like universal health care.
At least, if it’s done like the French or Japanese do. If you’re cutting out a piece of the pie for the insurance companies, the expensive inefficiency in the system is what you call “profit.”
This comment was written by will shetterly.Report this comment to the moderators
July 8th, 2007 at 11:48 pm
I hope you get better soon.
About five years back, I picked up my daughter on my regular visitation period. She complained that she wasn’t feeling well. Sure enough she had a fever. So I went by my family doctor. I have good health insurance and was a regular patient. They hemmed and hawed about it for a while, then decided they would if I would pay the full cost to set up a new patient - $120. I agreed and went out to get my check book. However, when I came back in, they told me that the would not treat her period. Not for insurance. Not for cash. I felt pretty helpless that day. They suggested I go to the emergency room. Sometimes it sucks to be a man.
At least neither of us has been sick in a long time. It was a good thing that I had excellent medical insurance when she was born. She tried to join us four months early. Thanks to the miracles of modern medicine and about $35,000 in medical insurance expenses they were able to keep her in til she was only three weeks early - when they stopped the treatment because her lungs were mature enough.
I went to work for my current company about ten years ago. I was already divorced when I hired on. They provided health insurance for me and my daughter without any issues for nine years. Then they changed the HR people. The new staff decreed that I could only cover my daughter on the medical insurance every other year since I could only claim her as a tax dependent every other year. In the years that she was not covered, I could cover her under a COBRA plan. However, the price they wanted under the COBRA plan was not the incremental cost they paid every year as an additional dependent. They wanted me to pay to cover her as if she was a terminated employee.
I could cover her every year if I went back to court and got a QMCSO (Qualified Medical Child Support Order). This is essentially a document allowing a third party to obtain coverage under your plan. The ‘qualified’ word means that the plan must be written to your companies requirements. I asked them for the necessary documents and they refused to provide them. Now I went through a ‘grumpy’ divorce and would rather chew my arm off than go back to court. But eventually the deadline arrived. So I prepared a QMCSO using a standard plan from states family law book. My ex agreed to sign it with no quibbles. The judge agreed to sign it with no quibbles. I sent it in to the company and they pitched a hissy fit.
They requested a meeting with me without saying why. I invited my plant manager to the meeting so that I would have a witness. They complained about six different parts of the QMCSO that I had prepared. I was very upset. Fortunately the plant manager managed to task them to put their complaints in writing. Most of the complaints were bogus - they were things that they were required to do under state law. I eventually got them to agree to the document after reviewing my options with an attorney for $400. He confirmed that I would have to sue the company in federal court, and that while I would win, I would likely only get the medical insurance provided and I would be out the legal fees. He wouldn’t give me a firm number on the legal fees, but he didn’t disagree that they would be about $10,000. In the end, the company agreed to write a letter stating their reservations to the document - most of which were specious. The company was happily covering the step-children of the remarried women with insurance. It is very humiliating to not be considered enough of a parent that you have to get both the ex’s and a judges approval to obtain health insurance. Sometimes it really, really sucks to be a man.
This comment was written by Nick.Report this comment to the moderators
July 8th, 2007 at 11:58 pm
Oh, Mandolin, let me give you a big hug!
My medically famous arse is about to need another lil surgery, and I’m still uninsured
(I got this fancy paper from Social Security a while back, but, so far nothing else has come of it).
My stepmom has MS and my mom has neuropathy; at least they’re interesting illnesses!
* * *
Hmm. Some bright side, huh?
(And thus, a medical communist is born. I want to move back to Europe where they just look at you and say, “You look ill. Here’s some medical care.”
;D
This comment was written by defenestrated.Report this comment to the moderators
July 9th, 2007 at 12:43 am
Mandolin: I hope your symptoms turn out to be something very benign and treatable, but if they don’t and MS is still a possibility, may I make one suggestion: Make sure your insurance is absolutely bomb-proof before you get diagnosed. Get insurance for things like long-term care and rehab, durable medical equipment, etc. You may never need it, but once you have a diagnosis of MS, you will never be able to get coverage for your “pre-existing condition” again. That having been said, don’t panic. MS is treatable and becoming moreso all the time and you are good prognosis. The above advice was just to make sure you never find yourself in the situation of wondering how you’re going to pay for some necessary treatment or piece of equipment. (I can give numerous anecdotes of people getting stuck in the hospital for weeks or months because they don’t have insurance for durable medical goods so they can’t afford to have, for example, a brace to support a spine destroyed by multiple myeloma or CPAP for sleep apnea, etc. Or stuck in an acute care hospital when what they need is rehab, etc. This is, of course, much more expensive for everyone as well as obnoxious and inconvenient for the patient, but it happens under the current system.)
Yes, you are absolutely right about universal health insurance.
This comment was written by Dianne.Report this comment to the moderators
July 9th, 2007 at 4:09 am
Universal health care countries tend to have a higher (often much higher) average level of health care.
In reality, though, that comes at a cost (surprise!) The cost is, generally speaking, that universal-coverage countries make huge savings by essentially chopping off the superexpensive “right tail” of the cost distribution. Most UHC countries are not all that hot at providing highest-level care; part of the reason our system is so ungodly expensive is that we have a whole buttload of available technology and specialists which other places tend not to have.
Take your friend who needed an MRI. in Canada, for example, (2005 stats) there are only 176 MRIs at all:
http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_08feb2006_e
There are probably more MRIS in the Boston and New York areas (combined) then in all of Canada. Hell, my own small semirural hospital has one. I’d eat my hat if there aren’t another 20 MRIs within 50 miles of me.
We have all those MRIs because we demand two things:
1) We don’t like dying of things that “could have” been caught by an MRI; and
2) we don’t like dying while we wait for an MRI.
Universality requires tradeoffs, though the average is much better.
This comment was written by Sailorman.Report this comment to the moderators
July 9th, 2007 at 4:28 am
The cost is, generally speaking, that universal-coverage countries make huge savings by essentially chopping off the superexpensive “right tail” of the cost distribution. Most UHC countries are not all that hot at providing highest-level care;
Evidence? Or, rather, further evidence, since you so far have cited one example of a particular problem with one universal health care system. This hardly seems adequate evidence to condemn all such.
The link about Canada’s MRI situation is interesting, but hardly definitive. A couple of notes about it:
1. The use of MRIs and CTs is up in Canada. This suggests that they have detected an underuse problem and are attempting to correct it.
2. MRIs and CTs are used more intensively per machine in Canada. This suggests that the scanners that are available are being used in an efficient manner and operated by experts. Many MRIs in the US are run and read by people who have little experience or expertise in their use and the results they give can be worse than useless. (Anecdotal example, for what little anecdote is worth: During fellowship, I cared for a patient with hepatoma (liver cancer). He was getting chemoembolization as a treatment with reasonably good results, but required regular MRIs to keep track of the disease. Unfortunately, the underfunded public hospital at which he was a patient had an MRI waiting time of about 3 months. This was usually solved by my calling the radiology resident and pleading for an overbook. One time this did not work, for some reason (I’ve forgotten why*.) Anyway, he decided to get an MRI at an outside clinic. This MRI was of very poor quality and the outside reading was even worse. The official reading claimed that he no longer had liver cancer. This was, unfortunately, not true. It was not pleasant explaining to him that he did, in fact, still have hepatoma. A bad MRI is worse than no MRI.)
*Though the probability is, I’m afraid, that I or the resident fell down on the job, probably through inadequate persistence at the game of pager tag. It shouldn’t happen, but it does, particularly with very tired people.
This comment was written by Dianne.Report this comment to the moderators
July 9th, 2007 at 4:50 am
“Mandolin: I hope your symptoms turn out to be something very benign and treatable, but if they don’t and MS is still a possibility, may I make one suggestion: Make sure your insurance is absolutely bomb-proof before you get diagnosed. Get insurance for things like long-term care and rehab, durable medical equipment, etc. You may never need it, but once you have a diagnosis of MS, you will never be able to get coverage for your “pre-existing condition” again. ”
Thanks for the advice, Dianne. I am quite concerned about that aspect of it, especially since I’m insured through my parents and my school.
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 5:27 am
I am quite concerned about that aspect of it, especially since I’m insured through my parents and my school.
How much cursing do you allow on your threads? Because my verbal response probably went over the limit…I’m sorry that this issue has come up for you. I hear Vancouver is very nice. So is Montreal, if you don’t mind the cold. Have you considered moving? No, I’m not joking. I realize that the proposed solution is unlikely to be practical, but it might be worth considering.
This comment was written by Dianne.Report this comment to the moderators
July 9th, 2007 at 5:29 am
I have considered moving, yes. Does being ill make it impossible?
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 5:52 am
Dianne,
I’m not condemning UHC. As I said, they can raise a country’s average standard of care. (I lean somewhat towards UHC in the U.S., though I see some problems with it.)
But I do dislike the voodoo economics claims of some UCH proponents. It seems fairly obvious that providing health care costs money. Providing health care to more people costs… more money. There are some obvious savings, of course, notably in the areas of preventative and emergent care. I don’t dispute that those savings could certainly pay for the increased basic and low level care of much of the population.
But providing high level care is hideously, hideously, expensive. Most countries that provide UCH don’t have the same access to high level care as do the really well-insured people in the U.S.
Should we stick with Canada for a moment? I like Canada; it’s a great country. And I don’t intend to make this an anti-Canada spiel. Let’s see. Wait times for cancer treatment in canada tend to be fairly long, for example. they’ve been having a devil of a time fixing it.
http://www.theglobeandmail.com/servlet/story/RTGAM.20061121.wwaittimes21/BNStory/cancer/home
On to the U.K. That may well be the most similar country in terms of health care. Their system seems to be on the verge of failing in many ways; I’ve read many writings that suggests it’s already essentially broken. They don’t offer their patients the latest cancer drugs, for example, and have low cancer survival rates.
http://news.independent.co.uk/health/article2527714.ece
(note that the U.S. has one of the highest rates of using the new cancer drugs) They also have UCH applied to dentistry, but because of the pay scale they have many in their population who are untreated by dentists. You might want to read NHS Blog Doctor if you want some UK health care details.
A better example might be this (more general:)
This comment was written by Sailorman.In the U.S. we demand an unusually high standard of care. We don’t hesitate to sue doctors who we think violate this standard. We want medical professionals to check behind every door, to look under every rock. From an economic and efficiency standpoint, this is madness. You simply can’t spend loads of money on procedures or tests that have only a small chance of turning up useful data. UCH systems can’t afford to do this.
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July 9th, 2007 at 5:52 am
Not as far as I know. It might depend on how badly they need people with your particular skills. You’re obviously fluent in at least one of the official languages, which helps too.
This comment was written by Dianne.Report this comment to the moderators
July 9th, 2007 at 6:01 am
Well, I’m highly educated in fluffy fields, but the fiance has some hard science skills.
Why yes, I’ve been thinking about this for a while, even before health care issues came up. :-P
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 6:05 am
Sailorman, do you really think the US health care system doesn’t involve long waiting periods? Maybe rich people can get appointments quickly, but for most of us long wait times are common.
As for the MRIs, Japan — which has universal health care — has many more MRIs per capita than the US. Switzerland and Finland don’t have as many MRIs per capita as the US, but they have a high number of MRIs by world standards. So I’m not sure your example here holds any water.
Insofar as the advantage you describe exists at all, it only really exists for wealthy people in the US. And in most countries with universal health care, wealthy individuals are still able to buy above-average care by paying premium prices. So it seems to me that the “rich people can get really high-end care” advantage is not unique to the US.
This comment was written by Ampersand.Report this comment to the moderators
July 9th, 2007 at 6:28 am
Nick, sounds to me like you need a new doctor.
There are some obvious savings, of course, notably in the areas of preventative and emergent care.
And in the elimination of the insurance industry as a vampiric, for-profit enterprise sucking money out of the health-care system.
This comment was written by mythago.Report this comment to the moderators
July 9th, 2007 at 6:42 am
Sailorman:
Canada has, for a wealthy country, an extremely mediocre health care system; it only looks good to Americans because ours is even worse. France (which, admittedly, has a low number of MRIs per capita, but also many more doctor visits per capita than us) is a much better example of how good UHC systems can be. So by using Canada as your prime example, you’re unintentionally being unfair to UHC.
Preventive and emergent care savings are important, but as Mythago points out, even more important are the savings on bureaucracy and insurance. From an article by Ezra Klein:
Another advantage is being able to use a UHC’s bulk-buying power to negotiate lower prices of pharmaceuticals, which is why Americans pay 60% more than Canadians for the exact same drugs. When all these savings combine, the result is that the US pays much more for health care that varies from being slightly worse than the UK’s and Canada’s, to much worse than France’s.
This comment was written by Ampersand.Report this comment to the moderators
July 9th, 2007 at 7:03 am
On to the U.K. That may well be the most similar country in terms of health care. Their system seems to be on the verge of failing in many ways; I’ve read many writings that suggests it’s already essentially broken. They don’t offer their patients the latest cancer drugs, for example, and have low cancer survival rates.
news.independent.co.uk/health/article2527714.e…
(note that the U.S. has one of the highest rates of using the new cancer drugs)
Sailorman! You’re wonderful! The original paper that the Independent is reporting on here is exactly the reference I need to finish the manuscript I’m procrastinating on. Thank you.
This comment was written by Dianne.Report this comment to the moderators
July 9th, 2007 at 7:21 am
Amp, I don’t disagree that the U.S. system is on average bad. But I hope you realize that your comments about “better” and “worse” are average statements.
I am a bit confused, because I am clearly not talking about averages (if you don’t mind, I’m going to stop repeating the comments regarding averages in every post.) I am talking about the maximum involved.
There are many, many, folks in the U.S. who will be better off under UHC. There are also some folks–far fewer–who will be worse off. Why is that so hard to admit?
This comment was written by Sailorman.Report this comment to the moderators
July 9th, 2007 at 7:30 am
Sailorman, I should’ve mentioned that I also have friends in France. Sicko is accurate there, too.
Mandolin, I don’t know if it would do you any good to add extra health insurance now. “Pre-existing” does not mean you have not been diagnosed. Sicko mentions that if a “reasonable person” (I forget the exact phrase) would suspect they have a condition that they do turn out to have, the condition is retroactively counted as “pre-existing.” Our system continues to be based on the idea that health care should be affordable for the healthy and the rich.
This comment was written by will shetterly.Report this comment to the moderators
July 9th, 2007 at 7:38 am
“There are many, many, folks in the U.S. who will be better off under UHC. There are also some folks–far fewer–who will be worse off. Why is that so hard to admit?”
On the internet, sometimes small degrees of disagreement are magnified enormously (see almost any discussion about class and race). In this case, we don’t know what you mean by “worse”. Will they die? No. Will they be in worse health? No. Will they pay more than others? No. “Worse” here means Canadians (but not most other nationalities under universal health care systems) might, under some circumstances, wait slightly longer than if they were in the States. Doe the French wait longer or get less health care for anything than a person in the US?
I’ll also note something that US opponents of UHC fail to mention about Canada’s rare queues: if your health deteriorates, you get bumped in the queue. Here, if your money runs out, you get dumped on Skid Row.
This comment was written by will shetterly.Report this comment to the moderators
July 9th, 2007 at 7:58 am
My insurance is actually amazing & rock solid. I’m primarily worried about the possibility being forced out of it.
As far as the idea that people with incredibly awesome health care may suffer by being brought down to the level of the proles… I think Sailor is actually right. Sort of. I have a hard time believing that private insurance would be eradicated in the US, even if we got UHC. So, I would suspect that the people who can afford teh awesome health care will continue to get it, by manuevering in a different system.
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 9:01 am
[shrug] I don’t know exactly what I mean by ‘worse” either. Any discussion of the U.S. under a UHC system is based on a whole lot of speculation, since we are very unlike any other country (in terms of size, ethics, government, etc etc.) Neither pro- or anti-UHC people have much other than guesses. Our system wouldn’t be like France’s system, exactly; whether it would be a good compromise or a bad one is part of the debate.
I don’t think it’s exactly fair, though, to keep ignoring the fact that our next door neighbor doesn’t have great success with UHC, and neither does Britain. You wanted examples and I gave you two. I am sure that both Britain and Canada wish their systems were like France. And they’ve been unable to get there so far. So rather than the rosy “We’ll be like France, but without speaking French!” view, I tend to wonder how we can avoid ending up like the UK.
As for the “the rich can afford it in any scenario” argument: Unless UHC is provided without raising taxes at all (which seems unlikely) then there will be some class of people who get hurt. They are the folks who (now) can afford private insurance that exceeds the UHC standard, but (post-taxes) cannot afford supplemental insurance for the same. This is because the taxes will of necessity reflect charges for other people’s insurance, while they are currently paying only for their own. Those folks are probably in the (upper) middle class.
That’s a pretty stark statement of fact. Are you saying that NOBODY–not a single person–will die as the result of a failure in a UHC system, who would not have died otherwise?
In Britain, for example, the lack of access to cancer drugs almost certainly means a difference in survival rates. The increased health and cure benefits are what make the new drugs desirable; the lack of them has a direct effect on the cure.
In Canada, the “line jumping” isn’t really a solution either. As I’m sure you know, the goal is to detect things before they have discernable symptoms. The goal of cancer treatment almost always involves early intervention. Waiting a long time is a cost–whether or not it is apparent at the time–and waiting, only to be jumped if your symptoms worsen–is ALSO a cost. If there was less of a line, perhaps the symptoms wouldn’t worsen in the first place. And so on.
As for the “dumped on the street” issue: yeah, yeah, how many times do I have to say this? (apparently every post…) I KNOW that a huge advantage of UHC is that you don’t get dumped on the street. Really, I know that. That’s the basis of the whole “average is higher” issue.
I don’t know. Do you have any data?
This comment was written by Sailorman.Report this comment to the moderators
July 9th, 2007 at 9:12 am
I think that this is basically true, but more to the point, let’s turn it around.
Right now, with our current health care system, we are ensuring lavish health care for the very few by letting the many suffer horribly.
Of course those who are prospering under this system would not prosper as much or in the same way under UHC. The Tsar didn’t prosper as much after the revolution, the Communist party bigwigs didn’t prosper as much after the fall of communism, and the slaveowners didn’t prosper as much after emancipation.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 9th, 2007 at 9:18 am
Oh yeah:
Yes. And I actually like UHC, at least in theory. But I think it’s crucially important to discuss, and acknowledge, the problems with UHC (real and potential) as well as the benefits.
People are not idiots. My own standard of care, for example, would probably fall under a UHC program (or get more expensive for me to maintain.) As I know a lot of fairly rich folks, I also know a lot of other people for who this is also true. That doesn’t bother me; I think the social benefits of UHC are much more important, which is why I would support it. But it does sort of get me tweaked when other folks insist that there’s no chance, no how, that I or anyone else would see ANY degradation at all. It’s just not true.
I think a lot of people are willing to accept minor changes in their health care in order to support a huge countrywide benefit. But I don’t think sugarcoating the truth is the way to get there.
And since you mentioned class and race: Yup. I get in similar arguments with folks who, say, claim affirmative action doesn’t discriminate against whites. Which it does (that’s the whole point) and which is completely OK with me (it’s justified for a variety of reasons)… but there’s a big moral and political difference between “justified” and “doesn’t exist”, and I don’t accept the inaccurate presentation.
This comment was written by Sailorman.Report this comment to the moderators
July 9th, 2007 at 10:33 am
Many Canadians have private health insurance in addition to the universal system. Most get it through their workplaces as part of a benefits package, although some buy it individually. All of the upper middle class people I know (my own family included) have private health insurance to cover mental health care, prescription drugs, dental and orthodontic services, optometrists, physiotherapy, in- home nursing, and out of country coverage. I have no idea how much private health insurance in Canada is compared to the US, but I can’t imagine we pay significantly more for it.
Mandolin,
This comment was written by debbie.I have no idea if you’re actually interested in immigrating to Canada. Being ill doesn’t make it impossible, but it might make it more difficult. There are a number of ways to immigrate to Canada, but you’re not a refugee, and I’m guessing you don’t have family to sponsor you. That means you would have to qualify as a skilled worker or an investor/entrepreneur under the points system (here’s the government website that explains how the points break down). It used to be very difficult for people with chronic conditions or diseases to immigrate because the government didn’t want people to come to Canada who couldn’t work and thus pay into the system. If I recall correctly, it was primarily being used against people with HIV/AIDs. I’m pretty sure this changed in 2002 when all the policies were overhauled. However, the regulations favor people who are younger, able-bodied, don’t have dependants, and have already completed their training/education.
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July 9th, 2007 at 10:53 am
Mandolin, “separate but equal” health care scares me as much as “separate but equal” education.
Sailorman, two points about Canada: Their system works better than the critics say. Its flaws come from Canada’s version of the neocons who constantly work to undermine it. (The UK is in a similar situation, but I don’t know as much about that.) I think one of Moore’s sidepoints in Sicko is right: the French get excellent healthcare because the people take to the streets to demand fair treatment.
As for UHC, every country with UHC has a longer life expectancy and a lower infant mortality than we do—even poor Cuba (whose critics seem to forget what it was like under Batista). So it’s possible an individual might suffer under UHC who wouldn’t under the US system, but as we know all too well, far more people will suffer if we continue our system.
This comment was written by will shetterly.Report this comment to the moderators
July 9th, 2007 at 11:10 am
It’s not hard to admit. It’s obvious that any time you make changes to a large-scale, complicated system, even if the changes being made are enormous overall improvements, some people somewhere would have been better off before the change. I agree with that.
However, that general point isn’t the only claim you’ve made; you’ve made a lot of related claims, many of which are wrong.
You’re factually wrong when you say that UHC has to mean fewer MRIs (and theoretically on dubious ground in assuming that more MRIs means better treatment); you’re factually wrong when you cite “preventative and emergent care” as the only notable savings under UHC systems, you’re factually wrong when you claim that “Providing health care to more people costs… more money” to suggest that the US would have to spend more on health care than we currently do to have UHC.
You are wrong when you talk about Canada’s waiting problems as if they are caused by UHC. Long waiting periods are not a result of UHC; Germany, France, Austria, Belgium, and Japan all have no significant waiting periods, for example.
(According to this OECD paper [pdf link], summed up in this post by Angry Bear, long waiting periods are statistically associated with a combination of lack of hospital beds per capita, older average age of population, and salaried specialists (who aren’t motivated to try and handle more cases). There is no statistical association between UHC and long waiting periods.)
Yes, many things are wrong with both Canada’s and the UK’s health care systems (although they’re still overall better than the US’s, as we all agree), and both of those health care systems are UHC systems. But it doesn’t follow that everything wrong in the Canadian and UK health systems are caused by UHC. Yet that’s what your arguments seem to assume.
Eh. Although Brits do complain a lot about their health care (and rightly so), I’m not sure that most Brits want to pay a lot more for health care; the chief virtue of Britain’s system is that it is genuinely cheap compared to many other wealthy countries’ systems. And for all the problems with Canada’s system, I’m not sure that there’s popular desire for large-scale change comparable to what we have in the US.
To avoid becoming the UK, we can choose not to design a system with significantly below-average spending on health care per capita. Britain’s system puts economic pressure on doctors to avoid treating patients unless they absolutely, absolutely have to. That makes the UK system relatively cheap, but also hurts their outcomes. (They still do better than us, though, on average.)
The way we make it more likely that our eventual outcome will be more like Germany, or France, or the VA system in the USA, is by talking about and advocating designs based on those systems, rather than limiting our view of how UHC works to examples to Canada and the UK. I’m not saying that we shouldn’t discuss what’s wrong in Canada and the UK; but we should be looking at them for examples of mistakes to avoid making when we switch to UHC, rather than falsely claiming that Canadian and British problems are outcomes of UHC.
This comment was written by Ampersand.Report this comment to the moderators
July 9th, 2007 at 11:18 am
“Mandolin, “separate but equal” health care scares me as much as “separate but equal” education.”
Who said anything about equal?
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 12:22 pm
I’ll be thinking of you, Mandolin. I hope whatever you have is minor and curable.
MA, where I live, seems to have pretty good health care by US standards, or at least we did — having always had the luxury of employer-provided insurance, I don’t know the ins and outs of the insurance requirements Romney put in place (although I will admit that anything championed by Romney has two strikes against it as far as I’m concerned). I do know that hospitals can’t refuse to treat anyone who can’t pay, at least if they’re in labor or otherwise in immediate need.
I agree that we need UHC, though. I think a lot of the resistance is just fear of the unknown, and some is xenophobia of the same flavor that’s made us the only First-World country (maybe the only country?) not on the metric system — and some, of course, is the howls of the privileged. It irritates the crap out of me (but doesn’t surprise me) that all the health-care proposals I’ve seen so far basically tinker around the edges — not one of them has the guts to go for full-blown single-payer UHC.
I have to say I’m amazed at the story of $280,000 after insurance in one week. That is just insane. For treatment of a malignant brain tumor my son went through two major surgeries and a number of minor ones, almost a month in an acute hospital and almost five months in rehab, radiation and chemo, and numerous tests of various kinds, and, thank goodness, pretty much all of it was covered. Even if it hadn’t been we would have been eligible for state insurance that covers disabled children, albeit at a hefty premium. I never fully appreciated before how truly lucky we were and are, and yes, I know that’s the very definition of privilege.
