Saturday, November 19, 2005

Dead Meat

I just watched a new documentary by Stuart Browning and Blaine Greenberg that exposes the socialist healthcare system of Canada. Interviews with patients who have been left waiting, sometimes for years, to get surgeries or procedures for life threatening illnesses will expose the viewers to the cruelty and unaccountability of a single-payer health care system. Liberals in the US talk a good game of having universal health coverage where everyone benefits--including the poor. The joke is, the single payer system provides poorer care for everyone--including the poor. I also find it ironic that the majority of people who support the Canadian system appear to be well. Try being sick and involved in one of these socialist healthcare systems and I think that view would quickly change. See the trailer for the documentary , Dead Meat, here.

Update: Stuart Browning, from On the Fence Films, addresses our discussion about the politics of the Canadian Health Care System.

Another Update: A news story describing the wait times in Ontario. Thanks to Newsbeat 1.

Update III: Here is more information on wait times at doctorrw.

104 Comments:

Blogger Greg Kuperberg said...

This is propaganda that is ultimately stoked by people who profit directly from the expensive American system, even if it can be passed on out of pure intellectual belief. Anyone can make any country's medical system look bad with anecdotes and fragmented statistics. But if you study comprehensive data, a different picture emerges. Americans spend 80% more on health care per person than Canadians. Nonetheless Americans, on average, aren't particularly happier with their health care than Canadians are with theirs. Moreover, Canadians live longer than Americans do. Even if you control for ethnicity and climate, for example if you compare New Brunswick to Maine, the Canadians live just as long.

But it isn't just about Canada. The fact is that America does have a single-payer health for two important groups: seniors and veterans. Medicare and the VA do about half the job of health care in the United States already (since their subscribers are older and sicker on average), and they are both essentially single-payer systems. Should we feel sorry for veterans that they must suffer with single-payer health care? No, they have absolutely no inclination to part with what they have. Instead, they can feel a little smug that they don't need the expensive private simulation of single-payer health care that most Americans buy.

For that matter, I also have it a lot better than most Americans, since I have medical coverage from a tenured job. I suspect that if you are married to tenured faculty, you are in the same position. It would be hypocritical of me to promote a system whose greatness weakness is its coupling to unstable employment.

11:36 AM, November 19, 2005  
Blogger dadvocate said...

It is really hard to discern the truth about the Canadian system versus the U.S. system. My personal doctor is a native Canadian who moved to Kentucky with his family about 10 years ago. His wife is also a native Canadian and a MD. Both were trained in Canada.

The primary reason they moved to the U.S. is money. But this probably does mean we attract and keep more doctors and such because of our system than countries such as Canada.

BUT, on the over hand, our cost of medical care is way to high. I earn slightly under $50,000 per year. With three dependent children, I have great difficulty meeting the costs of medical care. This ususally means neglecting my own health care needs in order to attend to my children's.

Costs have skyrocketed of the past 40 years also surpassing inflation by many times. My first child was born in 1971. Total costs were less that $500 including prenatal care, delivery, semi-private hospital room for 3 nights, etc. I paid less than $20 out of my own pocket after insurance. Now that wouldn't cover the cost of a sonogram.

Hopefully, we can create a system where needs are met, doctors and other medical professionals make a good living (they deserve it), and costs are reasonable.

12:01 PM, November 19, 2005  
Blogger Greg Kuperberg said...

DAdvocate: I will just guess that even though your medical care is expensive, you don't have a really serious chronic illness. I wonder what your medical coverage would look like if your insurance company asked you, "Do you have a pre-existing medical condition?", and you had to answer, "ventricular fibrillation".

12:45 PM, November 19, 2005  
Blogger Helen said...

To greg,

In Canada, I would probably be dead--my cardiologist had me with a specialist within the week and after testing--I was given a defibrillator within two days. I would still be in Canada on a waiting list to see a specialist at this point.

1:10 PM, November 19, 2005  
Anonymous Elliot1 said...

Medical costs will contnue to escalate for a very simple reason: technology and treatment options continue to expand.

Implanted defibrillators have been mentioned here. Does anyone know of someone who had one of them 15 years ago? They are a new technology, hence an incremental cost. The folks who needed them 15 years ago died and their medical costs ceased.

Likewise we have added the CAT scan, MRI, orthoscopic surgery, human growth hormones, and a thousand others that I can't name. Under our system, these are widely available.

We can reduce medical costs by reducing the availability of these technologies and treatments. Does anyone advocate that?

We can expect even more advances, and each time an advance becomes available, incremental costs rise.

It is possible that technology will reach a point where it will have such a preventative effect that the number of maladies rquiring treatment will fall. This could lead to a decrease in total costs.

Who wants to wait when their life depends on prompt treatment? Who wants to wait because someone has a study pointing to averages that dont apply to them? Who is willing to let someone else wait?

2:05 PM, November 19, 2005  
Blogger Greg Kuperberg said...

Helen: I think that it's wild hyperbole to say that you would "probably" be dead if you lived in Canada. My uncle is a doctor in Canada, or was until he retired. He would be the first to tell you the problems with the Canadian system. But it isn't a Dickens novel in which doctors as a group do nothing for dying people.

The starting point of this discussion should be that the life expectancy in Canada is 80.10 years, while the life expectancy in the US is 77.71 years. This is according to the CIA factbook. If so many people are dying on waiting lists in Canada, where did these extra 2.4 years of life come from?

Well, one reason is that even if waiting lists are bad, they are not as bad as outright denial of care. I bet that for every Canadian who dies from ventricular fibrillation on a waiting list, proportionately as many Americans with the same condition die from lack of medical coverage.

Elliott: Again, if the United States is so full of miracle technology, how come Americans don't live as long as, for example, residents of France?

2:17 PM, November 19, 2005  
Blogger Helen said...

To Greg:

Here is the answer to that question on the film's website:


Yes, but Canadians, on average, live slightly longer than Americans. Isn't this proof that their health care system is better?

No, it's not. A nation's average life expectancy is the result of a multitude of factors including the lifestyles, genetic makeup, environment and education of it's citizens - and the U.S. is composed of large ethnic groups having differing life expectancies. For example, the average life expectancy of a black male in the U.S. is 68 years, while a man of asian descent has an average life expectancy of 81 years! The quality of a health care system has very little to do with the average life expectancy of an entire population - however, it has a lot to do with the the health outcomes of those who are already sick - and on that score, the U.S. does better than Canada. 25% of those diagnosed with breast cancer in the U.S. die from it - while the mortality ratio in Canada is 28%. Similarly, the U.S. prostate cancer mortality ratio is 19% while 25% of those diagnosed with prostate cancer in Canada die from it.

2:33 PM, November 19, 2005  
Blogger Greg Kuperberg said...

Well, this is stacking inaccurate terminology on top of selective statistics. There is nothing "slight" about 2.4 years of life expectancy. 2.4 years is a lot. If the producers of this movies were actually loyal to their point about race and education and so on, they could have controlled for it. The white life expectancy in the United States is 78.0 years. The Canadian life expectancy for all races is 80.1 years. There are more Asians in Canada, but not nearly enough to explain the difference.

I don't think that the producers are going to find racial and ethnic excuses to fully explain why Canadians live longer. They would have to claim that there are more uneducated white rednecks in the US than in Canada. Even if they were willing to claim that, it would support the larger point that there is more to health than billed health care. It would mean that the American system is, compared to Canada and many other countries, an ounce of prevention and a ton of cure.

Even looking at specific question of health care, it is propaganda to seize on the specific faults of the Canadian system, as if the American system had none. And to equate delays in elective surgery with single-payer health care. Germany also has single-payer health care, and its average wait for elective surgery is shorter than the United States.

But I suspect that if the same people made another movie about Germany, they would ignore surgery waits; they would seize on the one facet of health care that makes Germany look the worst relative to the United States. And they would continue to ignore the fact that the United States already has single-payer health care for people over 65.

3:04 PM, November 19, 2005  
Blogger Sally said...

Greg-

I see a lot of problems in the U.S. health care system. After working in an area of welfare reform, it was horrifying for me to see how healthcare is divied up: the very poor receive free healthcare through medicaid, those with stable full-time jobs often receive it through employment and still others pay huge rates when they apply for health insurance independently. The working poor and middle class who do not receive health insurance through their employment are the ones who are most screwed.

