Adventures in British Medicine

It's been a while since I've beat up on the NHS, and in light of Rudy's comments criticizing Britain's health care system, cribbed from this City Journal article, it's, I think, time to catch up with the wacky world of socialized British medicine. Some recent stories for your amusement:

From the BBC (10/24): "NHS trusts have a £4bn ($8 billion) backlog of key maintenance repairs which range from fixing heating to meeting fire safety rules, government figures suggest. The figure is eight times this year's much-heralded NHS surplus, which was achieved by making a variety of cuts."

From the BBC (10/25): "Poor leadership within the NHS is to blame for the problems with hospital superbugs, according to the minister in charge of reviewing health care. Lord Darzi told MPs on the Commons Health Committee that hospital deep clean programmes had already started. But he said the deaths of 90 patients in Kent from Clostridium difficile showed the need for cultural change."

From the Daily Mail (11/02): "A 75-year-old man was forced to spend his life savings on a vital hip operation after the NHS cancelled his appointments four times. Edward Crane claims he has nothing left after clearing out his bank account for the £9000 private surgery after waiting more than six months for a consultation at his local hospital."

From the Daily Mail (10/28): "Record numbers of Britons are travelling abroad for medical treatment to escape the NHS - with 70,000 patients expected to fly out this year. And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa for major surgery to avoid long waiting lists and the rising threat of superbugs, according to a new report."

From the Daily Mail (11/01): "Banning a heart treatment on the grounds that it is too expensive could end up costing both lives and money, doctors warn. The Health Service's rationing watchdog saysdrugcoated stents used to treat around 30,000 patients a year are not cost-effective and should no longer be provided."

From the BBC (11/01, supply and demand edition): "The number of NHS dentists in London is well above the national average, but only half the city's population use them, a London Assembly report shows."

Incidentally, Michael Moore's Sicko has been released in Europe and, as I predicted in my review of the film, the reaction has been less charitable than in the past. Writing in the London Times, Minette Marrin was puzzled by Moore's depiction of the NHS. A sample:

Unfortunately Sicko is a dishonest film. That is not only my opinion. It is the opinion of Professor Lord Robert Winston, the consultant and advocate of the NHS. When asked on BBC Radio 4 whether he recognised the NHS as portrayed in this film, Winston replied: "No, I didn't. Most of it was filmed at my hospital [the Hammersmith in west London], which is a very good hospital but doesn't represent what the NHS is like." I didn't recognise it either, from years of visiting NHS hospitals. Moore painted a rose-tinted vision of spotless wards, impeccable treatment, happy patients who laugh away any suggestion of waiting in casualty, and a glamorous young GP who combines his devotion to his patients with a salary of £100,000, a house worth £1m and two cars. All this, and for free.

Full review here.

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    The Times is a conservative paper. Not saying what they say isn't true, but I wonder if even the liberal papers (think the Guardian) will think he was a little too optimistic about the NHS?

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    But he said the deaths of 90 patients in Kent from Clostridium difficile showed the need for cultural change."



    Dan T.? joe?

  • Paul||

    Oh, Paul Krugman is writing an article about the "myths" of socialized medicine. He takes on Rudy Giuliani's statements about the NHS. (I've heard none of Giuliani's statements about the NHS-- I don't listen to anything Giuliani says) I'm eagerly awaiting Krugman's glowing report of centrally managed healthcare, and how everything bad is a misquote, misinterpretation or lie.

  • Syloson of Samos||

    Moynihan,

    I'm pretty sure that I could come up with a number of unpleasant stories about patient treatment, etc. in the U.S. Not that I am defending the NHS.

    ______________________________________

    The Times article is well worth reading.

  • ||

    You can all relax about singlepayer health care. It has a 0% chance of ever happening in this country. The insurance/HMO/pharmaceutical complex owns far too many Congresspersons on both sides of the aisle.

    Besides, despite the aberration of the 2006 election, we're looking at another 20+ years of Republican dominance at the federal level. Keeping a large uninsured population is in their political interest. The sick, desperate and uninsured will eventually flock to Republican megachurches, since lacking access to real healthcare, being cured by Jesus will be their only hope.

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    Dan T.? joe?

    Dagnabit, Jamie Kelly, you beat me to it!
    A curese upon your seed! ;-)

  • ||

    A curse upon your seed!

    Too late. God beat you to it.

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    Well chosen handle there, Illiterate J.

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    Keeping a large uninsured population is in their political interest. The sick, desperate and uninsured will eventually flock to Republican megachurches, since lacking access to real healthcare, being cured by Jesus will be their only hope.

    So you're assuming the other side is not merely wrong, but actually evil? Thats not a good place to begin a discussion.

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    Illiterate,
    I'm not a political analyst or expert, but from where I'm sitting, it does not look like the republicans are going to win in 2008.(sure, they might, but it doesn't look likely) There were very real and specific reasons why the Dems won in 2006, it was not an aberration.

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    So you're assuming the other side is not merely wrong, but actually evil? Thats not a good place to begin a discussion.

    Well, you the one who has assigned them to being "the other side", not me. The Republican Party draws a large fraction of their votes from the churchgoing. It's not hard to see that increasing church attendance is in the Republican's political interest.

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    By coincidence I spoke to the only person I know in Britain the other day.

    I guess he had just seen it. Needless to say it confirmed every cartoonish view he has of America.

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    Illiterate,
    being uninsured makes you want to join a church?
    explain the logic again please

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    Well, you the one who has assigned them to being "the other side", not me.

    Your post sure made it sound like you favored universal government health insurance. Which would make those who oppose it, "the other side". Sorry if I was wrong.

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    J sub D | November 2, 2007, 5:10pm | #

    Dan T.? joe?

    Dagnabit, Jamie Kelly, you beat me to it!
    A curese upon your seed! ;-)

    Jamie Kelly | November 2, 2007, 5:13pm | #

    A curse upon your seed!

    Too late. God beat you to it.



    JK, You corrected my typo without even pointing it out, passing on a chance to belittle me! Noted and appreciated.

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    Illiterate,
    being uninsured makes you want to join a church?
    explain the logic again please


    Being uninsured doesn't make people want to join a church. Being sick and not being able to afford treatment makes people want to join a church. Many fundamentalist Christian churches offer healing services in which charismatic ministers claim to heal physical ailments by the laying on of hands, just as Jesus was said to have done in the Gospels. Lacking any better health care options, the uninsured and desperate are more likely to attend these churches in the hopes of obtaining a miraculous cure.

