(Originally published in Dollars and Sense magazine)..
When capitalized, "Sie" is the formal way to address adults of either gender in polite German. I majored in the…
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If one assumes that a person is making their money, including enough money to have no incentive to "work", by…
Ob sie wirklich Deutsch spricht. Normalweise, kommt die US Soldaten nicht ins Stadt und spricht nicht so oft mit denn…
As for being a Nazi, ich spreche fliessend deutsch und wohnte in Deutschland fuer drei Jahre mit der americanishe Luftwaffe…
And of course this "incentive" only applies to poor people: Rich people who already have enough to live off of…
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I love the “Libertarian Guy” for #2. It pretty much nails the ones I’ve known: “Rebellious and Iconoclastic As Long As It Won’t Upset The Boys At The Firm.” Thus, the bow tie.
Of course, maybe I’m reading too much into it.
Maybe you just like drawing bow ties.
—JRC
Though, in all fairness, there is no shortage of people on the Left who’d posit: “Let’s be rational. ‘Big Business’ is just evil! Evil! Eeeeevviiiilllll!”
P.S. What does “Ampersand by B. Deutch” mean? I thought your nom de cartoon was Ampersand, no?
JRC, you read the bow tie correctly. :-) (Actually, numbers seven and especially five were digs at libertarians, too).
And yes, a libertarian cartoonist could do the same gag replacing the word “government” with “business.” ;-p
Ampersand is the name I use online, and the title of my comic strip. Why? I dunno, it just is.
there is no shortage of people on the Left who’d posit: “Let’s be rational. ‘Big Business’ is just evil! Evil! Eeeeevviiiilllll!”
Well sure. . .but. . .do they wear bow ties while doing it?
Ha. I thought not.
Crumble before the might of my awesome rhetorical prowess.
—JRC
Did you read the recent NYT article about the opening of a NHS (Natl Health Service) dentist’s office in Wales? The office opened up 50 slots for new patients. Over 1000 patients applied. Socialized medicine in a nutshell. It sucks so bad, and is so overcrowded, that you have to get private health insurance anyway, on top of astronomical taxes to pay for the system. Doesn’t sound like an improvement to me.
JRC, that made me laugh out loud – thanks.
Brett, I know many people – Americans – who wait years and years and years between dental visits, because they can’t afford to see a dentist unless it’s an emergency. What makes you suppose people wait less in the USA than in Wales?
In any case, my bet is that Wales doesn’t spend nearly as much (as a % of GDP) on medical care as we do in the US; if we kept our spending about constant (or even lowered it a bit) and switched to single-payer medicine, we could support many lot more dentists per capita than Wales probably does.
Yeesh, Amp. Finally you give us another cartoon.
I dunno, Joe had a point there. The fact that you didn’t include a five page essay after the second-to-last panel explaining how liberals can be just as hypocritical as libertarians demeans the entire cartoon. Excuse me, I must go beat my head against the wall so until I’m able to believe that.
I think the number 8 reason is the funniest here, although I love the smile on the guy’s face as his head protrudes from the dumpster.
I definitely liked #5. I’ve just seen too many people argue that exact thought (I even saw one guy say he preferred UPS over USPS simply because one was business, the other was government).
“Did you read the recent NYT article about the opening of a NHS (Natl Health Service) dentist’s office in Wales? The office opened up 50 slots for new patients. Over 1000 patients applied. Socialized medicine in a nutshell. It sucks so bad, and is so overcrowded, that you have to get private health insurance anyway, on top of astronomical taxes to pay for the system. Doesn’t sound like an improvement to me”
Hey there from Canada — we’ve got this ‘evil’ system, and we like it rather:) Ampersand’s cartoon is much closer to the truth than your horror story. Our health care doesn’t suck — it’s as good as yours (I’ve been sick in both countries). Sure, there are horror stories, but the one time I needed an emergency operation worked like this: I walked into my doctor’s office, on a Thursday, the day before a long weekend, and said ‘look here, isn’t this thing on my stomach funny”. I was slotted into a bunch of specialist’s office hours over the long weekend and had a diagnosis (‘well, it’s a cyst, probably not cancer, but it’s gotta come out *now*’) by Tuesday morning. I was on the operating table under the hands of one of the best surgeons in the city on Thursday. One week with a long weekend in between – that’s not bad.
