Want to get a broad ranging discussion going.
In the wee hours of the morning I got a tweet from the President indicating that the Senate had just passed comprehensive health care reform.
I have more questions than answers. What are your thoughts? All opinions welcome.
My questions and comments:
1) Is America too big for a national plan? Is the reason it works in Europe and elsewhere that those countries are smaller?
2) We have a functioning “junta” or “cartel” of health insurance companies which continue to mess with me personally. I’m the healthiest almost-50 year old I know (oldest person I know who shreds the half-pipe snowboarding), and my premiums are an outrage. I just tried to switch companies to get a better rate and got refused. Am sure I’m not alone. What’s your experience? Especially those, like me, who are self-employed.
3) This cartel did everything it could to block any reform. The cartels have to be broken. That is the job of government. Where is Teddy Roosevelt when we need him?
4) American health care is only good if you have a solid government/public job, an exceptional employer, or are simply too wealthy to care about insurance. Otherwise, you may as well live in Cuba or Poland.
5) Our lack of ability to insure our population has led to bizarre use of emergency rooms as public clinics. This costs all of us.
6) Billing is outrageous; ask for an itemized medical bill and you won’t believe what you get charged for sheets of paper and cotton balls.
7) No nation spends as big a percentage of our income on health care as we do.
8] Christian conservatives have a bizarre allergy against health care reform. It’s as if Jesus wants us to call our Senators to keep the cartel in power.
9) Our biggest health concern is obesity. Fat is the “new normal.” The cost of this, long term, is a bill we cannot, as a society, pay.
10) The government is not totally useless. They put a man on the moon. They whupped the Nazis. They built the interstate highways. They designed this internet. We have socialized fire departments. Socialized traffic lights. Health care? What do you think? And, “government is useless” is not an intelligent reason not to go there. There may be good reasons why government should not regulate health care, but blanket cynicism is not helpful in a nation with government “by the people.”
11) When I lived in Chicago, there was a free hospital–Cook County General. Whatever happened to hospitals like that in our big cities?
12) Before you complain about Canada’s system, have you actually talked to a real Canadian about it? Or just listened to talk radio?
I don’t, obviously, have answers. What do the rest of you think?
David Housholder Essays 
81 comments
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December 24, 2009 at 4:17 pm
Randy Wawrzyniak-Fry
Your constant depiction of America’s health insurance companies as a “junta” or “cartel” is inflammatory and certainly shows a closed mind on the subject, which surprises me. Your categorization of health care companies is based on your own experiences with and since, in your own eyes, you are a very low risk (btw a self employed, almost 50 year old who engages in potentially dangerous sports is not low risk) it must mean that there is a conspiracy afoot to keep you paying ridiculous rates.
The answer to your particular issue is not for the government to create less competition but for it to allow more. Our free enterprise society has yielded the best health care in the world. It grieves me to think of all the advances that might have come in the next 30 years will not happen because a government bureaucrat will be making decision instead of the free market.
The end result of what our government is pulling off will be that our children will be saddled with a huge debt to pay for substandard health care. But hey, you might save a few bucks so I guess that makes it all right.
I apologize for my own inflammatory rhetoric but I am so incredibly saddened by the things that have happened in Washington this year. The things that made this country great are slowly and systematically being stripped away. Our country, our future, and our children’s future will be the worse for it.
December 24, 2009 at 4:27 pm
David Housholder
In no objective, measurable sense do we have the best health care system in the world. There is no serious movement afoot anywhere in the developed world in other countries to abandon their system for ours. If you want a good laugh, suggest it to them.
No one else suggests that we have the best system except some of us.
You need to get out more 🙂
Your points on the direction of the country, however, are well taken.
December 24, 2009 at 6:54 pm
Daniel Pettit
Wow Hous I am very surprised with your attitude on this post. Considering some of the inflammatory statements you start out with it is hard to believe you really want to discuss this issue. With your condescending reply to your first poster it is obvious to me that discussion is mute. IMHO making a personal dig and then mitigating it with a smiley is not conducive to open safe dialog.
December 25, 2009 at 12:07 am
Randy Wawrzyniak-Fry
First of all Daniel, Hous and I have known each other for years and I did not take his reply to me as an insult. He’s wrong, but not insulting. I could post links supporting my opinion but there is no point when minds are made up. Besides it’s Christmas Eve and I have a lot better things to do. We’re iced in here in the Midwest so I’m relaxing with my family watching Christmas movies.
Merry Christmas to all, and to all a good night!
December 24, 2009 at 5:10 pm
Dennis
Well, I guess it’s how you define “health care system.” When it comes to availability, quality, innovation, development, etc. you know, the things that give quality to the service provided, then yes, the American system is quantitatively hands down the best in the world.
American health care facilities are full of health care tourists who have come here because their “superior” system has either denied them the service, the wait for the service is too long, or the health ministry has decided that the cost of offering the procedure is too high. So they save their money & come to the United States, where they can decide what is too expensive, & analyze the cost/benefit parameters for themselves. So they do choose our system over their own, when it benefits them.
The major problems with US health care is actually rooted in government control. giving the government more control to fix their ineptitude, especially when they clearly don’t even recog nize themselves as the problem, seems quite illogical.
December 24, 2009 at 5:20 pm
harveykate
A few ideas on this topic from a theological standpoint?
First, what is our idea of healthcare? Is it to care for our existing health or to help us, at any cost, avoid death? How can we have a governmental health care system avoid taking a religious standpoint (especially a secularistic avoidance of death) when it has the reigns of life and death in its hands? Stanley Hauerwas speaks of how we seek to avoid death and use healthcare in this sort of manner. So often we want to die old, in our sleep, painlessly, quickly, and without being a burden to others. As Christians, our mindset should be on living in eternity, not spending as long on earth as contemporary medicine deems plausible. Until the government determines a secular ideal of death and Christians form a Christian ideal of death, we may have problems. After all, we’re supposed to be those who follow a crucified and suffering God.
Secondly, I wonder if we are truly loving our neighbor as ourselves in our critiques on healthcare reform. Sure, this bill may not be to my benefit, but does it benefit society as a whole? How may this bill benefit my neighbor in need? What is the eternal significance of you paying more to help with the costs of those who can not afford healthcare?
Perhaps if the church were the church (google: “The Dream Center”), we would be taking care of the poor and the government would be asking us for solutions, instead of people trying to make the government do the job of the church! Jesus never weighed in on what Caesar was doing (though many rabbis in his time did), but instead he just did the kingdom!
December 29, 2009 at 11:58 pm
Maggie
I agree with what you have said. We need to spend less time thinking about how things will effect us as individuals, but how it will effect (for better and for worse, everyone.
And yes, are we simply trying to avoid death at all costs and calling it “healthcare”.
I do not think that a government is the solution to our problems…we are the solution to our problems. When people are caring for people, and families for families than we will see change. Of course that does not negate medical treatment, but when weare happier, we are healthier. Maybe we need “universal love care”. : )
December 24, 2009 at 6:58 pm
David
This is one of the most perceptive blog postings I have read on this topic. Good work David.
I want to echo your comment that the U.S. is not thought to have the best health care system in the world. In fact, many measures put us far down the list. Read this article to get a quick overview: http://www.nytimes.com/2009/11/05/opinion/05kristof.html?_r=1. As the author points out, “We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the United States is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland.”
There are many other statistics in the article that point out just how badly our health care system stacks up against others. Yes, we do a great deal of research and a for-profit system funds much of that, especially in the pharmaceutical business. And that won’t change with the reforms that have passed the House and Senate.
As for the health tourism argument, note that that is a two way street. Many Americans go abroad each year for the same kind of medical tourism. They purchase affordable drugs in Canada and Mexico. They go to India and Vietnam for surgery. They do this because otherwise they cannot afford their treatments. Is this our idea of how more competition will work? Americans going to the 3rd world for health care? Buying drugs from companies unregulated by the FDA because that is all they can afford? It is time to be a little more realistic about health care. There is a place for market competition in some aspects of health care, but there is also a need to recognize that the market has failed us badly in this area. The market is not the only or best solution to our need to provide affordable quality health care to everyone, nor to our need to control rising costs (which are a burden for both business and government). We need to recognize a right to affordable quality care for all Americans and we need to insure that the profit motive does not interfere with that right.
The current legislation is far from perfect. But it does set the stage for providing affordable health care for most of the Americans that do not currently have insurance. It will alleviate, at least partially, a burden that has made American business less competitive around the world. And it will slow the rise in cost of our health care system. This health care reform will free us and our children to be more entrepreneurial without having to worry about whether or not we can afford to get sick.
The ability to meet these kinds of needs — to rise to the challenges that face us and develop policies that allow us overcome them — are precisely what makes this country great. Randy, above, seems to live in some other country, one that shrinks from its challenges and that has a diminished sense of ambition. I live in the United States, a country with vast ambitions, vast resources and a great sense of collective destiny. I believe that our best days are in front of us.
December 24, 2009 at 11:56 pm
Randy Wawrzyniak-Fry
Using a Nicholas Kristof opinion piece in the NY Times as evidence in a debate about the free market is hilarious.
December 25, 2009 at 4:31 am
David
Does that mean you think the numbers are lies? Because if you have better numbers, let’s see them.
December 24, 2009 at 7:02 pm
Sue Krautbauer
I believe that healthcare needs reform, because insurance premiums increase without many checks and balances…Doctors can’t afford to be general family/internist doctors unless they specialize so they can charge more, businesses struggle to provide plans that are affordable, etc. HOWEVER, with that said, federalized medical care is a scary place to head, folks. Nationalized databases of your medical information (private) is very scary big brother stuff, frankly I’m nervous about that – especially in relation to end times. But that’s another topic for a different post….I digress.
Back to my point – by spreading the costs across all states you penalize those states that are managing the healthcare issue better than others. Case in Point: I lived in California for 16+ years and for many reasons, including the then obvious financial crisis that CA was obviously heading towards (and is currently mired down in today), we moved away from CA in 2001. We now live in MN, and Minnesota ranks third in the nation in the percentage of people who have health insurance, according to recent figures from the U.S. Census. Specifically, figures released September 2009 estimate about only 8.7 percent of Minnesotans don’t have health insurance coverage. This is directly opposed to our fellow states which hug our national borders; CA, which stats show 18.6% uninsured averages, Texas leads with 24.4% uninsured and Florida tucks in-between with 20.5%. So practically speaking, if national reform levels the playing field, I’ll see my MN premiums go up to accommodate (smooth out) those states which aren’t performing well. BIG OUCH. My preference, let the states handle their own healthcare – our constitution was formed to keep primary control of most things at the state level, so why do we keep thinking that pushing things to a federal level will be a cure all?
BUT, an even bigger issue and is somewhat hidden in all the noise/debate regarding national healthcare coverage, is specifically claims approval. You can mandate federal health coverage so the individual is covered and thus is paying ‘affordable’ health insurance premiums, but if your illness or physical issues are denied coverage, then the insurance is just a pretty policy that does the individual very little good. The CA Nurses Association issued a press release on 9/2/2009 that outlines this much larger issue:
For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.
Claims denial rates by leading California insurers, first six months of 2009:
• PacifiCare — 39.6 percent
• Cigna — 32.7 percent
• HealthNet — 30 percent
• Kaiser Permanente — 28.3 percent
• Blue Cross — 27.9 percent
• Aetna — 6.4 percent
So, I say rather than legislate mandatory healthcare across the entire US, perhaps a better solution is to a) cover high risk folks with a government subsidy so it’s affordable, and b) start looking closer at public and private claims histories – which affect each person individually.
Last but not least, let’s rethink ‘show up and treat’ regardless of citizenship. I understand the humanity reasons behind providing emergency care at our public hospitals for illegal aliens, but fiscally speaking, plug that hole by mandating Citizenship at point of healthcare access and we might stop some of the fiscal hemorrhaging across the nation. Ah yet another digression and a topic for another time.