But, your argument correlating life expantancy in Canada with a superior healthcare system is weak. Perhaps Americans live 2.4 less years than Canadians because we guzzle gas instead of walking, work extraordinarilly long hours and adore junk food? I'm not sure that these are the reasons Americans have a lower life expantancy than Canadians, but you have shown no proof that health care is the reason for this.

4:26 PM, November 19, 2005  
Blogger Greg Kuperberg said...

Allicent: I do not just mean to argue that the Canadian system is better just because Canadians live longer. There is a lot more to it than that. My point is that if they do live longer, it is unlikely that our health care system is fantastic and theirs is terrible. If the movie "Dead Meat" had been meant as advice for Canadians, you would be completely right and my point would be irrelevant. But the real message of this movie is for Americans. It is that we have nothing positive to learn from Canada, home of a failed socialist health care system. In fact that the only lesson from Canada is that we shouldn't have single-payer health care at all. That message is just political propaganda.

Anyway, a modest proposal: If single-payer health care is such a terrible idea, and if it is also important to respect our nation's veterans, then we should not offer them single-payer health care. We should dismantle the VA and instead grant every veteran a lump sum matched to its average cost per veteran. Then veterans can buy their own medical care in the superior private insurance system.

Next from the modest proposal file: Let's also dismantle tenure and medical benefits at public universities in favor of more capitalist solutions. Health care is not a right, you know. Neither is tenure. Okay, I know that this is downright mean-spirited and I do not mean it at all seriously. I also have tenure and medical benefits at a public university.

5:21 PM, November 19, 2005  
Anonymous scooby said...

But if you study comprehensive data, a different picture emerges. Americans spend 80% more on health care per person than Canadians. Nonetheless Americans, on average, aren't particularly happier with their health care than Canadians are with theirs. Moreover, Canadians live longer than Americans do. Even if you control for ethnicity and climate, for example if you compare New Brunswick to Maine, the Canadians live just as long.

I'm still waiting for your comprehensive data. So far you've established that Canadians live longer and are just as (un)happy as Americans with their health care.

Nothing "comprehensive," yet. Sounds more like the anecdotes and propaganda you mentioned earlier.

5:35 PM, November 19, 2005  
Blogger Sally said...

Greg,

As I wrote previously, I agree that there are a lot of problems with the U.S. health system. I also believe there are a lot of problems with the Canadian systems, judging from what I have read and from the stories of family friends in the medical community in Canada. It would be nice if people could reflect on the benefits and negatives of each system, so that we could rationally reflect on how to make both systems better.

In regard to life expectancy in the U.S. vs. Canada, you are still drawing a correlation between life expectancy and heathcare. And as I said before, you have no proof that there is indeed a correlation between the lower life expecancy in the U.S. and healthcare. As I said before, there are many variables to consider and nothing can be concluded from those 2.4 years.

5:49 PM, November 19, 2005  
Blogger Helen said...

Greg,

I would be very reluctant to make my healthcare anything like the VA's--I work with veterans and believe me--the care is not great.I once read an article stating that they had made more medical mistakes than civilian facilities. If that is your model of a single payor system--it's not a good one.

5:50 PM, November 19, 2005  
Blogger Greg Kuperberg said...

Allicent: By the way, your paragraph on the situation with American health care looks dead-on to me. I think that you summarized it very well. And I think that it does a lot to explain why the American system is 80% more expensive per person than the Canadian system, even though in any realistic light it certainly doesn't look 80% better.

scooby: Of course it is not my comprehensive data. I do not have time to make my own documentary. Good analyses exist, but the makers of "Dead Meat" (as you might expect from the title) aren't too interested in them. They are from the Michael Moore school of ambush journalism.

Even so, if you want at least better statistics that reveal something about common lifestyle, province-by-province tables for Canada are here, while state-by-state tables for the US are here. I have never noticed much demographic or lifestyle difference between Maine and New Brunswick, for example; and indeed their life expectancies are about the same. But New Brunswick residents have much cheaper health care. (Granted, this is still simplistic, but it is at least an improvement over an anecdote-based documentary.)

5:59 PM, November 19, 2005  
Blogger Greg Kuperberg said...

Helen: I have relatives who work in the VA system too, and I think that you are right that the VA is not a very good single-payer system. Maybe none of them are. But it may be as Winston Churchill said about democracy as a system of government: it is the very worst system, except for all of the others.

I can tell you what would become of my modest proposal to dismantle the VA in favor of lump sum checks. What would happen is that a lot of veterans would no longer be able to pay for their health care.

Allicent: I can only say that I agree with everything that you say, other than your interpretation of my position.

Well, maybe not quite. If you took all the countries in the world, and hypothetical countries too, you would at least expect a correlation between life expectancy and health care. You would not expect them to have absolutely no relation. But your real point is that life expectancy and health care are not equivalent. In that, I agree with you.

6:12 PM, November 19, 2005  
Blogger Sally said...

I agree Greg, something needs to change in the U.S. and I am by no means a bleeding heart. As a former educator for the welfare system, I saw many in need of the system, as well as many who exploited it. My students would spend 8 dollars every day going out for lunch (unlike the homemade inexpensive lunches the teachers would bring) yet they would make an appointment with a doctor under their free medical care, just to receive a free prescription for Tylenol. They would also make an appointment for every tiny malady - from diarrhea to headaches. Not very cost effective. Meanwhile, the working poor are stuck with the option of paying 600 dollars a month for healthcare or just not receiving healthcare when needed. This is insane.

I also can't imagine that the U.S. healthcare system supports innovation in family structures and employment options. As a member of the upper-middleclass, I by no means enjoy being held hostage by employers that offer health benefits. This means less choice in who we can work for and how we can work. My husband would much rather work for a small company, or start his own, but healthcare is a looming issue. How does this encourage innovation in our capitalistic society?

However, I do not want the U.S. to adopt a Canadian system. Does anyone know about the Austrailian healthcare system? From what I know, you pay for health insurance, although the fees are much more reasonable. I'd like to see the U.S. go in that sort of direction.

6:40 PM, November 19, 2005  
Anonymous Elliot1 said...

Greg wrote:
"We should dismantle the VA and instead grant every veteran a lump sum matched to its average cost per veteran. Then veterans can buy their own medical care in the superior private insurance system."

Elliot1 answers:
Perhaps we should. I'd be interested in the average cost of treatment for the population that receives most of its care from the VA. (This population is far lower than the total number of vets.)

An age adjusted payment might provide good insurance coverage for vets that would also deliver better treatment than they get today.

Regarding the question of longevity as related to quality of health care, does the population with the highest longevity have the best health care system? If the US population covered by Aetna Preferred had higher longevity than the total population of Canadians, would that mean Aetna Preferred had a better health care system than Canada? I would say there is insufficient information to make that call.

11:26 PM, November 19, 2005  
Anonymous Anonymous said...

Doing nothing is not an option in the US, at least not for too much longer. We are beginning to see the end of the health care as a benefit of employment, and that will increasingly push the issue to the forefront.

Why don't we just expand the Medicare program to cover the whole population.

This would offer several advantages. First, it would mean the broadest possible risk pool, which is the best way to keep premiums down. Second, it would allow people to choose their own doctors. Third, those who wanted more than what was offered under Medicare could buy private insurance, or Medigap policies, leaving a role, even if a smaller one, for private insurers. Fourth, it would de-couple health care from employment status, which is increasingly necessary as fewer and fewer people will be working for one company--or any company--for most of their career. Fourth, it would remove from American business and industry the enormous healthcare obligations they now have, which leave them much less able to compete in a global economy. (In today's New York Times, GM officials point out that their challenge is NOT in controlling wages, but in health care costs.)

Laying out the flaws in other national health care systems, and throwing out reasons why any chanage at all won't work, is neither a solution NOR an option we will enjoy for much longer.

11:55 PM, November 19, 2005  
Blogger Greg Kuperberg said...

Anonymous: You have the right idea there. Why not just lower the eligibility age for Medicare year by year until it reaches zero? It's too late to condemn Medicare as an un-American socialist heresy. (Well, it may have crossed Bush's mind, but he has no shot at it.)

As you say, it would lift an enormous burden off of the backs of American companies, a burden that they are trying to ditch anyway. To a large extent, GM is now a medical insurance company — cars are just a side show. And GM is not alone.

