Although I’ve opposed universal health and single-payer on economic grounds, I realize it’s probably going to happen in one form or another. The electorate has spoken, and health care was no small part of that vote. So, I’m trying to keep an open mind. Still I worry that whatever “solution” Congress comes up with will bankrupt the US (even more than it is already bankrupt).
One thing you don’t hear often is that medical costs are increasing everywhere, ahead of composite inflation rates, regardless of health care system used. But the US rate of inflation may be among the worst. It’s going to take well thought-out reforms to get that under control, if it’s even possible.
Over at Electric City, Rob Natelson contends that the mere existence of a third-party payer causes prices to increase because consumers don’t shop around. This probably applies to college tuition as well due to subsidized student loans and grants, and to everything else for which the consumer is not really bearing the full cost. But somehow I don’t think we’re going to return to pay-go anytime soon.
At Piece of Mind, Mark Tokarski takes a look at the Baucus plan and finds it wanting. It won’t work, he says, because it keeps the crooked cherry-picking insurance companies in the middle of the action. He wants them out. Yet…it seems to me that there is some method to this patchwork mess. The new system will have so many problems, will be shown so inadequate after much tweaking, that there will arise universal demand for - single payer! With Canada as the model of course.
But is Canada the only game in town? No, according to a series of posts by retired surgeon and professor of medicine at USC, Micheal Kennedy. He is the author of a book A Brief History of Disease, Science and Medicine and authors a blog. I tend to trust this guy because of his impeccable conservative credentials and his argumentive skills, often on display in Patterico’s comment section. Except, Dr. Kennedy believes that the US does need to adopt some sort of universal health. But he prefers a different example.
In considering reforms, most critics of the US system look to Canada for ideas. This is because they are close to us and share our language and many of our institutions. They are not, however, a good model. I believe many mistakes were made and too much coercion was used in dealing with providers, a feature of our current treatment of doctors in the US. Because of language, few know much about the French health care system but those of us who have been working in health care, especially in surgery, are aware of the very high quality of care and innovation. We should also become aware of the similarities and of the very high level of satisfaction, both by patients and doctors.
Kennedy details at length how the French Securite Sociale came into being amid in the chaos of WWII, and how it compares with ours.
In both countries, “Usual, Customary and Reasonable” fee schedules were the Achilles heel of private fee-for-service medicine. How the French solved this problem, to the extent they have solved it, is the major lesson of the comparison. Gradually, Securite Sociale covered greater and greater portions of the population until now 99% are covered. The government pays for those who do not earn enough to contribute and Couverture Maladie Universelle (CMU) determines how much the member must pay. Above a certain income, the member pays their own way for the 20% (or more like 30% now) that is not covered by the Securite Sociale. In 1958, a survey of members asked “Should the healthy pay for the sick or should everyone get back only what they put nto the system?” 86% answered that the healthy should pay for the sick and 95% approved of the compulsory nature of insurance even though complete coverage of the population, including agricultural workers, came only in 2000.
The most significant difference was that, in France, the private insurance companies provided the “gap” coverage and the government program provided 80% of the payment. In the US, except for Medicare and Medicaid, it was all private. The book comments that French doctors have lesser incomes compared to US doctors but French medical school is free and US doctors might well choose that over the huge student loans they must repay the past 20 years. The makings of a grand bargain might just lie in that difference.
So it’s as if everyone had Medicare with a Medicap policy. In the US only seniors and people on Social Security disability can get anything similar.
He turns to stateside experiments in the US.
The US has 50 states and there have been a few attempts to use states as “laboratories of democracy” to test health care reform experiments. These do not work (except, perhaps, for Hawaii, which is relatively isolated) because states are not large enough and people will move around to acquire benefits. Any real reform has to be national. What I propose is to move to a universal Medicare program which would pay 80% of health care costs. The co-payment would be paid by private insurance, just as is done in France. Costs would be subject to “Evidence-based Medicine” criteria for reimbursement. If people want chiropractic treatment or acupuncture or massage, let them pay for it without subsidy. This may, in fact, be the most difficult part of the problem to solve as our state regulation is highly politicized and influenced by lobbies of various health care organizations.
His proposed version of “Medicare,” however, would not be a government agency but instead a nonprofit run by a combination of business, industry and consumer representatives. (Hawaii’s experiement, by the way, is faltering. ) Then there is the issue of doctors’ pay.
New doctors are heavily burdened with debt. USC medical school, where I teach, now has a tuition rate of $40,000 per year. The average medical student leaves with loan balances of $250,000. New young doctors must earn enough to repay loans. The problem has become so severe that a new medical school organized by the Cleveland Clinic and Case Western University has decided to grant 100% scholarships to all students accepted, in hopes of encouraging more to choose academic medicine. The military services offer full scholarships to medical students who agree to serve a minimum time as military physicians. What if we offered all new doctors, who agreed to accept the national fee schedule as payment in full (after co-payment), a full scholarship to medical school ? If later, they decided to shift to the equivalent of Sector 2 in the French system and charge higher fees, they would have to repay their scholarships. A system to forgive existing loans could even be introduced. Each year a new doctor participated in the Sector 1 equivalent, part of the loan was forgiven.
I wonder if medical students would go for this? Would we get more internists this way, and fewer hotshot specialists? Would that be a good thing or not?
Anyway, read the whole series if you have the time. We’re going to need good information in the years to come. Here are the posts in chronological order:
on Dec 2nd, 2008 at 7:11 pm
How expensive can a vial of Lourdes Water be?
on Dec 2nd, 2008 at 7:13 pm
LOL. Yeah I’m stilling pulling against this. Aren’t there any model countries without universal health care?
on Dec 2nd, 2008 at 7:37 pm
Congo???
on Dec 3rd, 2008 at 9:57 am
Switzerland has universal health care but the insurance market is private.
on Dec 3rd, 2008 at 10:02 am
No country that had universal health care has ever opted back to the private system. Except one - Iraq, done by force by Paul Bremer. The latest to go public was Taiwan, and though the public was initially skeptical, it’s now very popular.
WHO rates France best in the world, US 37th primarily because we are not universal. Canada’s system has many problems, but Canadians are generally satisfied - that is, even though they constantly scuffle about it, there is no significant movement to ditch the system.
Germany has a public system for 90% of their population supplemented by private insurance, but the insurance covers things like private room and doctors outside the system. And the critical factor that keeps private insurance alive is allowed in Germany - tehy are allowed to cherry pick and turn down clients.
The private system of insurance doesn’t work, can’t work. It’s at odds with itself - insurance companies can only profit by turning down clients and containing costs. The baucus model subsidizes private insurance. It will be a boondoggle. You think it’s expensive now? Just wait.
on Dec 3rd, 2008 at 10:09 am
Dave, I’ve heard good things about the Swiss system too. Yet, could there be a more different nation than Switzerland, as far as size and diversity? I realize they have a French-German-Italian population, but still, it’s soooo small. For whatever that’s worth, maybe nothing.
My point is that I hope Congress picks the best of the best, but I’m afraid they’re going to make a bloody hash of it.
on Dec 3rd, 2008 at 10:14 am
The claim: “insurance companies can only profit by turning down clients and containing costs.”
Wrong. From its beginning insurance of any kind works and is profitable when there is a spread of risk that generates payouts less than the premium inflows. Risk pools have to be self-funding or there is no underwriting of that particular risk. We have state insurance comissioners and auditors to watchdog unfair claim management. Ultimately, an insurance company’s license is at stake.
on Dec 3rd, 2008 at 10:21 am
Craig - you’ve obviously never been turned down by an insurance company. Adverse selection is their undoing - sick people are drawn to insurance, healthy people not. The private insurance model works with employer-provided insurance because insurance is not why people are hired, and you do get a good cross section of healthy people to insure. Without that, the insurance model fails. Right now there are twelve million Americans making more than $48,000 who do not have insurance. It’s not that they cannot afford it. It’s that they can’t get it.
on Dec 3rd, 2008 at 12:02 pm
Like with many things when words like “insurance” are stretched to mean something they are not, we run into problems. For example, buying insurance to cover a vehicle after a wreck, buying insurance after the building has burned. Doesn’t make sense. In those situations, what we really have is “loss financing” whereby the financier lends the money at a given finance charge. Buying healthcare coverage after one’s body is sick or broken is much the same. There are those finance agencies who will lend the money and others won’t. Pre-existing conditions are rammed down insurance cos throats to finance, but it is not really insurance and it clouds the understanding to call it such. It begs the question, what are the array of funding mechanisms that address the issue openly rather than disguise those costs as insurance. I would like to see all of the 401k’s and IRA type vehicles include the MSA and allow large tax reduction contributions and withdrawals as one source.
on Dec 3rd, 2008 at 12:22 pm
Mark T. wrote: “[A]nd you do get a good cross section of healthy people to insure.”
