Reason Magazine
- reason.com
- reason.tv
- reason.org
- Donate
- Site Search:
Reason on Facebook
Reason on Twitter
Reason on YouTube
Reason RSSGet Reason E-mail Updates!
Manage your Reason e-mail list subscriptionsadvertisements
Arizona and Health Care Reform
From the Wall Street Journal's coverage of the fascinating Proposition 101 in Arizona:
Proposition 101, the Freedom of Choice in Health Care Act, has set off a storm of opposition, though its language hardly seems controversial. It reads that "no law shall be passed that restricts a person's freedom of choice of private heath care systems or private plans of any type." Also: "No law shall interfere with a person's right to pay directly for lawful medical services . . ."
Who could be against an initiative that protects the right of patients to choose and pay for a doctor or a health plan? The answer is proponents of a health-care system run by the government. For them, enshrining into law protections for private health plans is anathema. Believe it or not, the Phoenix Chamber of Commerce also opposes the initiative. Its big health-insurance members want to protect their interests as contractors to the state's Medicaid plan.
Democratic Governor Janet Napolitano argues that Proposition 101 would limit future health-care reform options. Eric Novack, a physician and the chairman of Proposition 101, responds, "The only option that our initiative rules out is a mandatory single-payer system." Single-payer health-care systems, as in Canada, make it illegal in most cases for people to go outside the government's system and contract for their own medical services. Arizona's proposition forbids those kinds of restrictions.
classwarrior|11.3.08 @ 3:43PM|#
"Single-payer health-care systems, as in Canada, make it illegal
in most cases for people to go outside the government's system and
contract for their own medical services."
Not quite. Doctors in Canada must opt out of the public health care
system entirely if they are to bill patients privately, and there
are a few who do. The other option is travel out of the country for
treatment for those who can afford it.
Paul|11.3.08 @ 3:54PM|#
Believe it or not, the Phoenix Chamber of Commerce also opposes the initiative. Its big health-insurance members want to protect their interests as contractors to the state's Medicaid plan.
Believe it. Corporations and big business are going to usher in a
single-payer system in this country.
|11.3.08 @ 4:01PM|#
Not quite.
So that whole Supreme Court of Canada's striking down of Quebec's
law against private provision of medical services was part of some
alternate reality that only I experienced?
If so, then what do you see at
this link?
|11.3.08 @ 4:06PM|#
Mexican hospitals are about to get a major infusion of patients if single payer ever goes through. In a related note, anybody want to invest in some Mexican hospitals?
Mike Laursen|11.3.08 @ 4:07PM|#
Wasn't it the case that Quebec was more restrictive of private medical practice than the rest of Canada?
Kyle|11.3.08 @ 4:08PM|#
It will be interesting to see how many of the ballot proposals (eg. relaxation of drug laws in Mass. or Prop. 8 in CA) will turn out. I think their results will be more telling of the sentiment in the country than who wins the White House.
Mike Laursen|11.3.08 @ 4:08PM|#
I know folks in the southern part of New Mexico who, for years now, have had all of their prescriptions filled in Mexico.
|11.3.08 @ 4:19PM|#
I can recall just how many times I was at the DMV and said to myself, "Wow! I wish going to the doctor was just like this!"
|11.3.08 @ 4:20PM|#
One needs to be careful when talking about the "Canadian" system
since there are, in fact, ten different provincial systems.
It is true that they all federally mandated and have to meet
minimum federal regulations and that they are federally funded but
rules can differ from province to province.
The extent that the system succeeds (and it is quite successful at
delivering primary care) is, I suspect, largely due to this limited
decentralization.
I am quite doubtful that the "Canadian system" or a "Scandinavian
system" could be successfully administered in a country the size of
the US. It might be interesting to see the states experiment
though.
Naturally this is from a policy point of view considered
independently of the implcations for individual liberty.
|11.3.08 @ 4:21PM|#
I love watching scumbag politicians and interest groups contort to find some way of opposing something so clearly positive. It just shows you how depraved they truly are.
|11.3.08 @ 4:30PM|#
This is the danger of both the McCain and the Obama health
plans. Having the government pay your health insurance premiums is
just as bad as single payer. Once the insurance companies become
dependent on the government dole, the government will be able to
control them and they will have a vested interest in the government
continueing the payments.
As far as business, they don't want to pay medical benefits
anymore. They would like to dump people onto the public dole and
get out from under the cost. What do they care if the care sucks
and it raises income taxes through the roof? All that matters to
them is that they no longer have to pay insurance premiums anymore.