The Tsar didn’t prosper as much after the revolution
This comment was written by Lu.(dark, muted chuckle) This has to be the first time I’ve seen execution by firing squad, or by any other method for that matter, referred to as not prospering as much.
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July 9th, 2007 at 1:10 pm
Myca says, right now, with our current health care system, we are ensuring lavish health care for the very few by letting the many suffer horribly.
Actually, I think that’s backwards.
The many have health insurance (what is it–85%?) At least half of them (unionized workers–including government workers, over-65’s, and the wealthy) have more coverage than the single-payer systems offer.
It’s a relative few who suffer under our present system.
This comment was written by SamChevre.Report this comment to the moderators
July 9th, 2007 at 1:17 pm
No, because it’s not a binary “insured or not” we’re looking at, we also need to worry about levels of insurance, gaps in insurance, and what on earth to do if we lose our jobs, and thus our health coverage.
This is akin to saying that as long as there are crumbs and gruel to eat, 95% of the nation is ‘fed’.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 9th, 2007 at 1:53 pm
Also, I would like to see some evidence for your claim that that roughly 42-43% of our population has more coverage right now than they would under UHC.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 9th, 2007 at 2:31 pm
Myca,
It’s a guess.
It seems to be commonly accepted (and could be wrong, but I’m assuming not) that the US has higher levels of care for cancer, discomforts of aging (more knee/hip replacements, for example) and end-of-life care. I’m assuming that at least half the population has either government-job insurance or Medicare, both of which are “good” insurance.
This comment was written by SamChevre.Report this comment to the moderators
July 9th, 2007 at 2:33 pm
Note that I’m NOT disagreeing on the “staying insured” issue, which is a real problem. I’m just arguing that most people do have insurance, and many of them have pretty good insurance. Given that only about 10% of my friends and family are in the insurance-having category, I’m thoroughly agreed that lack of access to health care is a problem.
This comment was written by SamChevre.Report this comment to the moderators
July 9th, 2007 at 2:59 pm
[Edited to desnark. Sorry about that.]
Regarding the US’s higher level of care for cancer, it’s not commonly accepted — at least, not among scholars — that our level of care is higher.
(except among right-wingers, whose opinions are not based on reality) that the US does better.Quoting Ezra:And by nearly all accounts, countries like France and Germany provide better outcomes than Canada does.
One of the cancers that UHC critics often bring up is prostate cancer, because the US does well compared to Europe on prostate cancer outcomes. But it’s unclear if that’s because our care is better overall, or because our care system is adept at picking the low-hanging fruit — that is, easily curable patients who probably didn’t require treatment. From an article in The New Republic:
Are insured people in the US better off than people in Germany or France? I don’t think so. In America, even if you have good insurance coverage, you almost always have to worry that your insurance company will do everything it can to dump you if you ever get really, really sick. Plus, our insurance leaves a lot uncovered; even insured folks can easily wind up owing six or seven figures and being forced into bankruptcy. I think I’d be better off with the security of not having that possibility hanging over my head.
This comment was written by Ampersand.Report this comment to the moderators
July 9th, 2007 at 4:22 pm
Mandolin, re “Who said anything about equal?”
Okay, “good enough for poor people” health care scares me *even* more. If we want universal health care to be meaningful, we shouldn’t settle for a two-tier system.
Oh, for folks talking about Canada, another thing to remember: Yes, drugs aren’t covered by the basic health care program. But they are cheaper up there.
This comment was written by will shetterly.Report this comment to the moderators
July 9th, 2007 at 4:24 pm
Will,
So, are you suggesting as a practical political step that we outlaw private insurance?
Sam,
Are you arguing that your friends and family represent a statistically random polling population? That’s quite an acheivement.
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 5:46 pm
Mandolin, I don’t like forbidding things. I want universal health care that’s so good that only madmen and right-libertarians would buy additional health insurance.
This comment was written by will shetterly.Report this comment to the moderators
July 9th, 2007 at 7:22 pm
Thanks. We got one. Being discriminated against sucks.
and the replacement of them with the vampiric politicians.
For example: The government runs the school systems. There are spots of excellence; outrageous costs; and lots of failed systems. In Orleans parish, my daughter goes the to the best public school in the state {rating: 200+ gee, there is a benefit to being divorced}, but aside from two other schools, the Orleans parish school system is a nightmarish failure. Most of the schools other schools in the parish are were rated as ‘complete failures’ {ratings 20-30.} and this was pre-Katrina. The state passed a law that if they didn’t improve they would take them over. The state takeover was done post Katrina.
For example: Louisiana runs a charity hospital system. They provide the best care in the city {or did before the storm} for gun shot trauma victims {practice makes perfect - the cities high murder rate}. Unfortunately the hospital was run down and its equipment was decrepit. It needed to be torn down and replaced. The hospital had to beg the state for money and rarely got it. The hospital took heavy flood damage from Katrina. So now the state is trying to sucker the Feds into paying to replace it.
The current system sucks wind, but UHC comes with a lot of baggage. There has to be a better way.
This comment was written by Nick.Report this comment to the moderators
July 9th, 2007 at 7:56 pm
It’s a guess.
In other words, you made it up because having a percentage made your position sound good.
and the replacement of them with the vampiric politicians.
Government isn’t driven by the profit motive. Sometimes this is bad, sometimes good.
This comment was written by mythago.Report this comment to the moderators
July 9th, 2007 at 9:38 pm
Mythago, when you say, “Government isn’t driven by the profit motive. Sometimes this is bad, sometimes good,” you’re falling for the lie that profit is somehow related to efficiency. Capitalism is only efficient when efficiency is profitable. Case in point: when treatment is more profitable than prevention, you get a health care system that looks remarkably like ours.
This comment was written by will shetterly.Report this comment to the moderators
July 9th, 2007 at 9:42 pm
In Louisiana, it is rarely good.
Government isn’t driven by a profit motive? Um, all of our politicians are. It is only a questions of how much they can steal.
For example: Rep. ‘cold hard cash’ Jefferson, or is that ‘African art’ Jefferson. He even got re-elected after he got caught with the 100,000 in bribe money in his fridge.
We had another one on video taking money from fast Eddy (the governor), he was stuffing the $20,000 in his pants.
fast Eddy is still doing time in the federal pen for just a small part of his graft.
He pardoned our former Sheriff who did time for shaking down the local businesses. The former Sherriff then became our three time Parish President til the feds caught him again. He did four years for that one.
The current governor got elected in part by promising pay raises for teachers. Instead the first bills pushed were a 50% increase in salary for the governor an 14% raises for the judges {fortunately both bills failed}. Meanwhile the teachers continued to be promised raises every year but never given one.
In the United States, government has for the most part been good. A lot of graft, but relatively good. In other countries, when the government gains too much power lots of people die.
This comment was written by Nick.Report this comment to the moderators
July 9th, 2007 at 10:52 pm
I oppose universal health care partly on principle: I believe that in the overwhelming majority of cases government intrusion into personal affairs makes matters worse, not better; I also believe that whatever problems there are in the current American system, they are not as bad as the problems in places like Canada or Britain.
That may not be true. Insurance claims are only one part of the equation. Take for instance how Canada controls drug costs. Each of Canada’s ten provinces has a review committee that must a new drug for a province’s formulary, which determines which drugs will be paid by the health program. A drug may be approved by one province but not another. What is the cost of having a centralized government that pays for healthcare ( and makes it illegal for citizens to have private insurance that covers procedures theoretically available under the national scheme) and then has a review board for each province?
Under a national health care scheme there are layers of approval for every facet of the system: how will money be spread among the provinces; which drugs will be approved for patient usage and which wont; which hospitals will be shut down and where will new ones open etc.,
In America if you don’t like your health care plan then you can leave it and get a new one. The ability of people to opt out of the system and either go without coverage or find another plan discourages the building up of any excess bureacracy because it unnecessarily raises costs.
That’s not true. I found the following information in “Explaining Waiting Times Variations for Elective Surgery across OECD Countries”. On page 9:
Carroll et al. (1995) focused on waiting times for cardiovascular procedures in four countries. It found that the percentage of the respondents in need of elective coronary bypass who had been waiting for more than three months was 88.9% in the United Kingdom, 46.7% in Canada, 18.2% in Sweden and 0% in the U.S. For elective coronary angiography the percentage was 22.8% in the United Kingdom, 16.1% in Canada, 15.4% in Sweden and 0% in the U.S. Similarly, Coyte et al. (1994) found that surveyed patients in need of knee replacement had a median waiting time of eight weeks in Canada (Ontario) and three weeks in the U.S. In Germany, self-reported mean waiting times for cataract surgery was equal to 35 days in 2000 (Wenzel, Reuscher and Aral, 2001; the survey was based on 450 institutions and 926 operating ophthalmologists).
If you start on page 8 and go through page 10 there are several graphs that show the excessive wait times many people are enduring in other OECD countries compared to the US.
That’s definitely not true. In other countries virtually everything about a patients treatment is determined by their GP ( who is responsible for referment to a specialist), a specialist ( who determines your course of treatment), and the government which governs everything from waiting lists to access to which drugs are available ( see reference above regarding Canada).
This comment was written by Jamila Akil.Report this comment to the moderators
July 9th, 2007 at 11:15 pm
will shetterly said:
This has little to do with any failings of the US healthcare system. because in the developed world there is very little correlation between health care spending and life expectancy. The number of years a person will live is primarily a result of genetic and social factors, including lifestyle, environment and education. The same factors heavily influence infant mortality and the US
For example, Japan’s average life expectancy (78.6 years) is one of the highest in the world, about three years higher than that in the U.S. If the three-year difference were the result of lower-quality health care in the United States, you would expect Japanese-Americans living in this country to experience shortened life spans. They don’t. According to the National Asian Pacific Center on Aging, in 1980…… white Americans had an average life expectancy of 76.4 years, while Japanese-Americans had an average life expectancy of 79.7 years - just about the same three-year spread that exists between the populations of the two countries. Similarly, the California Department of Health reports that people of Asian or Pacific Island ethnic origin living in the state and using its health care system have a life expectancy 5.3 years longer (81.2 versus 75.9 years) than white Californians.
Of the industrialized countries with better life expectancies than the U.S., nearly all have overwhelmingly white populations of European descent. None have large black populations. Unfortunately, black Americans have more health problems and shorter life expectancy (70 years in 1991) than whites. The American population is a mixture of several ethnic groups - some with longer and some with shorter life spans than whites. LINK
This comment was written by Jamila Akil.Report this comment to the moderators
July 9th, 2007 at 11:33 pm
Ampersand:
But the real question is this: Once everyone is bulk buying and forcing the drug companies to lower prices, the pharmaceutical industry will eventually reach a point where it is no longer economical to develop new drugs. Research and development ( and yes, marketing too) costs billions of dollars. Will the government take over the cost of paying R&D when the drug companies decide that it is no longer profitable for them to continue doing it?
Right now the US produces far more new medicines than other countries because of the widespread lack of price controls and other countries are benefiting from the drugs that are developed here.
This comment was written by Jamila Akil.Report this comment to the moderators
July 9th, 2007 at 11:42 pm
Good to know you’re on the side of suffering and forcing ill people to be homeless, Jamila. I’ll bear it in mind should I ever encounter you in person.
This comment was written by Mandolin.Report this comment to the moderators
July 9th, 2007 at 11:50 pm
If we judge the effectiveness of healthcare primarily on how well it maintains the health of a country’s inhabitants (and I’m not sure what else we should judge on), then your belief is flat-out untrue.
And obviously so.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 9th, 2007 at 11:54 pm
Mandolin Writes:
Yes, I’m a heartless libertarian bitch! And damn proud of it too. j/k
But seriously. I’m all for health care, just not government mandated universal health care. And I’m sure that if you met me in person you would find it hard not to like me. I’m very likable. :)
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 12:06 am
Jamila Akil, what poor countries without universal health care have lower rates of infant mortality and longer average life spans than Cuba, the poorest country with UHC?
And your mistake is here: “According to the National Asian Pacific Center on Aging, in 1980…… white Americans had an average life expectancy of 76.4 years, while Japanese-Americans had an average life expectancy of 79.7 years” You’re failing to factor culture into the equation. Asian Americans get more exercise and eat healthier meals than white Americans.
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 12:22 am
In fact the government already pays for much of the R&D that is new and truly innovative, and private comapnies access it for free or close to it.
This comment was written by curiousgyrl.Report this comment to the moderators
July 10th, 2007 at 12:27 am
It’s not obvious at all.
–The percent of American seniors reporting they are in good health (72.6 percent) is the highest of any country in the OECD.
–Among those age forty-five to sixty-four who report they are in good health, Americans top out at 85.4 percent; the others range from 84.9 percent in Canada to 58.2 percent in Germany.
Source: OECD Health Data 2002 (According to the book “Lives At Risk: Single-Payer National Health Insurance Around the World”)
As I’ve said before, much of what appears to be a problem with the US health care system is really due to other factors such as illegal immigrants ( many of whom are not receiving routine care and only enter the health care system when something is seriously wrong with them), personal choices that people make (such as eating habits and higher rates of smoking among certain populations), differences between ethnic groups ( some groups have higher rates of infant mortality than the average etc.)….
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 12:39 am
will shetterly Writes:
July 10th, 2007 at 12:06 am
will shetterly said:
I don’t understand your question. Are you asking me are there any third-world countries without universal health care that have lower infant mortality and longer life spans than Cuba? If that is what you mean then the answer is a resounding yes.
Or are you asking me if I think that poorer countries would do much better in keeping their citizens healthy is they instituted UHC?
The entire point of providing those stats was to point out the cultural factor.Asian Americans have similar health outcomes as Asians in other countries and the same can be said for Italian Americans when compared to Italians abroad. The same is true for black people in the US when compared to black people in other countries. However, when one ethnic group ( black people for instance) have higher infant mortality rates than the average and there is a substantial number of people from that group in a population ( such as the large number of blacks in the US as compared to Canada or Sweden) they will drag the average down.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 6:38 am
Jamila, the data’s here and in other locations on the internet. I’ll let other people argue down your incorrect numbers, which they are good for doing.
Meanwhile, I’d just like to bring attention back to the fact that, should I be poorer and the worst about my medical situation be true, you’d be in favor of my having to choose between shelter and increasing disability leading to death.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 8:40 am
Here’s what i see happening:
1) Someone makes the claim that Japan has better health than the U.S.. This claim is supported by numbers showing that Japanese citizens have a longer life expectancy. in context, this is considered as support for a UHC system.
2) Jamila notes that people of Japanese descent *in the US* also have unusually long life expectancies. (in fact, they appear to exceed the expectancy of Japanese citizens, though not by much.) This provides an alternate explanation for the difference in life expectancies, that appears not to be inflienced by the health care systems of the two countries (since the numbers are almost identical.)
In context, this undermines the claim that the increased Japanese life expectancy is related to better heath care in Japan. Rather, it suggests that it is related to being of Japanese descent.
3) Will counters that this is due to cultural effects and can be ignored. This is a complete non sequitur. Or more accurately, the point is incomplete: the claim of cultural effect only has meaning if you demonstrate that the cultural effect (presumed to increase life expectancy) is GREATER in the U.S. than in Japan.
4) mandolin says Jamila is evil.
Come on folks, the point was valid; a little concession would be appreciated. It’s only polite.
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 8:53 am
Mandolin,
I was explicitly arguing that my friends and family are NOT a statistically normal population–they are far less likely to be insured than average.
Ampersand,
The study Ezra refers to specifies low-income patients for cancer care; I don’t see any inconsistency between “low-income patients do worse in the US” and “well-insured patients do better in the US.”
Mythago,
It’s a guess (that 40% or so of the population has good–high-coverage, low-cost-of-use health insurance); it’s a very conservative guess. I’m intending it as a minimum on the number of people whose health coverage will be theoretically worse under any reasonable, proposed UHC plan.
This comment was written by SamChevre.Report this comment to the moderators
July 10th, 2007 at 9:06 am
Do you have any evidence to back up that this guess in conservative?
I mean, look . . . I understand that 42/43% is an estimate. Maybe it’s 40%. Maybe it’s 45%. What I’m looking for is evidence that it’s neither 30% nor 50%.
If, when asked to present evidence, your response is, “I’m guessing,” then I don’t think anyone is out of line in discounting your argument out of hand.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 9:09 am
By way of example, I think the number of people whose health coverage will be theoretically worse under any reasonable, proposed UHC plan is 4.
Four people.
And this is an exceedingly generous estimate. It’s probably 1/2 a person.
Evidence? I have no evidence. It’s a guess.
An exceedingly generous guess, though!
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 9:09 am
Sailorman, I’ll happily concede once a fact’s been proven. When you begin poking at details in a statistic, you have to poke at all of them: the distribution of wealth and health care, diet and exercise, family structure, religion, etc. So far, you and Jamila Akil might as well be arguing that Shinto is the deciding factor. Your argument boils down to “UHC is a coincidence,” and you ignore the strange coincidence that this “coincidence” happens to line up quite neatly with the healthiest populations in the world.
And Mandolin has a point that right-libertarians hate: Sometimes the right thing to do is–brace yourself, neocons and Libertarian Party members–the more expensive choice.
But in this case, you’ve already decided what the most expensive case is while you ignore the real world examples. We know from the example of other countries that populations are healthier under UHC, and their expenses are lower. A look at Cubans under Batista and after Batista should be able to tell you a great deal.
Many of the things that you and Jamila Akil misunderstand are addressed here, where Michael Moore’s researchers have the answers and links to the many things that CNN misrepresented when they critiqued Sicko. (CNN being a puppet of the insurance companies, their “errors’ are no surprise.)
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 9:15 am
Sailorman,
Jamila is opposing universal health coverage. One of the consequences of that is that if I were in a less stable financial situation, and my health were at the worst of the possibilities, I would probably end up homeless, disabled or dead.
That’s not an ad hominem. That’s not a bad argument. Just because you, or she, don’t like the fact that her opposition could cost lives — even the lives of people you’re talking to — doesn’t make it untrue.
Also, your paraphrase is disingenuous (to be clear, I mean your suggestion that I’m calling her “evil.”). Don’t do that again.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 9:15 am
Sam,
Enough with the guesswork; it calls all your comments into doubt, and it’s really silly. Start supporting with stats, or stop making claims.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 9:16 am
(Is this blogging software a bit wonky? Earlier, I thought I left a post which disappeared; when it didn’t appear, I decided I must’ve decided not to leave it, which I sometimes do. Today, I left a long post, and it hasn’t shown up. When I tried submitting it again, I got a message saying it was a duplicate post, but it still hasn’t appeared.
If it’s lost, it was brilliant, I tell you. Brilliant.
If it shows up, uh, never mind.
The most important part was this link, which answers many of Sailorman’s and Jamila Akil’s misunderstandings: here.
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 9:23 am
Will,
I grabbed some of your comments out of spam. (If your comments just disappear like that it’s because the program thinks you’re spamming. Go ahead and let me or one of the other moderators know — as you did — and we’ll grab them out for you.) Did I get everything or is there something still missing?
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 9:38 am
Myca/Mandolin,
Here’s how I got my guess. (By the way–85% of Americans have health insurance is NOT a guess–it’s from the Census Bureau most recent–?2005–figures).
The federal civil service has an insurance program that’s frequently used in discussion as an example of “really good.” Most states have comparable programs. Since the government accounts for a bit over 30% of GDP, it seems reasonable that about 30% of Americans are covered by government civil-service insurance programs.
Medicare is good insurance. It’s frequently used as a benchmark by proponents of UHC–Medicare for all. 12.4% of Americans are over 65, and almost all are eligible for Medicare–say 12%.
That’s 42% right there. It’s a conservative guess because many–I’d say most–unionized workers have good insurance; with 7.4% of private-sector workers unionized, it seems reasonable that at least 2/3 have good insurance–that’s another 5%.
That’s still not allowing for any non-unionized workers in the private sector, at least some of whom (like me) have good insurance.
This comment was written by SamChevre.Report this comment to the moderators
July 10th, 2007 at 9:39 am
Mandolin, #67 was the important one. Thanks!
Though in retrospect, the tone could’ve been a touch politer.
But, having said that, I’ll risk being less polite:
Jamila Akil, when you say you’re a nice person and I would like you in person, I don’t doubt that. Most of the people who know me in person like me; it’s only people online who decide I’m an asshole, because online, they have little more to judge than my opinions. They don’t get the ameliorating cues that say there’s far more to a person than their opinion on one or two issues.
But you really should be careful about offering “niceness” as a defense of your opinions. Most of the people who knew Hitler thought he was a great guy; he was kind to children and animals, and he painted roses. That his opinions resulted in millions of deaths has nothing to do with him being “nice” in social situations.
Under universal health care, more lives are saved than under any other system we know. If we were at a party, you could disagree with me, and I would still like you–I have many friends who disagree with me.
But you would also still be wrong.
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 10:08 am
Will, #67 wasn’t important. Here’s why: You raised the point that “every country” with UHC had a longer life expectancy.
As a result, you are the one who is making the thesis that Japan’s life expectancy is related to UHC, and now you’ve got to support your point. You don’t get to make a point, and then answer an entirely relevant attack by demanding perfection in the attack itself. You need to defend your point–that’s how science works.
As a result, Mandolin’s wishes notwithstanding, #67 doesn’t answer squat. Either concede that your “every country” example is wrong, or explain why the japanese-in-U.S.-have-equal-life-expectancies counterargument is irrelevant. But you’ve got to do one of the two.
And nice Godwin, by the way. You’re familiar with Godwin’s law, right?
Mandolin, this:
“Good to know you’re on the side of suffering and forcing ill people to be homeless, Jamila” (your quote I responded to)
is an inaccurate straw man representation of this:
“if I were in a less stable financial situation, and [if]my health were at the worst of the possibilities, I would probably end up homeless, disabled or dead” (emphasis mine.)
That’s an ad hominem attack. It’s in the same loathsome category as accusing opponents of the war as “wanting U.S. citizens to die a fiery death” or accusing opponents of higher taxes as “wanting poor children to starve to death in the street.” UHC is only one way to avoid suffering; it is only one way to avoid your ending up homeless, disabled, or dead.
I don’t want you to end up homeless, disabled, or dead; I suspect Jamila doesn’t either. And you don’t get to assign that desire to me just because I happen to disagree with you about some aspects of UHC.
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 10:19 am
Godwin’s law is useful if you read it as “do not compare your opponents to Hitler. Their badness is not as bad as his.”
Godwin’s law is abso-freaking-lutely useless if you read it as “OMG YOU MENTIONED HITLER GODWINGODWINGODWIN!”
This was not a Godwin. Will was using Hitler as a nice, unambiguous example of badness. Hitler is often used this way, because it’s something virtually everyone agrees on.
In this case, Will was saying “Niceness is good, but it is not an indicator of rightness. After all, Hitler was very nice.” This is true, and reasonable.
If he’d said “You’re just like Hitler! You know, he opposed universal health care too!” You’d be right in calling Godwin on this. As it is, I don’t think you are.
Also, I wish the goddamn meme would just die.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 10:22 am
Sam,
Can you please define, “really good” health insurance? Without a definition, we’re going to have different ideas about what that means.
Sailorman,
You are absolutely wrong. You are equating “Japan” & “Japanese-American”. One is a country, the other is not a country. Thus, holding that Japanese-Americans have a longer avg. lifespan than Japanese citizens in no way refutes the claim that “every country with UHC has longer average lifespans than the USA.”
Also…
I don’t want you to end up homeless, disabled, or dead; I suspect Jamila doesn’t either.
But you are advocating policy (that costs more than UHC) that inevitably leads to that result for many, many people. Mandolin isn’t the only one who has a hard time seeing why that semantic distinction is important.
This comment was written by Jake Squid.Report this comment to the moderators
July 10th, 2007 at 10:30 am
My point remains. Many Americans lack health insurance coverage, and more lack health insurance coverage that will allow them to compensate for sustained or severe illness. If one denies that health care is a basic human right, one is supporting unnecessary suffering, bankruptcy, homelessness, disability, and death.
You don’t get to blink that away because it’s unpleasant.
(And yes, I understand your point, but it’s academic. The real world, pragmatic consequence of denying health care to Americans is disability, suffering, homelessness, bankruptcy, and death.)
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 10:37 am
Mandolin Writes:
Mandolin, I got my data off the internet and provided the links to prove it. No one is going to argue down my numbers because everything that I said is correct.
I don’t want you, or anyone else for that matter, to end up flat broke or disabled. Instead of a UHC I think that alternative for the US should be a government safety net for only the poorest of citizens and/or those people who are physically or mentally disabled. Other than those folks, if don’t purchase health insurance then you should rely on private generosity, use teaching medical schools for your health care needs where the cost is cheaper ( that’s what I do with my teeth), or you can pay out of pocket.
And in case you don’t know, there are plenty of people ending up dead or disabled from waiting for care in countries with UHC.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 10:49 am
will shetterly Writes:
No, we don’t know that at all. In fact, this assertion can be proven false by looking at WHO and OECD data. You have yet to provide a link to any information that shows people in countries with UHC are healthier due to their superior healthcare ( which I know for a fact you can’t provide, but I’d like to see you scramble and try anyway).
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 10:51 am
Jake, do you you understand what the effect of an alternate explanation is on an initial hypothesis? I’m beginning to think that nobody does.