I don’t propose to have anything but a lot of opinion about this topic, but admit it, the government has traditionally been very adept at taking private programs, public-sizing them and then screwing them up completely. I say Pelosi and crew, stay out of healthcare, except to provide a safety net for those high risk folks with a subsidy to assist them.
‘Nuff pontificating on my part. Blessings to all!
December 25, 2009 at 5:37 am
David Housholder
The denial rates are truly amazing.
December 24, 2009 at 8:59 pm
Bob M
This may really be a sad time for our great country’s future. First I must say to David, above, what has made this country Great is not what the Federal Government has been able to do for us. There is little that they do well without HUGE amounts of money! Our best days are not in front of us if this out of control spending government continues to take more and more of our money and spend it (and increase the debt, as well) so inefficiently on things they were never given the authority to be involved in!
Many things in this country are far from perfect and yet among the best in the world. Health care IS one of those things. Our system does not work perfectly – By Far! What country has a system that works better without half of the federal budget going to make it happen. Besides, WHY is it the role of the federal government to fund health care? I have not found that in ANY of our Founding Father’s papers – Did I miss it?
It would be great if our health care system would work better!! It would be great if no one (Yes-especially the children) would ever have to be sick or when they got sick the could get health care to help them…BUT, That Does Not Mean That it Is A Right!!! Can we actually say that Health Insurance is a God given right, just like Life, Liberty, and The Pursuit of Happiness?? If so, where does it stop?!?
When the federal government supplies all of our needs, we are then slaves to it as the debtor is to the lender!!
Proverbs 22:7
The rich rule over the poor, and the borrower is servant to the lender.
December 24, 2009 at 10:22 pm
David Housholder
Great posts everyone.
Thanks for contributing. Please give others the link and have them post.
More questions:
1) What is a family-values free-market libertarian like myself supposed to do if I truly believe that our current system is a mess? I feel /intense/ pressure from all non-Democrats and non-Liberals to pretend like our system is really great as it is. It isn’t.
2) The senate plan has no public option. Thus no “socialized medicine.” No fair jousting at a straw man.
3) Wouldn’t caps on medical lawsuits and allowing people to cross state lines to get insurance help a lot? How about if we allowed foreign competition in the insurance business?
4) I’m not advocating government takeover of anything. But praise God they regulate (USDA) the purity of your Christmas dinner. Regulation is not all bad. The whole criminal code is regulation. We reject toys with lead in them from China. Why? Regulations. I am pro-small-government. Way small. But I am not cynical about all government. Humans need some “chalk lines” on their football field. And umpires. Otherwise the strong and the rich run everything, consolidate their hold on things, and disappear into gated communities, sending their money abroad. I am for democracy, not aristocracy. Unregulated society leads to aristocracy. We need to continue to level the playing field so it is fair for everyone. America is based on the rejection of inherited privilege (nobility in all of its economic and social forms). Have you ever met a California trust-baby?
December 25, 2009 at 12:20 am
David
Again, David H. makes excellent points here. (And he reminds me that I must acknowledge the complexity of our relative worldviews, since there is so much we don’t agree about, but we do clearly share some ideas here, so I vow to be careful in responding to his thoughts on other things as well…)
1) For Bob, it is nice to assert that our health care system is best, but the numbers, which I cite above, do not back you up.
2) The argument that the “founding fathers” did not declare health care a right is entirely irrelevant. They did declare some interesting things about Indians and slaves that we no longer accept. We get to change our rights, our priorities and our ways of doing things. That is one excellent aspect of the system our founding fathers set up.
3) For Sue K.: I am amazed by the selfishness of much of your argument. You seem to want to want each state to operate as a distinct country. But the wealth and strength of the U.S. comes from the whole country. Minnesota is a nicer place than most (with excellent social policies not available in more conservative states, as well as higher taxes to pay for them), but it would not be as wealthy without the rest of the country.
4) Also for Sue K., as David H. pointed out, there are a lot of straw dogs in your argument that have nothing to do with the actual health care legislation. Immigration is one of them. I find it even more notable that you don’t seem to care if the immigrants in question are legal or illegal or even if they have paid for insurance or for their care…you just want to draw a line at citizenship. How inhospitable. Since so many people who write here are fond of quoting biblical verse, let me add a final note from Leviticus (19:34) on this topic that guides my thinking in matters regarding immigrants (and health care, for example) and hospitality in general:
“The stranger who sojourns with you shall be as a native from among you, and you shall love him as yourself; for you were strangers in the land of Egypt. I am the Lord, your God.”
Perhaps that only applies to my people, but not yours. Then again, immigrants are hardly the main issue here.
December 25, 2009 at 2:45 am
Mark Strandjord
This will always be a debate. It’s human nature to protect self-interest. I pray the Health Care Reform will benefit many that presently cannot afford it…knowing it will be taken advantage of at the same time. Personally, I trust Jesus alone. He is my Benefit Provider and He is my Retirement Package. Compared to eternity, life is a momentary mist, now here and quickly gone. I’m a missionary that cannot afford good health insurance. Whether, the Government’s health care reforms benefit me or not, is not important. I’m secure in my Heavenly Daddy’s love. Even if I die from a disease because of lack of coverage…I’m eternally secure. I pray our Heavenly Daddy blesses each and everyone of you with His Peace and Joy during these season.
December 26, 2009 at 7:51 am
Luthor Nelson
Inflammatory language like “junta” and “cartel” reminds me of Obama’s continuous habit of demonizing almost every industry except legislators. “Surgeons cutting off legs and tonsils from people that don’t really need them removed.” He goes on and on about pharmacies and you name the industry, he seems to hate them all. What makes you feel like there is such a glut of evil people in health insurance industry over any other? What makes them so suspicious? Are they much worse than life or car insurance companies? Part of the problem is car insurance doesn’t change our brakes, it doesn’t change our wiper blades but we expect our health insurance to take care of every sniffle. We have removed people from any connection to their health care costs. We should all cover our routine costs and just have insurance so big stuff doesn’t put us in the poor house, that is real insurance, not full health care.
Most of the problems related to biggest problem you seem to have with insurance companies is related to the high price and lack of flexibility. Again, most of that comes to special interests in each state legislating coverage for things the average person may not want his insurance to cover but are made to by law. You can’t buy health care in Washington state without mental health coverage. That contributes to high rates there and they can’t go across state lines to get insurance that doesn’t include that.
In #8 you talk about Christian conservative having a bizarre allergy to health care reform you must not be listening to any of them. THey are full of great ideas of reform. Obama won’t even invite them in to talk about them. The main stream media won’t give them the time of day. You only hear about them on talk radio or conservative cable. Some of us just don’t want to nuke a system that has some degree of success for a DMV/Post Office form of health care rationing.
Let real competition take place across state lines. Rates could be cut in half for many people. Limit lawsuits and bring some common sense into the court room.
December 26, 2009 at 7:58 am
David Housholder
Governments can ensure competition.
What other things can be done to ensure competition?
And the post office? It’s way better than it used to be.
I ship books all over the country. USPS is usually the best, fastest and cheapest.
A “public option” seems to have helped competition here.
And who else will send a Christmas card across the country for 44 cents?
December 26, 2009 at 4:01 pm
Randy Wawrzyniak-Fry
1. Governments can NOT ensure competition. Governments can only restrict it.
2. Only the free market, a fully functioning fully FREE market, can ensure competition.
3. “Better than it used to be” is a strange criteria to use.
4. A single sample survey based on individual preference is not statistically significant.
5. The “public option” in the post office only restricted competition. No one other than the USPS is allowed to use your mail box.
6. Who else is given the opportunity? How much more does it really cost the taxpayers to send that Christmas card?
Luther was right on in his suggestions. The problem with the health care debate the way it is being framed is that people are looking at an industry that has been over regulated, over legislated, and over judiciated (I think I made up a word) and the only solution that has been even considered is MORE regulation and MORE legislation. And let’s not take the time to have an honest debate. No let’s do it NOW! We can’t afford to think, we have to act! Point to the insurance companies and screech “DEMON”, “JUNTA”, and “CARTEL”! Hous, I love your teaching on grievance vs. forgiveness thinking, but I’m afraid that in this case you are setting a very poor example of that teaching. You seem to be so caught up in the circumstances of how much YOU have to pay for something.
This debate has been a microcosm of what is wrong with our country. We have spent the last 30+ years raising a nation of economic illiterates. We don’t teach how a free market works and we don’t teach how our republic was founded to work. We have bastardized our foundation documents to mean something very different than what they were ever intended to be.
I apologize. I have veered off in a different direction than the one that was originally intended.
Carry on.
December 26, 2009 at 10:37 pm
Daniel Pettit
I don’t really care for the tactic of always using the post office as a scapegoat, I think the USPS does a pretty good job. Though it is not a financial success and I have a feeling that if UPS and FedEx were allowed to handle first class mail the USPS would go out of business and the cost of stamps would be about the same. At the moment the USPS can not deliver a Christmas card across the country for 44 cents, aren’t’ they running yet another billion $ deficit this year? Why not open first class mail to competition? Well that is a topic for another day.
December 26, 2009 at 4:06 pm
Luthor Nelson
USPS is only a little cheaper because it is totally subsidized by you and me. That is the only way it can compete with private enterprise. If the new Obama plan charges what they say no insurance will be able to compete with that heavily subsidized plan. It will kill competition.
December 26, 2009 at 6:12 pm
David
I was going to respond to some of these messages by noting that, as usual, people here seem easily distracted by side issues (and I find it amusing and pathetic that the followers of Beck and Limbaugh here are insulted by what they call “inflammatory” language…). But then a note by Paul Krugman reminded me not to. He writes: “There’s no use addressing complaints from the right; in general, the safest thing when dealing with crazy people is to avoid eye contact.” Of course, he is correct and if you see yourself in that comment, then I am sure you will whine about it.
But before you do, read the whole entry:
http://krugman.blogs.nytimes.com/2009/12/26/numerical-notes-on-health-care-reform/
And, no, simply saying that you don’t like Krugman because he is to your political left is not an argument in itself. Sorry.
December 26, 2009 at 6:29 pm
Randy Wawrzyniak-Fry
Thank you. Your response epitomizes exactly what is wrong with our country and our government. The complete disregard and disdain for those who disagree with you. That’s why you want a government controlled society. You want to control what people are allowed to think because anyone with beliefs different from your own are crazy.
There are two types of people to avoid. Crazy people and people who think you are crazy because both types are essentially crazy. What I find “amusing and pathetic” is that the only person on this blog that mentioned Beck or Limbaugh has been you. When you believe that anyone who agrees with you is enlightened and anyone who disagrees is delusional you give up your ability to learn from others.
December 26, 2009 at 10:47 pm
David Housholder
Actually, I LOVE this whole thread. So seldom that people who disagree on this issue actually talk to each other.
We need more of that in America. We are getting too silo-ed with “like minded people.”
I am a pro-life, pro-free-enterprise, free-market, traditional family guy. But I think we are losing (i.e. getting OUR health care reform ideas passed, and elections, by the way), because we have been duped into defending the status quo on healthcare rather than having the social and political will to having reform of our own.
The current healthcare system is a train wreck. The liberals GET that and they beat us to the punch. And America will like their way of fixing it better than our way of not fixing it.
By saying silly things like “best system in the world” and “socialized medicine” (which health care without a public option simply is not), trying to defend the (broken) status quo, we missed a chance to go truly bipartisan and add “our” stuff (free market reforms) to the reform package.
Instead of a plan with some liberal and conservative elements, we put all our chips on “block any plan” and we lost.
I’m not a liberal. I would like to see school vouchers, the abolition of income tax, a marriage amendment, and a bunch of things that are borderline wing-nutty.
But we really really missed this one.
The other side has more vision, more will, and a more constructive plan. That’s why they have such a majority in congress. That’s what America wants.
If we had championed health care reform instead of pretending like everything is great, we may have had a whole different administration in power.
December 26, 2009 at 11:27 pm
Daniel Pettit
I’d love to see a civil and intelligent discussion delving into the meat of the issue and not waste time on politics. To do so I think we need to agree on some foundational issues so we can get past the politically charged rhetoric of the Becks and the Kristofs of the world.
