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.
Jamila wrote:
First of all, the US health care payment system is at least as complicated as anything you’ve described above. In Canada, there are ten provinces, each of which has its own list of what is and isn’t covered. However, a doctor’s office only has to deal with the one such list — the list for the province it’s located in.
In contrast, in the US there are not only many dozens of insurance companies, but each insurance company has multiple plans and levels of coverage, all of which makes a difference to what’s covered and how much, and doctor’s offices must be prepared to routinely deal with all of them.
As far as I know, every study ever done comparing the US’s health care administrative costs to that of other wealthy nations has found that we spend far, far more on administration here (for example, and for another example [pdf file]). The main debate is over how large our administrative spending gap is, enormous or super-enormous.
As Angry Bean points out, a look at the incentives in the US system should lead us to expect higher administrative costs here:
Returning to Jamila:
Wow. Are you serious? Have you ever had a long-term, expensive illness in the US? Your argument here is so far removed from the real world that it’s hard to know how to respond.
Sick people can’t switch to a private insurance company of their choice in the US, because they’ll just get turned down. The only choice is to stick with the insurance you already have, or do without insurance at all.
Of course, maybe you can insurance some other way. In some states, you can get insurance through the government — but that’s hardly a defense of free market health insurance, is it? Or you can get insurance through an employer, in which case you have no choice but to take the employer’s choice of insurer.
You know what I think real choice is? I think real choice isn’t being able to choose between dozens of private insurance companies, all of which will try to dump you when you get sick, none of which will accept you if you’re already sick. Real choice is being able to choose the doctor you want and make an appointment with them — without having to check to see if they’re on your insurance company’s list of “preferred providers.” That’s how they do it in France, and for real-world purposes, that’s much more free choice than the majority of Americans, insured or not, get.
Of course, all systems have some limits; but in the US, our gatekeepers are often insurance companies whose incentive is to try to avoid having to pay for us to get care. Or, worse, our gatekeeper is poverty. There are many better systems than this.
This simply isn’t true. The administrative costs of health care are higher in the US, both as a percent of total health care costs and per capita.
Um, OK. I realize you started this thread with a personal bent, but this isn’t exactly post 2, and the thread’s got a lot of general stuff in it.
But the “there’d be a faceless person anyway” argument isn’t true. As you know well, social strictures demand that I (normally) treat you differently from a “faceless person,” and that you return the favor.
What are my choices here, if you want to use yourself instead of a faceless person? Not to argue with your personal claims (which makes the general stuff tricky?) Argue against your personal issues, and force myself to act in a rude manner? Open myself up to my own personal attacks? You know full well that while the personal is the political, there’s a damn good reason that political issues often get discussed generally. And you’re cheating.
Anyway, that’s your call, though I wouldn’t do it myself.
Any system is going to have limits. There is no current system AFAIK, and I don’t think a system can exist, where everyone gets all the health care they could have. Someone is always going to define the line between “need” and “option;” between “justified” and “unjustified.” Because we live in a money-limited society, the decisions regarding those lines are probably going to include expense as a factor.
Including expense is appropriate. Health care is a bit logarithmic in cost. The initial expense provides huge benefits in care. But the expense/benefit ratio climbs for more advanced procedures. It’s cheap to vaccinate; it’s ludicrous to avoid doing it. But other procedure are much more expenive in proportino to their benefit.
If a group of people has an expensive, unusual illness, then depending on the relative cost and benefit, there is a point at which I would not support further treatment for that group. After that point, survival or quality of life would probably be linked to whether or not members of that group had money.
That will involve tough choices. Yeah, yeah, everyone’s willing to knock off the odd advanced cancer patient in order to save 10,000 children, that’s easy. But it’s not always easy. Do we stop resuscitating 100 22.5 week old infants so that we can provide better quality of life for 1000 MS patients? How many infants does it take? Who gets to decide what QOL is acceptable?
oh damn gtg will finish this post later from another computer.
I’ve had some interest in the deregulation arguments for various industries over the years. They always sound so convincing! Their proponents always sound so passionate and sincere!
A while back, though, after listening to many of these arguments, we here in California largely deregulated our energy industry. It was, of course, a massive clusterfuck, in which the energy companies took immediate advantage of every single opportunity to deceive and manipulate the public. Which was precisely what the opponents claimed would happen beforehand.
So now I’ve learned my lesson, and I don’t take deregulation arguments seriously without some kind of evidence up front.
Thus my question is, Jamila: Do you have any examples of countries that have had better results from deregulated free-market healthcare than countries like France, Germany, and Japan have had from their UHC? Lower infant mortality, better public health, better old-age care for most people, etc.
I’m not interested in arguments that the California energy situation wasn’t really deregulation, because it makes no difference to me. I need examples. I need proof. Pretend I’m from Missouri and Show Me.
—Myca
Interesting post today by Kevin Drum:
The whole thing is worth reading.
Jamila, when you talk about a more free-market health-care system, do you have in mind lifting some of these restraints on labor-market flexibility? UHC would do the same thing. Health insurance became widespread in the first place to address the fact that for all but the super-rich, catastrophic illness meant crushing debt or denial of care with severe medical consequences (sometimes both). I don’t see any way of going back to pure free-market health care without resurrecting those pernicious effects.
As Mandolin so cogently points out, advocating the free market as a panacea for all social ills is like saying, “I don’t care how many chairs there are as long as I get one, and anyone who’s not fast enough to get a chair doesn’t deserve one.”
These options are pretty limited, aren’t they? If I understand correctly, you can’t usually get emergency govenrment help with medicla expenses unless you are already effectively broke, and then you get to spend the money you don’t have on low co-pays instead of food & shelter. And your employer’s insurance can still refuse to cover pre-existesting conditions, can’t they?
I think that these are worthwhile questions, and they’re not easy ones to answer.
The good news is that in order to move from the lower slope of ‘okay’ public health to the upper slope of ‘pretty good’ public health, we don’t need to answer these questions. Building an intelligent universal health care program, though it doesn’t, in itself, address these questions, is still a great first step.
We’re in a boat that’s filling with water. You’re right that we need to talk about how to bail water, what implements we should use, whether or not we should use a pump, etc., and figure out which is the right choice long-term. Hopefully right now, we can agree that we need to patch the damn holes. Whatever trade-offs we make in the future, that’s the right choice.
—Myca
I don’t know the size of this effect either, but I certainly know of people who are basically stuck in their jobs forever because they have an expensive, chronic condition that wouldn’t be covered during their first year at a new job.
For all the faults of the current healthcare “system,” that is not one of them. As long as you maintain seamless coverage (normally by paying COBRA to the policy of your former employer), no pre-existing condition can be excluded by your new policy. For any amount of time.
The problem is for those of us who can’t afford the COBRA payments (currently at $878/mo for me) for those three months. If you can’t afford that, then you’re subject to pre-existing condition clauses and you’re fucked.
Ampersand Writes:
I agree with you that on paper the US looks shabby when compared to other countries but again, this is mainly due to the differences between the US and other countries that have nothing to do with the health care system, such as the methodology used to make the comparision and the differences ( such as ethnic makeup) between nations.
Which comparison specifically do you want me to address?
The US has problems that other nations don’t have and thus it costs more money for us to handle those problems: the incidence of AIDS is almost ten times more prevalent in the US than in Canada; the male homicide rate is three time that of Canada; the US also has health care costs related to war injuries, including those of Vietnam veterans, and now the wars in Afghanistan and Iraq; teenage girls who are more likely to have premature babies and other complications stemming from pregnancy become pregnant almost twice as often in the US when compared to Canada and give birth nearly two and one-quarter times as often.
Health care costs so much per capita in the US in large part because we have a population with a greater variety of expensive health care needs.
In many cases the US does provide better health outcomes. According to OECD Health Data 2002 the “potential years of life lost” due to lack of preventive care per 100,000 population is 214 years in the US. France, the UK, Germany, Denmark, Ireland, and New Zealand all have greater years of potential life lost. In the US the prostate cancer mortality ratio is lower than France, Australia, Canada, or New Zealand. The breast cancer mortality ratio is also lower in the US than those other countries.
So depending upon exactly what you get sick from, you might be better off in the US, even if you have to go broke to pay for your treatment.
Oh, and
In addition to the excellent points Amp already made about health-care bureaucracy in the US versus elsewhere, the uninsured often end up getting very expensive ER treatment at taxpayer expense and/or getting treated at taxpayer expense for costly illnesses that could have been prevented by routine care. I would much rather that my tax dollars were spent on 100 pap tests than on treating one case of cervical cancer, for example: it would be both more humane and cheaper.
I’d say I agree with Myca, but isn’t that a default? I’ll let y’all know if I ever disagree with him.
(For the record, if you’re at the “fill in the holes” stage — and you believe that everyone should have some level of health care, even if we have to work out the details — then I’m not talking to you when I’m talking about policies that support suffering, etc. I’m talking to the people still standing in the cold, denying that health care should be a universal right.)
Regarding what government help is available, it depends on which state you’re in. In Oregon, there is a government plan for getting health insurance if private insurance companies refuse to cover you, but you still have to pay for the insurance. There’s a separate plan for free insurance if you’re broke, but it’s very underfunded (Oregonians are very anti-tax).
As I understand it, the specifics of switching insurance companies due to switching employers can vary based on state laws and on the particular plan the particular employers use, which may vary in turn based on what position you’ve been hired for within the company. It seems to me that in many cases, the insurance will cover pre-existing conditions but only after a certain amount of time has passed (like a year) — which means that for a year or so you’re basically uninsured regarding the thing you most need treatment for.(Never mind what I crossed off there, which was inaccurate; just read Jake Squid’s most recent comment.)
Which brings us to that post that Lu linked to — thanks, Lu. That’s a really good point.
Merci, y’all.
Lu Writes:
Yes.
I don’t think that a pure free-market of absolutely no government intervention is feasible. I’m not advocating allowing hospitals to throw sick people out on the street because they can’t pay their medical bills. I am advocating that we lift many of the laws and restrictions that force the price of health insurance up and that the government should neutral as to whether or not people have health insurance, perhaps by giving a subsidy to people to purchase their own insurance and leveraging a tax against those who do not.
I don’t believe the free market would solve everything but I don’t think the answer is to turn it over to the government to solve either. Some minimal level of government intervention may be not only desirable, but required, for the system to work without being overburned by free riders who know that they will receive health care even if they don’t purchase insurance.