  • Episiarch||

    joe and Dan T. seem to be MIA.

    A shame, too, as the NHS is one of those things where joe won't listen even if (like me) you have personal experience with it. Willfull blindness can be fun.

  • BakedPenguin||

    ...the deaths of 90 patients in Kent from Clostridium difficile showed the need for cultural change.

    A culture change? To what - E. coli?

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    I'm always fascinated by how out of whack the thinking of partisans is about the "other" party.

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    Joe would say "Well, people are denied treatment in the United States too!" or something along those lines.

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    I'm always fascinated by how out of whack the thinking of partisans is about the "other" party.

    I'm also amazed at how one Team always thinks the other Team is way more all-powerful and conspiratorial than it actually is.

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    And Dan T. would say, "Well, if they don't like the health-care service, they're always free to choose ..."
    and then his head would fucking explode and there would be no more Dan T.

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    Illiterate,
    Ok I understand you. Just so we're clear, that's some of the most dubious reasoning I've ever seen. we're supposed to believe that the number of people who join a religion because they are sick and too poor to afford treatment and think they can be healed by Jesus is large enough that the republican party recognizes the phenomenon and conspires to keep these people from getting treatment in order to increase the size of the religious right and get more votes for their party.
    sure....

  • duster||

    "No, I didn't...doesn't represent what the NHS is like."

    If only we had bureaucrats like that in the states....

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    None of these problems mean we should abandon the idea of a universal shared system of healthcare. It's clear we would not want the American model, even if it isn't quite as bad as portrayed by Moore. It's clear our British private medical insurance provision is a rip-off. I believe we should as a society share burdens of ill health and its treatment. The only question is how best to do that and it seems to me the state-run, micromanaged NHS has failed to answer it.

    As soon as the right people can be put in charge it ought to be ship-shape and Bristol fashion in no time at all!

    Yes! The status quo! That'll fix it!

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    Cesar,

    Yes, that too. The Keystone Cops are gurus of organization compared to either political party. Not to mention that the broad characterizations made about parties that contain many tens of millions of people are positively hysterical.

    The my team/your team dichotomy in politics, religion, etc. is a major problem in human thinking. We need to fix it.

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    The Health Service's rationing watchdog saysdrugcoated stents used . . .

    Lone Wacko/ Is that you?

  • ||

    Unfortunately Sicko is a dishonest film.



    Or, equivalently, "Unfortunately Sicko is a Michael Moore film."

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    J sub D wrote

    JK, You corrected my typo without even pointing it out, passing on a chance to belittle me! Noted and appreciated.


    Don't worry, we'll get around to belittling you later. (And so will joe, if he ever gets around to posting on this one.)

    ;P

  • Paul||

    The sick, desperate and uninsured will eventually flock to Republican megachurches, since lacking access to real healthcare, being cured by Jesus will be their only hope.

    Kayyyyyyyy.

  • LarryA||

    I'm always fascinated by how out of whack the thinking of partisans is about the "other" party.

    What about those of us who look upon both Rs and Ds as "the other party?"

    I believe we should as a society share burdens of ill health and its treatment.

    It's called "insurance." Just like you buy for your house and your car. Unfortunately the governments of both the U.S. and Britain have virtually regulated free-market-driven health insurance out of existence, then blamed the health care woes on the free market.

  • Z||

    RE RUDY G.'S Statements

    The Reason Rudy was completely wrong about what he said is that early detection of prostate cancer does not change the overall mortality figures - most of the time a no-action treatment has the same effect. So, while people in america live longer after their diagnosis of prostate cancer - they still die at the same time they would have otherwise.

    to clarify: the "survivorship" data looks better in america because there is more testing. a patient who would die at date X in america may be into their seventh year after diagnosis, while only in their third year after diagnosis in brittain. so they "survived" longer after diagnosis - but they did not survive longer on this earth.

    sorry to bring a bunch of facts into this otherwise amusing discussion of the republican mega-church/no-healthcare conspiracy.

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    I believe we should as a society share burdens of ill health and its treatment.

    What blatant crap. Is health care more important than food? No? Then we need national food coverage, right? How about housing? Is health care more important than that? No? Than we need national housing, right?

    The health care crisis is all socialist bullshit. It's dipped in a coating of alleged rights, with a sprinkling of supposed fairness. But the yummy, chewy, inside is still Grade A, 100% pure socialist bullshit! Hillary and Co. know it, too. Plainly and simply, it's a power grab to give the state more control over our lives.

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    The Reason Rudy was completely wrong about what he said is that early detection of prostate cancer does not change the overall mortality figures

    I'm having a difficult time believing the prostate cancer is not treated more successfully with early detection. All the other cancers are. Why would prostate cancer be any different?

    IOW, Linky-link, please.

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    Don't worry, we'll get around to belittling you later. (And so will joe, if he ever gets around to posting on this one.)

    Oh yeah, Alan Thicke, Anne Murray, Pamela Anderson, Don Cherry and Pierre Trudeau. Back at ya!

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    Aresen, to my previous post, add Peter North. SSPLATT! ;-)

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    Ron's new radio ad touches on health care.

    All I want to know is, how the hell did he get Ronald Reagan to do the voice-over?

  • Franklin Harris||

    Once again, "Yes, Minister" is instructive:

    http://www.youtube.com/watch?v=Eyf97LAjjcY

  • iih||

    Where's the weekend thread?

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    "Oh yeah, Alan Thicke, Anne Murray, Pamela Anderson, Don Cherry and Pierre Trudeau. Back at ya!"

    Deal, as long as y'all retain custody of Celine Dion and Hayden Christensen.

    I'll personally take care of Pamela.

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    My understanding is that Hillary's program would force those who don't want (and probably don't need) health insurance to buy it anyway.

    ...not my solution, but it does, at least, address the main causes of the problem--which is the government not paying full price for the services people on Medicare, Medicaid/Medi-Cal consume.

    I'm not pointing any fingers in this thread, but it often seems to be the case that those who support programs like Hillary's often do so in terms of damning the current system for being administered by evil corporations... As if it's just a given that evil corporations are dead set against the government forcing people to buy what evil corporations are selling.