Here is where I’m coming from, where are you at?
1. There is no crisis of Health care QUALITY in the US and we certainly have the most ADVANCED medical care on the planet.
I know some of you are screaming BS right about now but have you actually looked into those statistics?
Once you correct for social differences and look past the just the raw numbers of say the WHO healthcare rankings. You should be able to agree the US quality of care is comparable to any first world nation.
Ireland’s rate of maternity mortality is (based on WHO #s) 11 times lower than the US. The next highest county is 3 times higher. If you’d only heard wouldn’t it? Netherlands is 6 times higher, why do the Dutch hate mothers so much more than the Irish? I think Ireland’s number is in error. [Garbage in garbage out] A realistic number for the US compared to modern Europe would be less than double. But that number doesn’t take into account social factors. (Americans have babies later in life, are much fatter, have a broader social economic basis)
Infant mortality the US ranks like 25th, the problem with this number is how different countries report births. The US tries to save just about every baby at any cost (a point to discuss) and counts them all as a birth.
….The World Health Organization (WHO), which defines a life birth as any baby showing any signs of life. While the U.S. carefully follows this definition, many other countries do not. As the WHO itself points out, “underreporting and misclassification are common, especially for deaths occurring early on in life.” For example, the U.S. tries to save extremely premature babies, many of which die and then get counted as an infant mortality. Other countries simply count these as stillbirths. In Switzerland, a baby must be at least 12 inches long to be counted as living, according to Nicholas Eberstadt, a scholar at the American Enterprise Institute. In Japan, “social and cultural customs favor the recording of infant deaths as stillbirths because the latter are not recorded in the Koseki, the Japanese family registration system,” noted a report from the congressional Office of Technology Assessment. In addition, other countries have suspiciously low infant mortality rates in the first 24 hours after birth. Eberstadt found that in the U.S., Canada and Australia, more than 33% of infant deaths occurred in the first day of life. In France, just 16% died in the first day, in Luxembourg just 10%, and in Hong Kong only 4% of infant deaths occurred in the first day of life. Eberstadt concludes that these countries are artificially pushing down their infant mortality rates by counting many first-day deaths as stillbirths. All this led researchers in the American Journal of Public Health to conclude: “The usefulness of crude infant mortality rates in international comparisons is questionable because of differences in the registration of births and deaths.” …. http://tinyurl.com/yh5csya
Same problem with life expectancy.
….The claim that the U.S. fares far worse than other countries on life expectancy suffers a similar problem because it fails to take into account the multitude of factors other than health care that affect life expectancy. The simple fact is the U.S. suffers from lots of problems — more drug abuse, more murders, more traffic fatalities — that cut into overall life expectancy. The murder rate, for example, is seven times higher in the U.S. than in Japan…. http://tinyurl.com/yh5csya
The US has much higher cancer survival rates than the UK by almost, if not every category.
2. We need health insurance reform. (more competition, everyone being able to obtain and keep coverage, more oversight on approval/denials)
3. Having x-million of Americans without health insurance is not a crisis. When most of them choose to not have it how can that be a crisis?
4. The US spends too much money on health care for the results.
5. Hospital expenses specifically are out of wack, (those $10 aspirins and $20 bandaids)
6. If we are to have private industry participate in health care then they have a right to earn a profit.
7. We have a emergency room availability crisis (at least in the border states)
That should be a good start, any major point I miss?
December 26, 2009 at 11:45 pm
David Housholder
Daniel, really good points on the latter numbers. I would respectfully dispute #1, however.
Please find me ONE non-US-American, non-right-winger anywhere on the planet who says that America has the #1 health care system in the world.
There is simply no non-partisan, objective consensus anywhere near that point of view.
We supply high-end “boutique” health care (a la Mayo Clinic) to Sheiks and Billionaires. That does not give us a good health care system on Main Street.
We pay way more than anyone else for our health care and get way too little. It’s as simple as that.
Pretending it’s first-rate doesn’t help anything get fixed.
December 27, 2009 at 3:07 am
Daniel Pettit
Hous, I didn’t claim the the US has the best. I said Quality of care is not lacking compared to other countries. Now distribution of said quality care, I would agree needs to improve.
So just who is this #1 country anyway?
What country has better doctors, drugs, technology, facilities?
Exactly how would you define best anyway? Waiting times, infant mortality rates, cancer survival rates, cost/outcome ratio, equality of access?
If you have an unknown or rare ailment AND you have money there is a #1 option and that choice is the US. You said it yourself the billionaires and sheiks come here.
So now that I think about it the US is the best, but is it the FAIREST?
December 28, 2009 at 6:20 pm
CBI
Please find me ONE non-US-American, non-right-winger anywhere on the planet who says that America has the #1 health care system in the world.
[Grin] I’m tempted to respond: find me someone who says the U.S. health care system is among the worst in the developed world who isn’t a left-winger or passing on claims left-wingers originated! [very big grin]
OK, we have that out of the way. 🙂 One problem is that we all [me included] tend to believe what we hear and are told, especially when it fits in a given framework or paradigm. However, reality often isn’t that simple.
More seriously, I do think that the U.S. usually does quite well when studies are made which try to control for things like ethnic origin, etc. Take cancer survival rates. A study published in Lancet Oncology [not exactly a ‘right-wing’ journal: Verdecchia et al., 8(9), pp.784ff (2007)] found some arguably statistically significant differences in five-year survival rates:
All malignancies:
U.S. women: 63%
European women: 56%
U.S. men: 66%
European men: 47%
These comparisons are pretty consistent among cancer types: lung, breast, bladder, prostate, thyroid, etc. They also are overall consistent when countries are examined individually (rather than lumping together the E.U.). Germany and Switzerland tend to do better than many, although usually not up to U.S. rates; Great Britain tends to drag the E.U. rates lower. [BTW, it is beneficial in its own right to read the article for the insight it gives on how difficult it is to conduct this sort of research.]
We supply high-end “boutique” health care (a la Mayo Clinic) to Sheiks and Billionaires. That does not give us a good health care system on Main Street.
I’m not so sure of that, David. I don’t consider overall cancer survival rates to be necessarily high-end “boutique” health care.
It is not unusual to hear of Canadian “medical pilgrims” coming to the U.S. for medical treatment unavailable to them in Canada. While not definitive, that does indicate that medical care in the U.S. must not be too shabby (at least compared to Canada).
Perhaps the most well-known recent example would be the Jepp
quadruplets. Karen Jepp of Calgary, AB, Canada (pop. 1.1 million, the
fifth largest metropolitan area in Canada) was set to give birth to
quadruplets. Canadian Medicare arranged in advance for sufficient
neonatal ICU facilities to be available there. Unfortunately, other
premature babies were born, and the ICU were needed. When the quads’ birthdate approached, there were not enough ICU units available.
A search was made: there was no place in which had four available neonatal ICU units.
So the search was expanended to the U.S. The nearest U.S. hospital with four free units happened to be in Great Falls, Montana (pop. 57,000). They were not preparing anything special, but they had enough neonatal ICU spaces to handle the four babies. This was so, even though the population Great Falls was only ~5% of Calgary. [http://news.bbc.co.uk/2/hi/americas/6951330.stm]
In the case of medical need, a hospital in a small U.S. city was better able to handle a neonatal ICU unexpected emergency than one of the largest Canadian cities was able to handle a planned event.
None of this is definitive, of course, but I think it indicates some good things about the U.S. That doesn’t say that other countries have bad health care, but that one needs to look beyond the fact of “medical pilgrimages” to the reasons they are made. The Canadian-to-U.S. pilgrim tends to come here because of availability and reduced waiting times (which means higher survivability). The U.S.-to-Mexico and U.S.-to-India pilgrims tend to do so to lower their cost. [That is one reason why I believe that removing impediments to competition — which tends to lower cost — should be a goal of changes to U.S. medical laws and regulations.]
We pay way more than anyone else for our health care and get way too little. Its as simple as that.
I’m far from convinced it’s that simple. We “pay too much” for what we get, although we do get a lot. The neonatal ICU facility difference which helped out the Jepps is one example. Another: the U.S. has roughly four times the number of MRI scanners, and three times the number of CAT scanners (both per capita) than Canada (which tends to do better than the E.U.), according to a recent Canadian study. [http://tinyurl.com/ohcvob] That probably affects cancer survival rates, as does the greater prevalence of mammograms in the U.S.
On the other hand, in the U.S., record-keeping requirements and administrative costs tend to be higher than in Canada, as are costs (both direct and indirect) associated with medical malpractice; it is not clear to me that these provide benefit.
Finally, these all are likely interrelated and, more importantly, the effects differ from person to person. One size does not fit all.
Oh, there is another elephant in the room, that often gets ignored: more prosperous countries spend more on health care and tend to have a healthier population. That suggests that increasing economic prosperity would usually increase health. But that’s also a whole ‘nother issue.
December 28, 2009 at 5:21 pm
CBI
Daniel P. has already touched on this, but let me share one experienceof mine. A few years back — mid 2000s — I began some independent research on something which seemed simple: infant mortality.
It turned out to be far from simple.
I had expected that the U.S. rate would be slightly worse than those of most E.U. countries and first-world Asian countries, due to the U.S. having a *much* more heterogeneous population. On the other hand, my experience with health care in Europe from when I lived there, although limited in scope and now dated, gave me the impression that on a case-by-case basis, on the average, the U.S. would come out ahead.
The problems: definitions combined with common practices. It turned out that each nation not only set its own definition of “infant mortality”, the specific “general practices” differed enough that no effective comparison could be made.
For example, in the U.S., the general case is that, when a baby is born, every effort is made to get the baby breathing, and then to treat it and keep it alive, with the goal of saving its life. This happens even when the chances of success are very small — less than 10% at times.
This is not the case everywhere. In some countries, a baby born in significant distress is not encouraged to start breathing, and is allowed to die quickly. The baby counts as a stillbirth, and does not count as an infant death. In many countries, a baby has to remain alive for a given period of time — 24 hours was not that uncommon — for it to count as a live birth.
Bottom line: I found it impossible to do an apples-to-apples comparison of infant mortality.
Why is this significant? Two reasons. First, infant mortality is often used in reporting as if it is a ‘gold standard” for overall medical care: lower ‘infant mortality’ is presumed to mean better overall health care. Second, infant mortality weighs highly when calculating “average” (mean) life expectancy. Errors in this statistic can often produce significant errors in longetivity statistics.
I should state that my research was the product of a few days’ free time, and was not funded or in-depth enough to make me stake my life on it. However, it does support similar critiques to the use of such data in comparing systems for funding medical treatment, and is quite concordant with Daniel’s post.
As an aside, it is also good to be leery in general of using data for policy decisions when the report is of rankings (e.g., such-and-such is ranked #25 behind so-and-so), rather than statistically significant differences in a single free variable (with other variables controlled). This is often not possible, so one makes do with what data is available, but “with a block of salt”.
December 28, 2009 at 6:07 pm
Randy Wawrzyniak-Fry
Another excellent post, which brings up subject of knowing where the data comes from, how it was gathered, who gathered it, and why it was gathered in the first place. These issues are difficult enough when using data from within one organization, let alone when using data from multiple organizations, from different countries, and gathered for different reasons. (This entire thread was kicked off by Hous ‘ conclusions based on a one sample survey.)
Back in 1954 Darrell Huff and Irving Geis produced their first version of “How to Lie with Statistics”. Here we are 55 years later and we are still being fooled by statistics, charts, and graphs – sometimes intentionally and sometimes accidentally. As you have wisely pointed out, if you don’t have knowledge of the data you can’t have confidence in the statistics resulting from that data.
It is interesting how a discussion that was begun on “health care” has generated posts on economics, politics, markets, and statistics just to name a few.
December 26, 2009 at 11:35 pm
David Housholder
Randy has some good points about economics.
What if we, however, looked at a bigger picture?
What if the Great Depression, for which massive Gov’t spending (The New Deal and WW2) was the answer, was solved by one approach.
Let’s assume that approach had run its course by the 1970’s “malaise.”