It's one of those ideas that's just too simple for politicians to accept.

12:16 AM, November 20, 2005  
Blogger AmericanWoman said...

I agree that something must be done in most healthcare systems. None are working well. Even Austrialia is suffering from a cash crunch.

It is the same issue as Social Security. How much control of your life (and your money) do you want to give the government?

Yes, Medicaid is wonderful for seniors and some others. The costs of if are also skyrocketing. I am not convinced that our government, or any government, is the best entity to control something as important as our healthcare. All you need to do is look to the UK to see how care is rationed. It would just be trading one limiting system for another.

People have to understand that healthcare is not a right, but a commodity. It is going to cost you money one way or another. People that work in healthcare and for pharmaceutical companies are not working for free. They have to eat too.

My company just changed its healthplans for next year. Like everyone else, we will be paying more OOP than before. Some people view a $20 co-pay as a life sentence. Do you honestly think these same people will agree to a 10-15% hike in federal taxes to pay for 'Medicaid for everyone'? I wouldn't.

As with Social Security, the government should care for those that TRULY cannot care for themselves. That means the poor, and old poor. Many older people are not poor and don't need government handouts. AND something must be done about the insurance requirements in private insurance to bring costs down.

Those of us that can afford to fund our own retirements and healthcare have an obligation to do so, so that those who again TRULY need help will be able to get it.

8:22 AM, November 20, 2005  
Blogger Helen said...

Hopefully technology will bring prices of health care down--the big problem is the bureaucracy that goes into third party payment. Bureaucrats make everything expensive. There are not many areas where government has made things cheaper--that is my problem with any type of socialized medicine. In addition, I would never want my healthcare determined by the government--just think of the political ramifications of it--women with pink ribbons would be advocating for their "rights" to more money spent on breast cancer and being a big voting block--they might get more money for treatment than say, people with heart problems etc. It is a mistake to politicize healthcare more than we already have.

9:17 AM, November 20, 2005  
Anonymous Anonymous said...

At the risk of being eventually bumped off by doctors, one reason being forwarded as to why healthcare in the US is so expensive is the AMA. Restrict the supply of doctors, and their salaries go up.

"In the days of its founding AMA was much more open--at its conferences and in its publications--about its real goal: building a government-enforced monopoly for the purpose of dramatically increasing physician incomes. It eventually succeeded, becoming the most formidable labor union on the face of the earth."

"Since AMA's creation of the Council a century ago, the U.S. population (75 million in 1900, 288 million in 2002) has increased in size by 284%, yet the number of medical schools has declined by 26% to 123."

http://www.mises.org/story/1547

Also, "How Medical Boards Nationalized Health Care":

http://www.mises.org/fullstory.aspx?Id=1749

10:27 AM, November 20, 2005  
Blogger Sally said...

American Woman -

You said - healthcare is not a right, it's a commodity.

I absolutely disagree. And I have to ask you if you would say the same thing for education. Should we privatize education for children? How insane would that be?

You also say that the poor should receive assistance for medical care, and no one else. Well, when it comes to medical care, most Americans are poor in the face of the huge health insurance rates and costs of treatment. Even with my middleclass to upper middleclass salary, my husband and I would be devastated if we didn't receive healthcare through his job.

11:22 AM, November 20, 2005  
Anonymous Anonymous said...

Re: My last post on extending Medicare to cover the whole US population and the good comments in response, I'd lilke to offer a few more thoughts....

First, expect nothing to happen for the next three years. Its going to take new leadership--especially in the GOP.

The government, today, is already the nation's largest healthcare insurer--between Medicare, Medicaid and the VA. While I understand the genuine differences in philosophy, this will not change, and the government role will not decrease.

Medicaid is already the largest item, by far, in many state budgets. Since the welfare reform of the 1990's, enrollment has grown as many who formerly collected welfare have gone on to low wage hourly jobs that offer no healthcare. Medicaid is a welcome and, in many cases, only option for them and their families. It makes welfare reform workable.

As to Medicare, it has been fairly successful in controlling costs. The challenge it faces is that the covered population are those over 65 and those on Social Security disability--folks whose health care needs are high.

It is, in many ways, the same problem state chartered insurers like Blue Cross face in many states. They have to take anyone who applies, and exist in a market where many small and mid-sized insurers, who don't operate with the same requirments, can "cherry pick" the market, only taking younger and healthier people. (Ever see those roadside signs--Health Insurance $100 per month??) Result--Blue Cross rates are much higher. That is what happens when the risk pool is cut up. The flip side of the coin is that many of these non chartered insurers make out very well in the current situation. They are also very well organized, politically, and would fight any attempt to change.

Also, under our current financing system, about 31 cents out of every dollar goes for administrative expenses. Each insurer has its own claim forms and processing procedures. It is inefficient, but there are alot of people who benefit from this inefficiency, which is why it is so hard to change things.

As to pharmaceuticals, the new Medicare act, which is really a thinly disguised attempt to begin privatizing Medicare, is specifically not designed to have any cost control--only a limit on the amout of benefit it provides seniors. The act specifically prohibits the government from using its purchasing power to negotiate directly with the drug industry to get the best rates. It is the almost the only good or service covered by Medicare for which this is true. Why? The pharmaceutical industry, which does many good things, also has about six lobbyists for every member of congress.

Also, seniors are asked to try to pick drug plans, which cover different drugs, from what is often more than 30-40 insurers. The opportunties for confusion, damage and outright fraud are huge. Look for this act to be amended in the next few yearsa.

I believe the solutions to our healthcare financing problem--and this is what we are really talking about--will suggest themselves as the problem becomes bad enough. Keep your eye on the doctors. The real tipping point will come when, as health care is less and less a benefit of employemnt, they have fewer and fewer patients with insurance, or with decent insurance. They will demand a greater federal role for their own professional survival. It is already beginning to happen.

The result of doing nothing will be fewer and fewer insured, a great many with poorer insurance coverage, and severe limits on which doctors insureds can see and what kind of treatment they can have--in fact, all of the things we were warned about by "Harry and Louise" in those 1990's TV commercials aimed at defeating Clinton's efforts.

The only difference will be that these restrictions will be put in effect by private insurers doing so in a process that will be much less transparent and accountable to the public than the decisions controlled by those we elect.

The arguments over whether government should be involved are interesting, but have nothing to do with the real situation today or in the future. The government is a big player and will remain and become more so.

A happy Thanksgiving to all.

11:35 AM, November 20, 2005  
Anonymous Anonymous said...

Allicent: Health care is NOT a right. And I agree that the public education system should be dismantled. Ever since the creation of the federal Department of Education, American children have been consistently getting worse and worse educations in comparison with other nations.

I don't have private health insurance. The cost/benefit ratio makes no sense whatsoever. $3,000 to $5,000 a year for insurance? I don't think I've ever spent that much on health care in a year. What a mandatory government single-payer system would do is force me to spend that $5,000 a year on health insurance I simply do not want. I would be forced, by government order, to subsidize someone else's health care usage.

And expanding Medicare? Please.

What scares me most about this is that while there is absolutely no evidence that government can do anything right, people are willing to give the government control over the most intimate decisions a human can make - those of their own health, life, and death. Do you really want to give the government the ability to say to you "We're sorry, but your condition is just too expensive to fix. Here's a nice burial stipend."

12:15 PM, November 20, 2005  
Blogger Greg Kuperberg said...

I think that in this discussion, Helen and American Woman are conflating government provision with government control. If you're on Medicare, no one prevents you from buying any extra or alternative medical care over medical coverage you want. In fact Medigap policies are an important private supplement that is sort-of built into the system. It's the same as with public schools. No one forces you to use them; you can send your kids to private school instead.

Moreover, they are also glossing over the extent to which the government already does control all of the important decisions relating to medical care. They have already accepted the things that they say that they would "never" accept. The government has already decreed that at least emergency health care is a right. It is completely illegal for a hospital to turn away a heart attack victim just because it has no proof of payment. The government also already has full approval control over all practical treatment for serious diseases, through medical certification of doctors and FDA approval of drugs.

Of course any kind of government control can be abused (just look at the manipulated process for approval of the Plan B pill), but these controls exist for a reason and there is exactly zero chance that they will go away. In fact, the United States is the world's gold standard of treatment approval decisions and many other countries substantially rely on the FDA's thinking.