What you get is a random sample of people who are capable of performing the work, not a cross section of healthy people. Of course, it is presumed the worker is healthy enough to perform the work, but there is also the chance that he might already be ill, or that he might fall ill after a week on the job.
Anyway, what is your problem with uninsurable people? Why would an insurance company write a policy on a guy who keeps getting loaded and crashes cars? You seem to be railing against logic.
Bottom Line: Nobody in America has ever been refused medical treatment for lack of insurance.
You also wrote: “It’s not that they cannot afford it [insurance]. It’s that they can’t get it.”
Really? I was always of the opinion you could get any kind of insurance you wanted if you were willing to pay the premium. Can you give some examples of people who cannot get insurance at any price?
Carol wrote: “My point is that I hope Congress picks the best of the best…”
Heh. After the last two years of a Democrat-controlled Congress, you really are hopeful.
on Dec 3rd, 2008 at 12:38 pm
Craig Moore:
You are correct in your assertions that some healthcare insurance is nothing more than loss financing. But that is only when the premium is paid with private money. When the premium is paid with public money, it becomes loss shifting.
I will take your argument one step further and say that universal health insurance is nothing more than a middle-class scheme to protect assets. Even the name “universal health insurance” is misleading; for no one can insure any one’s health. All that can be done is to insure no one’s assets will be seized to pay health care costs. (And note, that would be “ensure,” not ”insure.”)
on Dec 3rd, 2008 at 1:03 pm
“universal health insurance is nothing more than a middle-class scheme to protect assets.”
Bingo! You win again, Max.
Only the pro- crowd have a point: people who go without insurance (like my brother for about 20 years before Medicare kicked in) tend to avoid routine and preventive care. Sure you could go to ER but for a prostate exam? Not really. I think preventive health is the opening by which they get a foot in the door.
on Dec 3rd, 2008 at 2:33 pm
Carol:
Prostate exam—awful example! But I get your drift.
One company I know of kicks back two months’ of employee health insurance premiums if the employee goes in for a “wellness exam” and fills out a brief Web-based questionnaire. (There is another stupid word that ought to be banned—wellness.) The company pays for the exam, too.
As for using preventative health care as a lever for total health care, I understand what you are saying, but I think it really does not matter what you go see the doctor for. You either can pay for it or you cannot.
I guess the government could give everybody one free doctor’s exam each year, but that would just overload the system with hypochondriacs. Most young and healthy people rarely go in for a yearly check up, no matter who is paying for it.
Say, while we are talking about government giveaways, how would you like a Federal Reserve Credit Card, maybe in jet black with gold trim? I am thinking, since the Fed is getting financially involved in everything, the easiest way out of this mess is just to issue a government-backed credit card to everybody. Then we do not have to fool around with “affordable” housing and healthcare and college and affordable this and affordable that. People could still run themselves into debt all they wanted, but we would not need politicians to help them anymore.
on Dec 3rd, 2008 at 4:38 pm
“Bottom Line: Nobody in America has ever been refused medical treatment for lack of insurance.”
I have.
I also have a degree and a job, which, by conservative logic, should provide me access to medical coverage. Yet, I can’t afford it. So I don’t have it.
on Dec 3rd, 2008 at 4:59 pm
Jesse, what was the name and where was the emergency room where you were refused treatment?
on Dec 3rd, 2008 at 5:12 pm
A place in Guam. Not America, I realize, but still under America’s health care system. Maybe it wouldn’t have happened in the U.S. proper, I don’t know. You’re obviously more involved with the health care system than I am, so if that’s the case, I take it back.
on Dec 3rd, 2008 at 8:35 pm
Jesse wrote: “I also have a degree and a job, which, by conservative logic, should provide me access to medical coverage. Yet, I can’t afford it. So I don’t have it.”
1. Explain why your job does not offer health insurance.
2. Explain why you cannot afford health insurance.
on Dec 3rd, 2008 at 9:06 pm
By the way, Dr. Kennedy’s praise for the French healthcare system makes no mention that it is currently about $14B in debt and loosing ground. So what problem does the French system solve if that system cannot pay for itself?
on Dec 3rd, 2008 at 10:57 pm
Max - I have been turned down for health insurance in the best of places. So has my wife. We have preexisting conditions. If you’re talking about the emergency room care system, you’re really out of touch. Emergency rooms don’t treat conditions, they merely stabilize people or are in tough situation. They can’t do anything about prostrate cancer or diabetes - they just treat them and move them out.
I guess I come here to see how the other side thinks. It’s rather enlightening. We’re not even communicating, not on the same planet. You’re not in the game.
on Dec 3rd, 2008 at 11:01 pm
Craig Moore - you’re right about the nature of insurance, which is why private insurance doesn’t work for health care. It’s called adverse selection - in the free market, healthy people don’t buy insurance, but people who are likely to get sick do. So insurance companies can only profit by avoiding people who are likely to get sick. The deal is this - we don’t need them, their private profit is not a public benefit. Taking care of sick people is. That’s why we are moving, ever so slowly to public systems.
The private insurance model works with employee provided insurance because the selection factor is not health, but work. They get a cross selection, and adverse selection is avoided.
That’s how the game is played. That’s the nature of the beast. That’s why all the other industrialized countries opted out of private systems.
on Dec 4th, 2008 at 1:00 am
We have the best healthcare system in the world. End of story.
on Dec 4th, 2008 at 1:10 am
Actually, we’re 37th. Guess you didnt’ get the memo.
on Dec 4th, 2008 at 1:15 am
Trust me.
on Dec 4th, 2008 at 8:16 am
Here’s some background on the WHO report that Mark embraces as gospel truth.
on Dec 4th, 2008 at 8:27 am
Here is another good analysis on the methodology problems with the WHO report by the Canadian Patient Safety Institute.
on Dec 4th, 2008 at 8:29 am
Craig, I hear all Europe’s going to encounter trouble borrowing money. Related to its many entitlements?
Right now my health care is great. I doubt I could have gotten my very esoteric knee surgery two years ago going the ER route. Took less than a month from decision to operation.
I just hope things like that are doable with any new system Congress cooks up. It might start great, as NHS did, but how long until it deteriorates the same way?
on Dec 4th, 2008 at 8:59 am
Here’s a bit from U.S. News & World Report on infant mortality.
This is written by DR. Bernadine Healy M.D., former head of the NIH.
on Dec 4th, 2008 at 9:35 am
Mark T, if you and your wife are suffering from cancer and diabetes, my sympathies and prayers for your fight and quality of life.
Again, this is a matter of loss financing, not insurance. We need to examine the array of possiblilities from “you’re on your own” on one side to “it’s free” on the other side. I pointed to one possibility above. In my opinion, loss financing should be removed from an insurance discussion which is more meaningful when insurance is limited to risk for events that have not yet happened.
on Dec 4th, 2008 at 10:07 am
Our conditions are minor and not worthy of sympathy - don’t worry about us. But the list of preexisting conditions for which insurers deny coverage is long. The point is not us - and it’s not a”broken” system - it’s a mismatched system. The private model of health insurance simply doesn’t work outside the workplace. It can’t function because insurers, to stay in business, have to deny coverage to people who might actually file claims. They are not bad people - they are just doing what they have to do to stay in business. So there cannot be universal coverage in the private marketplace. The only way it can work is to broaden the risk pool to cover all people, and only government can do that.
on Dec 4th, 2008 at 10:09 am
By the way, typical of debate in this country, after the WHO study came out, American think tanks attacked WHO. Very predictable - rather than face our problems and fix them, ignore them and attack the messenger.
on Dec 4th, 2008 at 11:16 am
Well, Mark, I cited only one American think tank. I included an article by a staunch supporter of universal health care and a Canadian study. Fair, balanced and unafraid.
It might be worth your time to understand the debate. It seems, however, that you’re every bit a guilty of finding information that supports your position as you accuse others of doing. Not very studious of you.
on Dec 4th, 2008 at 12:39 pm
Years ago, I stopped reading all the international socialists’ bogus statistics on the American healthcare system. But I need somebody to explain something:
If our healthcare system is ranked 37th in the world, what will it be ranked if the government adds about 40 million more people to the rolls?
