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.
Oh boy, the ‘right’ is written into the constitution. Pity she undermines that claim in the very next paragraph. The care she is describing is based on the private pay-as-you go system and not on the public health care which as expected is inadequate.
Ronda Kaysen article
Nick, she appears to have meant the MEXICAN constitution (I don’t know, but I assume the claim is accurate.) I don’t think she was claiming that the right is in the U.S. constitution, which obviously it is not.
And how does she undermine the claim?
And how is she related to this conversation (not that UHC systems aren’t related to the conversation, but the way Nick’s comment is presented just sort of drops me into a conversation I wasn’t previously aware of)? I may have missed something, but I didn’t see her brought up before Nick’s comment. Did Amp bring her up first? A little context would be nice.
Blargh. It’s more than a little sad that in all my myriad applications for health care (Medicare/aid, social security/disability, etc.), my ever-changing weight has never been much of an issue. It’s low, but it fluctuates within a 30 pound range.
Now, the cigarettes…the cigarettes I get to lie about ;)
* * *
My deepest health/health care sympathies are with you!
mandolin:
Your post had many interesting comments on how expensive healthcare is in the USA; I wish I had time to address them all & share what I know.
You see, I have an insider’s view point. I work for one of the major USA health insurance companies, and you’re darn right being sick is expensive.
I don’t deny the healthcare industry is sick our country, and from what little glimpse I have of it in my daily worklife (which is at best, miniscule), I do my best to do the right thing & provide any member that calls in to me with my commitment to quality healthcare.
Allow me add to your comments on few things. A surgery that costs $250,000? Sure. Easy. You have at least 5 bills now, instead of one from a hospital. You pay a surgeon, a hospital for the facility (bed, supplies,etc.); you also pay the outsourced anethesiologist, the outsourced pathology lab, the outsourced pathologist who looked at your blood, and wrote a report to the prescribing physician; and you also have fees from your pharmacy for your drugs, & maybe charges after you get out to see a doctor as follow up or my have had physical therapy.
Hospitals are now outsourcing certain staff, and if your policy that your employer dictated to the insurance company does’nt have a RAPL clause written in you are in for a little surprise….like a bill for $1500 for 15 minutes of anesthesia.
the highest charges I see on daily basis are not from your surgeon or physician, but from the anethesiologist, the lab & the rehab centers. oh yeah, lets not forget the non-standard pharmacy drugs, which have to be approved & mailordered 90 days at a time from a specialty pharmacy if bum-who-knows-where in NY. (apologies to said residents in advance.)
I ask myself what drives these costs up higher than others? I’ve been able to hypothesize a few scenarios with the info in front that passes in front of my face every day.
one is: I see employers wanting to cut high costs of administering healthcare benefits to employees. They use the insurance company as the administrator of the employee’s benefit plan, but they pay the claims themselves. This is called an ASO plan. This is only one type of plan out there, folks.
Actually, a healthcare insurance company will insure & cover anything and everything a person could want regarding their health….just like Lloyd’s of London. It will cost the employer X amount per contact year. They employer tries to cut costs by having the employee help pay for part of the cost, thru payroll deduction, deductibles, copayments & coinsurance percentages.
I often see clauses & limitations written in, and quite cleverly, I might add….written in at the employer’s demand. You want to not cover any employee who has a chronic underlying condition, like chronic obstructive pulmonary disease? ( I.E. you ‘re the fella who chain smoked for 35 years & has to cart around an O2 tank every day, ’cause your lungs are’nt able to take in enough O2 to keep you functioning normally)….write in a ‘pre-existing condition” clause. the insurance company has to look back for a time period, say, 6 months, to see if you recieved treatment. you may be denied coverage for that condition for up to one year if you don’t show proof of prior coverage that paid out on your condition or proof that you were not treated in the past 6 months ( i.e. this is a new diagnosis for you).
Mandolin, I’m not trying to cover my employer’s behind at all – the guy that sells this insurance coverage is just as bad as the guy who insists on buying it this way. it’s a huge mess. All I can do is just fix what I am in control of. One thing at a time.
I have a lot more I’d say, but my time is limited tonight. God bless you, please write if I can do anything to help you sort thru the maze. I’ll post as soon as I can this next week.
Sorry, my bad. Is the link working?
Yes, she is talking about the Mexican health care system. She never gets round to covering the Mexican health care system other than the toss away dismissal line.
All the joys she expresses are the great friendly service she gets from the private system and the freedom of not being under an insurance companies thumb — all for far lower costs than we pay.
The article is an interesting comparison of the US and Mexican pay systems.
That article, published last month, came up after reviewing this article on her finding herself pregnant and their family deciding to have the baby .
Link to the having a baby article
The five or more bills stuff is confusing. It gets hard to know what the insurance company is going to pay and what has been paid when new bills just keep showing up in the mail.
Looks like the health care in some of the countries with a “good” UHC may not be so good afterall. From an article by Johnny Munkhammar in the Examiner:
and
Read the entire article HERE.
I’m glad that you made it explicitly clear that your argument about Asians could be attributed to culture, not biology, though I still think you leave the door open for the latter by a much wider margin than reputable science allows. (At this point, Arthur Jensen is the intellectual equivalent of a keyhole peeping Tom.) However – and perhaps I should have stated this clearer from the outset, as Sailorman doesn’t seem to understand where I’m coming from either – you drastically overestimate the effect that differential racial biology, however much lip service you give in saying that it is minute, makes on something such as health. Race-linked disorders such as Tay-Sachs and cystic fibrosis are the exception, not the norm, and often times the statistical significance of the link is exaggerated in the public mind. There is far more genetic variation within a population than between populations, so I find it hard to swallow that racial diversity would somehow confuse a health care system into underperforming.
If racial diversity is a problem, the problem most likely has been created by people, not by nature. The effects of discrimination and isolation, perhaps barely noticeable on a case by case basis, could conceivably depress outcomes for the group that becomes significant when you analyze them as a whole. But I’ve yet to see either a causal link or even a base level of evidence suggesting that America is somehow unique in this. Yes, America is Hung Up On Race as it pertains to epithets on prime time, but if you want to see truly racist societies, book an international flight sometime.
And thank god this isn’t the SATs, because I failed reading comp with regards to your argument about government hiding costs of UHC. Let me re-address that one.
Your point is that some of the costs of administrating UHC would not be counted among its expenses, whereas its private sector equivalent would be. For instance, levying taxes probably would not count under a public health care expenditure, whereas the internal shuffling of money within a corporation would for private health care. Local politicians advertising health care proposals doesn’t count as a cost of UHC; marketing and advertising does for private care. On a strict number to number comparison basis, this may make a small difference; I wouldn’t know. But there are many problems with this argument:
1. Competition with other companies takes up a lot of spending that doesn’t go directly into health care, such as marketing and advertising. The closest public sector equivalent are political parties touting their difference health care proposals, and I highly doubt this comes anywhere close as an expenditure.
2. Compensation for executives and shareholder profit is the probably the single largest administrative cost for private health care companies (where administrative is defined as anything that doesn’t directly fund health care), and this has even less of a public sector equivalent. At most, we have the salaries of the file clerk guys who work at a separate government agency.
3. More to the point, if a given private health care company doesn’t exist, they don’t advertise, market, shuffle money, etc. However, if a given UHC doesn’t exist, the ‘indirect’ ways the government administers it, such as sessions of congress and political campaigns, still take place, albeit with a different focus. The taxpayer money taken up debating the national health care program would just be spent elsewhere. Campaigners who would spread the word on health care proposals would just campaign on something else. So the cases you bring up, are expenditures in the most academic sense in that they are money-valued, but those who pay for them aren’t losing anything they’d otherwise have. To the extent that the tendency exists for the costs of UHC to mix in with the costs of government in general, it is precisely the very thing that makes it more efficient.
4. And lastly, there’s such a thing as going too far in this direction. I could also cite all the money lost by other creditors when someone declares bankruptcy as a result of private medical payments, or the money spent in political battles to preserve the obviously unpopular for-profit system, as uncounted expenditures of private health care system. All this fraying at the edges won’t change the fact that public health care is just a fundamentally more efficient system than private health care.
But wait, can’t the same arguments I’ve made for UHC be applied to any other industry – leading to a slippery slope? Should we nationalize toothpaste then, since then toothpaste companies won’t have to spend money competing with each other, and toothpaste execs won’t have to be compensated? In a sense, yes, all private and competitive markets share this same inefficiency. But in many cases, it’s more than counterbalanced by the efficiencies that the profit motive brings. As many here have alread delineated, however, health care, particularly health insurance, isn’t an industry that provides the right incentives. So it’s the worst of both worlds.
“Please provide me with some statistics that say the US has a surgical mortality, lower patient satisfaction, and a very low rate of access to primary care physicians.”
I regret that there was one handy link where I first got this, and I’ve long since lost it. I’ve made do here with other links I happen to have.
Scroll down to the Manitoba study. The rest just deals with clinical outcomes for various ailments for which Canada is superior to the US, which I’ve already gone over.
This is an article, not a study, that talks about patient satisfaction. I will find the original link, or something like it, soon.
“The infant mortality rate and life expectancy of the US is not a sign of the failure of our health care system.”
By itself, infant mortality rate and life expectancy don’t give the whole picture, yes I’ve gone over that. But to suggest they aren’t even signs, or symptoms of a failing health care system at all, is ludicrous. The only ones claiming that are Republican political activists and diehard neoliberals – post hoc after they found out that America happened to be far behind on those measures. Give me a long standing school of informed medical dissent over these measures, dating at least back to when the US *wasn’t* behind on these statistics, and I’ll treat it as an informed position.
While we’re at it though, this article brings up something interesting: Canada’s infant mortality rates were on par with America’s until we adopted UHC. Perhaps I gave the other side more credit than they deserved on this.
“White Americans have a life expectancy and infant mortality rate similar to those found in western Europe. Japanese people have low infant mortality in Japan and here in America. African Americans and Latinos have higher infant mortality than the rest of the white population which raises the overall infant mortality rate.”
You know, America has this tendency to score low on a number of international comparisons, which is a real burr on the sides of those who want to believe that high inequality and entrenched wealth are signs of a good society. I hear the same “if you only count White (read: real) Americans… ” line of reasoning when arguing country by country violent crime rates. Let’s dissect this.
1. Right off the bat, any comparison where you manipulate what is being compared to move it in a desired direction, as in comparing the better off 88% of America with 100% of another country’s, is statistically and scientifically invalid.
2. I cannot stress enough that America is not alone or unique in having a racially or ethnically defined underclass that does worse than the rest of society on nearly every measure, be it health indicators or crime rates. On the contrary, this is a basic pattern followed by every society in history that isn’t small and genetically isolated. America does have a history with race and social injustice that’s perhaps more defined that those of its contemporaries, but then we’d need to establish and if possible, quantify, this discrepancy. Not simply toss it out for other countries entirely out of a desire to make a favoured political system look better.
3. Yes, Scandinavian populations pose that sort of a problem, which is why I don’t use them in population comparisons. However, France and Germany don’t, and you can’t discount Japan, a country with over 120 million people, for being homogeneous without being really, really racist. (There are other ways to be heterogeneous than by ethnic ancestry – for instance, the urban/rural divide you brought up.)
My points above are all related, I know. I just like numbers.
“There is nothing about drug research that drug companies can do that universities can’t, but why should there be any preference that the universities or the NIH do it when, as you say, the drug companies usually end up taking over in the end anyway?”
In a calm, neutral world, I would have no preference. However, more than a few right-wingers have suggested that drug companies need to be given favours or mollycoddled to protect their *irreplacable* R&D contributions. You yourself suggested that we need to pay higher prices for drugs, or else R&D would suffer. I’d rather the government take over the whole process by force than give those companies more power than they already have.
I’ve taken this long to reply to one thorough post (#155), so I’m not going to try it again with everything you’ve said since, Jamila. (Most of the argument wheels back and repeats, in any case.) But I’ve noticed you keep bringing up cancer as an example. Since you’re interested in direct country by country evaluations, did you miss the links provided, separately by myself and Ampersand, showing that Canada has higher cancer survival rates than America?
Oh, OK, now I get what you’re saying. Sure, I agree, the genetic variation is not all that huge. (of course, it’s an issue of phenotype, not genotype, and the % genetic variation may not always reflect the changes in phenotype) But in any case, isn’t it appropriate to take other factors into consideration, even if they’re nongenetic? If the goal is evaluate the efficacy of UHC, it seems relevant.
Imagine for a minute that Vikings are discriminated against pretty much everywhere. They may also have special Viking-only genetic issues. But for whatever reasons, they seem to have a lower life expectancy and worse health than non-Vikings.
Even if we don’t know whether the Vikings’ “worse” health is the result of genetics or of discrimination, we can still make the same conclusion: A country with an unusually high proportion of Vikings is likely to have their health issues “look worse” than they actually are.
Most of the issues I have seen w/r/t America and race don’t claim that America has racism issues that don’t exist elsewhere. Rather, they claim that America has an unusually high proportion of people who, for whatever reasons, tend to have ‘worse’ numbers.
Obviously, a good UHC system would NOT have that problem, as part of the function of a UHC system would be to provide universality, hopefully WITHOUT the disparities that exist in our current system. So countries that have meaningfully large populations of Vikings but who do not show the ‘normal’ (unfortunate) outcome difference between Vikings and non-Vikings could “honestly” claim that their differences were the result of UHC.
However, countries that continue to have worse outcomes for Vikings don’t get that assumption. THEY have to be compared to other countries by first accounting for the “viking effect.”
Ah, the old deserved-sickness argument. As I think I mentioned way upthread, my son was diagnosed at age four with a highly malignant brain tumor. Was that his fault or ours, his parents’? (I don’t know how much his treatment cost as nearly all of it was covered by insurance, but it’s a pretty safe bet that it was at least six digits.)
Sailorman, you said that is a much clearer and more succinct fashion than I could.
sylphhead Writes:
Sailorman addressed this issue better than I could.
Public health care is not fundamentally more efficient than the private system; in fact I would argue that it is fundamentally less efficient based on the same reasons you provided.
1. Competition with other companies: A private company is going to compete with other private companies by attempting to lower costs ( thus increasing profit) and/or increasing the services to select from ( different insurance plans). The government has no incentive to do either because 1) everyone gets the same plan no matter what; 2) costs can be shuffled around to other government offices; and 3) if the money is not spent on some aspect of the UHC then some other office gets to spend it thereby eliminating the pressure to cut costs and improve efficiency. A private company is internally pressured to cut costs while the government must be pressured by the tax-payers ( and I won’t even try to estimate how much that costs).
2. Compensation for executives and shareholder profit: A private company is responsible to the shareholders and if the chief executives are not providing benefits commisserate with what they are earning then the executive gets replaced. Because a private company cannot shuffle or share costs it is much easier to directly measure the monetary benefit that a given executive provides the company. Executive pay is like any other expense for a private company: the company wants to reduce it as much as possible and still get its money’s worth.
The countries that we routinely think of as having the best UHC’s have almost all moved toward increased privatization to cuts costs and increase efficiency.