The one area where the government has relatively little influence is medical coverage — not treatment itself, but coverage — for people under the age of 65. Unlike over age 65, where it provides Medicare. Now, it is true that Medicare's costs are out of control. However, they are less out of control than those of private medical plans. Private medical plans in the United States are the most expensive group medical coverage in the world.

Here the word group points to why single-payer health care survives as an idea. Your ahead-of-time choice of medical coverage plans is hardly ever useful for any personal reason. There is little real competition because the decision is just too complicated. All you want to do is sign up to the group with the most effective group buying power. And that's why Medicare is "less bad" than the alternatives. It's simply because it's easily the largest group medical coverage plan in the United States.

12:20 PM, November 20, 2005  
Anonymous Anonymous said...

Greg -

The FDA's effectiveness is certainly in question. Vioxx anyone? Also note your admission that the FDA is subject to political pressure.

Imagine, if you will, a system of medical care expenditure subject to political pressure. I can imagine someone with lung cancer being refused treatment because they smoke. We already know that public opinions about the "fault" for a disease can go a long way toward determining the amount of research money that disease gets.

Simply - government bad. And there is no evidence anywhere that government works. Therefore the amount of power granted government and responsibility ceded to government should be minimized.

12:28 PM, November 20, 2005  
Anonymous Cover Me, Porkins said...

Missed amid the stalwart defense of socialized medicine: Has anyone ever spoken to a friend or relative of a doctor whom wanton litigation has not adversely affected? A doctor whose costs have not been directly or indirectly driven upward? No?

All right, then.

There's a reason why all the princes of Araby come to the city on the south, not the north, side of Lake Erie for their most pressing medical procedures.

12:43 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Yes, the FDA's effectiveness is a question. And I know the answer to that question. The FDA is far from perfect, but it's not as bad as the alterantives.

If you have cancer or heart disease, you are perfectly free to drive to Mexico for treatment unmolested by FDA approval or American medical certification. If your chemotherapy or heart medication is just a placebo, well, caveat emptor.

After all, what did the FDA do with Vioxx? The complaint is that it failed to stop a dangerous drug, not that it should not have intervened. If you want a "good" drug that has been victimized by the heavy-handed FDA, try Laetrile. Or don't try Laetrile. Laetrile is a fraud and it doesn't matter if you try it or not. But if you resent the government telling you that Laetrile is a fraud, you can probably find it in Mexico. Caveat emptor.

12:52 PM, November 20, 2005  
Anonymous Anonymous said...

If the Canadian healthcare system is so great, why do tens of thousands of Canadians come to the US to recieve care that they have to pay for? In Canada there's no CHOICE, people. You wait if they tell you to wait.

1:26 PM, November 20, 2005  
Anonymous Anonymous said...

Greg, that's not the point, and you know it. Although there are many who feel that "FDA-Approved" means "perfectly safe", and have sued Merck on that very basis.

The point is that the government has shown that it is far from perfect, subject to political whim, and resistant to accountability besides.

This, by me, is a bad combination.

1:28 PM, November 20, 2005  
Blogger Helen said...

Once government interference begins--there is no telling where it will end. The people in Canada have no right to buy any private insurance, nor can they sue the doctors if they die while on a waiting list--these factors alone should make Americans fear socialized medicine.

1:55 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Anonymous #1: You have a two-sided exchange in which some Canadians go to the US for some kinds of treatment (e.g., elective surgery) and some Americans go to Canada for other kinds of treatment (e.g., prescription drugs). As long as either side offers any advantage for any type of patient (cancerous, diabetic, rich, poor), you are going to see this type of exchange.

The real bottom line is that the American medical system is 80% more expensive than the Canadian system per person without standing out as 80% better. There are advantages and disadvantages on each side, but it doesn't look like the 80% particularly wins anything.

One question is if Canada outright bans privately paid elective surgery, or if it is simply that America has better privately paid elective surgery because of the greater scale of its economy. If it's the former, then I agree that it is not a good rule for the Canadians. If it's the latter, then the lesson of it has nothing to do with medical insurance.

Anonymous #2: No one should believe that "FDA approved" means "perfectly safe". That's like saying "I wear seat belts, therefore my car is perfectly safe". That's juts nonsense.

If the FDA is not as accountable as it should be, then it is no solution to outright abolish accountability. If you think that Vioxx is bad, you can look at what happened with Ephedra. It has been obvious for years that Ephedra is not safe, but it has been almost impossible for the FDA to establish any accountability, because its hands are tied by Libertarian-minded rules on health supplements.

2:02 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Helen: I agree that insurance coverage jealousy is a terrible idea. No insurer, public or private, should ever prevent you from buying complementary health insurance. (Double payment from two insurers is of course not okay.) If it were really true that Canadians have no right to buy any private insurance, the Canadian system would not be fair or safeguarded.

However, it is not true. You can't opt out of single-payer health care in Canada, but you can buy other insurance for things that it doesn't do.

Here in the United States, our partial socialized medical coverage systems (VA, Medicare, Medicaid) have never been protected by insurance jealousy laws as far as I know. Until the Bush administration came along, that is. The new Medicare prescription drug plan has a coverage "doughnut hole". If you sign up for this plan, you are not allowed to fill the doughnut hole with supplementary insurance.

2:38 PM, November 20, 2005  
Anonymous Anonymous said...

"I would still be in Canada on a waiting list to see a specialist at this point."

Probably not true, because as a Doctor you would have connections in the medical community which would have allowed you to jump the queue. Many times friends of mine in different areas of medicine have gotten me or my family treatment without waiting. Plus there are rumors of money changing hands to get preferential treatment. Or if that did not work, you would just drive down to the states and pay for the tests, as many people do.

So only the poor and unconnected have to wait...

2:53 PM, November 20, 2005  
Anonymous Anonymous said...

When your car breaks down do you expect your car insurance to pay for the repairs? No, people usually only bill their car insurance for major collisions, otherwise you simply deal directly with your mechanic (i.e. no middle man). However health insurance is billed for almost every visit to the doctor. I think Dr. Helen’s comment about how added bureaucracy always increases the price of a service while at the same time making it less efficient is right on target. Think how much time and effort patients, doctors, and hospitals have to spend trying to recover costs from health insurance companies. Perhaps if we started treating health insurance more like car insurance health care costs might start to fall. For the general aches and pains caused by life you would go to the doctor and, just like with the mechanic, pay the doctor directly for the cost of the service. In this scenario health insurance would only kick in for major illnesses and procedures (i.e. cancer, heart attacks, baby delivery).
I realize that this is an oversimplification of both the problem and the solution; however, it seems that most people feel our healthcare system is broken (or is in the process of breaking) and some changes need to be made. Instead of trying to think of ways to give the government a bigger role in the process, it seems just as valid to try and think of ways to actually decrease the government’s role in healthcare. If our government can’t even balance a budget, what makes us think they will do a good job making decisions about our healthcare industry?

3:19 PM, November 20, 2005  
Blogger Chris said...

The idea that the Government can come up with one list of procedures that they will pay for (or in HillaryCare, allow), is criminal. I think most socialized countries do allow some escape, even if it's only to go to the US or some other country.

My beef with the socialized medicine is in the general restriction on process. It took 8 years, trips through 5 hospitals (including Mayo) to get a diagnosis of Sarcoidosis. Unlike CFS/Fibromyalgia patients, I was 'lucky' enough to have clear symptoms, like recurrent high fevers. Had I been limited to the expertise of the first 4 hospitals, I might never have been diagnosed. Medical expertise, and diseases processes are just not uniform enough to be subject to government management.

3:37 PM, November 20, 2005  
Blogger Helen said...

I think another aspect of socialized medicine is like all other government handouts, people expect entitlements. I find it humorous, if not downright, ridiculous that patients balk at the idea of birth control pills, viagra etc. not being covered by insurance. Insurance is now a catch all to mean "pay for everything." You should see the looks I get from clients who are asked for a $5.00 co-pay--you would think I was asking them for their inheritence.

Those who are used to government subsidies are the worse as they expect my work to always be provided for free and I find I am treated more as an indentured servant than a health care provider--one reason I no longer want to do much health care work.

