FrontPageMagazine.com | Jacob Laksin July 18, 2007
When Michael Moore recently premiered his new documentary Sicko, liberal Democrats and likeminded pundits were quick to applaud the big-budget paean to socialized medicine. Not among those clapping was filmmaker Stuart Browning.
If Moore’s film channels the prevailing left-wing wisdom about the alleged glories of government-run healthcare, Browning’s work represents a much-needed corrective: a skepticism about government’s ability to provide efficient coverage and a confidence that the free-market is a better compass for change than a Hollywood ideologue. “I can’t imagine anything more crucial than the right to make life-or-death decisions, the right to privacy, the right to choose one’s own doctor. And all these things are at stake,” said Browning in a recent interview from his Florida office.
Browning’s faith in the market is anchored in part in his business background. A Virginia native and entrepreneur, Browning has presided over several successful enterprises. Embarcadero Technologies, a San Francisco software firm Browning founded, was rated the nation’s top IPO in 2000. Most recently, he has attracted notice through his production company, On the Fence Films, the force behind Evan Coyne Maloney’s critically acclaimed Indoctrinate U. Consequently, Browning makes no effort to conceal his distaste for Moore’s view — repeated ad nauseum in Sicko — that the profit motive is a disease that must be cured to save American health care. “I want to banish the idea that profit is the problem,” Browning said. “The problem in health care is not a problem of the market. It is a failure of government.”
Browning made his entry into the healthcare debate in 2005, when he co-directed (with California lawyer and business partner Blaine Greenberg) a 25-minute short film investigating the perilously long waiting times in the Canadian medical system, which is often cited by advocates of universal healthcare coverage as a model for the United States. His findings were summarized in the film’s mordant title: Dead Meat. Since then, Browning has produced several short films that examine the flaws of the Canadian system and take a critical look at statistics — such as the much-cited but misleading figure that 45 million Americans lack health insurance — that are used by proponents to mount a case for single-payer health insurance.
Particularly compelling are the films on Canada’s health care system. Posted on Browning’s website, FreeMarketCure.com, they provide a powerful counterpoint to the reverential treatment that the Canadian system receives in Moore’s movie. For Moore, complaints about long waiting times are nothing more than insurance-industry propaganda aimed at discrediting a flawless system. For Browning, they are something else entirely: the stories of real people that the government has left behind.
Case in point is his film A Short Course in Brain Surgery. In it, Browning tells the tale of Lindsay McCreith, a retired body shop owner from Ontario who was forced to wait four months for an MRI to determine whether he had a brain tumor. Banned by Canadian law from seeking private care, he finally got the MRI in Buffalo, New York, whereupon he discovered that the tumor was indeed real. But he still needed surgery. In Canada, he would have been required to wait six to eight months — by which time the tumor might have proved fatal. In the United States, he got surgery within a week.
Not all of Browning’s films have a happy ending. Two Women, for instance, documents the unhappy plight of a Canadian woman whose bladder had failed. Needing urgent surgery, she was instead placed on a three-year waiting list. Pleading with authorities to be moved up by the list proved futile. Meanwhile, she suffered repeated infections. In the end, doctors had to remove her bladder in order to save her life. By contrast, a man seeking sex-change surgery found a sympathetic ear in a gay parliamentarian: He is now she. It’s the kind of unflattering insight into the realities of the Canadian healthcare system that the more zealous cheerleaders of universal coverage are uneager to dwell on.
. . . more
This article is guilty of the same offense that it accuses Michael Moore of committing: using isolated anectodes and horror stories to make their case rather than more solid, empirical evidence.
On the basis of a few isolated horror stories we are supposed to believe that the Candian health care sytem is inferior to ours. The empirical data, however says otherwise. Canada has levels of patient satisfaction and medical outcomes equal to or surpassing those of the United States, and they do so at far less cost, per capita, than here in the US.
It is particularly dishonest and outrageous to accuse Canada of having long waiting times for care when the financial design of the US system produces the same long waits and barriers to care for millions of Americans.
– Many Americans take jobs where they have to work for 6 months or a year before they become eligible for health benefits.
– Americans who do belong to HMOs and PPOs are limited to the small number of specialty physicians who are in their plan’s networks, and who may have a backlog of many months for appointments.
– Because of low Medicaid reimbursement rates, the number of specialty physicians available to medicaid beneficiaries is also very low, resulting in long waiting times for an appointment.
– Those without insurance may receive some care in the emergency room or local clinic for the poor and indigent, but if they need specialty care they have to pay for it out of pocket, and the unisured are charged the highest rates of all. So inability to pay beciomes a practical barrier to care as well.
Saint Paul admonished the Corinthians that they shouldn’t have social divisions in their churches, with the rich in special seating right-up in front, and the poor in standing-room only balconey’s way in back. It’s curious that a Christian nation would set up a system of care for the sick that operates that same way.
Dean, You raised some valid points about HMOs, but your arguments actually support more competition and privatization and less gov’t interference. The problem with HMOs is that they are run more like gov’t bureaucracies instead of private enterprises. They place too many layers, rules, and regulations between the patient and the doctor. They are not responsive to their patients and doctors, but must look to faceless bureaucrats and lawyers in making many important medical decisions. Once again, your solution is to add more of that to fix the medical system. Don’t forget HMOs are a legislative “solution” created by politicians NOT private enterprise. We are going to, once again, trust those that created this mess to “fix it.” It doesn’t make any sense!
Also, re:
It’s not the “financial design” of the US system that produces long wait times. It’s (a) the 12+ million illegal immigrants (probably 15 million or more) who use the Emergency Rooms as free healthcare clinics; leading to many hospitals and Emergency Rooms closing, (b) the countless regulations and processes created by gov’t rules that have added a mountain of bureaucracy and costs to all medical transactions, and (c) unethical trial lawyers and run-away product liability lawsuits that have driven doctors and medical providers to the brink of bankruptcy.
HMO’s—Health Maintenance Organizations were originally designed to provide inexpensive preventative care on the assumption that catching acute disease early would provide better outcomes both financially and medically.
