July 13, 2007
From the desk of Jane Galt:Point, thou art missed
The new favourite activity of progressive bloggers seems to be pointing out that in America, you sometimes have to wait to see a doctor!
No system, free market or government-run, can guarantee that you can get into see a particular doctor immediately, any more than they can guarantee a table at your favourite restaurant. Neither system is going to require that doctors refuse to book appointments so that they will always have time to see you whenever a spot of healthcare strikes your fancy.
The difference is, in a free market system, you can go see a different doctor. In Canada or Britain, you just have to wait it out.
Posted by Jane Galt at July 13, 2007 9:19 AM | TrackBack | Technorati inbound links"); ?>As comments to other threads have pointed out, wait times vary greatly by location and by physician specialties. It's difficult if not impossible to reach any grand conclusions.
Posted by: Peter on July 13, 2007 9:26 AMYou realize, of course, that this argument of yours is completely at odds with the standard libertarian position that the AMA and government conspire to limit the number of doctors. IF the libertarian position is correct the available supply of doctors is rationed by two things -- prices and/or waiting times.
Now which is correct, the standard libertarian argument or your position that by switching doctors you can eliminate waiting times?
Posted by: spencer on July 13, 2007 9:42 AMspencer: "That you can go to other doctors" is not even close to contradiction with "doctors are artificially limited in supply".
In any case, under a *more* libertarian system, finding an alternative would be even *less* of a problem.
Posted by: Person on July 13, 2007 9:50 AM"The difference is, in a free market system, you can go see a different doctor. In Canada or Britain, you just have to wait it out."
I lived in the UK for two and a half years, between 1999 and 2001, and in my experience, that's just not true. Where are you getting that from?
Posted by: Ted Barlow on July 13, 2007 9:59 AMAnd I live in Canada, and you can see a different doctor if my favorite one isn't available. Is this myth of "A bureaucrat assigns you a doctor" still being peddeld in the U.S.???
Posted by: Paul Morphy on July 13, 2007 10:04 AM"The difference is, in a free market system, you can go see a different doctor."
Really?
So when I made an appointment for my daughter with a pediatric neuologist and was told I had to wait 9 months, I could have asked for a different doctor? Damn. Odd thing is, I didn't ask for any specific doctor. I just asked for the ealiest available one.
Posted by: Njorl on July 13, 2007 10:14 AMWe're talking about two different groups of doctors.
In England, and in Canada, AFAIK, you can go see any doctor you want . . . provided that you can get a new doctor, which is, anecdotally and according to the relevant health systems, nearly impossible to do in many areas. I have friends in England who trek home to out counties because they can't find a dentist or GP in London who is taking new patients. Theoretically, this could happen in the United States; practically, it doesn't. I've never sat around in an American office (and I've worked at lots with rotten and/or no health plans) and listened to coworkers trade strategies for getting on a dental waiting list, or tricking a GP into seeing you. My friends recently transplanted to Canada relied on free clinic care for the first year of their daughter's life, which has about the same characteristics as American emergency room care (unpredictible waits, never seeing the same doctor twice. Although, since my doctor doesn't remember a damn thing about me except what he reads in the charts, I don't know why this is supposed to be such a problem.) The American who had trouble getting an appointment with his GP almost certainly got an appointment at the next GP down the road; the Briton with the same problem could spend half a day dialling for slots, and still not find one. (A colleague who was looking for a GP in his cachement area gave up after the first twenty five said "no new patients", and went back to Devon where his parents' GP was. This didn't seem to surprise anyone in my office; it would certainly surprise the hell out of any American.)
An American who wants to see a specialist can go see any specialist in his network; at each, waiting times will be rationed by the demand for that particular specialist. Ditto tests, hospital beds, and so forth. As I understand it, a Canadian or Briton who wants to do these things goes on the list for their cachement area, and they get to have the test or the bed when their slot comes up on the list, no shopping around. Am I incorrect?
Posted by: Jane Galt on July 13, 2007 10:16 AMYes and no. That has been the traditional way of doing things in Canada and it really depends where you are.
Waiting lists are prioritized by urgency, not by first-come, first-serve. If you really want to see a specialist, your GP will fix you such a meeting, but both will decide on a meeting time that is relevant with the urgency of the situation.
As I said, that was the traditional way of doing things. But it's changing. There is a big push for the centralization of waiting lists, by regions.
Waiting lists are currently like a line-up at the grocery store. You pick the doctor you want, like you would pick a register line. (Not a perfect analogy, because a register is first-come-first serve, but it's close enough). Then, you hope that your line will move faster. But Murphy's law being what it is, your line is always the slowest.
Centralizing waiting lists(which is among physicians and doesn't involve government) means that there is only one big line, that is moved to the first available register. If you insist on one particular register, you can still wait be on an old-fashion waiting list, but if you want to be treated faster, this will insure it.
Also gaining in popularity is the one-stop shopping, which is not currently very used. I guess you can compare it to the U.S. HMO system as you can get all your treatments under one roof (for breast cancer examination, that would be visit to personal doctor, mammography, ultrasound, biopsy and surgery if needed, of course). Currently, because of the highly decentralized system, every step is usually done at a different place, and everything goes back to the personal physician which compound the waiting times.
The difference with the HMO structure is that you are also insured out of such a network.
I strongly believe that the problem with waiting times in Canada is one of administration and organization, not of funding.
"Theoretically, this could happen in the United States; practically, it doesn't."
I beg to differ. I have plenty of experience trying and failing to find specialists willing to take new patients. I was lucky enough, last time I moved, to find a GP that was taking new patients, although I still have to wait weeks for an appointment. This is anecdotal, of course, but so was your evidence.
Earlier this week I called a specialist at 9am, had an appointment at 11.30 am and a CT scan at 2pm. My condition was urgent, in the sense that it was causing me significant discomfort and could have serious long term effects, but certainly not life threatening.
In Australia (where I'm originally from) the waiting time for non-emergency CT scans in the publicly funded system is approximately 6 months. Even if you have supplementary private insurance it can be as long as 2 months.
Yes, health care in America is expensive (don't I know it since I went for one of those high deductible, HSA insurance plans so I paid for a big chunk of this out of my own pocket). But like everything else in life you get what you pay for.
All the 'free' health care systems I've ever seen use waiting lists to ration services. This is the way the old Soviet Union rationed pretty much everything. Shuold this then be the basis of our health care system?
Posted by: Dan Hill on July 13, 2007 10:48 AMDan, a few years ago, I visited a Canadian physician about a problem that was causing me a significant discomfort, but was not life-threatening. He referred me to a specialist whom I met less than a week later, and had surgery done within three weeks. Would I have preferred to get the surgery within a week? Of course... But this is a reasonable wait in the context of a universal system where EVERYONE has access to the system.