Australia has a UHC and it uses the private sector so extensively that it is now only second to the United States among industrialized nations in the share of health care spending that is private.
Since 1993 the German government has been experimenting with American style managed competition to give citizens more options and cut costs.
The Netherlands also has an extensive network of private health care providers and more than one-third of the population is privately insured.
Health insurance is compulsory in Switzerland and is handled by the nation’s competing private insurers.
The insurance industry is like any other industry and the incentives are the same. Insurance companies want to provide a service to people and make a profit by doing so. As I’ve already said, overregulation by the government has increased the cost of doing business for the insurance companies and created perverse incentives by forcing some insurance companies to accept some people they would not have accepted etc.,
This study says plenty of good things about the US, such as: “United States women reported higher rates of mammography screening “within less than 2 years” but not within the past 5 years. United States respondents were slightly more likely than Canadians to give a rating of excellent to their hospital (but not to their physician or community-based) care. United States respondents were also more satisfied than Canadians with their hospital and community-based care, but not with their physician care.”
And while the conclusion of the study is that “United States residents are less able to access care than are Canadians” in the discussion section of the study it states that “The JCUSH data suggest that Canada no longer enjoys greater satisfaction
with its health care than does the United States” and that “the US uninsured fared much worse than Canadians on most of these measures, whereas the US insured fared slightly better than Canadians (results of statistical testing not shown).”
Which leaves me with the impression that all things considered being insured in America is better than being under a UHC in Canada and that the results of this study are greatly affected by the different demographic factors of the population between the two countries–which it also says in the discussion.
Are they signs of how well the health care system is doing? Sure. But do they tell the whole, or even most, of the picture? Absolutely not. Do they suggest that the health care system if failing without looking at other indicators that might carry even more weight? I don’t think so. I’ve already pointed out that infant mortality and life expectancy have more to do with demographics than the health care system.
Why don’t you provide me with evidence dating back to before the US was behind on these measures that declares infant mortality and life expectancy have more to do with whether or not a country has UHC?
The article says the following about Canada: “For example, in the case of new cancer treatment, the latest pharmaceuticals (such as visudyne for macular degeneration), and high-tech diagnostic tests, Canadian governments simply reduce their expenses by limiting the service. Such a method of rationing is only possible in a single-payer monopoly. Medicare also shares other defining characteristics of monopolies: limited information, little transparency and poor accountability.”
Did you notice that it also says this?: Canadians wait an average of 5 months for a cranial MRI scan; Americans just 3 days (Bell, et al, 1998). Unsurprisingly, many choose to fly south to the US for diagnosis and treatment. A key factor behind these statistics is the inability of the Canadian system to provide even equipment deemed basic, let alone new technology.
That link also notes the “creeping privatization” occurring in the Canadian health care system to combat waiting in long lines for treatment.
But the best part of your link is that it makes my point for me: So why does Canada perform relatively well?Studies have shown that a number of non-health system related factors affect health outcomes.
That’s not what I’ve done.
Then establish and quantify this discrepancy (or find a study that does so) , if possible, and get back to me with some conclusive results.
1) I’m not discounting Japan. I’m just pointing out that Japan has cultural and linguistic homogeneity and the WHO rates the country number 1 in overall health; yet, Asians (not just Japanese) in America have a longer life expectancy than Japanese people in Japan.
2) Neither France or Germany is as heterogenous as the US in any factor that I can think of. Neither has as many of illegal and legal immigrants as the US to contend with either.
Am I racist for pointing that out?
I never suggested anything such thing. In my opinion we should leave the drug companies alone to do what they do best–produce drugs. No mollycoddling or favors required. But we also don’t need to suppress drug prices by using the government to force the companies to charge less than they want to charge.
I must have, because I know that for certain cancers, the US has a higher survival rate than Canada. I also know that there are higher rates of survival for cervical cancer in Canada than the US.
I have a really hard time seeing insurance as “like any other industry” with similar competitive “incentives.” Insurance companies are, at their heart, legalized gambling operations: they insure people who they believe are least likely to get sick and cost them money, then try to spread the costs over as large a group as possible. They make sure premiums outweigh costs by either refusing to insure high-risk populations or denying expensive claims from low-risk populations who have paid their premiums. In addition, they often make their money by investing their premiums in other enterprises, making them more akin to investment banking firms than the providers of a service. As always, we come back to the fact that the most reliable way to keep costs down is to deny care rather than provide care. They only thing they provide to consumers with any reliability is peace of mind, and consumers buy insurance so they can know that they’ll be covered in the event of an emergency. Unfortunately, they can only increase profits if they steal this peace of mind right when you need it.
No, insurance ain’t like manufacturing toothpaste or even like owning a spa. They’re not collecting payment for a service. They’re in the business of collecting premiums from a population that’s statistically unlikely to need their help, and then trying their darndest to avoid paying when the statistical aberration falls ill. Just like a gambler tries to avoid paying his debts when he loses and keeps on collecting when he wins.
This, in and of itself, isn’t an argument for UHC. But it is important to think about the relative merits of free market thinking with respect to different types of industries (think natural monopolies), especially with other moral concerns come into play.
And as for wait times: who here has looked at U.S. examples? We have Medicare and Medicaid already… I’m wondering what the wait times are for Americans covered under those systems as opposed to those covered with private insurance… especially ’cause hip replacements seem to be a big deal among the Medicare set (stolen from yesterday’s Krugman op-ed.)
In addition, they often make their money by investing their premiums in other enterprises, making them more akin to investment banking firms than the providers of a service.
This cannot be overemphasized. The market crash & stagnation in the early part of the decade and the attendant loss of investment profit for health insurance companies is a large part of the reasons we saw huge spikes in premiums. They needed to replace that lost income for their stockholders.
I think it’s important to note that the current system is not a health care market. UHC wouldn’t represent a move from market rationing to technocrat rationing. It would be more like replacing an unpleasant messed up system with another unpleasant system that is messed up in a different way. Plus a deficit.
Sailorman, the difference between faulting biology and faulting culture is huge in the qualifications on the *strength* of your argument that you would be able to make, which is why bona fide racists go to such trouble to ensure that the former, not the latter, define the terms of the debate. Let me go over how this is so:
1. Perhaps the most important one is that biology can only be a cause, never an effect. With culture, causality is a sticky point. Cause? Effect? Cause-and-effect feedback cycle?
2. Biology “crowds out” all other explanations; culture is nuanced, multifaceted. For instance, it’s entirely possible for Asian culture, what with us being so polite and genteel and all, to have standards of hygiene and moderated living that promote health. But within an ethnicity, “culture” is not a monolith, and is in fact fairly well defined by class. The culture of predominantly upper class Asians that are overly represented among Japanese, Korean, and Chinese immigrants of the past thirty years, and that of impoverished Hmong and Laotians in California, are at opposite ends of the pole. It’s entirely possible both for Asian immigrants self-selected by class to pull up numbers for Asian Americans, while other factors – with culture, there by necessity are many such other factors – such as universal health care, raise numbers at home. A broad, statisical trend is generally indicative of a single cause, yes, but only biology *necessitates* it. (Besides, apart from biology, what “single cause” could there be? Hygiene?)
3. Biology is specific, culture is inclusive; related to point (2), as the specificity of biology is what makes it Universal health care and a preference for collectivisation can itself be a part and parcel of culture itself
This is far from an exhaustive exposition, and I’m sure some of the bloggers here who study this stuff for a living could have done more with it, but I’m sure I’ve touched upon it sufficiently to make my point. The difference between a biological difference and a cultural difference is so often the dividing line between “point that helps my argument”, and “fairly neutral observation, the roots of which probably loop back to my opponent’s arguments anyway”. See any racist arguing minority crime rates for more information.
“Public health care is not fundamentally more efficient than the private system; in fact I would argue that it is fundamentally less efficient based on the same reasons you provided.”
Jamila, everyone here has taken basic economics at some point in their lives. Re:why a rote copy and paste of chapter 3 of the textbook is inappropriate in this case (as it usually is):
1. The incentive is for private companies is to be efficient on a relative scale, not an absolute one. You don’t need to beat your opponents 15-2 when it’s more economical to do it 4-2. A company that pays its executives 8 million dollars each is perhaps more streamlined than one that pays them 10, but it’s still worse off than one that doesn’t have to work within the confines of a system that has to pay executive compensation to begin with.
2. Like introductory economics texts everywhere, your oversimplified models pose an obstacle to their relevance to real world examples. In this case, a “company” is no more a discrete entity than a government is. In the grand tradition of proclaiming that collective entities such as “society” don’t exist, “companies” don’t exist. Companies are made up of disparate departments, in which work disparate individuals. Individuals working in companies, if feeling particularly loyal, may strive to correct whatever problem they’re working on to the betterment of the company. They may also find ways to shift the costs to make it the problem of someone else within the department. Departments may do this to other departments. And neither is this an all-or-nothing proposition; they may doing both, in helping the company against other companies while also burning a lot of money through internal friction. This is a problem with all large scale organization, and your argument here simply bursts with special pleading.
3. If you can’t find a flaw in the circular reasoning involved in “executives must be worth it, otherwise they wouldn’t be paid what they are paid”, then there’s little I can do to help you. I could point out that the average CEO gets paid more than six times that his counterpart did in the early eighties (keeping in mind in many cases it’s still the same person), and that American CEO’s get paid much more than their European or Asian brethren, and all the complications these pose to the simplistic textbook explanation. I won’t delineate them in detail at the risk of going off topic once again; suffice to say, the principle behind point (1) applies here: CEO’s may be “commensurately” compensated (though it’s still not a certainty) in relation to other, similar CEO’s also testing the market, but it’s harder for the market to correct the under- or over-valuation of an entire class of workers. Sure, we could substitute away from a class of overvalued workers, if we can ignore path dependency, institutional inertia, and the political power that the overvalued workers in question wield within the very firms that need the reforms.
“The countries that we routinely think of as having the best UHC’s have almost all moved toward increased privatization to cuts costs and increase efficiency.”
The question then, is why none moved towards complete privatization to cut costs and increase efficiency even further. Must be some significant drawbacks to that, I assume. Because so far, the scorecard from private-to-public vs. public-to-private is something like 12-0.
Not that I can’t see a bit of a logical fallacy in “what changes these other countries must always be for the better, therefore if enough countries agree with me then by argumentem ad populum I win”. But you can’t have it both ways. A move toward privatization can’t suddenly be indicative of anything that the reverse move toward nationalization wouldn’t be. (Quick question, the US is in the infant stages of a increased move toward collectivisation of health care. What is this indicative of?)
A combination public/private system is indeed what I personally think to be the best, and not just in logistical terms. I don’t approve, for instance, of a public system forbidding people from obtaining outside care (like Canada does, to some extent).
Also, the fact that both UHC systems internationally and programs such as Medicare within the US have proven to be far more efficient on a measured scale should not be forgotten. I realize that what we’re dealing with here is a challenge to that very same measured scale, but to assume a level neutrality here would be too much.
“This study says plenty of good things about the US”
If you’re looking for me to say that Canada is better than the US on absolutely every front, you’ll be sadly disappointed. The study is fairly straightforward in saying that on the net, the Canadian system is superior.
On a related note, the question of insured Americans fare vs. all of Canadians is a frame that even left-wingers such as Moore have accepted, but this is being far too generous. A comparison between 85% of Americans selected to have received better health care than average (where “average” would necessarily include all 100% in its calculations), and that of 100% of Canadians, is invalid for reasons I’ve already gone over. We should drop 15% of Canada – say, people who live in the northern Territories, reserves, outlying islands, etc.
“Why don’t you provide me with evidence dating back to before the US was behind on these measures that declares infant mortality and life expectancy have more to do with whether or not a country has UHC?”
What? Sounds like you started off saying one thing and ended with another. What we’ve proposed is the fairly straightforward proposition that infant mortality and life expenctancy are (incomplete) measures of quality of health care; it “has to do” with whether or not a country has UHC only insofar as the numbers suggest a correlation.
Also, do you deny that pretty much anyone who harps on the shortcomings of either of these measures is a true blue defender of the American system? Do you not understand the problem that this presents re:credibility?
“I’ve already pointed out that infant mortality and life expectancy have more to do with demographics than the health care system.”
You’ve opined it, yes, but you haven’t come close to establishing anything, besides a single tenuous one involving Asians (“tenuous” re: culture vs. biology, see top of post). A number of fairly ludicrous ones you started out with, such as obesity and whatnot, I see you’ve quietly dropped after I pointed the problems with using such measures, and are now using race exclusively. Well, if this is to become another thread on race, so be it.
Also, we’ve gone a long ways in pretending this whole thing is a country by country comparison, US vs. Japan. But every UHC country, each with its own culture, each with its own mitigating factors, each with its own issues with demographics, outperforms the US. Why, specifically, does the US score so low? Is it all the Black people?
“That’s not what I’ve done.”
Anytime you want to discount Black Americans in international comparisons because they (and you among them, which troubles me a bit) apparently *embarrass* America and/or the glorious cause of neoliberalism, that’s exactly what you’re doing.
The only way it would be justified is if similar measures were done with every one of the other countries as well, but here the big if is the word “similar” – as in similar in number, similar in extent. Discounting Black Britons, just off the top of my head, would be a disingenuous half-measure, because Black Britons have not experienced the same history of race-based stigmatization, oppression, and cycles of poverty as have Black Americans.
In fact, this is part of the reason why playing the race card to level international comparisons, as it is used to force the numbers America’s way in some manner or another, is invalid. The race problem in America is in some ways unique, or at least rare, (though here we must make a difference between historical racism, which was greater in America, and present day racism, which is greater in Europe), and is also well-publicized with the dissemination of American culture and media internationally. There may be equivalent ways some other alien culture has been historically divided that we’re simply not cognizant of. That culture would also look better if we could conveniently fudge their own problem elements. But instead, we have America’s bete noire, race. And we conveniently fudge it, *across the board*.
To exaggerate a bit for effect, imagine if I, as a cwazy commie leftist, were to propose that capitalist America was a more unequal society than traditional India. But I’ll discount religiously defined untouchable castes, *across the board for both countries, equally*. Get it?
“Then establish and quantify this discrepancy (or find a study that does so) , if possible, and get back to me with some conclusive results.”
Jamila, you’re the one who brought up the race factor, and the one pushing it as an argument. This wouldn’t matter if I were putting forward a separate, positive claim regarding the race factor, but I was merely pointing out the flaws in the reasoning you have already employed. Any burden of proof here lies entirely with you.
“2) Neither France or Germany is as heterogenous as the US in any factor that I can think of. Neither has as many of illegal and legal immigrants as the US to contend with either.
Am I racist for pointing that out?”
No, but neither are you correct. The factors that Jamila Akil can think of and the factors that there actually are, objectively speaking, are two different sets. (Props to Amp for introducing me to this particular snarky mode of response.) There is more to heterogeneity than ethnicity, and more to ethnicity than the gross number of residents without documentation. In many ersatz developed countries, notably in East Asia but with notable European exceptions such as Italy, the urban/rural split is that of a postindustrial vs. preindustrial society. In Canada, we live virtually along a cline whereby all measures of quality drop the further north you go. These are but two examples of great heterogeneity that America is lucky to not to have to contend with.