Also, if you know the answer to that, maybe you can explain this:
Why is wholesale unleaded gasoline selling for 99 cents a gallon today?
on Dec 4th, 2008 at 8:43 pm
Max - the uninsured was a large reason for such a low ranking. Adding them to the insured would raise us in the rankings. Since we have some of the best technology around, we’d do pretty well. But on things like available hospital beds, we still trail European countries.
on Dec 5th, 2008 at 12:58 am
Mark T.:
I figured it was something like that. Given America’s vast investment in medical schools, hospitals, pharmaceuticals, and medical technology, a rank of 37 in the world seemed absurd.
So, here we are in the Peoples Republic of East Erewhon. We have a population of 25,001 and one hospital, which is a thatched hut operated by a “traditional healer,” a fat old lady with a mustache who can pull diseased organs out of patients without surgery. Our healthcare system is ranked number 2 in the world because every Erewhonian has health insurance. (We would be ranked number 1, but the yard out behind our hospital can only hold 25,000 patients at a time.)
on Dec 5th, 2008 at 1:47 pm
What good is an MRI machine if only a few people have access to it? And, for what it’s worth, Cuba, which is ranked right by us, does so well because of the number of doctors and beds and universal access. Though those things don’t matter to you, they do to most of us.
Half of all bankruptcies in the US, which will probably reach a million this year, are due to medical costs. We are spreading the costs around, but in a back door fashion.
on Dec 5th, 2008 at 7:46 pm
Mark T.:
Ah, yes, the vaunted Cuban healthcare system. I remember when Fidel was dying after being treated by his Cuban doctors. As I recall, he had to bring in some new doctors from Spain, no doubt a country ranked above Cuba in the healthcare hierarchy, in order to save his life. I wonder if Fidel was covered for that.
One mistake I have made getting involved in this discussion is disregarding an axiom for arguing with liberals, socialists, and communists: Never concede the premise. By merely engaging in this discussion it appears that I accept the idea of universal healthcare or universal healthcare insurance, i.e., the premise that it is a social good or that it is a fundamental right or whatever. I do not. I do not accept that premise. I think healthcare is like any other service. You get as much of it as you can afford.
Therefore, the financial and technical aspects of the various schemes for implementing some kind of universal healthcare or universal healthcare insurance are of little interest to me. Moreover, if such a system were in fact implemented, I would neither pay for it nor use it.
However, I will leave you with one suggestion, assuming you are still hell bent on pursuing this erroneous idea: Consider using a preexisting government system rather than trying to reinvent the wheel.
Medicare immediately comes to mind. Lower the age requirement from 65 to 55 for starters. Adjust everyone’s Medicare contributions to reflect the increased coverage. Then see what happens. If the system works satisfactorily, then lower the age requirement from 55 to 45 and so forth and so on. (I am suggesting starting with the oldest people because they use the most medical resources; whereas, the young tend to use less medical resources. But if the scheme works, eventually everyone would be covered.)
on Dec 5th, 2008 at 9:17 pm
One mistake I have made getting involved in this discussion is disregarding an axiom for arguing with conservatives, right wingers, and fascists: Never presume they want to solve problems. In their view, if the market can’t do it, it can’t be done. So I urge you to step aside, get out of the way, watch the Democrats screw it up. They’ve already started - they are depending on the private insurance model to help solve the problem. Can’t work.
Regarding Cuba, yes, I know our poor little embargoed neighbor doesn’t have shiny new stuff, that they need some democratic changes, but it is absolutely hilarious that they can deliver health care of adequate quality (not excellent - most things they need are embargoed) to their people. Their neighbor to the north can’t.
on Dec 5th, 2008 at 11:34 pm
I am always suspicious of a person who both defines the problem and then claims to have the solution, especially when he offers to solve the problem with other people’s money. That is all you are doing here.
I do agree that Cuba has been victimized—by her own communist dictatorship.
on Dec 6th, 2008 at 10:43 am
Your first comment is a non-starter. People who want to solve problems usually first try to define the problem.
Regarding Cuba, I bet you look into the fascinating history of that country since 1959 in depth. Yes, Castro is a bad dude, yes, they could use some democracy. But it is amazing that Castro is even alive. From the day he took power the US set out to topple him, and tried on countless occasions to assassinate him, often using Mafia people. Officials of the Cuban government were often enlisted, so that Castro became rightly paranoid, and in the end trusted no one but his brother. Even poor Che was imprisoned and eventually exiled. Castro finally turned to the Soviets because he knew he could not long hold power without a powerful ally.
Cuba today would be a land of very rich and very poor with mob-run casinos, American corporations owning the means of production and critical resources, and a puppet government had the US not so badly screwed it up. Seems the Cuban people were screwed no matter which way they turned. That’s life.
on Dec 6th, 2008 at 12:22 pm
There has been a movement afoot to extend Medicare down to 55 and I believe that’s part of Baucus’s proposal. One thing I didn’t bring up in this discussion was cost-shifting. I forget the exact percentage but I think well over 10% of the “true costs” of Medicare and Medicaid are shifted to private payers. Now, I don’t know if these “true costs” are real or just industry “greed” or how you determine that. But where do they shift the difference as the public insurance expands? It seems like it would make private/employer insurance just that much more expensive.
I think it was Doc Kennedy who brought up also that Medicare got past the AMA originally because the doctors were promised 100% payment. Later that was chipped away until some doctors will no longer take Medicare patients. How do you “make” them take these patients under Medicare or any other system?
As for France being billions in the hole, I think that’s an effect of worldwide medical inflation. I wonder if any system has managed to lick that.
And Max by posting this topic I didn’t mean to concede the point. I am wary of the hyped & calls to *do something* but the proponents have done a convincing job of giving it all an air of inevitability. I’ve simply taken advantage of the election to at least broach the subject from this side of the spectrum. It’s going to be hard to maintain objectivity though because the proposed plans would probably benefit me personally. I remember when my mother hit 65 there was no way to discuss Social Security dispassionately with her, LOL.
on Dec 6th, 2008 at 2:07 pm
>>>As for France being billions in the hole, I think that’s an effect of worldwide medical inflation. I wonder if any system has managed to lick that.<<
Rather I think it is the result of a govt run system being weak-kneed to zero base budget. Much easier for others to fix the mess and take the heat down the road.
on Dec 6th, 2008 at 5:01 pm
Craig - here are some comparisons for you: Health Care spending per capita, 2002: US (2002) $5,267 (2007: 6,711), France (2002) $2,736.
Physicians per 1,000 people: US 2.7, France, 3.3
Hospital Beds per 1,000 people: US 2.9, France 4.2
Administrative overhead as a % of total health care costs: US, 31%, France - I’ve seen estimates of 2% to 17%.
Uninsured people: US, 47 million, France: negligible.
Underinsured: US 25 million, France, negligible.
Those damned government-run systems don’t measure up to ours, do they.
on Dec 6th, 2008 at 5:07 pm
Addendum: Cancer survival rates varies by type of cancer - the US does very well. The five best in the world, US, Australia, Canada, France and Japan. The breast cancer survival rate in Sweden is 90%.
Life expectancy: US 77.1 years, France, 79.2 years.
on Dec 6th, 2008 at 5:33 pm
Mark T., it’s “those damned govt run systems” that run deficits without accountability and consequence that I was talking about. $14B and rising for the French. What will they do to see that their user base pays the freight now, in the future, and catch up for past sins? Tap dance all you want with your prevarications but their sinking ship is taking on water at an accelerating rate.
on Dec 6th, 2008 at 6:11 pm
In the context of unintended consequences, what will be the cost in lives when we defund market incentives for the worlds greatest center of medical innovation? Other countries get a free ride on our medical developments and regulatory oversight. This may have something to do with how they get by cheaper. One also has to wonder what the value of being #1 in cancer treatment is. Quite a bit, I would imagine, to the fellow who has his cancer cured.
on Dec 6th, 2008 at 8:18 pm
Craig - France has incentives built into their system - co-pays, and the government doesn’t pay 100% of most things. You’re determined that our harebrained way of doing things just has to be the best way, no matter the evidence.
Wolfpack - read Carol’s links above. You’ll find that medical innovation is doing fine in France. That’s another myth. We do have a lot of innovation here, but most of it is government funded.
on Dec 6th, 2008 at 8:37 pm
Mark T, I have made NO such determination. Be honest and answer my question.
on Dec 6th, 2008 at 9:20 pm
Craig - they will have to pony up. At 9.5% of GDP (versus 16% for the US), they have to go some before they become nearly as spendthrift as us.
What don’t you get about paying for health care? It’s a societal expense. Some are efficient about it and manage to take care of everyone, some are not and leave 47 million out in the cold.
on Dec 6th, 2008 at 9:36 pm
Mark T. - I don’t think you fully appreciate the US’s dominance in medicine. We may be 37th based on socialist WHO criterion but we are number one in most fields and much research effort outside of the US is done in the hopes of cashing in on the US market. Admittedly the French system is one of the best alternatives I’ve seen but any changes to our system must be carefully weighed for world wide ramifications. The French’s medical innovations are small compared to our own.