Let’s assumes that Reaganomics (of which Clinton was also a proponent, economically–look at stocks during his time) was the proper correction to that “malaise.” The 80s-90s were amazing.
What if the 2001-2009 decade is our next 70’s and Reagan’s approach has run its course? Someone just as conservative as he was
presided over the diminishing returns and eventual engine seizure of the whole thing.
What if we need new thinking?
What fresh ideas can conservatives/libertarians bring to the changed economic climate? One of the biggest problems of any movement is looking back to a golden age when the game has, in fact, changed since then.
This impacts health care.
The right answer during the new deal or during the Reagan revolution may not be the right answer now.
I think it’s OK to be a little “inflammatory” with each other. We’re all big people. I believe you and I need to be shocked out of our outdated patterns of thinking or we will just be left behind.
To restate: I believe in a level playing field and that rewards should be handed out only for hard work and achievement. I also believe that you should not get a head start for having had rich parents. That’s why we kicked the British out and threw their tea in the water. I don’t believe in inherited privilege.
A truly free market and libertarian politics only works if a society continues to level the playing field and chalk the lines. And umpire well.
People should have to pay for their own health care, cash if possible; that would bring costs down and foster competition. And we should throw some money into a pot (probably at a local level–but that’s debatable) to ensure that all children, the elderly and the mentally/physically handicapped have access to care if they can’t afford it. The cash-positive elderly and children of middle class and up parents should keep paying cash for services.
Personally, I have a problem with able bodied people in the prime of life having someone else pay for their (non-catastrophic) health care. Call me non-compassionate, but it’s how I feel.
We also have to do something for catastrophic health situations which destroy the net worth of a family. We have to find a way to share that burden.
December 27, 2009 at 1:02 am
CBI
1) Is America too big for a national plan? Is the reason it works in Europe and elsewhere that those countries are smaller?
I’m not sure what you mean by “works” in this, but on theoretical grounds alone, the answer is clear. The best ‘plan’ for an individual would be tailored to that individual. The more generic a ‘plan’ is, the fewer people it would ‘work’ best for. As the quip goes: when they say “one size fits all”, it doesn’t!
This observation leads to a few others. For example, in a relatively ethnically homogeneous population (e.g., say, of all Scandinavians), the range of diseases and treatment responses would be fairly constant. In an ethnically diverse population (e.g., any U.S. city), there is a wider range of both diseases and responses. For example, sickle-cell anemia is almost unheard of in Norway: it is much more common in the U.S. Bottom line: any ‘plan’ covering any significant urban area in the U.S. should be expected to ‘work’ less well than in a comparably-sized area in (say) Europe or Asia. (There are some exceptions likely, in cities such as, e.g., Marseilles, with a large immigrant population.)
Two other kickers. The U.S. health and medical portion of the economy is already very highly regulated. It is illegal to purchase medical insurance across state lines (leading to some creative work-arounds on the part of large insurance companies. (This is a federal law; efforts to repeal this restriction were defeated early in the current congress., since doing so would reduce the influence of state government regulators by allowing people more flexibility.) State regulations are notorious for skewing coverage and costs.
Second, the entire discussion tends to conflate several very different concepts: (1) paying for ordinary medical are; (2) paying for extraordinary elective medical treatments; and (3) medical insurance against unexpected catastrophic expenses. This has been encouraged by current tax laws and regulations, but a bit of reflection shows that these are different in kind and not merely different in degree.
December 27, 2009 at 1:29 am
David Housholder
I really like your filet-ing the issue into three segments.
1) Able bodied people should pay cash for #1
2) Elective care, ditto #1
3) We need to find a way to share the risk of #3, and the bigger the pool, the better….
December 27, 2009 at 10:13 pm
CBI
Thanks for your comment, David. I can take no credit: the three-fold analytical division is common among conservative and libertarian observers. I think it fair to say that the current House and Senate bills move us further away on #1 and #2; what they do for #3 is more problematic.
It is probably an overstatement to say “the bigger the pool, the better” when it comes to catastrophic medical coverage. It would be better to have a pool large enough so that year-to-year statistical variations in incidents pose an acceptable financial risk, yet small enough so that competition between insurers provides incentives for better services, lower costs for acceptable treatment, and medical improvements.
With too large of a “pool” — in a monopolistic or overly-regulated system — the impact of these sorts of incentives drops drastically, and the incentive of health care workers and the omnipresent administrators shifts away from patient care and more toward meeting (internal or external) regulatory requirements. The patient, unless gifted with bureaucratic or political pull, has little say in the matter.
But that leads away from this thread, so I’ll stop here.
December 27, 2009 at 1:09 am
Luthor Nelson
Dave, you keep talking about conservatives wanting to preserve the status quo. I don’t know where you get that. We see all kinds of problems that can be fixed and we have provided solutions. Democrats don’t have all the ideas they just have all the votes right now. We didn’t do enough when we had the votes I know.
You still have not answered why it is that you think health care insurers are so uniquely corrupt and evil.
December 27, 2009 at 1:24 am
David Housholder
Luthor, you are one of the FEW conservatives I’ve met that is actually progressive. You think outside the box. You are so rare that you don’t even recognize it.
I don’t think insurers are evil.
I think that they are self-interested.
They are as good and bad as you and I. What they don’t have is a check and balance to push back on them. They are sovereign. And without a push back, they have every right to be.
You and I are self employed. I pay cash for all health care and am happy to do so. But I have to pay (over) twice that to protect my family’s net worth from catastrophic situations (chemo, etc.). They look at my credit rating and think: A source of money. And they raise my rates monthly by double figures until I bail. Then I shop around, and get rejected because of “pre-existing conditions.” There is no true competition out there. I should be able to insure through a start up in Arkansas if I want to.
I don’t pretend to know why there is no competition. I’m just a Bible teacher. But I have no true choices in coverage if I want to protect our cumulative hard work over decades.
The cost of living and the cost of health care is simply not going up as fast as my premiums. I have no problem paying for valued service, but I’m getting gouged. And gouging is serious if there are no real choices.
Middle class self-employed people are in a hopeless situation. We don’t need insurance. We can pay for care. I don’t want government involved in my prescriptions and routine visits/tests. And we need to find a way to (collectively) protect our assets from that one nasty (God forbid) diagnosis that is fair and cost-effective.
December 27, 2009 at 2:53 am
Randy Wawrzyniak-Fry
Hous – Since you have met few conservatives that are, in your words, progressive and think outside of the box I have a suggestion for you. You need to get out more. 😉 Luthor’s ideas and thoughts are not so rare as you might think. They may be rare for your state but they are not rare for the country.
We all know that you think you pay too much for health insurance. What we disagree on is why. You think that it’s all just about greed. I think that while greed plays a part, the lack of competition, a lack that is mandated by law, is much more to blame. You need to understand that in a free market greed works in our favor and keeps prices down. In a controlled market scarcity and greed raises prices.
The problem is that there is nothing sexy about allowing a free market to work. It just means staying out of the way most of the time. Unfortunately our government is run by people who have to DO something, or at least appear to, so they can take credit for things and get reelected. So we have law on top of law on top of law all of which restrict our liberty and prevent the free market from doing what it does best.
December 27, 2009 at 3:28 am
Randy Wawrzyniak-Fry
I’ve been rethinking my last response and I want to change one thing. To label someone a progressive conservative is at best a contradiction and at worst insulting. People who are politically progressive believe that the government is the best one to distribute scarce resources and that wealth is a zero some game. Conservatives believe that wealth can be created by the free market and that governments role should be limited.
December 27, 2009 at 6:26 am
CBI
2) We have a functioning “junta” or “cartel” of health insurance companies which continue to mess with me personally. I’m the healthiest almost-50 year old I know (oldest person I know who shreds the half-pipe snowboarding), and my premiums are an outrage. I just tried to switch companies to get a better rate and got refused. Am sure I’m not alone. What’s your experience? Especially those, like me, who are self-employed.
There are a number of premises here which are open to dispute. You write that your premiums are “an outrage”. Why is that? For starters, you live in a state where the highly-regulated insurance companies are required by law to cover many things under “health insurance”, rather than merely insuring against unforeseen catastrophic medical expenses. Without knowing the details of California insurance laws, I’d wager a small confectionery that, if you read through what is ‘covered’ under you plan, you would find (a) items that you would as soon not be pay to be ‘covered’ for, and (b) it covers a significant amount of non-catastrophic medical care. (Again, I don’t know California’s insurance laws, but this reflects general practice.)
In other words, the ‘insurance’ premiums you pay cover a large number of medical expenses which, other things being equal, you wouldn’t want to pay for, but are forced to.
(If your state regulates the so-called “co-pay” by keeping it low, two perverse incentives arise. (1) There is more incentive to seek medical attention in marginal cases, which increases demand and results in longer waits for those who really need the medical care. (2) Insofar as the medical market can respond (which is complex in itself), the pressure is for higher costs for the same service.
)
Additionally, because of current federal tax laws, you are required to pay your ‘premiums’ with “after-tax” dollars: insurance premiums are not “deductible”. Were you an employee, you would be allowed to pay the premiums with “pre-tax” dollars: in other words, that portion of a persons wages or salary which goes to pay the ‘premiums’ is not taxed: the equivalent of a tax deduction. This drives up the effective cost of medical care for the self-employed.
As to why you were refused a better rate with another company: that is beyond the knowledge of anyone here. But consider two things for a moment.
(1) The company you desired to switch to has an incentive for you to switch to them: they earn more with more customers. Since you did not, they lose you as a customer. That means that they believe that the risk is too great that you would actually cost more money to ‘cover’ than you would pay. The question is, “why?” Some of the answers may lie in the regulations covered above, where your current policy may have you ‘grandfathered’, but a new one would not. Absent the details, we can not know.
(2) There are also other costs and risks involved, including the cost of taking on a new customer, and the current regulatory uncertainty. Both of these would put a damper on an insurer seeking new customers: it is less risky to make no change than to make a change with an highly uncertain outcome.
Finally a note on “cartels” (not “junata”: a very different breed of cat). The current legislative proposals would make the medical insurance industry more like a monopoly than a cartel.
Remember that current regulations already restrict competition. Adding additional regulations moves it even further toward a cartel/monopoly situation. (Bills to promote competition were defeated.) A key component is that more medical and insurance decisions are made not by the customers making choices themselves, but based upon political or bureaucratic power and connections.
It is totally inconsistent to be against “cartels” — which serve to limit market competition by setting various restrictions — and yet also to be in favor of a national, single-payer regime — which totally eliminates market competition by setting a single product.
In addition, the financial incentive shifts for those in the medical industry, to make a profit (get higher wages, or however you word it) not by better serving customers, but by meeting bureaucratic and political ends.
But that really belongs in another post.
December 27, 2009 at 3:11 pm
David Housholder
Especially lucid post, CBI. One of the better ones in the thread.
On Cali insurance, I have no co-pay, but rather a 10k deductible. I want to pay cash for health care costs. I just want coverage for catastrophic. And 10k is the legal limit (why?) for a deductible. What I need is a 100k annual deductible.
So, I pay cash for everything for my family, and pay another $600/mo for useless insurance which I need, but is not what I really want (asset protection).
I am seriously interested in starting up a new insurance company to compete with the big boys. Anyone else in? But what would we face? Bizarre regulations.
December 27, 2009 at 5:20 pm
Randy Wawrzyniak-Fry
Why? Because a government bureaucracy decided that it knows more about what is best for you that you do. Early on in this thread you stated that the government can ensure competition. I want to return to that, because it is absolutely untrue. Government ensures monopolies not competition. Government supporting competition is like me saying I want to help Usain Bolt run faster so I will hold on to him and push him to make him go faster. The health insurance industry you are complaining about is an example of government supporting competition by telling companies what and how they can compete. We are about to spend trillions of dollars of our children’s and grandchildren’s money to make things worse. It is just so sad.
A random thought came to mind while I was typing the above. Why is it that when we have to pay more for something we assume that it’s because somebody is greedy, but when we get paid more we’re just getting what we deserve?