I am not disputing the FACT that Japan has higher life expectancy than the U.S. Why bother? Facts is facts, and that one is true.
I am disputing the HYPOTHESIS BASED ON THAT FACT, which was clearly that such a result was due to the other fact involved, namely Japan’s UHC.
In that context, providing an alternate explanation for the existence of the fact is relevant. Namely, that those of Japanese descent tend to have longer life expectancy for unknown reasons rather than because they are in a UHC country such as Japan. (the descriptor I used, “japanese descent,” applies to people both in and out of Japan.)
I was unclear in my previous post, though. You don’t need to concede the “every country” example is factually incorrect, you need to concede that the data from Japan don’t support your point. (which makes using “every” incorrect in context.)
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 10:56 am
Sailorman, I wish I had time to analze every factor in every country that might account for greater longevity and and lower infant mortality. I’ll immediately concede that diet and exercise are factors. That said, if you want to keep thinking UHC is irrelevant, that’s cool by me. I’ll just hope we’ll outvote you someday soon.
Oh, as for your specific example: “Japanese in the US” and “Japanese in Japan” are not two different countries. I realize we’re all typing quickly, but if I’m wrong about universal health care, it should be very easy for you to show me the chart that says which *countries* without universal health care rank higher than *countries* without UHC. I’m not saying culture and ethnicity are irrelevant. But when talking about national health care systems, you should stick to nations.
Also, science is a dialogue. Neither side gets to say, “No, you gotta prove it!”
Myca, thanks. If anything, Sailorman should be glad that I brought up Hitler, who does have a place in the history of UHC. Though Hitler hated communism, he didn’t dare abolish Germany’s experiments in universal health care (begun in 1883, so no one can blame Hitler or the Nazis for the idea that every citizen should have health care).
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 10:59 am
will shetterly Writes:
I would rather that you risk being correct for a change.
“Niceness” was not my defense of my opinions. My defense of my opinions is that they are correct. It was Mandolin who said I was evil because I disagree with her.
And if it’s any consolation, I don’t believe that you are evil or nice ( because I don’t know you that well), but that instead you are just woefully misinformed and illogical.
Another statement with no basis in fact and which can easily be disproven by even a little bit of research. So please, provide some info to back that statement up.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 11:00 am
Just wanted to highlight this. THAT is the issue. The issue isn’t whether Japanese have both longer lifespans and also have UHC. The issue is whether Japanese have longer lifespans because of UHC.
Correlation is not causation.
Amp seemed to realize this: when we were talking about wait times he hypothesized that the lower wait times in the U.S. were due to more beds rather than to a benefit of a non-UHC system. That is an excellent example of a good counterargument to a correlation-as-causation claim. I’m not sure why so many other people seem to be denying it w/r/t Japan, for example.
So, say we’re arguing about differences in life expectancies.
One hypothesis might be that UHC increases a country’s life expectancy.
An alternate hypothesis might be that there exist biologically-, racially-, or culturally-based differences in life expectancy which are not controlled for in the country data.
That would require a new set of data to address it, and so on.
It’s the WHY that is important, not the WHAT IS.
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 11:17 am
Re: Ad Hominem Attacks
An ad hominem attack is of the form “Your arguments are wrong because you suck.” It attempts to invalidate arguments through personal insults.
In no way is pointing out the natural consequences of a policy an ad hominem attack. Instead, it is the duty of the opponent to either A) argue that these are not the natural consequences of the policy in question or B) argue that the consequences are justified by concomitant benefits.
That is all.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 11:24 am
1) Did I use the word evil anywhere? Pretty sure I didn’t. Unless I did, then stop it.
2) Welcome to an actual ban on ad hominem, as correctly defined by Myca. Next thing that crosses the line? Is being kittened. (Last thing that crossed the line? JA’s attack on Will. This is a warning.)
3) Loving the new claim that “health care doesn’t actually make you healthier.” Also loving the new claim that “you can really get adequate health care without going broke even if you don’t have insurance” — data to the contrary has been provided; you want to argue that it’s possible? Gimme the data.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 11:41 am
Jamila Akil, you might start by looking at Population Health Forum. They have the 2004 list of nations by “Health ranked by average number of years lived.” The US is #30. Cuba is #29. The most significant fact about the countries doing better than us? “All of the countries that rank higher in the Health Olympics have a smaller gap in income distribution between their richest and poorest citizens.”
I think all of those countries have UHC. (I didn’t double-check every one; I only checked the ones I thought didn’t, and to my pleased surpise, Costa Rica and Israel do have universal health care.) If I’m wrong, if one or more of them do not have UHC, it may mean that when wealth is more equalized, UHC becomes less important. But that would be a very odd argument for a right-libertarian to make.
I hope you will be spared that argument and simply have to admit that the champions of UHC are right.
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 11:42 am
will shetterly said:
Will, the OECD and the WHO both have issued statements saying that their rankings of countries should be understood in light of the myriad differences within countries as well as between them. And there is a very good reason for this.
Take the US for example: A country of over 300 millions people with the greatest variety of immigrants (we have more illegal immigrants here than any other nation in the world), ethnicities, and religion on earth spread over urban and rural areas. Then look at Sweden: A country of less than 10 million people with a homogenous population concentrated in an urban area. The multitude of factors that must be controlled for in order to do a valid comparion between the health of the citizens of both countries is almost staggering.
There is a reason why scientists attempt to control for mitigating factors and variables when completing experiments; the same thing should be done when comparing health care across nations if you expect your conclusions to be valid.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 11:46 am
will…. damn, if you don’t understand what is or is not logically relevant in a scientific debate, then stop arguing it already. Or go learn. You are wrong in how you are approaching the effect of Japanese ancestry. It’s a confounding factor; I don’t need to limit myself to country data in order to discuss a flaw in how the country-level data is linked to the effect of UHC.
You may well be right about UHC in general, I’m open to being convinced. But this conversation about Japan makes it difficult to have the followup conversation with you. Rather than fill up the thread here, try these threads on my blog, which I wrote in response to the many people who don’t understand this. The first one is the most recent (and actually on this exact point;) the others may also be helpful.
http://moderatelyinsane.blogspot.com/2007/07/statistics-for-believers-5.html
http://moderatelyinsane.blogspot.com/2006/05/statistics-for-believers-1.html
http://moderatelyinsane.blogspot.com/2006/05/statistics-for-believers-2.html
http://moderatelyinsane.blogspot.com/2006/05/statistics-for-believers-3.html
http://moderatelyinsane.blogspot.com/2006/05/statistics-for-believers-4-exclusion.html
http://moderatelyinsane.blogspot.com/2006/05/experimental-design-101-growing-grass.html
Myca, so if I start accusing you of “wanting to tax me so much that I lose my house, have to move and lose my job, and end up struggling to make ends meet” then you won’t view that as illogical? You’ll happily go into details, explain why it’s incorrect, etc? Pointing out the “natural consequences” also takes a bit of support.
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 11:53 am
Oh, also. Let’s go back to the “Mandolin potentially has MS” thing. Further, spot me the “Mandolin loses her health insurance after graduating from her current program, and her new employer’s insurance won’t cover her due to pre-existing condition rules.”
So, all of a sudden I need reuglar appointments with a neurologist. I need MRIs. I need medication to try to prevent new attacks. I have an attack anyway; I end up hospitalized. The hospitalization eats through my parents’ savings. I’m permanently disabled and can’t work. My husband is still working, but he also has to take care of me, and we’re eating thorugh his paycheck to keep me in medications. I need physical therapy and expensive equipment to get around.
And now, I have another attack, and I have to be hospitalized again.
My survival and physical functionality are dependent on my ability to pay for my care. I don’t have that money. Now I’m in the position that everyone here (including me!) hopes I never get into. Nevertheless, I’m there.
In order for us to accept that health care is not a basic right, we have to accept that the worth of my body, my mind, and my life is dependent on how much money I have. We have to accept that if I have more money, then it is more likely that I will be able to keep thinking, keep moving, and keep breathing. We have to say that rich people are more deserving of these things.
I reject that. And here, I’ll use that word you wanted. I think it is evil to suggest that people’s right to breathe and be healthy should be dependent on how much money they have. Wealth is not a marker of personal worth.
Capitolism as a system has a built in class of losers. It’s like a game of musical chairs. (I’m ripping this metaphor off from a writer I heard interviewed on NPR once; if anyone knows his name, I’d love to have it.) We can talk about why people don’t get the chairs. Maybe they don’t move as fast, or they don’t have good enough hearing to react in a timely fashion when the music cuts off. But that’s ignoring the basic problem — THERE AREN’T ENOUGH CHAIRS.
Those of us who have money and social and cultural capitol don’t have to worry too much about chairs. We can buy seats. Sometimes our parents left us seats. But our seats are dependent on the fact that other people must stand.
Can we please stop whining about how we might have to give up some cushioning so that someone else can have a stool? In my seated position, I already get lots of treats that they don’t. Should we really be in the position of saying that health care is a treat? I have to dehumanize other people to make that leap. I have to believe that they don’t deserve to live, breathe, and function as much as I do.
Now, one of the interesting features of this argument is that however secure my chair appears to be — and it’s pretty secure — I can still lose it. Despite the advantages of my relatively wealthy parents, my white skin, the cultural capitol of my education, I am as vulnerable to really nasty illness as anyone. Contracting a nasty, chronic illness before I (or my husband) have a really steady job could fuck me over. It could boot me out of my seat. Tragedy, although it would take a different form, could happen to almost any of us.
So, even if I lacked the empathy to imagine being a poor person without health care, and even if I lived such a sheltered life that I didn’t know poor people who grew up as children without dental and medical care (like my fiance, for instance), I should still be able to engage my own selfishness and understand the precariousness of my position.
That’s why I keep harping on my medical problems. They are the crux of this issue. They are my vulnerability; they are also your vulnerability. You could be laid off, and be without insurance. You could decide to start your own business, and in that precarious period before ou can afford insurance, you could get a brain tumor, like the commenter’s brother in my post. We are all vulnerable.
And we are all worthwhile. None of us deserve to lose our lives, our limbs, or our function because of bad luck. The rich and insured are not worth more than the poor and the struggling. Breath is breath, and it is all priceless.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 12:19 pm
I see a couple arguments popping up on the anti-UHC side:
1) UHC doesn’t explain differences in life expectancy, culture or race does.
First, I’d argue that, even though cultural/racial factors played a role in life expectancy, health care plays a role as well. I’d wager it’s almost impossible to argue cohesively that something like race has anywhere near 100% determinacy when it comes to life expectancy. Broad measures of well being like life expectancy are too complicated to distill down to one cause — especially when those damn French smoke and drink and eat fatty food and are still HAWT (because of UHC? we’ll never know.). It’s just as reasonable to say that UHC partially explains a difference in life expectancy as it is to say that lifestyle factors partially explain a difference in life expectancy. Now, I’d personally be interested in any study that links UHC to lifestyle factors that increase longevity — like, I don’t know, less financial stress, more time off for illness, ability to leave a crappy job because you don’t have to worry about insurance, a government-run nanny service (!)…
2) UHC might actually cause deaths — probably from long waits for cancer treatment, fewer cancer drugs available, or subpar emergency room treatment.
I’d like to turn this second argument back on its proponents — do you think that something inherent in UHC causes long waits and fewer experimental treatments? I’d personally argue that UHC is about as good as the government and the political will that manages it. Winning the battle for UHC in the US wouldn’t alleviate the need to fight for better care, more care, more equitable distribution of care, more funding, more technology, and so on. It would, however, take the edge off. For those who argue that the government f*cks everything up by its nature, I’d ask an additional question: is there something inherent in our current, profit-based system that causes people to die because they can’t afford life-saving treatment? Maybe it’s because profit-based care will do anything in its power to avoid caring for unprofitable patients? Maybe that’s the part I think is immoral.
This comment was written by Murphy.Report this comment to the moderators
July 10th, 2007 at 12:21 pm
This is why the social scientists who study this in detail use measures other than life expectancy (primarily “potential years of life lost” for various conditions or “disability adjusted life years”). However, even using the more targeted measures, the US still consistently does worse than other wealthy nations in a large majority of comparisons. And we do it while spending far, far more money on health care.
Even if you argue that no measure is perfect (it’s true no measure is absolutely perfect, but that gambit strikes me as a bit desperate), it’s clear that other countries are able to get results that don’t appear to be worse than the US’s, while providing universal care and spending less on health care per capita. Even if we concede that, despite study after study using many different measures, we can’t be certain that the US is really worse than most of the first world, why should we want to pay more for health care that doesn’t even provide universal coverage and doesn’t provide better outcomes?
This comment was written by Ampersand.Report this comment to the moderators
July 10th, 2007 at 12:27 pm
It would be up to you to demonstrate that the policies I advocate have that as their natural consequence (as Mandolin has done for those who oppose universal health care). Once that had been demonstrated, it would be up to me to either disagree or argue that, though those costs might be onerous, they are justified for some reason
What we’ve seen here is that Mandolin demonstrated a perfectly reasonable (and common) consequence of our current health care program, and was accused of an ad hominem attack. This is false.
“Ad Hominem Attack” is a phrase with a specific meaning, and it does not mean ‘being called to account for the consequences of the policies you advocate.’
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 12:32 pm
Mandolin, how do you see this thread going? I don’t see how we can keep discussing generalities of UHC and your own personal specifics at the same time. Or at least I don’t see how we can do it unless you’re prepared to have things said that would, by virtue of their personal nature, normally be considered rude, which doesn’t seem especially Alas-like. Or very nice.
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 12:38 pm
Mandolin said:
Mandolin, under any health care system, the rich and those who are politically important will always receive the best health care by being able to more easily jump ahead in the queue or opt out of system by paying for services elsewhere. I don’t say that rich people are more deserving but they do have access to more money, and they should be able to buy premium services with their money if they choose to do so.
Your argument that the only way for people of all social classes to have access to health care is if the government guarantees it is a false one. In countries with UHC there are still people at the back of the line waiting for care in agony, and yes, some of those people end up dead or disabled.
My argument is that a freer market would provide more people with better healthcare than a UHC. As it currently sits, the US has created a web of perverse incentives for insurance companies and health care providers that results in higher costs which force many people to go without insurance, for health care providers to lower quality of care, and for insurance companies to operate ineffeciently. My solution to better health care for all is less government intervention and for the free market to take its course.
Much of my information comes from “Lives At Risk: Single-Payer National Health Insurance Around the World” by Goodman, Musgrave, and Herrick. It’s available on amazon dot com and I highly recommend it to anyone who wants to know just how good American health care is and how much better it could be with less government intervention, not more.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 12:39 pm
Contracting a nasty, chronic illness before I (or my husband) have a really steady job could fuck me over.
You need to edit that sentence. Eliminate all words after “illness” and before “could.”
Go on, ask me about what happened when my wife was diagnosed with TMJ & Fibromyalgia while I had a good job & what passes for “good insurance” in this country. It’s been nearly 10 years and there is still no end in sight for paying off those debts. And my income has increased by about 67% in that time.
This comment was written by Jake Squid.Report this comment to the moderators
July 10th, 2007 at 12:42 pm
My argument is that a freer market would provide more people with better healthcare than a UHC.
Have you ever worked in or with the health insurance industry in the US? Have you seen what happens to customers when Blue Cross/Blue Shield goes from non-profit to for-profit?
I’m curious because I can’t see how that statement is compatible with the realities of the insurance industry in the USA.
This comment was written by Jake Squid.Report this comment to the moderators
July 10th, 2007 at 12:45 pm
Murphy,
I think I’m the one advocating your #2, so let me re-state my position.
I think some form of UHC would be a good idea.
I think that the possibility of getting a system that provides as good care as France, as cheaply as France, is about 0.
I think that UHC will hurt certain people; minimizing how many people it hurts will make it easier to achieve.
I think that if all current government programs and employer-provided insurance are replaced with some kind of universal system, some people will not get health-care they now get; some of those people will die. I’m OK with that outcome; having a few thousand cancer patients and extremely premature babies die because low-success, high-cost treatments aren’t covered is better than having a few million people not getting adequate health care.
This comment was written by SamChevre.Report this comment to the moderators
July 10th, 2007 at 12:46 pm
Sailor,
If you’re unwilling to deal with the real-world — and yes, indeed, personal — consequences of your policies, then that strikes me as your problem. If you’re not willing to say “Yes, your death and poverty are an acceptable consequence of my political beliefs” then you’re being hypocritical — because even if it weren’t my personal situation, it would be someone’s. You would still be saying it to a faceless person.
Alternately, consider framing your argument as Myca has suggested. Prove that your policy does not invite my death or poverty (or that of people in a comparable situation). If you can’t, then maybe you need to rethink your position.
(FTR, I thought you supported UHC. Are you just speaking on behalf of JA? I have no idea. In any case, [edits from original text follow] it seems to me that your insistence that political debate should be generalized and referred through third person texts is problematic at best. Politics is personal. These are real, individual lives that are at stake. One cannot always hide behind anonymity. It’s important to face that there are real people whose lives, sometimes at the most primal level, are affected by what we happily discuss in the abstract. This is the heart of the “civility debate” that crops up here occasionally.
Further, you’ll note that this particular post began rooted in my own experience of the health care system, and my personal, subjective terror in the face of these potential life-threatening and life-ruining diagnoses. Therefore, it’s not really fair to ask that this post retain an abstract, third person mode of argumentation. It did not begin that way.)
Jake,
I hope you will tell your story in as much detail as you feel comofrtable providing on the internet.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 1:08 pm
Jamila,
1) Demand for health care is fixed, not relative. People cannot adjust their health care needs according to the market, in order to martial the usual kinds of supply and demand. You can’t shop around for the best-priced ER when you’ve cut off your hand; you can’t put off your need for an angioplasty until there’s a 2-for-1 deal.
2) Increasing the pressure on health care to operate on a for-profit model means that people will continue to be asked to pay not just for the basic necessities of keeping themselves alive and functioning, but also to increase the profit margin of the people running the hospitals.
3) Increasing the pressure on health care to operate on a for-profit model will increase the pressure on insurers to refuse care wherever possible, in order to maximize their own profit.
4) These other problems aside, the libertarian free market solution still requires that a certain class of poor people be unable to obtain insurance coverage and health care. Thus, you are still trading in their lives for… well, what benefit? What benefit could possibly be worth it?
5) You argue that poor people will always receive less health care than rich people. Accepting for the nonce that this is true (although I think it’s not necessarily true for all human economic models), you seem to be further arguing that we shouldn’t act as a society to minimize that risk. This seems, to me, to be similar to arguing that the urge to rape is natural, and therefore we feminists should stop getting het up about it. Simply because something seems natural or programmed into a system does not mean it shouldn’t be fought; simply because it appears that it won’t be eradicated does not mean that it shouldn’t be ameliorated to the best of our collective ability.
6) Americans pay more for their taxes plus health care than other countries with higher taxes pay for their taxes which include their health care. Thus, even if the rest of this were untrue, you’re still arguing that you feel you should pay more in order that fewer people should have health care.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 1:23 pm
SamChevre-
I think we fundamentally agree, then, if I understand your point correctly. UHC is probably a better option than our current system, but it is possible that some people will be worse off even as the average level of care rises. However, I don’t want to concede that it is inevitable that certain patients will be worse off with UHC. I think it’s entirely possible for an insanely wealthy nation to provide insanely good care to every citizen, including expensive care for cancer patients and premature infants. One of the main advantages to a publicly owned system, in my view, is that citizens can agitate for better care and elect representatives who’ll fight to increase standards. We can’t rise up politically against the HMOs and vote them out of office. (It’s hard to vote with our wallets, too, as Mandolin points out above.)
But I’ll admit I’m an idealist. I think agitating for UHC will be a more politically difficult fight than fighting to keep it and improve it later on, once health care is seen as a human right instead of a profit margin.
This comment was written by Murphy.Report this comment to the moderators
July 10th, 2007 at 1:34 pm
Jamila wrote:
First of all, the US health care payment system is at least as complicated as anything you’ve described above. In Canada, there are ten provinces, each of which has its own list of what is and isn’t covered. However, a doctor’s office only has to deal with the one such list — the list for the province it’s located in.
In contrast, in the US there are not only many dozens of insurance companies, but each insurance company has multiple plans and levels of coverage, all of which makes a difference to what’s covered and how much, and doctor’s offices must be prepared to routinely deal with all of them.
As far as I know, every study ever done comparing the US’s health care administrative costs to that of other wealthy nations has found that we spend far, far more on administration here (for example, and for another example [pdf file]). The main debate is over how large our administrative spending gap is, enormous or super-enormous.
As Angry Bean points out, a look at the incentives in the US system should lead us to expect higher administrative costs here:
Returning to Jamila:
Wow. Are you serious? Have you ever had a long-term, expensive illness in the US? Your argument here is so far removed from the real world that it’s hard to know how to respond.
Sick people can’t switch to a private insurance company of their choice in the US, because they’ll just get turned down. The only choice is to stick with the insurance you already have, or do without insurance at all.
Of course, maybe you can insurance some other way. In some states, you can get insurance through the government — but that’s hardly a defense of free market health insurance, is it? Or you can get insurance through an employer, in which case you have no choice but to take the employer’s choice of insurer.
You know what I think real choice is? I think real choice isn’t being able to choose between dozens of private insurance companies, all of which will try to dump you when you get sick, none of which will accept you if you’re already sick. Real choice is being able to choose the doctor you want and make an appointment with them — without having to check to see if they’re on your insurance company’s list of “preferred providers.” That’s how they do it in France, and for real-world purposes, that’s much more free choice than the majority of Americans, insured or not, get.
Of course, all systems have some limits; but in the US, our gatekeepers are often insurance companies whose incentive is to try to avoid having to pay for us to get care. Or, worse, our gatekeeper is poverty. There are many better systems than this.
This simply isn’t true. The administrative costs of health care are higher in the US, both as a percent of total health care costs and per capita.
This comment was written by Ampersand.Report this comment to the moderators
July 10th, 2007 at 1:34 pm
Um, OK. I realize you started this thread with a personal bent, but this isn’t exactly post 2, and the thread’s got a lot of general stuff in it.
But the “there’d be a faceless person anyway” argument isn’t true. As you know well, social strictures demand that I (normally) treat you differently from a “faceless person,” and that you return the favor.
What are my choices here, if you want to use yourself instead of a faceless person? Not to argue with your personal claims (which makes the general stuff tricky?) Argue against your personal issues, and force myself to act in a rude manner? Open myself up to my own personal attacks? You know full well that while the personal is the political, there’s a damn good reason that political issues often get discussed generally. And you’re cheating.
Anyway, that’s your call, though I wouldn’t do it myself.
Any system is going to have limits. There is no current system AFAIK, and I don’t think a system can exist, where everyone gets all the health care they could have. Someone is always going to define the line between “need” and “option;” between “justified” and “unjustified.” Because we live in a money-limited society, the decisions regarding those lines are probably going to include expense as a factor.
Including expense is appropriate. Health care is a bit logarithmic in cost. The initial expense provides huge benefits in care. But the expense/benefit ratio climbs for more advanced procedures. It’s cheap to vaccinate; it’s ludicrous to avoid doing it. But other procedure are much more expenive in proportino to their benefit.
If a group of people has an expensive, unusual illness, then depending on the relative cost and benefit, there is a point at which I would not support further treatment for that group. After that point, survival or quality of life would probably be linked to whether or not members of that group had money.
That will involve tough choices. Yeah, yeah, everyone’s willing to knock off the odd advanced cancer patient in order to save 10,000 children, that’s easy. But it’s not always easy. Do we stop resuscitating 100 22.5 week old infants so that we can provide better quality of life for 1000 MS patients? How many infants does it take? Who gets to decide what QOL is acceptable?
oh damn gtg will finish this post later from another computer.
This comment was written by Sailorman.Report this comment to the moderators
July 10th, 2007 at 1:35 pm
I’ve had some interest in the deregulation arguments for various industries over the years. They always sound so convincing! Their proponents always sound so passionate and sincere!
A while back, though, after listening to many of these arguments, we here in California largely deregulated our energy industry. It was, of course, a massive clusterfuck, in which the energy companies took immediate advantage of every single opportunity to deceive and manipulate the public. Which was precisely what the opponents claimed would happen beforehand.
So now I’ve learned my lesson, and I don’t take deregulation arguments seriously without some kind of evidence up front.
Thus my question is, Jamila: Do you have any examples of countries that have had better results from deregulated free-market healthcare than countries like France, Germany, and Japan have had from their UHC? Lower infant mortality, better public health, better old-age care for most people, etc.
I’m not interested in arguments that the California energy situation wasn’t really deregulation, because it makes no difference to me. I need examples. I need proof. Pretend I’m from Missouri and Show Me.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 1:37 pm
Interesting post today by Kevin Drum:
The whole thing is worth reading.
Jamila, when you talk about a more free-market health-care system, do you have in mind lifting some of these restraints on labor-market flexibility? UHC would do the same thing. Health insurance became widespread in the first place to address the fact that for all but the super-rich, catastrophic illness meant crushing debt or denial of care with severe medical consequences (sometimes both). I don’t see any way of going back to pure free-market health care without resurrecting those pernicious effects.