Single payer medical care is nothing but a giveaway to big
corporations and a way to ensure that working hard gets you
absolutely nothing. Doesn't matter if you work your whole life or
are a crack addicted bum, you get the same care.
|11.3.08 @ 4:30PM|#
Sugarfree
In Canada doctors are still independent private practioners
(admittedly subject to a boatload of regualations - as if US
doctors aren't).
For the most part going to a primary care physician is much the
same as going to one here with good insurance (the Canadian system
does prohibit copays - one of the fed regulations). It is when you
get into specialist care and treatment for serious illnesses that
the problems start.
That's why the vast majority of Canadians are happy with it.
If one is going to criticize something it is valuable to understand
what one in criticizing.
|11.3.08 @ 4:32PM|#
"Not quite. Doctors in Canada must opt out of the public
health care system entirely if they are to bill patients privately,
and there are a few who do."
It's not as simple as that. A practitioner is not allowed to bill
patients privately for any service that is covered by the
government (e.g. MRIs, physiotherapy, etc.). They can only offer
services which are not covered (e.g. cosmetic surgery, LASIK,
etc.).
The rationale is this. If a patient can pay a doctor directly, then
they can skip the government wait-list, which is unfair to people
who can't afford to pay. Canadians are almost universally and
religiously opposed to such a "two-tier
system".
Yes... health care truly sucks moose cock up here in Canada.
|11.3.08 @ 4:34PM|#
Democratic Governor Janet Napolitano argues that Proposition
101 would limit future health-care reform options.
Isn't that kind of the point? To keep these fuckers from "health
care reform options" that tell us who we can go to for care?
Corporations and big business are going to usher in a
single-payer system in this country.
You bet your ass. They would love to lay their current liabilities
for health care off on the taxpayer.
Having the government pay your health insurance premiums is
just as bad as single payer.
It will be nothing but disguised single payer, because with the
government checks come the government regulations on what the plans
have to offer, what they can charge, what they have to do,
etc.
What will be really interesting will be the extent to which you can
go outside the system for care. Initially, of course, you will be
able to, but over time expect restrictions, most likely imposed on
doctors and hospitals.
New World Dan|11.3.08 @ 4:35PM|#
Corporations and big business are going to usher in a
single-payer system in this country.
What they're really after is semi-subsidised employer provided
health care. They want to keep control over health care because
that gives them leverage over their employees while at the same
time they want to shed the cost. I thought it was terribly funny
(and sad) that during the debates McCain's health care plan was
criticized because it would take us away from employer provided
health care.
|11.3.08 @ 4:38PM|#
Isaac,
I'm sure that there are differing ways to implement a single-payer
system that will have unique perks and drawbacks, but my point is
more along the lines of "What is the general impression of the
difference in private and governmental service ethics?" I have
never dealt with any level of government that had a decent service
ethic. I refuse to believe that government run health-care will be
the exception to the rule.
|11.3.08 @ 4:40PM|#
"It is when you get into specialist care and treatment for
serious illnesses that the problems start"
So the system works as long as I don't have a serious illness or
any need for specialist care, which is pretty much the only times I
would have any real interest in it working. Oh I feel so much
better now.
|11.3.08 @ 4:43PM|#
"I refuse to believe that government run health-care will be the
exception to the rule."
It won't be. Worse yet, it will be rife with corruption and
chronyism. Do you think some important fuck like Barney Frank will
ever be on a wait list? Hell no. Those who are connected will go
right to the top of the list and the rest of us will just die. Take
a look at single payer healthcare and then think about what they
want to do the pharmaceutical industry and what a plaintiffs bar
would do to the medical profession given the opportunity. You might
as well get a wich doctor or figure out how to treat yourself
because if those fanatics ever get a hold of our health system we
are going back to the dark ages.
|11.3.08 @ 4:45PM|#
Just think Sugerfree once the government gets its paws on the healthcare system it can start descriminating against disfavored lifestyles. Weigh too much, they can tell you to go to a government mandated re-education and diet camp or kiss your healthcare goodbye. Smoke or drink? They can tell you to quit that or face losing your coverage. Since it will be a single payer system, it will be illegal for you to pay a premium to keep your freedom. You will either have to quit or be denied treatment.
SIV|11.3.08 @ 4:49PM|#
What branch of the Federal Government will conduct the raids on private health care facilities in Arizona?
|11.3.08 @ 4:52PM|#
Oooh! Oooh!! What about Cuba? What about Cuba? Cuba Cuba Cuba?!! Man walks into a bar, CUBA!! Woohoo!
|11.3.08 @ 4:53PM|#
John, I was presenting an analysis, not defending the
system.