“I never suggested anything such thing. In my opinion we should leave the drug companies alone to do what they do best–produce drugs. No mollycoddling or favors required. But we also don’t need to suppress drug prices by using the government to force the companies to charge less than they want to charge.”
Jamila, haggling over prices is part of any market. Prices will always be “suppressed” below that which the supplier *wants* to charge – at least, in any market that’s functioning properly. Enforcing by law (which probably involves Men With Guns, now that I think of it) to remove a particular situation whereby the supplier might not get exactly what she wants is in fact mollycoddling.
“I must have, because I know that for certain cancers, the US has a higher survival rate than Canada. I also know that there are higher rates of survival for cervical cancer in Canada than the US.”
Then go back and read them, if you please.
First off, I linked to the wrong study; no mention was made of the Manitoba study there. However, it (is it the same Manitoba study? I don’t know) forms a centerpiece of this report.
Second, I realize I said I wouldn’t play tit for tat for Jamila again, but it turns out I just did. Curse my competitive nature; what an excellent capitalist I’d make.
But if we want to quote mine and argue the earlier study, by all means let’s do so. I have an appreciation for gall and I like that you’ve tried to quote my link against me, but if we go down this road, it’s not one you can possibly win, given what the study itself actually says. (I invite all on-readers to go read it.) This will shape up to be my favourite sort of competition: ones that are pre-emptively stacked in favour.
“… quality-of-care ratings were similar in the 5 [Anglophone] countries3. Some4, but not all5, have found better health care quality in Canada.”
The study referred by the “not all” referred to income-based inequities that persist in Canada’s UHC. So while there are studies that rate Canada higher, there don’t appear to be any that explicitly do the same for the US.
“Very-low-income populations, who may be less likely to own a telephone, may be undersampled.”
So this study understates the gravity of downward effect that the uninsured would have on America’s standing, insofar as very low income is correlated with lacking insurance. Which, I’m sure, is a reasonable assumption.
“Compared with Canadians, US residents are one third less likely to have a regular medical doctor, one fourth more likely to have unmet health care needs, and more than twice as likely to forge needed medicines.”
I believe the first sentence answers an inquiry for a source regarding a comment about primary care physicians. I think ‘regular medical doctor’ and ‘primary care physician’ is more or less talking about the same thing, though I could be wrong.
“… long waiting times led to an unmet health need for only a small percentage (3.5%) of Canadians.”
Make no mistake, this number is smaller in the US (1%). But let’s compare 3.5% vs. the 15% of Americans who are uninsured.
“Universal coverage attenuates inequities in health care, and should be implemented in the United States.”
If you say so, doc.
Murphy: exactly. To them, every market is a market of widgets: homogeneous product, large number of buyers, large number of sellers, no spillover effects, no adverse selection… in other words, the absolute theoretical perfection that a market could obtain. They (and Jamila may not be part of the ‘they’ here, as I don’t know enough about her other positions) then use this to try to shoehorn advocacy for the greater inequality and stratified moneyed power that they so desire. Health insurance is among the tamer of what I’ve heard right-libertarians try to manipulate in this way: in no particular order of fucknutted-uppitude, I’ve heard that constitutions, police protection, legal tenders, and human-rights-as-legal-vouchers, should be privatized and made to work as functional markets.
“Plus a deficit.”
Joe, not only is the average American paying more for health care than the average resident of an industrialized UHC nation, he is paying more just in taxes for the tax-funded component of American health care than those of other nations – not even getting into private expenditures. I’ve already provided the links for these, please read them before presuming to know something that the rest of us don’t.
“I think it’s important to note that the current system is not a health care market.”
Yeah, yeah, US health care (and Californian power, and post-NAFTA Mexico, and pre-Kirchner Argentina…) is not a True Market at work. Just like the Soviet Union was not True Communism.
Slyphhead, my point about markets was only that we wouldn’t be abandoning a healthy, working market by going to single payer, and that the current system is not great. This is more of an argument for UHC than it is an argument against it. (CATO would probably say it’s also an example of how interference in the market causes distortions and strange systems but that’s not the topic at hand)
Re
I’ll stipulate that we could do what you say if the government took all of the money now spent on health care, and intelligently used it and only it for the public good.
I don’t think they’ll do that. I’m sure that congress will want to allow companies to keep some of the money they’re currently spending on health care. I know GM wants UHC so that their costs relative to foreign competition will go down. I assume most of the other large companies in support of UHC have a similar rational. Funding UHC by making companies that currently pay for generous health care benefits pay all the public costs would have some fairly obvious problems. So there will be tax cuts involved. If there aren’t then there will be substantial resistance by many of the large companies that currently want UHC. There will almost certainly be tax increases in some areas as well.
I also suspect there will be substantial transition costs as we migrate from the current system to a new system and that there will be substantial start up costs.
I also don’t think that congress will be willing to implement UHC on a paygo basis.
Neither party has shown any real desire for budgetary discipline.
So yes, I think that implementing UHC will involve an increase in the budget deficit.
Ampersand already answered this question in post #162 and I agreed with him on post #175. It makes people feel good to have a safety net, regardless of how much that safety net costs, how long the queues are to receive care, or how much more likely you are to be cured of whatever ails you.
This will be my last post in this thread because I also don’t want to waste anymore time going tit-for-tat.
Aww… I’m still up for it. In any case, if it is making people ‘feel good’ – which about fits the tautological definition of economic utility – and they are making informed choices, as would be expected if health care indeed is just like the theoretical markets described in textbooks, some self-appointed defenders of the market are going to awful lengths to clamp down on these people’s choices; not by serving them better as consumers, but through political means. Should we always do this when consumer choices effect unacceptable social consequences? Perhaps, but I’d be wary of it.
Universal health care is about as unambiguously good a cause as you’re going to get – it is morally, practically, systematically better, as everything everyone’s presented here has shown. It is a shame that a dogmatic ideology that is *facially* anti-government has to take it upon itself to beat back common sense against the pleas of fellow citizens, and it’s a shame that diehard followers rote memorize CATO-approved screeds of half-truths where ignorance can take a breather when barraged too heavily by objective reality.
sylphhead Writes:
Should those who want a UHC be allowed to force it upon those of us who don’t want it, thereby restricting our choices? I think your answer would be yes.
I value my freedom far more than I value a promise of healthcare by the government. The more I think I about it, the more I see that the battle over a UHC in America is really a battle over values. There are those of us that value our freedome more than anything and there are those of us that value equality and/or a safety net more than anything. The two sides will never agree because they don’t see eye to eye on values.
[Robert, this is still one of my threads. –Mandolin]
You might as well ask why we have to pay taxes at all. If having any government services at all is such a great idea, why can’t we achieve it by forming a voluntary collective of individuals who choose to pay for it?
From the current issue of The New Yorker:
Some things, including UHC, are only workable if everyone does it. It benefits almost everyone to be part of a large, collective system, but it only works if everyone can be assured that everyone else is going to be acting likewise.
It’s nonsensical to demand that government-paid health care be tried first as a private system; by definition, it’s NOT a private system. (But check out the VA health care system for an example of a government-run health care system that works great.)
As for “armed coercion,” this trite libertarian talking point can be used against having any government at all. If you’re really so far out of the mainstream that you favor anarcho-capitalism, then there’s probably not much point in debating with you.
If, in contrast, you do believe in the social contract, then I need to remind you that in the US, paying taxes for the services provided by government is part of the social contract. You don’t get to pick and choose which government services to pay for, except by picking and choosing which politicians to vote for (and also lobbying, writing letters, etc).
Finally, can you name any nation-scale social system that has ever worked in the real world which didn’t require “men with guns” at some level of the system? Do you actually favor a system that you think is viable which doesn’t involve “men with guns”?
Why should I accept a profit-based health care system being forced upon me, and others who don’t want it?
I value my freedom just as much as you do. I simply think that more people will be substantively freer under an adequate UHC system than under our current system.
I disagree. I think the real conflict is between those who believe that freedom is expanded, rather than limited, by effective safety nets; versus those who think that the only freedom that matters is freedom from government interference.
[Robert, this is still one of my threads — Mandolin]
[Robert, this is still one of my threads –Mandolin]
Robert,
All UHC systems are at heart redistributive. But it’s not a disguise. You can’t provide valuable services to poorer people without overcharging the richer people and/or subsidizing the poorer people, both of which are redistributive in nature.
If some people get more than they pay for, then other people are paying for more than they’re getting.
No one is forcing it on you. That’s the point. If you can find a doctor who’ll treat you for free, no one is stopping you.
OK, I’m assuming all “engage the actual argument” rules are out the window.
This will be fun.
Sam,
I don’t know to what you refer, but Robert, BrandonBerg, and Daran have all been asked not to participate in my threads. Robert is aware of the rule, and has been reminded on this and other threads.
So I should accept UHC being forced upon me instead?
If you valued my freedom as much as I value my freedom, you wouldn’t try to force a UHC on me.
I think we are saying the same thing and I agree with you, but I would like to add that I don’t just want freedom from government interference, but freedom from well-meaning people who think they know what is better for me than I do; that includes people who insist that they just want to expand my freedom by a UHC despite the fact that I tell them I don’t want it.
Ampersand Writes:
Not in the industrialized world.
G.K Chesterton once said: “The Christian ideal has not been tried and found wanting; it has been found difficult and left untried.”
I would take that statement and apply it to the ideal libertarian society: it hasn’t been tried and found wanting, it has been found wanting ( in theory) and left untried.
That’s probably because it would be ideal, rather than real.
but freedom from well-meaning people who think they know what is better for me than I do
The job of “well-meaning people” is not to put the preferences of Jamila Akil above all other considerations. For example, it would probably be better for me if I were allowed to do whatever I pleased but everybody else was bound by law and custom; do you think I should complain that “well-meaning people” are cockblocking my freedom?
mythago Writes:
I don’t believe that I ever asked them to make it their job.
You can complain about cockblocking all you like. Heck, if you can make a mean apple martini I’ll come and complain with you just for a free drink. But I think we both know that a society where only one person is bound by law is not the kind of society that I was talking about.
I’m suggesting a society where we are all bound by the same laws, where you don’t intrude on anyone elses rights to make their own choices and you don’t ask others to pay for your mistakes.
Mythago, remember this when the cockblocking (odd choice of phrase) of well meaning people involves medical procedures you feel are a fundamental right.
If we go with a national system South Dakota is going to get two votes in the senate just like Alabama, Kansas, and California. If we go with a state managed system I feel scared for the people of some states.
“Should those who want a UHC be allowed to force it upon those of us who don’t want it, thereby restricting our choices? I think your answer would be yes.”
I wouldn’t and don’t support efforts to ban peripheral private care, as I’ve made it clear numerous times in this thread, just like I wouldn’t ban private education or private security forces. I don’t support efforts for people, so long as they wish to remain a citizen of the country, to opt out of paying for UHC, any more than I’d allow single people to not pay for public schools or gated suburbanites to not pay for the police.
“I value my freedom far more than I value a promise of healthcare by the government. The more I think I about it, the more I see that the battle over a UHC in America is really a battle over values. There are those of us that value our freedome more than anything and there are those of us that value equality and/or a safety net more than anything. The two sides will never agree because they don’t see eye to eye on values.”
Jamila, 90% of the human race in general – and in particular 99% of those outside the postindustrial West – would look strangely at you if you were to suggest the fundamental antithesis to freedom is equality. Most of the heroes and agitators in history who have brought us our freedom, so that right libertarians can redefine it, would also be surprised if we posthumously told them that what the enemy they were fighting was equality.
On the other hand, a majority of people around the world would agree, and many through firsthand experience, that unmitigated private property rights are an enemy of freedom.
“I think we are saying the same thing and I agree with you, but I would like to add that I don’t just want freedom from government interference, but freedom from well-meaning people who think they know what is better for me than I do; that includes people who insist that they just want to expand my freedom by a UHC despite the fact that I tell them I don’t want it.”
Libertarians, who by any measure are a minority political faction, fit this bill on most any issue they’re involved in, including telling the majority of Americans who want government health insurance that it’s not actually good for them. People will never agree on everything and unless well-meaning people all voluntarily retreat into schizophrenic mental worlds of their own creation, they will always intrude upon others in this manner – and not always is this a bad thing. Ideologists have tried for hundreds of years to try to word this in a manner that makes it a bad thing when the other side does it, but somehow different when they do it. It never takes.
Mythago, remember this when the cockblocking (odd choice of phrase) of well meaning people involves medical procedures you feel are a fundamental right.
It already does. Read Roe v. Wade if you are confused on that point.
I’m suggesting a society where we are all bound by the same laws, where you don’t intrude on anyone elses rights to make their own choices and you don’t ask others to pay for your mistakes.
Is this also a society where nobody else’s choices intrude on you, and others agree to pay for their mistakes that affect you? It’s interesting how much the Libertarian discourse focuses on “leave me alone!” rather than “your freedom means responsibility too!”
For the benefit of those of us who have difficulty digesting 239 posts, do I understand this right?
Mythago and sylphhead support some government-mandated (and publically financed) minimum health care for all US citizens, much as government provides some basic level of public education, police, fire protection, etc. I have not understood them to advocate altering anyone’s right to pursue private health care as well, or to decline to receive government-financed health care.
Jamila Akil objects to being compelled to pay for such a system, seeing the taxes as an unwarranted intrusion on the discretion that he (?) exercises over his resources. I have not understood Jamila to advocate imposing his preferences on others except to the extent of avoiding taxation for himself and all similarly-situated taxpayers (which likely entails most US citizens).
And I understand Robert to [mew in a heartrending fashion and lick himself], as usual.
In short, some people are advocating for socializing the cost/risk of bad health, whereas others advocate leaving the risk/cost of bad health to be born by each individual. With so many good, juicy policy arguments on either side [ok, except Robert’s], there’s really no need to resort to distorting either side’s argument to make a point.
Neither side advocates that health care risks are borne by the individual.
One side advocates that health care should be a fundamental human right.
The other argues that health care should be apportioned preferentially to those who have scored well in the capitalism lottery, via birth, education, hard work, and economic interaction — none of which can be accomplished alone.
The libertarian idea of a society in which “you don’t intrude on anyone elses rights to make their own choices and you don’t ask others to pay for your mistakes” is fallacious and impossible, and the result of very bad reasoning.
Consequently, attempting to impose it on real-world situations such as the need for health care leads to bad and callous policies.
“Cost” and “risk” are two different things.
Yeah, that’s a good point, Mythago. I used the word incorrectly above.
Free Idea Monday: Science fiction story in which health risks are distributed by lottery. (You’ve drawn 1,670,877. Please go to line X to be infected with rubella.)
Mandolin, if I have a fundamental human right to health care (as I have a fundamental human right to worship as I choose) how do you justify denying it via rationing? Also do you propose limiting it to citizens or would you provide it to say illegal immigrants? This would be a real concern in many states.