Your position on the waiting list is determined by need, not by your bank balance. And because the system is universal and not run for profit, it’s compartively cheap: up here, the taxes of the young and healthy subsidize the old and sick.
Yep, if you need an operation to correct a minor condition (removal of bone spur on foot) you’ll wait *forever* because the operating rooms are full of people having heart surgery. And you can’t just pay a little extra and go to the front of the line. Canadian health care is universal, and can’t be opted out of or supplemented. It doesn’t pay for things like glasses, dentistry or perscriptions (alas) unless you’re under 18 or over 60. It does pay for everything else, either through taxes or nominal premiums plus taxes. We’re rabid about it up here, in part because we hear HBO horror stories from your side of the border.
Universal health care is pretty cheap, but every so often provincial governments try to strip-mine the system (it’s the most expensive thing the governement runs next to schools) which results in shortages, hospital closings and strikes. Shortages occur when the pool of doctors is artificially limited; we’ve got one here, simply because the (conservative) provincial government cut funding to the medical schools, reducing the number of new doctors entering the system. This will be rectified, since it’s finally dawned on everyone that the numbers have to go up.
Anyway — we like it. Everyone — on all sides of the political spectrum — likes it. It’s worth the money.
This post deserves an exclamation mark in the title! Because finally a new cartoon, and because it’s so good. Props. I’ll be emailing it.
Nice comments too.
I guess I would add some items to your list of reasons to oppose it..
11. Everyone’s quality of care would go into the toilet. There’s a reason Canadians come here for surgery — we’re better at it and we have many, many more surgeons, even per capita. Care would be equitable, but it would equitably suck.
12. It would create the biggest government bureaucracy in the history of our country. Government spending as a % of GDP would probably double. Recipes for disaster.
13. Doctors’ salaries would be cut drastically, prompting fewer people to go to medical school.
14. The govt would probably impose price controls on drug companies, cutting incentives to develop new drugs and spend the billions on R & D that have resulted in the amazing drugs of the last 20 years.
15. The govt would be forced to condemn existing health care facilities, at a cost of potentially trillions. This cost would be borrowed through bonds, probably doubling the national debt.
Wouldn’t it be better just to make sure everyone had health insurance, and fill in the gaps with OHP-like programs?
The British National Health System is supposed to combine the worst of single-payer with the worst of private health insurance–which is why it, not Canada or France, is the example that conservatives and libertarians love to use when arguing about universal health care.
Jo –
Your perspective is appreciated as someone who has much more experience with a single-payer system than anyone here. I appreciate your perspective, but I think Canada’s lessons don’t necessarily govern what our experience would be. Your system was implemented long ago, and didn’t involve the kind of huge disruption that a switch here would involve at this point. And to say that no one opposes the system is not really the case; I’ve certainly read lots of stuff from Canadians complaining about the system. Also, what of people, and there are many, who travel here for care?
As you point out, less care is available for Canadians. If an emergency exists, things are fine, but what percentage of the health care you’ve received in your life was emergency care? I just had a non-emergency operation myself, and it solved a very painful, but not life-threatening, problem in my foot (coincidentally). I wouldn’t have wanted to wait 6 months without being able to walk.
I don’t doubt that for most Canadians, the system works fine. I’m just not so sure it would here.
Oh, I get it … I thought *you* were “Ampersand”.
So it’s “Ampersand by B. Deutch” in the sense of “THe Far Side by Gary Larson”.
So, the health care system in Holland isn’t actually universal – the government provides insurance for anyone under an income cutoff, which is about 60% of the population. The other 40% are covered by a combination of employer-provided insurance, private individual insurance, and out-of-pocket health care purchases.