As I understand it, the specifics of switching insurance companies due to switching employers can vary based on state laws and on the particular plan the particular employers use, which may vary in turn based on what position you’ve been hired for within the company.
Nope. Pre-existing conditions are subject to HIPAA. See: http://www.dol.gov/elaws/ebsa/health/glossary.htm?wd=Preexisting_Condition_Exclusion
…free riders.
…on health care.
What, are we worried about a sudden outbreak of Munchausen’s?
“‘Scuse me, gov’nor, I thought I’d just contract a bit of yellow fever so I could run through all my unpaid sick days and take advantage of the health care system.”
We can call them Health Care Queens.
Yeah, and actually this is one of the sort of neat catch-22s of our current system. You can maintain your health care as long as you’ve got a lot of extra money to spend on it . . . at precisely the time you’ve got no money coming in.
—Myca
I’m very sorry to hear that you are sick. I hope that you get better/do well.
But there aren’t enough chairs. (or in this case beds) There’s no getting around that. How do we decide who get’s a chair?
I don’t think UHC is a right. Not in the way I think free expression, assembly, equal treatment under the law, self defense or travel are rights. (not a complete list)
But I’m pretty open to being convinced that it’s a good idea.
Any system will involve rationing. Before I signed on I’d want to know how the limited resources will be rationed. The devils in the details. Who decides who has what? How will the rules be changed as time goes on? What’s the process? Is it a state thing? (my preference fwiw) Or will Wyoming and Maine get the same plan? My next question is how will it be paid for? general fund? Special tax on something? We spend more money than we raise in taxes, and I think that’s a very serious long term problem.
Finally I want to know if it will be mandatory, and than I need to decide how it will affect me and my family.
So UHC sounds nice. I like the theory. But before I vote yes I need all those questions answered, and I’m against any plan to complicated for me to understand.
Well, there aren’t enough chairs for everyone to have the kind of job that has a chair, no. But we could get together and build some extra chairs by making our own chairs slightly less fancy. That’s what a social net is.
So let’s build some extra chairs.
Myca Writes:
Your question is very broad. The only nation that I can compare any of those countries to is the US and that’s exactly what I’ve been doing. Name one specific area that you want me to address, like infant mortality and tell me which country you want me to compare the US to.
Well, no, hasn’t your point been that the US needs to be more deregulated?
I’m asking for evidence that that’s a good idea. Expecting us to be the guinea pigs for the ‘let’s try deregulating stuff’ game is breathtakingly irresponsible (and was a massive disaster when the libertarians pushed it through for California energy), so I want to know where it’s been tried and worked before.
There is plenty of evidence that UHC seems to work better, and the supporters of UHC are able to offer up country after country with better public health than the US.
I’m asking for a country with fewer healthcare regulations than the US that has better public health than the countries UHC supporters cite.
—Myca
PS. As a bonus, it ought to cost less than our current system. It’s only fair, since the UHC plans we’ve been discussing do.
Jake Squid Writes:
I’ve never worked for any insurance agent and I haven’t studied the health insurance industry and the HMO’s as well as many who advocate for less insurance regulation and a freer market. However, from what I have read and what I do know, I have come to believe that less regulation is the way to to.
However, from what I have read and what I do know, I have come to believe that less regulation is the way to to.
I’m beginning to think that we have different ideas about what the word “regulation” means. Can you give some specific examples of how you would like to lessen regulation on healthcare and the insurance industry?
Apologies for bowing out of this; I have a book tour to prepare for.
Myca, I was in L.A. during the Enron experiments. I thanked Los Angeles’ socialized energy system every time I heard about the rest of California’s privatized blackouts.
Jamila Akil, I did a cross-comparison of countries with longer average life spans than ours and countries with universal health care. I came up with five exceptions: Hong Kong, Singapore, Switzerland, Malta, and the United Arab Emirates. So I apologize for saying that all countries with healthier citizens have UHC; please amend that to “the vast majority of countries with healthier citizens have UHC.” The other countries have significantly smaller gaps between rich and poor; since you don’t like universal health care, perhaps you would prefer to support sharing the wealth.
Mandolin, capitalism is predicated on having too few chairs because you need to keep the people insecure. For ages, the US interest rates were automatically raised whenever unemployment dipped below 5% as a measure against inflation. But where did the inflation come from? Workers confident enough in their work to be willing to strike for higher wages. And why was that inflationary? Because the capitalists were never content with smaller profits; they would raise prices to restore their profits, and then blame the workers for wanting a fairer piece of the wealth created by their labor.
To all, a merry discussion! And to Mandolin, best wishes for your next health reports.
Myca Writes:
Yes, but you brought up other countries and I wasn’t quite sure exactly which country you wanted me to compare the US to and which point of comparison I was supposed to be using, such as infant mortality ratio or cancer prevention or cancer treatment or elderly care. That’s what I mean’t by saying what specifically do you want me to address.
If it’s ok with you I’ll compare the US infant mortality ratio to another European country. Would that be ok?
I’ve already made the point that those comparisons do not account for differences within the US in level of education, ethnicity, personal habits etc.,
The US is the only industrialized nation that lacks a UHC and I don’t think using a third-world country would make for a good comparision to anything. So I think the best way to settle this is for you to pick a country, say Italy or Germany perhaps where OECD data is available, and I’ll compare it to the US.
“I also believe that whatever problems there are in the current American system, they are not as bad as the problems in places like Canada or Britain.”
Clearly, there are problems in all three countries that we generally don’t see in countries with actually good health care, such as France or Germany. But in saying this, you’d have to account for why two-thirds of America want to switch to a system like Canada’s while the number of Canadians who want the reverse borders on the statistically insignificant.
“That may not be true.”
Hmm? As per the numbers we’ve already seen, that America wastes more health care money – a lot more – on administrative costs is a fact, not an hypothesis.
“In America if you don’t like your health care plan then you can leave it and get a new one. The ability of people to opt out of the system and either go without coverage or find another plan discourages the building up of any excess bureacracy because it unnecessarily raises costs.”
Christ. We can argue about the feasibility of shopping around for health coverage as it pertains to the everyday life of millions of working age Americans. We can argue that the fact that UHC nations better contain costs and that the primary source of excess health spending in America stems from buck-passing and paper-shuffling has been established as just that – a fact, not a viewpoint in an open debate. We can also argue that there’s nothing stopping citizens under a UHC country from seeking alternative private coverage (at least in the system we’re proposing; I’m aware of measures trying to make it otherwise, including here in Canada, and rest assured I’m opposed to them), making your entire statement not only false but also irrelevant.
But first and foremost, let me address my boilerplate response to neolibs who repeat the tired line that disaffected workers and consumers can simply go elsewhere. Disaffected liberatarians and taxpayers can also leave America and go to any functional non-tyranny where you are not coerced by men with guns to give pennies to the poor. (Strangely enough, such places more often resemble actual tyrannies where men with guns really do coerce you, but then no one said any market will provide you with the perfect choice.) The theoretical option to vote with your feet does not exonerate existing abuses or shift ethical responsibility in any way.
“This has little to do with any failings of the US healthcare system. because in the developed world there is very little correlation between health care spending and life expectancy. The number of years a person will live is primarily a result of genetic and social factors, including lifestyle, environment and education.”
Jamila, the same sort of argument can be applied to any international comparison, ever, at any time, including ones libertarians like to make, such as unemployment. Notwithstanding the especially restrictive definition of unemployment that America uses, I could easily say with perhaps more merit that many countries in Europe have a relaxed attitude toward work of which large safety nets are a symptom, not a cause. It would certainly account for those countries that have all three: wider safety nets than America, low unemployment, and a puritanical attitude toward work, such as many East Asian countries.
However, when a universal correlation exists – and believe me, number 37 in the world is pretty much in ‘universal’ territory – it does beg some questions. Some UHC nations are ethnically homogeneous, such as Japan or Sweden. Others are as diverse, such as Canada and Britain. Some, like France and Germany, have even more problems with immigrant participation. Some health problems that would confound comparisons, such as lack of exercise, are acutely worse in the US. Others, such as alcohol consumption, are better. The spectrum ranges with UHC countries, and the two constants that hold are that all have UHC, and all individually trump the US by most criteria of health care.
I think even you accept that other nations have superior health indicators, because you go through significant trouble to list cultural factors that could bias the results. That’s a fair argument, but what’s illogical is to then say that the onus is on others to prove that the cultural factors that you just thought of are not what’s causing the difference. Since it’s humanly impossible to prove this universal negative, you then sit back and declare victory. That’s not how it works. The burden of proof is on you, it’s you who has to explain away every possible discrepancy. Comment 86 is a good step along those lines, although it still doesn’t account for nations much larger than Sweden, such as France.
Also, there are concrete marks of failure of the US healthcare system besides infant mortality and life expectancy, such as surgical mortality, patient satisfaction, and a very low rate of access to primary care physicians. The connection with a private health care system is far more concrete here, I should think.
“Will the government take over the cost of paying R&D when the drug companies decide that it is no longer profitable for them to continue doing it?”
They already do. The NIH and universities fund most drug research in America. Big Pharma plays a part, to be sure, especially when it comes to the later stages of refinement and clinical trials, but is there anything essential about this process that a corporation can do but anything else can’t?
In an absolute sense, America probably does develop more drugs than most other countries, but this is from their unique place on the world stage and not contingent on their political systems as such. To goad a familiar libertarian example, medieval age Iceland was also probably bested by the theocratic Islamic empire on just about every social development front, if only in absolute terms.
In a relative sense, though, if it’s medical innovation you’re looking for, you can’t go much wrong with Cuba, which has innovated loads of new vaccines the past few decades, including meningitis B, pneumonia and meningitis, the most effective one for hep B, and some of the world’s top biotechnology reserach centres.
Jake Squid Writes:
Many states have enacted laws that make it easier for people to get insurance after they get sick by forcing insurance companies to take all comers, regardless of health status. The same is also true for my state’s insurance for poor people and for other states I have been to: the insurance for poor people is regressive for up to 3 months–meaning that if you get sick and you go a month or two before getting insured with public aid, then insurance will still cover your previous costs. These laws have the effect of encouraging people to go without insurance until they actually get sick and it costs the insurance industry more money because people don’t enter the pool until their health care costs have skyrocketed.