One last note, where do you get your facts to support the statement that most innovation is goverment funded. I looked but couldn’t find anything that backed you up. I did find this though that credits industry by a large margin for medical research budgets.
http://www.nytimes.com/2005/09/21/national/21medical.html?_r=1
on Dec 7th, 2008 at 12:08 am
Mark T.:
Your Cuba-as-victim story is fairly threadbare. And of course it does not explain why nobody else in the world would do business with them, except for the Soviet Union, until that communist dictatorship collapsed, also. I think you need to look within Cuban to find the reasons for its pathetic existence. Or you can move on to North Korea and try your luck with that failed communist society.
Face it, Mark, you are just promoting another socialist welfare scheme. You have a problem with people paying their own way. In a nutshell, you want somebody else to take care of you. Yesterday it was food, shelter, and clothing. Then it was college tuition. Now it is medical care. Is there no end to your continual panhandling? Try doing something on your own hook for a change. You might like it, and you will feel a lot better about yourself and your country.
Carol:
At the outset of this thread you said, “I realize it’s probably going to happen in one form or another.” That is fatalism. And that is how the socialists win. They keep coming back with the same failed ideas, year after year, and before you know it, they have you believing in the inevitability of their schemes.
Look at what will be occupying the White House. Do you think that was inevitable?
on Dec 7th, 2008 at 9:50 am
wolfpack - just as you ask me to put up information concerning research, so too should you back up your statement I don’t think you fully appreciate the US’s dominance in medicine. We may be 37th based on socialist WHO criterion but we are number one in most fields and much research effort outside of the US is done in the hopes of cashing in on the US market. Sounds like mindless flag waving to me.
Private industry does indeed fund most research, but it is of the commercial-oriented variety - that is, they don’t invest in ventures that don’t show potential for near-term profit. That is done by government. Once there is a breakthrough, industry steps in, but it is government that funds the breakthrough. This is the model for most research in all fields. Hence, the internet.
Max - your condescension is very off-putting. I’m calling you out - you don’t know dick about me, or Cuba.
on Dec 7th, 2008 at 10:23 am
In the land of public health care and with the option to go to France, this Brit came to the US:
http://WWW.breakingnews.iol.ie/entertainment/?jp=mhkfmheyeyid
>>>>
Furnish slams Michael Moore
02/06/2007 - 12:38:30
Elton John’s partner David Furnish has hit out at filmmaker Michael Moore for criticising the US healthcare system.
The star - who lives in England - insists new movie Sicko is inaccurate, and has praised America’s medical services - branding it “the only place to get good treatment”.
He says: “I completely disagree with Michael Moore. With my own father, when he was ill, the only option was to hire a jet and fly him to America. It was the only place to get good treatment.”
<<<<<<
It’s telling beyond the rhetoric when people of means vote with their wallets as to purchasing quality.
on Dec 7th, 2008 at 10:48 am
Anecdotal. If you had read Carol’s links above, you would have seen a comparison between the French and UK systems, the French far outshining the Brits. If the UK changes, it will be more like the French - not us.
Part (only part) of the failing of the UK system is that it is severely underfunded - in 2002, they spent $2,160 per capita, compared to $2,736 in France. They are at a point where many realize that changes are needed, but I’ll wager that they won’t adopt our failed system.
on Dec 7th, 2008 at 11:02 am
Gosh, a wealthy, educated, and worldly Brit, votes with his wallet and decides that he cannot trust the healthcare of his father to the French when he can choose the US at 37th in rank? Mark T, isn’t it possible that a European like David Furnish knows the relative merits of nationalized healthcare better than you?
on Dec 7th, 2008 at 12:26 pm
Nationalized anything is bad idea. There is no sense arguing about it. History has already passed judgment on it.
Mark T. would have you plow through dubious statistics and get you arguing about this number versus that number. For example, he claims Cuba and America are ranked about equally for healthcare. But anyone can play that game. (Cuba has five healthcare workers for every 1000 people. America has 55 healthcare workers for every 1000 people. Source: National Geographic, December, 2008, p.78.)
But all you have to do is look around at the world: No one is better off when the government controls an enterprise.
Healthcare is not a human right. If you think it is, then you will be drawn into arguments such as you see here, hopeless statistical arguments that have no end. Once you accept the premise that “something must be done,” then you are sucked into the downward spiral of “what to do?” The only outcome you can be certain of is that your money will be given to somebody else.
on Dec 7th, 2008 at 12:55 pm
“That is fatalism. And that is how the socialists win.”
I owned up to that in #40. Maybe it’s not inevitable. I hope you’re right. But to be strictly opposed to something year after year on principle & pragmatism does get wearying, especially when it may not be in my own self interest. If I were truly a Republican greed-head I’d embrace universal health for the reasons Max states in #11 - protection of assets. There are lots of newly unemployed boomers out there with lots to lose who’d like a shot at Medicare because private is $1000/month, but I don’t think the system can bear the load as it is now.
on Dec 7th, 2008 at 1:29 pm
Mark t. - Your ignorant arrogance is getting a little old. You accuse me of mindless flag waving for saying the US is at the top in medical research and for questioning your fact-less assertion that goverment finances most of our medical research. Your only response to me challenging your ignorant claim, with proof, is that industry research isn’t as important so the fact that there is twice as much should be ignored. Also to back up my claim that US medicine is at the top of the field below is a link to Nobel prizes by country. We do quite well by far in a forum where we are not politically favored, not that facts will change your opinion. I have provided backup for what I say, you just provide ever shifting lip service.
on Dec 7th, 2008 at 1:30 pm
The link I promised.
http://en.wikipedia.org/wiki/Nobel_laureates_by_country
on Dec 7th, 2008 at 3:21 pm
Craig - a wealthy person coming here for health care is no surprise. We have a very good system if you are an “insider”. If you’re not, we have a very bad system. No access, you see. Furnish came here because he can afford the very best. 47 million Americans, plus 25 million more that are uninsured, cannot. That’s why we rank down with Cuba. Deal with it.
Wolfpack: I admitted I was wrong about the source of medical research, but what I did find out is that basic research (that which can see no immediate profit on the horizon) is done by government through NIH, colleges and universities. The pharmas, for instance, will research the hell out of any medication they think will have to be taken monthly and produce dependable cash flow, but have given up entirely on things like superbugs - drug resistant strains of bacteria, which do not produce that kind of money. They are of little use.
Max - you said No one is better off when the government controls an enterprise. False statement. The French, with their government controlled health care system, are better off than us. Public fire departments, public police, public roads are all better than private counterparts. It’s an absurd statement. I go back to what I said before:
on Dec 7th, 2008 at 3:49 pm
Mark T, you wrote: “Furnish came here because he can afford the very best.” So, you are saying that a capitalistic US healthcare system has the best care in the world; but you prefer the govt run healthcare systems like France and Britain that Furnish ran away from. Perhaps you will find a cheap flight to take you there. As I recall one of the reasons Furnish brought his father here was the long line that rationing created. His father simply could not wait that long. Book your tickets soon as your treatments may not be sceduled for years. Any nationalized healthcare system includes rationing, as there simply is not any other way to sort and prioritize limited resources for the demand with limited funding. Look at nationalized healthcare on US Indian reservations to see what I mean about rationing.
on Dec 7th, 2008 at 4:03 pm
For a comparison of the French and US models, see these comments by a French expert: http://www.kcpw.org/article/4216
$14B in the hole and sinking fast. Is this what we want to copy?
on Dec 7th, 2008 at 4:56 pm
Mark T:
Again, you need to face up to the fact that all you are doing is advancing another mega-welfare scheme. Your time would be better spent finding ways for individuals to advance themselves so that they can afford to purchase whatever services they need or want.
But no. You would rather see people become less self-reliant and more dependent on the central government. You would rather see people turn to the state instead of turning to themselves, their families, and their friends. Your only interest is in creating a socialist ant pile, with people like yourself at the top.
Well, bad news, Mark. A free society does not work that way. So long as you promote a beggar mentality, you and others like you will stay right where you are.
on Dec 7th, 2008 at 5:18 pm
Craig, there’s not a lot at your link, though this does stand out:
on Dec 7th, 2008 at 5:29 pm
Carol - that’s pretty hard to reconcile with 9.5% GDP versus 16% for us. Your links - the ones you provided - provide better data. SOunds like a hatchet job.