    "Lacking any better health care options, the uninsured and desperate are more likely to attend these churches in the hopes of obtaining a miraculous cure."

    That's the best example I've seen of a reverse engineered premise in a long time.

    It's the mega-church cabal! They're the ones behind the high cost of health insurance--they're behind everything!

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    All that, and they still get better health outcomes for the overall population. Ah, well, a pox on both their houses.

    I predict that the United States will adopt a system of universal coverage and private medical practice that will work so well that countries with nationalized health systems, like England, will reform them along American lines.

    And no, if you don't understand the difference between health insurance and medical care yet, I'm not going to explain it to you.

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    Psst: when Mayor Free Market Health Care got diagnosed with cancer, you know what the first thing he did was?

    Sign up for the public-sector health insurance system offered to public employees in New York City.

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    Oh yeah, Alan Thicke, Anne Murray, Pamela Anderson, Don Cherry and Pierre Trudeau. Back at ya!


    That's hitting below the 49th parallel!

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    joe: The fact that your favorite Mayor got himself a piece of the public pie doesn't make it right.

    Aristotle: "Socialized medicine inverts the market incentives for the health care industry."

    Socrates: "But Mayor Free Market Health Care signed up for public-sector health insurance."

    Aristotle: "Oh damn, you've run rings 'round me logically!"

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    Brandybuck,

    My favorite mayor? You've gotta be kidding me.

    Sorry you missed the point.

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    "Psst: when Mayor Free Market Health Care got diagnosed with cancer, you know what the first thing he did was?

    Sign up for the public-sector health insurance system offered to public employees in New York City."


    Isn't that the point?

    Privately insured patients have to pay for all the deadbeats on the state and federal programs--that's the friggin' problem. That's why private programs cost so much...

    So you're saying he could get a better deal through the state?! Duh! It's subsidized by private insurance.

    You show me a hospital in a demographic with a low private insurance to Medi/Medi ratio, and I'll show you a hospital that's in trouble. When I ran stats for our hospital, the first thing the CFO wanted to see--every morning--was the patient census. ...and what he wanted to know was how many Medi/Medi patients we had relative to how many were in on private insurance.

    So being in a public program is less expensive than being privately insured?! No shit? What do you think we're talking about? Us regular working people, on private insurance, have to pay for people on government programs--government employees and otherwise--via our taxes, and then we have to pay for the freeloaders again through our insurance premiums.

    If making private insurers pay for all the freeloaders is the problem, then putting more freeloaders into the system isn't the solution.

    Oh wouldn't it be great if everyone could be a freeloader too?! I know you don't mean that. I think you're just missin' what the cause of the problem is.

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    I left the hospital/hospital software business about five years ago. As of then, as I recall, Medicare payed about 25% of the average billing--that's the average pay out for all codes nation wide--and Medicaid/MediCal paid an average of about 12 cents on the the dollar.

    Do the sources and uses--and, yeah, guess where the rest of that money was comin' from?

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    Oh, and try to keep in mind that people over 65 use a disproportionate share of our medical resources.

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    If those percentages hold true, we would have to triple the size of the Medicare and Medicaid programs, just to cover 100% of the costs of the people we're servicing now--never mind the moral hazard. Do you have any idea what tripling the size of Medicare and Medicaid programs would do to our economy? ...of course you do!

    ...and for what?! Just to provide health care to people who need it, with all the inefficiency of a government program, when we could serve the market much better and less expensively with a free market? Why?!

    More defenseless people are going to suffer needlessly because of this. Good intentions be damned!

    Like I said, at least Hillary's program--evil as it is--addresses a cause of the "problem". ...which is that there aren't enough people paying for health care that they don't need. So she has to force them. It's pathetic.

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    Money spent on health care in the UK: $2317 per capita. In the US: $5711.

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    OK so English healthcare is fucked. What are some of y'alls criticisms of Swedish healthcare?

  • src||

    Yep. We spend a lot on health care per capita, compared to other countries with nationalized health systems. (I don't remember the figures, but I believe it's true for France as well.)

    One thing that may contribute is that Americans are willing to pay a whole lot for doctors and prescription medicines. An American doctor is (usually) rich; it's not unusual to see a family practicioner work one day a week and make a six-figure salary. In Europe, it's not assumed that medicine is especially lucrative, perhaps because it's more feminized. Also, our prescription drugs cost more. I'm not sure if it's due to strict government testing rules, or the drug companies' oligopoly, but even outside the national system drugs are a lot cheaper in the UK. A tourist with no British insurance at all can get prescription antibiotics for the equivalent of $15.

    I think it's a little premature to say that nationalized health care saves money. There may be other factors involved in our high health care prices; remember we do not really have a free market system in place now.

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    In the US, in a year, 25% of population didn't visit a doctor when sick because of cost; 23% skipped treatment recommended by a doctor; 23% didn't fill a prescription. Equivalent figures for UK 2%, 3% and 5%.

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    "Money spent on health care in the UK: $2317 per capita. In the US: $5711."

    And how much of that can we attribute to the rationing of health care in the UK?

    Total dollars isn't the issue. If everyone paid their fair share, the total dollars spent wouldn't matter as much--once again, the reason health care costs so much for people who aren't on a government program, i.e. the privately insured and the uninsured, is because the government isn't paying it's fair share for the services the people on its programs consume.

    It can't. The sum of the costs of the health care has to equal the money spent on health care. ...unless a) we force people to work in the health care industry for free... Wait, actually that just lowers the cost; it doesn't give us more health care than costs. So we're stuck with b) finding a magic unicorn that lays golden eggs. If we find a unicorn that lays golden eggs, then the money we spend doesn't have to equal the costs.

    We cannot have our cake and eat it too. We cannot give health care away for free, entirely or in part, without making people who aren't getting the free health care make up for the shortfall. ...just because the people who are making up for the shortfall don't realize that that's what they're doing, doesn't mean they aren't making up for the shortfall. Most of them think the health care they're paying for is their own--and that the prices are ridiculous! It's an illusion.

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    Let's ask this: why do you think private insurers care so much about which hospitals you go to?

    Why do they make you pay so much more for going to a doctor or a hospital outside of their network?

  • BakedPenguin||

    ...if you don't understand the difference between health insurance and medical care yet, I'm not going to explain it to you.

    ...All that, and they still get better health outcomes for the overall population.


    joe, what are you measuring health outcomes by? Life expectancy? If so, then I'd point out there are many factors other than medical care that impact life expectancy.