In other words, you do not have any examples of a country with less public health regulation then the US that has better public health than (say) France?
Just to be clear.
—Myca
I can see you may be a little bit unclear about what I’m asking, Jamila.
Here’s the thing. I am advocating taking our health care in one direction (UHC), and you are advocating taking it in another (free-market deregulation).
To support my position, I (and my idealogical allies) are offering examples of places our suggested solution has been tried and has worked.
I would like an example of a place where your suggested solution has been tried and has worked.
Using the US to support your position doesn’t work, because that’s evidence (maybe) for keeping the system we currently have, not evidence for further deregulation.
Is that a little clearer?
—Myca
will, I was under the impression that in places like Hong Kong and Singapore only privatize outpatient care, GP, and the like. There are no for-profit hospitals like there are in the US, though I could be wrong. Either way, it’s extensively more socialized than anything in the US, and if anti-UHCers want to claim these two for their own, they’re adopting a pretty low standard that they would not accept in any other industry – despite their repeated insistences that health care is not a unique industry and thus needs no unique intervention.
Also, I left my laptop on before posting, then went back later to edit it; in the meantime, it looks like the discussion nearly doubled in length. So some of the stuff I said in the post above will read oddly out of place. Apologies.
Myca Writes:
The United States of America. The US bests many countries with UHC on many different indicators of health.
Yes, it is evidence for keeping the system we currently have and not going further in the direction of UHC. But it is also evidence that an alternative to UHC which can provide many of its benefits and few of its drawbacks is also possible.
You’re making the assumption that the only way we can know whether or not further deregulation would help is if there was a country already in existence that provided complete health care to everyone by the free market. This is a faulty assumption. It’s as if saying that the only way you can suggest whether or not something will work is after it has already been done.
Regarding comment #125 by sylphhead: There was so much about that post that needs debunking that I’ll have to take some time and post on it tomorrow.
I just wanted you to know that I read it and wasn’t going to ignore it.
Cya tomorrow!
Not at all.
I gave the deregulation folks the benefit of the doubt the first time around, and they turned out to be massively, apocalyptically wrong about absolutely everything. Every single objection to their laughable position came true. In spades.
Deregulation ended up helping nobody but the crooks, liars, and charlatans that used it to take advantage of the common people.
So yeah. These days, if a deregulation fan told me the sky was blue, I would go check first. Fool me once shame on you, fool me twice shame on me.
Yes, I require some evidence. If you have none, I think that says all that needs to be said.
—Myca
“The US bests many countries with UHC on many different indicators of health.”
By a great many more, it fares worst. There are too many resources on this for those willing to look, but here’s a cursory stab from retrieving links I posted before on another forum.
The US ranks below other Anglophone nations with UHC.
Given identical diagnoses, a Canadian is likely to fare better than an American.
Canadian cancer survival rates are better.
I’m far from the most knowledgeable on this, so ask around – much can be learned something by reading something other than carefully selected material from Amazon.com that agrees with preexisting prejudices.
Even more so than engaging in linklisting wars, I’d like to point out that what outcomes other countries fare worse on could also be offset by compounding factors, as you pointed out occurs when comparing disparate, heterogeneous entities. But I suppose this muddling only ever works in one direction.
“You’re making the assumption that the only way we can know whether or not further deregulation would help is if there was a country already in existence that provided complete health care to everyone by the free market. This is a faulty assumption. It’s as if saying that the only way you can suggest whether or not something will work is if it has been done already.”
What’s unreasonable about that assumption? It’s asking that your countrymen not be made lab rats for what sounds to be a risky political experiment. Remember the California blackouts? Try that with life support systems.
I have no idea what country you’re even talking about. New Zealand?
But I suppose it doesn’t really matter.
“Regarding comment #125 by sylphhead: There was so much about that post that needs debunking that I’ll have to take some time and post on it tomorrow.
I just wanted you to know that I read it and wasn’t going to ignore it.
Cya tomorrow!”
Regarding statements such as these, let me address the entire board. Why precisely, do I, or anyone else, need to know this? I know you read it; simply by virtue of its length it’s hard to ignore. It’s rather like Christians who tell me that they’ll be praying for me when I profess something that offends them – does my knowledge of the prayer thereby increase its effectiveness? Sounds like an odd sort of bind on the Almighty. It’s not like here, in the one day of solar time that the board sits still, we all think you’ve shrivelled up and died in awe of my holy light. In both cases, the statement is made for the sake of the one saying it, usually out of some deep seated insecurity. You think that others assume you’re ignoring it, but that’s an insecurity you’re projecting onto others.
Hey, playing message board psychiatrist is at least only as obnoxious as talking about a post you have yet to write. And by no means are you the only one; in any extended thread, a statement like the above comes up at least once, from people of all sides of the spectrum. I just find it annoying.
But I’ll give you time to plumb Lew Rockwell and your bookmarked sites to cobble something together. That is, unless I start pre-emptively lashing out at the same sort of libertarian apologetics that I’m no doubt going to see – I’m stranded in a hotel room for the day, so I got a lot of time on my hands.
You don’t need to know, but I thought it would nice to make it clear that I had read the post and hadn’t managed to miss it in haste or by going on to another thread and just deciding not to come back.
I don’t know what you know, that’s why I decided to tell you. But for future reference I’ll just assume you know everything I know.
Or would this post be an example of me assuming that you don’t know what I know? Who knows and who cares. Cya tomorrow! (Again)
(But since you are sitting bored in a hotel room it would be nice if you could start without me.)
Okay, popping back in for a moment:
Sylphhead, I don’t completely trust that list of non-UHC countries with longer life expectancies than ours; I calculated it using a list of healthcare countries that I’ve since realized is incomplete (it didn’t include Norway or South Korea, for example). So my five potential countries for Jamila Akil’s side may actually be countries for ours.
I’m also beginning to think there’s no point discussing this with Jamila Akil, who doesn’t think that lower infant mortality or a longer life expectancy are valid measures of health.
Occasionally people get accused of ignoring points they can’t rebut. It makes sense for people to make it known that they are waiting, rather than ignoring.
It especially makes sense when the person is in the minority position, as Jamila Akil is here. After all, if I ignore a post, I can expect Myca or Amp or you or Will or someone else will address it for me. Since Jamila’s arguing alone, she can’t really expect anyone else to take up the point before she has a chance to get back to it.
Anyway, it makes sense to me.
Moving away from addressing sylphhead alone — it seems to me this thread is skating the excessively personal. I imagine that’s because I’ve been setting it within the realm of my personal experience. This IS a personal issue, and one we would do well, I think, to remember has an extreme personal effect on the lives of people who may be commenters or readers. Nevertheless, we could probably refrain from calling each other stupid quite so much, please.
I’m discussing the California energy deregulation scheme of the early 2000’s, which I referenced in posts #103 and #120 and which Will Shetterly referenced in post #123 (and 133).
—Myca
I thought the safety net was to keep people who fell on hard times from dieing. You’re talking about something more.
But that wasn’t my point. Before I sign up for a new plan I want to know how my new chair is going to be different from my current chair. There isn’t as much chair as everyone wants. There will be some way of rationing. I also want to know how it’s going to be paid for.
Actually, will, I also don’t regard life expectancy and infant mortality to be the trump cards that some of my fellow leftists do, and I wish they’d stop quoting it all the time. Make no mistake; for good reason, the two are regarded as comprehensive measures of public health by WHO and similar bodies – but public health and health care are not synonymous. (Granted, public health is perhaps the single largest, most important component of health care.) The problem is, many influential Americans won’t listen to socialist calls for public health, and will not sacrifice individual health care for public health. To a lesser extent, I’m averse to that as well. I just want it to differentiate the two, and the American system fails at both.
For instance, why don’t we talk of maternal mortality in addition to infant mortality? At 17 deaths per 100,000, America’s MMR is more than double that of most European nations, and I think many – not all, but many – of the concerns people have with taking infant mortality as a straight indication of health care quality will be addressed will be alleviated by mentioning MMR in tandem.
On my post 133, go to the second link I provided. Scroll down to the tables. You’ll find concrete examples of evidence, however inconclusive, of the superiority of Canadian health care (not just public health) to America’s. More success against renal failure. More success with kidney and liver transplants. More success against certain types of cancer and angina, and a lot more success against HIV/AIDS (though to be fair, I can think of one very confounding factor in the US that somewhat lets the health care system off the hook). Such information is not new; Amp posted something similar earlier on this very thread. THIS is what I wish more lefties would focus on.
Not that there aren’t areas where America fares better. On a consistent basis, I’ve seen evidence that the US health care system takes better care of their elderly; hip replacements, cataracts, etc. are a point of weakness for the Canadian system. Given that health care for the elderly is the second most socialized aspect of American health care (after veterans’ health care), I doubt anti-UHCers would be too eager to use this particular example, but could it be that Canada rations away care from senior citizens? It’s possible.
But in the tables and lists comparing Canada to the US, I’ve yet to see one in which the list of American advantages is longer than the list of Canadian ones.
Now, greater success with kidney transplants doesn’t, in and of itself, mean better health care. Even with my MMR example, there are some things that are difficult to explain: Canada and the UK are very similar, multicultural anglophone countries with largely underwhelming universal health care. Yet Canada’s MMR is 6 per 100,000, while Britain’s is 13, making it the only Western European nation to come close to America on this statistic. This one statistic, by itself, cannot be used to conclude anything definite about the quality of health care in these respective countries.
But once several such statistics start coalescing into trends and broad tendencies, we can start drawing some conclusions. I think Jamila’s challenge to narrow everything down to one country and one statistic commits the Fallacy of Composition. A single statistic is not wholly dependent on one factor, and if one really tried, one could explain one of them away on outside factors. But when there are many such statistics, each requiring a slightly different set of outside factors, something must be afoot. A broad tendency or trend is generally indicative of a broad cause, and the argument that a patchwork of causes (obesity, illegal immigrants, crime, et al.) artificially creates low US health indicators is wholly unconvincing to me – not to mention the argument that such random factors should depress American results more than anyone else’s. And international health care comparisons, pretty much by definition, reflect broad tendencies or trends.