None of the assumptions proved to be true for a lot of reasons, among them:
1. As soon as the providers learned how to manipulate the billing system, the cost savings disappeared.
2. Many people did not access the “preventative care” until symptoms forced them to—no savings because of that. (This is a symptom of one overall problem—lack of patient responsibility which is also required for proper preventative care)
3. The savings were largely projected for acute situations, not chronic ones. (Allopathic medicine is structured for treating acute conditions and is still largely baffled by chronic ones anyway)
4. Patients demanded more services than could reasonably be delivered through the HMO model.
5. Technology exploded, but technology is not cheap (this includes prescription medications)
6. Due to patient expectations and increased lawsuits, more tests became the norm and costs escalated.
7. Direct advertisement of prescription drugs increased the use of the most expensive drugs by as much as 40%
8. HMO’s got greedy
9. Providers got greedy
10. Patients wanted something for nothing
11. HMO management did not respond to the changes with creativity and flexibility.
12. Government subsidized the greed of all parties and the inefficiency while fanning the flames of patient expectations.
Since Dean lives in California, dominated by HMO’s, he is probably not aware of the other models that exist and work better. The HMO model depends upon a large patient base with relatively low utilization of costly procedures. HMO’s are structured to force patients to lower utilization and less costly procedures. It is exactly what would happen under government controlled health care except we could add even more bureaucracy and politically favored classes of people and diseases. If Dean thinks the government is the answer to the HMO dilemma, he’s smoking something that is illegal in most states. But who knows, it might be a state mandate that his HMO has to pay for in California.
It is a fallacy that health care is just like any other market for a good or service.
The Health of Nations, Arnold S. Relman
In other words, patients (or consumers of health care services) are in a poor position to “shop around”. They don’t have the same level of medical knowlege as their physician and if their condition requires immediate treatment, may not have time to make a careful evaluation of alternative treatments or providers.
A glimpse at the Republican vision for health care …
http://www.thehealthcareblog.com/the_health_care_blog/2006/03/controlling_hea.html
Dean, Note 4, Arrow misses his target, medicine no different than law in terms of economics
Let’s look at Dr. Arrow’s reasoning of why medical services are not like every other market.
–
This is no different than the demand for legal services arising from the ordinary American citizen. The ordinary person doesn’t know when he will get involved in a car accident or when he might be arrested. The need for legal services often are associated with the client being injured or seriously ill. Lawyers still compete based on price for various services.
The supply of legal services is definitely shaped by the professional judgment of lawyers. Many clients come into law offices and are told they don’t have a case by the lawyer. Many clients come in believing that they have one kind of lawsuite when, in fact, they have another. Ethical standards for lawyers are, in fact, quite high as each state has a vigorous Board of Ethics Review which is available to process complaints from any affected person. Lawyers are required to put ethics above considerations of profit. We still compete for clients.
– a limitation on the entry of providers into the market, resulting from the high costs, the restrictions, and the exacting standards of medical education and professional licensure;
Every profession limits the “entry of providers into the market.” There are a limited number of C.P.A’s coming into the market. There is a limited number of bona fide degreed engineers coming into the market. Accountants and engineers still compete with each other based on price.
– a relative insensitivity to prices; and a near absence of price competition.
Arrow confuses two things. A person may not decline an appendectomy because it is too expensive, he may not have that option, BUT, every person I know would shop for the cheapest qualified surgeon if he thought that information was available. In my metropolitan area, a survey showed that hospital charges for a simple, uncomplicated natural birth ranged from $3,000 to $9,000, this was simply for the provision of a sterile birth room. Period.
Buyers could shop IF medical suppliers allowed the shopping to occur.
It if resistance from the health care providers that defeats medical shopping.
Sorry, Dean, there is nothing unique about medical care that prevents it from being a market.
Dean, have you ever shopped pharmacies by calling them and asking them what their price for a particular prescription was before you purchased the drug? I have, there are big differences even for established brand, name non-generic drugs? So what, it is a market and consumers will shop if they can.
By the way, I find it difficult to believe that Arrow wrote this.
Missourian: If Physicians are told that cost is now the basis upon which patients will evaluate and select providers, doesn’t this create a bias for the physician to recommend the least costly mthod of treatment, even if that method of treatment may fall short of completely addressing the patient’s medical needs.
For example a patient needs to have a growth from her breast removed. Doctor A, says “With your family history of breast cancer I also want to have a biopsy done to see if the growth is malignant – but that will cost an additional $1,200.” Doctor B says, “You know, I’ve seen hundreds of these growths and chances are that that growth is benign. Let me remove the growth for you and save your money on the biopsy.”
Is Doctor B telling the patient the truth or responding to a financial incentive to lower costs in order to capture business? Without going to medical school and/or having done thorough research on the subject, how would the patient know for sure whether the physician’s recommendation is correct? There is the information assymetry that referred to by Arrow. In a perfect market both sellers and buyers have all of the information. In the health care market, the buyer’s information is much more limited.
We rely upon physicians to recommend the proper course of treatment regardless of cost. We don’t want to introduce other elements such as, “market competition” that may bias their decisions in a manner which may compromise care.
Dean, Note 7, no different than lawyers, in the end, we have to rely on integrity
Analogous situation. Client visits with Attorney A. He suspects that some members of his family are abusing the trust of a wealthy elderly parent. Attorney A collects the documents and does a preliminary investigation.
After the investigation he has to give Client advice. If Attorney A recommends litigation Attorney A stands to make quite a bit of money regardless of the outcome. If Attorney A recommends no action, he makes no money, but, he may spare Client A the cost and trauma of a family fight.
Questions for you. How would the Client know that Attorney A’s recommendation is correct? Here is an “information assymetry”, Client A has not gone to law school.
Analogous situation. Client visits with Certified Public Accountant. He has just received a tax due notice from the IRS regarding a previous tax return that Client had filed on time in good faith and paid in full. The C.P.A. examines the tax return and the tax due notice from the I.R.S. and he has to prepare a recommendation to the Client. Should the Client spend money contesting the tax due notice OR should Client just pay the tax due notice and get on with his life. The C.P.A. will personally make more money if the Client contests the tax due notice. The Client has not studied the tax code and has no experience with I.R.S. tax controversies, there exists a ”
information assymetry.”
You argument applies with any profession: accounting, engineering, law and yes, the holy of holies, medicine. I suggest that it is the medical profession which has resisted the normalization of medical practice. The M.D.’s do not want to compete on price and quality and they don’t want their mystique questioned.