  • BakedPenguin||

    "Money spent on health care in the UK: $2317 per capita. In the US: $5711."

    In addition to the points Ken made, there were 11 million cosmetic procedures done in the US in 2006. That's $11 billion worth of plastic surgery. If the $5,711 per capita figure is correct, about 1% of what is spent in the US on health care goes to cosmetic procedures.

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    "...All that, and they still get better health outcomes for the overall population."

    I was going to pipe up, by the way, that my understanding is that cancer survival rates among managed care patients are much better than they were under traditional Medicare/Medicaid. ...and that's because of manged care's emphasis on early detection.

    It's true that the later you detect cancer, the more expensive it is to treat, but it's also true that the sooner you detect cancer, the better the survival rate. So HMOs were offering, for instance, free mammograms back when Medicare and Medicaid wouldn't pay for a mammogram unless there were already signs of cancer. That's changed recently, in part because the cancer survival rates among traditional Medicare/Medicaid patients, when compared to those in managed care, were so completely embarrassing.

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    Money spent on health care in the UK: $2317 per capita. In the US: $5711.

    Ooooooooooo....Lookee! Meaningless numbers with no context whatsoever.

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    Is the per capita spending in the UK half that of the US because folks are healthier in the UK because the follow through with diagnosis and treatment nearly 100% of the time? Does "socialized" medicine result in an overall healthier populace?
    We have socialized police and fire protection. Socialized military. Socialized governance. Why not medical as well? Why do we draw the line there?

  • BakedPenguin||

    I suspect that one of the big factors in our "overspending" versus other nations is the money we spend in the last few days of the lives of terminal patients.

    Imagine an 85 year old patient with, say, congestive heart failure. Without a living will, they would put this person through every procedure in order to give them a few more days. I think they would take a more rational (pun intended, I guess) approach in other countries.

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    "We have socialized police and fire protection. Socialized military. Socialized governance. Why not medical as well? Why do we draw the line there?"

    Are you asking why we don't have socialized restaurants and socialized auto factories, a socialized movie industry and socialized semiconductor design? If so, it's 'cause of this crazy little thing called the invisible hand--it's like a force of nature. ...Try to cuff it and it starts smashing the things you were trying to fix, the things you care about.

    On the other hand, give it free reign and nothing makes things and services more available to more people at lower costs and higher quality than the invisible hand. So that's why we should give it free reign to do it's best--particularly with something as important as health care. Show me some evidence that free markets are hurting health care in some way, and I'll consider it, but I've seen a mountain of evidence suggesting that it's the socialization that's causing most of the problems.

    P.S. Private security is all the rage now, by the way. ...and right here at Hit & Run, I recently saw an interesting piece on a private fire service that was working out here in California, as I recall. The private fire service was having their helicopters drop fire retardant on homes that weren't even signed up for the service. Pretty cool, huh?

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    Money spent on health care in the UK: $2317 per capita. In the US: $5711.

    Ooooooooooo....Lookee! Meaningless numbers with no context whatsoever.

    You are kidding me? Aren't you?

    You're reading a post that is...

    * Pegged on ignorant/misleading comments from perhaps the maddest of all those running to be US President.

    * Billed as part of an occasional series 'beating up' the NHS.

    * Playing shamelessly to two overlapping crowd: libertarians - "look at what life is like in a socialized hell hole!"; and Americans - "aren't Europeans backward and benighted?"

    * Doing so through a string of anecdotes, with 'no context whatsoever' - like an anti-Sicko.

    And you're worried about a comment that brings some facts into play!!! Get a grip man - or become a neo-conservative.

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    "We have socialized police and fire protection. Socialized military. Socialized governance. Why not medical as well? Why do we draw the line there?"

    It's because socialized medicine makes people suffer needlessly.

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    I am suggesting that health services are as important to society as fire and police protection and the military.
    As for evidence, I saw a christian preacher/scientist last year state that continental drift happened in the last 6000 years. He had evidence as proof. Point being we can conjure up evidence to support our beliefs, no matter how absurd they are.

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    "I am suggesting that health services are as important to society as fire and police protection and the military."

    I criticized some of the essential problems with socialized medicine above--it has nothing to do with "belief".

    You can believe that socialized medicine will improve the quality, cost and availability of care if you want to--you can believe in unicorns that lay golden eggs! It's a free country.

    You can also close your eyes, put your fingers in your ears and scream egalitarianism all you like--that won't make the rest of us ignore arguments and facts. ...Like the ones I've presented. ...Like the ones Moynihan cited.

    And there's no reason why you should have to respond to a question about why grocery stores shouldn't be socialized if you don't want to.

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    > Privately insured patients have to pay for all the deadbeats on the state and federal programs--that's the friggin' problem.

    > Show me some evidence that free markets are hurting health care in some way, and I'll consider it.

    > It's because socialized medicine makes people suffer needlessly.


    I am sure that a complete free market of the kind you envisage (only those who pay get treated) would provide great care for many, but others would die untreated.

    If you're prepared to step over the bodies, fine - but to pretend that a free market solution is without any cost at all is insane.

    Even a libertarian utopia would not lead to the abolition of trade-offs.

    And, as for evidence, try my comment at 8.40am.

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    There was a question abot grocery stores? I saw restaurants, movie industry, semi conductor and auto factories. All recieve govt subsidies in one form or another. Do we privatize everything to satisfy the invisible hand? Do we ignore the segment of the population that is unable or unwilling to provide for themselves? Would society be better if we just killed all the worthless folks not taking care of themselves? It would be the logical thing to do. That would certainly end the drain on the private health care system and end the discussion on Hillary care.

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    In the US, in a year, 25% of population didn't visit a doctor when sick because of cost; 23% skipped treatment recommended by a doctor; 23% didn't fill a prescription. Equivalent figures for UK 2%, 3% and 5%.

    No linkee, no believee.

    "I am suggesting that health services are as important to society as fire and police protection and the military."

    Even granting this premise doesn't mean that the state should force people to buy insurance or otherwise extend its takeover of the health care sector.

    Even a libertarian utopia would not lead to the abolition of trade-offs.

    Yeah, but (a) we libs don't pretend otherwise and (b) we let you make your own damn trade-offs.

    the reason health care costs so much for people who aren't on a government program, i.e. the privately insured and the uninsured, is because the government isn't paying it's fair share for the services the people on its programs consume.