BTW Jamila, your comment on the hotel room has made me realize that my sourness over my day being ruined has spilled onto my online posts. Starting with this post, I’ve made an effort to be more intellectual and open to discussion. In particular, please ignore comments such as going to Lew Rockwell to cobble arguments together.
“Occasionally people get accused of ignoring points they can’t rebut. It makes sense for people to make it known that they are waiting, rather than ignoring.
It especially makes sense when the person is in the minority position, as Jamila Akil is here. After all, if I ignore a post, I can expect Myca or Amp or you or Will or someone else will address it for me. Since Jamila’s arguing alone, she can’t really expect anyone else to take up the point before she has a chance to get back to it.
Anyway, it makes sense to me.”
Perhaps, but I don’t think the tone of ‘your arguments are so faulty that I’ll need to set apart a special time and place to impart my wisdom’ is in the spirit of good argument, either. This tone ALWAYS accompanies these types of statements. I responded by insinuating that the reason that anyone would need to speak in such a tone is a realization that they’re losing control of the argument, which is of course equally baseless and in poor sport. Mea culpa.
Sylph,
You’re right about the tone. By the time I got to the end of your post, I’d forgotten the beginning with: “There was so much about that post that needs debunking that…”
Sylphhead, total agreement those factors don’t give the complete picture.
Unsubscribing from this thread now! (But not from an obsession with improving everyone’s health care, of course.)
Many states have enacted laws that make it easier for people to get insurance after they get sick by forcing insurance companies to take all comers, regardless of health status.
So, I did understand what you were advocating. How is the free market going to guarantee that everybody has access to health care, then? And if you’re going to free up the insurance companies to be able to deny benefits to the sick, why not also allow hospitals to deny treatment to the poor? I don’t see the difference.
How anybody can be against the laws like that is beyond me. What code of ethics and morality advocates abandoning the sick and the poor?
UHC has advantages in (at least) two areas. It is cheaper (economics) and it is moral (social). I can’t help but find your position to be both economically foolish and morally reprehensible – not to mention detrimental to national health.
Insurance companies make money when they 1) minimize risk 2) deny claims. Neither of these is bad per se (I used to work for an insurance company, and I saw some pretty bogus claims), but both work against the goal of delivering good health care for everyone.
What insurance does well is to spread risk throughout a broad population. Jamila’s point about not signing up for insurance until you get sick is valid — doing this is a bit like picking your lottery number after the drawing — but, once again, this problem would be addressed by UHC, because everyone would be enrolled, and everyone’s taxes would contribute.
To put that another way, UHC maintains the benefit of risk-spreading while eliminating all the time, energy and money spent risk-avoiding, not to mention all the bureaucratic hoop-jumping forced upon providers.
I just wanted to post to point out that Kevin Drum’s ongoing series of posts on this is a must-read.
His most recent, here, is on waiting times for basic care, and why so many US patients end up in the emergency room.
—Myca
Mandolin, you are being very eloquent for healthcare reform. Joe in #117 has expressed in his response what I think many Americans hold as reservations against UHC.
For myself, I think UHC could potentially be better than what we have now. But I think in the U.S. any UHC system would have to allow for private insurance, because the people who have enough money now to pay for top-of-the-line healthcare on demand are not going to give that up, ever. I’m remembering the onset of HMOs as I write this, BTW, so maybe that is influencing me on the pessimistic side. The thing is, any big system can work reasonably well as long as the individual situation fits within the designed normal limits of the system. I think I have a justifiably healthy skepticism of our government’s ability to design AND IMPLEMENT a UHC that actually functions better than our current one.
To extend Mandolin’s metaphor about musical chairs, suppose we agree to build enough chairs so that everybody has a chair. Great! This is a good thing. But in order to do this, the quality of chairs built is such that a certain percentage of chairs will break, usually for no immediately obvious reason. People with enough money will have a spare, high quality chair that they paid for themselves handy and will be able to sit down again almost immediately (or maybe their government-issued chair is sitting in storage while they use their own sturdy chair and therefore they’ve never had to worry about breakage), while others with less money will have to stand until they have a new chair. I think a major fear in agreeing to give everybody a chair is that the new chair will not materialize instantly but rather will be held behind the counter until The Powers That Be decide that the reason for the breakage of the old chair has been adequately determined and explained and you’ve promised faithfully to take better care of the new one.
Two of my main concerns with UHC are:
1) If you allow private insurance, how do you make sure there are enough public providers of services and that they are distributed appropriately by location? Do you require that every practitioner must accept at least half their practice as UHC patients? Do you set quotas on certain specialties and only grant x number of plastic surgery licenses because we need more geriatric care personnel? Do you tell young interns that only two out of every medical school can become pediatricians because we need more proctologists?
2) At what point will you be allowed to challenge your diagnoses and treatments by getting outside opinions? How to you seek redress under UHC, and if it is by suing the doctor for malpractice, how is this addressed? I ask because (even though anecdotes are not data) I have 3 friends who have had absolutely horrible experiences with European UHC systems (1 in Belgium, 2 in Germany) and a Canadian cousin with a very bad experience.
Do we all agree that any UHC system will involve some rationing? Or (if you prefer the chair analogy) that not everyone can get an Aeron chair?
I keep hearing people suggest it’s immoral to refuse someone treatment; this claim rarely gets qualified. But obviously we can’t give perfect treatment to all. (and that’s “all” as in “all citizens;” we haven’t even gotten into the fascinating morass of illegal immigrants’ access to any UHC system.)
My own view is that it’s obviously immoral to refuse someone basic treatment, or pain relief, or emergency treatment. But the full kebang? I dunno. If I get AIDS, what then? Does society have an obligation to provide me with drugs that cost $100,000 per year and that will vastly increase my chances of survival? Does society have an obligation to provide me with drugs that cost $10,000 per year and make my survival likely but less certain? Do they have an obligation only to make sure I don’t die in agony?
And do they have to do this with an eye towards what they’re giving everyone else? Can these decisions be made on an individual basis? Will a UHC, to satisfy its goals of helping everyone, be required to choose the most efficient treatment? Be careful on that last one. “efficiency” is what drives a lot of what people complain about now.
How do we see this rationing happening? Any “general” effect will simply screw over poor people. Any “targeted” effect will screw over expensive people–by and large the disabled, those with expensive diseases, and/or the elderly.
Right now, some people are dying. They are dying because they are unlucky–they have medical problem that they can’t pay to treat.
Under UHC, some people will still die because they are unlucky. They will die because they have medical problems that the government has deemed unworthy of treatment.
As I think about this, I wonder whether politicizing the life/death decisions inherent in health care is a good thing.
I keep hearing people suggest it’s immoral to refuse someone treatment; this claim rarely gets qualified…
Specifically, I am suggesting that it is immoral to allow HI companies to refuse to cover people who are sick. Specifically, I am suggesting that it is immoral for a hospital to refuse to treat someone (and when we talk about hospitals, we are usually speaking about emergency or fairly immediate life-saving care) because they are poor.
Of course there will be rationing. There is rationing under every system for which there are limited resources.
As I think about this, I wonder whether politicizing the life/death decisions inherent in health care is a good thing.
You think that it isn’t already politicized? Allowing wealth to decide life/death treatment is a political decision.
As to discussions about how rationing will work… there are some pretty well accepted models in use today. Also, can you define “general” and “targeted” and how those have the effects that you assert? I’m not understanding you.
Under UHC, some people will still die because they are unlucky. They will die because they have medical problems that the government has deemed unworthy of treatment.
The theory is that fewer people will die because they’re unlucky. Theoretically, many people will be diagnosed at an earlier point in their illness due to access to medical care. This will allow effective treatment/cure.
Allowing wealth to decide life/death treatment is a political decision.
Yes. But it’s a different kind of political decision, don’t you think? It’s not a specific one.
Sailorman,
No, I think that it is just as specific as deciding what life/death treatment will be covered by national UHC.
For example:
If I have (can afford, wealth)health insurance, treatment to save my life may or may not be covered. If it is covered, great but that was not my decision. If it isn’t covered, I only survive if I have the cash to pay for it.
If I don’t have (can’t afford, lack of wealth) health insurance, I can only get life saving treatment if I have the cash to pay for it. Unlikely if I don’t have HI.
Under UHC, if the national plan covers treatment to save my life, I get it. It doesn’t matter how much or how little wealth I have.
Under UHC, if the national plan doesn’t cover treatment to save my life, I’m no worse off than I am under the existing system. If I have the cash, I live. If I don’t , I die.
The big difference between the two is a) whether a health insurance company which I have no influence on makes the decision or whether a government that I have a tiny influence on makes the decision and b) whether or not I can receive a treatment covered by the program (current: if I can afford insurance, UHC: Yes).
So, I really don’t see the difference.
SM wrote:
The qualifier “UHC” gives an odd spin to your question. You might as well as “do we all agree that all tall people have noses?” Yeah, that’s true, but why are you talking about tall people? A more accurate statement is “any health care system requires some rationing.”
But yes, I feel sure everyone here is aware of that.
In the US, we have two main levels of rationing. The first is rationing by wealth, which screws over both the poor and the middle class in different ways. The second is rationing by profit, in which (among other problems) insurance companies face rational incentives to place as many barriers between patients and care as they can get away with. Yes, all rationing — including the rationing provided by the various forms of UHC — is imperfect. But rationing by wealth and by profit are even worse.
Considering how much money the health industry gives to political candidates each year, I think it’s naive of you to suggest that our status quo doesn’t have a significant political element to it.
Amp,
I’m really not sure that everyone admits there will be rationing. A lot of the time this discussion comes up people sidestep the fact that there WILL be rationing under any system. They talk instead about gains in efficiency or reduced overhead or rolling all ‘profit’ back into the system. Since I have insurance (that I pay for) I want to know what the new system will look like. When the issue is ignored I start to worry. The devil you know and all that.
Any new system is going to fall into one of three very broad groups for me.
Better for me and my family.
Worse for me and my family but justified. (for example everyone gets covered as well as I do now but my taxes go up a small amount)
Worse for me but not worth it.
There are a lot of people with some sort of coverage today. I think most of them will use the same set to evaluate any new proposal.
I think rationing by wealth and profit are really the same thing. But that’s beside the point.
Why is rationing by cost worse?