As I mentioned in my previous post, the Canadian system is not perfect, far from it. But it most pressing problems can be solved by improving on its administration and organization.
By the way, I would venture to guess than an insurance like yours is probably worth between, at a minimum, $300 to $500 a month (if employer-based, I mean the premium you and your employer pay).
In Canada, I calculated the premium we pay through our taxes for our basic coverage (which admittedly doesn't dental care, vision care or pharmacare) to be US$160 per Canadian. And we can get our treatments anywhere in the country, which especially comes handy when traveling.
Posted by: Paul Morphy on July 13, 2007 10:58 AMMy mother is 84, has diabetes and a heart problem. The doctor has said she needs to have a pacemaker, since her heart rate is in the 32-34 bpm range (when the blood can't detoxify the tissues and it is, basically, a slow death), and has scheduled her...FIVE WEEKS down the road. They said there just isn't room to schedule it sooner.
Needless to say, I'm working on getting her somewhere else. Difficulties is the 2000 mile distance and limited locations in the very rural midwest.
Posted by: falkoyn on July 13, 2007 11:04 AMEveryone is missing the point. We can trade anecdotes the live-long day and keep missing the point. The supply of medical care is artificially constrained everywhere, in the United States, in Canada, in Europe, and everywhere else. The constraints take several forms such as price ceilings or the formation of government-sanctioned cartels, but they are a reality. On balance, if one doesn't want to wait for care, then you are better off in the United States since you really do have more freedom to shop around, more freedom to pay more for more immediate care, and simply a larger supply of medical services and goods to begin with, but the situation could be better if we dismantled the price ceilings and cartelization mechanisms that we outlaw in other businesses.
Posted by: Yancey Ward on July 13, 2007 11:25 AMDan, I don't know how urgent your condition was but if it was an emergency you certainly would not have had to wait for 2 months down here in Australia.
Wait times are a problem faced in all health care systems in all countries. Overall i think Australia's 2 tier system is quite good in most situations. The wealthy can get good health care reasonably fast in any first-world country, that's a no-brainer. What the rest get is the problem.
Here, I get an appointment to see a GP on any day of the week through the public system, as can anyone in any major city in Australia. If I need to see a specialist a bit faster than possible through the public system or want the choice of surgeon and hospital for an operation, I can use the private system. My health insurance is in no way attached to my employer, which is important for many reasons, not least competition.
There are pros and cons to all health care systems and regardless of which way one leans politically, focusing on a few narrow details without taking into account many many others is, though sometimes amusing, usually not helpful.
Posted by: Clinton McMurray on July 13, 2007 11:29 AMIn Canada you are free to seek treatment from any doctor you choose. Doctors are not employees of the state. The main difference from the U.S. is that in Canada the doctor sends the bill to the government, not to the patient.
Re. wait times, this is from a British Columbia Ministry of Health website:
"An individual who needs emergency surgery does not go on a wait list. If you require emergency surgery or treatment, you will receive it without delay. For example, about half of all heart or cardiac surgeries in B.C. are done on an emergency basis, with no time spent on a wait list. If you need surgery or treatment that is not an emergency, you will be placed on a wait list."
Of course, then you get into a semantic discussion as to what constitutes an emergency. I'd wager that a cardiac patient is likely to have a more liberal notion as to what constitutes an emergency than does any health care system. Yancey's post is dead on; supply is artificially constrained everywhere, because prices aren't used to signal how much supply is needed. I understand the resistance to rationing medical care on the basis of price, but it'd be nice if people would acknowledge the trade-off, which occurs everywhere.
Posted by: Will Allen on July 13, 2007 11:57 AMHow ironic.
Matt's post was clearly poking fun at those who warn about long wait times in other systems.
He wasn't using long wait times here in America as a reason for universal health care.
"Yes, health care in America is expensive (don't I know it since I went for one of those high deductible, HSA insurance plans so I paid for a big chunk of this out of my own pocket). But like everything else in life you get what you pay for."
Except the US pays more, and gets worse results.
Posted by: Rob Coover on July 13, 2007 12:20 PMMegan,
I think you should correct this post.
Long wait times was the critique of choice for those who oppose a national health care system.
Progressive bloggers have simply tried to show that the critique is pretty worthless because there's long wait times in America as well.
As I said the before, the post is painfully ironic.
Posted by: goosen on July 13, 2007 12:26 PMGoosen,
Uh, no. What the progressive blogs have shown is that immediate service is to be found nowhere. What they have not demonstrated is that wait times in the United States is as long as in other countries. Without showing this, it cannot be said that they have proven the argument against universal care to be worthless. To date, no one has demonstrated that wait times are as long in the US as they are in other countries.
Posted by: Yancey Ward on July 13, 2007 12:38 PM"Uh, no" back to you, Yancey... Progressive blogs are actually attacking the notion that there are no significant wait times in the U.S. Show me these blocks who talk about "immediate service is to be found nowhere".
As for the wait times, look at the Commonwealth Fund study (http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678).
The U.S. are lagging behind the United Kingdom, Germany, Australia and New Zealand and only (barely) ahead of Canada.
You also have to acknowledge that in terms of waiting times, the U.S. start with a 5 to 12% advantage due to the fact that many of the uninsured or the poorly insured have given up on accessing the system and thus, even though they might need medical attention, won't show up on any wait list.
Posted by: Paul Morphy on July 13, 2007 12:46 PMMy point isn't to argue that waiting times in the US are longer.
I have two points here
1. Megan misinterprets Matt's post
2. The current round of discussion about long wait times really isn't a result of progressive bloggers thinking they've found a winning issue. It's a response to critiques of foreign health care systems.
Posted by: goosen on July 13, 2007 12:51 PMThanks for putting things into perspective, Goosen...
I'm just a sticker for accurate statements and I wish the system I live under to be accurately represented. It's not perfect, and there are problems that have to be addressed for sure, but it's certainly not the living hell that opponents of single-payer have been depicting.
Posted by: Paul Morphy on July 13, 2007 12:58 PMRob: "The US" doesn't "pay more and get worse results".
You see, the problem here is that "The US" is not a monolith that spends money on health and gets an amalgamated result (unlike in a system where the State does all the paying).
People spending their money (directly or via insurance they pay for) on the healthcare they want is not "the US" paying for it, nor is the amalgam of results within the US strictly related to what individuals pay.