In all cases, the public depends on the ethics of the individual practitioner and vigorous oversight by a Board of Professional Ethics that investigates complaints from the public.
Again, Dean, you need to do more, you have to show me why going to the V.A. hospital is preferable. Government has failed miserably in providing good health care to veterans, so why should they be entrusted with providing health care to the general public.
It has been my experience that the brightest people RARELY go into governement. It is hard to get good lawyers to work for DOJ because of the massive institutionalized stupidity of federal government. Good lawyers don’t want to work with that stupidity.
Note 7, how to break the “information assymetry” logjam
Dean, few people know that hospitals collect performance data on their own operations and on the performance of doctors. This performance data is NOT available to the public, but, only to the federal government and its accreditation committees.
Accreditation commitees look at:
Mortality rates by hospital department: OB/GYN, CARIAC, ORTHOPEDIC, etc.
Mortality rates by surgeon:
Infection rates: the percentage of people who become infected for the first time IN THE HOSPITAL
Complication rates for various procedures: normal delivery, C-section delivery
All of this information could be made public and the public would have a very good idea of which hospital to go to. Right now the medical profession blocks the dissemination of this information because they paternalistically don’t think we should have it.
This is just the beginning, there are many other ways that medical people can be forced to disclose performance data. Boy, they sure don’t want to do that.
Missourian: You write:
First, while there is no doubt that the VA system has some problems, the situation is not as black and white as you describe it. The VA does have a problem with an aging hospital infrastructure, wear and tear, and a backlog of cases – which are, of course, problems caused by underfunding by the Bush administration.
Patient Care in the VA system, on the other hand, has consistently received good ratings over the last ten years. It’s developed a computer system (VISTA) giving every veteran a full electronic medical record, it has become one of the leaders in providing chronic care management using advanced technology for veterans in their homes, and the quality of the clinical care it delivers to chronically ill veterans has been shown in peer-reviewed studies to exceed that of some of the better private sector HMOs.
See “The Best Care Anywhere“, Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they’re producing the highest quality care in the country. Their turnaround points the way toward solving America’s health-care crisis. Washington Monthly, January/February 2005
and
The Best Medical Care In The U.S. , How Veterans Affairs transformed itself — and what it means for the rest of us, Business Week, JULY 17, 2006
Businee Week notes:
While there have been problems at Walter Reed Medical center, it should be noted that WRMC is operated by the Defense Department and is not part of the VA system.
Looking beyond the VA, the very quality indicators you cite as providing guidance to consumers show no association between public and private operation of hospitals. In California, we have the excellent Santa Clara Valley Medical Center operated by Santa Clara County, and the scandalously mismanaged King-Harbor/King-Drew Public Hospital in Los Angeles which has been on the verge of being closed down for years.
In Redding, California, the privately operated Redding Medical Center, part of the Tenet Hospital system, was raided by the FBI and nearly closed down a few years ago, for performing hundreds of unneccesary cardiovascular surgeries billed to Medicare, Medicaid and the military’s Tricare program.
Note 10, your argument is based on the impossibility of market competition
Dean, if the medical profession stopped blocking the collection and publication of the data that accreditation agencies use to evaluate hospitals hospitals would have to stand accountable for their performance. Patients would not agree to be treated at bad hospitals.
Doctors can be evaluated also. Hospitals routinely evaluate the performance of doctors who hold privileges to practice. This information could be made publicly available.
Market competition is blocked by the medical profession. It exists in engineering, accounting, and law. It can exist in medicine.
The King hospital was not closed because it was a black institution. Non-black employees had leveled quite a few discrimination charges against that hospital. Those discrimination charges were investigated and reported on by a national news network. Jobs at the hospital were treated as a form of political spoils for politically connected blacks. If it had been a white hospital it would have been closed long ago.
Note 10, BDS, it is really silly to claim that Bush caused everything
The Veterans Administration is like the Queen Elizabeth transatlantic ship. It doesn’t change course quickly. Problem in the V.A. go back decades. It wasn’t as if the V.A. was in tip-top condition the day Bush was inaugurated and then went precipitously downward. Large institutions don’t change that quickly.
The fault is with government. People get tenured positions and they don’t have to perform well. They have so much job security no one can fire them no matter how bad they perform. It is called “government” and it why the court system stinks and the V.A. stinks.
Dean, Note 10, Everything negative is attributed to Bush, everything positive is attributed to the glories of government
Taking your cited article Best Care Anywhere at face value, you have to give the Bush administration credit for the improvement which was documented as of……. drum roll……2006. This is six years after Bush was inaugurated. Luckily we have the Dean rule: :if defects exist, they were created by the Bush administration; if positive attributes exist, they are the part of the glory of government.”
What?!? No one is suggesting that we stop collecting quality data or discourage competition. My only argument was that those very qualty indicators we do collect show that there is no relationship between public or private ownership of hospitals and quality of care.
If anyone is trying to discourage competition in health care it is the conservatives who have sought to cut funding for public health programs at every turn while lavishing governnment subsidies on the private sector. The Bush adminstration is seeking to cut Medicare reimbursement for physicians at the same time it is funding private “Medicare Advantage” health plans that cost taxpayers 12% more that regular Medicare. It was the Bush administration that refused to allow the government to negotiate directly with pharmeceutical companies for lower drug prices, thus insulating them from the market.
If you really believe in competition, ask any senior citizen if they would rather have Medicare, or one of those threadbare private insurance plans with high deductibles and copays that can disenroll them at the first sign of a preexisting medical condition.
Within the next few weeks will see one of the most evil, immoral and shameful acts of any American Presidents when George W. Bush, as promised, vetoes the appropriation by Congress of additional funding for SCHIP (the State Children’s Health Insurance Program). This program funds health care for needy children and Bush knows full well that current funding levels fall short of what is needed to take care of children already enrolled.
Bush knows that his alternative plan, tax credits to pay for private insurance, will be inadequete for lower income families who pay little taxes to begin with, and as result millions of children will be left uninsured. Congressional legislation would spend an additional $35 billion over 5 years to expand health coverahe for children. Compare that with the $700 billion already spent in Iraq.