I can actually see some good reasons to support a basic single-payer system that many (or even most) people supplement with additional private insurance:
I don’t wholeheartedly support such a scheme, because I haven’t thought through the economics of it all – but for now, I’m tentatively in favor. Also, there was an interesting episode of Fresh Air last night with a medical ethicist, a medical economist, and a guy from Blue Cross of Pennsylvania. Definitely worth a listen.
I’m rather new to this blog, but as a fully employed and totally unisured person (which, as I understand, is increasingly common), I appreciate your cartoon. I can’t speak to the quality of care issues regardig major health problems, but I can say that not being able to go to the dentist, get glasses, get a pelvic exam or treat a bladder infection (all of which I’ve had to deal with), well, it sucks.
I’m venting here, so commisserate or ignore me as you see fit :)
And apologies for the spelling errors.
“The govt would probably impose price controls on drug companies, cutting incentives to develop new drugs and spend the billions on R & D that have resulted in the amazing drugs of the last 20 years.”
Much of that money is spent by public institutions for private profit.
My understanding from poring over Public Citizen’s *Health Watch*, among other pubs., is that an alarming number of those alleged “miracle drugs” are either A) Rushed to the market w/o adequate testing, thanks to a toothless FDA and bought-off doctors and colleges B) Increasingly out-of-reach to the working and poor folk, owing to antiquated and exploitive patent laws, not to mention useless advertising and C) Often just “vanity” drugs to deal with issues like baldness. You can’t take away an “incentive” that appears to already not exist. My tax dollars are already going to fund private-sector bullshit, without my permission. I’d rather see the public sector given “incentive” to push for affordable and safe drugs/care for serious conditions, even if said conditions aren’t impor– er, profitable enough for the private sector to dirty its hands on.
Can I be issued my bowtie now ? :p
“Private-sector bullshit” such as AZT and protease inhibitors that have transformed the lives of AIDS patients? Prozac, which has made it possible for millions of the formerly mentally ill to function in society? These are just two that I can think of off the top of my head. If you think anything “private-sector” is inherently suspect, greedy, and bad for everyone, then you think everything should be public-sector, right? You know what we call that? Communism. Name a drug developed by a Communist society. The fact is, pharmaceutical research is incredibly expensive, and can only be undertaken by large companies with billions to spend on R & D. Without those companies, we would not have drugs. Without those drugs, millions of people alive today would be dead. Public-sector money is not spent (with some exceptions) on specific drugs – it is spent on basic science which is applicable to the whole industry and many more. That has always been the role of government in research.
Of course they make profits – it’s called capitalism. Look into it.
I’m sure the elderly and working people who can’t afford perscriptions to keep them alive are comforted by the fact that drug companies are making a profit.
> 11. Everyone’s quality of care would go into the
> toilet. There’s a reason Canadians come here for
> surgery — we’re better at it and we have many,
> many more surgeons, even per capita.
Better? Can you provide evidence to back that up?
More surgeons? Why would that change? There’s no reason a tax-funded health system would have fewer surgeons than the current mess.
Average quality of care would only drop if less money was spent on healthcare than now, and there’s no reason for that. Quality of care for the rich would suffer somewhat, but personally I’m not too bothered by that.
> 12. It would create the biggest government
> bureaucracy in the history of our country.
And eliminate an even bigger set of competing, massively redundant private bureaucracies, a net reduction in bureaucracy.
> Government spending as a % of GDP would probably
> double.
And that is a problem because?
> 13. Doctors’ salaries would be cut drastically,
> prompting fewer people to go to medical school.
Why? There’s no requirement for the government to pay less. Personally I’d approve of lower salaries, but free education, so you’d get the best possible doctors rather than only those who could afford medical school and are often more interested in big salaries than helping people.
> 14. The govt would probably impose price
> controls on drug companies, cutting incentives
> to develop new drugs
A lot of the R&D is pointless, developing patentable replacements for older drugs that still work just fine but aren’t as profitable. The government is perfectly capable of funding useful drug research.