Why is it worse if my grandmother can’t get surgery due to the cost than if she can’t get surgery because the system says she’s too old to justify the procedure?
sylphhead Writes
I have never read any survey stating that two-thirds of Americans want to switch to a system like Canada. That sounds like an extremely high estimate considering that most people I know who do want UHC don’t hold Canada up as the model they aspire to.
Determining exactly how much a government spends on administrative costs under a UHC is problematic partly because some costs can be shifted to the patient and/or the physician and other costs are subsumed within government budgets and never counted at all. For instance, collecting taxes or lobbying for additional funding are not included in the overhead expense of public programs whereas collecting premiums and marketing would count toward the cost of a private insurer.
Administrative costs can be reduced in the US system but I suggest that the disparity between costs in the US and other countries with UHC would shrink dramatically if those other countries could not hide some of their costs within the government budget as debt for other programs.
I could say the same thing about people in America who advocate for UHC; they can always pack up, leave, and move to Canada or Britain or wherever else they can get “free” health care while leaving the rest of us that don’t want it here to make do.
The first thing that should be pointed out is how the WHO rankings do not support the claim that other nations which rank higher than the US have higher quality care.
WHO’s assessment system was based on the following indicators, along with their weight in the scoring system: overall level of population health ( 25 percent of the score); health inequalities (or disparities) within the population ( 25 percent); overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts) (12.5 percent); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system)(12.5 percent); and the distribution of the health system’s financial burden within the population (25 percent), which measures how much more, as a portion of income, higher-income groups pay for their health care than lower-income groups.
On page 8 of the 2000 WHO report you’ll find the following statement: “Ultimate responsibility for the performance of a country’s health system lies with government. The careful and responsible management of the well-being of the population – stewardship – is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent.”
With the aforementioned information in mind, the problem with the report should be clear: (a) It reflects a scoring system that gives more weight to fairness and equality than saving lives and curing diseases; and (2) the report is designed in such a way that favors government financing and control of the system, which obviously puts the US at a distinct disadvantage to begin with because we are the only system without a UHC.
Japan ranked first on the attainment of health in the WHO study. But so what? As I’ve said before, demographics make a big difference. Japan has low infant mortality and a high expected lifespan. Asian populations in America, Canada, and the UK have similarly low infant mortality and high expected lifespans when compared to the general population. Thus you would expect a country full of Japanese people to score high on health indicators, just as Japanese people all over the world do. This says more about the health of Japanese people than it says about how good their health care is. Clearly, homogenous populations such as Japan, Sweden, Switzerland are advantaged.
France and Germany have nowhere near the number of immigrants ( illegal and otherwise) or non-white/non-Asian groups straining their health care system and pulling it down in the rankings.
The US ranks first in the responsiveness of its health care system. Meaning that of all the countries in the WHO study the US system exhibits the most “(a) respect for persons (including dignity, confidentiality, and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider)”. France, the country with the highest overall ranking, comes in at number 16 on the responsiveness rank.
No. I don’t believe that other countries have superior health indicators. If I got sick, there is no place else in the world that I would rather be than the US. And this is coming from a poor black woman.
It’s not illogical at all. When a scientist comes to a conclusion, if he/or she wants her results to be considered valid then the scientist bears the burden of proving that the results were not biased by external factors, not the person doubting the claim. It is you who are claiming that the US needs UHC because then we all will have better health care. The burden of proof is on you to prove this, and just because you have discounted the cultural factors (confounding variables) doesn’t make your assertion any more valid.
The WHO and the OECD both say that their rankings should be looked at in light of the differences between and within countries. So if those two organizations both acknowledge the insufficiency of their rankings, then why are you so hesitant to look at them too? Perhaps if you did, UHC wouldn’t look so fantastic after all.
The burden of proof is indeed on me to back up any assertions that I make, but that is only because too many people cherry pick information from WHO and OECD statistics without reading or understanding the reports that the information came from. If those people who constantly brought up the US ranking of number 37 were more informed about the actual WHO report that they quote I wouldn’t have to do so much research to explain things to them that they should already know. This isn’t directed just at you, but many other folks do the same thing when arguing for a UHC.
The WHO report is over 200 pages long ( in PDF) and I haven’t read the whole thing, but the point is that more has to be done than picking out one stat and believing that’s the whole story.
In the overall health ranking of the population for France came in at number 6 with an indexed score of 91.9 and the US came in at 15 with an indexed score of 91.1. I’m no statistician, but that doesn’t appear to be that big of a difference in overall health–particularly when you consider that France supposedly has the best health care system in the world and the US is ranked number 37.
Please provide me with some statistics that say the US has a surgical mortality, lower patient satisfaction, and a very low rate of access to primary care physicians.
The infant mortality rate and life expectancy of the US is not a sign of the failure of our health care system. White Americans have a life expectancy and infant mortality rate similar to those found in western Europe. Japanese people have low infant mortality in Japan and here in America. African Americans and Latinos have higher infant mortality than the rest of the white population which raises the overall infant mortality rate.
Infant mortality rates for some segments of the US population are similar to and sometimes lower than in European countries. Norway and New Hampshire are composed of small homogenous populations; their infant mortality rates are 4.1 and 4.4, respectively.
There is nothing about drug research that drug companies can do that universities can’t, but why should there be any preference that the universities or the NIH do it when, as you say, the drug companies usually end up taking over in the end anyway?
I’m always one to give credit where credit is due. Cuba has done some good things since they instituted UHC.
Jake Squid Writes:
No system guarantees that everyone will receive treatment for whatever ails them–not the free market or UHC. There was a recent Supreme Court case in Canada that had to declare that access to a waiting list was not the same as being guaranteed care. Under UHC you are theoretically insured, but if the powers that be decide that treating you would be a waste of money, then you’re out of luck unless you can pay for treatment somewhere else on your own.
The choice is between (a) rationing by the government under a UHC, but theoretically you should be able to get treatment even if you have to wait for it, and (b) rationing by cost, in which you can get whatever treatment your insurance company and you can afford. I prefer choice b.
Insurance companies should not be allowed to deny benefits after someone who has been dutifully paying insurance gets sick. I am saying that insurance companies should not be forced to insure everyone who applies or be forced to insure everyone at the same rate.
I am also saying that public aid insurance should not pay for any medical bills incured before the person applied for aid. This would force more people who are eligible for public aid–but are not enrolled–to enroll before they get sick; thereby cutting down on the number of uninsured people.
Whether or not something is moral depends on how you determine morality. I don’t believe that a system that rations care by a governmental authority is anymore moral than a system that rations by money.
Lets say for instance that under a free market there are additional costs related to providing consumers with choices that they would not ordinarily be offered under a UHC, if that’s the case then reducing my choices to make things cheaper would not be an advantage in my opinion.
I can’t help but find your position to be both economically foolish and morally reprehensible – not to mention detrimental to national health.
I don’t know if anyone’s found that people want Canada’s system; in the USA, very few people know the wonky details, so “Canada” tends to be used as shorthand for “tax-funded universal health care” or something like that.
It’s certainly true that many polls have found significant majorities of Americans favoring UHC. For example, here’s some results from the Washington Post-ABC News Poll, October 20, 2003:
This is nonsense. First of all, you’re wanting to count unmeasured costs of UHC systems, but there are also unmeasured costs of our system, which are passed on to patients and doctors. Hours of insurance paperwork are shifted on to some unlucky patients in our system, for example; those costs are not accounted for in any measure. When doctors hire administrators to handle insurance paperwork, that is counted as an administrative cost; but the opportunity costs to the doctor (time spent having to recruit & hire an additional employee, time spent assisting the insurance administrator) are not. The forgone additional benefits to patients if doctors could , instead of hiring the insurance administrator, hire an additional nurse or physician’s assistant, are not counted.
If you’re going to talk about hypothetical unmeasured factors, you should talk about them for both the US and for UHC; that you mention such factors only when talking about UHC shows the weakness of your argument.
The administrative costs of allowing the Bush tax cuts to expire when they’re scheduled to (which, combined with economies of scale and administrative savings, would pay for most or all of the costs of UHC) are very minor; the IRS already exists, after all, and its workload pre-Bush was not significantly more expensive than its workload post-Bush, afaicd.
Our current health care system includes tens of millions of dollars spent lobbying every year. If we assume that health care companies are economically rational, then whatever amount they spend on lobbying must be a fraction of the returns they expect to get through profit. Any system that substantially reduces the profit available to insurance companies and other health care actors can therefore be expected to reduce lobbying costs in the long run.
That’s not what Jake asked. The question isn’t will everyone receive treatment for whatever ails them, but will everyone have (reasonable) access to basic health care.
In the US, many people lack reasonable access to health care such as a GP exam once a year or routine medication for serious but common and controllable conditions. No one lacks that in France.
Let’s talk about type 2 diabetes, for example. In every wealthy country with UHC, diabetics who’d benefit from metformin can get it, for as long as they need it, and regardless of ability to pay full price. The same is true for the other things diabetics should have, such as an annual eye exam and bi-annual foot exams by specialists, and regular blood and urine testing. Many should also have blood pressure medication.
These treatments actually save money in the long run; they also can save a great deal of agony. But in the US, not everyone can afford such basic treatment.
[Edited to improve wording.]
Jamila,
Here is what I wrote:
How is the free market going to guarantee that everybody has access to health care, then?
Here is how you responded:
No system guarantees that everyone will receive treatment for whatever ails them–not the free market or UHC.
Can you see that you responded to a totally different statement than I made. UHC does, in fact, guarantee that everybody has access to health care. Can you tell me how the free market is going to guarantee that everybody has access (not receive treatment for whatever ails them, no matter what the ailment may be – this is an important distinction) to health care?
Regarding the worse health care outcomes for American Blacks, and the better health care outcomes for Asian Americans, no doubt much of the difference isn’t attributable to different racial groups receiving different quality of health care in the US. But that’s part of the story. Here’s a chart that the Washington Post made, from data from the National Healthcare Disparities Report.
(Curtsy to Kevin Drum.)
This report (pdf link) includes citations to many peer-reviewed studies finding that yes, Virginia, not having access to health care is bad for your health. For the people who have inadequate access to health care, the US health care system is not working nearly as well as a universal access system would.
Edited to add: It’s also worth nothing that the VA system deals with a diverse population of patients, including many African Americans — but still delivers the best health care in the US, easily comparable to the best health care systems anywhere in the world.