(Though experiment: If rich people decide to pay billions on a new, notional and very expensive bit of cosmetic surgery that has no net effect on overall health, that would be a massive increase in healthcare spending, to no net effect on "the US", health-wise.
But it would tell us nothing at all about "the US healthcare system" vs. any other one, other than that in the US people will spend their money on healthcare as they see fit.
Adding up total spending over the entire population and comparing it with some metric of "entire population health" is pointless, when total spending is controlled (even mostly, since we do have some State expenditure) by individuals rather than a Central Health Planning Authority.
The underlying assumptions are incompatible.)
Posted by: Sigivald on July 13, 2007 1:27 PMA lot of this started from the hip replacement surgery comparisons. But of course, in the U.S. over 60 % are paid by Medicare, maybe more, and since the system in Canada is also Medicare, this really comes down to Medicare versus Medicare, not public versus private as everyone has claimed. Somehow the debate has missed this fact.
Interstingly, I've been told that for hip replacements, somewhere around 20% to 30% decide they don't need one after thinking it over in the interim while waiting for surgery. Quick isn't always better if your doctor stands to make money on the procedure...
Posted by: Mark Thoma on July 13, 2007 1:29 PMQuick isn't always better if your doctor stands to make money on the procedure...
Yeah, I hate when people make money on transactions with me. (???)
Posted by: Person on July 13, 2007 1:32 PMExcept the US pays more, and gets worse results.
No, no; see, the correct form of argument is "assertion, evidence". So your statement should have read,
Except the US pays more, and gets worse results, as demonstrated by __________.
Except that, as someone already pointed out, there is no single entity "US" paying for a monolithic basket of services that can be compared to other healthcare systems in a mere thumbnail sketch.
Posted by: anony-mouse on July 13, 2007 1:37 PMGoosen,
Well, if that was your point, then you misstated it. What you actually wrote was this:
Progressive bloggers have simply tried to show that the critique is pretty worthless because there's long wait times in America as well
Well, they have not shown the argument is worthless because they have not shown that wait times in the United States are as long. Take, as an example, the "study" that Paul Morphy cited above about access. The study, such as it supplied any detail or methodology at all, did not say what he implied that it said about access. The US ranked lower on access not because of longer wait times, but rather because some lack health insurance and presumably no ability to pay otherwise. Now some, like Paul Morphy, think it invalid to compare those with insurance in the US with, let us say, a citizen of Great Britain because it excludes those in the US without insurance, some of whom have infinite waiting time for service they can't pay for. However, his objection is the invalid one. The pertinent comparison is the one between those with paid-for medical insurance in the two countries. The argument against universal care is that wait times will increase for those who have insurance today. It is nearly impossible to counter this argument since the universal care advocates themselves talk of capping prices as part of their plan, and capping prices is certain to restrain supply further in the US.
The problem I have in understanding this thread is the lack of reporting in the American press about health systems here and abroad. Taking France as an example, are there really longer wait times there than in the United States? How much does health insurance cost there? Is the French public happy with their health system, or would it prefer an American style system? I haven't the foggiest idea. Unfortunately, American newspapers, magazines, and, of course, television news is not in the business of reporting on stuff like this. As a result, even in good forums like this one all I see is anecdotal evidence intersperse with ideological rants.
Posted by: stan on July 13, 2007 2:21 PMCome on, Yancey... Did I really say such things?
I think not. Comparisons are valid, and the Commonwealth Fund study, while showing that wait times in the U.S. are slightly better than in Canada, also show they are still worse than Great Britain. There is no mention of the uninsured or under-insured who don't access the system, so it is, indeed, a study of "insured vs. insured."
So I brought one credible (inasmuch as the Commonwealth Fund cannot be construed as a socialist organization nor as a Cato spinoff) study showing that the U.S. suffer from waiting times as do single-payer, universal coverage countries. I do believe the study is methodologically sound, even though is probably slightly overstating the problem in these latter countries because no one is discouraged from entering the system for lack of decent coverage. I am willing to challenge my belief if a similar study (similar methodology, not from an ideologically-blinded organization) shows me otherwise.
That is all that I meant.
@person
Please refrain from such flaming language as "Central Health Planning Authority.". I've never dealt with a bureaucrat regarding my health insurance or the health services I needed during my whole life, except filling and mailing the form to get my health insurance card every four years. That's it. I deal with doctors and health professionals, who themselves never deal with any other bureaucrat.
There's nothing communist or remotely soviet about it. But there's something definitely efficient: administration costs are about 20% to 30% lower in Canada than in the U.S. for health insurance.
Posted by: Paul Morphy on July 13, 2007 3:21 PMPaul,
Uh, you said it here:
You also have to acknowledge that in terms of waiting times, the U.S. start with a 5 to 12% advantage due to the fact that many of the uninsured or the poorly insured have given up on accessing the system and thus, even though they might need medical attention, won't show up on any wait list
The study you cited talked about access, not wait times. The US appears low on that dimension because of the lack of universal insurance, and, indeed, made the curious statement that those with insurance in the United States had rapid access to care. If you wish to point me to where they discuss queuing explicitly, then feel free to do so.
Posted by: Yancey Ward on July 13, 2007 3:33 PMAnony-mouse, I agree with you that any assertion regarding systems should be accompanied by sources. So much disinformation has been spread already on this topic...
But you are not right about the second part: the U.S. can be compared to other countries in terms of the delivery of health services, as both produce outcomes that can be measurable. They can be wait times or a procedure's success rate, but they are measurable and comparable.
What can more difficultly be compared is the financing of the system, because the U.S., with its private system with a means-tested limited public insurance system is compared with countries that fully finance their system with universal public insurance. This is where you can explain the fact that an additional 7% of GDP is spent for health care in the U.S.: administrative costs.
Posted by: Paul Morphy on July 13, 2007 3:37 PMYancey, I take good note of your comment. I should be a little less forceful in equating the concept of access to the concept of wait times.
However, Figure 5 of the study (on page 15) has various data on wait times that show that the U.S. don't really do better or worse than the other countries involved in the study. Figure 7 (P. 19) pretty much shows the same for ER waits.
Nothing is really black and white in this debate, and you're right to point it out to me.
Posted by: Paul Morphy on July 13, 2007 3:48 PMBut you are not right about the second part: the U.S. can be compared to other countries in terms of the delivery of health services, as both produce outcomes that can be measurable. They can be wait times or a procedure's success rate, but they are measurable and comparable.
Different goalposts. What you're describing is a process of breaking "healthcare" out by comparable sectors, then comparing them, which is useful.
What Rob Coover said was, in regard to healthcare overall, "Except the US pays more, and gets worse results" -- which is silly.