> 15. The govt would be forced to condemn existing
> health care facilities
Why?
> You know what we call that? Communism.
You say that like it’s a bad thing… 8)
> pharmaceutical research is incredibly expensive,
> and can only be undertaken by large companies
> with billions to spend on R & D
Or by taxing large companies with billions to spare, and using that to fund public research.
12. It would create the biggest government bureaucracy in the history of our country.
Uh huh. Are we familiar with the Pentagon?
I would like to see some cartoons take on corporate scandals. There are the well known scandals: SCO, Tyco, Enron, etc. But there are less known ones also that have not been touched by the media. Check Northwestern Mutual for example. That link should give you more than enough ammo to draw with :).
“The govt would probably impose price
> controls on drug companies, cutting incentives
> to develop new drugs”
Except, of course, that NIH already is responsible for somwhere north of 50% of the drug research in this country …
Hm. Lots of responses. What I hear is a fundamental disagreement with the capitalist system of market incentives. Market incentives are why doctors get paid a lot – their services are valuable, and they’re not willing to work for less. Market incentives are why drug companies are willing to spend billions on research that carries no guarantee of return. Market incentives are why we have some of the most innovative medical technology, and new procedures, on the planet. Think LASIK, arthroscopic surgery, organ replacements, synthetic tissue, etc.
You all seem to think that the government could just take the baton from private companies and maintain the same level of technological advancement and innovation. That’s just not the case. No government in the history of the world has been able to do that – the incentives just aren’t there.
Some specific responses:
There’s no reason a tax-funded health system would have fewer surgeons than the current mess.
Yes there is – capitalism. Surgeons are paid very well, and thus there is a long line of people waiting to get into medical school. To be sure, there are other reasons, but money, unfortunately, is paramount. Look at other sectors of society – government employees are paid less than private-sector ones. It comes with the territory – higher wages are traded for job security, better benefits, and intangibles. Cut surgeons’ salaries and there are fewer of them. That’s the way it actually works, regardless of the way you think it should work.
And [government spending increasing] is a problem because?
Because the more of the economy that is taken up by the government, the less that the economy actually produces, and the less wealth we have. Government spending is essentially parasitical; it comes from tax revenue, which comes directly out of your pocket. The more government spends, the less you have. The less you have, the less you can afford to pay in taxes. See the problem? That’s why we have limited government.
A lot of the R&D is pointless, developing patentable replacements for older drugs that still work just fine but aren’t as profitable. The government is perfectly capable of funding useful drug research.
Horsesh*t. See above about incentives. There is just no way the government would have come up with the variety of effective drugs that companies have produced in the last 20 years. As I said, name a drug created by a Communist society. There have been plenty: Cuba, the USSR, Eastern Europe, China, etc.
15. The govt would be forced to condemn existing health care facilities
Why?
Because that’s the nature of a single-payer system. The government would own and administer all healthcare facilities, pay doctors’ and nurses’ salaries, and dole out drugs and treatment. Unless you propose building new hospitals everywhere?
Or by taxing large companies with billions to spare, and using that to fund public research.
And which companies are those exactly? Liberals seem to think that there is an unlimited amount of money out there in unspecified “large corporations” that can simply be stolen from its rightful owners.
I’m sure the elderly and working people who can’t afford perscriptions to keep them alive are comforted by the fact that drug companies are making a profit.
I’m sure these elderly and working people are comforted by the fact that they’re alive due to those prescriptions, which were developed by those evil drug companies because they could make a profit on them. It’s called irony. Look it up.
First of all, I’m pro-regulated-free-market when it comes to creating prescription drugs. And, in fact, it was a heavily regulated free market that created most of those wonderful drugs (the FDA is an example of heavy gov’t regulation). So I don’t think you can claim that a regulated market – which is all people are arguing for – will prevent all innovation from taking place.