I break it down as one side wants to ration it technocraticly, the other wants to ration it via cost. Either way, someone will not get the all the health care they want. The debate seems to be about the best way to ration.
(The current system does a poor job with cost rationing but libertarians like it better anyway. )
Actually, nobody.really, the meat of the 239 posts have dealt with whether or not UHS delivers healthier results. Discussion over taxation has only crept up over the past ten posts or so, but in any case, you reinforce my post #221. We are merely advocating expanding the number of available consumer choices in health care by one – government health care, which the consumer is by no means obliged to accept, even if he can’t afford anything else and he’s just being weird.
Shouldn’t consumers decide which provider of health care, then, is best for them? Or are the social costs of other people’s economic transactions suddenly important enough to impinge on ‘consumer rights’? The latter is certainly a realistic principle, but in this particular case, I’d say the social costs really run the other way.
The only viable avenue with which to oppose UHC, then, is to cry foul over having pay taxes for them. Not only is there a problem with this position in the abstract (what specifically differentiates health care from, say, the fire department? We ‘socialize the risks/costs’* of people’s burning houses, but not their cancer-stricken bodies?), but as I’ve already pointed out and cited, switching to UHC from the present system would actually decrease the tax load for all Americans.
The only reason to oppose UHC is thus purely ideological. That ideology isn’t consumer rights, as we’ve seen that right libertarians have no problem with working to limit the consumer’s total number of choices. That ideology isn’t opposition to taxation, as we’ve seen that switching to UHC would lower taxes, not raise them. No, actual right libertarian ideology is a different beast altogether that may incorporate the two above principles when convenient, but has no problem discarding them when they pose an obstacle to larger goals.
*Yes, I’m aware that *home insurance* is a private market, and that’s not what I’m talking about. Everyone has equal rights to a firefighter’s services without payment, and fire departments work for the city, not for profit.
Slyph, i like the idea of basic UHC, with the frills paid for by the individual. Now the debate of ‘basic’ and ‘frills’ should be fun.
I don’t get how your calling a mandatory service into which I have to pay a ‘choice.’ If it’s a choice can I opt out? If i can’t opt out how is it a choice?
My concern about UHC is about implementation. How will you get us from here to there? How will rationing be done? How will it be paid for? As I said before, I don’t have a lot of faith in the curent congress when it comes to budgetary discipline. (or anything else for that matter.) Price controls on drugs is a key part of UHC cost controls. If the US does it, how will this affect the development of new drugs? How do we deal with the fact that a lot of Americans have dumb ideas about womens health issues? Making it public gives them more power to do harm. Will government control of health care increase government interference with other aspects of my life? Weight comes quickly to mind since we’re already seeing transfat bans.
The theory is fine, other countries have UHC and the sky didn’t fall. So it can be done. Whether it will be done better or worse than the current system is my concern. It doesn’t seem like a slam dunk.
All that said I see the problems with the current system, people dieing from easily cured diseases, lack of investment in preventive care, inefficiencies from duplicate systems, entrepreneurship being stifled to name a few.
BTW Your argument about fire fighters seems flawed. It would be possible to end all public fire protection and allow people to contract for it privately. Except for the fact that fire spreads. So it’s not really a ‘private’ matter. Your lack of fire fighter insurance could easily have a direct impact on your neighbor, thus local government interference is justified to protect the property rights of others. But I digress.
Joe — health risks spread. That’s why it was particularly assinine for California to have stopped providing vaccination to illegal immigrants with prop 187. We are voluntarily subjugating ourselves to epidemics and mutations.
Mandolin, Contagious diseases are a pretty easy case. How about back surgery and cardiac care? This is a serious concern about any public health care plan since it could drive the cost way way up.
Also, I’m not trying to be a dick with my other question about how you square UHC is a universal right with deciding to limit care in some way. I’m genuinely curious what you think if you’d care to go into it.
“I don’t get how your calling a mandatory service into which I have to pay a ‘choice.’ If it’s a choice can I opt out? If i can’t opt out how is it a choice?”
You already don’t have a choice whether to buy health insurance or not. The distinction between coercion by government and coercion by nature and reality may be a significant one to the few genuine anarchists and the many neoliberals who hanker for a philosophical means to justify wealth inequity, but for the vast majority of people it isn’t something worth arguing about. Biology and everyday life limit your choices, not Men With Guns.
In any case though, you can opt out by not accepting government health care, which no one will force you to do. Sending your kids to a private school is your choice, even if you do have to pay taxes for public school. Let consumers decide what they like better.
Rationing already occurs under your present system, and I’m not even talking about the abstract principle of rationing by income – though we shouldn’t brush that off too lightly. There’s nothing that government will do that a private insurance firm or an HMO already doesn’t do to existing customers to screen for treatments. I don’t work for any sort of health bureau, public or private, so I don’t know what method they use to evaluate applicants, but I assume it’ll mostly remain the same, with a possible shift toward less stinginess.
I could go on about how crowded places aren’t the only places where there are fires, and that I’d doubt that most people who flinch at UHC would seriously defend a policy whereby, say, farmers’ houses can burn down unabated if the family can’t afford to pay firefighters – proving that they are merely taking their cue from right wing talking heads and in their heart of hearts do not accept the rancid ideology they parrot. But let’s just shift the analogy to education or police protection, then.
“… local government interference is justified to protect the [i] property rights [/i] of others.”
Is that really people’s greatest concern when there’s a freaking fire in their homes, where their family lives? Sounds like you’re trying too hard to preemptively defend some pretty indefensible libertarian principles. (Perhaps the parallel argument for health care would have been too obvious had the more obvious wording been used.)
Calling health care a “fundamental human right” doesn’t help my understanding. The most noteworthy thing about the United Nation’s “Universal Declaration of Human Rights” is how un-universally it is practiced. The US has been talking about the fundamental rights to life, liberty and the pursuit of happiness since 1776, but this did little to deter the Klan or organized crime; those organizations were deterred only when we chose to allocate resources to deterring them. So please forgive my crassness when I focus on questions of costs, and who bears them. “Follow the money.”
True, my health care costs reflect a lot of things that are beyond my power to control. But I don’t see the “capitalism lottery” as the only lottery at issue; the “genetics lottery” plays a big role, too. On the other hand, the state of my health also reflects the extent to which I engage in health activities: exercise, diet, avoiding risks. It is not simply a function of a lottery.
So the libertarians are missing the boat when they object to bearing the costs of “other people’s choices,” because much of health care costs (or, if you rather, the risk of bearing high health care costs) is a function of things beyond the power of individual choices to control. But communitarians are missing the boat when they object to people being left to the vagaries of a “lottery,” because individual choices also affect health care outcomes.
An individual’s health care costs are a function of both chance AND choice. Our policies should reflect this dynamic.
Don’t know how it works as a SciFi story, but it’s already been done as a philosophy. In his Theory of Justice, John Rawls asks us to imagine what kind of world we would have voted to create “behind the veil,” before we were born and knew what social position we would have in the world. That is, we wouldn’t know whether or not we’d contact rubella, but we’d get to pick how much of the world’s resources to allocate to reducing the odds that we’d contract it. Rawls argues that most people would adopt the game-theory strategy of risk-minimization: improving the position of the worst-off person, even at the expense of reducing the position of other people. In essence, Rawls argues that people would insure against risk. Then Rawls argues that the state is justified in using coercion in redistributing wealth to achieve the kind of world we would have chosen to recreate before we became self-interested actors in the world.
The argument has a curious analogy in the world of health care finance. It is my understanding that once upon a time, health insurance companies lacked the sophistication to identify people who were likely to be high-cost patients. In this sense, they acted out of ignorance of their own self-interest, much like people “behind the veil” in Rawl’s imaged world. Insurance rates were more uniform and offered more freely, with the consequence that aspects of heath care costs were spread more broadly throughout society. (Admittedly, insurance companies also reflected the larger racial segregation in society, too, but that’s a whole ‘nuther thread.)
Today heath insurance companies have developed elaborate actuarial algorithms to try to match insurance costs to individuals. They are acting more like self-aware and self-interested parties “in front of the veil.” As a consequence, insurance companies allocate more of the cost of caring for an individual to the individual him- or herself, and spread less of it to the rest of the pool of insured parties.
Ironically, this dynamic of “adverse selection” is ultimately self-defeating. Insurance’s value to individuals, and to society as a whole, is in helping people defray risk. But “risk” implies uncertainly. The better the insurance industry becomes at predicting things, the less uncertainty there will be to insure against. Taken to its logical conclusion, imagine a world in which each person’s health care costs was perfectly knowable: Every insurance company would offer each person a policy that reflected that individual’s costs, and no individual would have a reason to buy the policy, because it would be no cheaper than simply bearing the cost him- or herself.
Amp more or less noted this dynamic back at post #101: Whatever the other benefits of universal health care, it tends to fulfill Rawl’s theory of justice by redistributing the cost of health care by spreading those costs away from those with expensive health care and toward everyone else.
Health is not a controllable substance. People who are ill aren’t ill because they failed to be properly healthy (for more strains of this argument, read: virtuous). One can’t out-slim an attack of multiple sclerosis. While healthy behaviors (which tend to be correlated to the amount of free time one has, and therefore also to class) may be a boon, bad luck is a foil. Everyone can get sick.
Gosh, I’ve never known anyone who worked for the tobacco industry before.
Mandolin, nr was noting (correctly) that health in a general sense is NEITHER fully controllable, NOR fully immutable.
Obviously there are some things involved in “health” that you can’t do a damn thing about: you have the genes you have, for example. And equally obvious is the proposition that you can influence other things about your health, through what I’ll circularly refer to as “living a healthy lifestyle.”
Living in a healthier fashion doesn’t mean you’ll be HEALTHY. It means that you are (statistically speaking) more likely to be healthier than you would otherwise be.
I.e. living a smoke-free lifestyle doesn’t mean you won’t die of lung cancer. And it doesn’t mean you’ll be “healthy” in other respects.
The pressure on people to “live a healthy lifestyle,” as if that was a moral obligation or an immunization against disease, has been documented elsewhere for being pernicious.
I have no particular problem with noting that “a healthy lifestyle” can reduce one’s statistical likelihood for certain diseases, but it is ludicrous to suggest that such will obviate one’s need for health care. Luck continues to be a factor. Many illnesses have nothing to do with lifestyle. Therefore, the beneficial effects of “a healthy lifestyle” are not an adequate argument against universal health care — and it’s a pretty chilling one, if one fully considers its implications.
Until and unless you are going to deny police help to people who don’t have the best locks installed on their doors, fire help to people who have dry leaves near their houses, or any number of other situations, the implication that people who don’t live “a healthy lifestyle” are therefore less deserving of health care (which is the implication of “factoring in the choice aspect of health”) is bullshit. It is moralizing, continuing on the durable American theme of tying morality to health.
To repeat what I said earlier: One can’t out-slim an attack of multiple sclerosis. While healthy behaviors (which tend to be correlated to the amount of free time one has, and therefore also to class) may be a boon, bad luck is a foil. Everyone can get sick. Therefore, everyone needs insurance against health risks.
Mandolin,
I’m not sure who you’re arguing against.
Has anyone here actually said that living a healthy lifestyle will prevent any and all need for health care? That’d be an extraordinary claim, and I would happily join you in attacking it. But if nobody’s said it, why argue against a straw man?
This, however, I don’t really agree with:
Well, bullshit aside, it’s a “durable theme” because we tie morality and behavior to LOTS of things. We don’t deny police help to folks without the best locks, but we give insurance bonuses to people who have good burglary protection systems (as we should.)
I do not see what is so problematic about morality here. Hell, how do you plan to get around it? This isn’t an infinite-resources system; SOMEONE is going to have to make morality choices.
Do you think the limits of the UHC system will be convinently defined by some outside neutral person? Fat chance. The issue of who to resuscitate is a morality decision; so is the question of who to give the liver to; who to spend the limited surgical funds on; who to give the first crack at the MRI this evening.
We call them “medical” decisions sometimes, but they’re moral ones: we’ve arbitrarily assigned values to pain, to suffering, to loss of movement, to death; to feti and mothers and babies and old people. Do you have a non-moral way of making those calls?
The “choice” aspect of health care is, arguably, a good way of rationing. After all, at least you’d have some control over things. But the “morality sucks!” approach seems suspicious.
And to repeat what i said earlier: Has anyone SAID that you can?
Sailorman, the ‘morality’ here is the idea that health care should be alloted by virtue: people whose “lifestyle” increased their risk of illness or injury mustn’t be given health care because they don’t deserve it, etc.
Contagious diseases are a pretty easy case.
If the principle is that nobody should be forced to buy into a system where they pay for others’ health care, no, it’s not an easy case at all.
Let’s distinguish between the positive from the normative – the “is” vs. the “ought.”
IS: I and Sailorman posit that there is SOME DEGREE to which a person can influence her own health, and SOME DEGREE to which a person can’t. I have not yet read anyone to dispute this proposition explicitly.
OUGHT: What relevance does this have to the design of a Universal Health Care system?
In the absence of a UHC system, people have a greater tendency to bear (directly or indirectly) the cost of their own health care. This gives them a financial incentive to engage in healthy behavior and avoid risks. To the extent that a UHC system socializes health care costs, it reduces people’s incentives to engage in healthy behaviors and avoid risks. In effect, a UHC system may have the effect of transferring wealth from people who wear seatbelts to people who smoke, speed, skydive and have unprotected sex.
This dynamic strikes me as unfair and inefficient. It isn’t a judgment about who “deserves” care; it’s a judgment about who should bear the cost of a person’s decisions. Unavoidable costs should be spread throughout society; avoidable costs should be borne by those who cause them.
Arguably we could eliminate the unfairness and inefficiency by providing people with a menu of choices: “Basic” UHC is free. UHC coverage for discretionary risky behavior costs extra, where the extra reflects the anticipated added cost. This remedy opens a canful of worms, however. We’d need to decide which behaviors were sufficiently risky and discretionary to warrant an adder. Smoking? Child birth? Sexual activity generally? In addition, it’s not clear how an adder system could be enforced. Rely on self-reporting? Spy on citizens at random, or after medical care is obtained? So I don’t see this as a practical remedy.
Alternatively, as Mandolin suggests, we could exclude coverage for conditions arising from risky discretionary activities. Alas, I suspect it’s hard to prove whether my lung cancer resulted from my smoking, or my wife’s smoking, or my genes, or my environment, or some combination thereof. Again, not practical.
In short, I suspect that a UHC system would tend to reduce incentives for healthy behavior and reduce disincentives for risky behavior. It is perhaps no accident that Europeans smoke more, on average, than Americans do. But I also suspect that this effect would be small relative to the cost savings and other benefits of a UHC system. It is perhaps no accident that, despite their smoking rates, Europeans tend to be healthier on average than Americans are. Given the incentives that each of us already has to look and feel healthy, I suspect the marginal incentives provided by a UHC system have little practical effect.