    Bingo. Take it from someone in the biz, a 2% shift away from private pay to government pay can wreck a hospital's finances.

  • ||

    I am sure that a complete free market of the kind you envisage (only those who pay get treated) would provide great care for many, but others would die untreated.

    As if people didn't die because of the socialization of medicine. Never mind those who croaked because they put off care until they had to go to the emergency room, and then it was too late.

    What if health insurance was more affordable--what if private health insurance customers' premiums didn't have to cover the 70% of the bill (for the overwhelming majority of the national census) that Medicare/Medicaid doesn't pay? How much would health insurance cost?

    I used to work in an acute care hospital--it's a full lock-down psych ward now.

    We went out of business as acute care because the demographic in that part of Los Angeles didn't have a large enough privately insured population to support a hospital. Now that emergency room is gone--all those people have one less emergency room to go to. I don't need to do a study--somebody died because of that.

    Increasing the number of people who are eligible for care, if the cost of that care isn't covered, won't bring that hospital back. No one can keep a hospital afloat if it can't charge enough to cover its costs of operation. ...and that goes for government hospitals too.

    King Drew is always in the news. County USC has been in trouble for years. Harbor UCLA, likewise.

    Socialization has destroyed what access once was in this country. Complete socialization might turn a lack of access in the inner cities into rationing in the suburbs and relieve some of the financial pressure on having a hospital in an undeserved area, but for what reason?

    ...please tell me you're not advocating this to increase the accessibility of care! Making care inaccessible to all of us is not a reasonable solution to inaccessibility among the poor in the inner cities.

    "If you're prepared to step over the bodies, fine - but to pretend that a free market solution is without any cost at all is insane."

    All hail the hyperbole, straw man, ad hominem combo! ...five points!

  • ||

    "There was a question abot grocery stores? I saw restaurants, movie industry, semi conductor and auto factories. All recieve govt subsidies in one form or another. Do we privatize everything to satisfy the invisible hand?"

    I once saw a hopeful immigrant interviewed in his home country. He was a refugee, and the reporter asked him why he wanted to come to America. He could have opted for Canada or Australia--why America? The refugee said if he was going with nothing and he had his choice, he wanted to go to a country where all the poor people were fat.

    You know what's great about grocery stores here in America? We have food in abundance. We have so many varieties--it's amazing. And the prices! My understanding is that here in America, we have more food in more varieties in higher quality and at lower cost on a larger scale than you can find anywhere else in the world.

    The reason we don't completely socialize groceries and the food distribution system is obvious--it would ruin that. Instead of having plentiful, high quality, low cost food, we'd have low quality food, and we'd have shortages. ...I'm sure the wealthy would get along okay.

    Sounds kind of like the way health care is now, in Great Britain, doesn't it? Sounds like the way health care would be here if it was completely socialized. Imagine if we had a presidential candidate who was running on a Universal Food Program, which would force young, hungry, low wage earners to buy more food than they needed...

    If you think health care is a god given right, you must think people have a right to something to eat, don't you? I try to think of what could be worse for poor people than completely socializing food production, and only one thing comes close.

    ...Guess!

  • ||

    JsubD,

    I'm having a difficult time believing the prostate cancer is not treated more successfully with early detection. All the other cancers are. Why would prostate cancer be any different?

    IOW, Linky-link, please.


    Prostate cancer is one of the most prevalent forms of cancer in men worldwide. Screening for prostate cancer requires diagnostic tests to be performed in the absence of any symptoms or indications of disease. These tests include the digital rectal examination (DRE), the prostate specific antigen (PSA) blood test and the transrectal ultrasound-guided biopsy (TRUS). Screening aims to identify cancers at an early and treatable stage, therefore increasing the chances of successful treatment while also maintaining a patient's quality of life. This review identified two trials, consisting of 9,026 and 46,486 participants; however, neither was assessed to be of high quality. This review demonstrates that there is not enough high quality evidence to inform whether or not screening for prostate cancer, via either a DRE, PSA or TRUS biopsy, is more effective than no screening in reducing the number of deaths attributable to prostate cancer. The effects of screening upon quality of life and cost have not been researched in randomised controlled trials. The results from two large trials, to be completed in the next few years, will provide greater information on this issue.

    http://www.cochrane.org/reviews/en/ab004720.html

  • DavidS||

    In the US, in a year, 25% of population didn't visit a doctor when sick because of cost; 23% skipped treatment recommended by a doctor; 23% didn't fill a prescription. Equivalent figures for UK 2%, 3% and 5%.

    No linkee, no believee.


    Here's the link.

  • ||

    "If you're prepared to step over the bodies, fine - but to pretend that a free market solution is without any cost at all is insane."

    All hail the hyperbole, straw man, ad hominem combo! ...five points!


    Apologies. Perhaps I didn't understand your argument.

    But you seemed to be suggesting that: all healthcare problems were down to socialization; 'deadbeats' should be subsidised by 'ordinary working people'; and that in a pure market, everyone would get better care (12.17am, 10.03 am etc).

    Now I'm just confused. What are you suggesting should happen to those 'deadbeats' who can't afford to pay for their own care?

  • ||

    Er, I meant "deadbeats shouldn't be subsidised by 'ordinary working people'"

  • ||

    We have social programs, (WIC, food stamps,) to help the poor to eat and the food prices are nice and low in the free market. We have social programs,(medicaid, medicare,) to help the poor get medical services yet the price of private insurance is very high. 1200 bucks a month for bc/bs at my work. why is this? Greed of the capitalists or the govt forcing medical providers to accept pennies on the dollar?
    somewhere between capitalism and socialism is a balance that fulfills the needs(not wants) of society and rewards aggressive self betterment.

  • Neu Mejican||

    DavidS,

    Interesting study. I look forward to the counter arguments to this basic finding from it.

    Cross-country comparisons indicate that insurance design affects patients' overall care experiences as well as access. With high rates of adults being uninsured and underinsured, the United States stands out for cost-related access barriers and financial stress. U.S. findings also reveal multiple indicators of inefficient care, including medical record/test result delays and mistakes, duplication, time spent on paperwork or disputes, and perceptions that doctors provide care of little value. Further, U.S. adults often report waits for primary care, find it difficult to get care after hours, and end up seeking care from ERs-joining Canada with symptoms of a primary care system under stress.