One thing that can’t be measured by statistics — or at least, not by the one’s I’ve seen brought up — is the question of security during a health crisis. The biggest problem of the US system, after the large number of entirely uninsured people, is that the risks inherent in the system are huge for people who are sick or injured.
Avedon Carol, an American who has been living in Britain for years, points out that this lack of worry is a great benefit; when contemplating needed health care, she never has to ask “can I afford to get treated”?
Most Americans aren’t ultra-rich, and aren’t getting the best healthcare in the world; many of us are getting very good healthcare. But people in other wealthy countries get healthcare that’s about as good or better, and they get it without worrying about if they can afford it. That sounds immeasurably better to me.
Let me reword my response then:
The free market does not guarantee that everybody has access to health care.
The free market does not guarantee that everybody has access to health care.
Which means that the free market is inferior to national UHC by this measure (among many others).
I’m glad we have that sorted out.
Ampersand Writes:
There are unmeasured costs to both systems. However, a UHC has the advantage of being able to share costs with other government divisions, thus making it look cheaper than it really is.
Also, the additional cost of a private system is partly due to offering a wider variety of insurance options to customers to fit different needs; and it costs money to administer a variety of insurance plans. A UHC doesn’t have this cost ( or the benefits that come along with it) because everybody is being given the same plan with the same benefits.
I’m not talking about hypothetical unmeasured factors at all. I’m talking about actual factors that are left unmeasured because measuring them is not part of a UHC. When a private insurer has an internal audit or has to hire an outside firm for that purpose the cost of the audit has to be included in the insurers cost. When a government program is audited by an outside firm or by another office, the cost of that audit is not necessarily included in the cost of health care administration.
I said the following in a previous post: “Administrative costs can be reduced in the US system but I suggest that the disparity between costs in the US and other countries with UHC would shrink dramatically if those other countries could not hide some of their costs within the government budget as debt for other programs.
For instance, collecting taxes or lobbying for additional funding are not included in the overhead expense of public programs whereas collecting premiums and marketing would count toward the cost of a private insurer.”
I say abolish the IRS altogether and we can really save some big bucks. But I think abolishing the IRS is a whole ‘nother argument.
I also say that with fewer taxes and a simpler tax code more people could afford health care.
You understand that for many of us, that is a fatal flaw, whatever its other virtues?
—Myca
Since I think the uninsured who are most in danger are those who are uninsured due to unemployment or part time work, I think that cutting the taxes they don’t pay on the money they’re not earning would do precisely zero to enable them to afford health care.
I do not believe that our country has a serious problem with people who want non-employer subsidised health insurance, but cannot afford it because of their tax burden. If you believe that we do, please offer evidence.
—Myca
Myca Writes:
Yes, I understand. But for me, and those like me, I don’t consider it a flaw at all; I’m not easily swayed by government promises.
Myca Writes:
It would leave room for employers to help pay insurance costs (since they won’t be paying so much in taxes) and it will leave the private health care providers to offer cheaper options for insurance and preventative services (since they won’t be paying as much in taxes).
And while poor people are paying lower taxes than everyone else they still pay them. When I was working the government was taking 21-25% out of my paycheck in taxes; I got it back at the end of the year but I would have preferred that the government didn’t take it in the first place.
Wait, don’t you mean, “I’m not easily swayed by actual evidence from the countries who have (over and over and over again) achieved this very thing?”
I know that’s snarky, and I’m sorry, but seriously . . . we KNOW that under our current system, there are a lot of people left out in the cold. We KNOW that other nations have achieved the guarantee that everybody has access to health care.
This isn’t an issue of being swayed by government promises, this is a situation of being swayed by facts.
—Myca
Isn’t this just utterly discredited trickle down economics?
One at a time:
Why on earth would employers do this? Especially for part time workers, which is what we’re discussing.
Why on earth would the insurance companies do this? Wouldn’t they just take the money as profit? Would they have any motive whatsoever to cover the unemployed for free, which is what we’re discussing?
—Myca
Jake Squid Writes:
If the most important thing to you is a guarantee then I guarantee you that I will sell you a bridge in Brooklyn at a discount. I’m less concerned with what a government guarantees me than what it can actually provide.
And if I had cancer I would care less about the government making me a guarantee of treatment than I would care about the actual survival rate and how long I’m going to have to wait in the queue to receive my guaranteed treatment.
I don’t care about promises; I care about results. I would rather be alive and broke from paying for my own cancer treatment than dead because my cancer didn’t get treated in time under a UHC or because the UHC decided it wasn’t cost effective to cure me. So if the lack of a guarantee makes a health care system inferior in your book, then so be it.
Myca Writes:
Since when has trickle down economics been discredited, and by whom?
Because the promise of health care can be used to attract workers to the company. If I’m a part-time worker and I can choose between companies that are roughly equal in every way and one offers health care and the other doesn’t, I’ll choose the company that offers health care.
Companies want to continue to exist so that they can continue to make money. If a company (I’m talking about a private enterprise here) can use the promise of health care benefits to attract the best employees and use those employees to make more money than it costs to pay health care benefits then thats what the company is going to do.
Insurance companies also exist to make money. If they can offer insurance packages to people that will allow them to make even more money, then thats what they will do. There is no incentive to put the extra money from taxes back in their coffers if they can use it to make even more money instead.
Myca Writes:
No, I mean what I wrote: I’m not easily swayed by promises.
Other countries have achieved the guarantee that everybody has access to a waiting list. I know that under current UHC systems in other countries there are plenty of sick people languishing in pain on waiting lists waiting for their guaranteed treatment. And yes, I acknowlege that there people here in America who are also going without treatment or who have been denied by their insurance company. I’ve already said that America rations by money and other countries with UHC’s ration by wait times.
I’m still waiting on someone to provide some facts that unequivocally state a given sick person will be better on in another country rather than here. All I keep hearing about is that other countries make you a promise and they put you on a waiting list if necessary.
Ampersand wrote:
And I think that is ultimately what it all boils down to: many people would rather that the government manage risk than for them to have to do it. A guarantee of health care made by the government is very reassuring and in the end I think this is the reason why America will probably accept some form of UHC in the future.
Jamila Akil Writes:
Oops, forget about that statement in post #173. Error in understanding on my part.
As I’ve already pointed out twice in this thread, this simply isn’t true. There are numerous UHC systems with low waiting times for treatment. For example, as the link you provided points out, Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland all share with the US a reputation for low waiting times.
Of course, one problem with the study you (and I) linked to is that it didn’t actually do a direct comparison, using the same methodology, of waiting times between the US and other countries. This study, in contrast, used the same questions and methodology to compare waiting times; unsurprisingly, the US and Canada have longer waiting times than the other countries studied.
So if waiting times are a significant indicator of how good the medical system is — and you’ve been implying throughout this discussion that they are — then the US is in fact significantly worse than some UHC countries.
In fact, the US combines the worst of both worlds; not only do we have long waiting periods, but we also fail to treat low-income people who would have received treatment in other countries.
You write:
In the US, people are almost six times as likely to have to not get needed health care because they can’t afford it as they are in the UK. Surely that extra 45% who have skipped some needed health care in the US would be better off in a country where they wouldn’t have to do that nearly so often?
And by the way, notice that the countries kicking the US’s butt in this study are not countries with great health care systems — they’re just the countries where the population mainly speaks English, which all happen to have pretty mediocre health care systems. Had the study compared the US to France and Germany, we would almost certainly have come out looking even worse by comparison.
Apologies that I do not have the wealth of time I did yesterday. I will reply to your post in instalments, however much I can get done in about five minutes each.
“I have never read any survey stating that two-thirds of Americans want to switch to a system like Canada. That sounds like an extremely high estimate considering that most people I know who do want UHC don’t hold Canada up as the model they aspire to.”
A miswording on my part, though that two-thirds of Americans want government to pay for everyone’s health care is really old news.
http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml
“Determining exactly how much a government spends on administrative costs under a UHC is problematic partly because some costs can be shifted to the patient and/or the physician and other costs are subsumed within government budgets and never counted at all. For instance, collecting taxes or lobbying for additional funding are not included in the overhead expense of public programs whereas collecting premiums and marketing would count toward the cost of a private insurer.
Administrative costs can be reduced in the US system but I suggest that the disparity between costs in the US and other countries with UHC would shrink dramatically if those other countries could not hide some of their costs within the government budget as debt for other programs.”
Ampersand may have already addressed this, but I want a stab at it as well. Your argument is saying that we can’t trust government to be perfectly truthful with their figures. Fair enough. It’s a truism of Canadian politics that the official opposition will always accuse the party in power of ‘bungling up health care’ in preparation for the next no-confidence vote. Is there an incentive to fudge politically inconvenient numbers? Yes. (Though it should be mentioned that the groups that gather these numbers are strictly non-partisan and work independently of the rest of the government. Government is not nearly the monolithic entity that libertarian models assume it to be.)
But are corporations always straight with their figures? Do they ever spend quite as much on R&D and on environmental and consumer safeguards as they claim to? With the amount of money they waste on administration and kickbacks, I suspect they give the full body massage treatment. You may take it on faith that corporate executives are just naturally more honest than our elected officials, but I don’t. Bureaucratic transparency cuts both ways.
“I could say the same thing about people in America who advocate for UHC; they can always pack up, leave, and move to Canada or Britain or wherever else they can get “free” health care while leaving the rest of us that don’t want it here to make do.”
Given that I already live in Canada, that may not quite be the indictment you think it to be, but let’s break it down: Libertarians who want lower taxes and fewer regulations are not obligated to move away from the jurisdiction of their present government. They may, but they may also work to fix things to their liking where they are. Liberals who want UHC and oppose the war are not obligated to do so, either; they can choose to fight the political battles at home.
And workers who labour in unsafe conditions or are horrendously underpaid (a problematic, subjective measure, granted, but in some cases there’s no two ways about it) aren’t obligated to go find a job; in a majority of cases, that may be the better idea, but not always, and not every worker can do so with the same ease. The worker has not agreed to every detail of his present conditions by virtue of the fact that he’s working there and not elsewhere, anymore than residence does for political objectors.
Ditto for consumers and unsafe products. There’s only so much parallel structure a guy can write.
The next section in your response concerning the WHO study, requires a detailed response that I cannot write out in full now without neglecting other threads of interest here. However, I’ll respond to this one point:
“France and Germany have nowhere near the number of immigrants ( illegal and otherwise) or non-white/non-Asian groups straining their health care system and pulling it down in the rankings.”