This is the pure unadulterated evil of the Bush administration. Its is willing to spend $12 billion, a month, in a futile attempt to referee Iraq’s civil war, but unwilling to spend $7 billion a year to help America’s needy children.
Note 14, why don’t you hold up a “needy child” Dean.
Social Security is unfunded. The prescription drug plan for seniors recently passed isn’t really funded. Unfunded entitlement programs will swallow up the American economy in the next ten years if something isn’t done.
Cooking up a program “for the children” and placing Bush in the position in which he vetoes the bill is nearly all politics. Health care needs to be examined as a whole, not piecemealt: one bill “for the children” and one bill for the elderly, etc. etc. etc. Health care also needs to be examined in terms of the entire economy.
How about stimulating the economy so that employers can expand and hire people. Those employed people can then pay for their own health care, pay for their own insurance or negotiate for insurance from their employers as a benefit.
Your approach freezes the “poor” in place, creates a massive incentive for continued government dependency and does nothing to move the poor out of poverty into self-sufficiency and work.
No, I am not going to cave in just because some Dems cynically posture over the fate of poor chidren. Let’s get their parents a job.
Canadians are rebelling against their system, a system allows patients to rot, and even die while waiting in line
Canadian Doctor Describes How Socialized Medicine Doesn’t Work
By DAVID GRATZER | Posted Thursday, July 26, 2007 4:30 PM PT
I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people.
My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute.
Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.
Dr. Jacques Chaoulli faces the media in Montreal in June 2005, after he got Canada’s Supreme Court to strike down a Quebec law banning private insurance for services covered under Medicare — a decision the rocked the country’s universal health care system.
I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic — with a three-year wait list; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.
Government researchers now note that more than 1.5 million Ontarians (or 12% of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment.
These problems are not unique to Canada — they characterize all government-run health care systems.
Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled — 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave — when many doctors were on vacation and hospitals were stretched beyond capacity — 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on.
Single-payer systems — confronting dirty hospitals, long waiting lists and substandard treatment — are starting to crack, however. Canadian newspapers are filled with stories of people frustrated by long delays for care. Many Canadians, determined to get the care they need, have begun looking not to lotteries — but to markets.
Dr. Jacques Chaoulli is at the center of this changing health care scene. In the 1990s, he organized a private Quebec practice — patients called him, he made house calls and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.
Eventually, Chaoulli took on the government in a case that went all the way to the Supreme Court. Representing an elderly Montrealer who had waited almost a year for a hip replacement, Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. A majority of the court agreed that Quebec’s charter did implicitly recognize such a right.
The monumental ruling, which shocked the government, opened the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of Canada for now, at least two people outside Quebec, armed with Chaoulli’s case as precedent, are taking their demand for private insurance to court.
Consider, too, Rick Baker. He isn’t a neurosurgeon or even a doctor. He’s a medical broker — one member of a private sector that is rushing in to address the inadequacies of Canada’s government care. Canadians pay him to set up surgical procedures, diagnostic tests and specialist consultations, privately and quickly.
Baker describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion — he had no family history of epilepsy, but he did have constant headaches and nausea, which aren’t usually seen in the disorder — he requested an MRI.
The government told him that the wait would be 4 1/2 months. So he went to Baker, who arranged to have the MRI done within 24 hours — and who, after the test revealed a brain tumor, arranged surgery within a few weeks. Some services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him.
Other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week.
Canadian doctors, long silent on the health care system’s problems, are starting to speak up. Last August, they voted Brian Day president of their national association. Day has become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center and challenging the government to shut him down.
And now even Canadian governments are looking to the private sector to shrink the waiting lists. In British Columbia, private clinics perform roughly 80% of government-funded diagnostic testing.
This privatizing trend is reaching Europe, too. Britain’s Labour Party — which originally created the National Health Service — now openly favors privatization. Sweden’s government, after the completion of the latest round of privatizations, will be contracting out some 80% of Stockholm’s primary care and 40% of its total health services.
Since the fall of communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany.
Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money.
Politicians like Hillary Clinton are on board; Michael Moore’s new documentary, “Sicko,” celebrates the virtues of Canada’s socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance.
One often-heard argument, voiced by the New York Times’ Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.
Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren’t academic — homicide rates in the U.S. are much higher than in other countries.
In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country.
And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England — a striking variation.
Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn’t quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn’t unreasonable for it to spend more on health care. Take America’s high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.
That said, American health care is expensive. And Americans aren’t always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.
But such initiatives would push the U.S. further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs — but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment.
America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home — in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.
Gratzer, a physician, is a senior fellow at the Manhattan Institute. This article is adapted from the forthcoming issue of City Journal.
That communist rag “Business Week”, reports:
The Doctor Will See You—In Three Months, Business Week, July 9, 2007
Policy should be made on the basis of evidence and data, not anecdote or propaganda. Here is what an investigation of the data found:
no “moderation” please:
That communist rag “Business Week”
Actually, it is a liberal rag, much like Britian’s “Econonmist”
Hey Dean, I wonder if you could cross post a little more…I don’t think you are getting enough debate points in…;)
Christopher – it was a tongue in cheek comment.
Obviously, I agreed with the main point of the Business Week article. Those who compare the health care systems in the United States and Canada using Waiting Times as a benchmark of performance are using a poor yard stick. People in Canada on waiting lists for elective surgery are probably not in any clinical danger, while US metrics on waiting times fail to capture the full picture.
Not true.
Even in our own highly “socialized” systems, like the California one for public workers (I forget the name), people die all the time waiting for critical services. My aunt in California waited 5 months for a MRI, and finally had to involve the lawyers to get it. By then, her bone cancer had metastasized. She died about 6 months later.
You and your ilk would inflict evil in the name of “fairness”, your false God. Your too stubborn to see the evil that you would do. Now go back to your idols…
The Social Darwinist orientation of conservatives is reflected in their approach towards health care, which they believe should be reserved as a privilege for the rich and reject as a human right for all.
The two conservative health “solutions” that have been advanced, tax credits and health savings accounts, are primarile vehicles to further enrich the wealthy and would make health care more expensive and less accessible for lower income Americans.
Tax credits and health savings accounts wouldn’t significantly improve health outcomes and may even worsen them. Lower income Americans would be unable to obtain tax refunds large enough or save suffiently to pay for their own medical care. Instead they would simply forego treatment.