Posted by: anony-mouse on July 13, 2007 4:58 PMQuestion; Does anyone here expect to see anything come of all this other than mandatory health insurance? That is, not universal care, not single payer, not any of the other wild schemes that are tossed about by the idealogues, but just a legal mandate that everyone obtain insurance - with perhaps a bit of subsidy thrown in for the bottom tier.
Posted by: Randy on July 13, 2007 5:02 PMApparently no good data on waiting times in the US exist so a realistic comparison can not be made.
However, neither our host nor any commentors have disproved the argument that there are significant waiting times in the US.
Pearson, yes in a perfect system there would be no waiting times. But no one is discussing a perfect system. You or no one else has negated my point that if Megan is serious about her argument -- if one is willing to change doctors there would no waiting times in the US --she has to give up the libertarian argument that the AMA and government limit the supply of doctors so that some form of rationing -- either price and/or waiting times or some combo-- exist in the US.
The two argument are mutually inconsistent.
She is trying to have her cake and eat it too.
Posted by: spencer on July 13, 2007 5:08 PMYancy:
Well, if that was your point, then you misstated it. What you actually wrote was this:
Progressive bloggers have simply tried to show that the critique is pretty worthless because there's long wait times in America as well
Well, they have not shown the argument is worthless because they have not shown that wait times in the United States are as long.
That's the second truly ironic thing about this post.
What I actually wrote was:
Progressive bloggers have simply tried to show that the critique is pretty worthless because there's long wait times in America as well.
Tried. Not have shown. Tried to show.
Reading.
Comprehension.
Cheers
This is where you can explain the fact that an additional 7% of GDP is spent for health care in the U.S.: administrative costs.
Really now, cite please.
Never mind, I found this chart by the Center for Medicare and Medicaid services. It’s actually about 1.2% of GDP.
http://healthguideusa.org/health_statistics/administrative_health_care_expenditures_GDP.htm
The only group I found claiming numbers in the 5-6% of GPD range was a group calling for a Canadian-style single payer system and they had to issue a correction when someone caught them halving the amount spent on health care while increasing the number of employees involved in administrative activities by about 50%.
Posted by: Thorley Winston on July 13, 2007 6:11 PMThorley,
I had a long reply that didn't seem to get processed by the site... I have two peer-reviewed studies demonstrating that administration costs represent a large component of the difference in expenditures:
http://www.rwjf.org/reports/grr/036617.htm (which summarizes the findings) and http://www.cmaj.ca/cgi/content/full/170/12/1817.
However, I realize that my post left the impression that I attributed all the difference to administrative costs. I simply meant to say they are a large component of that difference.
Posted by: Paul Morphy on July 13, 2007 6:26 PMI had a long reply that didn't seem to get processed by the site... I have two peer-reviewed studies demonstrating that administration costs represent a large component of the difference in expenditures:
The study claiming “31% administrative costs” which was published in the NEJM was the one I was referring which had to publish a correction because they tripled the number of employees supposedly involved in the United States for administrative activities. Which no doubt explains in part why their overall numbers were about five times higher than the ones from the CMMS. The authors couldn’t even keep their ideological preferences out of their abstract by calling for the United States to switch to a Canadian-style single payer system.
Also as far as the “Canada controls administrative costs better than the United States” study – the methodology of that study was to estimate approximately how many minutes a doctor or office worker spent per week performing administrative functions and then find out the cost by prorating it based on their annual earnings. The “higher administrative costs” was a function of higher wages in the United States rather than more time actually being spent performing administrative functions.
So what they’re stuck with then is arguing for cutting the wages of doctors, nurses, and other health care workers because that’s the supposed “efficiency” that Canada’s single-payer system has achieved.
If you read the study and its correction, you'll see that it's not the case: the operation of nine U.S. plans were studied and the number of enrollees in one plan (UnitedHealthcare), was underestimated by half (8.5M while it should have been 15M). A second correction, which stated that the same firm employed 20,000 rather than 30,000 in the management of its services. This correction didn't affect the other eight plans where the numbers were challenged. All in all, the table demonstrated that these companies employed between 14 and 31 employees per 10,000 enrollees.
The methodology was much more complex than this, as you would find out by reading the study.
Economist Henry Aaron, in an editorial, criticized the study, and his criticism was countered by two health policy academics. Not having access to Aaron's original piece, I can't comment on his original criticism. I can certainly see how the study is debated... I don't see how it's debunked, especially in a peer-review journal.
The correction is available (without subscription) at http://content.nejm.org/cgi/content/full/349/25/2461.
The full table is available (after free subscription) at http://content.nejm.org/cgi/content/full/349/8/768/T3.
So what they’re stuck with then is arguing for cutting the wages of doctors, nurses, and other health care workers because that’s the supposed “efficiency” that Canada’s single-payer system has achieved.
I can see that you're not without bias either...
Posted by: Paul Morphy on July 13, 2007 7:59 PMWell, you can hardly expect people who live in the US to be without bias about the potential drastic change in the US healthcare system. I'll put it bluntly: the system more or less works for me so I don't want to fix what ain't broken. Period. And with a real possibility of a Democrat in the White House come 2009, this is a pressing issue. Why am I expected to be "unbiased" about it?
Goosen,
Fair enough, but then there is no real irony since the progressive bloggers have simply failed.
Posted by: Yancey Ward on July 13, 2007 8:37 PM"An individual who needs emergency surgery does not go on a wait list. If you require emergency surgery or treatment, you will receive it without delay. For example, about half of all heart or cardiac surgeries in B.C. are done on an emergency basis, with no time spent on a wait list. If you need surgery or treatment that is not an emergency, you will be placed on a wait list."
Maybe in BC, but I know a man who was put on a waiting list in Western Ontario, just to get tested. His kids fortunately had the resources to send him to the Mayo Clinic, where tests revealed stomach cancer.
Mayo then operated on him successfully, and he was in recovery several weeks before the Canadian tests would have been conducted.
Mayo even financed the $50,000 cost so the man's children paid it off with monthly payments.
Posted by: Patrick R. Sullivan on July 13, 2007 8:57 PM"In Canada or Britain, you just have to wait it out."
ABSOLUTELY AND UTTERLY FALSE. I thought you were a journalist? ever heard of fact checking before before spewing out bullshit darling?
Posted by: new west living on July 13, 2007 8:57 PM""In Canada or Britain, you just have to wait it out."
ABSOLUTELY AND UTTERLY FALSE. I thought you were a journalist? ever heard of fact checking before before spewing out bullshit darling?"