The number of immigrants may not be nearly as relevant as the degree of their isolation from the rest of society – that’s the whole reason why immigrants would even ‘pull down’ numbers, right, not because they’re of a genetically inferior stock – and France and Germany today are both far more racist societies than America is. Last I checked, it wasn’t American Hispanics who looted, destroyed, and bombed a thousands cars in the suburbs of DC and rammed one into a federal building.
This is important, because it’s also part of a response to another point further down.
Okay, I can’t sleep, it’s 37 degrees here. (That’s Celsius, you Yanks.)
Update on Jamila’s response to Amp, which I didn’t realize was made the last time. The only thing you’re doing is reasserting “actual dammit… not hypothetical” but providing nothing more but a long winded exposition on a potential scenario that, without cites, we have no reason to believe actually happens on a scale worth worrying about – your faith in corporate audits is a little touching, though, nonetheless. While we’re on this, though, it should be noted that even without counting private payments, Americans already pay more for health care just in taxes than countries with UHC do.
Jamila, your objections to the WHO study mostly echo the public health vs. health care distinction (that is, apart from the parts that weirdly veer into racial essentialism) that I was the first to bring up, so rest assured I know what you’re trying to say. But I began with a caveat saying that while public health measures and health care may not be one and the same, the former is the most important component of the latter. Your position says that it isn’t a component at all. Why shouldn’t we gauge fairness and equality when measuring the overall quality of a nation’s health care system?
You probably think that equality is either unimportant, an actual evil (a rather extreme libertarian position), or that it may be – eeeerrrrr – somewhat important, but it should be considered afterward as a sidebar or footnote so we don’t confuse it with the REAL issues. (Such as the Initiation of Force inherent in free breakfast programs for impoverished elementary schools.) My guess is probably #3, but in any case if you accept any of them as self-evident axioms, rather than propositions to conclusively reason towards, you will never see eye to eye with at least two thirds of your fellow citizens. For the simple reason that you’re arguing different things and will simply talk past east other. That the US ranks number 37 on a scale that you say measures ‘too much equality’ may actually be both shocking and relevant for all the right reasons for many, many Americans.
That being said, now that I think about it, the inclusion of the effectiveness of government involvement does seem to be a bit of a dubious measure. Government medical programs are extensive in America, and programs such as Medicare are as good, if not better, than their counterparts in other countries, so this may temper it a bit, but it doesn’t sit right.
“It’s not illogical at all. When a scientist comes to a conclusion, if he/or she wants her results to be considered valid then the scientist bears the burden of proving that the results were not biased by external factors, not the person doubting the claim. It is you who are claiming that the US needs UHC because then we all will have better health care.”
Jamila, you’re confusing empirical facts with a study, and evidence with proof. We who quote facts we come across on our reading do have certain intellectual responsibilities, but they are a far cry from those of a scientist publishing a study. We did not collect the data, we did not design the algorithm with which the data was interpreted, we did not write the papers; someone else did. That someone else, in this case, released their findings to the public domain. We read these facts and use them to form an opinion – these opinions are not “results”, and our position is drastically different from that of someone undergoing peer review, which is the context you are clearly implying. Sounds to me like you’re trying to narrow the goalposts as much you can to prevent people from using empirical figures that make your pet high-inequity system look bad.
Second, it’s reasonable to demand corrobating evidence before anyone puts forth claims and an argument. It’s not reasonable to demand proof. Applied science and social policy would be at a standstill if we tried to universalize this principle. Complete proof is hard to come by outside of pure mathematics and formal logic, and besides anyone can think up hypothetical, minute flaws. The one who does this does not some sort of diplomatic immunity herself, and you yourself scale some veritably unscientific ground when coming up with your explanations, including several that suggest discredited race science. Call it the creationist, climate change denier’s mode of scientific discourse.
“just because you have discounted the cultural factors (confounding variables) doesn’t make your assertion any more valid.
The WHO and the OECD both say that their rankings should be looked at in light of the differences between and within countries. So if those two organizations both acknowledge the insufficiency of their rankings, then why are you so hesitant to look at them too? Perhaps if you did, UHC wouldn’t look so fantastic after all.”
I haven’t discounted the cultural factors and confounding variables. I’m discounted the idea that we know how they would break down. To say that the US would be uniquely helped by the inclusion of these factors, while the panoply of developed nations with UHC, which all have different cultures to factor with, which all confound variables in their own idiosyncratic ways, would uniformly be brought down, is an extraordinarily extraordinary claim. Without, of course, any cites.
Okay, two-thirds done. To be continued…
It’s also worth nothing that the VA system deals with a diverse population of patients, including many African Americans — but still delivers the best health care in the US, easily comparable to the best health care systems anywhere in the world.
It’s Clinton’s fault, you know. He was the one who instituted computerized record keeping (with the most user friendly interface I’ve seen in any hospital anywhere, including several private ones), standing committes on reducing medical errors, etc. Bush is doing his best to undo Clinton’s subversive attempt to demonstrate that the US government is capable of running a decent hospital system by underfunding the VA (in the interest of supporting the troops, you know), but hasn’t managed it yet. Thus demonstrating that the changes are reasonably robust, even in the face of an awful chief exec.
Sylphead,
“racial essentialism” is not what is going on here. That term is generally used to assign different races differing mental characteristics. In that context, it’s bunk.
Recognizing that races are sometimes physically different, OTOH, is good science. Different races have at least some different physical characteristics, as a general rule (that’s part of what people use to distinguish the races) and are, occasionally, prone to different diseases, problems, etc. IGNORING this fact–as was done for a long time–can be quite racist, actually, and can really screw over the patients.
Saying that people of ____ race tend to be more/less prone to ____ disease is, if accurate, not a problem. It allows us to properly assess risk (not many people of Asian descent have Tay-Sachs disease, for example.) It also, if practiced correctly, allows us to be more efficient in treatment.
I also take issue with your protests re the “equality” tests inherent in the rankings. To date, you and many proponents have been talking about two things separately
1) “Look, our health care sucks, we do a bad job providing health care; in fact we’re only #37”
and
2) “moreover, we’re not equal at all in how we distribute it; a lot of people don’t get health care at all; we need more equality/universality.”
It looks like your first argument is a bit off. As you’ve all been making it, you’re talking about dying, and statistics of survival, and all those other things which you say (and I agree) define “health care.” You’ve been SEPARATELY arguing (again, appropriately in my view) about access to said health care and/or affordability of said health care.
What Jamila is saying is that the much-vaunted #37 statistic has a lot included in it which–surprise!–isn’t exactly a measure of HEALTH, but is more a measure of POLICY. E.g. a less-equally-distributed country would presumably rank lower than an equally healthy equally-distributed one.
That’s a bizarre argument. It amounts to saying that UHC is better because someone in the U.N. who assigned values to things decided that UHC is “better” so they gave points for having it.
Why did they do that? [shrug] you got me. Seems a lot more accurate to “rate” health care by, you know, health. 10 sick people and 100 well people are what they are health-wise, whether they’re in a UHC system or not.
IMO, the numbers that really matter are the ones that are at heart FACTUAL measures and not OPINION measures. Survival. Life expectancy. Life years saved. Etc.
Okay, quickie before I go.
” “racial essentialism” is not what is going on here. That term is generally used to assign different races differing mental characteristics. In that context, it’s bunk.
Recognizing that races are sometimes physically different, OTOH, is good science.”
Not every means by which races are posited to be physically different is good science; most are not. Claiming that races of people – and statements such as populations of non-whites and non-Asians dragging down health numbers, no matter where they are, strongly implicate genetics and biology, not culture, I think you’ll agree – just by virtue of who they are, are less healthy, is something that actually needs to be documented and verified. Not something that can just be thrown out there as ‘food for thought’ and expect the onus to be on us to counter it. Is there any evidence to suggest that Japanese babies are naturally hardier than Hispanic white babies? Because Jamila’s statements about Asians, in particular, flirted with racial essentialism.
As for your comments about the WHO study, you are confusing my position with that of some other liberal you’ve met. Short version, policy is a component of health care. You must have not read my last post properly if you think I wouldn’t actually agree that segregating points (1) and (2) is a good argumentation. However, neither should you or Jamily segregate policy from health care, equality vs. more ‘real’ measures. Equality is a component of quality.
Long version, will have to wait.
Who said anything about less healthy? Lifespan is but one measure of health (I’d rather die hale and hearty at 97, personally, than be decrepit by 80 and live to 102 in a decrepit state.) I find this an interesting area and actually i doubt we disagree much. racial classifications are oft misused. But that’s a sidetrack, I think; I’ll leave it alone here.
I’d rather die hale and hearty at 97, personally, than be decrepit by 80 and live to 102 in a decrepit state.
You say now, but what will you say when you’re 97? In any case, I seem to remember there being a measure of “healthy life expectancy” s0mewhere (WHO?) and that the US didn’t come out on the top of that either. Sorry about not doing the research properly, I’m posting in a hurry. With some luck I’ll come back and do it properly.
Yes, no disagreement: I recall seeing some similar measure somewhere too, and I don’t think the U.S. was on top. I was addressing sylphead’s (apparent) accusation regarding racial unhealthiness.
Obviously, all these global measures are a bit like the U.S. News college report: some of one’s place in the ranking depends on actual quality, but a decent percentage depends on how the ranker has elected to weight each individual factor in the rankings.
If you’re first (or last) in every category, then you’ll end up being first (or last) no matter what But if you have a “life expectancy” score that’s a bit low, and a “quality of life” score that’s a bit high, then a lot of your ranking may depend on whether the ranker takes my view (quality value > expectancy value) or what appears to be your view (expectancy value > quality value).
There is no objectively “true” method of assigning weight. As a result, it’s entirely possible that two people will have vastly different opinions on the validity of said rankings. That’s part of why these ranking arguments tend to get messy.