  • ||

    "What are you suggesting should happen to those 'deadbeats' who can't afford to pay for their own care?"

    We should let them pay for their own care. Personally, I'd consider means testing Medicare--no matter what your age is. I'd let people opt out of Medicare. I'd exempt providers from being forced to care for those who aren't on their plan in under served areas. I'd do all of the above and more.

    In the meantime, I would not exacerbate the problem by socializing what few competitive and free market components we have left.

    "somewhere between capitalism and socialism is a balance that fulfills the needs(not wants) of society and rewards aggressive self betterment."

    There's a happy balance between price and availability alright, and it's completely disrupted whenever the government sticks its nose where it doesn't belong.

    Everywhere I see a failure in the health care market, I see the government's fingerprints all over that failure. ...and if government interference is the cause of those problems, then there's no reason to balance government interference against free market solutions.

  • DavidS||

    So - deadbeats still get subsidised if their earnings are below a certain level?

  • miche||

    An American doctor is (usually) rich; it's not unusual to see a family practicioner work one day a week and make a six-figure salary.



    Where is that? Seriously, I must tell my husband that he is getting screwed working months at a time without a day off. I'd love for him to have no overnight call as well. The easiest schedule I've seen is a derm practice at 4 days a week.

  • src||

    "We cannot give health care away for free, entirely or in part, without making the people who aren't getting free health care make up for the shortfall."

    That's actually an argument for mandates, as far as I can tell.

    The high price of health care comes from high premiums on insurance; healthy people with insurance bear the cost burden for the uninsured and the chronically ill. Ken Schultz, as you pointed out, people who buy insurance are paying for Medicaid and Medicare too since the government doesn't cover all of it. There's a moral hazard here as healthy people have little incentive to buy insurance and every reason to "freeload" when they have to go to the emergency room.

    So actually the way to lower prices is to make everyone "pay their fair share" and purchase health insurance. The libertarian in me winces, but it looks like we need government intervention to correct a market failure.

  • src||

    miche: the examples I was thinking of are in Chicago, at a university hospital. I have no idea if it's typical nationwide.

  • ||

    No market failure exists.

  • ||

    "So actually the way to lower prices is to make everyone "pay their fair share" and purchase health insurance. The libertarian in me winces, but it looks like we need government intervention to correct a market failure."

    Like I said above, HillaryCare, as bad as it is, does seem to address some of the causes of the problem. ...not that it won't cause all sorts of other problems and make many things worse than they are now.

    ...and it isn't a "market failure"--it's government intervention that's causing this in the first place. I'm tryin' to keep it brief here, 'cause I have a weekend to start, but, again, if government intervention is the problem, doesn't the suggestion that a government takeover will make things better seem really counter-intuitive?

    Other suggestions? Theoretically, they could stop forcing so many people to pay for other people's health care. ...or at least they could lessen the burden, which is why I was suggesting means testing as an interim step.

    They could exempt some hospitals and plans from taking people on government programs--even if they come through the ER. I imagine something like a charter school program for hospitals--just not funded by the government.

    At the very least, they shouldn't load the system up with more entitled people. If the system is having problems when government programs are only paying for 1/3 of the costs of the program, how much will it cost if they pay full price?

    ...and before we answer that question, let's not forget that the first social security check mailed to a baby boomer went out about a month ago.

    We need to limit the number of people on the program--not make it universal.

    And there's more at risk here than our libertarian sensibilities. We're talking about an enormous cost burden on our economy, a deteriorating quality of care, unquestionably we're talking about rationing, and we're talking about inefficiency in the economy. ...and that's just getting started.

  • ||

    So - deadbeats still get subsidised if their earnings are below a certain level?

    Many of those deadbeats got ripped off their whole lives to pay for other people's healthcare--just like me. Most of them don't even realize they're deadbeats.

    They go to public schools. They graduate from university with a diploma financed by a government loan. They get a government job. They send their kids to public schools. They don't save for retirement; they're gonna live on Social Security. They go on Medicare as soon as they can. Eventually, they'll go into a nursing home and the government will pay the bill.

    In the meantime, they point a finger at single women with kids and call them "Welfare Queens." ...as if not being on food stamps makes them superior somehow.

  • ||

    This review identified two trials, consisting of 9,026 and 46,486 participants; however, neither was assessed to be of high quality. This review demonstrates that there is not enough high quality evidence to inform whether or not screening for prostate cancer, via either a DRE, PSA or TRUS biopsy, is more effective than no screening in reducing the number of deaths attributable to prostate cancer. The effects of screening upon quality of life and cost have not been researched in randomised controlled trials. The results from two large trials, to be completed in the next few years, will provide greater information on this issue.
    J sub D's emphasis.

    Translation, those trials mean nothing. We're working on it.

  • ||

    Oh, Forgot my manners, thanks for the link.

  • Chavez is a thug||

    "And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa"

    Holy shit, you know things are bad when people are going to Malaysia for health care. They would be better off going to Cuba, with its 100% literacy rate and world class health care, right joe?

  • Chavez is a thug||

    "Unfortunately Sicko is a dishonest film"

    Moore dishonest? Say it isn't so. Next thing you know someone on this site will try to claim that Hugo Chavez isn't a democrat. Thank god we have joe to set them straight.

    Thankfully, as evidenced by the absymal boxoffice of Sicko, even the left saw through the bullshit contained in his latest "documentary". This is an encouraging sign as his "documentaries" were always exercises in preaching to the choir, rather than legitimate contributions to a particular debate.

  • Dr. D||

    An American doctor is (usually) rich; it's not unusual to see a family practicioner work one day a week and make a six-figure salary.


    HA HA HA HA HA HA...

  • ||

    You are kidding me? Aren't you?

    Nope. Find out what those numbers mean and get back to me. You know, what it measures, what it doesn't, how the data were collected and so on.

    Then you might have a point.

  • ||

    I am suggesting that health services are as important to society as fire and police protection and the military.

    I'd say food is an even greater priority than health care. Should we then just round up the citizenry and ship them off to collectives?

  • ||

    I'd say food is an even greater priority than health care. Should we then just round up the citizenry and ship them off to collectives?

    Yeah, and what about housing? Clothing?

  • ||

    I'd say food is an even greater priority than health care. Should we then just round up the citizenry and ship them off to collectives?