And to anonymous who stated that I would be treated due to being a doctor--maybe so but this is just playing the system as you point out and increases the unfairness of socialized medicine. I remember being up in the mountains of Kentucky with a British journalist last year. One of the people we interviewed told us she needed to get her gall bladder out but the hospital refused her Medicaid stating that it was not an emergency. The British journalist huffed and said to the woman, "If you were in Britian, you would get treatment right away. I would know who to talk to" I just laughed--not in her face, I waited until I got home.

3:58 PM, November 20, 2005  
Blogger kidneydoc said...

hmm, interesting thread of comments. I would like to comment only on dr helen's statement of 'waiting for a specialist'. I have been a physician in canada for just over a year. I do not know the exact circumstances of your ilnness, but if you did land in the ER, and in time (yes, there's a long waiting period in the ER too, usually in hours stratified on how sick you are) someone took an EKG, then appropriate and timely action would have definitely been taken, i.e. coronary intervention/defibrillation etc. In Canada, it is not the extremely sick who suffer, it is those in between. E.g. if you were a 37 yr old woman who goes to the family doc with some atypical chest pain, yes, you would wait for months to see a specialist. Once you actually had an MI (heart attack) things move pretty fast! Sad, but true.
Also, if you are in a waiting list, you can choose to go
1. elsewhere in the province where waiting times may be smaller or
2. US/Cuba/India wherever - and get your medical costs re-imbursed as long as some doc in canada had prescribed it.
I am not defending the canadian healthcare system (the earliest an ENT specialist can see my son's elective complaints is in 6 months!-inspite of me being in the system) but all the comments above are not factually correct.

4:32 PM, November 20, 2005  
Blogger Helen said...

To Kidneydoc,

Thanks for your input. Hope your son is seen soon.

4:40 PM, November 20, 2005  
Anonymous Anonymous said...

From Anonymous 5:

Medicare, Medicaid and VA are here to stay. You will find NO support for getting rid of any of these programs. The issue will not be whether government is involved, but the specific nature of its involvement.

Since WWII, most Americans have had health insurance as a benefit of employment. Employers were the providers, in that sense. This will not be the case in the future, and is already not so for growing numbers of Americans.

Your choice is to either tell people our healthcare finance system is just fine, life's a crapshoot and if, through job loss, pre-existing condition or whatever, you don't have coverage, so sad, too bad. That line won't wash with the public, I assure you.

When you look at most of the alternatives proposed, you will find that expanding Medicare to cover the whole population is the best option for the largest number of people. It offers a basic "floor" level of coverage for everyone, while allowing those who want and can afford more, to buy Medigap polices that offer greater coverage.

As for the person who stated that "government can't do anything right", I'd suggest you look at how we won WWI and WWII, the Tennesee Valley authority and the Interstate Highway system, to name just a few things. You also might think about the space program. As for government not having a role in human welfare, I suggest you read about Herbert Hoover and the Great Depression. He felt somewhat the same way :-)

Government, just like any other sector, is not perfect, but it is dangerous illusion to think that it can't do anything. There are a whole lot of things the marketplace can't and won't take care of.

The best thing to do is to get the key stakeholders'round the table and work this out sooner or face a real crisis later. Debating whether the government has any role in healthcare is like Nero fiddling while Rome burned.

4:40 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Helen: I agree that copayments are a logical part of any medical coverage, precisely because the world is full of people who don't want copayments to stand in the way of a self-conceived right to unlimited medical care. Not only a right to basic care, but in fact to unlimited care. In fact, I would take it a step further. I would advocate 5 to 10 percent coinsurance for most medical care, except for poor people in clear emergencies.

But this point still sidesteps the question of who provides medical coverage. If you are covered through your employer (or your spouse's employer), then you're covered. People in that situation can be just as ridiculous about copayments and unlimited doctor's visits as people with public medical coverage. The only difference is that they are mooching off of the employee base, which can be tens of thousands of people, instead of the government. Indeed, if the employer is the government, it's hardly different at all.

For that matter, if you think that single-payer health care leads to imperious patients, that too is an interesting claim about the VA. Never mind the VA's deficiencies as a medical system; is it wasted on ingrates?

4:43 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Anonymous5: It would make a huge difference if they simply lowered the eligibility age of Medicare from 65 to 60. There are an enormous number of cancers and heart attacks in that narrow five year range. No one in this discussion has suggested replacing Medicare with something "better", nor that Medicare recipients are welfare bums. That's just not the way that people want to treat their own grandmothers.

People tossed this idea around some years ago when there was less plutocracy in Washington. I read an article that got an interesting response from a retiree in Florida who was on Medicare. Why should they lower the eligibility age, she wondered; she thought that that would be just a waste. Instead, she wanted to see more Medicare for people her age. She was libertarian when it came to other people's medical care, but socialist when it came to her own.

5:00 PM, November 20, 2005  
Blogger AmericanWoman said...

You also say that the poor should receive assistance for medical care, and no one else. Well,

You completely misinterpret what I said. Most working people are covered by their employers, and I have not advocated changing that. Just that we all have to expect more out-of-pocket expenses (deductibles, co-payments, etc).

5:01 PM, November 20, 2005  
Blogger Helen said...

Greg,

So far you have named several "single-payer health care systems." At least the people involved in these have some method of comparison--it is not the only game in town. A monopoly would only make things worse with no where else to go if you do not like the service. My insurance, at least, tries to keep me somewhat satisfied because I am eligible to switch insurers.

5:02 PM, November 20, 2005  
Blogger AmericanWoman said...

greg, perhaps the Canadian system seems as if it costs less, because it is giving less services. These services (knee replacements, cataract surgery, hip replacements, bypasses) may not 'save lives' but they certainly improve quality of life and productivity.

I don't think the US system is perfect, but the Canadian system is NOT the way to go.

5:10 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Helen: I don't know how your medical care is covered, but I'm just going to assume for the sake of argument that you get it from the University of Tennessee. (Even if it's not true, it's a realistic scenario.) If so, then I suspect that you are a write-off and your insurer would like nothing better than for you to switch to a different university medical plan. A major reason that you wouldn't get more grief in this case is that you are not the real customer, the university is. In any case, the company's first loyalty is to its shareholders, not its customers. I do not mean to sound anti-capitalist; if I ran a company, the shareholders would come first for me too.

So the point is that all of this is decided at a far higher level than your individual choice. Which is only consistent with the ridiculously obfuscated menu of choices in enrollment periods. The university, not you, did the real negotiating; you just get a menu of flavors.

Everyone understands that the biggest, toughest price negotiator in the business is Medicare. They are the Wal-Mart of American medical coverage — the product is chintzy sometimes but there is no beating the prices. So all that needs to happen is to expand Medicare's eligibility to everyone. Under Medicare's rules (except for the obnoxious Bush drug plan), you can still add any other medical coverage that you think is better.

5:32 PM, November 20, 2005  
Anonymous Anonymous said...

Fascinating discussion. I'll add an anecdote here about the British system. A friend of mine is British, and just a few months ago he had kidney stones and ended up at the ER because of it. When they finally saw him, they told him they couldn't treat him because they didn't have the equipment to take care of it. He was then sent on to another hospital, where he was told he would have to be put on a waiting list. So they sent him home with some pain killers and were finally able to take care of him about 3 1/2 weeks later.

Pretty pathetic.

5:56 PM, November 20, 2005  
Blogger Mr. Snitch said...

It's tragic that we have so much magnificent lifesaving technology and such a poor means of delivering it!

One thing I don't hear much about is prevention. One can argue about the effects of legal costs on insurers (won't go into that in this comment), but people who lead healthier lifestyles are generally better risks, and should pay less. Besides the obvious stuff like not smoking (I think some insurers offer breaks for that already?) I'd sure like to see breaks for people who, for example drink vegetable juice regularly. (I mean the real, fresh stuff, not V8.) Gym memberships should be worth a break (assuming one shows up at the gym). What about those in traditionally longer-lived professions? I'd say a 50-year-old securities trader is a lock for a heart attack, and by the time a poliitician reaches 60 he's lived a stressful life with bad food and little excecise that's added years to his age. A bricklayer gets out in the sun, gets excercise, goes about his business and goes home.

That's all top of the head. Just saying, some insurance rebates for the health-conscious should be in order.

6:39 PM, November 20, 2005  
Anonymous Anonymous said...

I am from Norway, and we have a typical state-run health care system. It has some serious flaws, poor quality is probably the most important, in addition to waiting time. It is like an East European car in the Soviet time: In theory, everyone got one, but you had to wait for a long time, and it was chronically low quality.