December 27, 2009 at 5:11 pm
Randy Wawrzyniak-Fry
Excellent post CBI. Well thought out and explained.
December 28, 2009 at 5:36 am
CBI
Thank you, Randy. I’ve benefited from your posts, and have recommended them to others.
Regarding government and competition: I’m still thinking that one through. it seems to me that as an enforcer of contracts (and contract law), government /ipso facto/ promotes competition, and that that is a valid and beneficial government function.
Less clear to me is the prevention of monopolistic and monopsonistic practices and situations. I’ve read good arguments on both sides, but haven’t deemed a clear winner. I do think it clear, however, that when government assumes a monopoly (or monopsony), one can expect all sorts of problems — and this is usually worse than a private monopoly, since government retains its coercive powers.
This may sometimes be justified in the case of a public good — think military defense or general police protection — but there are grey areas.
December 28, 2009 at 1:31 pm
Randy Wawrzyniak-Fry
Thank you CBI. You’re very kind.
At the risk of hijacking this thread into economics (and when you are talking a piece of our economy the size of health care you can hardly avoid it), and to verify that we are on the same page, I think we should clarify some terms.
Very simplistically
Monopoly = one seller many buyers
Monopsony = one buyer many sellers
I can see your point, especially as it refers to contract law, of areas where government can promote competition, but more often than not government’s attempts to level the playing field usually end up tilting it in the other direction. My problem with government attempting to control monopolies is that when the government steps in natural market forces are ignored and the result can often be detrimental to consumers. I can go into further detail, but I fear that will take me even further off the trail than I have already wandered.
I agree with you in regards to services such as military and police protection, that the government has a vital role, although the pure libertarian would argue this. I do not believe that health care or insurance is one of those areas. We’ve argued back and forth about who offers the “best” health care, but leaving that aside I think we can agree that the major contributor to advances in health care (drugs, equipment, procedures, etc.) has been the free market, and more specifically the United States.
When the government takes over much of the profit incentive will disappear. The result will be a stagnation of health care advances. The goal is supposed to be to offer health care to all Americans (although there seems to be no agreement that that is even the goal), but when you take away the incentive you reduce the supply and when you reduce the supply someone will have to go without. When that happens in a free market prices go up, attacking additional competitors, increasing supply, resulting in price reductions. In a government controlled monopoly if prices cannot fluctuate the only other option is rationing.
December 29, 2009 at 11:03 pm
CBI
Yes, Randy, those were the definitions I was using. And, upon reflection, you are right in that I over-stated the point that government enforcement of contracts promotes competition. That may be an indirect consequence, but the main benefit is that it reduces cheating and promotes integrity. Your comments concerning the risk of government attempts to control monopolies are very true, and reflect some of the reasons I’ve come to no firm and well-founded conclusion on the matter.
You explained clearly some disadvantages of a government takeover. I’d like to add an emphasis that these disadvantages hold whether the government is a single provider (monopoly) or single buyer or payer (monopsony) as well as when the government so tightly regulates options as to basically control actions. Definitions are muddled enough so that, while “socialism” and “fascism” both aptly describe the model, the use of labels tends to side-track rather than clarify.
December 27, 2009 at 10:37 pm
Daniel Pettit
Here is some policy info for a family similar to Hous’s, mind you this would be for perfectly healthy non-smoking individuals with no preexisting conditions.
http://tinyurl.com/yh7fy9o
I’m glad I looked this up as I am far from having the most affordable Anthem(BlueCross) PPO policy anymore.
December 29, 2009 at 3:27 pm
David
I know some of the writers here would rather fantasize about immigrants, creeping government takeovers, irresponsible health consumers and the balm that libertarian ideology could bring to all of us, but let’s not mistake that for real information. There have been some remarkable articles in the past year about health care reform that I think are quite useful and rather than add to the rhetoric here, I thought I would simply point you in their direction.
David Brooks has provided links to some excellent articles, most of which I read when they came out, that go into the issues confronting our health system from a number of different perspectives. See part I of his annual Sidney awards here: http://www.nytimes.com/2009/12/25/opinion/25brooks.html.
I know some of you probably can’t read this because you fear the New York Times. But, hey, it gets worse. because his best article of the year, by Atul Gawande, is in the New Yorker, here: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande. It is about controlling costs and there is not even a little bit of libertarian ideology in it. Crazy, huh?
He also recommends this piece of satire, http://www.nationaljournal.com/njmagazine/st_20090926_4826.php, in which the health care system we currently enjoy is applied to air travel. Those of you feeling pain from reading the New York Times and the New Yorker will be relieved to see that this is in National Journal.
But while we are at it, go back to the New Yorker and read the more recent piece by Gawande on health care costs: http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande.
And lastly, if you want to enjoy a look at the history of reform in other countries, read here: http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande.
The last two, by the way, are my recommendations, not Brooks’. Enjoy.
December 29, 2009 at 6:06 pm
David Housholder
David, I was hoping you would post today. Thank you. Give me time to work through the material. As you know, I don’t think fast.
December 29, 2009 at 8:25 pm
Randy Wawrzyniak-Fry
David – I’ll make you a deal. I’ll check out your links if you promise to keep the condescension to a minimum in future posts. That’s probably too much to expect, but I’ll read the articles anyway. Keep in mind however that I read articles from left leaning publications like the New York Times, New Yorker, and National journal with the same grain of salt that I’m sure you would apply to the National Review and the Limbaugh Letter.
December 31, 2009 at 5:07 pm
CBI
12) Before you complain about Canada’s system, have you actually talked to a real Canadian about it? Or just listened to talk radio?
I think this has been answered already with some anecdotes, but there is also some survey information available. While it is true that “all evidence is anecdotal”, surveys tend to aggregate the anecdotes and, if done well, can provide good insight.
There are surprisingly few surveys which have sought to compare personal health care experiences of Canadians and ‘uninsured’ Americans. The most recent comparison I know of is one of Americans (commissioned by ABC, USAToday, & Kaiser Foundation; conducted by TNS) and one of Canadians which sought to ask the identical questions (commissioned by Inst. for Policy Innovation; conducted by Harris/Decima).
In general, insured Americans were most satisfied with their health care. Canadians ranked their health care between uninsured and insured Americans, but usually much closer to the uninsured. To quote:
While Canadian satisfaction levels generally fall between uninsured and insured Americans, they are usually much closer to the uninsured than they are to the insured.
Overall, there are 28 direct comparisons that can easily be made between Americans and Canadians (seven questions and four levels of satisfaction or dissatisfaction). Of those 28 cases, uninsured Americans and Canadians provide answers that are not statistically different from each other in 20 instances (71 percent). Making the same comparisons
between insured Americans and Canadians is much more likely to show a difference in how they view the care that they receive, with it not being possible to reject that the two groups are the same in only 10 of the 28 possibilities (36 percent). In short, uninsured Americans are more similar to Canadians, who have universal coverage, than insured Americans in how satisfied they are with their health care.
Bottom line from the study:
For most comparisons, the Canadians are experiencing satisfaction levels much closer to that of America’s uninsured than they are to the insured. That suggests the drop in satisfaction for the insured under a U.S. health care reform initiative could be much greater than the increase in satisfaction for the newly insured Americans.”
Since there are almost seven times as many insured as ‘uninsured’ Americans, adopting an approach similar to Canada’s would harm many more people than it would help.
Report at Social Science Research network website: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1395928
I’d originally hoped to contribute to each of the twelve theses of David H., but, with all the balls I’m currently juggling, probably won’t be able to. Sorry.
January 3, 2010 at 1:00 am
CBI
But, hey, it gets worse. because his best article of the year,
by Atul Gawande, is in the New Yorker . . . .
Actually, David (not H. or L.), I had read two of the articles you listed
when they first came out. The one by former Clinton administration
official and political activist Gawande had struck my eye because it
included both the town where my mom grew up (McAllen) and where a
co-worker did his PhD work (Mayo).
For me an indicative bellwether involves the use of statistics. The
specific mention of ‘infant mortality’ is a clear indicator of the
direction of bias; a use of rankings (instead of statistical
measurements) indicates that the author’s purpose is advocacy, rather
than information. Not that advocacy is evil (see below): but I want
it to be open and acknowledged.
So, when reading outside the party line, it is not surprising that
I had a different take on some things.
A single payer system tends to raise prices, all other
things being equal. More precisely, the tendency is to extract the
maximum amount available from the system. This is what occurred in
McAllen, and was spreading as more and more people realized the
possibilities from gaming the system. The immediate question which
arose in my mind was why didn’t consumers switch to less
costlier health care providers? But the government kept them
isolated. The problem occurred under Medicare, where the
immediate out-of-pocket expense was negligible and total
expenditures pretty much out of the sight of the beneficiaries and
ultimate (tax)payers.
Fewer doctors. Medicare has an additional perverse
incentive: it incentivises doctors not to take Medicare patients.
By paying doctors well under the prevailing rate (usually some 60-70%),
many doctors refuse to see Medicare patients.
Higher prices overall. Those physicians who do accept
Medicare patients will often actually lose money on them,
forcing other patients to take up the slack.
As a follow up to the above, you may have seen the news report that
due to Medicare paying below cost, the Mayo Clinic will no longer treat Medicare patients at some of its Arizona clinics.
[http://tinyurl.com/yjmxoyn]
If the Senate bill becomes law, it will get worse: the Senate
Obamacare bill cuts Medicare payments to doctors by 21%.
Expect even more clinics to refuse to take Medicare patients or, if
forced to, to just go out of business. (Thoughts on the side effects
on employment and on the tax base are left for the interested reader.)
Finally, another nice anecdote, from Japan.
[http://tinyurl.com/yhobge7] What I like is its mention of the dirty
secret of “connections”, which occur as things become distributed not
based upon market allocation, but upon political and bureaucratic
determinations.
Two tangential comments.
I have nothing against persuasive writing (AKA ‘propaganda’ or
‘advocacy journalism’ per se, as long as the writers are
honest concerning their intent. However, I am suspicious of those
who masquerade as journalists without disclosing their own biases.
Perhaps The New Yorker has a section that wasn’t
prominently linked which discussed Dr. Gawande’s political
background and connections, but, well, there was nothing I found on
their website to indicate his extensive 20+ year history of
political activism, his association with various statist (I’m using
the term as a descriptive, not a pejorative) groups, nor his
one-sided affiliation with statist politicians. [And, to be as
clear as possible, I believe he is likely an excellent
endocrinologist and wonderful father.] I am not criticizing these
things themselves, but I am very much criticizing attempts to
ignore or cover them up, q.v., The New Yorker.
Those on the conservative and libertarian sides of these
discussions tend to be much more familiar with the arguments made by
their statist opponents than statists are of conservative and
libertarian positions. Part of this is because persuasive writing
(‘advocacy’) is so prominent in the dominant news media that it is
difficult to escape. This gives conservatives and libertarians wide
exposure to alternative worldviews. Those on the Left seldom have
that benefit, and are generally not exposed to conservative or
libertarian ideas in high school or college. But that’s another
topic. My point here is that this shows up in how spokesmen from
each side will use the epithet “crazy”. Those on the Left call
libertarians and conservatives “crazy” (quoting David (not H or L)
quoting Krugmann) with the subtext “avoid them” or “don’t listen to
them” or “be afraid of them.” OTOH, libertarians and conservatives
are more likely to say that so-and-so’s arguments (not necessarily
the person) are “crazy . . . and here’s why.”
December 30, 2009 at 12:11 am
Maggie
I didn’t read all of these, so I am sorry if someone already made this point. This is my concern with government healthcare: certain conditions are very expensive. Some of these can be attributed to choices that people make everyday (diabetes, obesity, cancer, birth defects) some of these issues simply just happen (diabetes, cancer, birth defects…). I am concerned that in a society that permits abortion, and even pushes it on some people, that the day will come when expensive patients will not receive treatment and will ultimately die because the government cannot afford to care for them. I know this may not be a fair assumption, but I believe it would be naive to assume that this could not happen.