    Let's not forget the pressing need for government-run gas stations, and car factories, and ...

  • ||

    I note that many have identified the hybrid government-market nature of our system as the primary source of problems (possible, not sure I am sold yet).

    I also note that many have suggested that, given the fact that government intrusion into the market is the source of the problem, then more government does not make sense as a solution.

    It seems, however, that a move to a pure government system gets rid of the issues that result from the hybrid nature of our problem just as "logically" as moving to an entirely free market system. If it is the hybrid system that is the problem, eliminating the hybrid system can go either way.

    Empirically, it seems clear that talking broad strokes about "socialized" versus "market" solutions in this realm will miss the key differences between successful systems on both ends of the scale. Some socialized systems work quite well. Some don't. It is conceivable that the US could design a workable system. It is not just a matter of saying "universal healtcare." The devil in all policy debates has to do with the details.

  • ||

    It is conceivable that the US could design a workable system.

    Do you think it would be better run then, say, a military campaign in the Middle East?

    I find your excess of faith disturbing.

    The devil in all policy debates has to do with the details.

    I suspect the ol' devil will be many places at once in this scheme.

  • ||

    I'd really like the pro-socialization people to explain to me why the market does a very good job at providing me and mine with the essentials to life: food, shelter, clothing, fuel for heat, transportation, electricity (in some cases), (I'd say water if it weren't so tightly, and poorly, controled by the state) and so on, but yet the health care I consume requires a massive guvmint machine and bureaucracy in order to provide us with such.

    I just don't get it.

  • ||

    Do you think it would be better run then, say, a military campaign in the Middle East?

    The military campaign in Iraq was run very well, thank you. The occupation and nation building on the other hand, not so well. Just quibbling.

  • ||

    ... yet the health care I consume requires a massive guvmint machine and bureaucracy in order to provide us with such.

    I just don't get it.


    Because it's just not fair that some people better health care thann other. It's just NOT FAIR! That is all that is there when you boil it down.

  • ||

    "It is not just a matter of saying "universal healtcare."

    That is the program put on the table by the leading Democrat--she's wants to make everybody buy insurance regardless of whether they want to.

    Universal Health Care--it's what's for dinner.

  • ||

    The military campaign in Iraq was run very well, thank you. The occupation and nation building on the other hand, not so well. Just quibbling.

    Good point, but it's all one in the same in my head. I'm sure the Iraqi's aren't too big on that distinction either. ;-)

  • ||

    For my money, Michael Moore has just proved his worth by fouling the nest of anti-Americanism in Europe. If they genuinely see Sicko as a work of rhetorical fiction, it calls into question every anti-American stereotype that they've ever even loosely associated with him.

  • ||

    "a shortage of nurses so dire that staff did not have the time to wash their hands between patients and on some occasions even told those in their care to 'go in their beds."'

    Yes, this happened to my 90 y.o. grandmother in a London hospital. Well, actually the nurse told her to go to the toilet by herself. So she got out of bed and, as she told it, "piddled on the floor."

    She also got pneumonia once while hospitalized, and waited over a year for a second hip replacement after the one she had been given 25 or so years before wore out. She was in pain during that time.

  • ||

    some body hit my head on the road,ambulance came late,they admite in emegency,after 4 hour i was sitting on chair nobody came to see me.the hospital was charing cross hospital. i was waiting and waiting,after i was tried to wait and i left as it my injury. my comment is that we paying high national insurance & tax, why we don't get service.

  • src||

    Sorry about the rich doctors thing. I was wrong: anecdote, not fact.

  • src||

    I guess I was also wrong about the need for mandates. You can probably achieve better results just by letting (or making) people opt out of Medicare.

    My worry is "exempting hospitals and plans from taking people on government programs." That's already happening: a Wall Street Journal article
    (http://online.wsj.com/article/SB1184801648770935.html)
    show that more and more doctors are refusing to see patients on Medicaid. They have to pay out of pocket for Medicaid and Medicare patients, so understandably they're avoiding it; but it's a disaster if you actually need treatment and can't get it.

    It seems to be a bad idea to increase the number of people who nominally get gov't benefits, without actually being able to provide them with medical care.

  • DavidS||

    Family physicians reported salaries - lowest: $111894; average: $142516; highest: $197025.

  • DavidS||

    Of course, there's more money in bowels than treating children.

    Reported salaries for a colorectal surgeon - low: $186000; average: $263199; high: $420175.

  • VM||

    "So actually the way to lower prices is to make everyone "pay their fair share" and purchase health insurance. The libertarian in me winces, but it looks like we need government intervention to correct a market failure."

    moral hazard (which you mention) is half the market failure.

    Adverse Selection is the other -that makes assessing what the "fair share" is difficult/impossible. So people are paying "an incorrect price" (price doesn't act as a signal), people drop out of the mkt for health insurance, and mkt failure.

    think: Akerlof's Lemons Principle.

    Risk Adjustment (see: Cutler/Zeckhauser "Anatomy of Health Insurance" and Wynand and van de ven and Ellis, "Risk adjustment in competitive health plan markets"), the mechanism for dealing with problems that impede the effectiveness and efficiency of resource allocation in health care is the topic of ongoing research.

    But the health econ standard answer to insurance: "moral hazard and adverse selection" is a real kicker.

  • ||

    I predict that the United States will adopt a system of universal coverage and private medical practice that will work so well that countries with nationalized health systems, like England, will reform them along American lines. - joe

    They would be better off going to Cuba, with its 100% literacy rate and world class health care, right joe? - "Chavez is a thug"

    I've never actually been stupid, thug. Tell us, is a physically painful to be that stupid, or is it sort of a numb feeling?

  • ||

    Rimfax, do you actually think that a story in the Guardian, as reported by Reason, is giving you an accurate depiction of public opinion in Europe?

    Really? Do you really?

  • ||

    D'oh! Not the Guardian. Nevermind.

  • VM||

    hay joe - at least you closed the italics tag :)

    [ducks]

  • ||

    I can has corekt punk-tuashun?

  • VM||

    DEMAND KURV!!!

    (actually, the market failure from adverse selection and from moral hazard make the competitive market for health insurance one that the URKOBOLD loves so dearly!)

  • ||

    Public health insurance creates a moral hazard.

    Also, we don't need universal coverage, because hospitals have to provide treatment to people without insurance.