Secondly, you’re arguing as if there is currently a free market in doctors in the United States. In fact, the market is not at all free. Rather than letting the marketplace determine how many doctors to train, medical schools keep strict quotas, resulting in an artificial shortage of doctors (and therefore an artificially high rate of pay for doctors).
It would make more sense, from a market perspective, to get rid of the quotas and train more doctors. Trust that once we have so many doctors that it’s no longer profitable to be a doctor, at that point people will stop applying to medical school in such high numbers. No quota should be necessary.
It is certainly false, however, to claim that we couldn’t affordably have more doctors than we currently have. Merely getting rid of the quotas would accomplish that.
Third, the US medical system is the best in the world for wealthy people. That’s why wealthy people everywhere – including in Canada – sometimes come here to get treated.
However, it’s false to imply that all Americans get that level of treatment in our current system. I’m more concerned with the treatment given poor and working-class people; and by that standard, I think Canada – and, more to the point, France – does a far superior job to us. Trust me, low-income Canadians are not crossing the border to get treatment in the USA.
> What I hear is a fundamental disagreement with the capitalist system of market incentives.
Yes.
> Market incentives are why doctors get paid a lot – their services are valuable, and
> they’re not willing to work for less.
Yeah, if they weren’t paid so much doctors would all choose to go on the dole or get jobs at Walmart instead.
> Market incentives are why we have some of the most innovative medical technology,
> and new procedures, on the planet.
No, we have those because money was spent to develop them. And that money all comes from the workers in the end, whether through taxes or above-cost prices for drugs.
> No government in the history of the world has been able to do that – the
> incentives just aren’t there.
No government has had a sufficiently large economy and been willing to charge high enough taxes, yet.
> Cut surgeons’ salaries and there are fewer of them.
Even if you’re right, it isn’t necessary to cut their salaries. You seem to be assuming that a publicly funded health system would automatically have a smaller overall budget than the current private system – that’s simply not true.
> Because the more of the economy that is taken up by the government, the less
> that the economy actually produces, and the less wealth we have.
Nonsense. Spending on health care contributes exactly the same to the economy whether it’s public or private spending.
> Government spending is essentially parasitical; it comes from tax revenue, which
> comes directly out of your pocket. The more government spends, the less you have.
And private profits come directly out of your pocket too. Government spending doesn’t just disappear – it goes back in to the economy by buying goods and paying people’s wages.
> As I said, name a drug created by a Communist society. There have been plenty:
> Cuba, the USSR, Eastern Europe, China, etc.
I have no idea where various drugs were developed, and can’t be bothered investigating. I doubt you know the origins of all drugs either. Those countries were all incredibly poor before they became communist; they’ve had enough trouble feeding their people, let alone spending a fortune on research. And they’re all totalitarian states, nothing like a genuine socialist state in which democracy is fundamental.
> Because that’s the nature of a single-payer system. The government would own
> and administer all healthcare facilities, pay doctors’ and nurses’ salaries,
> and dole out drugs and treatment. Unless you propose building new hospitals everywhere?
What’s that got to do with “condemning existing health care facilities”? Any useful facilities can be taken over by the government. Any useless facilities… who cares?
> And which companies are those exactly?
The ones who currently have the money to spend on private research.
> Liberals seem to think that there is an unlimited amount of money out there
> in unspecified “large corporations” that can simply be stolen from its rightful owners.
The money is obviously there to do everything that is currently done by private corporations.
>> I’m sure the elderly and working people who can’t afford perscriptions to
>> keep them alive are comforted by the fact that drug companies are making a profit.
>
> I’m sure these elderly and working people are comforted by the fact that
> they’re alive due to those prescriptions
Um, the ones who can’t afford the prescriptions _aren’t_ alive, or won’t be for very long.
Just to pick a rather critical nit:
Brett, your comment that
Because that’s the nature of a single-payer system. The government would own and administer all healthcare facilities, pay doctors’ and nurses’ salaries, and dole out drugs and treatment. Unless you propose building new hospitals everywhere?
suggests that you misunderstand the nature of single payer systems rather severely. Single payer systems are not the same as total socialization of the medical infrastructure. Single payer replaces the private insurance industry with a government run industry, but it doesn’t involve seizing ownership of the actual medical infrastructure.