I also think that we need to stop using healthcare primarily for treatment. How about prevention? Alternative treatments such as chiropractic, accupuncture, and massage could be encouraged along with accurate information regarding which foods promote health and which foods do not. If people ate fewer refined foods and stuck to what God caused to grow up out of the ground, untampered with, we would see many chronic conditions decline substantially.
December 30, 2009 at 3:24 am
Sarah Radomsky
First off, I want to say “thank you” to everyone who has posted so far. When I follow some of the current debates over health care and health care reform I frequently feel overwhelmed by the commentary and find myself not knowing what to think. The comments here have been very thought provoking.
I am going to stray away from the woes/debates of how things are going to work out in the end, and pose the question of where our hearts are for the people a potential shift in care will be benefiting – those who can not afford to pursue treatment (please note, I am not a left-winger, and tend to fit David H.’s profile earlier of a pro-lifer, generally conservative, family-type of gal). I went to a Catholic college (no I am not Catholic either, not that that is bad/important) and one of the values impressed on us was care for the poor and needy. I think this would be in line with God’s heart for the people (native, immigrant, legal citizen or not) and despite how the workings of such a system would positively or negatively impact me or my family, I strongly feel that it would be a shame for child to go without treatment, or an elderly person to not be able to receive needed care. Recently, my own grandfather pointed out to me that many would be in worse states if there were no medicare/medicaid currently. A system devised of man is never perfect, but there are needs to be addressed.
We do have serious poverty issues in the population of the United States, where in my own community every year we hear reports at our church during drive times of the increasing level of poverty and the effects of provision of care and even issues with starvation affecting many of the people we interact with everyday locally.
I still am not sure what the best solution is to health care (and other social needs) and admit concern over the ability for myself or my family to recieve quality care , but if we look Biblically, we do see constant provision through God and those in the community, identifying needs and providing for them so that people don’t go hungry or in need. An ideal standard. Many churches do raise up to do some of this work, but there are many people in need and not enough taking action to help.
We are also faced with the growing problem that seems to be that the majority of the society we live in is not interested in care for others, but increasingly self-centered as we live in a culture that touts an “its all about you” motto of self-obsession and importance. Also, while many people searching for something to fill that God-shaped hole we all have, all to often turns towards money and stuff, leaving a heart for others and the things that break God’s own heart in the dust.
Wherever we fall in our opinions of exactly how/what should be done to address these community ailments, I pray all of us will attempt to have a heart like God’s for all people to guide our actions and thoughts. And also that we do not forget the power of prayer over this and other situations that may come up. I know I personally sometimes struggle with just wanting to not think about it all and become passive at times to let things happen as they will because I feel helpless in the midst of all that is happening. However, the truth is that prayer can change the outcome of a situation (Biblically we see many times where God answer’s the prayers of men with action, but another good resource for examples in our modern culture of God moving through prayer is Dutch Sheet’s ‘Authority in Prayer’, which really helped me to remember that God directed prayer and intentionality with our thoughts are important.
Again, thank you all for your thoughts and I will continue to follow this thread.
December 31, 2009 at 10:08 am
David Lund
—————-
1) Is the reason it works in Europe and elsewhere that those countries are smaller?
—————–
It works in Europe? You’ve got to be kidding.
Our oldest daughter nearly died in an ER of a Norwegian hospital. She was suffocating (from juvenile viral-induced asthma), they told me to wait. She started to turn blue, they told me to wait. I started shouting at the top of my voice that my daughter was going to die. Finally a nurse appeared and immediately began treatment.
The initial doctor was incompetent and barely spoke English, and spoke no Norwegian (National health schemes that don’t reward docs for excellence and efficiency wind up importing inexperienced docs from the the developing world– talented native-born people are not willing to study so much longer and work so hard if they are not compensated for it. You wind up having the good doctors in concierge practices, for the few who can pay the whole bill out of pocket. Even the good doctors from India wind up joining private concierge practices. It ensures that the non-rich class are stuck with mediocrity forever.)
A church member’s daughter had an intestinal disorder. Norwegians doctors in three cities (including the Rikshospitalet in Oslo) failed to diagnose correctly over 9 months. They put the little girl through hell. Finally I advised getting on a plane and going to Seattle Children’s hospital. At Children’s she received the correct diagnosis in 20 minutes. Today she’s healthy college student. Had the Norwegian NHS been the only option, she would now have been dead for 10 years. Anyone who is somewhere and is not getting better, and can travel to the USA, it’s a no-brainer. Get on the plane.
My secretary in Norway got cancer and there was only one place that would treat her– on the other side of the country. She refused to leave her family and be sick and alone far away– and in 6 weeks she was dead. The treatment she needed is provided in every large hospital in America.
I know anecdotes don’t say everything, but if you say the European systems work, we need to talk about your definition of the term “work.” I’ve received incorrect medical care in Germany, too, though it was not life threatening.
———————
5) Our lack of ability to insure our population has led to bizarre use of emergency rooms as public clinics. This costs all of us.
———————-
The only way to get care in an NHS is by going to the hospital ER. You think under a NHS here this would get better? It is worse. When our daughter had an ear infection in Norway, the doctor’s office said she could get an appt. in 9 days. 3 days later, the eardrum ruptured and bleeding began from her ear and she was in horrible pain and cried constantly. I took her to the hospital ER and waited 4 hours in the middle of the night. Finally got treatment. Had we waited 6 more days, she would have gone deaf in that ear. Today she is a musician.
When you say an NHS is superior to our system, it’s crazy talk. Ask anyone who has lived with an NHS, and has lived here. There’s no comparison.
—————————
12) Before you complain about Canada’s system, have you actually talked to a real Canadian about it? Or just listened to talk radio?
—————————-
I have talked with many Canadians who come to Bellingham or Mount Vernon to get treatment for a variety of things. They say, for truly non-urgent things the Canadian system is fine. But if you really get sick, they are glad that they can get in the car and get over the border to the clinics in Bellingham. Canadians wonder: if the USA goes the route of Canada, where will they go when get really sick?
It is fair to say that Canada can get away with their system because 90% of the population lives within 100 miles of the border. They have the “luxury” of having an inefficient, non-responsive NHS because they have a backstop over the border. And they all know it. Every patient, and every bureaucrat.
December 31, 2009 at 2:07 pm
David Housholder
Some good points.
Here are some other ones.
-These discussions are filled with overstatements such as “anyone who’s lived under both systems would prefer the US system.”
We’ve also lived in Europe and had the opposite experience.
We were uninsured grad students (super-common here) scared that Wendy was pregnant. Moved to Germany to study and were convinced we couldn’t get insurance because of her “pre-existing condition.”
They just looked at us funny; we were flabbergasted that the private insurance company would cover her–immediately.
They looked at our income and decided to charge us 22 Marks a month for insurance. (10 bucks).
Wendy had massive complications in childbirth. All of it (including intensive lengthy hospitalization) covered. Never saw a bill.
I could go on and on with our experiences.
Local doctor we could visit (we did once) at her home at 2 in the morning.
Another doctor that changed Wendy’s life and gave her hope when things looked really bad.
And Canadian friends from High School a couple of months ago (from 4 families) who laughed their heads off at dinner in Vancouver a couple of months ago when we suggested that our US system was better.
And the fact that here in LA people DO cross the border in droves for health care, braving Mad Max crime in TJ to get what they see as better service and prices….in Mexico.
December 31, 2009 at 2:55 pm
Randy Wawrzyniak-Fry
We had very similar experiences when our daughter was born in Long Beach, only a year or two after your experience in Germany. Neither experience is relevant. As David Lund mentioned, anecdotal evidence is not data. For every happy Canadian that you come up with there is a disgruntled one. (btw – when you visit other countries go you gripe about the problems of our country?) You choose to believe that our system is substandard. As you said before, we don’t get to vote on what you believe.
Comparing one country’s health care system to another in the global 21st century is probably an impossible task. Take the people that go to Mexico for cheap drugs. Were the drugs developed in Mexico? Probably not. The drugs were most likely developed in the United States. There are a number of factors that can explain why the drugs are cheaper in Mexico. One of the largest factors is that Mexico does not have to operate under the weight of our laws and regulations. My wife is an architect. You can build a high rise in Mexico a lot cheaper than you can in the United States, but don’t ask me to set foot in one.
What should be obvious from the discussion is that “best health care” is a very subjective term. I happen to believe that a free market will deliver the best goods and services. Right now our health care and insurance is very highly regulated and those regulations are costing us billions of dollars each and every year. Any one who believes that thousands of pages of additional rules and regulations and restriction, if not elimination, of the profit motive will improve this situation is kidding themselves. Certainly some, maybe many, individuals will benefit, but our nation as a whole will suffer.
Our country was founded on a set of principles. Those principles created a society which did something unique. It built wealth. Wealth is not a zero sum game where there is a fixed amount that needs to be divided up. Wealth is something that in a free market can be created and grown. Those principles (property rights being key) led to the incredible growth in our country.
Once again I have wandered far afield of the topic of “health care”, and for that I apologize. I believe that the health care debate that is going on right now is fundamental to our country, but not for the reasons that are being discussed. I believe that we are at a cross roads where we will choose to follow the principles our country was built upon or we will choose another path. It should be obvious what path I believe we should follow. It looks like we are about to choose the other path and that saddens me because once we start down that path we will never be able to come back. Liberty doesn’t work that way. Once you give it up you don’t get it back.
December 31, 2009 at 7:17 pm
David Lund
Germany is not a good comparison. David, you surely remember that Germany’s system is not a single payer NHS. It is “halb-staatlich”, with government subsidizing catastrophic care, but still with a strong market component that rewards excellence, efficiency, and prevention on the part of providers.
And recently it has been moving toward being less staatlich. I can tell because I hear Germans complaining about increasing premiums for their Krankenkasse, the private part.
What we have is already more than “halb-staatlich.” Over 50% of all care in the US is paid for by medicare, medicaid, and govt. block grant reimbursement for indigent care. Difference is, we have a crazy quilt with perverse incentives and the Germans are better organized. (They’re Germans).
Britain’s NHS is a better comparison. Single payer. Bureaucratic. Anglo, not Germanic. Disaster.
Ask patients (who can’t afford MedSupp and Medicare Advantage) and docs what they think about medicare and medicaid. Then imagine the whole population under medicare and medicaid.
It is amazing that the USA is considering an NHS, and people are promoting it, at the same time that continental Europeans are moving in the opposite direction, increasing the private side of the mix in order to make the system long-term sustainable and remain innovative.
December 31, 2009 at 8:53 pm
David Housholder
Never pushed for single-payer. What would be wrong with a heavily-regulated but private system (e.g. German system) with national catastrophic backstop?
And if Medicare is so bad why does the entire elderly population have a collective aneurism every time we suggest that it change? It’s the political “third rail” that no one dares touch?
December 31, 2009 at 10:18 pm
David Lund
>What would be wrong with a heavily-regulated but private system (e.g. >German system) with national catastrophic backstop?
Nothing. I think that is what I was saying.
BTW, this is what we have now. Anyone in this state who is taken to Harborview by car or helicopter gets treated at taxpayers’ expense. Medicaid is the chronic care backstop for anyone who needs it. Perhaps it’s not true in other states, but no one in WA goes without needed medical care. The difference seems to me is that our version is quite an inefficient and wasteful patchwork quilt compared to the German system. I think this can only be fixed by politicians with a strong enough backbone to pass needed reforms against vested interests.
There are many good ideas out there, it’s just that few of them are in the current bill proposal, either house or senate version. There won’t be until we have divided government again and therefore bipartisan work– and thus the ability to say no to powerful interests.
The simplest road to savings starts out with 2 things– tort reform and interstate competition. The very large reduction in premiums would start tomorrow. You’ve noticed, however, that in a 2000-page proposed bill, these subjects are never mentioned. Too many donations from trial lawyers and medical insurance monopolies I guess. (Over 90% to the party currently in power).