The system as it is is very good at keeping the vast majority
satisfied. The small number of people who suffer with waiting lists
and denial of service for treatment are seen as outliers who would
"suffer in any system".
And on top of that the masses really don't give a shit about them
as long as they perceive that they are getting their handout.
When one examines welfare states the myth of them as "compassionate
societies" gets pretty much demolished.
It's really all about buying votes and maintaining power by keeping
the hoi polloi placated.
|11.3.08 @ 4:55PM|#
John,
And anyone who says they won't try and influence lifestyle through
health-care coverage is either a bald-faced liar or has the IQ of
half-a-package of frozen spinach.
|11.3.08 @ 4:58PM|#
SIV,
If you ever talk to someone who actually lived under Communism ask
them about how it really worked. The way it really worked is that
no one did any work at their real jobs and then did everything for
a price after hours. For example, teachers never taught during
school hours but instead offered under the table tutoring sessions
after class.
Socialism can only work if you have the socialist man who works
hard for the collective and never for himself. Once someone starts
to work for themselves and grow tomatoes in their backyard and sell
them or work after hours tutoring, the system breaks down because
people stop working for the collective and only work for themselves
on the side.
That is why socialism always ends in totalitarianism and the death
of freedom. Since socialist man will never exist, the only way to
get people to work for the collective and not themselves is to
force them.
In the example of government mandated healthcare, people will start
running illegal pay for service businesses. There will be a lot of
demand for it because the government system will suck so bad. Of
course as more and more doctors make money on the side, the
government system will suck worse creating more demand for the
illegal on the side business. How do you prevent that? The
government way to prevent that is to kick in the door and throw any
doctor who practices on the side in prison. That is where this shit
leads. It always ends with someone going to jail or getting shot.
It is just how leftists function. They have to be that way.
Neu Mejican|11.3.08 @ 5:05PM|#
"They" are sure to "try to influence" you.
The details matter.
How is the influencing done.
Who are they.
What power do they have over you if their influence fails.
It is important to note that "we" have power over "them" as well.
We can influence them as well.
So, since we are in hypothetical land.
If the government run system included financial penalties for
"choices" made by an individual that increased their risk/cost
profile, is that an example of control, or a way to get personal
responsibility back into the system?
To get more concrete, in a national healthcare system that gave a
tax credit to non-smokers to influence people by rewarding
non-smoking, is the person who decides to continue smoking
responsible for the difference in their tax burden, or is the
state?
|11.3.08 @ 5:05PM|#
Isaac,
Whenever people talk about government healthcare I always think of
my sister. She is developmentally handicapped and has an IQ of
about 80. She had a stroke and went to the emergency room and the
doctor didn't get to her quickly enough to administer the drugs
that could have reversed some of the effects. She told my other
sister that "she was kind of slow anyway."
That right there will be the attitude of the government health
bureaucrat. The sick, the disabled, the less fortuneate will be
outliers who were screwed anyway and are not entitled to care from
the socialist paradise.
Neu Mejican|11.3.08 @ 5:07PM|#
John,
It is just how leftists function. They have to be that
way.
So it is a fight between good people and bad people and not a
discussion about how to create good versus bad policy?
Really?
Mike Laursen|11.3.08 @ 5:09PM|#
The system as it is is very good at keeping the vast
majority satisfied. The small number of people who suffer with
waiting lists and denial of service for treatment are seen as
outliers who would "suffer in any system".
You're on to something. It's rarely acknowledged in the health care
debates that basic day-to-day medical treatment isn't that hard to
do. You could have a system where most mundane healthcare is
administered by local Boy Scout troops and they'd do a pretty good
job of it.
It's not just universal health care advocates who don't want the
public to see this. It's the AMA, too.
|11.3.08 @ 5:09PM|#
"So it is a fight between good people and bad people and not a
discussion about how to create good versus bad policy?
Really?"
In this case yes. I think people who support single payer
healthcare are either unimaginably ignorant dupes or legitmately
awful people who just want control. When I look at the results in
places like the UK and Canada, I can't see how anyone could support
it in good conscience.
sage|11.3.08 @ 5:09PM|#
Oooh! Oooh!! What about Cuba? What about Cuba? Cuba Cuba
Cuba?!! Man walks into a bar, CUBA!! Woohoo!
I've got to be honest with you. I'm not too familiar with Cuba's
healthcare system - is it a government run system?