As Mandolin so cogently points out, advocating the free market as a panacea for all social ills is like saying, “I don’t care how many chairs there are as long as I get one, and anyone who’s not fast enough to get a chair doesn’t deserve one.”
This comment was written by Lu.Report this comment to the moderators
July 10th, 2007 at 1:38 pm
These options are pretty limited, aren’t they? If I understand correctly, you can’t usually get emergency govenrment help with medicla expenses unless you are already effectively broke, and then you get to spend the money you don’t have on low co-pays instead of food & shelter. And your employer’s insurance can still refuse to cover pre-existesting conditions, can’t they?
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 1:55 pm
I think that these are worthwhile questions, and they’re not easy ones to answer.
The good news is that in order to move from the lower slope of ‘okay’ public health to the upper slope of ‘pretty good’ public health, we don’t need to answer these questions. Building an intelligent universal health care program, though it doesn’t, in itself, address these questions, is still a great first step.
We’re in a boat that’s filling with water. You’re right that we need to talk about how to bail water, what implements we should use, whether or not we should use a pump, etc., and figure out which is the right choice long-term. Hopefully right now, we can agree that we need to patch the damn holes. Whatever trade-offs we make in the future, that’s the right choice.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 1:56 pm
I don’t know the size of this effect either, but I certainly know of people who are basically stuck in their jobs forever because they have an expensive, chronic condition that wouldn’t be covered during their first year at a new job.
For all the faults of the current healthcare “system,” that is not one of them. As long as you maintain seamless coverage (normally by paying COBRA to the policy of your former employer), no pre-existing condition can be excluded by your new policy. For any amount of time.
The problem is for those of us who can’t afford the COBRA payments (currently at $878/mo for me) for those three months. If you can’t afford that, then you’re subject to pre-existing condition clauses and you’re fucked.
This comment was written by Jake Squid.Report this comment to the moderators
July 10th, 2007 at 1:56 pm
Ampersand Writes:
I agree with you that on paper the US looks shabby when compared to other countries but again, this is mainly due to the differences between the US and other countries that have nothing to do with the health care system, such as the methodology used to make the comparision and the differences ( such as ethnic makeup) between nations.
Which comparison specifically do you want me to address?
The US has problems that other nations don’t have and thus it costs more money for us to handle those problems: the incidence of AIDS is almost ten times more prevalent in the US than in Canada; the male homicide rate is three time that of Canada; the US also has health care costs related to war injuries, including those of Vietnam veterans, and now the wars in Afghanistan and Iraq; teenage girls who are more likely to have premature babies and other complications stemming from pregnancy become pregnant almost twice as often in the US when compared to Canada and give birth nearly two and one-quarter times as often.
Health care costs so much per capita in the US in large part because we have a population with a greater variety of expensive health care needs.
In many cases the US does provide better health outcomes. According to OECD Health Data 2002 the “potential years of life lost” due to lack of preventive care per 100,000 population is 214 years in the US. France, the UK, Germany, Denmark, Ireland, and New Zealand all have greater years of potential life lost. In the US the prostate cancer mortality ratio is lower than France, Australia, Canada, or New Zealand. The breast cancer mortality ratio is also lower in the US than those other countries.
So depending upon exactly what you get sick from, you might be better off in the US, even if you have to go broke to pay for your treatment.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 1:58 pm
Oh, and
In addition to the excellent points Amp already made about health-care bureaucracy in the US versus elsewhere, the uninsured often end up getting very expensive ER treatment at taxpayer expense and/or getting treated at taxpayer expense for costly illnesses that could have been prevented by routine care. I would much rather that my tax dollars were spent on 100 pap tests than on treating one case of cervical cancer, for example: it would be both more humane and cheaper.
This comment was written by Lu.Report this comment to the moderators
July 10th, 2007 at 2:02 pm
I’d say I agree with Myca, but isn’t that a default? I’ll let y’all know if I ever disagree with him.
(For the record, if you’re at the “fill in the holes” stage — and you believe that everyone should have some level of health care, even if we have to work out the details — then I’m not talking to you when I’m talking about policies that support suffering, etc. I’m talking to the people still standing in the cold, denying that health care should be a universal right.)
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 2:06 pm
Regarding what government help is available, it depends on which state you’re in. In Oregon, there is a government plan for getting health insurance if private insurance companies refuse to cover you, but you still have to pay for the insurance. There’s a separate plan for free insurance if you’re broke, but it’s very underfunded (Oregonians are very anti-tax).
As I understand it, the specifics of switching insurance companies due to switching employers can vary based on state laws and on the particular plan the particular employers use, which may vary in turn based on what position you’ve been hired for within the company. It seems to me that in many cases, the insurance will cover pre-existing conditions but only after a certain amount of time has passed (like a year) — which means that for a year or so you’re basically uninsured regarding the thing you most need treatment for.(Never mind what I crossed off there, which was inaccurate; just read Jake Squid’s most recent comment.)
Which brings us to that post that Lu linked to — thanks, Lu. That’s a really good point.
This comment was written by Ampersand.Report this comment to the moderators
July 10th, 2007 at 2:09 pm
Merci, y’all.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 2:10 pm
Lu Writes:
Yes.
I don’t think that a pure free-market of absolutely no government intervention is feasible. I’m not advocating allowing hospitals to throw sick people out on the street because they can’t pay their medical bills. I am advocating that we lift many of the laws and restrictions that force the price of health insurance up and that the government should neutral as to whether or not people have health insurance, perhaps by giving a subsidy to people to purchase their own insurance and leveraging a tax against those who do not.
I don’t believe the free market would solve everything but I don’t think the answer is to turn it over to the government to solve either. Some minimal level of government intervention may be not only desirable, but required, for the system to work without being overburned by free riders who know that they will receive health care even if they don’t purchase insurance.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 2:15 pm
As I understand it, the specifics of switching insurance companies due to switching employers can vary based on state laws and on the particular plan the particular employers use, which may vary in turn based on what position you’ve been hired for within the company.
Nope. Pre-existing conditions are subject to HIPAA. See: http://www.dol.gov/elaws/ebsa/health/glossary.htm?wd=Preexisting_Condition_Exclusion
This comment was written by Jake Squid.Report this comment to the moderators
July 10th, 2007 at 2:17 pm
…free riders.
…on health care.
What, are we worried about a sudden outbreak of Munchausen’s?
“‘Scuse me, gov’nor, I thought I’d just contract a bit of yellow fever so I could run through all my unpaid sick days and take advantage of the health care system.”
We can call them Health Care Queens.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 2:18 pm
Yeah, and actually this is one of the sort of neat catch-22s of our current system. You can maintain your health care as long as you’ve got a lot of extra money to spend on it . . . at precisely the time you’ve got no money coming in.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 2:26 pm
I’m very sorry to hear that you are sick. I hope that you get better/do well.
But there aren’t enough chairs. (or in this case beds) There’s no getting around that. How do we decide who get’s a chair?
I don’t think UHC is a right. Not in the way I think free expression, assembly, equal treatment under the law, self defense or travel are rights. (not a complete list)
But I’m pretty open to being convinced that it’s a good idea.
Any system will involve rationing. Before I signed on I’d want to know how the limited resources will be rationed. The devils in the details. Who decides who has what? How will the rules be changed as time goes on? What’s the process? Is it a state thing? (my preference fwiw) Or will Wyoming and Maine get the same plan? My next question is how will it be paid for? general fund? Special tax on something? We spend more money than we raise in taxes, and I think that’s a very serious long term problem.
Finally I want to know if it will be mandatory, and than I need to decide how it will affect me and my family.
So UHC sounds nice. I like the theory. But before I vote yes I need all those questions answered, and I’m against any plan to complicated for me to understand.
This comment was written by Joe.Report this comment to the moderators
July 10th, 2007 at 2:32 pm
Well, there aren’t enough chairs for everyone to have the kind of job that has a chair, no. But we could get together and build some extra chairs by making our own chairs slightly less fancy. That’s what a social net is.
So let’s build some extra chairs.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 2:45 pm
Myca Writes:
Your question is very broad. The only nation that I can compare any of those countries to is the US and that’s exactly what I’ve been doing. Name one specific area that you want me to address, like infant mortality and tell me which country you want me to compare the US to.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 2:50 pm
Well, no, hasn’t your point been that the US needs to be more deregulated?
I’m asking for evidence that that’s a good idea. Expecting us to be the guinea pigs for the ‘let’s try deregulating stuff’ game is breathtakingly irresponsible (and was a massive disaster when the libertarians pushed it through for California energy), so I want to know where it’s been tried and worked before.
There is plenty of evidence that UHC seems to work better, and the supporters of UHC are able to offer up country after country with better public health than the US.
I’m asking for a country with fewer healthcare regulations than the US that has better public health than the countries UHC supporters cite.
—Myca
PS. As a bonus, it ought to cost less than our current system. It’s only fair, since the UHC plans we’ve been discussing do.
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 2:52 pm
Jake Squid Writes:
I’ve never worked for any insurance agent and I haven’t studied the health insurance industry and the HMO’s as well as many who advocate for less insurance regulation and a freer market. However, from what I have read and what I do know, I have come to believe that less regulation is the way to to.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 2:58 pm
However, from what I have read and what I do know, I have come to believe that less regulation is the way to to.
I’m beginning to think that we have different ideas about what the word “regulation” means. Can you give some specific examples of how you would like to lessen regulation on healthcare and the insurance industry?
This comment was written by Jake Squid.Report this comment to the moderators
July 10th, 2007 at 2:58 pm
Apologies for bowing out of this; I have a book tour to prepare for.
Myca, I was in L.A. during the Enron experiments. I thanked Los Angeles’ socialized energy system every time I heard about the rest of California’s privatized blackouts.
Jamila Akil, I did a cross-comparison of countries with longer average life spans than ours and countries with universal health care. I came up with five exceptions: Hong Kong, Singapore, Switzerland, Malta, and the United Arab Emirates. So I apologize for saying that all countries with healthier citizens have UHC; please amend that to “the vast majority of countries with healthier citizens have UHC.” The other countries have significantly smaller gaps between rich and poor; since you don’t like universal health care, perhaps you would prefer to support sharing the wealth.
Mandolin, capitalism is predicated on having too few chairs because you need to keep the people insecure. For ages, the US interest rates were automatically raised whenever unemployment dipped below 5% as a measure against inflation. But where did the inflation come from? Workers confident enough in their work to be willing to strike for higher wages. And why was that inflationary? Because the capitalists were never content with smaller profits; they would raise prices to restore their profits, and then blame the workers for wanting a fairer piece of the wealth created by their labor.
To all, a merry discussion! And to Mandolin, best wishes for your next health reports.
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 3:10 pm
Myca Writes:
Yes, but you brought up other countries and I wasn’t quite sure exactly which country you wanted me to compare the US to and which point of comparison I was supposed to be using, such as infant mortality ratio or cancer prevention or cancer treatment or elderly care. That’s what I mean’t by saying what specifically do you want me to address.
If it’s ok with you I’ll compare the US infant mortality ratio to another European country. Would that be ok?
I’ve already made the point that those comparisons do not account for differences within the US in level of education, ethnicity, personal habits etc.,
The US is the only industrialized nation that lacks a UHC and I don’t think using a third-world country would make for a good comparision to anything. So I think the best way to settle this is for you to pick a country, say Italy or Germany perhaps where OECD data is available, and I’ll compare it to the US.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 3:22 pm
“I also believe that whatever problems there are in the current American system, they are not as bad as the problems in places like Canada or Britain.”
Clearly, there are problems in all three countries that we generally don’t see in countries with actually good health care, such as France or Germany. But in saying this, you’d have to account for why two-thirds of America want to switch to a system like Canada’s while the number of Canadians who want the reverse borders on the statistically insignificant.
“That may not be true.”
Hmm? As per the numbers we’ve already seen, that America wastes more health care money - a lot more - on administrative costs is a fact, not an hypothesis.
“In America if you don’t like your health care plan then you can leave it and get a new one. The ability of people to opt out of the system and either go without coverage or find another plan discourages the building up of any excess bureacracy because it unnecessarily raises costs.”
Christ. We can argue about the feasibility of shopping around for health coverage as it pertains to the everyday life of millions of working age Americans. We can argue that the fact that UHC nations better contain costs and that the primary source of excess health spending in America stems from buck-passing and paper-shuffling has been established as just that - a fact, not a viewpoint in an open debate. We can also argue that there’s nothing stopping citizens under a UHC country from seeking alternative private coverage (at least in the system we’re proposing; I’m aware of measures trying to make it otherwise, including here in Canada, and rest assured I’m opposed to them), making your entire statement not only false but also irrelevant.
But first and foremost, let me address my boilerplate response to neolibs who repeat the tired line that disaffected workers and consumers can simply go elsewhere. Disaffected liberatarians and taxpayers can also leave America and go to any functional non-tyranny where you are not coerced by men with guns to give pennies to the poor. (Strangely enough, such places more often resemble actual tyrannies where men with guns really do coerce you, but then no one said any market will provide you with the perfect choice.) The theoretical option to vote with your feet does not exonerate existing abuses or shift ethical responsibility in any way.
“This has little to do with any failings of the US healthcare system. because in the developed world there is very little correlation between health care spending and life expectancy. The number of years a person will live is primarily a result of genetic and social factors, including lifestyle, environment and education.”
Jamila, the same sort of argument can be applied to any international comparison, ever, at any time, including ones libertarians like to make, such as unemployment. Notwithstanding the especially restrictive definition of unemployment that America uses, I could easily say with perhaps more merit that many countries in Europe have a relaxed attitude toward work of which large safety nets are a symptom, not a cause. It would certainly account for those countries that have all three: wider safety nets than America, low unemployment, and a puritanical attitude toward work, such as many East Asian countries.
However, when a universal correlation exists - and believe me, number 37 in the world is pretty much in ‘universal’ territory - it does beg some questions. Some UHC nations are ethnically homogeneous, such as Japan or Sweden. Others are as diverse, such as Canada and Britain. Some, like France and Germany, have even more problems with immigrant participation. Some health problems that would confound comparisons, such as lack of exercise, are acutely worse in the US. Others, such as alcohol consumption, are better. The spectrum ranges with UHC countries, and the two constants that hold are that all have UHC, and all individually trump the US by most criteria of health care.
I think even you accept that other nations have superior health indicators, because you go through significant trouble to list cultural factors that could bias the results. That’s a fair argument, but what’s illogical is to then say that the onus is on others to prove that the cultural factors that you just thought of are not what’s causing the difference. Since it’s humanly impossible to prove this universal negative, you then sit back and declare victory. That’s not how it works. The burden of proof is on you, it’s you who has to explain away every possible discrepancy. Comment 86 is a good step along those lines, although it still doesn’t account for nations much larger than Sweden, such as France.
Also, there are concrete marks of failure of the US healthcare system besides infant mortality and life expectancy, such as surgical mortality, patient satisfaction, and a very low rate of access to primary care physicians. The connection with a private health care system is far more concrete here, I should think.
“Will the government take over the cost of paying R&D when the drug companies decide that it is no longer profitable for them to continue doing it?”
They already do. The NIH and universities fund most drug research in America. Big Pharma plays a part, to be sure, especially when it comes to the later stages of refinement and clinical trials, but is there anything essential about this process that a corporation can do but anything else can’t?
In an absolute sense, America probably does develop more drugs than most other countries, but this is from their unique place on the world stage and not contingent on their political systems as such. To goad a familiar libertarian example, medieval age Iceland was also probably bested by the theocratic Islamic empire on just about every social development front, if only in absolute terms.
In a relative sense, though, if it’s medical innovation you’re looking for, you can’t go much wrong with Cuba, which has innovated loads of new vaccines the past few decades, including meningitis B, pneumonia and meningitis, the most effective one for hep B, and some of the world’s top biotechnology reserach centres.
This comment was written by sylphhead.Report this comment to the moderators
July 10th, 2007 at 3:45 pm
Jake Squid Writes:
Many states have enacted laws that make it easier for people to get insurance after they get sick by forcing insurance companies to take all comers, regardless of health status. The same is also true for my state’s insurance for poor people and for other states I have been to: the insurance for poor people is regressive for up to 3 months–meaning that if you get sick and you go a month or two before getting insured with public aid, then insurance will still cover your previous costs. These laws have the effect of encouraging people to go without insurance until they actually get sick and it costs the insurance industry more money because people don’t enter the pool until their health care costs have skyrocketed.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 3:46 pm
In other words, you do not have any examples of a country with less public health regulation then the US that has better public health than (say) France?
Just to be clear.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 3:56 pm
I can see you may be a little bit unclear about what I’m asking, Jamila.
Here’s the thing. I am advocating taking our health care in one direction (UHC), and you are advocating taking it in another (free-market deregulation).
To support my position, I (and my idealogical allies) are offering examples of places our suggested solution has been tried and has worked.
I would like an example of a place where your suggested solution has been tried and has worked.
Using the US to support your position doesn’t work, because that’s evidence (maybe) for keeping the system we currently have, not evidence for further deregulation.
Is that a little clearer?
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 3:58 pm
will, I was under the impression that in places like Hong Kong and Singapore only privatize outpatient care, GP, and the like. There are no for-profit hospitals like there are in the US, though I could be wrong. Either way, it’s extensively more socialized than anything in the US, and if anti-UHCers want to claim these two for their own, they’re adopting a pretty low standard that they would not accept in any other industry - despite their repeated insistences that health care is not a unique industry and thus needs no unique intervention.
Also, I left my laptop on before posting, then went back later to edit it; in the meantime, it looks like the discussion nearly doubled in length. So some of the stuff I said in the post above will read oddly out of place. Apologies.
This comment was written by sylphhead.Report this comment to the moderators
July 10th, 2007 at 4:14 pm
Myca Writes:
The United States of America. The US bests many countries with UHC on many different indicators of health.
Yes, it is evidence for keeping the system we currently have and not going further in the direction of UHC. But it is also evidence that an alternative to UHC which can provide many of its benefits and few of its drawbacks is also possible.
You’re making the assumption that the only way we can know whether or not further deregulation would help is if there was a country already in existence that provided complete health care to everyone by the free market. This is a faulty assumption. It’s as if saying that the only way you can suggest whether or not something will work is after it has already been done.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 4:21 pm
Regarding comment #125 by sylphhead: There was so much about that post that needs debunking that I’ll have to take some time and post on it tomorrow.
I just wanted you to know that I read it and wasn’t going to ignore it.
Cya tomorrow!
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 4:24 pm
Not at all.
I gave the deregulation folks the benefit of the doubt the first time around, and they turned out to be massively, apocalyptically wrong about absolutely everything. Every single objection to their laughable position came true. In spades.
Deregulation ended up helping nobody but the crooks, liars, and charlatans that used it to take advantage of the common people.
So yeah. These days, if a deregulation fan told me the sky was blue, I would go check first. Fool me once shame on you, fool me twice shame on me.
Yes, I require some evidence. If you have none, I think that says all that needs to be said.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 4:43 pm
“The US bests many countries with UHC on many different indicators of health.”
By a great many more, it fares worst. There are too many resources on this for those willing to look, but here’s a cursory stab from retrieving links I posted before on another forum.
The US ranks below other Anglophone nations with UHC.
Given identical diagnoses, a Canadian is likely to fare better than an American.
Canadian cancer survival rates are better.
I’m far from the most knowledgeable on this, so ask around - much can be learned something by reading something other than carefully selected material from Amazon.com that agrees with preexisting prejudices.
Even more so than engaging in linklisting wars, I’d like to point out that what outcomes other countries fare worse on could also be offset by compounding factors, as you pointed out occurs when comparing disparate, heterogeneous entities. But I suppose this muddling only ever works in one direction.
“You’re making the assumption that the only way we can know whether or not further deregulation would help is if there was a country already in existence that provided complete health care to everyone by the free market. This is a faulty assumption. It’s as if saying that the only way you can suggest whether or not something will work is if it has been done already.”
What’s unreasonable about that assumption? It’s asking that your countrymen not be made lab rats for what sounds to be a risky political experiment. Remember the California blackouts? Try that with life support systems.
This comment was written by sylphhead.Report this comment to the moderators
July 10th, 2007 at 4:59 pm
I have no idea what country you’re even talking about. New Zealand?
But I suppose it doesn’t really matter.
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 5:02 pm
“Regarding comment #125 by sylphhead: There was so much about that post that needs debunking that I’ll have to take some time and post on it tomorrow.
I just wanted you to know that I read it and wasn’t going to ignore it.
Cya tomorrow!”
Regarding statements such as these, let me address the entire board. Why precisely, do I, or anyone else, need to know this? I know you read it; simply by virtue of its length it’s hard to ignore. It’s rather like Christians who tell me that they’ll be praying for me when I profess something that offends them - does my knowledge of the prayer thereby increase its effectiveness? Sounds like an odd sort of bind on the Almighty. It’s not like here, in the one day of solar time that the board sits still, we all think you’ve shrivelled up and died in awe of my holy light. In both cases, the statement is made for the sake of the one saying it, usually out of some deep seated insecurity. You think that others assume you’re ignoring it, but that’s an insecurity you’re projecting onto others.
Hey, playing message board psychiatrist is at least only as obnoxious as talking about a post you have yet to write. And by no means are you the only one; in any extended thread, a statement like the above comes up at least once, from people of all sides of the spectrum. I just find it annoying.
But I’ll give you time to plumb Lew Rockwell and your bookmarked sites to cobble something together. That is, unless I start pre-emptively lashing out at the same sort of libertarian apologetics that I’m no doubt going to see - I’m stranded in a hotel room for the day, so I got a lot of time on my hands.
This comment was written by sylphhead.Report this comment to the moderators
July 10th, 2007 at 5:12 pm
You don’t need to know, but I thought it would nice to make it clear that I had read the post and hadn’t managed to miss it in haste or by going on to another thread and just deciding not to come back.
I don’t know what you know, that’s why I decided to tell you. But for future reference I’ll just assume you know everything I know.
Or would this post be an example of me assuming that you don’t know what I know? Who knows and who cares. Cya tomorrow! (Again)
(But since you are sitting bored in a hotel room it would be nice if you could start without me.)
This comment was written by Jamila Akil.Report this comment to the moderators
July 10th, 2007 at 5:12 pm
Okay, popping back in for a moment:
Sylphhead, I don’t completely trust that list of non-UHC countries with longer life expectancies than ours; I calculated it using a list of healthcare countries that I’ve since realized is incomplete (it didn’t include Norway or South Korea, for example). So my five potential countries for Jamila Akil’s side may actually be countries for ours.
I’m also beginning to think there’s no point discussing this with Jamila Akil, who doesn’t think that lower infant mortality or a longer life expectancy are valid measures of health.
This comment was written by will shetterly.Report this comment to the moderators
July 10th, 2007 at 5:25 pm
Occasionally people get accused of ignoring points they can’t rebut. It makes sense for people to make it known that they are waiting, rather than ignoring.
It especially makes sense when the person is in the minority position, as Jamila Akil is here. After all, if I ignore a post, I can expect Myca or Amp or you or Will or someone else will address it for me. Since Jamila’s arguing alone, she can’t really expect anyone else to take up the point before she has a chance to get back to it.
Anyway, it makes sense to me.
Moving away from addressing sylphhead alone — it seems to me this thread is skating the excessively personal. I imagine that’s because I’ve been setting it within the realm of my personal experience. This IS a personal issue, and one we would do well, I think, to remember has an extreme personal effect on the lives of people who may be commenters or readers. Nevertheless, we could probably refrain from calling each other stupid quite so much, please.
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 5:26 pm
I’m discussing the California energy deregulation scheme of the early 2000’s, which I referenced in posts #103 and #120 and which Will Shetterly referenced in post #123 (and 133).
—Myca
This comment was written by Myca.Report this comment to the moderators
July 10th, 2007 at 5:58 pm
I thought the safety net was to keep people who fell on hard times from dieing. You’re talking about something more.
But that wasn’t my point. Before I sign up for a new plan I want to know how my new chair is going to be different from my current chair. There isn’t as much chair as everyone wants. There will be some way of rationing. I also want to know how it’s going to be paid for.
This comment was written by Joe.Report this comment to the moderators
July 10th, 2007 at 6:07 pm
Actually, will, I also don’t regard life expectancy and infant mortality to be the trump cards that some of my fellow leftists do, and I wish they’d stop quoting it all the time. Make no mistake; for good reason, the two are regarded as comprehensive measures of public health by WHO and similar bodies - but public health and health care are not synonymous. (Granted, public health is perhaps the single largest, most important component of health care.) The problem is, many influential Americans won’t listen to socialist calls for public health, and will not sacrifice individual health care for public health. To a lesser extent, I’m averse to that as well. I just want it to differentiate the two, and the American system fails at both.
For instance, why don’t we talk of maternal mortality in addition to infant mortality? At 17 deaths per 100,000, America’s MMR is more than double that of most European nations, and I think many - not all, but many - of the concerns people have with taking infant mortality as a straight indication of health care quality will be addressed will be alleviated by mentioning MMR in tandem.
On my post 133, go to the second link I provided. Scroll down to the tables. You’ll find concrete examples of evidence, however inconclusive, of the superiority of Canadian health care (not just public health) to America’s. More success against renal failure. More success with kidney and liver transplants. More success against certain types of cancer and angina, and a lot more success against HIV/AIDS (though to be fair, I can think of one very confounding factor in the US that somewhat lets the health care system off the hook). Such information is not new; Amp posted something similar earlier on this very thread. THIS is what I wish more lefties would focus on.