Myca wrote
Myca, I’ve agreed with pretty much everything else you’ve said so far in this discussion until the comment above. As one of the many underinsured out there in the US, I think there is an increasing problem in the US right now where lots of us who don’t have access to employer sponsored health care can not afford the kind of insurance one would otherwise get if it were through an employer. My husband works for a small business that doesn’t provide insurance, and the I know several other folks who are self employed and in a similar predicament. According to the Economic Policy Institute, there were almost 4 million more uninsured workers in 2005 than in 2000, and it looks as though that number is only increasing. (Source: http://www.epinet.org/content.cfm/bp175)
As a result of the crappy private insurance coverage we currently have, we can’t afford to pay for my asthma medications because they are so ridiculously expensive (over $25o/month.) So I go without that medication and make do as best I can. I have considered trying to import the medication from Canada because it would only cost about a fourth of what it costs here in the US, but Big Pharma has pushed to keep this practice illegal.
That isn’t to say that I disagree with you about the utter lack of health insurance or health safety net for the truly poor in our country. Deregulation of the health insurance industry would do nothing to provide these people with better access to health care, and until we do more to provide them with that access they will continue to be left behind.
I think we really are moving closer to a true crisis in this country where eventually the only people who can afford good health care are the truly wealthy among us. Some form of UHC is likely the only way we can prevent that from happening.
Agreed, Lola.
I certainly don’t deny that this is a problem for some people, I just think that it’s only likely to be a problem for people who are:
1) self-employed or working part time without employer-provided health care
2) making enough money that cutting their taxes would enable them to pay for health care
3) but not making so much that they would be able to afford health care without a tax cut
I don’t think that this group is very large, but regardless, my quibble is mostly with the contention some libertarian acolytes have that cutting taxes is a sort of magical panacea that will make everything better, regardless of the situation.
As we’ve seen, that’s simply not true.
—Myca
The lure of UHC is the promise of ‘something for nothing’. Getting something of high value for ‘free’ or a highly discounted price is always very alluring.
Most of the advances in medicine have come from this country because of our system of medicine. Those wealthy people who can afford to have the ‘cutting edge ‘ surgeries have helped to generate the rapid advance in medical technology and medicines that we have seen today. It is the vast sums of money that this country voluntarily spends on its health that is the driving force.
UHC systems, except for a few symbolic show pieces, tend to lag far behind in equipment and innovation. Their staff tends to be underpaid. The U.K. has to import a large number of doctors because the job of being a doctor is just not that attractive to the natives.
A ‘single-payer’ system is patriarchal paternalism at its worst – hey, lets let dirty Uncle Sal {Grey’s anatomy joke} take care of us. If you are friends with the Uncle, you will get great treatment, but if he doesn’t like you, you will get horrible service.
No, it’s not. The vast majority of Americans realize that government services are paid for with taxes, which is not the same as being free.
Look at my comment #137, quoting the survey; the questions made it perfectly clear that what’s being discussed is a system paid for out of taxes. But even when that is made explicit, people still favor it.
Not true. Many of the largest pharmaceutical companies (all of whom create new drugs) are European, not American; and many important advances in technology have come from places like Japan and Germany.
Besides, in the US, much of the cutting-edge research is financed by the public sector, not by the free market.
Plenty of evidence has been posted on this thread showing that health care in many USC countries is as good or better than health care in the US, for patients. Other countries often have shorter wait times, and of course more universal access.
I’m not sure that you even understand what the word “patriarchal” means; and I doubt that you’re using it sincerely.
That aside, there’s nothing particularly “paternalistic” about public services. We all seem to live with “paternalistic” public road-building and maintenance, and “paternalistic” public fire departments; it’s my guess that we’ll be fine with public health insurance, too.
Collective action is not paternalism.
Eek! Marrow transplants? All my sympathies, that sounds like no fun…
(The insurance conversation is, well, much needed but also no fun, so I’ll leave it at the sympathies.)
Ampersand Writes:
I should have been clearer with my words. Just as you say, there are countries with UHC that have low wait times; I was specifically thinking of Canada and the UK when I made reference to extremely long wait times. New Zealand and Australia also have UHC’s and they have wait times in excess of several months for particular kinds of surgery and treatment.
From this point forward I’ll try to make reference to the specific country that I’m talking about.
Countries with UHC’s tend to have far more general providers ( GP’s or family doctors) than specialists so when people are sick, but not sick enough to go to the hospital, they do tend to get appointments faster than they would in America; however, America has a far higher percentage of specialists than most UHC’s and thus people who are really sick don’t have that long of a wait time for treatment.
According to a study by the Commonwealth Fund only 5% of Americans have to wait more than four months for surgery, compared to 23% of Australians and 26% of New Zealanders.
I don’t think that having to wait until the next morning or having to wait two-three days until Monday morning for non-emergency care is a significant indicator of the overall quality of care that people are receiving. If these people who want overnight care are seriously ill they can always go to a hospital emergency room. I think that care for the seriously ill is more important than prompt care for healthy folks who are temporarily sick. U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the ER, see a specialist, and have elective surgery.
You just acknowledged that US does not have long wait times when compared to the best of the UHC countries and I just provided a link ( see above) showing that the US has shorter wait times to see a specialist, have elective surgery, or be seen in an ER.
Low income people in America have Medicaid and they can go to an ER for emergency treatment.
In the US cost is most likely to be cited as the major obstacle to care while wait times and physican shortages are most likely cited in Britain and the UK.
When I say give me proof that a given sick person will be better off in another country than here, I mean tell me that the sick person is more likely to be cured of whatever ails them. If the choice is between going broke but I still get the best treatment and my cancer is gone vs not going broke because my treatment is free but I’ll have to wait in line for it and my chance of dying is greater, then I would choose going broke but at least I’ll be cured.
When the choice is between care rationed by money and care rationed by wait lists, the chance of survival is the deciding factor.
The study doesn’t show any countries kicking the USA’s butt. America still rates pretty high in overall health, we have low wait times for the ER/specialist/elective surgury, our wait times are comparable to the best of the UHC countries, and we have higher cure rates for certain ailments than the best of the UHC countries. So where, exactly, does France or Germany kick our butt?
I stuck define:Paternalism into google. and got this as the 2nd hit
paternalism A method of medical or administrative practice in which the values of the practitioner or administrator are imposed upon the person most affected by the decisions to be made, without adequately heeding that person’s own values or power to make decisions that directly affect them. For a discussion of paternalism in the doctor-patient relationship, read the box, Autonomy and respect for persons, in WebPage 26. See also autonomy and professionalism.
http://www.jansen.com.au/Dictionary_PR.html
I can easily see how public collective health care could develop in this way. It’s one of the reasons I’m not (yet) a supporter of UHC.
Public ideas about weight are a good example. I can easily imagine scenerios where UHC further adds to anti-fat bias. Now the health systems says you have to be skinny because that’s healthy.
Since weight is entirely dependent on personal decisions not only are fat people immoral and weak willed they’re also wasting my tax money because now I have to pay for their lard related diseases. Everybody knows that god made these sorts of health issues to punish people who sin with twinkies.
end snark
That statement is stupid and vile but so is congress.Orin Hatch is the ranking repub on the senate committee on health. He’s going to have a lot of input into any public health plan.
sylphhead Wrote:
As important as how integrated immigrants are into the larger society, the number of immigrants and their immigration status is also important. France and Germany are not dealing with 12 million plus illegal immigrants in their health care sytem. I was not trying to say that anyone was of inferior stock, only that particular groups are associated with particular ailments ( such as Jewish people with Tay-Sachs and black people with sickle cell anemia); the greater the ethnic variety in a country the greater the variety of genetic diseases.
sylphhead Writes:
It already has been verified, you just have to look at the figures. The Asian populations in the UK, Canada, and the US are healthier than the population at large. I don’t know whether this is because of some genetic factor or whether it has something to do with their culture ( maybe it’s religion, diet, excercise, etc.,).
As an example I’ll bring up my best friend who is the child of immigrants from Nigeria. Her family is still strongly culturally Nigerian even though she has lived in America her entire life. Perhaps the combination of traditional Asian cuisines (whether it is Japanese cuisine, Thai, Chinese, etc.,) combined with exercise and religion (Buddism, Confucianism) and this keeps them healthier than other ethnic groups.
At this point, the question isn’t “are they healthier?” but “why are they healthier?”
[Reply deleted, based on misreading of JA’s earlier comment. Sorry!]
Joe,
You make some good points. We do see anti-fat shit going down in other countries, and I’ve read some annoying quotes by UK taxpayers talking about how fat people are draining all their tax money.
Amanda @ Pandagon wrote a bit about the legitimate concern that assholes will be allowed ot ruin UHC, in order to prove that it doesn’t work.
Although, I must say, despite the fact that I have excellent, excellent insurance, my HMO does seem to be throwing roadblocks in the path of my ability to get a diagnosis. I am not convinced that the asshole factor will be worse coming from collective decision-making than it is coming from people motivated by profit who, possessing my cash already in their pockets, have every reason to deny me as much care as possible.
Anti fat bias is not limited to UHC systems. I hear arguments like, “all those fat people cause my insurance premiums to be too high” etc. Anti fat is anti fat and will need to be addressed, but I don’t think adding UHC will really do too much to worsen anti-fat bias in the US. It’s already despicable.
There are many competing political views in this country. I predict that if we had UNC there would always be a lot of people will always be convinced that the assholes running it are trying to ruin it, and the country at large. This fact will be constant no matter who is in charge. Amanda describes malice as their motivation. But I think we’d get plenty of ‘bad’ decisions based just on different values, viewpoints and trade offs without any malice.
It’s one of the flaws of a technocratic system. It’ll work great if the technocrats make the same decisions that I would. When the levers of power are in the hands of people I disagree with it doesn’t work as well.
Kate, i wasn’t trying to say anti-fat bias is limited to UHC. I was just trying to provide an example of a reasonable paternalistic decision making process that would result in something bad.
I thought about using mandatory helmet laws for motorcycle riders but I thought the weight one was more on point.
Replace premiums with Taxes though and you can already see how this could go bad once the bills have to be paid.
How much can we cut my taxes if we don’t pay for smoker’s lung issues, injuries from obviously dangerous activities, or STD for people that do things gawd says are icky? Most smokers are poor anyway. We need to cut social spending until they can’t afford to smoke! Two birds with one stone. It’s in Leviticus.
end snark
That’s part of why i want to know how any system will be rationed. I don’t think anyone here is really advocating that we provide unlimited medical care to any man of woman born who asks for (if you’ll pardon the gendered expression.)
My understanding is that UHC will provide necessary medical care. The definition of necessary will be key.