Researchers from the Kaiser Foundation who studied the fiscal impact of Health Savings Accounts on health care consumers found:
Savings Accounts and High Deductible Health Plans: Are They An Option for Low-Income Families?, Kaiser Foundation, October 2006
Conservative health care reform proposals do nothing to address the waste and inefficiency built into the US health care system. Th cause of that waste is not overuse by consumers but bureaucratic waste and inefficency built into the private insurance system.
A study published in Health Affairs magazine last year entitled The Cost Of Health Insurance Administration In California: Estimates For Insurers,
Physicians, And Hospitals, found that:
The Physicians for a National Health Program state the problem nicely:
Dean, You still don’t get it do you?
The waste and inefficiency is mostly caused by government regulations and interference that has created a massive bureaucracy. The medical providers are saddled with insane rules and idiotic “solutions” created by incompetent gov’t representatives and agencies. How can you blame private companies when it’s the gov’t rules that caused this mess. And your solution is more of the same! Where’s your common sense?
As I have stated previously: The problem with HMOs is that they are run more like gov’t bureaucracies instead of private enterprises. They place too many layers, rules, and regulations between the patient and the doctor. They are not responsive to their patients and doctors, but must look to faceless bureaucrats and lawyers in making many important medical decisions. Once again, your solution is to add more of that to fix the medical system. Don’t forget HMOs are a legislative “solution” created by politicians NOT private enterprise. We are going to, once again, trust those that created this mess to “fix it.” It doesn’t make any sense!
Dean says:
The Social Darwinist orientation of conservatives is reflected in their approach towards health care, which they believe should be reserved as a privilege for the rich and reject as a human right for all.
Which is of course an outright lie. Any adult, even of sub normal intelligence, who has been a part of OrthodoxyToday for as long as Dean has, knows this is an outright lie.
Now, why does Dean lie? He is a propagandize, not an honest (or honorable) participant of this blog. He is not even interested in a low form of “debate”, but only cross posting and propaganda. He is a Troll.
Perhaps the webmaster can flag such posts as “Troll” or “flame bait”?
Note 22. Dean writes:
Dean thinks that the people who gave us the Great Society should take over health care so that health care can become more efficient. Been there, done that.
Note 24. Chris Banescu writes:
Correct. And one of the loudest proponents was Ted Kennedy.
If it’s not Social Darwinism then prove me wrong. Why can’t we have the same health care system for all Americans?
Why are conservative groups pushing HSAs (Health Savings Accounts) in combination with cheaper high deductible, high copay health plans knowing that reward the rich and punish the poor.
High deductible, high copay health plans are not an option for older people with chronic disease who have high medical costs to begin with, and must remain in traditional insurance plans. The high deductible, high copay health plans, however draw healthy people out of the risk pools of traditional plans leaving a sicker, more expensive population which pushes up the average cost and therefore increases the premiums for those who remain.
As the Kaiser Foundation study I referenced reportedproduce no financial benefit for lower-income families and in fact create a financial disincentive to seek medical care. Just this month an article in JAMA (Journal of the American Medical Association) reported that higher drug copays were associated with decreased usage and declining medical outcomes:
Prescription Drug Cost Sharing: Associations With Medication and Medical Utilization and Spending and Health
Show me one conservative proposal that addresses the problem of the denial of private medical insurance to people with pre-existing conditions?
Note 27. Dean writes:
First of all, your Social Darwinism comment is not a substantive premise. It’s merely moral posturing; an assertion that socialists favoring the goverment takeover of healthcare care more about the poor than non-socialists.
Secondly, where do you get the idea that socialized medicine would lead to an equality of health care? The Great Society was sold with same moral appeals you use to justify socialized medicine (with the same people leading the charge). It created a permanent underclass.
Do you really think the Kennedy’s, Clinton’s, Edwards’, etc. will settle for the same health care plan that will be forced on the poor? I don’t, not when they pay $400 for haircuts.
Note 28
First of all, your Social Darwinism comment is not a substantive premise. It’s merely moral posturing
It’s not even that. It’s pure propaganda. Dean plays like an honest participant. He is not, he is pure political hack, a Troll…
Mr. Scourtes writes: “If it’s not Social Darwinism then prove me wrong. Why can’t we have the same health care system for all Americans?”
Let’s say we turn America into a socialist utopia. Everyone has the same medical care and education. We fix income disparity and nobody takes home more or less than $25,000/year.
Would this scenario satisfy you? Or would you then complain about all the poor people in the world who don’t have the same medical care Americans do, and advocate perfect socialism on a global scale? Then everyone on earth could live in a hovel on $4,000/year (if that), and have the satisfaction of knowing that life is perfectly fair and we could all wait in the same lines trying to get our free medical care. That would be the only way to remove what you are calling Social Darwinism, which by your definition seems to be the ability of people to better themselves by exercising their capabilities.
The reason that Americans (or all humans) do not have the same medical care is that the current system is very likely better than the unintended consequences of the fair socialist system (and no socialist system has ever turned out to be fair in real life).
There are imperfections in our free market economy. Sometimes those imperfections are due to socialist-inspired policies that work their way into the system, and other times they are due to corrupt behavior and human sinfulness. In any case, I think it would be better to work on those imperfections instead of turning to socialism.
Edwards taught me that I was living in the “other America”
I was pretty happy with my house until I learned that Edwards has not just a house, …… not just a mansion…. but a compound covering 20,000 square feet of living space.
I am floored. I realize now that I live in what Edwards calls “the other America.”
I cannot abide the injustice that Edwards has a larger house than me? How can there be any justice in the world if he has more floor space? My husband and I struggle along is this pitiful hovel of ours, far less than 20,000 square feet. (Gosh what must it cost to clean, heat and cool that montrosity).
How can Edwards sleep at night knowing that I, Missourian, lack my own basketball court?
There is a growing gap between Americans with their own basketball courts adn those without. The gap is growing larger every year. We need a Department of Basketball Court Equality to redistribute the availability of basketball courts in America. We need government funds to bus in people who do not have basketball court to Edward’s compound so that they can play basketball on his basketball court. We need to hire 100 government social workers and administrators to ensure that this program is a success.