A more persuasive an argument one will never find...
Perhaps next time you will provide something - anything, even an anecdote - that will contribute to the discussion.
The "it will be cheaper" folks haven't addressed the actual experience with US govt health care.
The US currently spends over 15% of GDP on healthcare. The universal health care advocates claim that a universal system will cost around 10% of GDP.
However, that over 15%% includes over 7% spent by govt and serves less than half of the population. Let's call the numbers 7% and 50% (rounding to the advantage of universal health care).
To cover 100% of the population for 10% of GDP, universal care will have to cover twice as many people for less than 50% more money.
If that's possible, why does it currently cost govt over 7% to cover less than half? If there are changes that can make it more efficient, why can't they be implemented now, saving tons of money?
How about we open up medicare and the VA to anyone who wants to pay the average cost? If govt really is more efficient (more care, less money), that will drive private health care organizations out of biz.
Metis 314...what a flamer you are! You have a problem with the post so you take one point you can flame out on and start doing the ad hominem story. If I thought you were a true asshole that deserved another moment's notice, then I'd probably call you that, as well as a m-effing SOB, but I won't, even though you do deserve it.
Different topic
I'd like it very much if MM were to do a comprehensive article in her mag. I thank the boys for their spirited back-and-forth, but I'd like to hear from the mistress and see what she can dig up.
By the way, I KNOW many friends in Vancouver BC who wait unconscionable amounts of time to get things done. Going to Bellingham and Seattle hospitals is the norm for them...they don't even try to go through the Canadian system for almost anything but a hangnail.
tootles!
Posted by: falkoyn on July 13, 2007 11:23 PMfalkoyn: The percentage of Canadians seeking health care in the U.S. is tiny. You obviously have some very weird friends -- or perhaps they are the kind of phantoms alluded to in this study:
http://www.pnhp.org/news/2002/may/phantoms_in_the_snow.php
However, don't worry. The insurance industry and Americans' fear of scary socialism (Boo!) will ensure that universal, single-payer health care never comes to the U.S.
Posted by: mijnheer on July 14, 2007 12:56 AMNew West said
ABSOLUTELY AND UTTERLY FALSE. I thought you were a journalist? ever heard of fact checking before before spewing out bullshit darling?
Which is a nice display of ignorance and arrogance all rolled up in one nice package. He does get bonus ignorance / arrogance points for the patronizing "darling".
I guess new west thinks that if you don't have any information to contribute to the discussion flinging spittle at his monitor will work as a substitute.
He might want to check out this link. It might
Helen Evans, a 20-year veteran of the country's National Health Service and now the director of a London-based group called Nurses for Reform, said that nearly 1 million Britons are currently on waiting lists for medical care — and another 200,000 are waiting to get on waiting lists. Evans also says the NHS cancels about 100,000 operations each year because of shortages of various sorts.Posted by: TJIT on July 14, 2007 4:01 AM
Did anyone look at the correlation between the tort environment in a particular state and wait times.
It is very difficult to get specialists like neurosurgeons and obstetricians to practice in highly litigious regions of the US.
Posted by: TJIT on July 14, 2007 4:08 AMmijnheer
Boo! to you too
French health service on verge of collapse, says commission
A government commission has warned that without fundamental reforms France's national health service, rated the best in the world by the World Health Organisation, will collapse within the next 15 years.Posted by: TJIT on July 14, 2007 4:15 AM
To cover 100% of the population for 10% of GDP, universal care will have to cover twice as many people for less than 50% more money.
Not a problem. You simply have to accept healthcare rationing along the lines of Canada and the UK. There is no free lunch. You can't get Lexus healthcare for Corolla prices.
Any single payer advocate who is trying to pretend otherwise is either unaware or unethical. (And I much prefer the Canadian system for all its flaws.)
Really, the debate is simply "Is healthcare a right?". If it is, the US is ethically obligated to try an provide some form of universal (not necessarily single payer) healthcare. If not, then the present system is adequate.
Posted by: Tom West on July 14, 2007 7:13 AMTom West,
I mostly agree with your summary of what the debate really is about. I come down on the side that it is not a right, and the reason I reach this conclusion is because the provision of healthcare must be done at someone else's expense if the recipient is not providing the funds himself. There are so many other goods and services that, if provided to those without the means, would enrich and lengthen their lives, but many of us would not call their provision "rights". I see no logical reason to extend to medical care the definition as a "right".
And, indeed, the attempt to define medical care as a right can have directly contradictory outcomes. One of the concerns about the complete socilization of medical care is that innovations will be even further stifled, and without those innovations present and future people will live less well than they would have. Haven't we now violated their "rights" to medical care.
Posted by: Yancey Ward on July 14, 2007 11:22 AMWhat frustrates me about this issue is that the people in Michael Moore's camp are dead set on lying about the alleged lack of trade-offs in going to the sort of system they prefer, and those opposed to to those sorts of systems tend to fight a entiely reactionary battle against the other side, which results in zero honest discussion of what could be done to improve health care services in the U.S..
This debate long ago started to resemble a religous schism.
Posted by: Will Allen on July 14, 2007 11:45 AMYancey Ward:
Do you think that basic education (elementary and secondary school) should be considered a right? Is there a difference in principle between education and health care?
"Really, the debate is simply "Is healthcare a right?". If it is, the US is ethically obligated to try an provide some form of universal (not necessarily single payer) healthcare. If not, then the present system is adequate."
Protection from foreign enemies isn't a "right" either, yet we pragmatically decided a long time ago that it was a reasonable function of government. Some would argue that even today, we already engage in public health activities which have societal benefit but still don't classify as right-granting (i.e. treating people with highly contagious diseases for free for the benefit of the rest of us).
So, no, you don't need to promote health care to a "right" to do something about it. You can argue about what ought be done, but clearly there are pragmatic reasons for doing something (we're _already_ doing something, just not enough).
Posted by: The Voice O' Reason on July 14, 2007 12:51 PMSimply put I hate going to the DMV. I hate dealing with the IRS. I hate dealing with the state government.
Any interaction I have with governmental entities are some of the most unpleasant things I have to do. Why would I want to deal with that kind of service when I'm sick or dying?
But even worse, NO ONE has adequitely explained how once gov. gets its hands into healthcare and starts setting prices what will happen to the drug companies and the various treatments that will no longer be invested in because the likely hood of return suddenly disappeared or greatly shrunk.
Are we doomed to continually repeat the failed history of the Soviet Union? These evil guys like Stalin weren't the reason why they collapsed in the late 80s/90s. Their economy designed to be a workers paradise only insured that less people lived in paraidse (except for those who were in charge) and everyone else lived in poverty.