In the absence of a UHC system, people have a greater tendency to bear (directly or indirectly) the cost of their own health care. In the absence of a UHC system, people have a greater tendency to bear (directly or indirectly) the cost of their own health care. This gives them a financial incentive to engage in healthy behavior and avoid risks. To the extent that a UHC system socializes health care costs, it reduces people’s incentives to engage in healthy behaviors and avoid risks. In effect, a UHC system may have the effect of transferring wealth from people who wear seatbelts to people who smoke, speed, skydive and have unprotected sex.
I think that you are wrong in this. How, precisely, does our current system (an absence of UHC) create a greater tendency for people to bear the cost of their own health care? For example, my health insurance costs the same whether I smoke or not. Always has. The lifestyle choices that I make bear no relation to the cost of my insurance. How would a UHC system be any different? It seems to me that our current system does exactly what you fear (transfer of wealth) already. It just excludes the poor.
Mythago, the contagious disease thing was posted by Joe, not by me.
You keep trying to slide the word “virtue” in there; I assume to make a semantic point. But it’s not necessary. (it’s also a bit confusing, as you seem to think virtue is bad, but that’s beside the point.)
Whether you think smoking is virtuous, or whether you think refraining from smoking is virtuous, doesn’t change the fact that it gives you lung cancer. Virtue is irrelevant.
The main issue is whether in a competition for limited resources, we should pay ANY attention to a person’s behavior in needing a slice of those resources.
I.e. if we’re faced with 2 needy lung transplant victims of identical age and medical status, should it matter that one was struck by a car, while the other ignored all the smoking warnings and smoked 2 packs a day?
If we’re faced with 2 nearly-identical people needing a liver, should it matter if one of them is/has been a lifelong alcoholic, while the other one happened to get liver cancer?
I realize this is a slippery slope, but we’re just discussing it and not making policy here.
Still, you keep claiming that “virtue” and “morals” are bad means of making decisions. Absent morals, how would you make those calls?
I have no knowledge of your particular health insurance, so I can’t comment on your circumstances in particular. But if you shop for health insurance, you will likely be asked about your age, height, weight, marital status, children, residence and tobacco use. See, for example, TheHealthInsuranceCenter.com. Wisely or not, some insurers seem to regard this data as relevant to offering an insurance quote.
Of course, many people receive health insurance as part of group policies offered by employers. I understand that this practice grew in popularity during the price control regimes of WWII, which limited changes in wages but not fringe benefits. Insurers then discovered that employed populations tend to be healthier than the population at large; these pools tend to exclude not merely those who are too sick to work, but also those who are too old to work. Insurance companies began pursuing pools of employed people more aggressively (and pursuing the rest of the population less aggressively). While a person may be unaware of how his lifestyle choices affect his insurance rates, he will become aware if his choices make him so incapacitated that he can no longer retain his job.
Group policies are priced based on (among other things) average health costs of members of the group. To be sure, this results in spreading risks within that group, but that’s still a far cry from spreading costs throughout society generally. Moreover, even when employees seem indifferent to the costs they impose of their insurer, the employer is not. Employers increasingly seek to influence employee choices by, for example, offering lower co-payments for people who join health clubs, take smoking cessation classes or accept “lifestyle coaching.”
Small employers are even more keenly aware of the problems posed by the health needs of individual employees. Some insurers go through a medical underwriting process before offering a plan to a given employer. This involves reviewing the health status and claims history of the individuals in the group and setting the premiums and terms of coverage accordingly. See the National Health Policy Forum’s “Health Insurance Coverage for Small Employers” at http://www.nhpf.org/pdfs_bp/BP_SmallBusiness_04-19-05.pdf
An increasing percentage of US citizens are employed by small employers and temp agencies. And increasingly these employers are electing to dump health benefits entirely. Even if employees used to be ignorant of the consequences of their decisions on the cost of their health care, the incentives become clearer once they start hunting for their own coverage at places like TheHealthInsuranceCenter.com.
In sum: Yes, any insurance will tend to spread risk away from each individual insured person, thereby muting the individual incentives to reduce health care costs. The smaller the pool, the less the incentives are muted; the larger the pool, the more they are muted. UHC would provide the biggest pool yet.
Of course, many people receive health insurance as part of group policies offered by employers.
I’m not sure that “many” is an accurate description. I would venture to say that “vast majority” better reflects reality within the US. Not to mention that, even as a smoker, an individual policy was both cheaper and offered better coverage than the one available through my employer 4 years ago.
And increasingly these employers are electing to dump health benefits entirely.
This leaves the majority of their employees with NO health insurance whatsoever as those employees are unable to afford an individual policy. Not that searching for an individual policy really gives you an idea of the added costs to you caused by your health status/lifestyle. So I still think that you’re very wrong about the incentives/disincentives of UHC. They are no different than those under the current system wrt bearing the costs for one’s own health care.
“Until and unless you are going to deny police help to people who don’t have the best locks installed on their doors, fire help to people who have dry leaves near their houses, or any number of other situations, the implication that people who don’t live “a healthy lifestyle” are therefore less deserving of health care (which is the implication of “factoring in the choice aspect of health”) is bullshit. It is moralizing, continuing on the durable American theme of tying morality to health.”
Right on. No one really accepts the idea that denial of help is an appropriate disincentive toward making some ill-advised choices – at least universally. Political opposition toward those choices, though, always helps. Denying car insurance to drivers who use cell phones – not to mention life insurance for pedestrians who do the same – makes much more sense from a statistical standpoint than denying health insurance to those who don’t go to the gym enough. But what are the chances of the former happening?
“IS: I and Sailorman posit that there is SOME DEGREE to which a person can influence her own health, and SOME DEGREE to which a person can’t. I have not yet read anyone to dispute this proposition explicitly.”
I get it, but the statement itself is so vague as to border on the irrelevant. How much is “some degree”? If a person can influence her own health, but doesn’t (by which I mean does so in the negative), what precisely should be the consequences, in your opinion? Outright denial of health insurance or care is the only position here that is consistent with opposing universal health care.* If you’re suggesting some means to penalize those who have exacerbated their own condition while still giving them the best care possible, I don’t think we’re in any disagreement here, and I assure you limited methods along those lines abound in existing UHC programs.
“In short, I suspect that a UHC system would tend to reduce incentives for healthy behavior and reduce disincentives for risky behavior. It is perhaps no accident that Europeans smoke more, on average, than Americans do. But I also suspect that this effect would be small relative to the cost savings and other benefits of a UHC system. It is perhaps no accident that, despite their smoking rates, Europeans tend to be healthier on average than Americans are. Given the incentives that each of us already has to look and feel healthy, I suspect the marginal incentives provided by a UHC system have little practical effect.”
I’m glad you added this last paragraph, because I’d have to have taken serious issue with the rest of your post otherwise. Econometric-soundishing words like ‘incentives’ are regarded as definitive, but they’re mere words. I can think of thousands of incentive/disincentrive schema directed at all sorts of positive or negative behaviours, and by far the majority would cause more harm than good. It isn’t enough to merely point out that a disincentive exists within a particular situation. What are the social costs of that incentive or disincentive in action? Is the disincentive proportionate to the crime? Do similar disincentives exist for other, similar situations – or are disincentives applied selectively? Given what real world data we have, is the disincentive something that would actually work someplace besides the abstract?
And if Europe’s smoking/drinking/having lots of sex is supposed to be an argument against UHC, I find that and Jamila’s ‘hidden health factors’ plea to clash quite ironically.
“In effect, a UHC system may have the effect of transferring wealth from people who wear seatbelts to people who smoke, speed, skydive and have unprotected sex.”
There’s no ‘may’ about it – a UHC system will do exactly that. But so will any private insurance pool. Isn’t that the basic philosophy behind insurance, anyway?
Your argument only makes sense if we regard those currently left uninsured under the American system as being unworthier of health insurance than those who are. Off the top of my head, I can think of three broad groups of people who are left uninsured currently: those who are rejected because of risky lifestyles, those who are rejected because of serious medical conditions, and those who are rejected because they can’t afford it. I realize that there’s overlap, but I’d say without reservation that the risky lifestyle group is dwarfed in number by the latter two on their own, let alone combined.
Finally, Sailorman, re:morality. The simplest way I can put it is, penalizing those who steal candy from babies and penalizing those who have babies, say, are both moral judgments. But to put it bluntly, one’s a right moral judgment and one’s a wrong moral judgment. I think what Mandolin was getting at was that our culture’s linking of personal fitness to morality is a wrong moral judgment. This argument will go someplace besides nowhere if you could affirm or dispute that.
* I realize that in the present American system, many people who make bad health choices have coverage whereas many who make good ones do not. But the whole point in bringing up this dilemma in this particular thread is to provide a conceptual means with which to justify denying people coverage, is it not? That appears to me to be in the vein of attacking UHC.
I.e. if we’re faced with 2 needy lung transplant victims of identical age and medical status, should it matter that one was struck by a car, while the other ignored all the smoking warnings and smoked 2 packs a day?
(Scratching my head and trying to figure out how an MVA can cause one to need a lung transplant. Maybe this does happen and I just don’t know about it) How about two people with equally bad COPD, one who smoked 2 packs per day, one who had alpha-1-antitrypsin deficiency, an inborn error in metabolism that leads to COPD even in non-smokers. This sounds like a “pure” case of one person being guilty of causing his disease, the other innocent, doesn’t it? So, should we give the lung to the innocent A1AT victim? Not necessarily. There is a treatment for A1AT deficiency, an enzyme replacement. It doesn’t always work perfectly or at all, but it is prefered as the first treatment, not transplant. Did this treatment fail or was the patient non-compliant? If the latter, then DON’T transplant this person. A non-compliant patient with a transplanted lung is dead. Go for the smoker. Maybe s/he’ll take his/her meds properly, being motivated to stay alive long enough for the next hit. Or maybe the long stay in the ICU after transplant will be enough for him/her to go through withdrawl and not need to smoke anymore so…ex-smoker. If, on the other hand, the A1AT victim was compliant, it is probably better to transplant him/her first: the smoker is more likely to develop other diseases (cancer, heart disease) and “waste” the organ by dying of other things soon after transplant.
If we’re faced with 2 nearly-identical people needing a liver, should it matter if one of them is/has been a lifelong alcoholic, while the other one happened to get liver cancer?
Tricky. Unexpectedly, alcoholics who are transplanted for cirrhosis do quite well and generally do not start drinking again after transplant. On the other hand, depending on the stage the liver cancer is in, the cancer (or whatever caused the cancer, ie a chronic hepatitis virus) might simply move into the new liver. So one could make the argument based on utility to give the liver to the alcoholic simply because we can do something for him whereas, except in rare cases where the cancer is very small, we can’t do much for the liver cancer patient. On the other hand, if the cancer is very small, transplanting NOW may save the cancer patient, whereas the alcoholic may be able to wait a bit longer, in which case go for the cancer patient. Or transplant both: it is possible to transplant a lobe of a liver from a living related donor or even to give one lobe from a cadaveric donor to each patient. I always prefer a technical work-around to a grand sacrifice myself.
The thing is, there’s always something to choose between two patients. If nothing else, the chances of having two patients, both needing the same organ, both with the same HLA type, at the same time is virtually nil. If faced with the issue, put the organ in the one who is least likely to reject it.
Actually, I suspect UHC would have the net effect of transferring wealth to smokers AND seatbelt wearers, and away from insurance companies. But I suspect smokers may derive a disproportionate share of the benefit.
I distinguish between the “basic philosophy” of insurance and gambling. I think of insurance as a means of allocating risks that would exist even in the absence of insurance. I think of gambling as the intentional creation of risk. By making risks easier to bear, insurance inevitably subsidizes gambling. I don’t think of this dynamic as the purpose of insurance, however.
Again, in the interest of clarity, I seek to distinguish what is from what ought to be. The question of “consequences” falls into the “OUGHT” part of post 257.
And in that subsequent discussion, I identify two possible consequences. One is to charge people more for insurance if they engage in discretionary risky behaviors. Another is to deny coverage to people who engage in discretionary risky behaviors, at least to the extent that those behaviors caused increased medical costs. Note that denying coverage would not necessarily mean denying medical care; it might simply means charging people for the costs that their choices have imposed on society. Inability to pay might result in bankruptcy, but it needn’t result in death.
Ultimately I conclude that these consequences would likely prove impractical. But I don’t find them objectionable as being too “moralizing.”
I’d like to hear more about this.
Again, I try to distinguish between what is and what ought to be.
IS: Does personal fitness influence health care costs?
OUGHT: If so, what consequences should follow?
I don’t find it helpful to frame policy questions in moral terms; I prefer thinking in terms of costs. But I don’t regard questions of cost as inconsequential. To reframe Sailorman’s question: Joe and Mary will die without a lung transplant, but we have only one lung available. One person will get it; the other will die. How do we choose? Let’s say that we pick Joe based on (more or less) objective considerations about risks of rejection, etc. But if we conclude that Joe also created the need for his own lung transplant by smoking, then arguably Joe should be charged with homicide immediately after the operation. Mary died as a (foreseeable?) result of Joe’s choice to smoke; put another way, the cost of Joe’s decision was Mary’s life.
Is the decision to smoke immoral? People will disagree. But I think we can agree that Joe’s decision was costly.
But maybe not.
Did Joe make a “decision” so smoke? Mary needed a lung transplant because she had a genetic predisposition to lung cancer. Joe needed a lung transplant because he had a genetic predisposition to compulsive or addictive behavior, including smoking. To what extent are our choices really a function of “free will” rather than a function of genetics, culture and environment? This philosophical question could have a powerful bearing on the design of a UHC system.
And what about Mary’s choice to have a child, knowing that the child would likely suffer from Mary’s genetic condition? Mary’s choice to procreate creates the need for a future lung transplant – potentially depriving other lung transplant recipients of a chance at life – similar to Joe’s choice to smoke. In choosing to give birth, was Mary engaging in homicide too?
No shortage of opportunities to derail this discussion….
The livers avenue of conversation is a complete miscue.
We’re talking about whether or not to provide universal health care. It was proposed that individual control over lifestyle was a foil for universal health care, because it means that responsibility should rest with the individual for making sure that sie has less statistical likelihood of getting sick.
Transplants are an extremely rare commodity. Health coverage is not. The two things are not analogous.
Further, transplants tend to be given to people who are more likely to survive. Health coverage includes a gigantic range of treatment — including preventative care — for which this kind of rationing is irrelevant. Rationing by money will depend on how much money the system is given; if we want universal health care coverage to be as rare as a donatable heart, then maybe we’ll have to make the call about whether to save the saintly little girl who never pulled her brother’s hair versus the wicked doctor who is inches from creating a cure for leukemia. Other than that, I think we can safely step away from these kinds of ethics games.
The issue is not “treat him, or her.” Looking at the European systems, we can see that it is possible to give everyone basic health coverage that suits most of their basic needs and creates outcomes that are comparable to (“slightly worse than!” claim the conservatives, “exceeding!” claim the liberals) our current system. It’s not salient to compare that to the transplant situation.
Don’t confuse statistical likelihoods for health in individuals. If you want to reduce the incidence of smoking, then attack smoking. It works. If you want to reduce the incidence of smoking, you don’t deny health care to people who have lung cancer because it’s their own damn fault. That’s the same logic that was tried against HPV vaccines and encourages some regimes not to treat people with AIDS.