Beyond that my ego has been injured by the realization that my hair is not as pretty as his and I am a girl. The government should correct this discrepancy. It should pay for Hose Herbert, the famous Hollywood hair stylist, to visit me to compensate me for my inequal hair (and that is just the beginning). Julia Roberts has a better figure. I need a personal trainer. I need a lock on the refrigerator paid for by the government. I need a nutritionist to instruct me to say no to donuts and yes to bananas.
Oh the inequality, how can you all sleep at night?
Dean, IMO the principals of Social Darwinism are more prevalent in many ideas, policies and attitudes associated with the left–the genesis of the welfare state, abortion policies, euthanasia, etc, etc.
Christianity and Social Darwinism are no more compatible than Christianity and scientistic Darwinism. The doctrine of evolution is a false doctrine which posits a false god. Therefore no matter how it is applied, falsity will result. You, as always find the solution in more of the same. Rather than returning to the Church, you just do your PHD (piled higher and deeper) routine. Let me make it clear: POLITICAL IDEOLOGY OF ANY TYPE WILL NOT HELP! If you form a thought that includes the conservative vs liberal dichotomy, repent, go back and rethink. (This is especially true if the conservative or liberal is immediately followed by Christian).
Health Savings Accounts are a perfect example. They will not do everything their proponents claim but neither are they the devil incarnate. Half of the individual HSA plans I have sold were purchased by folks who were uninsured. They were uninsured because they could not afford the cost of the traditional plan. Combined with a means tested, refundable tax credit for premiums paid, the HSA type of plan would help a lot of people. Where that approach is insufficient come up with something else.
You need to apply your version of just war to governement run health care Dean: EXHAUST every non-governmental solution, apply restraint, proportionality, a reasonable chance for success, etc. Your proposals now are the health care equivalent of the Iraq war.
You are an extremist Dean, you mischaracterise policies which you oppose by formulating them in their most extreme then leap to the other extreme as the solution. You are not alone, some who disagree with you do the same. I’m sure I’ve done it. It makes for a more entertaining blog, but produces nothing of substance.
Hey Missourian, you’re getting your wish, at least partially, on the food front. Trans-fat is now all but a controlled substance. Can the riots on the streets of Philly be far behind when the cheese steak is outlawed?
Michael, there will always be a BarBQ cooking somewhere in Missouri
Just at the British comfort themselves with the thought that “there will always be an England” so, do I, Missourian, comfort myself with the thought that there will always be a BarBQ smoking away somewhere in Missouri.
Some native Missourian will be patiently smoking a slab of ribs, a side of beef, or even a turkey or rack of lamb… it is enough to bring tears to my eyes (smoke will do that, you just have to chow down quick because the good stuff disappears reeeeel fast)
Gee, who would have ever thought that BarBQ would be a subversive activity?
A critique of the jus ad bellum of the war on health care (aka universal health care).
Assumption #1: All government power is founded upon the ability to inforce laws
Assumption #2: All enforcement is founded upon the ability of the government to punish
Assumption #3: All punishment is on a continuum that ends with the use of deadly force.
Assumption #4: For the government to take control of such a large segment of the population and the economy is equivalent to an invasion.
1. Just Cause. Criteria not met. The cause is not about improving treatment or care it is simply about “access” which always comes down to money. Therefore the cause is simply the granting of an economic benefit to a selected group of people and calling it a “right”. Such economic reasons for going to war are specifically forbidden.
2. Legitimate authority. Criteria not met. There is no moral or Constitutional authority for the U.S. government to assume such massive control of our wallets and our bodies.
3. Right intention: Criteria not met. The intention that I see is simply to acquire and maintain political power based upon socialist principals of class warfare and economic inequities.
4. Probability of success. Criteria not met. The consequences of such action are highly unpredictable and are much more likely to result in a decrease in the quality of care, nor will the economic equality sought ever be sufficient as long as one person can earn more money or accumulate more goods than everyone else.
5. All other means must be EXHAUSTED before even considering such an assault. Criteria not met. Not even close to being met. In fact the proponents of universal health care have a priori rejected all other means without any consideration on ideological grounds.
Michael – My objection to Health Savings Accounts is the same as yours – that, while useful, they should not be presented as a panacea to our nation’s health care crisis.
As I said before, the answer for the United States, isn’t neccesarily a Canadian style system. France and Germany, for example, have universal coverage but allow people to see private physicians and/or hospitals of their own choosing. In Germany, citizens can supplement their public health care benefits with private health insurance, and about ten percent of the population does so.
The problems with our US health care system are undeniably urgent and serious and we have to set goals and start working towards them. Right now I don’t see any conservative proposals that make more than a feeble attempt.
What are the goals:
1) Provide coverage for the 45 million Americans without health insurance.
2) Slow down the increases in medical inflation which annually greatly outpace increases in the cost-of-living
3) Eliminate bureaucratic waste and inefficency. Conservatives should be promoting this goal by means of expanded use of technology, electronic medical records and standardized claims processing.
4) Promote wellness and prevention. Medicare estimated that much of the increase in its costs were due to the increase in people with multiple chronic conditions, primarily obesity, diabetes, high blood pressure and high cholesterol.
Peter Orzag, the director of the Congressional Budget office reported last month, that:
http://www.cbo.gov/ftpdoc.cfm?index=8255
Got that? If we don’t do something to arrest the growth in medical spending, the federal government will be spending, as a % of GDP, as much on Medicare and Medicaid in 40 years as it spends on the entire federal budget right now. That is clearly an unsustainable situation.
Dean, I have no objections to health savings accounts. I think they are great. They ought to be promoted and used more. For people used to the “something for nothing” approach to health insurance (indeed all insurance) health savings accounts are a shock. Employer paid, group health insurance is a big contributor to the problem.
Note 36. Dean writes:
Dean, you advocate Hillary Care on the one hand, then argue it cannot be sustained on the other, all the while branding those who disagree with your assessment as “Social Darwinists”.
Sometimes your posts sound like talking points for the McGovernite holdovers in the Democratic Party (the paleo’s — Kennedy, Pelosi, etc.) — full of moral opprobrium but little common sense.
Thank you for suggesting the question:
If Medicare and Medicaid spending is projected to grow so much doesn’t this mean that publically funded health care programs are inefficient?