However, the system is "saved" by an important fact: The medicines, the sophisticated medical equipment, the vaccines, etc. are all developed and produced by private firms. Only the last step of delivery, doctors and nurses, are goverment sector.

If everything, like e.g. development of new drugs, was left to the government, we would be in serious trouble. In such a case I think state-run health would go into a Soviet-style breakdown, and be replaced by private health care a long time ago.

For now, on the crutches of privately developed and produced medicines and equipment, it limps along.

The question of health insurance can be adressed by the government paying a minimum insurance for everybody. The main point is that the health care sector should be run by private firms.

KH

6:39 PM, November 20, 2005  
Blogger AmericanWoman said...

Greg, in your plan, the US expands Medicare for everyone - bare bones coverage. So the vast majority of people in the US who are covered by employer plans, which would immediately be suspended because the corportation see an 'out', now have to pay for private coverage to bridge the gap between Medicare and what they had before?

Is that what you want? To punish the 80% or so who now have coverage to saitsfy some idealistic need?

Just increase the coverage for those who need it and leave the rest of us alone, thanks.

6:43 PM, November 20, 2005  
Blogger Helen said...

anonymous,

That is a very good point--I do worry with a single payer system about research, the development of drugs, medical technology and how that would play out with more government involvement--we now have the best medical technology in the world--would that change?

6:50 PM, November 20, 2005  
Blogger Greg Kuperberg said...

AmericanWoman: Of course I have no intention of punishing people on employer plans. I'm on an employer plan, and I have no interest in punishing myself.

There is nothing in Medicare that induces employers to suspend their health care plans. On the contrary, Medicare cooperates with MediGap plans. That's the whole point. Life would be better if my employer only had to offer me MediGap, which I could take or leave, instead of providing complete coverage that my life might depend on.

Because, when you get down to it, medical coverage is a cumbersome instrument of compensation. It's a pain in the rear for me and for my employer. I'm not offering Medicare as a cure-all. Life would simply be better if it were there as a base.

7:03 PM, November 20, 2005  
Blogger Greg Kuperberg said...

Anonymous: Of course there is nothing in either Medicare or the FDA that resembles either direct treatment or medical research. Medicare provides medical coverage, without any jealousy laws to prevent supplemental coverage until recently. The FDA approves drugs to keep snake oil out of the system.

The US government does have a separate, enormous organization devoted to medical research called NIH. Besides the administrative separation of NIH from Medicare (which may be a good thing), NIH is also not propped up by any kind of jealousy laws that prevent private medical care.

Jealousy laws that outright prevent private alternatives have very little place in American politics. The main example that I know of that is the postal service. We can agree that USPS is a mediocrity.

7:09 PM, November 20, 2005  
Blogger David A. Giles said...

I am from Canada. Our health care system is not all that it is cracked up to be. In fact, our health system killing people.

I live in Saskatchewan. Last year, the public health system waiting time for a diagnostic MRI was 22 months. We do not have private MRI clinics, nor will the government allow them. This alone will reduce

The average waiting time from first seeing a general practioner to receiving treatment decreased by a whooping 7.8 weeks to 25.5 weeks last year.

Earlier this year, the government threw another $41 billion into the health system to provide a fix for a generation. Along with this "fix," we were promised "acceptable" waiting lists for certain diagnostics by the end of this year. Now we are told that this will not happen.

Close to 50% of my income is collected in various forms of taxation. In my province, almost 50% of all taxes collected goes towards our public health care system. It has been estimate that in some provinces, 100% of all expenditures will go to health care within the next 15 years.

It was recently found that the prohibition on private health insurance in Quebec violated Quebec's Charter by failing to deliver public health care in a reasonable manner.

I would gladly pay half of what I currently pay in taxes to purchase my own private health insurance to suppliment both my public health insurance and my employee health insurance.

11:35 PM, November 20, 2005  
Blogger Greg Kuperberg said...

David Giles: When you say "our government", a lot of American readers might take that to mean the federal Canadian government. In fact, in the case of MRI, you mean the Saskatchewan government. Private MRI is legal, for example, in Ontario.

I agree that no medical system should be protected by anti-competitive jealousy laws. Saskatchewan is making a mistake on this one.

Although in your letter you are also confirming another point. You say that you have employee health insurance as well as national health insurance. As the web page I found explained, Canada has not banned private health insurance. What you mean by private insurance is rather personal insurance. I am not sure that you really can't get that in Canada (maybe it's hard in Saskatchewan), but it is generally extremely expensive either in the US or in Canada. Group coverage makes a big difference.

11:50 PM, November 20, 2005  
Blogger Helen said...

Mr. Giles,

Thanks for your informative comment---here in Tennessee we have TennCare, a type of socialized medicine for the uninsurable that was a test bed for the Hillary Clinton plan. Well, it was putting the state into bankruptcy and the state tried to impose a state income tax to help pay for it. The citizens here became outraged and marched/drove around the state capitol and the tax was denied.

I feel for you paying that kind of tax in Canada and receiving such poor care.

7:51 AM, November 21, 2005  
Anonymous frossca said...

This has been an interesting thread to read. But in all this discussion, I have not seen mentioned is the effect of tort costs and the price of malpratice insurance.

10:24 AM, November 21, 2005  
Blogger Greg Kuperberg said...

Outrage over taxes is an interesting element in the health care picture. It is absolutely true that many people, especially in the American South, are immediately and viscerally outraged over high taxes. But that is partly because it is actually useful to be outraged over high taxes. It's not only useful to voters, but also to leaders. One of the easiest arguments in any campaign is that taxation is theft and the other guy has been stealing from you. Political campaigns in general are mainly based on criticism.

The same is not true of high medical insurance premiums. Competing insurance companies have no incentive to condemn insurance premiums as theft. Most people with medical coverage are in group policies and have no leverage over high premiums. So, because it isn't useful to complain about medical premiums, a lot of people just take their lumps and pay high premiums. A lot of people pay more in medical premiums than in income taxes and never make the comparison.

At least in America, tax resentment seems to work better than the private competition to control health care costs. There is always a crisis around the corner with Medicare or state care, but that is what keeps costs down. After all the outrage over TennCare's costs, TennCare is still there.

Meanwhile, what was supposed to be private competition is buried and destroyed by massive complications. There is too much fine print in a medical plan for even a healthy, alert person to understand, never mind anyone who is sick. That is one reason that the United States spends a higher fraction of its GDP on health care than other countries. It is no surprise that it spends more dollars, because it has more. But it spends beyond that. It actually spends a larger fraction of what it has than Canada and other countries do.

11:24 AM, November 21, 2005  
Anonymous Elliot1 said...

Both the single payer system and the traditional insurance approach share a fatal flaw. In both, the consumer does not evaluate marginal medical treatment on a price/benefit basis.

Once a consumer becomes eligible for treatment by either paying a premium or falling under legislative requirements, he no longer has an incentive to use health care resources wisely. He does not do comparison shopping, doesn't question the need for a procedure, and doesn't care about price since he is not directly paying for the marginal treatment.

This is somewhat mitigated by high deductable policies, but once the consumer reaches the deductable amount, his normal consumer discrimination becomes inoperative.

In every other area the consumer evaluates what he receives against the price he pays for it. He does this in buying cars, food, education, and shelter. This consumer discrimination drives competition and keeps prices from escalating at the same rates we see in medical treatment.

This lack of consumer involvement is what causes 1) limitation of services for which an insurance company will pay, and 2) rationing of services in a single payer system.

The solution? I don't know. There are many suggetsions, none of which meet all needs. But in general, I suspect we will have a patchwork of various systems operating together since there is so much variation in individual consumer needs.

4:18 PM, November 21, 2005  
Anonymous Anonymous 5 said...

Talking about the Canadian or British systems is a "red herring". Neither will happen in the US. Yet, they are effective in killing any serious discussion of reform--at least until now. That's gonna change, however, because what many have now will not last.

I see a trend, in this discussion, of assuming that employer-provided plans will continue to be an option of most, or even many. Sorry to say, we are beginning to see the end of employer-provided health care. It is being done gradually, in stages, (ever growing premium co-pays) but it is happening, and for many employers, it can't come soon enough. So, whatever your position, don't bank on those employer provided plans you may now enjoy.