Finally, the argument that the fit deserve basic health coverage — as opposed to miscuing McGuffins — more than the unfit is… really, really disgusting. Why, yes, smokers deserve health care. And so do people born with HLA-B27. And fat people — because, really, in much of the western world “healthy lifestyle” is code for “being skinny.” Poor people deserve health care, too, even though stressers make their lifestyle less healthy than being rich. So do people with mental illnesses that make it difficult or impossible to care for themselves in a way that would meet with one’s approval.
How do you tell whether someone is eating “the wrong things” because of some quality that you feel comfortable denying them health coverage for, such as sloth or gluttony? Or whether they do the same because they are poor and have few options? Or whether they’re clinically depressed, and can’t stir themselves to eat, and have therefore been clinically underweight for years and years? Do you deny healthcare to all of them? Or do you make an exception for the sexual abuse victim who’s starved herself skeletal? She may not tell you what the problem is. She may not know. She’s probably, at first glance, indistinguishable from the lazy person. Except that one of them is guilty of a biblical sin.
Do you do all these people a favor by saying “yo, we’ve decided not to have universal health coverage — because really, you should acknowledge that part of the burden for your health lies with you?”
Do we provide health coverage only for those diseases that we are sure have no component of moral idiocy? I mean, some people think migraines can be caused by being fat. So be sure not to provide low cost Maxalt for the poor; it might discourage them from eating their veggies.
This line of argument is based on moral panic. It also appears to have a psychological root in a place extremely similar to the arguments about what women did wrong to get themselves raped. If that person ate too many eggs, they deserved that heart attack. I eat none. It won’t happen to me. I’m a good girl.
Also, I think it’s instructive to look at who has to bear the burden for this “well, just make sure your lifestyle is excellent” replacement for health coverage.
If providing tax-funded health care for everyone discourages “people” from caring from their lifestyles as well as they otherwise might, then who are “people” in this situation? Not “people” who have health coverage under the current regime. They’re safe. No, “people” = “the uncovered” = “disproportionately the poor.”
Once again, the poor deserve their diseases more than the rich do. The poor cause their diseases. The rich may, too, but they won’t be denied basic health care to grind home the point. It’s the poor who disproportionately bear the burden of maintaining their health through inadequate methods of hoping for statistical likelihoods that work for groups not to fuck them individually over (because it’s a great comfort to know your chances of heart attack are greatly reduced because you’re svelte when that brain tumor starts growing) — the people who have the least free time to use to maintain a “healthy lifestyle.”
Sailorman, both you and nobody.really are looking at only one side of the financial incentive issue.
In the absence of a UHC system, people have a greater tendency to bear (directly or indirectly) the cost of their own health care.
In the absence of a UHC system, people will also have a greater tendency to base health-care decisions on their immediate ability to afford that health care. The usual example is putting off short-term preventive care (e.g. semi-annual dental checkups) that are expensive and ending up with more expensive care in the long run (e.g. root canals). Or having problems that would have been minor had they been noticed earlier (e.g. colon cancer that could have been caught at the polyp stage).
The other assumption under the risk-benefit analysis is the assumption that people make risky health choices with an awareness of the connection to health problems later.
And it seems rather cheeky for a government that, for example, subsidizes unhealthy food to turn around and punish people who eat that food for “making bad choices”.
I don’t disagree. I also don’t see any conflict between what’s said here. I did not mean to say that in the absence of a UHC system people make good choices. I said that people have a greater incentive to make good choices because they will tend to bear more of the consequences of whatever choice they make.
I’d say it’s sub-optimal for government to subsidize unhealthy foods, period. While I quibble with the term “punish” (more to follow), I won’t dispute the cheeky part.
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I share the view that health stats demonstrate the merits of a UHC system. That said, I think the difference between the transplant example and other aspects of health care is only in degree, not in kind.
I live in a world of scarcity. Just as we don’t have enough livers or lungs to meet everyone’s needs, we don’t have enough money either. And never will. The transplant example is unusually dramatic, but it illustrates a common dynamic regarding the need to make choice about the allocation scarce resources.
Insurance shields the individual from bearing costs incurred on her behalf, but the costs do not magically disappear. Saying that “government” will provide the care, or the dollars, is an illusion. We provide the care and dollars. Each hour that Dr. Lee spends with Joe is a hour less that Dr. Lee has to spend with Mary. If there’s anything Joe could do to reduce the amount of medical attention he needs, it would really help Mary. And vise versa.
So if we can encourage people to conserve health resources, it will help society overall. On the other hand, if we give people no incentive to conserve health resources, people will suffer as a consequence. Excess demand might crowd out the opportunity to build that extra mental health clinic, or crowd out Mary’s access to a lung. UHC may obscure the ultimate source of health dollars and donors, but it doesn’t really change it that much.
Specifically, why not? What exactly is wrong with making people bear the consequences of their own decisions?
I sense a few arguments interwoven here.
1. “It frustrates our sense of compassion.”
For both compassionate and practical reasons, I largely agree that we should not withhold health care from people even if the health problems were self-inflicted. But I don’t see the problem with billing people for the incremental cost of their care if their (knowing?) choices caused society to bear additional health care costs. My sense of compassion extends not merely to the person who jumped to the head of the line because her self-inflicted problems required urgent attention; it extends to everyone else as well. If we can bill more, maybe we can afford to build more clinics (or reduce UHC taxes) for everyone’s benefit.
2. “Causation is too complicated; we can’t distinguish between health consequences that arise from a person’s decisions and health consequences that would have arisen anyway.”
I suspect this is true much of the time. But that doesn’t mean we couldn’t try to identify causation where we can.
3. “Any list of causal behaviors would be arbitrary. New studies come out daily revising the list of behaviors that are harmful or beneficial.”
True, no list would be complete. But the fact that we don’t identify EVERY helpful or harmful behavior is not a reason to ignore the BIG behaviors such as smoking.
4. “We can’t distinguish between behaviors that are ‘chosen’ and those that result from genetic predisposition, social circumstance, mental illness, etc.”
This one’s tough. I’m not saying it’s wrong, but by the same rationale we would abandon the criminal code. For better or worse, we presume free will. I suppose people would be free to refrain from paying, and in the subsequent collection proceeding to assert their lack of volition as an affirmative defense.
5. “We don’t allocate the cost of the fire department to people based on the risk of fire at their houses.”
Maybe we should. Again, that fact that we fail to address the adverse consequences of insurance in every situation is not a reason to refrain from doing so here.
6. “Making people bear the cost of their own decisions doesn’t actually modify their behavior. Human behavior cannot be explained by simple carrots and sticks.”
Yes, it’s possible to over-state the power of long-term costs to influence lifestyle decisions, but I don’t believe those costs have no consequence. Some people, to some extent, respond to incentives. Remember, we’re not talking about whether or not society should bear the cost of health care. We’re just deciding whether this portion of the cost should be borne by taxpayers or cost-causers. If any allocation scheme is roughly comparable from a societal perspective, why would we want to forgo even a little beneficial incentive that can be derived from allocating costs to cost-causers?
Moreover, another benefit of allocating costs to cost-causers is that we don’t have to allocate them to innocent parties. So even if this allocation has no affect on behavior, it might be warranted simply to relieve burdens on everyone else.
7. “If the goal is behavior modification, there are better ways to achieve it.”
I suspect this is true, too. But it’s a false dichotomy to suggest we must choose between allocating costs to cost-causers and creating campaigns to discourage smoking. Why not have both?
8. “There are lots of irrational arguments – moral panic, etc. – for allocating costs to cost-causers.”
True. Let’s ignore those and focus on the other arguments.
9. “Making people bear the costs of their own decisions looks punitive. It may inspire feelings of guilt and inadequacy dating back to that money I borrowed from my dad….”
And this is a real problem. I HATE fixing my car. I finished paying for it, and that’s it! I shouldn’t have to pay any more, right? Yeah, at a rational level I know that as long as I keep driving it I should expect to keep repairing it, but it pisses me off anyway. And interest payments are the worst. I know I should have paid that bill earlier; I know that the utility is paying interest on its own debts and that it’s only fair I pay for the time value of the money I didn’t give them earlier. But that’s not the way is seems at a gut level. At a gut level, interest payments seem like Punishment for the Sin of Disorganization, Tardiness and Debt, and they dredge up all kinds of feelings of guilt and inadequacy.
Again, on a rational level I can’t really justify my feelings. But hey – it’s the way I feel. And in a democracy where most of us have a much stronger emotional investment in our status as debtors than as taxpayers, I can well understand the practical challenge of asking people to reimburse government for stuff. Even for costs they acknowledge they caused government to incur. As I say, it’s a real problem.
In sum, I generally favor giving people the broadest discretion to make their own choices, together with the duty to bear the costs of those choices. I acknowledge the practical challenges to making such a system work. And I acknowledge that such a system might not be popular with most people, and popularity is certain to be a driving force in any UHC system adopted.
And I suspect that’s one of the facts that alarms libertarians.
But the fact that we don’t identify EVERY helpful or harmful behavior is not a reason to ignore the BIG behaviors such as smoking.
People who smoke have lower incidences of Parkinson’s and Alzheimer’s. Should we not pay for the treatment of non-smokers with these diseases because they should have known better than to not smoke?
My basic argument against the “we shouldn’t pay for diseases caused by people’s bad behavior because it encourages irresponsible behavior” is this: It doesn’t work. Abstinence education is a failure. “Just say no to drugs” is a failure. Lecturing people on the dangers of smoking is a failure. The things that decrease the smoking rate are decreasing the number of places where smoking is allowed and increasing the cost of smoking by increasing cigarette taxes. If you want to tax things that can cause health problems heavily (i.e. cigarettes) heavily, that might work. But telling teenagers (and most people start smoking when they are teens) that they shouldn’t smoke because the government won’t pay for problems that their smoking will cause in 30 years. Hah. What teenager doesn’t simulatiously believe that s/he is immortal and that s/he is never going to be as old as 40 anyway?
Oooo, that’s a good one!
I’d say that if someone’s refusal to get inoculated resulted in government incurring additional cost, then government could charge them for those additional costs. But we’d need to look at the cost and benefits of an individual’s choice to society as a whole. Yes, any given individual might get sick as a result of a choice to get inoculated, but the choice to get inoculated on average would result in lower societal costs.
The same policy would apply if smoking became, in effect, another kind of inoculation. That is, if the incremental benefit to society of a policy encouraging everyone to smoke (in terms of avoiding Parkinson’s and Alzheimer’s costs) exceed the incremental cost, then government should in fact charge people for their failure to smoke. Heck, government might even pay for your cigarettes!
The question about which behaviors reduce health-care costs is largely a factual one. And as new facts evolved, I guess incentive structures would change.
Here’s a trickier question: If I recall correctly, the states sued tobacco companies for causing them to incur additional health costs. The tobacco companies offered to provide evidence that, while smoking resulted in increases in some health care costs, it resulted in decreases in others because smokers tended to die earlier than non-smokers. The judge excluded that line of reasoning as being contrary to public policy.
But in that vein, we might identify any number of risky behaviors that might result in LOWER health care costs because they result in early, abrupt deaths. If not smoking, then how about suicide? Sky diving? Riding a motorcycle without a helmet? Russian Roulette? Should we tax people who refuse to engage in such cost-lowering activities? Conceptually, yes.
Note that this policy wouldn’t impose extra costs on the rest of us, on average. Imagine that the average person incurs $100/mo in health care costs, and imagine that members of the Sudden Death Club incur an average of $90/mo. in health care costs. If the Sudden Death Club didn’t exist, we’d all pay an average of $100/mo in UHC taxes. Because the Sudden Death Club exists, we’d all pay an average of $90/mo in UHC taxes (matching the health care costs of the lowest-cost lifestyle) plus $10/mo in Incremental Health Cost fees (for our choice to avoid activities that result in sudden death). So on average, it’s a wash.
(OK, ok, I guess the UHC taxes would be progressive whereas the Incremental Health Cost fees would not, so the existence of a Sudden Death Club might cause the system to be somewhat less progressive. Picky, picky….)
What exactly is wrong with making people bear the consequences of their own decisions?
Nice rhetorical framing. Let’s try it from the other direction: What exactly is wrong with recognizing that health care is not a cookie you get for having lived a virtuous life?
That aside, the problem with your argument is that it makes some assumptions:
1) Medical bills are the best, and possibly only, incentive, for making smart health choices. (You won’t quit smoking to avoid lung cancer and get that smell out of your clothes–but you will quit to save money on medical bills.)
2) Monetary incentives that exist under the current system would be lost under a UHC system. (This is the “you wouldn’t see a doctor if you had to pay for it” argument.) Again, that buys into the odd notion that people are frivolously blowing money on medical care that they wouldn’t if they had to pay for it themselves, as if health care were a luxury good.
3) People are completely rational actors and capable of connecting bad health choices directly to expensive health outcomes.
Good point about transplants being rare. Looking forward to the day after UHC, when we’re trying to keep the prices down, here are some ‘morality’ questions:
Do we provide full coverage for meth(whatever) addicts? Do we service other people first? (I don’t mean recovered / recovering addicts. I don’t mean treating the addiction. I mean an unapologetic meth addict walks and needs heart surgery. )
Do we provide full coverage for people that engage in behavior very likely to cause injury? Race car driving, amature Boxing/Mixed Martial Arts, eXtreme sports? How about coverage for recreational sky divers? It’s pretty safe but accidents are expensive. Why should I pay to lower the cost of their thrill ride? That money could provide better care for someone else.
Do we provide full coverage for people who do dangers things as part of their jobs? (IMO the employer should pay for that and pass the cost on to the consumer.)
Also, when I said up thread that treating contagious diseases was an easy call I meant that it’s sort of a no brainer. If you let say, the pox go untreated in others you could catch it.
Duly recognized. What policy implications flow from this statement?
I’m sorry I haven’t expressed myself more clearly. Let me take another swing at it.
– At Post 273, item 7, I meant to acknowledge that there may be other, and even more effective, means of influencing behavior than using cost allocations. I merely noted that I knew of no reason why we could not use cost allocations in addition to other forms of behavior modification.
– At Post 273, item 6, I meant to address the argument that people don’t alter their behavior to avoid bearing the cost of medical care. Specifically, I speculated that some do and some don’t.
Imagine society has only three smokers – Sue, Paul and Raoul – and society incurs an added $1000/yr/smoker in health costs. Imagine that Sue and Raoul would continue smoking even if they had to bear this added cost, but Paul would quit. If we spread the cost of smoking throughout society, society would bear added costs of $3000/yr for smoking. If we allocate the cost of smoking to the smokers directly, society will bear the added cost of only $2000/yr. That means society would have an extra $1000/yr with which to, say, provide mental health services. Given a choice between an allocation scheme that subsidizes smoking habits or a scheme that provides extra mental health services (or whatever), which would you choose?