Craig - you don’t read well. I have said repeatedly that we provide very good care to those who get care. It’s the 47 million who don’t get care, the 25 million under-insured, the 500,000 bankruptcies due to medical bills that downgrades our system. What part of that don’t you understand?
Max - do you have a pull-string on your back. You should have been alive in teh 1950’s, when that kind of talk was really popular.
Impeach Earl Warren!
on Dec 7th, 2008 at 5:49 pm
Mark T, I read just fine. Your claim that “47 million Americans, plus 25 million more that are uninsured,” has been debunked: http://www.ibdeditorial.com/IBDArticles.aspx?id=273280379232127 Your genuflection to the French system with its growing $14B deficit is not shared by others like the European, David Furnish, or the French health expert, professor Alice Teil.
on Dec 7th, 2008 at 6:13 pm
Mark T:
Your pull-string insult is really worn out, like most of your ideas.
“You should have been alive in teh [sic] 1950’s, when that kind of talk was really popular.”
As a matter of fact, I was alive during the 1950s. And I can tell you it was not talk. The average American was much better off than he is today. Everyone I knew could afford a new house on a 30-year mortgage and a new car every two years. (The standard automobile contract was for 24 months.) Only the father had to work to support an entire family. And nobody, I mean nobody, ever mentioned healthcare costs. It did not exist as an issue, so far as I know. Indeed, the doctor came to our house when someone was ill. We never went to him.
Thanks to people like you, that easy prosperity is gone. Why? Because research confirms that the general decrease in the average family’s wealth over the last several decades is primarily due to increased taxation. And that is what people like you do—you keep adding more and more taxes to support a larger and larger government.
You fancy yourself as the savior of the people when in fact you are their worst enemy.
on Dec 7th, 2008 at 7:58 pm
Craig - it’s 47 million uninsured, 25 million “under” insured. Your IBD piece doesn’t dispute the 47 million number and doesn’t talk about the 25 million one. They do say
IBD doesn’t get it. I’m aware of the income stratification of the uninsured. I’m part of it. These are mostly people who can afford insurance, but can’t get it because insurance companies refuse to issue them a policy. IBD is out of touch, like you.
Max - it has come down to this: You’re full of it. research confirms… - that’s nonsense. There’s no research to confirm any of what you say. Tax rates were higher in the 1950’s and 1960’s. End of story.
Honest, I thought more of you, as you come off as erudite and knowledgeable, but the bubble just popped.
Listen guys - enough - Craig - you’re insulated and don’t want to acknowledge that we have a problem, or, god forbid, that the market could be causing it. Max, you seem to be aware of the problem, but you seem a social Darwinist - let them perish.
Fine. Out of the way, both of you. Others will work on this problem.
on Dec 7th, 2008 at 8:21 pm
Mark T, enough of your prevarications and judgments. Deal with the problem of funding versus expenditure imbalance that is wrecking the French system. Deal with rationing where there is a shortfall of healthcare providers and funding. Deal with quality versus mere quantity of procedures. Deal with compulsory versus discretionary participation. Oh, and deal with the reality that you have misstated the numbers, such as the 47 million Americans you claim, which are erroneous. I quoted you exactly above and you fail to acknowledge your errors. All of this is a lot to deal with as you work the problem.
on Dec 7th, 2008 at 8:35 pm
Craig - I’ve dealt with every issue you raise, dammit. You’re merely stubborn.
Funding of the French system - they ahve a shortfall, but with a GDP of $1.9 trillion, they’ll manage.
Quality versus quantity? You wanna be a little more specific?
Compulsory versus discretionary - you might want to read up on the nature of health insurance, and adverse selection.
47 million uninsured - I’ve broken down the numbers here or elsewhere for you. The number is real. Included are people who cannot get insurance, no matter the price (IBD’s problem), legal aliens, the working poor and middle class people who don’t have access to employer-sponsored insurance, and young people who simply don’t want to pay for insurance. It’s all there for you to learn about.
Craig - you’re simply not willing to face facts. I don’t claim my solution, single payer, is the be-all end-all. But I do acknowledge we have a problem, and that puts me one step ahead of you.
on Dec 7th, 2008 at 10:00 pm
Mark T, you claim is about 47 million Americans. Even the New York Times debunks it. http://www.nytimes.com/2007/11/04/business/04view.html?ex=1351828800&en=7abf86ba1f3f353d&ei=5124&partner=permalink&exprod=permalink
>>>>>>>>
STATEMENT 2 Some 47 million Americans do not have health insurance.
This number from the Census Bureau is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.
To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.
The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.
The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.
Of course, millions of Americans have trouble getting health insurance. But they number far less than 47 million, and they make up only a few percent of the population of 300 million.
Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the work force is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.
<<<<<<<<<
on Dec 7th, 2008 at 10:22 pm
Illegal aliens are not counted in the 47 million. They are unlikely to present themselves for care, as they risk deportation. But legal aliens are. The figure cited by your course seem accurate. I can’t find it right now - but I seem to remember something like that.
I’ve dealt with that part of the population among the uninsured that can afford health insurance but don’t have it - you seem to suffer from the impression that you just go buy health insurance. You have to qualify for it, and the older you get, the less likely you are to qualify. Ever heard of pre-existing conditions? There are hundreds of them for which insurers deny coverage. My wife had a melanoma on her leg removed. She is now uninsurable. That is why high income people don’t have insurance. They can’t get it.
I think he overstates the number of people who qualify for Medicaid but don’t have it. I don’t think that’s true. But it’s late.
50% of the uninsured are people who make less than $30,000, who don’t have access to employer sponsored care, and who don’t qualify for Medicaid. 43% are under age 23. 46% are 25-44. 64% have a high school diploma or less. Denial is a river in Africa.
on Dec 8th, 2008 at 1:04 am
“[R]esearch confirms that the general decrease in the average family’s wealth over the last several decades is primarily due to increased taxation.” (Max Bucks)
“There’s no research to confirm any of what you say.” (Mark T)
“Research increasingly shows that workers are likely to ‘pay’ or ‘bear’ a substantial portion of business taxes through lower wages. Recent research considers the major corporate tax reforms occurring among major industrialized nations over the past several decades and finds that those with the largest reductions in their corporate tax rates experienced the largest increase in wages. The mechanism is less capital investment that reduces labor productivity and, ultimately, living standards.” (Tax Foundation, August, 2008)
My Best Regards to Mark T,
Signed, Max Bucks,
Still “Erudite and Knowledgeable” as Always
on Dec 8th, 2008 at 1:23 am
“My wife had a melanoma on her leg removed. She is now uninsurable. That is why high income people don’t have insurance. They can’t get it.” (Mark T)
Have your high income wife contact Lloyd’s of London. They will insure anyone or anything.
http://www.lloyds.com/About_Us/What_is_Lloyds/Insurance_for_beginners/
on Dec 8th, 2008 at 9:47 am
Mark T, my sister-in-law had a melanoma removed last year. She is still insured under their family policy. I had 2 cancer tumors removed last year. I remained insured under that policy that I purchased myself. Since then I changed coverage for breadth, depth, and cost of coverage reasons. I am still insured. Perhaps you had a lapse in coverage or a period in time when you chose to self-insure. I suggest you revisit your situation, and I sincerely hope you find what you need.
on Dec 8th, 2008 at 12:15 pm
Mark t. - Have you looked into MCHA. It was created in 1985 to address your wife situation. There seems to be some big holes in your knowledge base for a guy who is so sure of the solution for the rest of us. Do some research and take care of your own first.
“The Montana Comprehensive Health Association (MCHA) is a program that offers policies of individual health insurance to eligible Montana residents who are considered uninsurable due to medical conditions.”
http://www.mthealth.org/
on Dec 8th, 2008 at 2:36 pm
As this thread has progressed, it has become evident that Mark T has a personal financial problem obtaining health insurance which he is trying to project onto a large segment of the population. What at first appeared to be some kind of altruistic plea for the greater good now appears to be driven primarily by self-interest.
We have seen this behavior before. Very often, those without the wherewithal to obtain certain goods or services attempt to portray their personal situation as a national phenomenon, indeed, even a national crisis. A teary-eyed single mom testifies before a legislative body that she simply cannot afford a house. And up pops the statistics to show she is not alone. Why, this is a national crisis! Amy gets straight A’s in high school and is showered with all sorts of suspicious awards and letters of recommendation, but she has no money to attend college. And up pops the statistics to show she is not alone. Why, this is a national crisis!
And so it goes. People cannot afford all sorts of things. They can be found everywhere. What is new in that? What is new is that they become a statistical group whose numbers, usually exaggerated, astound the taxpaying population and numb them into silent agreement: Yes, the taxpayer thinks, this is a national crisis!
