On 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.
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.
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.
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).
(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)
(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)
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.
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.
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.
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.
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:
http://en.wikipedia.org/wiki/Health_care_in_Canada
[BB, I’ve asked you not to post on my threads. –Mandolin]
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.”
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.
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
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.
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.
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.
“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.
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.
I have considered moving, yes. Does being ill make it impossible?
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:)
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.
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.
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
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.
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.
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.
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.
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?
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.
“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.
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.
[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?
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
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.
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,
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.
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.
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.
“Mandolin, “separate but equal” health care scares me as much as “separate but equal” education.”
Who said anything about equal?
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
(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.
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.
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
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
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.
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.
[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.
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.
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.
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.
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.
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.
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.
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.
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).
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
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.
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.
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
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. :)
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.
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.
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.)….
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.
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.
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.
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.
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
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
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.)
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.
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.
(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.
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?
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.
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.
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.
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
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.
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.)
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.
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).
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.)
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).
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.
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.
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
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.
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.
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.
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.
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.
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 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?
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
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.
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.
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.
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.
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.
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.
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.
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.