– Furthermore at Post 273, item 6, I meant to note that behavior modification is not the only advantage to allocate costs to cost-causers. The other advantage is in relieving non-cost-causers from having to bear discretionary costs they did not cause.
Some electric utilities offer time-of-use rates. That is, because it costs less to supply electricity at 5am than at 5pm, some utilities charge customers according to the time they use electricity. Do time-of-use rates cause people to alter their patterns of electric consumption? Some people do; most don’t. But the program works either way. Everyone gets an incentive to change their behavior to help society lower its costs; no one is required to change their behavior to help society lower its costs; and everyone ends up bearing the costs of their own decisions. Given a choice between a uniform rate scheme and a time-of-use scheme, why not pick the time-of-use one?
– I have yet to hear anyone deny that the monetary incentives that exist under the current system would be lost under a UHC system. At most, I hear people dispute the magnitude of those incentives.
– As far as I can tell, health care IS a luxury good (or service). With luxury goods, the more you can afford, the more you are likely to purchase. I’m currently in physical therapy. I suspect I could derive much of the benefits of physical therapy by simply doing the exercises myself. But my insurance covers bi-weekly visits to the therapist, so I go. If I were paying for it out of pocket, I doubt I’d go; I’m sure I wouldn’t go as often. (Hell, I don’t wanna go even when its paid for). That’s the sign of a luxury good.
I sense that some people are not persuaded of the merits of having people bear the incremental health care costs of their own decisions. And I concede the practical challenges. But I have yet to hear anyone discuss the comparative advantage of any other cost allocation scheme. Anyone?
“If you let say, the pox go untreated in others you could catch it.”
And if you say that skydivers should be punished for their thrillseeking behaviors, then you are supporting the idea that trivial (again: trivial) choices should be judged by others to determine whether or not they invalidate your access to health care. That’s going to bite you in the ass, sooner or later. (My odds are on sooner.)
Again, I’m going to analogize this to rape. If you’re going to play the “how did this individual act in such a way that I can call hir guilty for her misfortune” card, then you’re going to find that the only people who can’t be blamed with ad hoc justifications are those who sit in padded rooms having their meals prepared by specially trained healthful chefs. And they probably didn’t get enough sunlight.
You’re people. I’m fat, but I’m people. My grandmother smoked, but she’s people. Children with leukemia are people. Autistic adults are people. Meth addicts are people, too.
Do we provide full coverage for meth(whatever) addicts?
That depends…on whether you want them to be live meth addicts or dead meth addicts. And if you want them to be lifelong meth addicts or have a chance at being recovering meth addicts someday. If you want live, recovering meth addicts, provide full care.
“If you want live, recovering meth addicts, provide full care.”
Right. I mean, basically, arguing against health care for meth addicts is saying that meth addicts are not worthwhile people.
By the by, I appreciate that this thread has stirred people to nearly 300 comments, but I’m starting to feel that it’s near the apex of its productivity. I’m going to let it go a touch longer, but please take care that it doesn’t continue going down the road of “Why People I Don’t Like Should Die For My Continued Access to Surplus Wealth” or, alternately, “101 Reasons Why I Shouldn’t Have to Pay for Fattie to Keep Breathing.”
The basic problem with the US model of health care is that it spends too much money for too little. It is an intermediate model that combines the expense of universal health care (and more) with the inefficiency of self-pay. Basically, if the US wants to save money on health care it should do one of two things:
1. Institute universal health care. Single payer is cheaper, but the German model (multiple competing public and private insurance companies with a guarantee of insurance paid for by the government for anyone who can’t get it otherwise for any reason) works reasonably well too. Although it isn’t as inexpensive as Canada’s or Switzerland’s. Basically this model saves money by decreasing the amount of emergency care that is needed. Everyone gets basic care and so the number of cases of a cold turned to pneumonia or mild hypertension turned to stroke and so on are reduced. And it has been proven to be cheaper. The US spends more money and more public money on health care than any other country in the world.
2. Go libertarian for real: Forget about public health care and just let everyone fend for themselves. Allow ERs to deny emergency care to people who can’t prove that they can pay for it. The downside of this, of course, is that quite a number of people will die unnecessarily, including people who have insurance but don’t happen to have their insurance card on them when they step out for a jog and get hit by a car or whatever. But it would be cheaper and at least no one would have any illusions about their safety.
Obviously, I prefer the first method. Because I’m too much of a chicken to make a moral argument (I’m scared that someone will answer “but I DON’T care if meth addicts die”), I’ll make the utilitarian argument: allowing people to die unnecessarily is inefficient and causes their potential contribution to society, even if it be only as a negative example, to be lost permanently and unnecessarily.
Before the thread ends I’d like to say the following.
1. I don’t think people are more or less human based on the choices they make.
2. I support the idea that people who need urgent medical attention should get it at once. The bill can be dealt with later. We sort of have this now.
3. I’m sure that UHC would be basically as good as what we currently have on average. But that it will have different trade offs. I think ignoring the trade offs is dishonest. I also don’t think anyone has really done that here.
4. I think the way that UHC is rationed and paid for will be extremely contentious and that these details are critical. I think it’s perfectly possible to create either a UHC system that is better or worse than what we have now.
5. I fear that once health is the government’s ‘job’ interference in personal choices will get worse. Look at locations that have tried to ban trans-fats and the way that painfully easy things like the HPV vaccine have been handled.
6. In general I think that a UHC system where people are expected to pay for their own costs if they can afford to (and to the extent they can afford) would be a decent thing.
7. This has been one of the better health care threads I’ve read online and I’ve really enjoyed it.
I meant to acknowledge that there may be other, and even more effective, means of influencing behavior than using cost allocations.
Sure. Reasons not to use cost allocations? They’re inexact, they have serious drawbacks, they may not end up with a net savings, and there are better ways.
Electricity is an extremely poor analogy because electricity, in your example, is not priced out of anyone’s reach; there’s no question of having to go without electricity because your options are “use it during peak pricing or not at all”; there is not a pricing scheme whereby if you have a job, your electric bill is subsidized, but if you don’t have a job you may not be allowed to buy electricity at all (or, if you do, you pay many times more than the guy with a job).
Smoking is also a rather bad example because of the ongoing, constant drawbacks of smoking–do you think that people who are not dissuaded by social ostracism, the cost of buying cigarettes, and the health effects and risks of smoking are going to say “You know, if I *do* get lung cancer–I’d have to pay for the treatment myself! That’s it, I quit tomorrow!”
Oh, and there’s that whole part about it being addictive, and the majority of addicts having started using the drug (nicotine) when they were children.
You seem to be projecting your own health-care gluttony (you don’t think PT is needful, but you’ll take it because it’s free) to the population at large and assuming that makes for good policy decisions.
Dianne, re “go libertarian for real”–even libertarians don’t REALLY want such a scheme. They don’t want to be catching diseases that are controlled or rare because of mandatory, subsidized vaccinations; they don’t want to be denied life-saving care because their health-care insurer acted in bad faith and said “if you don’t like it, sue us.”
David Gratzer, a physician who onced practed in Canada and now in America, has an article lambasting nations with universal health care.
Regarding life expectancy:
Survival rates:
Inexact relative to what? What policy would be more exacting? Drawbacks relative to what? Produce fewer savings than what? What “better ways”? By what measure are they better? And are these better ways inconsistent with allocating costs to cost-causers?
Churchill (allegedly) wrote that democracy is the worst form of government ever devised – except for all the others. There’s no challenge in finding fault; the challenge is in finding superior alternatives.
Good point. Joe (among others) has an idea for dealing with this problem: separate the giving of medical care from the paying for medical care. Give people whatever level of medical care they want (up to the limits provided by UMC) regardless of ability to pay.
Oh sure; I suspect there’s all kinds of things that would prompt a smoker to say, “I quit tomorrow.” The challenge is to get them to say “I quit today.”
Seriously, I think there are nearly 100 million smokers in the US. And whenever you have a pool of 100 million people, I suspect some portion of them will respond to damn near anything. More to the point, I suspect the portion of US smokers that would quit if they had to bear the cost of their decision to smoke would be greater than the portion that would quit if they didn’t.
A good point. Certain actions taken by children will have long-term medical consequences. Should we hold adults financially responsible for actions they took as kids that resulted in irrevokable medical conditions (addictions, diseases, injuries, etc.)? Perhaps not. While I want to make people bear the cost of their choices, I know that the law often regards children as incapable of making legally-cognizable choices (regarding contracts, marriage, etc.). Health care finance might provide a similar case.
Perhaps. Maybe I am speaking out of some delusion as a med glutton. And maybe someone else is speaking out of self-interest as someone who doesn’t want to bear the cost of his own lifestyle choices. Who knows? Motive, like morality, is murky, and I’ve rarely derived any constructive insights from an exploration of a commentor’s motives. Ultimately the merits of the argument must be evaluated independent of the merits of the arguer.
But hey, that’s just the perspective of a med glutton, and you know how they are…. :-)
There’s no challenge in finding fault; the challenge is in finding superior alternatives.
That’s pretty much my response to criticism of UHC; it’s not a perfect system, but it is better than what we have now.
To be blunter, using money as a stick to try and force people to make “right choices” is really looking at outcomes and punishing people who have those outcomes because some people with those outcomes contributed to their risk.
I suspect the portion of US smokers that would quit if they had to bear the cost of their decision to smoke would be greater than the portion that would quit if they didn’t
I suspect that the portion of US non-smokers who would be negatively impacted (denied care or overcharged for care) if we use a Calvinist health-care system is greater than the portion of smokers who would quit if they had to pay a greater share of their smoking-related illness.
Again, you’re relying on the assumption that social ostracism, disease and death are not motivators in the absence of “and when you’re sixty, you may have to pay for more of your own treatment!” That’s absurd.
Who knows? Motive, like morality, is murky, and I’ve rarely derived any constructive insights from an exploration of a commentor’s motives.
I see: for you to speculate on motives is useful, for me to do so is a waste of time. Don’t open a door and then pretend only you are allowed to walk through it.
Sorry: I did not mean to ask for comparisons between UHC and the health care system we have now. I meant to ask for comparisons between a UHC system in which people bear (more of) the cost of their own decisions and a UHC system and a UHC system in which people don’t (or bear fewer of them).
Another apology. I didn’t mean to argue in favor of denying care to all people who cause their own health problems. I tried to convey this idea in Posts 264 (“denying coverage would not necessarily mean denying medical care”), 265 (smoker Joe gets a lung transplant even if he caused his own lung to fail), 273 (“I largely agree that we should not withhold health care from people even if the health problems were self-inflicted”), and 288 (“Give people whatever level of medical care they want (up to the limits provided by UMC) regardless of ability to pay”). Let me know if I’m being ambiguous on this point, and I’ll try to clarify it further.
Nor did I mean to argue in favor of overcharging anyone for anything. Glad to have the opportunity to clear that up.
Clear writing is really hard! I’m going to try one more time:
1. My support for letting cause-causers bear their own costs does NOT rely solely on the idea that it will cause people to change their behavior. It also reflects a preference for freeing up funds that would be tied up paying for cost-causer’s care that cost-causers can pay for themselves. I tried to convey this idea in Posts 273 (“Some people, to some extent, respond to incentives…. Moreover, another benefit of allocating costs to cost-causers is that we don’t have to allocate them to innocent parties. So even if this allocation has no affect on behavior, it might be warranted simply to relieve burdens on everyone else.”) and 279 (“I meant to note that behavior modification is not the only advantage to allocate costs to cost-causers. The other advantage is in relieving non-cost-causers from having to bear discretionary costs they did not cause.”).
In Post 279, I provide a hypothetical example comparing A) a world in which the costs of smoking are spread throughout society to B) a world in which smokers bear their own costs, thereby freeing up funds to provide mental health services. When choosing between providing resources for a person who chooses smoking and a person who did not choose mental health disorders, I still can’t see why we would privilege the former over the latter.
2. That said, I’m also not persuaded that costs do not modify behavior. In the pool of nearly 100 million Americans who smoke, every day some of them decide to quit, and some of them think about quitting but don’t. What exactly is the precise collection of factors that go into persuading any given person to move from one category to the other? I really don’t know enough to make a dogmatic pronouncement about the efficacy of any given factor. But I have at least a theoretical basis to imagine that financial incentives might play a role.
Imagine that you’re a kid is thinking about smoking. You’re uncle is so cool, driving around in his convertible with a cigarette on his lips, drag-racing with his rebel buddy with the tattoos. You wanna show that you’re an outsider, a rebel just like your uncle, and you conclude that smoking is just the way to do it. But then your uncle’s convertible got towed away to pay his smoking-related medical bills. Now your uncle is always begging his tattooed friend for a ride. And suddenly maybe smoking doesn’t seem as cool. You think that maybe you’ll demonstrate your rebel status with a tattoo instead….
Would it happen? Dunno, but it doesn’t strike me as absurd.
I’m really enjoying a discussion of national policy issues, and I really can’t imagine how the individual foibles of any commentor could have any bearing on those issues. Please let me apologize for having impugned your, or any commentor’s, motives in this discussion. Wherever it occurred, I wholeheartedly retract it and beg everyone’s patience with the oversight. I’d hate to see this discussion get sidetrack it into petty squabbles about personalities.
Jamil: I’m not sure where Gratzer is getting his statistics, but they are not necessarily correct or uncontroversial–or explicable in the ways that you might initially think. For example, this study (the link is to the abstract, but I really suggest that you read the full article, which gives details not obvious from the abstract) which finds that the US and Germany have comperable survival rates for the most treatable cancers, ie testicular cancer, leukemia, lymphoma, and thyroid cancer. (In fact, survivals were higher for testicular ca and lymphoma and, IIRC, leukemia* in Germany, although not statistically significantly so). Additionally, stage for stage, cancer survival rates in Germany and the US are very similar. Germany has lower levels of screening and therefore higher levels of later stage. Yes, I know, this “should” be the other way around, but there it is: universal health care doesn’t mean good screening. Finally, one has to ask the question of whether the data from the US, which is derived from the SEER data, is really representative of the US as a whole. Patients who end up in the SEER registry live in places that have good cancer registries (SEER is one of the best in the world, possibly the best.) That means, among other things, they live in a place with medical care good enough to run a very high quality cancer registry. That may mean a higher quality of care than for people who live elsewhere. Or maybe not.
The issue of accidents/homicide versus non-violent deaths is an interesting one. If you have any citations from the peer reviewed literature for that stat, I’d love to see them.
*I may be wrong about leukemia. I don’t have the article in front of me. I remember testicular for sure because of the bizarre finding in Germany that men with testicular cancer actually had a higher 10-year survival than men in the general population. Presumably because of close follow up and therefore fewer deaths from other causes. Lymphoma had a high apparent gradient without a significant p-value, which is why I remember it.
Would it happen? Dunno, but it doesn’t strike me as absurd.
It strikes me as beyond absurd. It assumes that the kid will totally ignore his uncle’s lung cancer, the bad smell of cigarettes, the cost of cigarettes, and so on, but the possibility of Uncle’s having to pay medical bills that are directly related to his smoking will be obvious and convincing.