Not that there aren’t areas where America fares better. On a consistent basis, I’ve seen evidence that the US health care system takes better care of their elderly; hip replacements, cataracts, etc. are a point of weakness for the Canadian system. Given that health care for the elderly is the second most socialized aspect of American health care (after veterans’ health care), I doubt anti-UHCers would be too eager to use this particular example, but could it be that Canada rations away care from senior citizens? It’s possible.
But in the tables and lists comparing Canada to the US, I’ve yet to see one in which the list of American advantages is longer than the list of Canadian ones.
Now, greater success with kidney transplants doesn’t, in and of itself, mean better health care. Even with my MMR example, there are some things that are difficult to explain: Canada and the UK are very similar, multicultural anglophone countries with largely underwhelming universal health care. Yet Canada’s MMR is 6 per 100,000, while Britain’s is 13, making it the only Western European nation to come close to America on this statistic. This one statistic, by itself, cannot be used to conclude anything definite about the quality of health care in these respective countries.
But once several such statistics start coalescing into trends and broad tendencies, we can start drawing some conclusions. I think Jamila’s challenge to narrow everything down to one country and one statistic commits the Fallacy of Composition. A single statistic is not wholly dependent on one factor, and if one really tried, one could explain one of them away on outside factors. But when there are many such statistics, each requiring a slightly different set of outside factors, something must be afoot. A broad tendency or trend is generally indicative of a broad cause, and the argument that a patchwork of causes (obesity, illegal immigrants, crime, et al.) artificially creates low US health indicators is wholly unconvincing to me - not to mention the argument that such random factors should depress American results more than anyone else’s. And international health care comparisons, pretty much by definition, reflect broad tendencies or trends.
BTW Jamila, your comment on the hotel room has made me realize that my sourness over my day being ruined has spilled onto my online posts. Starting with this post, I’ve made an effort to be more intellectual and open to discussion. In particular, please ignore comments such as going to Lew Rockwell to cobble arguments together.
This comment was written by sylphhead.Report this comment to the moderators
July 10th, 2007 at 6:16 pm
“Occasionally people get accused of ignoring points they can’t rebut. It makes sense for people to make it known that they are waiting, rather than ignoring.
It especially makes sense when the person is in the minority position, as Jamila Akil is here. After all, if I ignore a post, I can expect Myca or Amp or you or Will or someone else will address it for me. Since Jamila’s arguing alone, she can’t really expect anyone else to take up the point before she has a chance to get back to it.
Anyway, it makes sense to me.”
Perhaps, but I don’t think the tone of ‘your arguments are so faulty that I’ll need to set apart a special time and place to impart my wisdom’ is in the spirit of good argument, either. This tone ALWAYS accompanies these types of statements. I responded by insinuating that the reason that anyone would need to speak in such a tone is a realization that they’re losing control of the argument, which is of course equally baseless and in poor sport. Mea culpa.
This comment was written by sylphhead.Report this comment to the moderators
July 10th, 2007 at 6:21 pm
Sylph,
You’re right about the tone. By the time I got to the end of your post, I’d forgotten the beginning with: “There was so much about that post that needs debunking that…”
This comment was written by Mandolin.Report this comment to the moderators
July 10th, 2007 at 6:23 pm
Sylphhead, total agreement those factors don’t give the complete picture.
Unsubscribing from this thread now! (But not from an obsession with improving everyone’s health care, of course.)
This comment was written by will shetterly.Report this comment to the moderators
July 11th, 2007 at 7:45 am
Many states have enacted laws that make it easier for people to get insurance after they get sick by forcing insurance companies to take all comers, regardless of health status.
So, I did understand what you were advocating. How is the free market going to guarantee that everybody has access to health care, then? And if you’re going to free up the insurance companies to be able to deny benefits to the sick, why not also allow hospitals to deny treatment to the poor? I don’t see the difference.
How anybody can be against the laws like that is beyond me. What code of ethics and morality advocates abandoning the sick and the poor?
UHC has advantages in (at least) two areas. It is cheaper (economics) and it is moral (social). I can’t help but find your position to be both economically foolish and morally reprehensible - not to mention detrimental to national health.
This comment was written by Jake Squid.Report this comment to the moderators
July 11th, 2007 at 9:56 am
Insurance companies make money when they 1) minimize risk 2) deny claims. Neither of these is bad per se (I used to work for an insurance company, and I saw some pretty bogus claims), but both work against the goal of delivering good health care for everyone.
What insurance does well is to spread risk throughout a broad population. Jamila’s point about not signing up for insurance until you get sick is valid — doing this is a bit like picking your lottery number after the drawing — but, once again, this problem would be addressed by UHC, because everyone would be enrolled, and everyone’s taxes would contribute.
To put that another way, UHC maintains the benefit of risk-spreading while eliminating all the time, energy and money spent risk-avoiding, not to mention all the bureaucratic hoop-jumping forced upon providers.
This comment was written by Lu.Report this comment to the moderators
July 11th, 2007 at 10:22 am
I just wanted to post to point out that Kevin Drum’s ongoing series of posts on this is a must-read.
His most recent, here, is on waiting times for basic care, and why so many US patients end up in the emergency room.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 11th, 2007 at 11:13 am
Mandolin, you are being very eloquent for healthcare reform. Joe in #117 has expressed in his response what I think many Americans hold as reservations against UHC.
For myself, I think UHC could potentially be better than what we have now. But I think in the U.S. any UHC system would have to allow for private insurance, because the people who have enough money now to pay for top-of-the-line healthcare on demand are not going to give that up, ever. I’m remembering the onset of HMOs as I write this, BTW, so maybe that is influencing me on the pessimistic side. The thing is, any big system can work reasonably well as long as the individual situation fits within the designed normal limits of the system. I think I have a justifiably healthy skepticism of our government’s ability to design AND IMPLEMENT a UHC that actually functions better than our current one.
To extend Mandolin’s metaphor about musical chairs, suppose we agree to build enough chairs so that everybody has a chair. Great! This is a good thing. But in order to do this, the quality of chairs built is such that a certain percentage of chairs will break, usually for no immediately obvious reason. People with enough money will have a spare, high quality chair that they paid for themselves handy and will be able to sit down again almost immediately (or maybe their government-issued chair is sitting in storage while they use their own sturdy chair and therefore they’ve never had to worry about breakage), while others with less money will have to stand until they have a new chair. I think a major fear in agreeing to give everybody a chair is that the new chair will not materialize instantly but rather will be held behind the counter until The Powers That Be decide that the reason for the breakage of the old chair has been adequately determined and explained and you’ve promised faithfully to take better care of the new one.
Two of my main concerns with UHC are:
This comment was written by Original Lee.1) If you allow private insurance, how do you make sure there are enough public providers of services and that they are distributed appropriately by location? Do you require that every practitioner must accept at least half their practice as UHC patients? Do you set quotas on certain specialties and only grant x number of plastic surgery licenses because we need more geriatric care personnel? Do you tell young interns that only two out of every medical school can become pediatricians because we need more proctologists?
2) At what point will you be allowed to challenge your diagnoses and treatments by getting outside opinions? How to you seek redress under UHC, and if it is by suing the doctor for malpractice, how is this addressed? I ask because (even though anecdotes are not data) I have 3 friends who have had absolutely horrible experiences with European UHC systems (1 in Belgium, 2 in Germany) and a Canadian cousin with a very bad experience.
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July 11th, 2007 at 12:24 pm
Do we all agree that any UHC system will involve some rationing? Or (if you prefer the chair analogy) that not everyone can get an Aeron chair?
I keep hearing people suggest it’s immoral to refuse someone treatment; this claim rarely gets qualified. But obviously we can’t give perfect treatment to all. (and that’s “all” as in “all citizens;” we haven’t even gotten into the fascinating morass of illegal immigrants’ access to any UHC system.)
My own view is that it’s obviously immoral to refuse someone basic treatment, or pain relief, or emergency treatment. But the full kebang? I dunno. If I get AIDS, what then? Does society have an obligation to provide me with drugs that cost $100,000 per year and that will vastly increase my chances of survival? Does society have an obligation to provide me with drugs that cost $10,000 per year and make my survival likely but less certain? Do they have an obligation only to make sure I don’t die in agony?
And do they have to do this with an eye towards what they’re giving everyone else? Can these decisions be made on an individual basis? Will a UHC, to satisfy its goals of helping everyone, be required to choose the most efficient treatment? Be careful on that last one. “efficiency” is what drives a lot of what people complain about now.
How do we see this rationing happening? Any “general” effect will simply screw over poor people. Any “targeted” effect will screw over expensive people–by and large the disabled, those with expensive diseases, and/or the elderly.
Right now, some people are dying. They are dying because they are unlucky–they have medical problem that they can’t pay to treat.
Under UHC, some people will still die because they are unlucky. They will die because they have medical problems that the government has deemed unworthy of treatment.
As I think about this, I wonder whether politicizing the life/death decisions inherent in health care is a good thing.
This comment was written by Sailorman.Report this comment to the moderators
July 11th, 2007 at 12:39 pm
I keep hearing people suggest it’s immoral to refuse someone treatment; this claim rarely gets qualified…
Specifically, I am suggesting that it is immoral to allow HI companies to refuse to cover people who are sick. Specifically, I am suggesting that it is immoral for a hospital to refuse to treat someone (and when we talk about hospitals, we are usually speaking about emergency or fairly immediate life-saving care) because they are poor.
Of course there will be rationing. There is rationing under every system for which there are limited resources.
As I think about this, I wonder whether politicizing the life/death decisions inherent in health care is a good thing.
You think that it isn’t already politicized? Allowing wealth to decide life/death treatment is a political decision.
As to discussions about how rationing will work… there are some pretty well accepted models in use today. Also, can you define “general” and “targeted” and how those have the effects that you assert? I’m not understanding you.
Under UHC, some people will still die because they are unlucky. They will die because they have medical problems that the government has deemed unworthy of treatment.
The theory is that fewer people will die because they’re unlucky. Theoretically, many people will be diagnosed at an earlier point in their illness due to access to medical care. This will allow effective treatment/cure.
This comment was written by Jake Squid.Report this comment to the moderators
July 11th, 2007 at 12:53 pm
Allowing wealth to decide life/death treatment is a political decision.
Yes. But it’s a different kind of political decision, don’t you think? It’s not a specific one.
This comment was written by Sailorman.Report this comment to the moderators
July 11th, 2007 at 1:06 pm
Sailorman,
No, I think that it is just as specific as deciding what life/death treatment will be covered by national UHC.
For example:
If I have (can afford, wealth)health insurance, treatment to save my life may or may not be covered. If it is covered, great but that was not my decision. If it isn’t covered, I only survive if I have the cash to pay for it.
If I don’t have (can’t afford, lack of wealth) health insurance, I can only get life saving treatment if I have the cash to pay for it. Unlikely if I don’t have HI.
Under UHC, if the national plan covers treatment to save my life, I get it. It doesn’t matter how much or how little wealth I have.
Under UHC, if the national plan doesn’t cover treatment to save my life, I’m no worse off than I am under the existing system. If I have the cash, I live. If I don’t , I die.
The big difference between the two is a) whether a health insurance company which I have no influence on makes the decision or whether a government that I have a tiny influence on makes the decision and b) whether or not I can receive a treatment covered by the program (current: if I can afford insurance, UHC: Yes).
So, I really don’t see the difference.
This comment was written by Jake Squid.Report this comment to the moderators
July 11th, 2007 at 2:30 pm
SM wrote:
The qualifier “UHC” gives an odd spin to your question. You might as well as “do we all agree that all tall people have noses?” Yeah, that’s true, but why are you talking about tall people? A more accurate statement is “any health care system requires some rationing.”
But yes, I feel sure everyone here is aware of that.
In the US, we have two main levels of rationing. The first is rationing by wealth, which screws over both the poor and the middle class in different ways. The second is rationing by profit, in which (among other problems) insurance companies face rational incentives to place as many barriers between patients and care as they can get away with. Yes, all rationing — including the rationing provided by the various forms of UHC — is imperfect. But rationing by wealth and by profit are even worse.
Considering how much money the health industry gives to political candidates each year, I think it’s naive of you to suggest that our status quo doesn’t have a significant political element to it.
This comment was written by Ampersand.Report this comment to the moderators
July 11th, 2007 at 2:47 pm
Amp,
I’m really not sure that everyone admits there will be rationing. A lot of the time this discussion comes up people sidestep the fact that there WILL be rationing under any system. They talk instead about gains in efficiency or reduced overhead or rolling all ‘profit’ back into the system. Since I have insurance (that I pay for) I want to know what the new system will look like. When the issue is ignored I start to worry. The devil you know and all that.
Any new system is going to fall into one of three very broad groups for me.
Better for me and my family.
Worse for me and my family but justified. (for example everyone gets covered as well as I do now but my taxes go up a small amount)
Worse for me but not worth it.
There are a lot of people with some sort of coverage today. I think most of them will use the same set to evaluate any new proposal.
I think rationing by wealth and profit are really the same thing. But that’s beside the point.
Why is rationing by cost worse?
Why is it worse if my grandmother can’t get surgery due to the cost than if she can’t get surgery because the system says she’s too old to justify the procedure?
This comment was written by Joe.Report this comment to the moderators
July 11th, 2007 at 4:45 pm
sylphhead Writes
I have never read any survey stating that two-thirds of Americans want to switch to a system like Canada. That sounds like an extremely high estimate considering that most people I know who do want UHC don’t hold Canada up as the model they aspire to.
Determining exactly how much a government spends on administrative costs under a UHC is problematic partly because some costs can be shifted to the patient and/or the physician and other costs are subsumed within government budgets and never counted at all. For instance, collecting taxes or lobbying for additional funding are not included in the overhead expense of public programs whereas collecting premiums and marketing would count toward the cost of a private insurer.
Administrative costs can be reduced in the US system but I suggest that the disparity between costs in the US and other countries with UHC would shrink dramatically if those other countries could not hide some of their costs within the government budget as debt for other programs.
I could say the same thing about people in America who advocate for UHC; they can always pack up, leave, and move to Canada or Britain or wherever else they can get “free” health care while leaving the rest of us that don’t want it here to make do.
The first thing that should be pointed out is how the WHO rankings do not support the claim that other nations which rank higher than the US have higher quality care.
WHO’s assessment system was based on the following indicators, along with their weight in the scoring system: overall level of population health ( 25 percent of the score); health inequalities (or disparities) within the population ( 25 percent); overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts) (12.5 percent); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system)(12.5 percent); and the distribution of the health system’s financial burden within the population (25 percent), which measures how much more, as a portion of income, higher-income groups pay for their health care than lower-income groups.
On page 8 of the 2000 WHO report you’ll find the following statement: “Ultimate responsibility for the performance of a country’s health system lies with government. The careful and responsible management of the well-being of the population – stewardship – is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent.”
With the aforementioned information in mind, the problem with the report should be clear: (a) It reflects a scoring system that gives more weight to fairness and equality than saving lives and curing diseases; and (2) the report is designed in such a way that favors government financing and control of the system, which obviously puts the US at a distinct disadvantage to begin with because we are the only system without a UHC.
Japan ranked first on the attainment of health in the WHO study. But so what? As I’ve said before, demographics make a big difference. Japan has low infant mortality and a high expected lifespan. Asian populations in America, Canada, and the UK have similarly low infant mortality and high expected lifespans when compared to the general population. Thus you would expect a country full of Japanese people to score high on health indicators, just as Japanese people all over the world do. This says more about the health of Japanese people than it says about how good their health care is. Clearly, homogenous populations such as Japan, Sweden, Switzerland are advantaged.
France and Germany have nowhere near the number of immigrants ( illegal and otherwise) or non-white/non-Asian groups straining their health care system and pulling it down in the rankings.
The US ranks first in the responsiveness of its health care system. Meaning that of all the countries in the WHO study the US system exhibits the most “(a) respect for persons (including dignity, confidentiality, and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider)”. France, the country with the highest overall ranking, comes in at number 16 on the responsiveness rank.
No. I don’t believe that other countries have superior health indicators. If I got sick, there is no place else in the world that I would rather be than the US. And this is coming from a poor black woman.
It’s not illogical at all. When a scientist comes to a conclusion, if he/or she wants her results to be considered valid then the scientist bears the burden of proving that the results were not biased by external factors, not the person doubting the claim. It is you who are claiming that the US needs UHC because then we all will have better health care. The burden of proof is on you to prove this, and just because you have discounted the cultural factors (confounding variables) doesn’t make your assertion any more valid.
The WHO and the OECD both say that their rankings should be looked at in light of the differences between and within countries. So if those two organizations both acknowledge the insufficiency of their rankings, then why are you so hesitant to look at them too? Perhaps if you did, UHC wouldn’t look so fantastic after all.
The burden of proof is indeed on me to back up any assertions that I make, but that is only because too many people cherry pick information from WHO and OECD statistics without reading or understanding the reports that the information came from. If those people who constantly brought up the US ranking of number 37 were more informed about the actual WHO report that they quote I wouldn’t have to do so much research to explain things to them that they should already know. This isn’t directed just at you, but many other folks do the same thing when arguing for a UHC.
The WHO report is over 200 pages long ( in PDF) and I haven’t read the whole thing, but the point is that more has to be done than picking out one stat and believing that’s the whole story.
In the overall health ranking of the population for France came in at number 6 with an indexed score of 91.9 and the US came in at 15 with an indexed score of 91.1. I’m no statistician, but that doesn’t appear to be that big of a difference in overall health–particularly when you consider that France supposedly has the best health care system in the world and the US is ranked number 37.
Please provide me with some statistics that say the US has a surgical mortality, lower patient satisfaction, and a very low rate of access to primary care physicians.
The infant mortality rate and life expectancy of the US is not a sign of the failure of our health care system. White Americans have a life expectancy and infant mortality rate similar to those found in western Europe. Japanese people have low infant mortality in Japan and here in America. African Americans and Latinos have higher infant mortality than the rest of the white population which raises the overall infant mortality rate.
Infant mortality rates for some segments of the US population are similar to and sometimes lower than in European countries. Norway and New Hampshire are composed of small homogenous populations; their infant mortality rates are 4.1 and 4.4, respectively.
There is nothing about drug research that drug companies can do that universities can’t, but why should there be any preference that the universities or the NIH do it when, as you say, the drug companies usually end up taking over in the end anyway?
I’m always one to give credit where credit is due. Cuba has done some good things since they instituted UHC.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 5:59 pm
Jake Squid Writes:
No system guarantees that everyone will receive treatment for whatever ails them–not the free market or UHC. There was a recent Supreme Court case in Canada that had to declare that access to a waiting list was not the same as being guaranteed care. Under UHC you are theoretically insured, but if the powers that be decide that treating you would be a waste of money, then you’re out of luck unless you can pay for treatment somewhere else on your own.
The choice is between (a) rationing by the government under a UHC, but theoretically you should be able to get treatment even if you have to wait for it, and (b) rationing by cost, in which you can get whatever treatment your insurance company and you can afford. I prefer choice b.
Insurance companies should not be allowed to deny benefits after someone who has been dutifully paying insurance gets sick. I am saying that insurance companies should not be forced to insure everyone who applies or be forced to insure everyone at the same rate.
I am also saying that public aid insurance should not pay for any medical bills incured before the person applied for aid. This would force more people who are eligible for public aid–but are not enrolled–to enroll before they get sick; thereby cutting down on the number of uninsured people.
Whether or not something is moral depends on how you determine morality. I don’t believe that a system that rations care by a governmental authority is anymore moral than a system that rations by money.
Lets say for instance that under a free market there are additional costs related to providing consumers with choices that they would not ordinarily be offered under a UHC, if that’s the case then reducing my choices to make things cheaper would not be an advantage in my opinion.
I can’t help but find your position to be both economically foolish and morally reprehensible - not to mention detrimental to national health.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 6:21 pm
I don’t know if anyone’s found that people want Canada’s system; in the USA, very few people know the wonky details, so “Canada” tends to be used as shorthand for “tax-funded universal health care” or something like that.
It’s certainly true that many polls have found significant majorities of Americans favoring UHC. For example, here’s some results from the Washington Post-ABC News Poll, October 20, 2003:
This comment was written by Ampersand.Report this comment to the moderators
July 11th, 2007 at 6:55 pm
This is nonsense. First of all, you’re wanting to count unmeasured costs of UHC systems, but there are also unmeasured costs of our system, which are passed on to patients and doctors. Hours of insurance paperwork are shifted on to some unlucky patients in our system, for example; those costs are not accounted for in any measure. When doctors hire administrators to handle insurance paperwork, that is counted as an administrative cost; but the opportunity costs to the doctor (time spent having to recruit & hire an additional employee, time spent assisting the insurance administrator) are not. The forgone additional benefits to patients if doctors could , instead of hiring the insurance administrator, hire an additional nurse or physician’s assistant, are not counted.
If you’re going to talk about hypothetical unmeasured factors, you should talk about them for both the US and for UHC; that you mention such factors only when talking about UHC shows the weakness of your argument.
The administrative costs of allowing the Bush tax cuts to expire when they’re scheduled to (which, combined with economies of scale and administrative savings, would pay for most or all of the costs of UHC) are very minor; the IRS already exists, after all, and its workload pre-Bush was not significantly more expensive than its workload post-Bush, afaicd.
Our current health care system includes tens of millions of dollars spent lobbying every year. If we assume that health care companies are economically rational, then whatever amount they spend on lobbying must be a fraction of the returns they expect to get through profit. Any system that substantially reduces the profit available to insurance companies and other health care actors can therefore be expected to reduce lobbying costs in the long run.
This comment was written by Ampersand.Report this comment to the moderators
July 11th, 2007 at 7:14 pm
That’s not what Jake asked. The question isn’t will everyone receive treatment for whatever ails them, but will everyone have (reasonable) access to basic health care.
In the US, many people lack reasonable access to health care such as a GP exam once a year or routine medication for serious but common and controllable conditions. No one lacks that in France.
Let’s talk about type 2 diabetes, for example. In every wealthy country with UHC, diabetics who’d benefit from metformin can get it, for as long as they need it, and regardless of ability to pay full price. The same is true for the other things diabetics should have, such as an annual eye exam and bi-annual foot exams by specialists, and regular blood and urine testing. Many should also have blood pressure medication.
These treatments actually save money in the long run; they also can save a great deal of agony. But in the US, not everyone can afford such basic treatment.
[Edited to improve wording.]
This comment was written by Ampersand.Report this comment to the moderators
July 11th, 2007 at 8:28 pm
Jamila,
Here is what I wrote:
How is the free market going to guarantee that everybody has access to health care, then?
Here is how you responded:
No system guarantees that everyone will receive treatment for whatever ails them–not the free market or UHC.
Can you see that you responded to a totally different statement than I made. UHC does, in fact, guarantee that everybody has access to health care. Can you tell me how the free market is going to guarantee that everybody has access (not receive treatment for whatever ails them, no matter what the ailment may be - this is an important distinction) to health care?
This comment was written by Jake Squid.Report this comment to the moderators
July 11th, 2007 at 8:43 pm
Regarding the worse health care outcomes for American Blacks, and the better health care outcomes for Asian Americans, no doubt much of the difference isn’t attributable to different racial groups receiving different quality of health care in the US. But that’s part of the story. Here’s a chart that the Washington Post made, from data from the National Healthcare Disparities Report.
(Curtsy to Kevin Drum.)
This report (pdf link) includes citations to many peer-reviewed studies finding that yes, Virginia, not having access to health care is bad for your health. For the people who have inadequate access to health care, the US health care system is not working nearly as well as a universal access system would.
Edited to add: It’s also worth nothing that the VA system deals with a diverse population of patients, including many African Americans — but still delivers the best health care in the US, easily comparable to the best health care systems anywhere in the world.
This comment was written by Ampersand.Report this comment to the moderators
July 11th, 2007 at 9:37 pm
One thing that can’t be measured by statistics — or at least, not by the one’s I’ve seen brought up — is the question of security during a health crisis. The biggest problem of the US system, after the large number of entirely uninsured people, is that the risks inherent in the system are huge for people who are sick or injured.
Avedon Carol, an American who has been living in Britain for years, points out that this lack of worry is a great benefit; when contemplating needed health care, she never has to ask “can I afford to get treated”?
Most Americans aren’t ultra-rich, and aren’t getting the best healthcare in the world; many of us are getting very good healthcare. But people in other wealthy countries get healthcare that’s about as good or better, and they get it without worrying about if they can afford it. That sounds immeasurably better to me.
This comment was written by Ampersand.Report this comment to the moderators
July 11th, 2007 at 9:53 pm
Let me reword my response then:
The free market does not guarantee that everybody has access to health care.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 10:35 pm
The free market does not guarantee that everybody has access to health care.
Which means that the free market is inferior to national UHC by this measure (among many others).
I’m glad we have that sorted out.
This comment was written by Jake Squid.Report this comment to the moderators
July 11th, 2007 at 10:37 pm
Ampersand Writes:
There are unmeasured costs to both systems. However, a UHC has the advantage of being able to share costs with other government divisions, thus making it look cheaper than it really is.