Posted by: cdub on July 14, 2007 2:35 PMSimply put I hate going to the DMV. I hate dealing with the IRS. I hate dealing with the state government.
Does your anus-clenching hatred of the public sector run all the way down? How about local government? Do you despise police officers and firefighters, too?
Posted by: Immoralist on July 14, 2007 3:27 PMDo you think that basic education (elementary and secondary school) should be considered a right? Is there a difference in principle between education and health care?
No and no.
Universal opportunity to education should be a right. Reasonable accomodation to that education should be all that needs to be offered.
Health care as a federally mandated right has boon doogle written all over it. A couple of weeks ago, CBS News ran a story about no pregnancy care in New Orleans since Katrina. (Yes, I was the one viewer they had that night.) IIRC, the story focused on two women both under 25 who had been pregnant three times each and had lost some of the babies because they had no way to get to a doctor. (One of the women was only 20 years old.) The obvious problem according to every one in the story was that the government was at fault.
Accept any level of Hillary Care(TM) and make health care a "right" and this issue becomes cause for Senate hearings, calls for impeachment, and billions of more dollars to be thrown at the problem. Personal responsibility, which is already non-existent in this case becomes non-existent in millions of other fringe cases once those on the fringe find out they have a "right" to the government taking care of them.
[Mrs. Fan, sometimes described as the "rational" one at stately Reagan Manor, calmly explained that the real effing problem in this case was that those effing wh@res were too effing stupid to keep their effing panties up when they knew they couldn't get to an effing doctor.]
Posted by: Reagan Fan on July 14, 2007 3:47 PMWhat Michael Moore hasn't done is lie in a corridor all night watching his severed toe disintegrate in a plastic cup
Hey, it could be worse. Imagine if something generally similar happened to John Wayne Bobbitt.
Posted by: Peter on July 14, 2007 5:12 PMmijnheer,
No, I don't view the provision of education to be a right. To expand on Reagan Fan's explanation, there should be no barriers otherwise to education, but your right to it ends with the beginning of another person's property. My problem with defining such things as rights is that there is really no limit to such "rights".
Posted by: Yancey Ward on July 14, 2007 9:00 PM"Except the US pays more, and gets worse results"
To those who took exception to this statement, I think he's referring to the fact that the US spends about 13.6% of GDP on health care (OECD stats), more than double the OECD average, but life expectancy is somewhere around the same as Jordan (44th worldwide: from Nationmaster.com).
"The difference is, in a free market system, you can go see a different doctor. In Canada or Britain, you just have to wait it out."
As someone who has experienced the health care system in the US, Canada, Hong Kong and a few other places, the only place I have ever had my choices limited as to who I could see was in the USA. This was decided by the bureaucrats running the health plan.
Posted by: Adair on July 14, 2007 9:26 PMI guess new west thinks that if you don't have any information to contribute to the discussion flinging spittle at his monitor will work as a substitute.
Actually, New West Living is little more than a grafiti vandal. His wacky display of undisciplined self-will captured for posterity in this thread, is typical of his behavior here ever since he found the place some months ago.
Posted by: anony-mouse on July 14, 2007 11:18 PMTo those who took exception to this statement, I think he's referring to the fact that the US spends about 13.6% of GDP on health care (OECD stats), more than double the OECD average, but life expectancy is somewhere around the same as Jordan (44th worldwide: from Nationmaster.com).
If that's what he meant, it's still silly, and that tired old horse should be put to stable.
(1) Not all countries count their infant mortality statistics the same way (which extends to willingness to attempt heroic resuscitation of stillborns), leading to fundamental reporting differences.
(2) The US has a higher incidence of health problems related to obesity (including diabetes and heart disease), which creates demand for associated healthcare services and shortens life expectancies without being related to the quality of the healthcare system.
(3) The US has available, and consumes, greater resources for extending the quality and quantity of life among the elderly.
The value of some of these things can be debated categorically on the merits, but statements equating life expectancies and healthcare expenditure are not strictly useful as any strong measurement of input and outcome.
Posted by: anony-mouse on July 14, 2007 11:26 PMWill Allen,
What I find interesting is how the proponents of nationalizing the healthcare system studiously ignore any evidence showing the bad results it has produced in other countries.
They also studiously ignore domestic evidence showing nationalized healthcare is likely to be a disaster.
It's like paying the lowest bidder to keep you alive!
Imagine you need a life saving cardiac operation for your severely diseased and failing heart. Then imagine your surprise when you find out that your Medicare government health insurance pays less than 40% of what private insurance reimburse anesthesiologists for the same procedure!Now imagine your concern when you learn that because of such poor reimbursement rates only a scant few anesthesiologists in your area will provide services for cardiac surgical cases when the insurer is Medicare!
Ironically these Medicare cuts combined with anesthesiologist shortages may lead to increased salaries as hospitals, desperate to find someone to staff surgical procedures, increase subsidies and provide recruitment incentives.Posted by: TJIT on July 15, 2007 12:05 AMMost of this added cost will be passed on to private insurers and some to tax payers as increased medical care costs.
Way to go Medicare! Their motto should be "We cut costs now and pay for the consequences later!"
Anony-mouse,
Even if you take infant mortality, obesity and care of the elderly into account, the average American gets the same quality medical care as the average Jordanian, and much lower quality medical care than one would get in France, despite spending a lot more money on it.
And speaking of free market systems, over half of medical expenditures in the US come from the public sector (and this proportion will soon increase to the Canadian level of 64% thanks to Bush-sponsored expansion of subsidies). What is left of the private sector is so heavily regulated that it would not make any difference if someone in DC made the takeover official. So I find it strange that people debate the merits of nationalizing the system as if it hasn't happened yet.
Posted by: Adair on July 15, 2007 5:15 AMC´mon. In *Brazil* I can see a doctor without having to wait so long.
Posted by: André Kenji on July 15, 2007 11:50 AMYes, let's all throw away our system of health care and follow those geniuses in Europe. From www.scotsman.com:
"ALMOST one in ten patients in Scottish hospitals is suffering from an infection such as MRSA, a survey suggested yesterday. The new study - thought to be the most comprehensive ever carried out in Europe - found 9.5 per cent of people in acute hospitals had a healthcare associated infection (HAI)...Experts and campaigners last night said that HAIs continued to be a problem because of poor hygiene in hospitals and a lack of isolation facilities."
Do some Googling to see what MRSA is.
And let's look at the corresponding rate from the leading PRIVATE hospital that competes with the crap national system: http://www.bupa-hospitals.co.uk/asp/hospital_performance/
Upper right. Yes, that's ZERO percent.