In Europe, damages are awarded with a calculator. What does/will your treatment cost? How much income will you lose? What will make you financially “whole?” That’s it. No punitive or “lottery” type damages. Also- loser pays court costs. There are no frivolous suits. But people are compensated properly in cases of clear negligence. This is one big reason the German and Scandinavian systems are solvent.
One good thing about single payer would be that you can’t sue the government. At least you can’t yet. (They’d try to find to change that, I’m sure.)
>And if Medicare is so bad why does the entire elderly population have a >collective aneurism every time we suggest that it change? It’s the >political “third rail” that no one dares touch?
Yes, that’s right– just like OASDI (Soc Sec).
The reason is because there are a lot of people for whom it is their only possible source of payment for care. Historically, “change” regarding Medicare has meant only one thing– reduction in benefits and/or higher out-of-pocket costs. There has not been an increase in benefit or reduction in cost in anyone’s living memory. Of course thay have kittens. So will you and I when we turn 65 and hear about “change” to Medicare.
There is only one change that would keep Medicare solvent and be humane: increase its revenue. And not decrease its benefits (keep pace with the cost of care at least). Either by increasing the limit at which you stop paying Medicare tax, increasing the tax rate, or allowing part of it to be privately invested and grow. Preferably all three. Fat chance that any of this will happen, as politicians who must be re-elected are in charge of the decisions.
March 10, 2010 at 1:17 pm
Sue Krautbauer
Amen David L. Although I only spent a year or two in the insurance market, it became very apparent that what you say is undeniably true and although also your opinion, it is very much based in hard reality facts. I believe much of the problem is that our generation, and the generations before us, have been instilled with a misconception that it is the government’s role to ‘take care of the people’. Fundamentally /constitutionally the federal government’s role is is to protect it’s people, against outside threats (military) and internal chaos (justice system). On a lesser level to provide catastrophic assistance for those in need (FEMA, National Guard, BASIC welfare and healthcare). However our generation has been lulled into accepting the concept that government programs are the cure for all our social ills. The national healthcare movement is just one symptom of a larger, much more dangerous skewing of the public perception. In years past, the local communities and churches/places of worship took care of the widows and children (those in crisis) thru faith based programs and community assistance. Now we look outside our communities to the government for our ‘help’. More insidious is the complacency of John Q Public to let the government have more and more access and control over his private info. The stimulus package provides doctors and hospitals with billions of dollars to automate and centralize private data thru electronic health records (easily accessed by the government once in a central databank) and our acceptance of this trend, no wait – more than acceptance, but as illustrated through this thread – a DEMAND for public centralization of private services, is one step closer to a national and global access/ ability to control actions of private people, including their dependence upon government run basic daily services. IMHO, Hello end times…. JC, looking forward to seeing you soon.
March 12, 2010 at 5:23 pm
David Beriss
I know this is like waving a red flag in front of a bull, but “bull” seems appropriate as a response to David Lund’s sadness. He is arguing against something that is not happening. Either he misunderstands the proposed reforms or he is simply arguing in bad faith. So here is the red flag: http://www.nytimes.com/2010/03/12/opinion/12krugman.html. Krugman is right on target here about the proposed health care reform. This is something we need now and it is time to stop with the misinformation (from folks like Lund).
March 12, 2010 at 9:51 pm
David Lund
Hmm…Any points in particular I made that you think are inaccurate or untrue? Or is the vague rhetorical body slam the extent of your comments?
March 13, 2010 at 3:15 am
David Beriss
The response, just to be clear, was to your March 10 comment about being sad. Your create a set of straw dogs (about “government insurance,” deficits, “progressives,” etc.) that do not correspond with reality, but that you can argue against. Krugman’s article is precisely about refocusing our attention on how the proposed health insurance overhaul will actually work. He makes his points quite well and I recommend the article to you. Enjoy.
December 31, 2009 at 2:19 pm
David Housholder
But best health care ever has been by Dr. Josette Taglieri. Private practice right here in the OC. We pay cash. She’s amazing. Little office. Personal focus.
December 31, 2009 at 2:58 pm
Randy Wawrzyniak-Fry
Ask her why. Ask her about her business model. Then honestly tell me if a government run bureaucracy could duplicate that business model.
December 31, 2009 at 7:01 pm
David Lund
I appreciate your honesty. You prove my point with this comment. You might tolerate an NHS because you have Dr. Josette, and can pay her. Norwegians tolerate an NHS because many of them can afford to go to a “private doctor” if they get really sick. Canadians tolerate an NHS because they can drive across the border and pay for services. An NHS is an ideological luxury that people who can pay for the private doctor can afford.
It’s the people who do not have the means you have, who cannot see Dr. Taglieri, who would be crushed beneath the wheel of a bureaucratized NHS.
December 31, 2009 at 9:52 pm
David
David Lund is missing the point entirely with the comparisons…and misunderstands the health insurance and health care systems of other countries while he is at it.
So, first point: do, as David L. claims, Europeans hate their health care systems? The amount of data suggesting that Europeans (and Austrialians, Canadians, etc.) are far more satisfied with their health care then Americans is truly staggering. According to OECD data, significant majorities in France, the UK, Germany, the Netherlands, and even Norway, are satisfied with their health care systems. According to the Commonwealth Fund, Americans are far more likely to say that their system needs to be rebuilt completely than people in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. Because of restrictions, deductibles, limited access to primary care physicians, Americans are far more likely than people in those countries to report that they have skipped medications, did not see a doctor when sick, or did not obtain recommended care in the past year. Interestingly, far more Americans report having trouble getting same day appointments than most of the other countries. Americans are more likely to report problems with billing and bureaucracy then people in the other countries.
Second, as I have pointed out earlier, the “systems” to which we refer (NHS, in the UK, for example, or single payer in Canada) are actually far less systematic and simply described or compared. Here is a brief (I promise) analysis of some lessons from France that compare interestingly with the U.S. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/#r6). You will note that their “single payer” system is actually far more complex…but it covers nearly everyone and keeps costs from rising as fast as here and people there like it. Keep in mind, however, that we are not starting here (nor did anyone anywhere else) with some kind of health care tabula rasa. We are building on what we have, just as they did. So while we can learn by looking elsewhere, we have to deal with our own system as it is, not as we imagine it to be.
The fact is, we all know people who are happy with their care and insurance and people who are not. My wife is British and I spend a fair amount of time there and in France (for work). I know many people — both patients and medical professionals — in both places who are very happy with their systems (which are very different from each other), but that does not mean they are not critical or that bad things do not happen. However, the survey data, as I have noted above, is overwhelming. People in the countries I cite are satisfied with their systems.
Ok, last point: none of this matters in the U.S. because the bills now being reconciled in Congress do not propose an NHS system (like Britain) or a single payer system (like France, at least partially). That was why the earlier discussion about monopolies and monopsonies was not really relevant either. Our reformed system will be very much like the current system, with more controls. A mixed public/private system, sort of like France, but without the single payer that covers some of their system…so, in reality, completely different. Having a public option would make all of that work better, but that seems to be off the table, so we’ll see how it goes.
I’ll finish with one story about being crushed under the wheel of the NHS (I love that image) in the UK. My good friend, Dr. David I, a Brit, educated at Cambridge, picks me up at the tube station near his house a couple years ago to take me home to dinner with his family. As I get in the car, he says, would you mind if we make a quick stop? I have to drop off this breast pump and check in on a patient who recently had a baby before we go home. And so he did. Just a friendly house visit. Covered by that soul crushing bureaucracy, the British NHS. The face of which is my good friend, Dr. David I. (and his wife, Dr. Carmel I., another extremely jolly GP who does house calls in London). Scary, these home visiting docs. Oh, they do house calls in France too. Some crazy idea that sick people should not necessarily be traveling around town for care…
Don’t worry, David L. Congress is making sure we don’t bring that sort of beast here. But at least more people will have access to affordable care and we might get a grip on rising costs (ours are rising the fastest in the world, by the way…).
So, to sum up:
1) People with national systems in Europe and elsewhere generally like them.
2) No such thing is being proposed here, in the U.S.
I hope that helps (and, Randy, I hope you feel I kept the condescension quotient to a minimum).
December 31, 2009 at 11:32 pm
David Lund
I have not considered you condescending. You make strong, well-reasoned arguments.
You might read people’s posts more carefully before critiquing them. Or saying they “miss the point entirely,” etc.
I did not say most Europeans hate their systems. (Or did I? Where?) I believe I said for the majority of cases, they’re fine. Of course, the majority of people will say they are satisified. They are. So is the majority here. That tells us nothing.
Relatively few people — the definition of minority– get rare or critical illnesses or injuries that threaten premature death. Since the majorities are satisfied in both cases, their feedback is not helpful. I am more interested in the experience of the minority.
Surely you don’t deny that Canadians come over the border for care? Lots of them. Or that Norwegians pay for private doctors if they are really sick and have the means? Yet I know no Americans who cross over to Canada for the same. Nor Norwegians who could afford better, but keep rattling around the NHS without diagnosis.
My argument explains the Mayo Clinic and the Childrens’ Hospitals around the USA. They exist because of the rare. The minority.
How do you explain Mayo? Or why people from all countries go there, when they are really sick and can’t get a diagnosis? It’s not just the rich, by the way. People who are informed know what to do, if they are able. Get on a plane to the USA.
I happen to believe that you take the moral temperature of a society by looking at how it treats minorities (especially expensive ones), not majorities.
Hence my conclusions about how each system deals with its medical minorities.
January 1, 2010 at 9:22 am
David Housholder
There are way too many Davids on this topic. Dr. Seuss wrote “Too Many Daves.” Hope you can all distinguish us from each other.
January 1, 2010 at 4:03 pm
Randy Wawrzyniak-Fry
I was thinking about there being a plethora (from the Greek Goddess of Oversupply) of Daves on this thread and was going to comment, but realized that I had used up my irrelevancy quota. Happily it’s a new year and (begrudgingly) a new decade mean means a fresh supply.
Where was I going with this? Oh yeah, I have several comments.
1) You can’t tell the Daves without a scorecard.
2) Did I ever tell you that Mrs. McCave
Had twenty-three sons, and she named them all Dave?
Well, she did. And that wasn’t a smart thing to do.
You see, when she wants one, and calls out “Yoo-Hoo!
Come into the house, Dave!” she doesn’t get one.
All twenty-three Daves of hers come on the run!
This makes things quite difficult at the McCaves’
As you can imagine, with so many Daves.
And often she wishes that, when they were born,
She had named one of them Bodkin Van Horn.
And one of them Hoos-Foos. And one of them Snimm.
And one of them Hot-Shot. And one Sunny Jim.
Another one Putt-Putt. Another one Moon Face.
Another one Marvin O’Gravel Balloon Face.
And one of them Zanzibar Buck-Buck McFate…
But she didn’t do it. And now it’s too late.
3) Dave’s not here!
4) I’m stopping well before eight because point eight turns out to be a smiley faced dude wearing shades.
8) Peace out
January 2, 2010 at 5:34 am
David
You can never have too many Davids. Perhaps in the future I will label myself David B., just to avoid too much confusion.
Anyhow, for David Lund, your point about non-routine cases is well taken, but I think that in terms of actual outcomes, the data also shows that many other countries (including Europe and Canada) do better with some of those things than we do, while we do better with others. Take a look at this article, which provides outcome rates on a variety of conditions comparing the US with other countries: http://content.healthaffairs.org/cgi/content/full/23/3/89. You will see that we perform better in some areas (U.S. breast cancer survival rates are higher), but less well in others (we do worse for colorectal cancer than the other countries). The author concludes by pointing out that each of the countries he compares could do better in some areas. One of the notable things, however, is that while the quality of care in the US seems to be not that different overall than the other countries, our costs are far higher. This leads the author to ask whether we are using our resources efficiently. After all, if our outcomes are not better, but we have to spend more to get there, that suggests a problem.
As for health tourism, it turns out that a growing number of Americans also cross borders for care, even to third world countries. I don’t have time to look up the numbers for you, but there have been a number of articles on this recently, pointing out the growing rate at which Americans (and others) travel abroad, often to 3rd world countries, for treatment for things they cannot afford here. And, of course, we have already discussed the use by Americans of pharmaceuticals from other countries.