Of course people are motivated by costs; the problem is that it’s extremely difficult to set up a system that sets up a system of motivation that also doesn’t disproportionately punish others.
I continue to claim that if you want to discourage smoking, the best thing to increase the cost of is not smoking-related health care, but cigarettes. That’s a much more immediate negative feedback (if you smoke you won’t have money for the cool car and tattoos) and much more equitable: it doesn’t hurt anyone who doesn’t smoke. The potential problems are those of making any addictive drug more scarce: sale of illegal (and potentially even more dangerous) versions, crime motivated by need to get money to buy drugs, etc. So it’s not a perfect system either, but less bad than limiting health care to those whose lifestyles are less than “perfect” would be.
I’m also not okay with the idea that becuase people smoke it’s okay for us to stand by and watch them die painfully.
Because it is vaguely on topic.
“Actually, I suspect UHC would have the net effect of transferring wealth to smokers AND seatbelt wearers, and away from insurance companies. But I suspect smokers may derive a disproportionate share of the benefit.
I distinguish between the “basic philosophy” of insurance and gambling. I think of insurance as a means of allocating risks that would exist even in the absence of insurance. I think of gambling as the intentional creation of risk. By making risks easier to bear, insurance inevitably subsidizes gambling. I don’t think of this dynamic as the purpose of insurance, however.”
I wasn’t comparing insurance with gambling – did I inadvertently signal a cliche or something? – so you increased the net entropy of the universe needlessly by typing the above. What I meant was, the net effect of any insurance scheme is to transfer wealth from those who have been unaffected by disaster to those who have; and since there must be at least a small percentage of disasters that the victim himself created or exacerbated, a further net effect of any insurance scheme is to transfer wealth from responsible people to irresponsible ones. Seatbelt wearers to smokers. It’s a price that I, as both a real life seatbelt wearer and smoker, am willing to pay, as is the broad population outside of hardcore libertarian Usenet circles, or else anyone who has a life.
As for your query at the bottom of the post, in British Columbia where I grew up, I’ve known people who have had their MSP premiums increased in response to stupid behaviour on their part. Also, MSP typically doesn’t cover those few aspects of health care that can seriously be considered ‘luxury’, such as physical therapy, chiropractors, or even regular eye exams for those not under 18 or over 65. That is, unless you have demonstrated financial need and been granted premium assistance status, but this can be a hassle and they don’t just give these away. All in all, they’re a fairly stingy, by-the-book government bureau, and most British Columbians don’t like them – though perhaps you and Sailorman may appreciate their style.
Dianne’s point about smoking and Parkinson’s is well noted. There is some merit to the basic point about punishing behaviours linked to poor health outcomes that drive up cost for everyone else (which is true for both public and private insurance pools, again). But there are too many variables in the world, too many factors that could influence too many disparate measures of health – how on Earth do we establish causality? Well, some factors have already had causality, however tenuous, established for them – they correspond with those behaviours that traditional religion and restrictive dogmas have scared everyone away from for hundreds of years. And now we want to do the same, except where excommunication left off, added medical bills take over. Some of you here say that you don’t want something like government intruding into our personal lives through health care, and I want to believe you, but really, I can’t imagine a more pervasive way than this convoluted sin tax method for allowing higher institutions to make personal decisions for us. Since occasional masturbation is linked to better prostate health in males, should some board of bureaucrats decide to impose what amounts to a tax on those who choose never to masturbate? Since some alcohol is linked to healthier circulation (though this one screams urban legend; I’ve never bothered finding out, but let’s suppose for sake of argument that it’s true), should a faceless department with a logo and a slogan decide how much, but not too much, alcohol I should drink? How utterly deplorable.
And yes, I’m aware that the effect on actual behaviour that such a system would have is debatable. Leaving aside the question of why we should adopt it in the first place if its effect is negligible, my problem is one of principle.
Jamila, as I’ve plainly demonstrated before in post 133, but will do so again here using other, separate links, Canada has better cancer survival rates than the US does. Also, this isn’t true just of cancer. Japan also has higher rates.
“I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic — with a three-year wait list; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.
Government researchers now note that more than 1.5 million Ontarians (or 12% of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment.
These problems are not unique to Canada — they characterize all government-run health care systems.”
To Jamila, Nick, and David Gratzer, I provided a study that, among other things, queried Canadians on their own experiences with their health care system. 3.5% reported that waiting times had resulted in an unmet health care need*. Three point five percent. However of a ‘little’ problem, however much of an ‘oh, that too’ you consider the nasty side effect of the American system whereby a significant number of people go uninsured, know that it is precisely 15/3.5 = 4.2857 times the problem that waiting times are for Canada.
“Single-payer systems — confronting dirty hospitals, long waiting lists and substandard treatment — are starting to crack”
Again, that would be a first, given that so far in human history, many, many countries have made the switch from private to public health care, while none so far have moved from public to private.
I mention this only to re-emphasize that movement toward privatization cannot be indicative of anything that the reverse move toward collectivisation won’t be. If you go in with the disposition that all movement toward the private are dictates of the head, and that all movements toward the public are dictates of the heart (with much implied derision, as if failing miserably to generate anything but widespread contempt of it is not itself a major policy failure), you have already assumed your own conclusion and are wasting our time with your rationalizations after the fact.
“One often-heard argument, voiced by the New York Times’ Paul Krugman and others, is that America lags behind other countries in crude health outcomes.”
Krugman mentions disability adjusted expectancy and potential years lost – adjusted, controlled measures taken by the medical community as definitive, which is more than I can say for the extremely problematic measure Gratzer… cites.
As for infant mortality, it’s hard to square Canada having comparable rates with the US only until it adopted UHC, or similarly differing maternal mortality rates, without UHC looming in as a major factor. (The latter specifically discards the argument that the difference is one of ‘classification’, since we don’t have to argue at what point during the delivery is the *30 year old woman* technically ‘alive’. The argument is already bogus because it’s true for virtually everything else as well. There’s dispute, for instance, between countries over what specifically gets to be classified as a cancer.)
“In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country.”
Given that he references a book, not a paper, I wasn’t able to see this for myself on trusty google scholar. But already it’s sounding like it’s falling flat. As I’ve grilled Jamila to no end throughout this thread, factoring out problems for one side of the comparison while not balancing it out for the other – aggravated many times if the factor itself is not randomly chosen – makes the comparison categorically invalid. It’s not a question of degree. The number of Europeans murdered or killed in transportation accidents (which would be the minimum necessary to use as a measure for international comparisons – not merely ‘car’ accidents) may in fact be smaller. For sure smaller, in the case of the former. But it isn’t negligible, and would have be adjusted for across the board. (Even this suffers from the ‘religious defined caste’ problem I used as an example, since everything hinges on what we choose to acknowledge as factors. But it’d be a sight better than this.)
It could be that Ohsfeldt and Schneider’s work was perfectly legitimate and has addressed my concerns. It merely needed a better man than Gratzer to vouch on its behalf. But I’ve seen too many statistics – adjusted in the ways that I’ve described – before I can allow this one further into the mix.
“Because the U.S. is so much wealthier than other countries, it isn’t unreasonable for it to spend more on health care.”
Why don’t let the American people decide what is reasonable or not? Yes, I realize that that’s Initiation of Force – I’m prepared to make that sacrifice.
This article is excellent and briefly makes me forget that I hate TNR. I’ll quote the relevant parts.
“Critics argue that measuring infant mortality and life expectancy is too crude, since whether a newborn dies or how long somebody ends up living may have as much to do with outside conditions like poverty, environment, and lifestyle as they do with the quality of medical care. And while it’s a bit unfair to treat these entirely separate from health insurance — universal coverage helps reduce poverty, among other things — the measures are crude. That’s why the scholars who specialize in comparing international health care systems prefer to look at some more finely tuned calculations: “potential years of life lost” or “disability adjusted life years.” The latter is the preferred measure of Gerard Anderson, a professor at the Johns Hopkins School of Public Health and a leading expert on international comparisons. But, as he’s noted many times, on these measures, too, the United States is decidedly mediocre compared to Japan and the more advanced countries in Europe.”
“Look at Japan. It has universal health care. It also has more CT scanners and MRIs, per person, than the United States.”
The land of the rising sun… so useful when it comes to complaining about health, demure Asians, and 120-million strong homogeneity (Okinawans? Zainichi? What’s that?) but strangely absent from these discussions. I wonder why.
“It’s true that the European countries tend to have less technology (although Germany and Switzerland appear to be comparable or at least very close.) But their citizens get more of something else relative to Americans: Face time with doctors and time in hospitals. Take France, for example. As New York University’s Victor Rodwin has noted, on a per capita basis the French get more physician office visits and more drugs than their American counterparts. When a woman in France gives birth, she gets to stay in the hospital for an average of nearly five days — even if it’s a perfectly normal delivery. In the United States, on average, a woman with normal labor and delivery gets to stay less than two.
Why the difference? The big reason is that private insurance in this country has squeezed inpatient time to the bare minimum, while universal coverage in France has preserved longer periods for convalescence — just as it has in other countries. The Germans get almost as much time as the French.”
“Cannon, Gratzer, Tanner, and others have all seized on the survival rates for cancers — particularly breast cancer and prostate cancer. In those two cases, Americans diagnosed with those diseases are significantly more likely to live than Europeans diagnosed with them. (…) Another wrinkle is that the comparisons look a lot different in you look at populations as a whole, rather than just those diagnosed with the disease. Yes, an American diagnosed with prostate cancer is less likely to die than, say, a German diagnosed with prostate cancer. But Americans on the whole are no less likely to die of the disease than Germans on the whole — and the same is true for most of the other well-developed countries in Europe. In fact, the percentage of the population that dies from prostate cancer is remarkably consistent between the United States and the most advanced European nations.”
Here’s a graphic representation of this conundrum:
http://ezraklein.typepad.com/photos/uncategorized/prostatecancermortality.jpg
Courtesy of http://ezraklein.typepad.com/blog/2006/05/i_wonk_because_.html
There are several explanations for this. First, Americans could be screened better than Europeans are. This would a real strength of the current American system then, I must admit – the efficacy of broad-based preventive care is perhaps the single best measure of health care quality. Given the nature of UHC, I’d think broad-based preventive care would come more naturally to it than with private care, and would be easy to remedy.
Possibly, Americans get cancer at rates over two and half times the British**, and that despite this seemingly unsurmountable hurdle American health care is busy treating and fixing advanced patients to bring the numbers down right to the uniform level seen on the graph (26, 26, 27, 27…). But that, I’m afraid, has our friend Occam and his Razor ready to strike above its head. In fact, the level uniformity of the graph suggests the simple explanation that Americans may simply be over-diagnosed as a result of aggressive screening – though it’s still hard to view this as anything but a point for the US of A as of now.
“The Swedes are more likely than Americans to survive a diagnosis of cervical, ovarian, or skin cancer; the French are more likely to survive stomach cancer, Hodgkins disease, and non-Hodgkins lymphoma. Aussies, Brits, and Canadians do better on liver and kidney transplants.
All of this comes with an important cautionary note: Measuring the outcomes of medical care is an imperfect science at best, in all countries. (Plus the measurement standards themselves are different sometimes.) It’s difficult to make a ironclad case that any one system is better than another. But the fact that countries with universal health care routinely outperform the United States on many fronts — and that, overall, their citizens end up healthier — ought to be enough, at least, to discredit the argument that universal care leads to worse care.
And that, in turn, ought to tip the scales of debate, since not even conservatives dispute the one clear advantage other countries have over us: You don’t see their citizens choosing between prescriptions and groceries, or declaring bankruptcy, because of medical bills.”
*The phrasing is important because we’re talking about concrete health care results. Not obtaining treatment that one would otherwise get is a concrete measure. Tapping the general worry over waiting times would not be, especially since this is a self-fulfilling prophecy that owes more to right wing punditry than the actual health care system. In any case, we could equivalently draw up the general worry over medical bills for the private American system, something I doubt neoliberals are willing to do.
** There are many things that could activate a proto-oncogene – cancer isn’t exactly perfectly random in a statiscal sense – but I’m not sure why they’d be so much more prevalent in America than in Western Europe. Is it all the sunlight we get?
So far, a couple of you have repeatedly attacked UHC and I, among others, sat back and defended, for the most part. But now I’d like to turn the tables a bit.
No one here is advocating banning private care to those who seek it. We’re advocating a basic level of service that the government can provide, which no one is forced to accept. (Perhaps an exception can be made for children and the mentally disabled, for whom if their legal guardians are not affording them any other care, this basic care level of care must be accorded them by law. But I digress.) Consumers can choose between expanded Medicare and any number of private firms. Some fence-sitters on this thread have called UHC a tradeoff; fair enough. Let’s let the customers decide what’s a fair tradeoff for them. Given that the 60% of the health care system that Americans finance through taxes is already more than the sum totality spent in entirely tax-funded systems, and that Medicare is by far the most cost efficient system there is (it spends two cents for administrative costs on the dollar, in contrast with nearly thirty cents for investor led private companies and assorted public/private hybrid companies in between), expanding Medicare for all will, if anything, result in a net tax decrease, a very small increase, or no movement at all.* Since almost any movement to fix the existing problems in American health care will hurt some group, somewhere, expanding Medicare for all and giving customers the option of signing on sounds like a great deal. So are all them neolibs and right wingers on board?
No. And why is that? Because they know damn well what most customers would choose if given this choice, and it’s unacceptable. They know that according to their ideology, the one that more customers choose must objectively be the better one (this isn’t something that follows from even the most doctrinal branch of neoclassical economics, but is a normative claim neolibs come up with when people criticize popular-but-bad companies like WalMart). They don’t care; all that empty rheotric was just a means to an end, anyway. They posit that customers may not know enough about health care to make the most informed choice. Irony overwhelms.
*As to how expanding Medicare may lower taxes, a significant amount of public health care spending subsidizes inefficient private practices, particularly where public/private insurance/treatment are intermingled.
More on waiting times.
Going back to my post 141, I stated that, despite the numerous measures by which treatment for various ailments is superior in Canada, and they are many, America does tend to take better care of their elderly. I can’t believe I missed this, but this isn’t much of a concession at all; as Paul Krugman points out, senior care in America is financed by Medicare. No wonder America performs well there.
Sylphhead Wrote:
I couldn’t get either of those links in post #297 to work. I received an “Error 404” message. Does that mean that the links no longer exist or have been moved?
The following is in regards to post #133:
The link says this “Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.”
But according to the WHO “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)”. “
So who are you going to believe, the commonwealth fund or the WHO?
I’ll accept the WHO ranking, especially since the study done by the commonwealth fund study “does not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative records.”
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 (according to the WHO). The US also has the lowest number of potential life years lost due to lack of preventative care.
I have no idea where you came up with conclusion from because it definitely wasn’t in the link you provided. Which says “the only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better” and then goes on to say “available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent..
Once again, I have no idea how you managed to come up with that conclusion from a study that only compares metropolitan areas in Canada and the US. The conclusion of the study mentions Hawaii and Toronto, but what about the other metropolitan areas in Canda and the US, and what about Canada compared to the entire US?