No it does not, because the the economic forces pushing Medicare and Medicaid spending higher are coming from outside rather than inside the programs and are pushing private health insurance costs up as well. If anything, Medicare and Medicaid spending, per person, have been rising at a slower pace than private insurance spending.
Private insurance plans are not immune to increases in pharmeceutical prices or the rising cost of hospital care. If anything, small private insurance companies have less bargaining power with the drug companies and hospitals then do public programs with their much larger numbers of benefiaries. The Veterans Administration which is allowed to negotiate on behalf of all the nation’s veterans it takes care of, pays prices for drugs that are as much as 40% lower than the small Medicare Part D Insurance plans, with far fewer members.
So one of the key goals of any health care reform package should be to slow down fiscal growth in these external forces driving health care spending higher.
Addressing the problem of the 45 million Americans without insurance is an importand step we can take to slow the growth in hospital costs. Currently the costs to take care of the uninsured, are passed on those with private insurance in the form of higher premiums and to the taxpayer. Governor Schwarzenneger has actually cited lower insurance premiums resulting from lower hospital costs as one of the hoped-for outcomes of his health care reform package for California.
On the public side, the Medicare and Medicaid programs make huge payments, literally billions of total dollars, to hospital facilities known as DSH (Disproportionate Share) Hospitals who care for a disproportionate share of the uninsured. Los Angeles County has 2.5 million people without health insurance, for example, so without DSH payments from the federal government LA’s health care system would collapse.
Mr. Scourtes, in #37 you mention that you don’t see conservative proposals to address the cost of medical care. In #40 you write:
No it does not, because the the economic forces pushing Medicare and Medicaid spending higher are coming from outside rather than inside the programs and are pushing private health insurance costs up as well.
And:
Los Angeles County has 2.5 million people without health insurance, for example, so without DSH payments from the federal government LA’s health care system would collapse.
So, how would socialized medicine solve the outside forces that are pushing up costs? I suppose one could regulate the cost of medicine. This would result in reduced incentive to research, develop, and market new medicines. Price controls always result in scarcity. One could, by fiat, regulate the cost of medical care, but that would result in scarcity.
I agree with your point in post #37 that electronic medical records could result in some savings. I am curious as to why you don’t mention the increased cost of liability insurance, which is a very significant component of the inflation you are worried about and has actually contributed to scarcity. I think every liberal who is concerned about the cost of medical care should be for tort reform, but I’m sure you know that the Democrats are in the pockets of the trial lawyers.
You mention LA’s medical system. Where do you think most of the 2.5 million uninsured come from? Sure, some are just poor or underpaid citizens, but a huge number of these uninsured who choke up the hospitals are illegal aliens. Anyone who has visited an emergency room in California knows this. I think every leftist who is concerned about the cost of medical care should advocate strict border control (a total end to illegal immigration). Funny thing, though, the Democrats are always trying to sabatoge efforts to control illegal immigration, making them in this case the party of the very rich.
The only people entering this country should be in this country should be here legally. If we want to keep the small net gain to our economy that cheap foreign labor brings (which only benefits those who hire the aliens and Latin American governments/citizens at the expense of middle and lower class taxpayers, workers, or would-be workers), then a temporary work program should be established with all medical care and other resultant social costs shifted to Latin American governments (as opposed to middle-class American taxpayers who lose money because of the cheap labor). The Latin American governments would probably agree to pay much or all of these social costs in order to keep the dollars flowing south.
If we want to get even more extreme, we could also restrict exports of new medications to nations with price controls on medicines, so we would stop effectively subsidizing their socialized medical systems with higher prices for pharmaceuticals here. In essense, we would be saying that if you want the benefit of research and development, you have to share in its cost and in paying people the incentive (profit) necessary to take on the risk of R&D.
If we address illegal immigration and out of control damages awarded in trials, perhaps a good part of the medical cost inflation problem would be solved – all without socialized medicine.
Dean, as to the number of uninsured people: when the number of illegal aliens, voluntarily uninsured, and temporarily uninsured is subtracted from the number, it is significantly smaller as I’m sure you realize but choose to ignore for propaganda purposes.
Also the access issue, at least where I live is false issue. I carry a catastrophic policy and choose to go private pay for the rest of the care I need because I have a flexible spending account at work. The last three times I’ve had to go to a doctor, specialists all, I told them I was private pay, no insurance. Two of the providers sent me bills, the third gave me a 20% discount because he didn’t have to file it with insurance. The two that sent me bills I never seen before.
Now there are situations where lack of insurance means that you don’t get care, I understand that. There are less draconian solutions to universal health care rationing.
Again, the same arguments you use against Iraq apply to government controlled health care. You do not think they apply because the issue is too important to you, it is a national priority, etc. Those who support the Iraq war have the same sense of priority and importance about that action, yet you dissmiss us with all kinds of perjoratives. Why should we listen to you?
D. George, world’s richest man is Mexican, maybe he can help Mexican poor
You might want to reflect on the fact that in Mexico you will not be admitted to an emergency room unless someone can show proof of ability to pay. Yes, you can die at the door of a Mexican emergency room for lack of an insurance card. You most assuredly will not die at the door of an American emergency room.
You might also want to reflect on the fact that South Americans entering Mexico illegally are summarily tossed in jail and detained indefinitely with virtually no legal or human rights.
Most South Americans entering Mexico are do so to try to get to America where even illegals are granted human rights if not civil rights. Just show up pregnant and your anchor baby is born in an emergency room and become an instant citizen. Ole.
Mandated emergency care + unchecked illegals = shutdowns
Federal law requires “general hospitals” to provide an emergency room open to all those who appear at its doors in need of care. The patient is accepted
and treated regardless of economic status or insurance and a bill is sent later. Most hospitals don’t have much luck actually collecting the bill.
Los Angeles has lost four emergency rooms in the last decade, a direct result of the federal mandate and unlimited, unchecked illegal immmigration.
Hospitals close and redefine themselves as specialized rather than general hospitals. For example, a group of orthopaedic surgeons buy a hospital building and devote it solely to their own patients pre-operative, operative and post-operative care. It is an orthopaedic hospital NOT a general hospital. There is no emergency room, no general medical wards, no OB/GYN to deliver babies. No ambulances stop at this hospital and the terrific expense of providing nearly unlimited ordinary medical care to illegals is avoided. Unfortunately, ambulance drivers have to drive longer to get to the next emergency room endangering their patients chances of surviving by adding crucial minutes to the ambulance ride.