Also, there is a limit to how much "comparison shopping" people will or should do with health care. If you, or your family, have a major illness, how many folks here will look for the cheapest specialists? You will want the best. Who is to say when a pain or other symptom does not require a doctor visit? There a many areas of the country where there is little or no shopping to be done. Healthcare in not like buying a car or a home or any other commodity.

It would be interesting to see a quick poll of forum participants on one question: DO YOU BELIEVE ACCESS TO BASIC HEALTHCARE IS A RIGHT, OR A COMMODITY, TO BE BOUGHT AND SOLD LIKE A CAR, HOUSE, ETC.?

Before adressing the question, any discussion is like putting the cart in front of the horse.

4:49 PM, November 21, 2005  
Blogger AmericanWoman said...

Elliot, if you are covered by a provider, your choices are usually limited by what they will cover, and who ill provide the service. For instance, for an MRI or Mammogram, I only have a choice of 2-3 places. I am assuming that my provider (UHC) has vetted these places and I know they charge UHC a lower 'group rate'. So even if I pay OOP for the service, I am still guaranteed a lower cost than if I went on my own.

It might come more into play if you are having surgery or another service where you want to go out of network.

7:16 PM, November 21, 2005  
Blogger AmericanWoman said...

I view it as a commodity. Any decent society should fund healthcare for those who truly cannot afford it. There should be no racial, sexual or other discrimination in healthcare, so in that aspect, everyone has a right to it, but you also have to fund it. I have a right to a job or a home, but the government doesn't have to provide me with one.

7:18 PM, November 21, 2005  
Blogger Greg Kuperberg said...

AmericanWoman: In your two most recent comments here, you neatly summarized the conflicted state of American thinking about medical care. It's a good thing that we don't have the monstrous waiting lists for MRI that Saskatchewan does, but, even if you are covered in the US, you may not have much choice for that MRI within your network. Health care is not a right, but, society should provided some minimum health care for those who can't afford it. Taxation is theft, but, if you want health care, you have to pay for it.

Well, the United States is dealing with these problems at least better for people over 65. Not perfectly by any means, but at least better. Not only does Medicare provide the basic minimum for the poor, it also makes the country one big network so that you can get an MRI anywhere you please (I think). And if you're not satisfied with Medicare — it is after all only a minimum — you can get MediGap to go with it. Medicare does lead to taxes, but you can think of those taxes simply as your health coverage premiums.

We would all do better if they just decreased the eligibility age for Medicare.

7:57 PM, November 21, 2005  
Anonymous Elliot1 said...

Commodity.

I am responsible for my health, just like I am responsible for my own food, clothing, and shelter.

I am willing to extend my help to those who are really in need, but I'd rather see them get rid of the extra car, bass boat, private school, and plasma TV before they come to me. And if they are going to come to me for help I'd also like to see them maintain a healthy weight, eat well, exercise, don't smoke, don't drink, and take personal responsibility. If they don't intend to come to me for help, I wish them well with whatever lifestyle they choose.

8:47 PM, November 21, 2005  
Blogger AmericanWoman said...

Not really, Greg. Medicare is expensive now and will become more and more of a boondoggle as the population ages and as you suggest, more and more people are added. And you can't go anywere on Medicare either.

Yes, I am limited by my provider, to a certain extent. But I can choose to go out of network and pay more if I truly want a special service or doctor. I can change health providers once a year, I can pay completely out of pocket or I can get insurance on my own.

These are the choices that Canadians do not have.

We have seen what happens when government services (and tax dollars) are given to the government. Social Security was a wonderful program in the beginning. Now it is a disaster. We simply cannot trust our elected officials to not squander more of our retirement and health dollars.

9:06 AM, November 22, 2005  
Blogger Helen said...

To americanwoman,

I absolutely agree--my biggest fear with government run healthcare is the lack of any control we have over it. I have basically given up on the idea of receiving much, if any Social Security at 67--which at least I can plan for. But we would have little choice, if any in a government run health care program, and you can't plan to take care of health care in the future because it is an unknown--like an expensive ICD which might not be allowed.

9:34 AM, November 22, 2005  
Anonymous Anonymous5 said...

Seems like some here assume that most of those who become sick are at fault and have "bass boats" and extra cars...and maybe even a motorcyle or two. Seems we have a few stereotypes here :-)

While lifestyle plays a part, the fact is anyone can become critically ill or injured, no matter how well they take care of themselves. A misjudged dive into the lake, car accident, hereditary or enviornmentally caused illneses--you name them. Many of the people who experience these things are solidly middle class and, yet they and their families would slide into poverty if not for Medicare and Social Security Disability. (Let's remember that both Soc.Security and Medicare cover millions of disabled, not just seniors.)

From what I see here, some folks have only dim understanding, if any, of these types of life misfortunes. When they happen, the absolute and simple ideologies about against government involvement don't mean much.

Any attempt to cutback, eliminate or privatize Medicare will fail for the same reason Bush's attempt to privatize Social Security failed. Both are based on misinformation and an almost blind ideology. (I am happy to specify as to the strength of Social Security, if you like.)

The American middle class, which has seen its sense of job, healthcare and pension security erode steadily in the global economy, is not going to accept more risk and uncertainly. If some continue to try to foist it on them, I'd predict a significant backlash at the polls....and you might not have to wait too long to see it.

11:27 AM, November 22, 2005  
Blogger AmericanWoman said...

Anonymous, A middle class person would have a job with health insurance. We are not discussing disability here, although perhaps we should. People wait for years to be eligible for disability, much like Canadians wait years for surgery. Governments prove over and over again that they can't handle social services, yet we keep wanting to hand them more and more.

If you feel Social Security is unrisky and a certainty then you are very deluded.

7:00 PM, November 22, 2005  
Blogger Echo Mouse said...

As a Canadian, I'd like to share with you the reason for the wait times. The former Conservative government which ruled Canada, as well as the Province of Ontario, instituted MASSIVE cuts to healthcare. *They* are the reason we have some wait times. Now that the Liberal government is back in power, much of that has been reduced.

Speaking as a Canadian with a family member who required specialized healthcare over the past 40 years, our system is incredibly good. Much better than what Americans endure.

7:43 PM, November 22, 2005  
Blogger Eric H said...

Echo Mouse;

You're health care is entirely dependent on who happens to have won the most recent election? Yikes.

BTW, if the CHC system is so good, why did the Canadian Supreme Court have to rule on whether or not private insurance was allowable (!)? As I recall, they basically ruled that the laws would stand, but that the wait times would have to come down.

9:12 PM, November 22, 2005  
Blogger Echo Mouse said...

Hi Eric. Boy this feels weird discussing in Dr. Helen's comments. Anyway, yep whoever is in power can change the gov't. Since our healthcare is paid for by the gov't (which comes from our taxes in part of course) they can choose what to do with it. This is one reason why the Conservative Party probably (hopefully) doesn't have much hope for re-election anytime soon.

As for the Supreme Court ruling on private healthcare, I hope I answered that. Few Canadians are financially capable of paying for private healthcare. The big discussion was about allowing it in the first place because if it's allowed to start, and it takes off with a select group of Canadians, it might threaten our gov't paid healthcare system. I actually agree it should be allowed in some cases but I do worry about it adversely affecting our current healthcare.

1:48 AM, November 23, 2005  
Blogger kidneydoc said...

Re: Mr Giles comment:
Sir, if private insurance comes in, true, you will be able to get an MRI done faster (in the private sector), but poorer folks will get their MRI done (in the govt run system)much later. There is a shortage of human resources here which is also going to limit the total services provided (unless it is possible to outsource healthcare to india or wherever!). There is no way around this fact. I am not judging either system, its just that it is hurting certain people now, and change is going to hurt another set of people. A system which does not reward the brightest and best (i.e. even if you pay more taxes, etc..you are the same as anyone else) does not seem, in principle, right to me too.
Also, MRI waiting times are terribly misleading. I can get an MRAngiogram done today for my patient who I can prove needs it (really). But if your physician has ordered an MRI for a patient with backache, no neurological symptoms-the wait is going to be longer (not that i justify it). I am not knowledgable about the US system, but, again, insurance companies will probably not cover un/poorly indicated tests. In Canada, there is no audit, no authority which says 'this test is not indicated'. Part of the reason for spiralling healthcare costs and loong waiting times!

4:43 PM, November 23, 2005  
Anonymous Elliot1 said...