Also, the additional cost of a private system is partly due to offering a wider variety of insurance options to customers to fit different needs; and it costs money to administer a variety of insurance plans. A UHC doesn’t have this cost ( or the benefits that come along with it) because everybody is being given the same plan with the same benefits.
I’m not talking about hypothetical unmeasured factors at all. I’m talking about actual factors that are left unmeasured because measuring them is not part of a UHC. When a private insurer has an internal audit or has to hire an outside firm for that purpose the cost of the audit has to be included in the insurers cost. When a government program is audited by an outside firm or by another office, the cost of that audit is not necessarily included in the cost of health care administration.
I said the following in a previous post: “Administrative costs can be reduced in the US system but I suggest that the disparity between costs in the US and other countries with UHC would shrink dramatically if those other countries could not hide some of their costs within the government budget as debt for other programs.
For instance, collecting taxes or lobbying for additional funding are not included in the overhead expense of public programs whereas collecting premiums and marketing would count toward the cost of a private insurer.”
I say abolish the IRS altogether and we can really save some big bucks. But I think abolishing the IRS is a whole ‘nother argument.
I also say that with fewer taxes and a simpler tax code more people could afford health care.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 10:48 pm
You understand that for many of us, that is a fatal flaw, whatever its other virtues?
—Myca
This comment was written by Myca.Report this comment to the moderators
July 11th, 2007 at 10:52 pm
Since I think the uninsured who are most in danger are those who are uninsured due to unemployment or part time work, I think that cutting the taxes they don’t pay on the money they’re not earning would do precisely zero to enable them to afford health care.
I do not believe that our country has a serious problem with people who want non-employer subsidised health insurance, but cannot afford it because of their tax burden. If you believe that we do, please offer evidence.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 11th, 2007 at 11:01 pm
Myca Writes:
Yes, I understand. But for me, and those like me, I don’t consider it a flaw at all; I’m not easily swayed by government promises.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 11:05 pm
Myca Writes:
It would leave room for employers to help pay insurance costs (since they won’t be paying so much in taxes) and it will leave the private health care providers to offer cheaper options for insurance and preventative services (since they won’t be paying as much in taxes).
And while poor people are paying lower taxes than everyone else they still pay them. When I was working the government was taking 21-25% out of my paycheck in taxes; I got it back at the end of the year but I would have preferred that the government didn’t take it in the first place.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 11:08 pm
Wait, don’t you mean, “I’m not easily swayed by actual evidence from the countries who have (over and over and over again) achieved this very thing?”
I know that’s snarky, and I’m sorry, but seriously . . . we KNOW that under our current system, there are a lot of people left out in the cold. We KNOW that other nations have achieved the guarantee that everybody has access to health care.
This isn’t an issue of being swayed by government promises, this is a situation of being swayed by facts.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 11th, 2007 at 11:13 pm
Isn’t this just utterly discredited trickle down economics?
One at a time:
Why on earth would employers do this? Especially for part time workers, which is what we’re discussing.
Why on earth would the insurance companies do this? Wouldn’t they just take the money as profit? Would they have any motive whatsoever to cover the unemployed for free, which is what we’re discussing?
—Myca
This comment was written by Myca.Report this comment to the moderators
July 11th, 2007 at 11:16 pm
Jake Squid Writes:
If the most important thing to you is a guarantee then I guarantee you that I will sell you a bridge in Brooklyn at a discount. I’m less concerned with what a government guarantees me than what it can actually provide.
And if I had cancer I would care less about the government making me a guarantee of treatment than I would care about the actual survival rate and how long I’m going to have to wait in the queue to receive my guaranteed treatment.
I don’t care about promises; I care about results. I would rather be alive and broke from paying for my own cancer treatment than dead because my cancer didn’t get treated in time under a UHC or because the UHC decided it wasn’t cost effective to cure me. So if the lack of a guarantee makes a health care system inferior in your book, then so be it.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 11:29 pm
Myca Writes:
Since when has trickle down economics been discredited, and by whom?
Because the promise of health care can be used to attract workers to the company. If I’m a part-time worker and I can choose between companies that are roughly equal in every way and one offers health care and the other doesn’t, I’ll choose the company that offers health care.
Companies want to continue to exist so that they can continue to make money. If a company (I’m talking about a private enterprise here) can use the promise of health care benefits to attract the best employees and use those employees to make more money than it costs to pay health care benefits then thats what the company is going to do.
Insurance companies also exist to make money. If they can offer insurance packages to people that will allow them to make even more money, then thats what they will do. There is no incentive to put the extra money from taxes back in their coffers if they can use it to make even more money instead.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 11:38 pm
Myca Writes:
No, I mean what I wrote: I’m not easily swayed by promises.
Other countries have achieved the guarantee that everybody has access to a waiting list. I know that under current UHC systems in other countries there are plenty of sick people languishing in pain on waiting lists waiting for their guaranteed treatment. And yes, I acknowlege that there people here in America who are also going without treatment or who have been denied by their insurance company. I’ve already said that America rations by money and other countries with UHC’s ration by wait times.
I’m still waiting on someone to provide some facts that unequivocally state a given sick person will be better on in another country rather than here. All I keep hearing about is that other countries make you a promise and they put you on a waiting list if necessary.
This comment was written by Jamila Akil.Report this comment to the moderators
July 11th, 2007 at 11:45 pm
Ampersand wrote:
And I think that is ultimately what it all boils down to: many people would rather that the government manage risk than for them to have to do it. A guarantee of health care made by the government is very reassuring and in the end I think this is the reason why America will probably accept some form of UHC in the future.
This comment was written by Jamila Akil.Report this comment to the moderators
July 12th, 2007 at 12:02 am
Jamila Akil Writes:
Oops, forget about that statement in post #173. Error in understanding on my part.
This comment was written by Jamila Akil.Report this comment to the moderators
July 12th, 2007 at 12:38 am
As I’ve already pointed out twice in this thread, this simply isn’t true. There are numerous UHC systems with low waiting times for treatment. For example, as the link you provided points out, Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland all share with the US a reputation for low waiting times.
Of course, one problem with the study you (and I) linked to is that it didn’t actually do a direct comparison, using the same methodology, of waiting times between the US and other countries. This study, in contrast, used the same questions and methodology to compare waiting times; unsurprisingly, the US and Canada have longer waiting times than the other countries studied.
So if waiting times are a significant indicator of how good the medical system is — and you’ve been implying throughout this discussion that they are — then the US is in fact significantly worse than some UHC countries.
In fact, the US combines the worst of both worlds; not only do we have long waiting periods, but we also fail to treat low-income people who would have received treatment in other countries.
You write:
In the US, people are almost six times as likely to have to not get needed health care because they can’t afford it as they are in the UK. Surely that extra 45% who have skipped some needed health care in the US would be better off in a country where they wouldn’t have to do that nearly so often?
And by the way, notice that the countries kicking the US’s butt in this study are not countries with great health care systems — they’re just the countries where the population mainly speaks English, which all happen to have pretty mediocre health care systems. Had the study compared the US to France and Germany, we would almost certainly have come out looking even worse by comparison.
This comment was written by Ampersand.Report this comment to the moderators
July 12th, 2007 at 12:47 am
Apologies that I do not have the wealth of time I did yesterday. I will reply to your post in instalments, however much I can get done in about five minutes each.
“I have never read any survey stating that two-thirds of Americans want to switch to a system like Canada. That sounds like an extremely high estimate considering that most people I know who do want UHC don’t hold Canada up as the model they aspire to.”
A miswording on my part, though that two-thirds of Americans want government to pay for everyone’s health care is really old news.
http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml
“Determining exactly how much a government spends on administrative costs under a UHC is problematic partly because some costs can be shifted to the patient and/or the physician and other costs are subsumed within government budgets and never counted at all. For instance, collecting taxes or lobbying for additional funding are not included in the overhead expense of public programs whereas collecting premiums and marketing would count toward the cost of a private insurer.
Administrative costs can be reduced in the US system but I suggest that the disparity between costs in the US and other countries with UHC would shrink dramatically if those other countries could not hide some of their costs within the government budget as debt for other programs.”
Ampersand may have already addressed this, but I want a stab at it as well. Your argument is saying that we can’t trust government to be perfectly truthful with their figures. Fair enough. It’s a truism of Canadian politics that the official opposition will always accuse the party in power of ‘bungling up health care’ in preparation for the next no-confidence vote. Is there an incentive to fudge politically inconvenient numbers? Yes. (Though it should be mentioned that the groups that gather these numbers are strictly non-partisan and work independently of the rest of the government. Government is not nearly the monolithic entity that libertarian models assume it to be.)
But are corporations always straight with their figures? Do they ever spend quite as much on R&D and on environmental and consumer safeguards as they claim to? With the amount of money they waste on administration and kickbacks, I suspect they give the full body massage treatment. You may take it on faith that corporate executives are just naturally more honest than our elected officials, but I don’t. Bureaucratic transparency cuts both ways.
“I could say the same thing about people in America who advocate for UHC; they can always pack up, leave, and move to Canada or Britain or wherever else they can get “free” health care while leaving the rest of us that don’t want it here to make do.”
Given that I already live in Canada, that may not quite be the indictment you think it to be, but let’s break it down: Libertarians who want lower taxes and fewer regulations are not obligated to move away from the jurisdiction of their present government. They may, but they may also work to fix things to their liking where they are. Liberals who want UHC and oppose the war are not obligated to do so, either; they can choose to fight the political battles at home.
And workers who labour in unsafe conditions or are horrendously underpaid (a problematic, subjective measure, granted, but in some cases there’s no two ways about it) aren’t obligated to go find a job; in a majority of cases, that may be the better idea, but not always, and not every worker can do so with the same ease. The worker has not agreed to every detail of his present conditions by virtue of the fact that he’s working there and not elsewhere, anymore than residence does for political objectors.
Ditto for consumers and unsafe products. There’s only so much parallel structure a guy can write.
The next section in your response concerning the WHO study, requires a detailed response that I cannot write out in full now without neglecting other threads of interest here. However, I’ll respond to this one point:
“France and Germany have nowhere near the number of immigrants ( illegal and otherwise) or non-white/non-Asian groups straining their health care system and pulling it down in the rankings.”
The number of immigrants may not be nearly as relevant as the degree of their isolation from the rest of society – that’s the whole reason why immigrants would even ‘pull down’ numbers, right, not because they’re of a genetically inferior stock – and France and Germany today are both far more racist societies than America is. Last I checked, it wasn’t American Hispanics who looted, destroyed, and bombed a thousands cars in the suburbs of DC and rammed one into a federal building.
This is important, because it’s also part of a response to another point further down.
This comment was written by sylphhead.Report this comment to the moderators
July 12th, 2007 at 2:28 am
Okay, I can’t sleep, it’s 37 degrees here. (That’s Celsius, you Yanks.)
Update on Jamila’s response to Amp, which I didn’t realize was made the last time. The only thing you’re doing is reasserting “actual dammit… not hypothetical” but providing nothing more but a long winded exposition on a potential scenario that, without cites, we have no reason to believe actually happens on a scale worth worrying about - your faith in corporate audits is a little touching, though, nonetheless. While we’re on this, though, it should be noted that even without counting private payments, Americans already pay more for health care just in taxes than countries with UHC do.
Jamila, your objections to the WHO study mostly echo the public health vs. health care distinction (that is, apart from the parts that weirdly veer into racial essentialism) that I was the first to bring up, so rest assured I know what you’re trying to say. But I began with a caveat saying that while public health measures and health care may not be one and the same, the former is the most important component of the latter. Your position says that it isn’t a component at all. Why shouldn’t we gauge fairness and equality when measuring the overall quality of a nation’s health care system?
You probably think that equality is either unimportant, an actual evil (a rather extreme libertarian position), or that it may be - eeeerrrrr - somewhat important, but it should be considered afterward as a sidebar or footnote so we don’t confuse it with the REAL issues. (Such as the Initiation of Force inherent in free breakfast programs for impoverished elementary schools.) My guess is probably #3, but in any case if you accept any of them as self-evident axioms, rather than propositions to conclusively reason towards, you will never see eye to eye with at least two thirds of your fellow citizens. For the simple reason that you’re arguing different things and will simply talk past east other. That the US ranks number 37 on a scale that you say measures ‘too much equality’ may actually be both shocking and relevant for all the right reasons for many, many Americans.
That being said, now that I think about it, the inclusion of the effectiveness of government involvement does seem to be a bit of a dubious measure. Government medical programs are extensive in America, and programs such as Medicare are as good, if not better, than their counterparts in other countries, so this may temper it a bit, but it doesn’t sit right.
“It’s not illogical at all. When a scientist comes to a conclusion, if he/or she wants her results to be considered valid then the scientist bears the burden of proving that the results were not biased by external factors, not the person doubting the claim. It is you who are claiming that the US needs UHC because then we all will have better health care.”
Jamila, you’re confusing empirical facts with a study, and evidence with proof. We who quote facts we come across on our reading do have certain intellectual responsibilities, but they are a far cry from those of a scientist publishing a study. We did not collect the data, we did not design the algorithm with which the data was interpreted, we did not write the papers; someone else did. That someone else, in this case, released their findings to the public domain. We read these facts and use them to form an opinion - these opinions are not “results”, and our position is drastically different from that of someone undergoing peer review, which is the context you are clearly implying. Sounds to me like you’re trying to narrow the goalposts as much you can to prevent people from using empirical figures that make your pet high-inequity system look bad.
Second, it’s reasonable to demand corrobating evidence before anyone puts forth claims and an argument. It’s not reasonable to demand proof. Applied science and social policy would be at a standstill if we tried to universalize this principle. Complete proof is hard to come by outside of pure mathematics and formal logic, and besides anyone can think up hypothetical, minute flaws. The one who does this does not some sort of diplomatic immunity herself, and you yourself scale some veritably unscientific ground when coming up with your explanations, including several that suggest discredited race science. Call it the creationist, climate change denier’s mode of scientific discourse.
“just because you have discounted the cultural factors (confounding variables) doesn’t make your assertion any more valid.
The WHO and the OECD both say that their rankings should be looked at in light of the differences between and within countries. So if those two organizations both acknowledge the insufficiency of their rankings, then why are you so hesitant to look at them too? Perhaps if you did, UHC wouldn’t look so fantastic after all.”
I haven’t discounted the cultural factors and confounding variables. I’m discounted the idea that we know how they would break down. To say that the US would be uniquely helped by the inclusion of these factors, while the panoply of developed nations with UHC, which all have different cultures to factor with, which all confound variables in their own idiosyncratic ways, would uniformly be brought down, is an extraordinarily extraordinary claim. Without, of course, any cites.
Okay, two-thirds done. To be continued…
This comment was written by sylphhead.Report this comment to the moderators
July 12th, 2007 at 6:47 am
It’s also worth nothing that the VA system deals with a diverse population of patients, including many African Americans — but still delivers the best health care in the US, easily comparable to the best health care systems anywhere in the world.
It’s Clinton’s fault, you know. He was the one who instituted computerized record keeping (with the most user friendly interface I’ve seen in any hospital anywhere, including several private ones), standing committes on reducing medical errors, etc. Bush is doing his best to undo Clinton’s subversive attempt to demonstrate that the US government is capable of running a decent hospital system by underfunding the VA (in the interest of supporting the troops, you know), but hasn’t managed it yet. Thus demonstrating that the changes are reasonably robust, even in the face of an awful chief exec.
This comment was written by Dianne.Report this comment to the moderators
July 12th, 2007 at 1:40 pm
Sylphead,
“racial essentialism” is not what is going on here. That term is generally used to assign different races differing mental characteristics. In that context, it’s bunk.
Recognizing that races are sometimes physically different, OTOH, is good science. Different races have at least some different physical characteristics, as a general rule (that’s part of what people use to distinguish the races) and are, occasionally, prone to different diseases, problems, etc. IGNORING this fact–as was done for a long time–can be quite racist, actually, and can really screw over the patients.
Saying that people of ____ race tend to be more/less prone to ____ disease is, if accurate, not a problem. It allows us to properly assess risk (not many people of Asian descent have Tay-Sachs disease, for example.) It also, if practiced correctly, allows us to be more efficient in treatment.
I also take issue with your protests re the “equality” tests inherent in the rankings. To date, you and many proponents have been talking about two things separately
1) “Look, our health care sucks, we do a bad job providing health care; in fact we’re only #37″
and
2) “moreover, we’re not equal at all in how we distribute it; a lot of people don’t get health care at all; we need more equality/universality.”
It looks like your first argument is a bit off. As you’ve all been making it, you’re talking about dying, and statistics of survival, and all those other things which you say (and I agree) define “health care.” You’ve been SEPARATELY arguing (again, appropriately in my view) about access to said health care and/or affordability of said health care.
What Jamila is saying is that the much-vaunted #37 statistic has a lot included in it which–surprise!–isn’t exactly a measure of HEALTH, but is more a measure of POLICY. E.g. a less-equally-distributed country would presumably rank lower than an equally healthy equally-distributed one.
That’s a bizarre argument. It amounts to saying that UHC is better because someone in the U.N. who assigned values to things decided that UHC is “better” so they gave points for having it.
Why did they do that? [shrug] you got me. Seems a lot more accurate to “rate” health care by, you know, health. 10 sick people and 100 well people are what they are health-wise, whether they’re in a UHC system or not.
IMO, the numbers that really matter are the ones that are at heart FACTUAL measures and not OPINION measures. Survival. Life expectancy. Life years saved. Etc.
This comment was written by Sailorman.Report this comment to the moderators
July 12th, 2007 at 2:51 pm
Okay, quickie before I go.
” “racial essentialism” is not what is going on here. That term is generally used to assign different races differing mental characteristics. In that context, it’s bunk.
Recognizing that races are sometimes physically different, OTOH, is good science.”
Not every means by which races are posited to be physically different is good science; most are not. Claiming that races of people - and statements such as populations of non-whites and non-Asians dragging down health numbers, no matter where they are, strongly implicate genetics and biology, not culture, I think you’ll agree - just by virtue of who they are, are less healthy, is something that actually needs to be documented and verified. Not something that can just be thrown out there as ‘food for thought’ and expect the onus to be on us to counter it. Is there any evidence to suggest that Japanese babies are naturally hardier than Hispanic white babies? Because Jamila’s statements about Asians, in particular, flirted with racial essentialism.
As for your comments about the WHO study, you are confusing my position with that of some other liberal you’ve met. Short version, policy is a component of health care. You must have not read my last post properly if you think I wouldn’t actually agree that segregating points (1) and (2) is a good argumentation. However, neither should you or Jamily segregate policy from health care, equality vs. more ‘real’ measures. Equality is a component of quality.
Long version, will have to wait.
This comment was written by sylphhead.Report this comment to the moderators
July 12th, 2007 at 5:12 pm
Who said anything about less healthy? Lifespan is but one measure of health (I’d rather die hale and hearty at 97, personally, than be decrepit by 80 and live to 102 in a decrepit state.) I find this an interesting area and actually i doubt we disagree much. racial classifications are oft misused. But that’s a sidetrack, I think; I’ll leave it alone here.
This comment was written by Sailorman.Report this comment to the moderators
July 13th, 2007 at 5:06 am
I’d rather die hale and hearty at 97, personally, than be decrepit by 80 and live to 102 in a decrepit state.
You say now, but what will you say when you’re 97? In any case, I seem to remember there being a measure of “healthy life expectancy” s0mewhere (WHO?) and that the US didn’t come out on the top of that either. Sorry about not doing the research properly, I’m posting in a hurry. With some luck I’ll come back and do it properly.
This comment was written by Dianne.Report this comment to the moderators
July 13th, 2007 at 7:05 am
Yes, no disagreement: I recall seeing some similar measure somewhere too, and I don’t think the U.S. was on top. I was addressing sylphead’s (apparent) accusation regarding racial unhealthiness.
Obviously, all these global measures are a bit like the U.S. News college report: some of one’s place in the ranking depends on actual quality, but a decent percentage depends on how the ranker has elected to weight each individual factor in the rankings.
If you’re first (or last) in every category, then you’ll end up being first (or last) no matter what But if you have a “life expectancy” score that’s a bit low, and a “quality of life” score that’s a bit high, then a lot of your ranking may depend on whether the ranker takes my view (quality value > expectancy value) or what appears to be your view (expectancy value > quality value).
There is no objectively “true” method of assigning weight. As a result, it’s entirely possible that two people will have vastly different opinions on the validity of said rankings. That’s part of why these ranking arguments tend to get messy.
This comment was written by Sailorman.Report this comment to the moderators
July 13th, 2007 at 12:24 pm
Myca wrote
Myca, I’ve agreed with pretty much everything else you’ve said so far in this discussion until the comment above. As one of the many underinsured out there in the US, I think there is an increasing problem in the US right now where lots of us who don’t have access to employer sponsored health care can not afford the kind of insurance one would otherwise get if it were through an employer. My husband works for a small business that doesn’t provide insurance, and the I know several other folks who are self employed and in a similar predicament. According to the Economic Policy Institute, there were almost 4 million more uninsured workers in 2005 than in 2000, and it looks as though that number is only increasing. (Source: http://www.epinet.org/content.cfm/bp175)
As a result of the crappy private insurance coverage we currently have, we can’t afford to pay for my asthma medications because they are so ridiculously expensive (over $25o/month.) So I go without that medication and make do as best I can. I have considered trying to import the medication from Canada because it would only cost about a fourth of what it costs here in the US, but Big Pharma has pushed to keep this practice illegal.
That isn’t to say that I disagree with you about the utter lack of health insurance or health safety net for the truly poor in our country. Deregulation of the health insurance industry would do nothing to provide these people with better access to health care, and until we do more to provide them with that access they will continue to be left behind.
I think we really are moving closer to a true crisis in this country where eventually the only people who can afford good health care are the truly wealthy among us. Some form of UHC is likely the only way we can prevent that from happening.
This comment was written by Lola.Report this comment to the moderators
July 13th, 2007 at 12:46 pm
Agreed, Lola.
I certainly don’t deny that this is a problem for some people, I just think that it’s only likely to be a problem for people who are:
1) self-employed or working part time without employer-provided health care
2) making enough money that cutting their taxes would enable them to pay for health care
3) but not making so much that they would be able to afford health care without a tax cut
I don’t think that this group is very large, but regardless, my quibble is mostly with the contention some libertarian acolytes have that cutting taxes is a sort of magical panacea that will make everything better, regardless of the situation.
As we’ve seen, that’s simply not true.
—Myca
This comment was written by Myca.Report this comment to the moderators
July 13th, 2007 at 9:28 pm
The lure of UHC is the promise of ’something for nothing’. Getting something of high value for ‘free’ or a highly discounted price is always very alluring.
Most of the advances in medicine have come from this country because of our system of medicine. Those wealthy people who can afford to have the ‘cutting edge ‘ surgeries have helped to generate the rapid advance in medical technology and medicines that we have seen today. It is the vast sums of money that this country voluntarily spends on its health that is the driving force.
UHC systems, except for a few symbolic show pieces, tend to lag far behind in equipment and innovation. Their staff tends to be underpaid. The U.K. has to import a large number of doctors because the job of being a doctor is just not that attractive to the natives.
A ’single-payer’ system is patriarchal paternalism at its worst - hey, lets let dirty Uncle Sal {Grey’s anatomy joke} take care of us. If you are friends with the Uncle, you will get great treatment, but if he doesn’t like you, you will get horrible service.
This comment was written by Nick.Report this comment to the moderators
July 13th, 2007 at 10:46 pm
No, it’s not. The vast majority of Americans realize that government services are paid for with taxes, which is not the same as being free.
Look at my comment #137, quoting the survey; the questions made it perfectly clear that what’s being discussed is a system paid for out of taxes. But even when that is made explicit, people still favor it.
Not true. Many of the largest pharmaceutical companies (all of whom create new drugs) are European, not American; and many important advances in technology have come from places like Japan and Germany.
Besides, in the US, much of the cutting-edge research is financed by the public sector, not by the free market.
Plenty of evidence has been posted on this thread showing that health care in many USC countries is as good or better than health care in the US, for patients. Other countries often have shorter wait times, and of course more universal access.
I’m not sure that you even understand what the word “patriarchal” means; and I doubt that you’re using it sincerely.
That aside, there’s nothing particularly “paternalistic” about public services. We all seem to live with “paternalistic” public road-building and maintenance, and “paternalistic” public fire departments; it’s my guess that we’ll be fine with public health insurance, too.
This comment was written by Ampersand.Report this comment to the moderators
July 14th, 2007 at 4:06 am
Collective action is not paternalism.
This comment was written by Mandolin.Report this comment to the moderators
July 14th, 2007 at 4:54 am
Eek! Marrow transplants? All my sympathies, that sounds like no fun…
(The insurance conversation is, well, much needed but also no fun, so I’ll leave it at the sympathies.)
This comment was written by defenestrated.Report this comment to the moderators
July 14th, 2007 at 5:17 am
Ampersand Writes:
I should have been clearer with my words. Just as you say, there are countries with UHC that have low wait times; I was specifically thinking of Canada and the UK when I made reference to extremely long wait times. New Zealand and Australia also have UHC’s and they have wait times in excess of several months for particular kinds of surgery and treatment.
From this point forward I’ll try to make reference to the specific country that I’m talking about.