This is the true cost of unchecked illegal immigration. This is what open-borders advocates don’t want us to think about. They push their moral superiority argument and don’t want people to understand that it is precisely the sick and the low and middle income people who are subsidizing the failure of the Mexican upper class to care for its own.
Illegal immigration is a form of welfare for the rich
D. George: Those are all good questions.
First, let me start with your last comment. I think one of the few good ideas George W. Bush had was a guest worker program. If people slipping into the US illegally to work, could enter legally and be documented, then either the government could collect taxes from them for their health care, or else require their employers to pay into a fund or provide employee insurance. That is what Mitt Romney’s plan in Massachussets does, but only for citizens and legal aliens.
Two, the Canadian system is just one model for the US to look at. Other countries like France and Germany, also have universal coverage, but have maintained a significant role for the private sector. In France, people choose their own doctors and hospitals. In Germany, people can supplement their public health benefits with private health insurance. So there are a lot of models to study to see what would work best here.
However, rather than accept the status quo, we should set broad goals and begin working toward them. We were once the nation that put a man on the moon. Why are we so paralyzed into inaction right now? Why have we allowed powerful special interests to hold us hostage?
The goals have to be (1) universal coverage – everyone in the risk pool, (2) elimination of bureaucratic waste and redundancy, (3) greater transpaency and/or uniformity in prices charged by different providers for similar treatments, (4) Greater use of technology to eliminate redundancy amd medical error, and (5) Medicine that promotion of wellness and prevention.
Three, malpractice insurance is not a major force driving medical spending higher – that is a major myth. When studied over time, the major increases in malpractice rates have all occurred during recessions and stock market declines when insurance companies saw their investment income decline. This was conformed by a Dartmouth University study in 2005:
Rising doctors’ premiums not due to lawsuit awards
Another study by the Harvard School of Public Health reached similar conclusions:
Study Casts Doubt on Claims That the Medical Malpractice System Is Plagued By Frivolous Lawsuits
Investing in technology to reduce medical error is a far better way to lower malpractice insurance costs then preventing people who have been genuinely harmed from medical mistakes from receiving a just compensation.
Note 46. Dean writes:
. . .which makes your call for a government takeover of the medical system all the more ludicrous given its problems with maintaining efficiencies and its record with waste.
Mr. Scourtes, thanks for the reply.
I’m no expert in malpractice insurance issues, but I do remember reading a couple of years ago that the problem affects certain specializations and certain states more than others, so a high-level nation-wide average may not be that instructive.
You write:
The goals have to be (1) universal coverage – everyone in the risk pool, (2) elimination of bureaucratic waste and redundancy, (3) greater transpaency and/or uniformity in prices charged by different providers for similar treatments, (4) Greater use of technology to eliminate redundancy amd medical error, and (5) Medicine that promotion of wellness and prevention.
It is easy to make a list of goals, and there really isn’t anything too controversial with the above list of goals. The question is how to achieve them.
I maintain that the problem of unaffordable medical care could be solved with (in order of importance) (1) strict controls on immigration, (2) elimination of the indirect subsidization of Canadian and European pharmaceutical costs by restricting medical exports to those nations that implement price controls on pharmaceuticals (and thus refuse to pay their fair share of incentivization and R&D), and (3) tort reform if/where appropriate. I agree that updating arcane record-keeping and clear advertisement of prices would help too.
In light of the potential effectiveness of the above reforms, I don’t think you have demonstrated why socializing the medical system (whether that involves government bureaucrats running it, or government subsidies to private service providers) is a necessity. Socializing the system will not solve any of the root causes I mentioned. The costs will still be there, and they will still be subject to high inflation. If we implement price controls, then shortages will result. So, why must we socialize our medical system?
A specific case in which cost competition would have helped
I recently underwent eye surgery. Besides myself three people participated in the surgery: my surgeon, an anesthetist and a nurse. The surgeon used hand-held instruments. No special equipment was used in this surgery. All that was required was a sterile room equipped with proper lighting and a machine for monitoring my pulse during the operation.
The hospital charges $9,600 for this 40 minutes operation. This was essentially the “room charge” it did not include the services of the surgeion, the anesthetist or the nurse.
This is a very, big component of the over all costs of my treatment. The surgeon charged only $3,200. This is something that is amenable to price competition. A basic surgical room is all that I needed, it was an out-patient procedure. My surgeon stated that he frequently did 4 or 5 similar operations a day.
I consider the $9,600 to be sheer profit gouging by the hospital. It was nearly impossible for me to find out in advance what the charge would be.
There are at least 15 hospital locations in my metropolitan area that could have provided a venue for this operation, it was, in surgical terms, routine.
No price competition occurred. Period. None. Price competition was entirely possible and could probably have driven down the price of the operation.
D. George, the socialization of the health care system is required because of Dean’s economic worldview that the only way to help the “poor” is to penalize the “rich”. It is similar to mercantilism actually.
We tax the rich to pay for municipal water departments that deliver clean tap water to every house. Under your philosophy, the rich who can afford thier own wells or deliveries of bootled water, should not be “penalized” to pay for the public procurement of free or subsidized tap water for the poor.
Why does the government provide free or subsidized tap water for the poor? Because before the establishment of municpal water departments people used to die by the thousands from water-borne diseases like cholera and typhus. There was a public health interest in government procurement of clean inexpensive water for all people then, just as there is a public health interest in providing universal health insurance coverage for all people today.
There is the moral question of how a Christian nation can allow it’s citizens to become sick and die of preventable diseases because they are lack sufficient income to purchase increasingly expensive insurance. But lets set that aside for a moment and focus on economics.
The numbers of people with employee based insurance continue to fall and the ranks of the uninsured continue to grow. The costs of providing care to the uninsured, are passed on to those with insurance causing insurance premiums to rise. A vicious circle is underway – the more uninsured, the more unreimbursed costs that are passed on to the uninsured – the more unreimbursed costs passed on to the insured, the more premiums rise – the more premiums rise the more employers drop coverage and more people become uninsured. How long do you think that situation can continue, before the whole system just collapses?