Off the top of google: a definition of single payer
Although there may be some posters here who would favor the total socialization of all industry, single payer health care relates only to the socialization of the medical insurance industry.
Price caps on medicine are actually also a separate issue from single payer health care. Even though Canada has both, there is no particular reason that they have to go together. Indeed, if prescriptions were included in the single payer system, then price caps would not even be necessary. Instead, the insurer would specify reimbursement limits to the providers, and the providers would negotiate prices with the suppliers (to much the same effect as price caps, but not actually the same thing).
I was once a member of a single payer system; right here in the United States. The system was financed through our precious government, but I could never seem to acquire any medical attention. As a matter of fact, no one could. All personnel were completely disregarded unless they literally had an arm falling off. I remember the recomendations that I was given from the doctors that I was lucky enough to see. “Motrin and rest.” Every time, same reply. I have a condition by the name of patella famoral pain syndrone, which requires much more than the equal treatment for a headache. THis single payer system was the military. Thanks U.S. Gov
Matthew,
Doesn’t the military use a fully socialized medical system (clinics and hospitals owned by the military, doctors, nurses and administrators employed by the military), rather than a single payer system (the government serves as the universal insurer, but doesn’t own the hospitals or employ the doctors)?
I think you can find equivalent horror stories if you take a look at the privately owned, for profit HMO’s. Where the budget is not determined by services rendered, and the cost cutters control the diagnosis, your health is pitted directly against someone else’s economic interests.
Also, the military’s socialized medical system has the problem that it is not universal. It only serves soldiers and their families. Whatever may be said for soldiers, they are generally not rich, and while all politicians may praise their sacrifices for their country, most politicians are perfectly happy to inflict those sacrifices (poverty wages, poor (if free) health care, needless wars, etc) upon soldiers.
A truly universal single payer, or a truly universal socialized medical system, would have the huge advantage that the service quality for the most powerful would be largely the same as the service quality for the least powerful, and this would give the most powerful an incentive to ensure that the service quality for all was satisfactory.
This two tier system (free, poor quality medicine for some and expensive, high quality medicine for others) is one of the main reasons that Britian’s socialized medical system (which coexists with a significant private medical system) is so often the example used for bad socialized medicine. Other countries with socialized medical systems that tolerate less of a two tier system do not have nearly as much of a problem with poor quality service by the state run portions of the health care system.
ampersand, minor quibble: you are mixing up the terms “market” and “free market”; they aren’t inbterchangable. The cartoon was funny without being mean. I represent panels 1 and 2.
Government interferance with health care is indeed evil, evil. A woman has a right to choose, and her decisions are between her and her healer of choice. Well-intentioned meddling with that violates her privacy and autonomy.
Dumpster diving for medicine is indeed fun. Beats hell out of golf. I haven’t found hospitals good locations for dumpster diving. I have better luck at drug stores, apartment complexes, dorms at end of semester. I also have a medicinal herb garden. At times I’ve been sued by our local health and hospital corporation because my herb patch violates the weed ordinance, and they sent out goons to cut down my marigolds. I digress.
In the short term, government-provided health care, as well as insurance, provides powerful disincentives for people to manage their own health via prevention.
In the longer term, government meddling that makes markets less free takes away incentives to innovate. This is a life or death issue for me.
I’m gonna need a new set of lungs some decade soon, and other life-extension gimmicks, or I will die. The current state of the art won’t do.
Markets are really really good at innovation and adaptation, in the same way that ecologies are better than monocultures. Governments aren’t.
(There is a subset of public health concerns, like mad cow or yellow fever, where government style command-and-control measures may have some advantage over unconstrained markets; it’s an externality problem, we’re working on it.)
So when somebody like Bush or Truman comes up with a new boondoggle program to further interfere in medical markets, what I hear is that they are trying to kill me. To which I am adverse.
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