Thus, Mark T, who cannot or will not pay for his own healthcare insurance, raises his personal problem to the level of a national crisis and bludgeons us with statistics from “his” group.
on Dec 8th, 2008 at 5:36 pm
Back in 2006 things were bad, and are not any better after 2 years of Dem control of Congress: http://www.usatoday.com/news/health/2006-05-18-retiree-health_x.htm
>>>>>>The federal government also has a $2.3 trillion unfunded liability for medical and disability benefits promised to civil servants and military personnel who retire. The costs are not the nation’s biggest financial problem. Medicare has a $33.4 trillion unfunded liability. Social Security has a $4.6 trillion shortfall.<<<<<
How can anyone justify massive new federal spending including taxpayer subsidized healthcare for everyone when the politicos don’t have a clue, let alone a plan, to deal with the growing devil in the details?
on Dec 8th, 2008 at 6:44 pm
Craig Moore:
That is the supreme irony of all this socialist talk about new or expanded welfare programs: The government is broke.
With about 8 trillion dollars already blown on loans and guarantees in just a few months, and all the unfunded liabilities you mentioned, it is difficult to imagine a bigger and better welfare state.
Of course, the last two years of Democratic idiocy might have been the just opening act. There is no limit to the financial damage a government can do once it goes out of control.
on Dec 9th, 2008 at 10:16 am
We are covered by MCHA. It’s very expensive. What I said was that my wife was “uninsurable” - that is, no private company would insure her. MCHA is government sponsored, another example of the private sector dumping their problems on government.
If you have an existing plan and have cancer, you cannot be dropped by that plan - that the law (government enforced otherwise you’d be dumped.)
In our case, we had employer-based care while my wife had the melanoma, and the company dropped the policy, leaving us to go into the private market for insurance. Good f****** luck.
on Dec 9th, 2008 at 11:10 am
Mark T:
Usually, “uninsurable” means no one will issue an insurance policy to cover you. But now it comes to light that you actually do have health insurance. You just do not like the cost.
Well, that is too bad. All of us pay for things we think are too costly. But the important thing is, we are not forced to pay for them. And no one is forcing you to pay for health insurance, at least not yet.
On the other hand, you seem to have no problem forcing others to pay for some or all of your health insurance. That seems rather selfish of you, not to mention awfully hypocritical.
I repeat what I wrote in #11, above: Universal health insurance is nothing more than a middle-class scheme to protect assets.
on Dec 9th, 2008 at 12:41 pm
Mark t. - The premiums for MCHA are needs tested. If you are poor then your premium is subsidized. Instead of being upset about having to pay your fair share you should be thankful that you are not poor. Your personal circumstance seems like a success of the system not the failure you assert.
on Dec 9th, 2008 at 12:49 pm
Mark T, I have pounded on you over your prevarications. Now, you reveal that you have misled people here with your parsing of the word, “uninsured.” You tried to paint yourself as a victim. What a fraud!!!! I believe you to be with such misdirection.
You have a loss financing situation to fund. Deal with it with the alternatives available to you. Self-fund or buy the MCHA policy.
on Dec 9th, 2008 at 1:05 pm
After reading what happened to Mark T over at the Electric City Weblog, I am beginning to understand why he is “uninsurable”: He gets the hell beat out of him wherever he takes his traveling snake oil show.
on Dec 9th, 2008 at 2:14 pm
You guys don’t read well. I said my wife was “uninsurable”, meaning that no private company would touch her because of a preexisting condition. As a result, we bounced all over the place, doing fake-employment in Colorado to get on a group policy, getting Cobra’s on that, finally winding up with MCHA.
MCHA is a government-sponsored program for people whom the private sector won’t touch becuase they are potentially not profitable. If you think that it is an excuse for private sector failures, you’re wrong. It’s just their way of dumping their problems on government so they can cherry-pick the population for profit. That’s a failed system.
FYI, there are 77,000 uninsured Montanans, and only about 3,000 can afford MCHA.
Regarding Electric City Weblog, Max, you remind me of the duncecap Eric Coobs, who perpetually declares victory no matter how bad he performs. I took Natelson on, because I regard him as a fraud and a phony. Regardless of your opinion, others told me I held my own quite well.
on Dec 9th, 2008 at 2:34 pm
“I took Natelson on, because I regard him as a fraud and a phony.”
What would you call that—War of the Frauds?
“Regardless of your opinion, others told me I held my own quite well.”
Yeah, I read Wulfgar’s attempt at giving you succor. Some fan club.
In any event, your credibility is shot.
on Dec 9th, 2008 at 2:59 pm
Not hardly.
on Dec 9th, 2008 at 4:42 pm
I took a look at your discussion and see many good points. I do have a couple of quibbles.
By the way, Dr. Kennedy’s praise for the French healthcare system makes no mention that it is currently about $14B in debt and loosing ground. So what problem does the French system solve if that system cannot pay for itself?
The problem with this statement and the link to the French physician’s comments is that the debt is not the healthcare system. Look again at that link. You will see:
Workers pay about fifty percent of their paycheck each month into healthcare, retirement and unemployment and more companies are outsourcing jobs to avoid those costs. Quality of care also suffers in France, says Teil, because hospitals and doctors resist government requirements to report their success and failures.
What is killing France is the 35 hour work week, high costs of employment, such as extreme difficulty laying anyone off so employers avoid new hires if at all possible, and high unemployment. Health care costs are about 14 % of GDP. well below ours. We could easily afford the French system scaled up for our larger country.
Two major problems I see in making such a change, however. One, the French legal system is different than ours and may save a lot of malpractice lawsuits. Two, we have filled our system with mandates that may be difficult to undo.
The uninsured are made up of, roughly, three groups: free riders, illegals and people with legitimate issues like pre-existing conditions. I have another post in that series called “When free riders get sick.”
on Dec 9th, 2008 at 5:21 pm
Mike K:
It is the total government burden on a worker’s paycheck that matters, which you have indicated in your comment to be about 50 percent. I am assuming the 50 percent figure is actually an income tax split among “healthcare, retirement and unemployment” contributions. I hope so! Otherwise, if the French worker must pay more taxes on top of that, he has been buried by socialism.
Americans can “easily afford” a lot of things. The US Government cannot.
Your division of uninsured persons into “free riders, illegals and people with legitimate issues like pre-existing conditions,” does not account for all the people who simply do not want health insurance.
Whatever. I reject your unstated premise that universal healthcare or universal healthcare insurance is a public good, a human right, the sine qua non of an advanced society, or merely something a good Christian nation ought to have, etc., etc.
on Dec 9th, 2008 at 9:15 pm
Feel free to reject my premise. I have been working in healthcare since 1962 so what do I know ? I don’t know it is a right but I think, as a practical matter, we are going to get it. My concern is how it is done. The French model is as close as I can come to a private system with the government regulating what is paid for and what the fees are. Usual and Customary fees killed fee-for-service medicine in the US. I covered that in more detail in my book chapter. Here is a a short version.
The taxes the French worker pays are chiefly equivalent to what we call FICA. The healthcare system is more private than ours considering Medicare and Medicaid. I have other posts on some of those issues.
Your division of uninsured persons into “free riders, illegals and people with legitimate issues like pre-existing conditions,” does not account for all the people who simply do not want health insurance.
What do you think “free riders” are ? More here.
on Dec 9th, 2008 at 9:28 pm
Thanks for all your trouble, Mike.
on Dec 9th, 2008 at 9:31 pm
Mike K, what can you tell us about the Dutch system that is the current #1 in Europe. The French system has taken a tumble. Their $14B boat anchor is a problem.
on Dec 9th, 2008 at 9:45 pm
Mike K:
“Feel free to reject my premise.”
I already did, but thanks for your permission.
“I have been working in healthcare since 1962 so what do I know?”
I have been paying taxes longer than that, so whatever you know, I know more. But, again, thanks for the full disclosure.
A “free rider” is not someone without health insurance. A “free rider” is someone without health insurance who expects someone else to pay his medical bills when he requires health care.
I am someone without health insurance. I pay cash for all my medical services. I am not a “free rider.”