Countries with UHC’s tend to have far more general providers ( GP’s or family doctors) than specialists so when people are sick, but not sick enough to go to the hospital, they do tend to get appointments faster than they would in America; however, America has a far higher percentage of specialists than most UHC’s and thus people who are really sick don’t have that long of a wait time for treatment.
According to a study by the Commonwealth Fund only 5% of Americans have to wait more than four months for surgery, compared to 23% of Australians and 26% of New Zealanders.
I don’t think that having to wait until the next morning or having to wait two-three days until Monday morning for non-emergency care is a significant indicator of the overall quality of care that people are receiving. If these people who want overnight care are seriously ill they can always go to a hospital emergency room. I think that care for the seriously ill is more important than prompt care for healthy folks who are temporarily sick. U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the ER, see a specialist, and have elective surgery.
You just acknowledged that US does not have long wait times when compared to the best of the UHC countries and I just provided a link ( see above) showing that the US has shorter wait times to see a specialist, have elective surgery, or be seen in an ER.
Low income people in America have Medicaid and they can go to an ER for emergency treatment.
In the US cost is most likely to be cited as the major obstacle to care while wait times and physican shortages are most likely cited in Britain and the UK.
When I say give me proof that a given sick person will be better off in another country than here, I mean tell me that the sick person is more likely to be cured of whatever ails them. If the choice is between going broke but I still get the best treatment and my cancer is gone vs not going broke because my treatment is free but I’ll have to wait in line for it and my chance of dying is greater, then I would choose going broke but at least I’ll be cured.
When the choice is between care rationed by money and care rationed by wait lists, the chance of survival is the deciding factor.
The study doesn’t show any countries kicking the USA’s butt. America still rates pretty high in overall health, we have low wait times for the ER/specialist/elective surgury, our wait times are comparable to the best of the UHC countries, and we have higher cure rates for certain ailments than the best of the UHC countries. So where, exactly, does France or Germany kick our butt?
This comment was written by Jamila Akil.Report this comment to the moderators
July 14th, 2007 at 5:26 am
I stuck define:Paternalism into google. and got this as the 2nd hit
paternalism A method of medical or administrative practice in which the values of the practitioner or administrator are imposed upon the person most affected by the decisions to be made, without adequately heeding that person’s own values or power to make decisions that directly affect them. For a discussion of paternalism in the doctor-patient relationship, read the box, Autonomy and respect for persons, in WebPage 26. See also autonomy and professionalism.
http://www.jansen.com.au/Dictionary_PR.html
I can easily see how public collective health care could develop in this way. It’s one of the reasons I’m not (yet) a supporter of UHC.
Public ideas about weight are a good example. I can easily imagine scenerios where UHC further adds to anti-fat bias. Now the health systems says you have to be skinny because that’s healthy.
Since weight is entirely dependent on personal decisions not only are fat people immoral and weak willed they’re also wasting my tax money because now I have to pay for their lard related diseases. Everybody knows that god made these sorts of health issues to punish people who sin with twinkies.
end snark
That statement is stupid and vile but so is congress.Orin Hatch is the ranking repub on the senate committee on health. He’s going to have a lot of input into any public health plan.
This comment was written by joe.Report this comment to the moderators
July 14th, 2007 at 5:27 am
sylphhead Wrote:
As important as how integrated immigrants are into the larger society, the number of immigrants and their immigration status is also important. France and Germany are not dealing with 12 million plus illegal immigrants in their health care sytem. I was not trying to say that anyone was of inferior stock, only that particular groups are associated with particular ailments ( such as Jewish people with Tay-Sachs and black people with sickle cell anemia); the greater the ethnic variety in a country the greater the variety of genetic diseases.
This comment was written by Jamila Akil.Report this comment to the moderators
July 14th, 2007 at 5:36 am
sylphhead Writes:
It already has been verified, you just have to look at the figures. The Asian populations in the UK, Canada, and the US are healthier than the population at large. I don’t know whether this is because of some genetic factor or whether it has something to do with their culture ( maybe it’s religion, diet, excercise, etc.,).
As an example I’ll bring up my best friend who is the child of immigrants from Nigeria. Her family is still strongly culturally Nigerian even though she has lived in America her entire life. Perhaps the combination of traditional Asian cuisines (whether it is Japanese cuisine, Thai, Chinese, etc.,) combined with exercise and religion (Buddism, Confucianism) and this keeps them healthier than other ethnic groups.
At this point, the question isn’t “are they healthier?” but “why are they healthier?”
This comment was written by Jamila Akil.Report this comment to the moderators
July 14th, 2007 at 6:17 am
[Reply deleted, based on misreading of JA's earlier comment. Sorry!]
This comment was written by Mandolin.Report this comment to the moderators
July 14th, 2007 at 6:21 am
Joe,
You make some good points. We do see anti-fat shit going down in other countries, and I’ve read some annoying quotes by UK taxpayers talking about how fat people are draining all their tax money.
Amanda @ Pandagon wrote a bit about the legitimate concern that assholes will be allowed ot ruin UHC, in order to prove that it doesn’t work.
Although, I must say, despite the fact that I have excellent, excellent insurance, my HMO does seem to be throwing roadblocks in the path of my ability to get a diagnosis. I am not convinced that the asshole factor will be worse coming from collective decision-making than it is coming from people motivated by profit who, possessing my cash already in their pockets, have every reason to deny me as much care as possible.
This comment was written by Mandolin.Report this comment to the moderators
July 14th, 2007 at 10:13 am
Anti fat bias is not limited to UHC systems. I hear arguments like, “all those fat people cause my insurance premiums to be too high” etc. Anti fat is anti fat and will need to be addressed, but I don’t think adding UHC will really do too much to worsen anti-fat bias in the US. It’s already despicable.
This comment was written by Kate L..Report this comment to the moderators
July 15th, 2007 at 4:54 am
There are many competing political views in this country. I predict that if we had UNC there would always be a lot of people will always be convinced that the assholes running it are trying to ruin it, and the country at large. This fact will be constant no matter who is in charge. Amanda describes malice as their motivation. But I think we’d get plenty of ‘bad’ decisions based just on different values, viewpoints and trade offs without any malice.
It’s one of the flaws of a technocratic system. It’ll work great if the technocrats make the same decisions that I would. When the levers of power are in the hands of people I disagree with it doesn’t work as well.
This comment was written by joe.Report this comment to the moderators
July 15th, 2007 at 5:04 am
Kate, i wasn’t trying to say anti-fat bias is limited to UHC. I was just trying to provide an example of a reasonable paternalistic decision making process that would result in something bad.
I thought about using mandatory helmet laws for motorcycle riders but I thought the weight one was more on point.
Replace premiums with Taxes though and you can already see how this could go bad once the bills have to be paid.
How much can we cut my taxes if we don’t pay for smoker’s lung issues, injuries from obviously dangerous activities, or STD for people that do things gawd says are icky? Most smokers are poor anyway. We need to cut social spending until they can’t afford to smoke! Two birds with one stone. It’s in Leviticus.
end snark
That’s part of why i want to know how any system will be rationed. I don’t think anyone here is really advocating that we provide unlimited medical care to any man of woman born who asks for (if you’ll pardon the gendered expression.)
My understanding is that UHC will provide necessary medical care. The definition of necessary will be key.
This comment was written by joe.Report this comment to the moderators
July 15th, 2007 at 7:13 am
Oh boy, the ‘right’ is written into the constitution. Pity she undermines that claim in the very next paragraph. The care she is describing is based on the private pay-as-you go system and not on the public health care which as expected is inadequate.
Ronda Kaysen article
This comment was written by Nick.Report this comment to the moderators
July 15th, 2007 at 9:06 am
Nick, she appears to have meant the MEXICAN constitution (I don’t know, but I assume the claim is accurate.) I don’t think she was claiming that the right is in the U.S. constitution, which obviously it is not.
And how does she undermine the claim?
This comment was written by Sailorman.Report this comment to the moderators
July 15th, 2007 at 9:10 am
And how is she related to this conversation (not that UHC systems aren’t related to the conversation, but the way Nick’s comment is presented just sort of drops me into a conversation I wasn’t previously aware of)? I may have missed something, but I didn’t see her brought up before Nick’s comment. Did Amp bring her up first? A little context would be nice.
This comment was written by Mandolin.Report this comment to the moderators
July 15th, 2007 at 10:55 am
Blargh. It’s more than a little sad that in all my myriad applications for health care (Medicare/aid, social security/disability, etc.), my ever-changing weight has never been much of an issue. It’s low, but it fluctuates within a 30 pound range.
Now, the cigarettes…the cigarettes I get to lie about ;)
This comment was written by defenestrated.* * *
My deepest health/health care sympathies are with you!
Report this comment to the moderators
July 15th, 2007 at 5:59 pm
mandolin:
Your post had many interesting comments on how expensive healthcare is in the USA; I wish I had time to address them all & share what I know.
You see, I have an insider’s view point. I work for one of the major USA health insurance companies, and you’re darn right being sick is expensive.
I don’t deny the healthcare industry is sick our country, and from what little glimpse I have of it in my daily worklife (which is at best, miniscule), I do my best to do the right thing & provide any member that calls in to me with my commitment to quality healthcare.
Allow me add to your comments on few things. A surgery that costs $250,000? Sure. Easy. You have at least 5 bills now, instead of one from a hospital. You pay a surgeon, a hospital for the facility (bed, supplies,etc.); you also pay the outsourced anethesiologist, the outsourced pathology lab, the outsourced pathologist who looked at your blood, and wrote a report to the prescribing physician; and you also have fees from your pharmacy for your drugs, & maybe charges after you get out to see a doctor as follow up or my have had physical therapy.
Hospitals are now outsourcing certain staff, and if your policy that your employer dictated to the insurance company does’nt have a RAPL clause written in you are in for a little surprise….like a bill for $1500 for 15 minutes of anesthesia.
the highest charges I see on daily basis are not from your surgeon or physician, but from the anethesiologist, the lab & the rehab centers. oh yeah, lets not forget the non-standard pharmacy drugs, which have to be approved & mailordered 90 days at a time from a specialty pharmacy if bum-who-knows-where in NY. (apologies to said residents in advance.)
I ask myself what drives these costs up higher than others? I’ve been able to hypothesize a few scenarios with the info in front that passes in front of my face every day.
one is: I see employers wanting to cut high costs of administering healthcare benefits to employees. They use the insurance company as the administrator of the employee’s benefit plan, but they pay the claims themselves. This is called an ASO plan. This is only one type of plan out there, folks.
Actually, a healthcare insurance company will insure & cover anything and everything a person could want regarding their health….just like Lloyd’s of London. It will cost the employer X amount per contact year. They employer tries to cut costs by having the employee help pay for part of the cost, thru payroll deduction, deductibles, copayments & coinsurance percentages.
I often see clauses & limitations written in, and quite cleverly, I might add….written in at the employer’s demand. You want to not cover any employee who has a chronic underlying condition, like chronic obstructive pulmonary disease? ( I.E. you ‘re the fella who chain smoked for 35 years & has to cart around an O2 tank every day, ’cause your lungs are’nt able to take in enough O2 to keep you functioning normally)….write in a ‘pre-existing condition” clause. the insurance company has to look back for a time period, say, 6 months, to see if you recieved treatment. you may be denied coverage for that condition for up to one year if you don’t show proof of prior coverage that paid out on your condition or proof that you were not treated in the past 6 months ( i.e. this is a new diagnosis for you).
Mandolin, I’m not trying to cover my employer’s behind at all - the guy that sells this insurance coverage is just as bad as the guy who insists on buying it this way. it’s a huge mess. All I can do is just fix what I am in control of. One thing at a time.
I have a lot more I’d say, but my time is limited tonight. God bless you, please write if I can do anything to help you sort thru the maze. I’ll post as soon as I can this next week.
This comment was written by CC, overworked.Report this comment to the moderators
July 15th, 2007 at 7:52 pm
Sorry, my bad. Is the link working?
Yes, she is talking about the Mexican health care system. She never gets round to covering the Mexican health care system other than the toss away dismissal line.
All the joys she expresses are the great friendly service she gets from the private system and the freedom of not being under an insurance companies thumb — all for far lower costs than we pay.
The article is an interesting comparison of the US and Mexican pay systems.
That article, published last month, came up after reviewing this article on her finding herself pregnant and their family deciding to have the baby .
Link to the having a baby article
This comment was written by Nick.Report this comment to the moderators
July 15th, 2007 at 8:02 pm
The five or more bills stuff is confusing. It gets hard to know what the insurance company is going to pay and what has been paid when new bills just keep showing up in the mail.
This comment was written by Nick.Report this comment to the moderators
July 15th, 2007 at 8:32 pm
Looks like the health care in some of the countries with a “good” UHC may not be so good afterall. From an article by Johnny Munkhammar in the Examiner:
and
Read the entire article HERE.
This comment was written by Jamila Akil.Report this comment to the moderators
July 15th, 2007 at 11:20 pm
I’m glad that you made it explicitly clear that your argument about Asians could be attributed to culture, not biology, though I still think you leave the door open for the latter by a much wider margin than reputable science allows. (At this point, Arthur Jensen is the intellectual equivalent of a keyhole peeping Tom.) However - and perhaps I should have stated this clearer from the outset, as Sailorman doesn’t seem to understand where I’m coming from either - you drastically overestimate the effect that differential racial biology, however much lip service you give in saying that it is minute, makes on something such as health. Race-linked disorders such as Tay-Sachs and cystic fibrosis are the exception, not the norm, and often times the statistical significance of the link is exaggerated in the public mind. There is far more genetic variation within a population than between populations, so I find it hard to swallow that racial diversity would somehow confuse a health care system into underperforming.
If racial diversity is a problem, the problem most likely has been created by people, not by nature. The effects of discrimination and isolation, perhaps barely noticeable on a case by case basis, could conceivably depress outcomes for the group that becomes significant when you analyze them as a whole. But I’ve yet to see either a causal link or even a base level of evidence suggesting that America is somehow unique in this. Yes, America is Hung Up On Race as it pertains to epithets on prime time, but if you want to see truly racist societies, book an international flight sometime.
And thank god this isn’t the SATs, because I failed reading comp with regards to your argument about government hiding costs of UHC. Let me re-address that one.
Your point is that some of the costs of administrating UHC would not be counted among its expenses, whereas its private sector equivalent would be. For instance, levying taxes probably would not count under a public health care expenditure, whereas the internal shuffling of money within a corporation would for private health care. Local politicians advertising health care proposals doesn’t count as a cost of UHC; marketing and advertising does for private care. On a strict number to number comparison basis, this may make a small difference; I wouldn’t know. But there are many problems with this argument:
1. Competition with other companies takes up a lot of spending that doesn’t go directly into health care, such as marketing and advertising. The closest public sector equivalent are political parties touting their difference health care proposals, and I highly doubt this comes anywhere close as an expenditure.
2. Compensation for executives and shareholder profit is the probably the single largest administrative cost for private health care companies (where administrative is defined as anything that doesn’t directly fund health care), and this has even less of a public sector equivalent. At most, we have the salaries of the file clerk guys who work at a separate government agency.
3. More to the point, if a given private health care company doesn’t exist, they don’t advertise, market, shuffle money, etc. However, if a given UHC doesn’t exist, the ‘indirect’ ways the government administers it, such as sessions of congress and political campaigns, still take place, albeit with a different focus. The taxpayer money taken up debating the national health care program would just be spent elsewhere. Campaigners who would spread the word on health care proposals would just campaign on something else. So the cases you bring up, are expenditures in the most academic sense in that they are money-valued, but those who pay for them aren’t losing anything they’d otherwise have. To the extent that the tendency exists for the costs of UHC to mix in with the costs of government in general, it is precisely the very thing that makes it more efficient.
4. And lastly, there’s such a thing as going too far in this direction. I could also cite all the money lost by other creditors when someone declares bankruptcy as a result of private medical payments, or the money spent in political battles to preserve the obviously unpopular for-profit system, as uncounted expenditures of private health care system. All this fraying at the edges won’t change the fact that public health care is just a fundamentally more efficient system than private health care.
But wait, can’t the same arguments I’ve made for UHC be applied to any other industry - leading to a slippery slope? Should we nationalize toothpaste then, since then toothpaste companies won’t have to spend money competing with each other, and toothpaste execs won’t have to be compensated? In a sense, yes, all private and competitive markets share this same inefficiency. But in many cases, it’s more than counterbalanced by the efficiencies that the profit motive brings. As many here have alread delineated, however, health care, particularly health insurance, isn’t an industry that provides the right incentives. So it’s the worst of both worlds.
“Please provide me with some statistics that say the US has a surgical mortality, lower patient satisfaction, and a very low rate of access to primary care physicians.”
I regret that there was one handy link where I first got this, and I’ve long since lost it. I’ve made do here with other links I happen to have.
Scroll down to the Manitoba study. The rest just deals with clinical outcomes for various ailments for which Canada is superior to the US, which I’ve already gone over.
This is an article, not a study, that talks about patient satisfaction. I will find the original link, or something like it, soon.
“The infant mortality rate and life expectancy of the US is not a sign of the failure of our health care system.”
By itself, infant mortality rate and life expectancy don’t give the whole picture, yes I’ve gone over that. But to suggest they aren’t even signs, or symptoms of a failing health care system at all, is ludicrous. The only ones claiming that are Republican political activists and diehard neoliberals - post hoc after they found out that America happened to be far behind on those measures. Give me a long standing school of informed medical dissent over these measures, dating at least back to when the US *wasn’t* behind on these statistics, and I’ll treat it as an informed position.
While we’re at it though, this article brings up something interesting: Canada’s infant mortality rates were on par with America’s until we adopted UHC. Perhaps I gave the other side more credit than they deserved on this.
“White Americans have a life expectancy and infant mortality rate similar to those found in western Europe. Japanese people have low infant mortality in Japan and here in America. African Americans and Latinos have higher infant mortality than the rest of the white population which raises the overall infant mortality rate.”
You know, America has this tendency to score low on a number of international comparisons, which is a real burr on the sides of those who want to believe that high inequality and entrenched wealth are signs of a good society. I hear the same “if you only count White (read: real) Americans… ” line of reasoning when arguing country by country violent crime rates. Let’s dissect this.
1. Right off the bat, any comparison where you manipulate what is being compared to move it in a desired direction, as in comparing the better off 88% of America with 100% of another country’s, is statistically and scientifically invalid.
2. I cannot stress enough that America is not alone or unique in having a racially or ethnically defined underclass that does worse than the rest of society on nearly every measure, be it health indicators or crime rates. On the contrary, this is a basic pattern followed by every society in history that isn’t small and genetically isolated. America does have a history with race and social injustice that’s perhaps more defined that those of its contemporaries, but then we’d need to establish and if possible, quantify, this discrepancy. Not simply toss it out for other countries entirely out of a desire to make a favoured political system look better.
3. Yes, Scandinavian populations pose that sort of a problem, which is why I don’t use them in population comparisons. However, France and Germany don’t, and you can’t discount Japan, a country with over 120 million people, for being homogeneous without being really, really racist. (There are other ways to be heterogeneous than by ethnic ancestry - for instance, the urban/rural divide you brought up.)
My points above are all related, I know. I just like numbers.
“There is nothing about drug research that drug companies can do that universities can’t, but why should there be any preference that the universities or the NIH do it when, as you say, the drug companies usually end up taking over in the end anyway?”
In a calm, neutral world, I would have no preference. However, more than a few right-wingers have suggested that drug companies need to be given favours or mollycoddled to protect their *irreplacable* R&D contributions. You yourself suggested that we need to pay higher prices for drugs, or else R&D would suffer. I’d rather the government take over the whole process by force than give those companies more power than they already have.
I’ve taken this long to reply to one thorough post (#155), so I’m not going to try it again with everything you’ve said since, Jamila. (Most of the argument wheels back and repeats, in any case.) But I’ve noticed you keep bringing up cancer as an example. Since you’re interested in direct country by country evaluations, did you miss the links provided, separately by myself and Ampersand, showing that Canada has higher cancer survival rates than America?
This comment was written by sylphhead.Report this comment to the moderators
July 16th, 2007 at 5:48 am
Oh, OK, now I get what you’re saying. Sure, I agree, the genetic variation is not all that huge. (of course, it’s an issue of phenotype, not genotype, and the % genetic variation may not always reflect the changes in phenotype) But in any case, isn’t it appropriate to take other factors into consideration, even if they’re nongenetic? If the goal is evaluate the efficacy of UHC, it seems relevant.
Imagine for a minute that Vikings are discriminated against pretty much everywhere. They may also have special Viking-only genetic issues. But for whatever reasons, they seem to have a lower life expectancy and worse health than non-Vikings.
Even if we don’t know whether the Vikings’ “worse” health is the result of genetics or of discrimination, we can still make the same conclusion: A country with an unusually high proportion of Vikings is likely to have their health issues “look worse” than they actually are.
Most of the issues I have seen w/r/t America and race don’t claim that America has racism issues that don’t exist elsewhere. Rather, they claim that America has an unusually high proportion of people who, for whatever reasons, tend to have ‘worse’ numbers.
Obviously, a good UHC system would NOT have that problem, as part of the function of a UHC system would be to provide universality, hopefully WITHOUT the disparities that exist in our current system. So countries that have meaningfully large populations of Vikings but who do not show the ‘normal’ (unfortunate) outcome difference between Vikings and non-Vikings could “honestly” claim that their differences were the result of UHC.
However, countries that continue to have worse outcomes for Vikings don’t get that assumption. THEY have to be compared to other countries by first accounting for the “viking effect.”
This comment was written by Sailorman.Report this comment to the moderators
July 16th, 2007 at 5:50 am
Ah, the old deserved-sickness argument. As I think I mentioned way upthread, my son was diagnosed at age four with a highly malignant brain tumor. Was that his fault or ours, his parents’? (I don’t know how much his treatment cost as nearly all of it was covered by insurance, but it’s a pretty safe bet that it was at least six digits.)
This comment was written by Lu.Report this comment to the moderators
July 16th, 2007 at 3:51 pm
Sailorman, you said that is a much clearer and more succinct fashion than I could.
This comment was written by Jamila Akil.Report this comment to the moderators
July 16th, 2007 at 7:40 pm
sylphhead Writes:
Sailorman addressed this issue better than I could.
Public health care is not fundamentally more efficient than the private system; in fact I would argue that it is fundamentally less efficient based on the same reasons you provided.
1. Competition with other companies: A private company is going to compete with other private companies by attempting to lower costs ( thus increasing profit) and/or increasing the services to select from ( different insurance plans). The government has no incentive to do either because 1) everyone gets the same plan no matter what; 2) costs can be shuffled around to other government offices; and 3) if the money is not spent on some aspect of the UHC then some other office gets to spend it thereby eliminating the pressure to cut costs and improve efficiency. A private company is internally pressured to cut costs while the government must be pressured by the tax-payers ( and I won’t even try to estimate how much that costs).
2. Compensation for executives and shareholder profit: A private company is responsible to the shareholders and if the chief executives are not providing benefits commisserate with what they are earning then the executive gets replaced. Because a private company cannot shuffle or share costs it is much easier to directly measure the monetary benefit that a given executive provides the company. Executive pay is like any other expense for a private company: the company wants to reduce it as much as possible and still get its money’s worth.
The countries that we routinely think of as having the best UHC’s have almost all moved toward increased privatization to cuts costs and increase efficiency.
Australia has a UHC and it uses the private sector so extensively that it is now only second to the United States among industrialized nations in the share of health care spending that is private.
Since 1993 the German government has been experimenting with American style managed competition to give citizens more options and cut costs.
The Netherlands also has an extensive network of private health care providers and more than one-third of the population is privately insured.
Health insurance is compulsory in Switzerland and is handled by the nation’s competing private insurers.
The insurance industry is like any other industry and the incentives are the same. Insurance companies want to provide a service to people and make a profit by doing so. As I’ve already said, overregulation by the government has increased the cost of doing business for the insurance companies and created perverse incentives by forcing some insurance companies to accept some people they would not have accepted etc.,
This study says plenty of good things about the US, such as: “United States women reported higher rates of mammography screening “within less than 2 years” but not within the past 5 years. United States respondents were slightly more likely than Canadians to give a rating of excellent to their hospital (but not to their physician or community-based) care. United States respondents were also more satisfied than Canadians with their hospital and community-based care, but not with their physician care.”
And while the conclusion of the study is that “United States residents are less able to access care than are Canadians” in the discussion section of the study it states that “The JCUSH data suggest that Canada no longer enjoys greater satisfaction
with its health care than does the United States” and that “the US uninsured fared much worse than Canadians on most of these measures, whereas the US insured fared slightly better than Canadians (results of statistical testing not shown).”
Which leaves me with the impression that all things considered being insured in America is better than being under a UHC in Canada and that the results of this study are greatly affected by the different demographic factors of the population between the two countries–which it also says in the discussion.
Are they signs of how well the health care system is doing? Sure. But do they tell the whole, or even most, of the picture? Absolutely not. Do they suggest that the health care system if failing without looking at other indicators that might carry even more weight? I don’t think so. I’ve already pointed out that infant mortality and life expectancy have more to do with demographics than the health care system.
Why don’t you provide me with evidence dating back to before the US was behind on these measures that declares infant mortality and life expectancy have more to do with whether or not a country has UHC?