Anonymous5,

If the sick and injured were limited to the population that had bass boats, we would have only a minor health care problem.

However, when someone can buy a bass boat and a plasma TV because I have paid for his health care, then we might ask why he didn't forgo the bass boat and TV so he could pay for his own health care.

And Social security? If you can specify as to the strength of Social Security, let's hear it.

11:22 PM, November 23, 2005  
Anonymous Anonymous 5 said...

Elliot 1, I don't think the problem is people with bass boats and plasma TV's not paying for their healthcare. That argument won't wash, factually or politically. Bush wouldn't dare make it.

As to Social Security...Here are some points to consider re: both the strength and role of Social Security....

1. According to Congressional Budge Office Figures, any projected "crisis" in the current system is at least 35-40 years away.

2. At present, the system takes in far more money than it pays out.

3. You could insure the system's solvency far into the future just by taxing income over 90K, even just to 150K. The 90K figure was set the last time changes were made, in 1983. Earning levels have changed, a bit, since then.

4. The argument that the trust fund is made up of government notes that are "just paper" and therefore of little value is cute--but too cute. US Government bonds, backed by the full faith and credit of the US Government are also "just paper." They are also the safest investment in the world today.

5. At present, Social Security is the largest single source of income for nearly 69% of retirees.

6. The above will remain true, and might even become more so, as defined contribution plans become the rule rather than the exception. To date, the performance of employee-directed defined contribution plans has not been nearly as good as employer or professionally-managed defined benefit plans. The next generation of retirees may not have the private pension/retirement income of the current generation.

Like healthcare, people can argue this issue till the cows come home. THE ARGURMENT REALLY ISN'T ABOUT SOLVENCY OR FACTS, IT'S ABOUT IDEOLOGY AND WHAT YOU SEE THE ROLE OF GOVERNMENT AS.

Those who don't believe the government has a role in this area will support any measure that kills off Social Security, or moves it in that direction.

9:20 AM, November 24, 2005  
Anonymous Elliot1 said...

Anonymous5,

I will agree that any system that has an open ended claim on taxation can be considered supported, but I would not agree that the economy can sustain such an appetite.

Currently, Social Security takes in more than it spends. The government then takes the surpuls and spends it on other things. The treasury dept gives the social security administration bonds in exchange for the money it takes. These bonds are in a file cabinet in Virginia. Some call it the "lock box."

But, these are special bonds. They are not the same as the treasury bonds routinely purchased by investors which are considered very safe. When an investor buys a T-Bond, it can be sold on the secondary market, and it can be "stripped" into two instruyments - one paying interest only, and one paying the final principle. The bonds given to the social sceurity administration cannot be sold on the secondary market; they can only be redeemed by the treasury.

In about ten years social security will need all the money it takes in to make payments. This will deprive the treasury of its cash cow, and it will have to get general fund money from either higher taxes or sales of negotiable T-Bonds.

In eleven years, social security will have to cash in some of those bonds in the Virginia lock box. Note it can't just sell them on the debt market, but must redeem them at the treasury. Now, the treasury will get money for these bonds by either pushing for more taxes, or selling additional negotiable bonds. Neither additional taxes nor additional bond sales will help the economy. Taxes will divert resources from investment, and borrowing will push up interest rates and crowd out private borrowing.

In each successive year, social security will be redeeming more and more Virginia bonds. By including the face value of the social security T-bonds, one can make a case that social security will be suported for many years. However, the problem is what is involved in the redemption of those bonds, and the additional taxes necessary to plug the hole left by the vanished social security surplus.

Here's a suggestion for anyone who is saving for their kids' education. I learned this from the US government.

1. Every month put half your paycheck in the kid's college fund.

2. Immediately after the deposit in the college fund, withdraw the money and use it for normal expanses. Replace the money with an IOU you put in the kid's piggy bank.

3. Watch with pride over the years as the kid's college fund grows, and point to the piggy bank (lock box) that ensures a fine education.

4. When the kid turns 18, he simply takes all those IOUs and presents them to the issuer for redemption. Since you are the issuer, you just write a check for the total of the IOUs.

5. Since this system works so well for social security, it can also guarantee every kid a first class college education.

I agree one can argue for years over the role of the government, but it is the economy, not the government, that does all the heavy lifting. The economy supports social security, and does not respond to orders from the government.

8:05 PM, November 24, 2005  
Anonymous anonymous 5 said...

Elliot1--

The comparison is really no comparison. Social Security, now, does not now spend more than it takes in.

I wouldn't worry to much about about the borrowing. It is the foreign buyers of our bonds that are keeping our economy going now. The worry seems to be that they will buy less, not more bonds.

Also, what is wrong with taxing income over 90k, the level set in 1983, when top income levels were very different than today?

You see, it really goes back to ideology. But, lets talk reality. Social Security is not going anywhere. Bush tried to privatize it this year, and failed. You might think hard about just why that is so.

I suspect the basic system will remain in place, with whatever modifications are needed, along the way.

8:10 AM, November 25, 2005  
Anonymous Elliot1 said...

Anonymous5

1. The credit mmarket is global, and I agree there are foreign players. That does not alter the situation.

2. Taxing from any additional source takes funds from some other application, and this cost must be appreciated when considering a potential benefit. The tax increase you suggest will reduce investment and curtail the economic growth.

3. The accounting remains the same regardless of ideology. Change will ocur when the economy can no longer sustain the system.

9:05 PM, November 25, 2005  
Blogger Mika said...

As a citizen of the United States not fortunate enough to be employed by a company that provides health care, I am one of those whose health-care experience in Canada would without question be infinitely better than my current experience here. Whether you consider the individual per capita cost of heath care or prescription drugs, life expectancy, or infant mortality, the United States is a dramatic loser, not just to Canada but to many other countries as well. There are sooooooooooooo many countries where I would rather face a serious illness than in the U.S. We have the most expensive, and exclusive, health care system in the world. And I'm not a beneficiary of it.

No one who complains seriously about waiting for surgery in Canada has been a member of an HMO in the US. The HMO is by far, far, far, the worse bureaucracy.

Almost all Americans believe that national defense, the police, fire protection, large-scale public health protection, emergency management, and public transportation are common concerns important enough to be unquestioningly brought under the wing of government. Why not medicine? Is there really a moral difference between my being attacked by criminals or by fire or by an earthquake and my being attacked by a virus? Why do we, alone among modern democracies, believe that for some reason defense against germs must be considered differently from defense against fire, against crime, and against "acts of god"? The function of government is to provide for the common welfare: that includes BOTH defense against human enemies and against germ enemies!

Doctors fight to protect the social welfare every bit as much as police officers, soldiers, civil defense workers, and firefighters. No American should be forced to have less access to a doctor than to a firefighter.

2:19 AM, November 27, 2005  
Blogger Helen said...

mika,

You may not have health insurance, but it is doubtful that you would be without emergency care in the US--hospitals would have to treat you. I have had the experience of working with people who have no insurance--even one immigrant who was treated--given numerous surgeries and put in a special program that paid for his treatment. I have known others who found doctors at well-know clinics and hospitals who provide free care or find a way to get the person the help they need. Here in Knoxville, we have the Innerfaith clinic for people like you who do not have health insurance. Doctors volunteer their time and treat numerous people.

Oh and about the police and fire department--they are under no obligation to help you and you cannot sue them if they don't assist you. I sure would not want my healthcare to be anything like the current police and fire department--think about it--you could not sue the government if they messed up your medical care and they have no incentive to provide care--great system that would be.

7:20 AM, November 27, 2005  
Anonymous Hippocrates said...

We seem to have disagreement about basic facts here, let alone opinion. The issue has been politicized to the fullest.

The right way to reform our health system is to start with more honesty and transparency.

For more check out our blog: Open Medicine vs. Single Payor Healthcare

4:32 PM, November 27, 2005  
Anonymous Anonymous said...

Ephedra is both a stimulant (similar to adrenaline) and a thermogenic.
It stimulates the brain, increases heart rate, constricts blood vessels
(increasing blood pressure), and expands bronchial tubes (making breathing easier).
Its thermogenic properties cause an increase in metabolism, evidenced by an increase in body heat.
Ephedra

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8:44 AM, May 05, 2009  
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8:44 AM, May 05, 2009  
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1:27 AM, June 07, 2009  

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