The only French Model that ever interested me was Brigitte Bardot.
on Dec 9th, 2008 at 10:06 pm
Dr. K, in addition to your thoughts on the Dutch vs. French systems, how do you feel about healthcare professionals having their incomes take a heavy hit under either system? Why should they be the varible that is “managed?”
on Dec 9th, 2008 at 11:10 pm
Max - the more I read of you, the more I think you’re just an outlier. There will come a time, unless you make it safely to Medicare, that you will qualify as a free rider.
on Dec 9th, 2008 at 11:21 pm
Mike K - I have rad studies of the uninsured, one by Catherine Schwarz, a professor of health economics at Harvard School of Public Health, author of Reinsuring Health: Why More Middle Class People are Uninsured and What Government Can Do”\, and also an essay (not in the internet) called Uninsured in America: New Realities, New Risks. The essay is available in the Book Health at Risk, America’s Ailing Health System, and How To Heal It , edited by Jacob S. Hacker.
I give you all of that to avoid telling you that “studies have shown” without citing, but these studies do show quite a different picture than your reference to “Free Riders” above. That, I think, is mostly anecdotal. The breakdown among uninsured by income stratification is 73% below $48,200, 43% below $30,000. You may dispute affordability at $48,200, but incomes of 30,000 and below usually find health insurance unaffordable.
Then there is the problem of older people with preexisting conditions and the 45 states that allow insurance companies to cherry pick. The older oyu get, the more likely you are to suffer some illness that precludes you from getting insurance.
These problems are intractable in the private insurance model. I too prefer the French model, and I’m not talking about Bridgette Bardot.
on Dec 10th, 2008 at 12:03 am
Mark T wrote: “Max - the more I read of you, the more I think you’re just an outlier.”
Thanks. America was built by outliers.
on Dec 10th, 2008 at 9:41 am
I was thinking of “outlier” more in the John Birch/militia model.
on Dec 10th, 2008 at 10:03 am
Mark T, you stand in the shattered remains of your glass house but you have the arrogant gall to continue to hurl verbal rocks to distract from the issues and your little credibility problem. Instead of inflicting your judgments of others from your view through broken, warped glass, how about you spend more time in front of a mirror and spare us the nonsense.
on Dec 10th, 2008 at 10:30 am
Max B
A “free rider” is not someone without health insurance. A “free rider” is someone without health insurance who expects someone else to pay his medical bills when he requires health care.
I am someone without health insurance. I pay cash for all my medical services. I am not a “free rider.”
Talk to me after you have spent a week in ICU because of an auto accident or had your appendix out. You are a free rider who doesn’t acknowledge it. I’ve spent thousands of hours operating on people like you. Just like you. For nothing.
I don’t know much about the Dutch system but I choose France because it is a big country and has a very free service, much like ours was 30 years ago. The German system was supposed to be the model for the Clinton Plan in 1993 but it is not as free as the French system and has some distortions typical of all German institutions. It’s very hierarchical.
Mark, I was using very rough proportions in my division of the uninsured. I suspect that a very large proportion, depending on the location, of the “under 30,000 income” group are illegals.
I think affordability is an issue but I buy insurance for my kids until they have their own from work. My 18-year-old daughter is a student. I pay 444 dollars a quarter for Blue Shield PPO insurance for her. That’s less than 150 a month. I know that is a big item for someone with an income of 35,000 and, if insurance were mandatory as in Hillary’s plan, the premium would be even less.
I’m the one advocating universal health care, remember. I’m not defending the present system. I just think there is a lot of misinformation out there coming from Canada-style single payer advocates. Almost all the academics advocate Canada-type programs and almost all of them are non-surgeons. They tend to be public health types who are reliably left-wing and have never taken care of patients in any setting except a clinic, if that.
HMOs used to be a reasonable option but they have changed and are no longer a good option. My younger son, who is a fireman, is an insulin dependent diabetic who has been an HMO member. He hadn’t seen the MD for two years and all his treatment was by a nurse practitioner. That’s OK but there is supposed to be supervision. About a month ago, after some discussion about why his blood sugar was persistently high, they fired him as a patient. They told him he was non-compliant and would have to find another endocrinologist. A week later, he was in ICU with sepsis and could have died. I think the sepsis may have been there and they missed it. There are few other endocrinologists around here who will take HMO patients. He is home now and will save his foot but that was crappy care. HMOs have become no better than the county hospital, if that good.
We need a better system but the Canadian system isn’t it.
on Dec 10th, 2008 at 10:58 am
Mike K - I’m glad you stopped by here and value your comments. I read with care and mostly agree with you. I regard the Canadian system as better than ours. What I have read of the French system is impressive. There are many models out there to choose from, but the power of the AMA, hospital corporations and insurance industry is aligned against us.
According to Swartz, just over a fifth of the uninsured are foreign-born. But they are here legally. Illegal immigrants are very unlikely to answer census questions, which is the source of the data.
on Dec 10th, 2008 at 11:24 am
Go to any emergency room after 6PM or go to any county hospital in California. They are filled with illegals. I agree that they don’t respond to census questions but they are flooding the health care system and bankrupting Los Angeles County.
Both the British and Canadian systems are unsatisfactory. What you see in surveys of Canadians are the opinions of those who have not gotten sick. The Canadian system was designed by politicians. It fills GPs waiting rooms with the worried well and routine minor illness. Where it gets into trouble is with sick people and they don’t answer surveys.
France is having trouble with British expatriates who are signing up for the French system under CMU, which was designed for the poor. They don’t want to go back to Britain for health care. The NHS, of course, won’t pay for care anywhere else. The last time I checked, about 25% of the residents of southeast England, the prosperous area around London, had private insurance and did not use the NHS. Like private schools, those people are reducing the load on the NHS and still paying for it. Even so, the NHS can’t take care of everyone who needs it. Doctor morale in England is very low, as in Canada.
Good discussion overall.
on Dec 10th, 2008 at 11:35 am
Heh. I had a friend in London about 20 years ago. He had a lot of lifelong health problems. I said, how is the health system here? I may have called it socialized medicine (quel faux pas!). He said oh it’s great, it’s fine etc. Did they take good care of his many problems? Oh, no no, he said, he had a private plan. He was just a retired businessman but it sounded even then like NHS was for the peons.
on Dec 10th, 2008 at 11:39 am
Mark T:
You wrote: “I was thinking of ‘outlier’ more in the John Birch/militia model.”
The militia made the America Revolution possible. But I would not expect you to know that, which is in keeping with your general lack of knowledge about America and how she became a great nation.
Mike K:
You wrote: “I’ve spent thousands of hours operating on people like you. Just like you. For nothing.”
I rather doubt that. In fact, I rather doubt you have ever met anyone like me. And based on the number of wives you have had, the houses and yachts you own, and your worldwide travel to exotic places, I also rather doubt you did a lot of free surgery.
on Dec 10th, 2008 at 11:49 am
Geez Max, getting a little ad hominemish isn’t it? Mike K paid his dues in the ERs of this world and with volunteer med groups, boards and other civic groups trying to help people in the free-market way.
I invited him to come check out the discussion since he wouldn’t normally take note of it.
on Dec 10th, 2008 at 12:42 pm
Max, you are free with opinions and insults. They are like heads, everyone has one or two. I ran a trauma center for seven years after I founded it. There are a lot of things you don’t know about me. I’ve also attended at the LA County Hospital since 1972. In spite of all the free surgery, I had a very busy practice and made a lot of money. Most of it is invested in ex-wives and children’s college degrees. I’ve had a number of offers from people who would like me to adopt them; or marry them in some cases. Most of them I turned down.
Envy is not becoming.
on Dec 10th, 2008 at 1:15 pm
Mike K - What I have seen of surveys of the Canadian population is that they are generally satisfied, especially knowing they are not threatened, like we are, with loss of estate and livelihood by medical emergency. They debate the cost of the system, they don’t like waiting periods for non-emergent illnesses, but there is no significant movement to go back to the private insurance model. That’s common throughout the industrialized world - no country that has gone to a universal system has ever gone back to private, except Iraq, but that was done by decree of Paul Bremer.
Great Britain’s biggest problem is that they underfund their system. I don’t know that 2% more of GDP would fix it, that it isn’t poorly designed, that they might not want to move towards the French model, but they are underfunded. That wealthy people get good care there, Carol? Your point?
I don’t dispute that emergency waiting rooms are popualted by illegals. That was not the point. We were taling about the census and the makeup of the 47 million. Illegals were not part of it. Include them, and you have a much higher number.
on Dec 10th, 2008 at 1:43 pm
My point was that a non-wealthy pensioner touted it but did not rely on it. Not damning so much as telling.
And I have no doubt that people will never willingly give up an entitlement. The Canadians are used to what they have and know they can come here for treatment if need be.
on Dec 10th, 2008 at 1:52 pm
Aye yi yi. The Canadians-crossing-border-for-care myth has been debunked time and again. Cite, dammit.
Read this.
on Dec 10th, 2008 at 2:20 pm
Carol, you have a lively blog. The 47 million uninsured number includes the illegals and is probably inflated by many who are transiently uninsured between jobs. Stiil, try to remember that I am not supporting the present system.