To further illustrate the point I made above about costs, look at this illustration from National Geographic: http://blogs.ngm.com/.a/6a00e0098226918833012876674340970c-800wi. It compares health care costs with average life expectancy at birth in different countries. Note the red line, which is the US.
Happy New Year to all.
January 2, 2010 at 5:50 am
David Housholder
Best sound bite of the entire thread: After all, if our outcomes are not better, but we have to spend more to get there, that suggests a problem.
January 21, 2010 at 1:47 am
David Housholder
I am up in Canada.
If there ever was a conservative “red” province it would be right here in Alberta.
I’m teaching all week at a Bible College on the prairies.
Hardly a hotbed of liberalism and socialism.
Everyone is asking me about the US healthcare debate and Obama.
They aren’t big fans of Obama.
But they think the US healthcare system is totally dysfunctional.
I go serious laughter when I suggested that that Canada should switch to our system.
One said, in the US, I’d be afraid to get a blood test because of the charges, co-pays, and whatever.
I told them what I pay in premiums and what I get for it and….honestly….I think that they think that I am lying. They think I am exaggerating.
January 22, 2010 at 3:38 pm
CBI
Thanks for the report from the cold “North strong and free”. For most people, an idea of “what’s it like” in another country for the majority of residents comes from various news and entertainment sources. In Alberta, I think that would mainly be CBC broadcasts and CP news reports (with AP & Reuters, and perhaps AFP appearing at times). There would likely be a modicum of U.S. television available. Given those sources, one would expect that most people to have the perception you have encountered.
In a previous post I mentioned a comparison of health care satisfaction among Americans with and without insurance and Canadians. The report is at:
Report at Social Science Research network website: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1395928
Bottom line from the study:
“For most comparisons, the Canadians are experiencing satisfaction levels much closer to that of America’s uninsured than they are to the insured. That suggests the drop in satisfaction for the insured under a U.S. health care reform initiative could be much greater than the increase in satisfaction for the newly insured Americans.”
I’d be interested in the reactions of some of the more reflective Albertans on the study.
January 23, 2010 at 4:40 pm
Randy Wawrzyniak-Fry
I thought some of you might be interested in the results of the latest Rasmussen Poll regarding health care. (Some say that Rasmussen is biased towards the Republicans, however it had the most accurate picture of the 2008 election and is widely held to be one of the most accurate.)
“Sixty-one percent (61%) of voters nationwide now say Congress should drop health care and focus on the economy. Seventy percent (70%) believe that the health care issue was at least somewhat important in Scott Brown’s victory in Massachusetts. . . . tracking poll for the proposed health care reform and found that 58% of voters remain opposed to the plan Congress was considering. That figure includes 50% who are Strongly Opposed.”
March 3, 2010 at 7:35 pm
Diane Camerer
I am not knowledgeable enough on our current health care system or any of the proposed systems to comment on any specifics but I would like to put down my thoughts. I do not think Health Care or Health Insurance industry as a whole should be financially driven. This country is overrun with big businesses that focus primarily on huge profit margins. The Health Care industry should not be one of them. What if our Fire Departments, Police Stations, Libraries etc all got into the business of profits? Start having to compete with each other? These are all community/social services. I think Health Care should be a community/social service too. If that means government run, then so be it.. Unfortunately in our system today, when someone doesn’t have health insurance they are afraid to get the medical attention they need for fear of not being able to pay the costs. Also, there are way too many people who are unable to afford the costs of their health care even with insurance. Prescriptions, co-pays and premiums alone are enough to be financially devastating for an individual or family in a lot of health issues. The bottom line is a non-profit system would reduce costs significantly for all. Treatment, procedures, Hospital stays, prescriptions, premiums.. all costs would go down.. more people getting the medical attention they deserve. I think Jesus would like that!
March 4, 2010 at 10:10 am
David Lund
I appreciate your honesty, Diane, and I know your words come from the heart.
Many people do not know that:
1) Health insurers are *required by law* in this country to make profits, in order to build and replenish the very large reserves they are required to have on hand. An organization like Blue Cross must build up tens of billions in reserves. So that if there were a major epidemic or disaster, they would have the funds available to pay for all the care. This is why they will always have a disadvantage against any “public option.” Government is not required to have reserves, since it has the taxing power. With a competitor who has no reserves required (and who, at the same time, forces the companies to keep a huge reserve), all private insurers go broke. There is no way they can survive on such a tilted playing field.
Then you have one health insurer (the govt) with no reserves. So what if there is an epidemic/disaster, and yet tax rates cannot be raised any higher– or worse, rates go higher and as a result, actual tax revenues go down. Then the govt. has to borrow the money and likely will never be able to repay it. Down the road comes default on the debt. When a govt. defaults, then all health insurance is GONE and only the wealthy can get medical care at all (for cash). This is why in many African countries, most people have no insurance and thus get no care at all (unless a Mercy Ship or NGO- paid for by donations from capitalists!– happens to sail into port)
What if the choices really are: inferior care for a few (what we have now) vs. much worse care (or none) for the many?
This is why (ironically) European govts are right now backing away and privatizing as much as they can. They are looking at eventual default and collapse of the system, and they are deciding that is not future they wish to have for their people.
Government’s ability to increase tax revenue is finite (though sometimes it doesn’t seem like it!). That’s why government health care always results in rationing. There’s nothing else they can do to remain solvent.
2) After filling up their required reserves, health insurers have among the lowest profit margins of any business. Their rates are already monitored and regulated by government– state government. (Part of the current push is for the federal government to grab regulatory power away from the states.)
A non-profit system would be an insurance system without reserves (like Social Security). An insurance system without reserves (a pool) is very fragile and easily collapses in adverse conditions. A house built on sand, so to speak. Just like you and me- we are in a solid position when we can pay all our bills and have money in the bank. We are in a vulnerable position when the opposite is the case.
3) A non-profit system would also mean the end of innovation in medications/pharma. Today it costs a at least around $500million to develop a medication and bring it to market. These sums must be garnered and built up through operating profits. Where else? Some may be content with nothing beyond aspirin, and don’t care about seeking any new cures for AIDS or cancer or anything. But most of do want this to continue, and it requires vast sums. Of private money.
It doesn’t cost half a billion dollars to develop a new fire truck.
I may have not persuaded you, but I hope you will digest these facts and pass them on.
Two things would make everyone’s costs go down tomorrow:
a. Reform and limitation of tort (medical malpractice) law. Stop people from filing suits simply because it is FAR more probable to get rich by suing docs and hospitals than it is by playing the lottery. Start doing damage awards by calculator (see my other post on this).
b. Loser pays. If you lose, you pay both sides’ court costs.
Both would lower premiums, cut out waste (defensive medicine and unneeded, expensive tests), and stop driving doctors out of practice.
March 4, 2010 at 6:42 pm
David Housholder
David Lund, great post. This “thread” is plumbing out all kinds of things that aren’t being talked about in the public marketplace.
Not that there is any malice or conspiracy–it’s just so complex that no one really “gets” it all.
Diane, I like your aligning health care with fire, police, etc. Why do we assume, even with all DL says about reserves, that it should be a for-profit part of our society?
March 4, 2010 at 8:38 pm
Diane Camerer
David L, I agree whole heartily on the tort thing… but as for the rest.. I am still not sold. I did learn more about our health care system after reading your post though. I did not know there was a law that required Health insurers to make a profit but laws can be changed, it is done every day. I do see the need for a reserve for a major epidemic or disaster as you say.. but what about the small epidemics and disasters happening everyday. I think it ludicrous to have have tens of billions of reserve on hand and also not granting insurance coverage for pre-existing conditions, have submitted claims rejected for whatever reason, the elderly going w/o food so they can buy their prescriptions, 20-somethings getting their checks and income tax returns garnisheed for payment to a hospital because they did not have health insurance when they broke their leg or something, and I could go on and on… It is like saving for a party you may not live long enough to attend. I do see the need for pharmaceuticals to have some $ for R & D. But 500 million to bring a drug to market? Maybe that in itself needs looking into. (That opens up a whole new can of worms.. why are drugs being developed for some ailments and not others. My fathers family seems to be ridden with neurological disorders. R & D is not being done on neurological disorders like it is for cancers and heart disease and such. Who or what is picking which disease get research and which does not… the almighty $) Is there a law that says a hospital or clinic needs to stash away large reserves, or even make a profit? Just bringing the word profit in the spectrum to me tells me we now have “profitable” sicknesses and “unprofitable” sicknesses
(hence the research choices), “profitable” patients and “unprofitable’ patients. Profitable patients get better care but they also get charged more to make up for the unprofitable less cared for patients. Shouldn’t there be some moral or ethic response to all this? I am all for the values we place on the freedom of free enterprise in this country and the economic benefits that may flow from a more efficient health care system. But are we willing to uphold these values at the cost of other important values, like the dignity of our people and a community-centered ethics that places the needs of people before profits? I think we all can agree everyone should have health insurance, we need to lower costs, we need to maintain quality, and that the expenditures right now in health care are unsustainable. It is just too bad some common ground can not be found on how to do it. I don’t know if there is such an animal. But I do believe that the people who do it should understand the science, who really are committed to patient care, and also be able to think about how to make those human systems work effectively. It all makes my head spin.
March 10, 2010 at 8:49 am
David Lund
This conversation makes me so sad. It reflects the detachment from reality of this whole debate. Many people do not know that insurance requires a (gigantic) reserve. All insurance is a pool of money that contributors put in for one another– for the time of any one person’s or family’s need. There is no other kind of insurance that actually insures anything.
Government “insurance” (like SocSec and Medicare) has no pool because the state has the coercive taxing power and can thus borrow vast sums when need is great. I wish it were understood that such an in-out scheme, when conducted by private persons, is a Ponzi scheme, it is called fraud and people go to prison for it. It is a fraud to promise people benefits in their time of need when you have no money.
When government does this, people call it “non-profit” and declare it “justice.” Except non-profit means you spend exactly what you take in. Government medical “insurance” spends more than it takes in- even when doctors are paid pennies on the dollar for the cost of their services. It is not for-profit, it is not non-profit– it is a for-negative-profit, or a for-loss enterprise.
Many seem to ignore or refuse to understand that borrowing cannot go on forever, even for a government. At some point the state will not be able to service the debt (pay the interest), let alone pay it back, and that is default. We should care about “other values” like the “dignity of people.” Of course we should. But are people aware of what happens when a government defaults and cannot pay for care anymore, and private mechanisms of paying for care are gone? A nation with a majority of people who get no care– only those who have available wealth (their own pool) get care — is a vast sea of indignity. I can think of few things more unjust. Like many African countries and Latin America in the 80’s. Don’t say it can’t happen here. It can happen anywhere.
There was a time when insurance pooling was understood, correctly, to be progressive. It moved us as a nation out of the medical dark ages. It is the means for masses of people to get good major/expensive care when needed, not just the wealthy who have their own reserves. It is depressing that the “progressives” of our day bad-mouth insurance and want to go back to a flimsy, in-out system that can be ruined by incompetent bureaucrats and thus return a population to a much more primitive condition of care-for-only-the-few.
“500 million to bring a drug to market? Maybe that in itself needs looking into.”
Indeed. You don’t need to look far. We live in a society run by lawyers (three-fourths of the house and senate (?), and the president) and many of them get very rich through litigation. This cost is almost entirely due to playing defense against the army of litigators, and the out of control awards. People die needlessly every day because medications are held back due to this all-too-real fear: the fear of a handful being harmed through a side effect and the ensuing lawsuit bonanza. Therefore we condemn 1000’s people to death who would have been helped. That’s the reality.
March 31, 2010 at 1:58 am
CBI
Dave H.,
You may already know this, but the policy you would like to have is now illegal in all fifty states. The new health care takeover law prohibits anything higher than a $2000 per individual deductible.
Quite frankly, I sometimes get to thinking Jeremiah-Wright-ish language concerning the current president and congress, and have to work hard to “be angry but sin not.”