And another thing. When these Democratic politicians cram this crappy national health care down out throats, does anyone expect them to endure it as well? Hardly. Every damn one of them will have a 24-hour private nurse and a zillion specialists on call.
How about some journalist ask them to pledge they will take the same lousy service we are all going to be forced to endure?
I swear, at some point soon we are going to have to have a 10 Million Shotgun March on Washington.
Adair wrote:
"the only place I have ever had my choices
limited as to who I could see was in the USA.
This was decided by the bureaucrats running
the health plan."
Do you honestly expect us to believe that those
bureaucrats physically restrained you from getting
off of what must be a very substantial arse and
going to another physicians office?
How long your nose must be.
You were just too cheap to pay ON YOUR OWN to
see another specialist. Or were there those
same bureaucrats waiting in front of the office
doors of every specialist you might want to see
in order to prevent your own august entrance?
otoh, a good friend of our family expired in a
Jordanian hospital because his wife could not
find their Blue Cross card. But then fat
Michael probably couldn't get his 7,500 calories
a day over there. So he wouldn't dare go filming
in any country where he couldn't maintain
his obscenely large belly.
Posted by: LordActon on July 15, 2007 3:32 PM
Even if you take infant mortality, obesity and care of the elderly into account, the average American gets the same quality medical care as the average Jordanian, and much lower quality medical care than one would get in France, despite spending a lot more money on it.
Cite please.
Interestingly, I've been told that for hip replacements, somewhere around 20% to 30% decide they don't need one after thinking it over in the interim while waiting for surgery. Quick isn't always better if your doctor stands to make money on the procedure...
Indeed. And one wonders why exactly it is hip replacement surgery that has become the gold standard in comparison analysis of waiting times. Although there are always exceptions to the rule (such as fractures due to falls), hip ailments are typically degenerative in nature, and worsen gradually with time. In other words, the need for surgery can often be forecasted and planned for well in advance ("Mr. Smith, you'll likely need that surgery in another 24 months."). And the point is, artificial hips don't last forever, so there is considerable benefit to the patient in avoiding "rushing" the surgery, as waiting increases the chances the repair will last the patient the remainder of his life.
I think waiting time is an important and interesting metric to investigate when comparing different nations' healthcare systems. I just wish so much attention weren't paid to a procedure where waiting is often easy to manage, and in the best interest of the patient.
Posted by: Jasper on July 15, 2007 7:33 PMThat is, not universal care, not single payer, not any of the other wild schemes that are tossed about by the idealogues, but just a legal mandate that everyone obtain insurance - with perhaps a bit of subsidy thrown in for the bottom tier.
Randy: Well, a legal mandate that everyone obtain insurance would be "universal care" if, by everyone, you truly mean everyone.
However, don't worry. The insurance industry and Americans' fear of scary socialism (Boo!) will ensure that universal, single-payer health care never comes to the U.S.
mijnheer: Although never is a long time, I agree that, thankfully, Canadian-style single-payer won't be coming to the US anytime soon. It's simply political impossible. I think it's likely, though, than in another 10-20 years Americans will enjoy a multi-tiered universal healthcare system similar to that of, say, Switzerland, France or Australia.
Posted by: Jasper on July 15, 2007 8:03 PM@The Voice O' Reason:
Protection from foreign enemies isn't a "right" either, yet we pragmatically decided a long time ago that it was a reasonable function of government.
You don't think safety from being physically attacked and killed by someone else is a right? Wow. Do you just not buy into this whole "rights" thing in the first place?
We do, in fact, have a right to our lives, our liberty, and our property, from criminals and invaders alike.
We DON'T have a right to education or health care. An easy heuristic for determining this is to ask yourself if the execution of the proposed "right" would impose on the freedoms of others. This is true in the cases of both education (teachers to teach you, classrooms to hold you, buses to bus you) and health care (doctors, equipment, medicines); therefore, they cannot be rights.
The federal government exists solely for the protection of our rights. The assumption of any other duties -- particularly one as egregious as national health care -- violates the property rights of each of us by forcing us to accept a product we don't want (or alternatively, to continue paying in absence of a product). Moreover, the product will not -- cannot -- be as efficiently produced, tendered, or serviced as it would be in an open, competitive marketplace of mutually agreed-upon transactions; the entire history and present gamut of government services is a testament to this reality.
Posted by: Jeremy on July 15, 2007 8:18 PMJeremy: The U.S. spends half a trillion dollars a year on its military. There are more than a few Americans who feel that much of this money, lifted from their wallets for a product they don't always want, would be better spent on defending their lives from invading bacteria and viruses, and from cancer cells run amok.
Posted by: mijnheer on July 15, 2007 9:00 PMActually, the U.S. Constitution tasks the federal gummint with maintaining national security (to provide for the common defense), and most, if not all, states have constitutional provisions for providing a basic education.
Sure sound like rights to me. Health care is not mentioned in these documents.
Posted by: Rex on July 15, 2007 9:44 PMJasper in blockqoutes:
one wonders why exactly it is hip replacement surgery that has become the gold standard in comparison analysis of waiting times.Because diseased hips can cause immobility and excruciating pain. We would like to minimize these things.
Although there are always exceptions to the rule (such as fractures due to falls), hip ailments are typically degenerative in nature, and worsen gradually with time.You are missing the fundamental point.
The decision to do surgery is made when the patient needs it. Delay after that point often means excruciating pain for the patient and decreased mobility.
Jeremy
Of course people have rights to not have violence visited upon them, but they don't have a right to protection from violence. This is a crucial distinction. If I beat you and take your wallet, I have violated your rights, but your neighbors, by not providing protection from violence have not violated them.
Posted by: Yancey Ward on July 16, 2007 9:29 AMThere are a lot of comments above about being able to go see a different doctor or not.
It all boils down to your insurance (or the equivalent of it in GB and Canada). If your provider has more available doctors, awesome. If not, I hope you have a free clinic (wait times are not always terrible at those places) in your area.
In this, the American system is infinitely better than the others mentioned because it is a LOT easier to change insurance providers (all you need is to be able to afford it).
Disclaimer: I am, thank God, covered by TriCare Prime and thus have an almost unlimited list of options no matter where I go in the USA.
Posted by: Raven on July 16, 2007 11:09 AM"Actually, the U.S. Constitution tasks the federal gummint with maintaining national security (to provide for the common defense)"
Yes. Still not elevated to a right. That's the point - something can be the legitimate function of government without it being elevated to a RIGHT. One could view this as "the government is ALLOWED to provide for the common defense".