The Canadian crossing the border story is supported by the huge medical centers in places like Spokane and Minnesota and Buffalo. They have a significant number of Canadian patents coming there. I used to go to surgical meetings in Canada and finally quit after all the outstanding surgeons had emigrated. The Canadian government closed nursing schools and stopped hospital construction. They cut back on medical school enrollment saying, as a policy pronouncement, that they would import third world doctors as it was cheaper.
I was at a quality improvement meeting a year and a half ago with a Canadian hospital architect who told me they have finally decided to go back to building hospitals after 15 years of stagnation.
This is not gleaned from some left wing blog. These people are people I know. You, of course, are free to believe what you choose to. I also know many British physicians and am familiar with the NHS. I served as a consultant to the NHS in 1994 when they were implementing the fund holding system. Being an expert as you are, I’m sure I don’t have to explain that to you, or its significance.
Have a nice day. Good comments.
on Dec 10th, 2008 at 2:37 pm
Mike K:
If you do not like insults, you ought to be careful whom you call a “free rider.” As for envy, I am reasonably certain I could pay cash tomorrow for all your houses, your dingy, and the entire marina where it is tied up. However, I am not sure if I would be interested in any of your ex-wives.
Carol:
If your friend Mike K wants to talk about how Galileo obtained the mathematics chair at the University of Padua, or why Tycho Brahe’s bladder exploded when he was hit by a carriage, fine. But when your friend Mike K–or anyone else–talks about spending my money in any way, shape, or fashion, this junkyard dog comes off his leash.
I think that I have some very interesting observations about Mike K and Mark T and the different worlds they inhabit, and why they are both interested in some sort of universal healthcare or universal healthcare insurance. But I will file a demurrer instead and withdraw from this discussion.
I apologize to you if I have insulted your guest. But you really ought to be more circumspect when sending out invitations.
on Dec 10th, 2008 at 3:44 pm
Aye yi yi … again.
Mike K - the 47 million number does not include illegals. It just doesn’t. It’s from the census, and illegals are not part of the census. You’re not paying attention.
Your statement about Canadians coming down for treatment is anecdotal at best. I’ve seen no study to support it, but several that debunk it. Try this one.
Up to this point, you’ve been pretty good. You just went off track.
on Dec 10th, 2008 at 4:00 pm
Oh dear. Is it happy hour yet?
on Dec 10th, 2008 at 4:45 pm
Carol, this Happy is for you: http://www.bitstorm.org/happyjoy/
on Dec 10th, 2008 at 5:17 pm
Carol, you have lots of experts so you don’t need me. Free Rider is a term of economics, sort of like Tragedy of the Commons. Anyone who brags about not having insurance when he can say, “I am reasonably certain I could pay cash tomorrow for all your houses, your dingy, and the entire marina where it is tied up.”, is a classic free rider. Here’s a link to one story.
Canada made a serious error in the design of their plan when they banned private practice. That might have avoided a lot of the rationing and kept in country the thousands of anecdotes who cross the border for care every year. The NHS corrected some of this during the Thatcher period. One correction was Fundholding.
That’s enough for me. You experts can take over.
on Dec 10th, 2008 at 6:53 pm
Didn’t read the study, did you Mike. Prefer not to have your treasured fallacies rained on?
Did you read the study, Carol? Just curious. I read all five of your links that started this free-for-all.
on Dec 10th, 2008 at 9:17 pm
Ok I read and it doesn’t debunk what I said. Canadians do come to the US for treatment for one reason or another. So, not in droves, but that’s not what I said anyway. Our system does seem to be a nice complement to theirs. And in similar ways the Mexican system seems to serve the SW border states. If we all went on the same system then *theoretically* anyway the medical tourist has to travel farther.
So there…
on Dec 10th, 2008 at 9:51 pm
Oh yeah. It debunks. It’s not the only study done reaching the same conclusion, either. The myth of Canadians coming to America for health care is just that. Statistically insignificant.
on Dec 11th, 2008 at 12:03 pm
“And the lights all went out in Massachusetts…”
Before Massachusetts enacted its mandate, it had a little more than 600,000 uninsured residents. Under the new program, about 219,000 previously uninsured residents have signed up for insurance, but nearly all of them receive subsidized coverage. Another 70,000 have been signed up for Medicaid. But fewer than 30,000 unsubsidized residents have signed up as a result of the mandate. Despite the mandate, as many as 300,000 Massachusetts residents remain uninsured.
And while failing to achieve universal coverage, the Massachusetts plan cost taxpayers a great deal. It is now expected to exceed its budget by $150 million to $400 million over the next year, and $2 billion to $4 billion more than was budgeted over the coming decade.
–Washington Post
The subsidized insurance program at the heart of the state’s healthcare initiative is expected to roughly double in size and expense over the next three years - an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions.
State projections obtained by the Globe show the program reaching 342,000 people and $1.35 billion in annual expenses by June 2011. Those figures would far outstrip the original plans for the Commonwealth Care program, largely because state officials underestimated the number of uninsured residents.
***The state has asked the federal government to shoulder roughly half of the program’s cost from 2009 through 2011,*** but there is no guarantee of that funding. Commonwealth Care provides free or subsidized insurance for low- and moderate-income residents.
“The state alone cannot support that kind of spending increase,” said Michael Widmer, president of the Massachusetts Taxpayers Foundation, a business-funded budget watchdog group.
–Boston Globe
on Dec 11th, 2008 at 12:10 pm
Are they talking about MittCare®?
Clearly, Congress has to act!
on Dec 11th, 2008 at 12:42 pm
>>> Are they talking about MittCare®? <<>> Clearly, Congress has to act! <<<
Take a number! Get in line!
2011– “Hello? Beijing? Obama here. We can’t pay for our national healthcare insurance. Any ideas?”
on Dec 11th, 2008 at 1:17 pm
“And the lights all went out in Massachusetts…”
Mass. Turnpike moving to lay off 20 toll takers
December 11, 2008 1:50 PM ET
BOSTON (AP) - The Massachusetts Turnpike Authority has begun the process of laying off 20 toll-takers, the first cuts aimed at saving millions of dollars by eliminating 100 tollbooth jobs.
Executive Director Alan LeBovidge told board members Thursday that layoff notices have been sent to the workers, who make an average of about $70,000 annually. The 20 workers previously volunteered for a layoff.
LeBovidge said the cuts would initially save about $1.4 million and $10 million annually when the full total is reached. The goal is to complete the staff reduction within a year. The Turnpike currently has about 400 toll-takers (400 toll-takers x $70,000 avg. salary = $28 million per year), but the agency has been moving toward electronic tolling to increase efficiency and reduce personnel expenses.
The layoffs come as the authority works to find ways to cope with $2.2 billion in Big Dig debt. Members voted last month to nearly double most tolls — from $3.50 in Boston tunnels to $7, for example — to generate about $100 million in additional annual revenue for debt service.
The proposal has touched off angry protests from commuters, as well as from residents of East Boston, Winthrop and North Shore communities who fear high tolls will leave them isolated and push a disproportionate share of the Big Dig cost onto them. The board must vote one more time to raise the tolls.
Board Chairman Bernard Cohen also told the members the authority is preparing a major infrastructure push to be ready if President-elect Barack Obama makes good on his talk of an economic stimulus program after taking office next month.
“We want to be ready when the money comes,” Cohen said.
on Dec 11th, 2008 at 1:17 pm
One problems with the MA approach - it subsidizes insurance companies, who are by their nature inefficient. In order for national health care to work, you’ve got to eliminate the hundreds of insurance companies, their high overhead, and cherry picking.
Would one of you, any one of you, stop and explain why other countries manage to pay for health care for all of their citizens at half of what we pay? Good care - countries with higher life expectancies, high cancer survival rates.
Any one of you?
on Dec 11th, 2008 at 2:48 pm
Rejected–Other countries manage to pay for health care for all of their citizens at half of what we pay. Good care - countries with higher life expectancies, high cancer survival rates.
Reason–Faulty analogy. Other countries do not have 25% minority populations.
on Dec 11th, 2008 at 3:20 pm
Ehhh, Max, what am I gonna do with you. You do know you have a static IP, right?
on Dec 11th, 2008 at 6:04 pm
It is those college interns in my office. I have something over 200 servers they can use, but they will not switch when they use my machine.
How do you like this IP address? Does that make you feel better?
on Dec 11th, 2008 at 6:11 pm
Whatever.
on Dec 12th, 2008 at 5:09 pm
Funny thing, Max - it sounded like you.