The article says the following about Canada: “For example, in the case of new cancer treatment, the latest pharmaceuticals (such as visudyne for macular degeneration), and high-tech diagnostic tests, Canadian governments simply reduce their expenses by limiting the service. Such a method of rationing is only possible in a single-payer monopoly. Medicare also shares other defining characteristics of monopolies: limited information, little transparency and poor accountability.”
Did you notice that it also says this?: Canadians wait an average of 5 months for a cranial MRI scan; Americans just 3 days (Bell, et al, 1998). Unsurprisingly, many choose to fly south to the US for diagnosis and treatment. A key factor behind these statistics is the inability of the Canadian system to provide even equipment deemed basic, let alone new technology.
That link also notes the “creeping privatization” occurring in the Canadian health care system to combat waiting in long lines for treatment.
But the best part of your link is that it makes my point for me: So why does Canada perform relatively well?Studies have shown that a number of non-health system related factors affect health outcomes.
That’s not what I’ve done.
Then establish and quantify this discrepancy (or find a study that does so) , if possible, and get back to me with some conclusive results.
1) I’m not discounting Japan. I’m just pointing out that Japan has cultural and linguistic homogeneity and the WHO rates the country number 1 in overall health; yet, Asians (not just Japanese) in America have a longer life expectancy than Japanese people in Japan.
2) Neither France or Germany is as heterogenous as the US in any factor that I can think of. Neither has as many of illegal and legal immigrants as the US to contend with either.
Am I racist for pointing that out?
I never suggested anything such thing. In my opinion we should leave the drug companies alone to do what they do best–produce drugs. No mollycoddling or favors required. But we also don’t need to suppress drug prices by using the government to force the companies to charge less than they want to charge.
I must have, because I know that for certain cancers, the US has a higher survival rate than Canada. I also know that there are higher rates of survival for cervical cancer in Canada than the US.
This comment was written by Jamila Akil.Report this comment to the moderators
July 17th, 2007 at 10:28 am
I have a really hard time seeing insurance as “like any other industry” with similar competitive “incentives.” Insurance companies are, at their heart, legalized gambling operations: they insure people who they believe are least likely to get sick and cost them money, then try to spread the costs over as large a group as possible. They make sure premiums outweigh costs by either refusing to insure high-risk populations or denying expensive claims from low-risk populations who have paid their premiums. In addition, they often make their money by investing their premiums in other enterprises, making them more akin to investment banking firms than the providers of a service. As always, we come back to the fact that the most reliable way to keep costs down is to deny care rather than provide care. They only thing they provide to consumers with any reliability is peace of mind, and consumers buy insurance so they can know that they’ll be covered in the event of an emergency. Unfortunately, they can only increase profits if they steal this peace of mind right when you need it.
No, insurance ain’t like manufacturing toothpaste or even like owning a spa. They’re not collecting payment for a service. They’re in the business of collecting premiums from a population that’s statistically unlikely to need their help, and then trying their darndest to avoid paying when the statistical aberration falls ill. Just like a gambler tries to avoid paying his debts when he loses and keeps on collecting when he wins.
This, in and of itself, isn’t an argument for UHC. But it is important to think about the relative merits of free market thinking with respect to different types of industries (think natural monopolies), especially with other moral concerns come into play.
And as for wait times: who here has looked at U.S. examples? We have Medicare and Medicaid already… I’m wondering what the wait times are for Americans covered under those systems as opposed to those covered with private insurance… especially ’cause hip replacements seem to be a big deal among the Medicare set (stolen from yesterday’s Krugman op-ed.)
This comment was written by Murphy.Report this comment to the moderators
July 17th, 2007 at 10:37 am
In addition, they often make their money by investing their premiums in other enterprises, making them more akin to investment banking firms than the providers of a service.
This cannot be overemphasized. The market crash & stagnation in the early part of the decade and the attendant loss of investment profit for health insurance companies is a large part of the reasons we saw huge spikes in premiums. They needed to replace that lost income for their stockholders.
This comment was written by Jake Squid.Report this comment to the moderators
July 17th, 2007 at 4:13 pm
I think it’s important to note that the current system is not a health care market. UHC wouldn’t represent a move from market rationing to technocrat rationing. It would be more like replacing an unpleasant messed up system with another unpleasant system that is messed up in a different way. Plus a deficit.
This comment was written by joe.Report this comment to the moderators
July 18th, 2007 at 12:25 am
Sailorman, the difference between faulting biology and faulting culture is huge in the qualifications on the *strength* of your argument that you would be able to make, which is why bona fide racists go to such trouble to ensure that the former, not the latter, define the terms of the debate. Let me go over how this is so:
1. Perhaps the most important one is that biology can only be a cause, never an effect. With culture, causality is a sticky point. Cause? Effect? Cause-and-effect feedback cycle?
2. Biology “crowds out” all other explanations; culture is nuanced, multifaceted. For instance, it’s entirely possible for Asian culture, what with us being so polite and genteel and all, to have standards of hygiene and moderated living that promote health. But within an ethnicity, “culture” is not a monolith, and is in fact fairly well defined by class. The culture of predominantly upper class Asians that are overly represented among Japanese, Korean, and Chinese immigrants of the past thirty years, and that of impoverished Hmong and Laotians in California, are at opposite ends of the pole. It’s entirely possible both for Asian immigrants self-selected by class to pull up numbers for Asian Americans, while other factors - with culture, there by necessity are many such other factors - such as universal health care, raise numbers at home. A broad, statisical trend is generally indicative of a single cause, yes, but only biology *necessitates* it. (Besides, apart from biology, what “single cause” could there be? Hygiene?)
3. Biology is specific, culture is inclusive; related to point (2), as the specificity of biology is what makes it Universal health care and a preference for collectivisation can itself be a part and parcel of culture itself
This is far from an exhaustive exposition, and I’m sure some of the bloggers here who study this stuff for a living could have done more with it, but I’m sure I’ve touched upon it sufficiently to make my point. The difference between a biological difference and a cultural difference is so often the dividing line between “point that helps my argument”, and “fairly neutral observation, the roots of which probably loop back to my opponent’s arguments anyway”. See any racist arguing minority crime rates for more information.
“Public health care is not fundamentally more efficient than the private system; in fact I would argue that it is fundamentally less efficient based on the same reasons you provided.”
Jamila, everyone here has taken basic economics at some point in their lives. Re:why a rote copy and paste of chapter 3 of the textbook is inappropriate in this case (as it usually is):
1. The incentive is for private companies is to be efficient on a relative scale, not an absolute one. You don’t need to beat your opponents 15-2 when it’s more economical to do it 4-2. A company that pays its executives 8 million dollars each is perhaps more streamlined than one that pays them 10, but it’s still worse off than one that doesn’t have to work within the confines of a system that has to pay executive compensation to begin with.
2. Like introductory economics texts everywhere, your oversimplified models pose an obstacle to their relevance to real world examples. In this case, a “company” is no more a discrete entity than a government is. In the grand tradition of proclaiming that collective entities such as “society” don’t exist, “companies” don’t exist. Companies are made up of disparate departments, in which work disparate individuals. Individuals working in companies, if feeling particularly loyal, may strive to correct whatever problem they’re working on to the betterment of the company. They may also find ways to shift the costs to make it the problem of someone else within the department. Departments may do this to other departments. And neither is this an all-or-nothing proposition; they may doing both, in helping the company against other companies while also burning a lot of money through internal friction. This is a problem with all large scale organization, and your argument here simply bursts with special pleading.
3. If you can’t find a flaw in the circular reasoning involved in “executives must be worth it, otherwise they wouldn’t be paid what they are paid”, then there’s little I can do to help you. I could point out that the average CEO gets paid more than six times that his counterpart did in the early eighties (keeping in mind in many cases it’s still the same person), and that American CEO’s get paid much more than their European or Asian brethren, and all the complications these pose to the simplistic textbook explanation. I won’t delineate them in detail at the risk of going off topic once again; suffice to say, the principle behind point (1) applies here: CEO’s may be “commensurately” compensated (though it’s still not a certainty) in relation to other, similar CEO’s also testing the market, but it’s harder for the market to correct the under- or over-valuation of an entire class of workers. Sure, we could substitute away from a class of overvalued workers, if we can ignore path dependency, institutional inertia, and the political power that the overvalued workers in question wield within the very firms that need the reforms.
“The countries that we routinely think of as having the best UHC’s have almost all moved toward increased privatization to cuts costs and increase efficiency.”
The question then, is why none moved towards complete privatization to cut costs and increase efficiency even further. Must be some significant drawbacks to that, I assume. Because so far, the scorecard from private-to-public vs. public-to-private is something like 12-0.
Not that I can’t see a bit of a logical fallacy in “what changes these other countries must always be for the better, therefore if enough countries agree with me then by argumentem ad populum I win”. But you can’t have it both ways. A move toward privatization can’t suddenly be indicative of anything that the reverse move toward nationalization wouldn’t be. (Quick question, the US is in the infant stages of a increased move toward collectivisation of health care. What is this indicative of?)
A combination public/private system is indeed what I personally think to be the best, and not just in logistical terms. I don’t approve, for instance, of a public system forbidding people from obtaining outside care (like Canada does, to some extent).
Also, the fact that both UHC systems internationally and programs such as Medicare within the US have proven to be far more efficient on a measured scale should not be forgotten. I realize that what we’re dealing with here is a challenge to that very same measured scale, but to assume a level neutrality here would be too much.
“This study says plenty of good things about the US”
If you’re looking for me to say that Canada is better than the US on absolutely every front, you’ll be sadly disappointed. The study is fairly straightforward in saying that on the net, the Canadian system is superior.
On a related note, the question of insured Americans fare vs. all of Canadians is a frame that even left-wingers such as Moore have accepted, but this is being far too generous. A comparison between 85% of Americans selected to have received better health care than average (where “average” would necessarily include all 100% in its calculations), and that of 100% of Canadians, is invalid for reasons I’ve already gone over. We should drop 15% of Canada - say, people who live in the northern Territories, reserves, outlying islands, etc.
“Why don’t you provide me with evidence dating back to before the US was behind on these measures that declares infant mortality and life expectancy have more to do with whether or not a country has UHC?”
What? Sounds like you started off saying one thing and ended with another. What we’ve proposed is the fairly straightforward proposition that infant mortality and life expenctancy are (incomplete) measures of quality of health care; it “has to do” with whether or not a country has UHC only insofar as the numbers suggest a correlation.
Also, do you deny that pretty much anyone who harps on the shortcomings of either of these measures is a true blue defender of the American system? Do you not understand the problem that this presents re:credibility?
“I’ve already pointed out that infant mortality and life expectancy have more to do with demographics than the health care system.”
You’ve opined it, yes, but you haven’t come close to establishing anything, besides a single tenuous one involving Asians (”tenuous” re: culture vs. biology, see top of post). A number of fairly ludicrous ones you started out with, such as obesity and whatnot, I see you’ve quietly dropped after I pointed the problems with using such measures, and are now using race exclusively. Well, if this is to become another thread on race, so be it.
Also, we’ve gone a long ways in pretending this whole thing is a country by country comparison, US vs. Japan. But every UHC country, each with its own culture, each with its own mitigating factors, each with its own issues with demographics, outperforms the US. Why, specifically, does the US score so low? Is it all the Black people?
“That’s not what I’ve done.”
Anytime you want to discount Black Americans in international comparisons because they (and you among them, which troubles me a bit) apparently *embarrass* America and/or the glorious cause of neoliberalism, that’s exactly what you’re doing.
The only way it would be justified is if similar measures were done with every one of the other countries as well, but here the big if is the word “similar” - as in similar in number, similar in extent. Discounting Black Britons, just off the top of my head, would be a disingenuous half-measure, because Black Britons have not experienced the same history of race-based stigmatization, oppression, and cycles of poverty as have Black Americans.
In fact, this is part of the reason why playing the race card to level international comparisons, as it is used to force the numbers America’s way in some manner or another, is invalid. The race problem in America is in some ways unique, or at least rare, (though here we must make a difference between historical racism, which was greater in America, and present day racism, which is greater in Europe), and is also well-publicized with the dissemination of American culture and media internationally. There may be equivalent ways some other alien culture has been historically divided that we’re simply not cognizant of. That culture would also look better if we could conveniently fudge their own problem elements. But instead, we have America’s bete noire, race. And we conveniently fudge it, *across the board*.
To exaggerate a bit for effect, imagine if I, as a cwazy commie leftist, were to propose that capitalist America was a more unequal society than traditional India. But I’ll discount religiously defined untouchable castes, *across the board for both countries, equally*. Get it?
“Then establish and quantify this discrepancy (or find a study that does so) , if possible, and get back to me with some conclusive results.”
Jamila, you’re the one who brought up the race factor, and the one pushing it as an argument. This wouldn’t matter if I were putting forward a separate, positive claim regarding the race factor, but I was merely pointing out the flaws in the reasoning you have already employed. Any burden of proof here lies entirely with you.
“2) Neither France or Germany is as heterogenous as the US in any factor that I can think of. Neither has as many of illegal and legal immigrants as the US to contend with either.
Am I racist for pointing that out?”
No, but neither are you correct. The factors that Jamila Akil can think of and the factors that there actually are, objectively speaking, are two different sets. (Props to Amp for introducing me to this particular snarky mode of response.) There is more to heterogeneity than ethnicity, and more to ethnicity than the gross number of residents without documentation. In many ersatz developed countries, notably in East Asia but with notable European exceptions such as Italy, the urban/rural split is that of a postindustrial vs. preindustrial society. In Canada, we live virtually along a cline whereby all measures of quality drop the further north you go. These are but two examples of great heterogeneity that America is lucky to not to have to contend with.
“I never suggested anything such thing. In my opinion we should leave the drug companies alone to do what they do best–produce drugs. No mollycoddling or favors required. But we also don’t need to suppress drug prices by using the government to force the companies to charge less than they want to charge.”
Jamila, haggling over prices is part of any market. Prices will always be “suppressed” below that which the supplier *wants* to charge - at least, in any market that’s functioning properly. Enforcing by law (which probably involves Men With Guns, now that I think of it) to remove a particular situation whereby the supplier might not get exactly what she wants is in fact mollycoddling.
“I must have, because I know that for certain cancers, the US has a higher survival rate than Canada. I also know that there are higher rates of survival for cervical cancer in Canada than the US.”
Then go back and read them, if you please.
This comment was written by sylphhead.Report this comment to the moderators
July 18th, 2007 at 1:06 am
First off, I linked to the wrong study; no mention was made of the Manitoba study there. However, it (is it the same Manitoba study? I don’t know) forms a centerpiece of this report.
Second, I realize I said I wouldn’t play tit for tat for Jamila again, but it turns out I just did. Curse my competitive nature; what an excellent capitalist I’d make.
But if we want to quote mine and argue the earlier study, by all means let’s do so. I have an appreciation for gall and I like that you’ve tried to quote my link against me, but if we go down this road, it’s not one you can possibly win, given what the study itself actually says. (I invite all on-readers to go read it.) This will shape up to be my favourite sort of competition: ones that are pre-emptively stacked in favour.
“… quality-of-care ratings were similar in the 5 [Anglophone] countries3. Some4, but not all5, have found better health care quality in Canada.”
The study referred by the “not all” referred to income-based inequities that persist in Canada’s UHC. So while there are studies that rate Canada higher, there don’t appear to be any that explicitly do the same for the US.
“Very-low-income populations, who may be less likely to own a telephone, may be undersampled.”
So this study understates the gravity of downward effect that the uninsured would have on America’s standing, insofar as very low income is correlated with lacking insurance. Which, I’m sure, is a reasonable assumption.
“Compared with Canadians, US residents are one third less likely to have a regular medical doctor, one fourth more likely to have unmet health care needs, and more than twice as likely to forge needed medicines.”
I believe the first sentence answers an inquiry for a source regarding a comment about primary care physicians. I think ‘regular medical doctor’ and ‘primary care physician’ is more or less talking about the same thing, though I could be wrong.
“… long waiting times led to an unmet health need for only a small percentage (3.5%) of Canadians.”
Make no mistake, this number is smaller in the US (1%). But let’s compare 3.5% vs. the 15% of Americans who are uninsured.
“Universal coverage attenuates inequities in health care, and should be implemented in the United States.”
If you say so, doc.
Murphy: exactly. To them, every market is a market of widgets: homogeneous product, large number of buyers, large number of sellers, no spillover effects, no adverse selection… in other words, the absolute theoretical perfection that a market could obtain. They (and Jamila may not be part of the ‘they’ here, as I don’t know enough about her other positions) then use this to try to shoehorn advocacy for the greater inequality and stratified moneyed power that they so desire. Health insurance is among the tamer of what I’ve heard right-libertarians try to manipulate in this way: in no particular order of fucknutted-uppitude, I’ve heard that constitutions, police protection, legal tenders, and human-rights-as-legal-vouchers, should be privatized and made to work as functional markets.
“Plus a deficit.”
Joe, not only is the average American paying more for health care than the average resident of an industrialized UHC nation, he is paying more just in taxes for the tax-funded component of American health care than those of other nations – not even getting into private expenditures. I’ve already provided the links for these, please read them before presuming to know something that the rest of us don’t.
“I think it’s important to note that the current system is not a health care market.”
Yeah, yeah, US health care (and Californian power, and post-NAFTA Mexico, and pre-Kirchner Argentina…) is not a True Market at work. Just like the Soviet Union was not True Communism.
This comment was written by sylphhead.Report this comment to the moderators
July 18th, 2007 at 3:36 am
Slyphhead, my point about markets was only that we wouldn’t be abandoning a healthy, working market by going to single payer, and that the current system is not great. This is more of an argument for UHC than it is an argument against it. (CATO would probably say it’s also an example of how interference in the market causes distortions and strange systems but that’s not the topic at hand)
Re
I’ll stipulate that we could do what you say if the government took all of the money now spent on health care, and intelligently used it and only it for the public good.
I don’t think they’ll do that. I’m sure that congress will want to allow companies to keep some of the money they’re currently spending on health care. I know GM wants UHC so that their costs relative to foreign competition will go down. I assume most of the other large companies in support of UHC have a similar rational. Funding UHC by making companies that currently pay for generous health care benefits pay all the public costs would have some fairly obvious problems. So there will be tax cuts involved. If there aren’t then there will be substantial resistance by many of the large companies that currently want UHC. There will almost certainly be tax increases in some areas as well.
I also suspect there will be substantial transition costs as we migrate from the current system to a new system and that there will be substantial start up costs.
I also don’t think that congress will be willing to implement UHC on a paygo basis.
Neither party has shown any real desire for budgetary discipline.
So yes, I think that implementing UHC will involve an increase in the budget deficit.
This comment was written by joe.Report this comment to the moderators
July 18th, 2007 at 2:11 pm
Ampersand already answered this question in post #162 and I agreed with him on post #175. It makes people feel good to have a safety net, regardless of how much that safety net costs, how long the queues are to receive care, or how much more likely you are to be cured of whatever ails you.
This will be my last post in this thread because I also don’t want to waste anymore time going tit-for-tat.
This comment was written by Jamila Akil.Report this comment to the moderators
July 20th, 2007 at 3:13 am
Aww… I’m still up for it. In any case, if it is making people ‘feel good’ - which about fits the tautological definition of economic utility - and they are making informed choices, as would be expected if health care indeed is just like the theoretical markets described in textbooks, some self-appointed defenders of the market are going to awful lengths to clamp down on these people’s choices; not by serving them better as consumers, but through political means. Should we always do this when consumer choices effect unacceptable social consequences? Perhaps, but I’d be wary of it.
Universal health care is about as unambiguously good a cause as you’re going to get - it is morally, practically, systematically better, as everything everyone’s presented here has shown. It is a shame that a dogmatic ideology that is *facially* anti-government has to take it upon itself to beat back common sense against the pleas of fellow citizens, and it’s a shame that diehard followers rote memorize CATO-approved screeds of half-truths where ignorance can take a breather when barraged too heavily by objective reality.
This comment was written by sylphhead.Report this comment to the moderators
July 20th, 2007 at 5:23 am
sylphhead Writes:
Should those who want a UHC be allowed to force it upon those of us who don’t want it, thereby restricting our choices? I think your answer would be yes.
I value my freedom far more than I value a promise of healthcare by the government. The more I think I about it, the more I see that the battle over a UHC in America is really a battle over values. There are those of us that value our freedome more than anything and there are those of us that value equality and/or a safety net more than anything. The two sides will never agree because they don’t see eye to eye on values.
This comment was written by Jamila Akil.Report this comment to the moderators
July 20th, 2007 at 7:01 am
[Robert, this is still one of my threads. --Mandolin]
This comment was written by Robert.Report this comment to the moderators
July 20th, 2007 at 7:27 am
You might as well ask why we have to pay taxes at all. If having any government services at all is such a great idea, why can’t we achieve it by forming a voluntary collective of individuals who choose to pay for it?
From the current issue of The New Yorker:
Some things, including UHC, are only workable if everyone does it. It benefits almost everyone to be part of a large, collective system, but it only works if everyone can be assured that everyone else is going to be acting likewise.
It’s nonsensical to demand that government-paid health care be tried first as a private system; by definition, it’s NOT a private system. (But check out the VA health care system for an example of a government-run health care system that works great.)
As for “armed coercion,” this trite libertarian talking point can be used against having any government at all. If you’re really so far out of the mainstream that you favor anarcho-capitalism, then there’s probably not much point in debating with you.
If, in contrast, you do believe in the social contract, then I need to remind you that in the US, paying taxes for the services provided by government is part of the social contract. You don’t get to pick and choose which government services to pay for, except by picking and choosing which politicians to vote for (and also lobbying, writing letters, etc).
Finally, can you name any nation-scale social system that has ever worked in the real world which didn’t require “men with guns” at some level of the system? Do you actually favor a system that you think is viable which doesn’t involve “men with guns”?
This comment was written by Ampersand.Report this comment to the moderators
July 20th, 2007 at 7:35 am
Why should I accept a profit-based health care system being forced upon me, and others who don’t want it?
I value my freedom just as much as you do. I simply think that more people will be substantively freer under an adequate UHC system than under our current system.
I disagree. I think the real conflict is between those who believe that freedom is expanded, rather than limited, by effective safety nets; versus those who think that the only freedom that matters is freedom from government interference.
This comment was written by Ampersand.Report this comment to the moderators
July 20th, 2007 at 7:50 am
[Robert, this is still one of my threads -- Mandolin]
This comment was written by Robert.Report this comment to the moderators
July 20th, 2007 at 7:52 am
[Robert, this is still one of my threads --Mandolin]
This comment was written by Robert.Report this comment to the moderators
July 20th, 2007 at 8:25 am
Robert,
All UHC systems are at heart redistributive. But it’s not a disguise. You can’t provide valuable services to poorer people without overcharging the richer people and/or subsidizing the poorer people, both of which are redistributive in nature.
If some people get more than they pay for, then other people are paying for more than they’re getting.
This comment was written by Sailorman.Report this comment to the moderators
July 20th, 2007 at 8:32 am
No one is forcing it on you. That’s the point. If you can find a doctor who’ll treat you for free, no one is stopping you.
This comment was written by SamChevre.Report this comment to the moderators
July 20th, 2007 at 8:33 am
This comment was written by Robert.Report this comment to the moderators
July 20th, 2007 at 10:26 am
OK, I’m assuming all “engage the actual argument” rules are out the window.
This will be fun.
This comment was written by SamChevre.Report this comment to the moderators
July 20th, 2007 at 10:31 am
Sam,
I don’t know to what you refer, but Robert, BrandonBerg, and Daran have all been asked not to participate in my threads. Robert is aware of the rule, and has been reminded on this and other threads.
This comment was written by Mandolin.Report this comment to the moderators
July 20th, 2007 at 6:36 pm
So I should accept UHC being forced upon me instead?
If you valued my freedom as much as I value my freedom, you wouldn’t try to force a UHC on me.
I think we are saying the same thing and I agree with you, but I would like to add that I don’t just want freedom from government interference, but freedom from well-meaning people who think they know what is better for me than I do; that includes people who insist that they just want to expand my freedom by a UHC despite the fact that I tell them I don’t want it.
This comment was written by Jamila Akil.Report this comment to the moderators
July 20th, 2007 at 6:46 pm
Ampersand Writes:
Not in the industrialized world.
G.K Chesterton once said: “The Christian ideal has not been tried and found wanting; it has been found difficult and left untried.”
I would take that statement and apply it to the ideal libertarian society: it hasn’t been tried and found wanting, it has been found wanting ( in theory) and left untried.
This comment was written by Jamila Akil.Report this comment to the moderators
July 20th, 2007 at 8:42 pm
That’s probably because it would be ideal, rather than real.
but freedom from well-meaning people who think they know what is better for me than I do
The job of “well-meaning people” is not to put the preferences of Jamila Akil above all other considerations. For example, it would probably be better for me if I were allowed to do whatever I pleased but everybody else was bound by law and custom; do you think I should complain that “well-meaning people” are cockblocking my freedom?
This comment was written by mythago.Report this comment to the moderators
July 20th, 2007 at 10:13 pm
mythago Writes:
I don’t believe that I ever asked them to make it their job.
You can complain about cockblocking all you like. Heck, if you can make a mean apple m