Posted by: Voice o' Reason on July 16, 2007 1:28 PMEven if you take infant mortality, obesity and care of the elderly into account, the average American gets the same quality medical care as the average Jordanian, and much lower quality medical care than one would get in France, despite spending a lot more money on it.
And all because you said so! One simple hand wave makes context flee and evidence crumble, leaving ideological conclusions standing tall and proud above the rubble! I am SO convinced now -- just write my name in on the True Believers roster, and I'll walk in your thrall for life.
Incidentally, can you perform this same trick to make Legal Tender appear in my wallet? (I prefer unmarked 20s with non-sequential serial numbers, if that helps.)
Posted by: anony-mouse on July 16, 2007 1:44 PMBecause diseased hips can cause immobility and excruciating pain. We would like to minimize these things.
Of course we like to minimize pain. Which is why the intensity of suffering ought to be considered when scheduling when a given medical procedure ought to be performed. That "scheduling" has to be done, however, whether the insurance company paying the bills is owned by the government or owned by shareholders. The real issue here is capacity, and it's not clear that the US system ranks particularly high on this metric. Higher than Canada? Perhaps. Britain? My guess would be yes. Australia? I doubt it. Switzerland, France? Almost certainly not. And, as has been mentioned ad nauseum, waiting times in even the supposedly subpar Canadian system are shorter than the waiting "forever" faced by a non-rich uninsured American.
FWIW, I'm personally not arguing in favor of Canadidan or British style single payer. I'm arguing in favor of making sure everybody has robust health insurance, along the lines of the better performing rich world systems like those of France and Australia (both of which feature ample representation from the private sector).
Posted by: Jasper on July 16, 2007 2:02 PMHow about the line of thought that goes Canada, France, etc. can afford to pay for these health care systems because they live under the virtual protection of the United States. Our enormous spending on defense allows them to siphon money they would otherwise spend and put it into social programs.
I'm sure even if we slashed defense by 50% that in short order the "everyone has a right to be healthy" crowd would still demand higher taxes to pay for even more benefits and rights...
But should the US just stop protecting foreign countries and international trade as a result of cutting our defense budget to pay for all this?
Posted by: cdub on July 16, 2007 4:12 PMHow about the line of thought that goes Canada, France, etc. can afford to pay for these health care systems because they live under the virtual protection of the United States. Our enormous spending on defense allows them to siphon money they would otherwise spend and put it into social programs.
Doesn't work. Canada and France spends *less* on healthcare than the USA, and that's taking % of GDP, take raw spending, and the USA *vastly* outspends practically everyone else in the world. If you were correct, they would be spending *more* than the US because they were freed from the costs of defense.
No, other countries can afford universal healthcare because they save money by healthcare rationing. You want the top of the line healthcare, you are going to *pay* for it. And the US does, in spades. Best place in the world to get sick, at least if you are are in the top earning quartile.
Posted by: Tom West on July 16, 2007 5:24 PMRationing occurs no matter what system you use.
In socialist style systems, the Government does the scheduling.
In America, the money does.
In my book, America's system wins out purely on that basis. It's a reason to make more money so you can get better healthcare.
The socialist systems offer no such incentive.
Posted by: Raven on July 16, 2007 5:44 PM"Best place in the world to get sick, at least if you are are in the top earning quartile."
Not even close. I'm in the top earning quartile; have one of these great new HSA plans which is maxed out; we exceed the deductible every year; and we wait out the wazoo for many things (months for various specialists).
You have to go quite a bit higher than the 75th percentile to be able to afford health care completely out-of-pocket in the gold-plated practices where you don't actually have to wait months-and-months to get an appointment with certain specialists. I know those exist; they have some in Florida where you pay a big annual fee to belong to one. But at 75th percentile, they're out of reach.
Note the high-deductible-with-HSA plan still sends you through long-wait and unapproved-treatment hell; just like lower-deductible insurance. You also get to drown in paperwork; but you do NOT get treated as a higher-profit customer, because you're not; the provider still gets paid on a discounted negotiated rate just like with traditional insurance.
Unless you spend a lot of time enjoying cigars and monocles, in other words, you aren't really getting the "best health care IN THE WORLD" (thanks, Mr. Rooney).
Posted by: Voice o' Reason on July 16, 2007 9:20 PMThe trenchant philosopher Stalin allowed the question, 'Is socialism in one country possible?' Currently in the US we have as it were 'health care socialism in each company' as the companies compensate their workers in part on the basis of a health plan. I think the call for a NHS is based largely on the fear that people have about losing their job or desire to lose it and facing losing their 'current socialism' in health insurance. BushHitler addresses that in part in his proposal to make private purchase of health insurance as tax favored as company purchased. On the larger question of can you make a country socialism as desirable as the current 'socialism in one company' I would venture to say, as the mathematicians were wont to do when they didn't want to go over the elementary details, OBVIOUSLY NOT. Let me just say however, that you haven't heard doctors 'who won't take Medicare.' I think given the legal restraints on forcing people to work, an NHS is going to give the left an analogy to the question, 'What if they gave a war and nobody came?' In this case it is going to be 'What if they gave an NHS and no doctors came?'
Posted by: Michael Brophy on July 16, 2007 10:47 PM"safety from being physically attacked and killed by someone else is a right"
This is not true. You can sue the police successfully for beating you up. It's been tried. It has succeeded many times with big cash awards.
You cannot sue them successfully for not coming to your house and, for example, stopping a rape in progress. It's been tried. It failed.
Not. A. Right. It's a good idea to do what you can to protect yourself.
"infinite waiting time for service they can't pay for"
No one in the U.S. has infinite waiting time for service they can't pay for. Doctors and hospitals are required to provide care even if people cannot pay. We all pay for indigent patients and bankrupt patients in terms of higher prices.
I'm not defending this method of dealing with the problem, but I don't think it should be misrepresented as infinite waiting time for service they can't pay for.
I'm in favor of manditory catastrophic insurance with sliding scale government assistance for those who cannot afford it. I'm in favor of severing the link between employment and health care.
Let's try improving our not particularly free-market system by giving us more health care funding choices first, not less. After that has failed we can talk. Please note that it hasn't been tried yet, although Massachusetts is coming close.
I've been told that in British Columbia you can pay extra for extra insurance. Don't know what it is allowed to pay for. But that isn't a single tier system.
As Jane has said before, changing who pays is not going to magically lower U.S. health care costs OR improve our outcomes. If it did Medicare, Medicaid and the VA would be cheaper and produce healthier people. But they aren't and they don't.
Yours,
Wince