    And, finally, it is irrational and inefficient for healthy young people to pay for health insurance.

  • ||

    With only a single day studying Demand Kurv economics, you - yes, you! - can express the three preceding opinions without batting an eye.

  • VM||

    yay!

  • e||

    providing me and mine with the essentials to life: food, shelter, clothing, fuel for heat, transportation, electricity (in some cases), (I'd say water if it weren't so tightly, and poorly, controled by the state) and so on, but yet the health care I consume requires a massive guvmint machine and bureaucracy in order to provide us with such.

    JW, while I applaud your self-sufficiency in acquiring these essentials of life, there are people who would starve, freeze, be naked, be unable to get from place to place, power their appliances, etc, without either government aid or charity. If we assume the existence of such people, then the argument for also providing health care for them does not look so unreasonable.

    "Well, why not let charitable organizations provide for them?" Well, maybe so, but if you acknowledge necessity of charity, aren't you admitting the market has failed?

  • ||

    JW, while I applaud your self-sufficiency in acquiring these essentials of life, there are people who would starve, freeze, be naked, be unable to get from place to place, power their appliances, etc, without either government aid or charity. If we assume the existence of such people, then the argument for also providing health care for them does not look so unreasonable.

    The perfect as the enemy of good.

    Usually, socialized medicine schemes are not just "for the poor." They are for everyone. What you describe already exists: Medicaid.

    The people you describe are the exception and not the rule. Tell me again why the lowest common denomitaor should determine the quality of care for everyone.

    "Well, why not let charitable organizations provide for them?" Well, maybe so, but if you acknowledge necessity of charity, aren't you admitting the market has failed?

    What market? The become a rich guy market?

    If 1% of the population, hell even 20%, fail to provide for themseleves, but the other 80%-99% do, that is your definition of a failure?

  • e||

    JW, I think I understand your point. You don't oppose universal health care as long as you are not required to participate. Indeed, you do not oppose other forms of government intervention because you acknowledge that as much of 20% of Americans need it. Although I support socialized medicine, I would not advocate forcing anyone to participate.

  • ||

    "With only a single day studying Demand Kurv economics, you - yes, you! - can express the three preceding opinions without batting an eye."
    Well, sometimes the explanation from Occam's Razor handles things better than the thinking of a confused city planner.

  • ||

    I get that this was a jab at those whose opinions on public policy emanate primarily from Econ 101--not that there's anything wrong with Econ 101--but...

    "Public health insurance creates a moral hazard."

    The suggestion that people might be more likely to seek treatment if they don't have to pay anything extra for it isn't an outrageous one.

    ...even if it is taught in Econ 101.

    "Also, we don't need universal coverage, because hospitals have to provide treatment to people without insurance."

    I haven't seen anyone argue that we don't need universal coverage because ERs take people regardless of whether they have insurance.

    ...and I don't see how thinking that would follow from sitting through an Econ 101 course.

    "And, finally, it is irrational and inefficient for healthy young people to pay for health insurance."

    I think the suggestion was that it is inefficient to force young and healthy people to spend their money on something they don't want to spend their money on. ...which is different.

    And again, if that's being taught in Econ 101 classes all over America, I don't see what's wrong with it.

  • VM||

    "Well, maybe so, but if you acknowledge necessity of charity, aren't you admitting the market has failed?"

    e - what is your understanding of what "market failure" is?

    psst - rorschach - it was funny!

  • ||

    Ken Shultz,

    My point wasn't that each of those statements is inarguably wrong, just that arguing them all together demonstrates a remarkable capacity for holding contradictory thoughts in one's head.

    Many people have made the argument about young adults not needing insurance - not just the freedome argument, but from actual economic efficiency grounds.

    And if you haven't seen people argue that the provision of emergeny care in hospitals regardless of ability to pay means we don't have problems with health care access, you haven't been reading many health care threads.

  • Neu Mejican||

    JW,

    I find your excess of faith disturbing.

    You misconstrue: "conceivable" and "I have faith" are not in anyway synonymous. But people who are arguing here against a socialized solution are working from the "it's inconceivable" frame.

    I suspect the ol' devil will be many places at once in this scheme.

    =/:^)

    We agree.

  • e||

    e - what is your understanding of what "market failure" is?

    VM, my original, naive understanding of the term was simply that there if there were people who were unable to secure the necessities of life, then the market failed. Looking at wikipedia, I find that it a market failure means an economically inefficient situation, which is a separate issue. My point was just that, if charity is permanently necessary to sustain a certain percentage of people, then has to be considered as part of the economic system - that is the society depends on extra-market intervention to maintain itself.

  • VM||

    "that is the society depends on extra-market intervention to maintain itself."

    I actually don't understand that, either. Maintain itself? Extra-market?

    It's not extra market - there certainly can be a market for charity. The consumer would donate, based on various constraints, and would gain utility. Also, how the tax structure currently is, there is a healthy market for charitable goods or services.

    Trying to see where JW may be going for a second - he might be saying that the free market based society he's talking about cannot guarantee outcomes. There are going to be downtrodden. Even in highly social democracies there is a need for charity. There are people who fall through the cracks.

    Do I think that FREE MARKET FREE MARKET is the answer to all the ills? No. There are times where there is market failure. There are other times where it does appear as though there are regulatory barriers thrown up to protect one interest group from the competition from up and coming entrepreneurial individuals.

    Do I have an answer how to address problems of poverty?

    Dunno: there are some pretty tough social ills. Some of them reinforced by the Great Society. Some reinforced by imagined "pull up yourself by the bootstraps".

    There are definitely places where I do think regulation is a problem (hair dressing licenses), other times I see the start up costs or the information costs so high in poor areas that there's a barrier that cannot be overcome.

    But there is market failure in the competitive market for health insurance, and that's a problem (the FREE MARKET cannot solve the problems).

    I'm sorry I can't give a more definitive answer.

  • Chavez is a thug||

    ":I've never actually been stupid, thug. Tell us, is a physically painful to be that stupid, or is it sort of a numb feeling?"

    Are you honestly trying to claim that you have never lauded Cuba's health care system and literacy rate? You are so full of shit it is coming out of your ears; you are the dumbest fuck on these message boards, so you tell me how it feels.

  • e||

    The consumer would donate, based on various constraints, and would gain utility.

    VM, really? How does a consumer gain anything by giving away money?

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