Neu Mejican|11.3.08 @ 5:09PM|#
John,
Questions:
Does your sister have health insurance?
How was the situation you describe the result of a failure in
government run healthcare?
|11.3.08 @ 5:10PM|#
"You could have a system where most mundane healthcare is
administered by local Boy Scout troops and they'd do a pretty good
job of it."
Very true. It is also why places like Wall Mart and CVS getting
into the healthcare business is a great thing. Most basic stuff can
be done easily and cheaply. But, good luck getting the AMA to buy
that.
sage|11.3.08 @ 5:11PM|#
In this case yes. I think people who support single payer
healthcare are either unimaginably ignorant dupes or legitmately
awful people who just want control.
Both of whom probably view health care as a "right."
|11.3.08 @ 5:12PM|#
"Questions:
Does your sister have health insurance?
How was the situation you describe the result of a failure in
government run healthcare?"
Yes she did. It is not the result of government run healthcare. It
is an example of the very kind of failure that will happen in such
a system. Whenever bureaucrats run things they will make decisions
based on rules and matrixes and money. Why spend money to help this
person who is slow anyway? Wouldn't it be more efficient to spend
it on healthy productive people? That will be the logic.
Neu Mejican|11.3.08 @ 5:13PM|#
John,
Just so I can keep up.
The AMA are among the bad people?
Or not since the AMA doesn't support single-payer?
http://www.pnhp.org/blog/2008/10/31/ama-position-on-single-payer/
Neu Mejican|11.3.08 @ 5:14PM|#
John,
Whenever bureaucrats run things they will make decisions based
on rules and matrixes and money. Why spend money to help this
person who is slow anyway? Wouldn't it be more efficient to spend
it on healthy productive people? That will be the logic.
How do you, then, explain all the money spent by the government on
programs to support those with developmental disabilities. Both at
the state and federal level?
|11.3.08 @ 5:14PM|#
"I've got to be honest with you. I'm not too familiar with
Cuba's healthcare system - is it a government run
system?"
It's awesome. There was this movie that everybody went and saw, and
it proved that Cuba's system was the best in the world even though
the people aren't into, like, material things. And I don't know
what "government run system" means, but I know what I saw.
Neu Mejican|11.3.08 @ 5:16PM|#
John,
It is not the result of government run healthcare. It is an
example of the very kind of failure that will happen in such a
system.
It is a better example of the kind of failure that occurs in our
current system. A system which often conflates financial criteria
into medical decision making.
I am not sure why you see this conflation increasing in the
hypothetical single-payer system.
|11.3.08 @ 5:16PM|#
Compulsory "single payer" health care systems will only force poor and lower middle class people to use the government's monopoly health care system. Politically powerful and/or wealthy patients will always be able to threaten and/or bribe their way to the head of the line, and rich and even middle class people will be able to leave the country and get their surgeries and other care in places like India or Thailand, and even be able to visit doctors online. "Medical tourism" is already a booming business.
sage|11.3.08 @ 5:18PM|#
From NM's link:
Single-payer systems are plagued with an undersupply of medical
personnel, long waiting periods and a lack of patient
choice.
Sounds like just the ticket.
|11.3.08 @ 5:19PM|#
"How do you, then, explain all the money spent by the government
on programs to support those with developmental disabilities. Both
at the state and federal level?"
They spend surprisingly little and a lot less than you would think.
Further, it is a case of the right hand not knowing what the left
hand is doing. Sure we will spend billions on developmental
disabilities but when someone who fits that mold or is old or some
other way defective needs care, all the programs in the world are
not going to stop the health care bureaucrat from looking at them
and saying "too bad" in the name of efficiency.
|11.3.08 @ 5:20PM|#
"It is a better example of the kind of failure that occurs in
our current system. A system which often conflates financial
criteria into medical decision making."
No. My sister had insurance and money. It wasn't a quesiton of
money.
Mike Laursen|11.3.08 @ 5:23PM|#
The AMA are among the bad people?
If we have to categorize everyone in terms of good and bad, then
the AMA is mixed good and bad. It's more useful, though, to put
aside questions of good and bad, and simply acknowledge that the
AMA is promoting its own interests.
Neu Mejican|11.3.08 @ 5:27PM|#
John,
They spend surprisingly little and a lot less than you would
think.
Well, maybe less than someone else would think (you may not recall
that I work in Developmental Disabilities). I appreciate your
support of greater government funding for disability
services.
Further, it is a case of the right hand not knowing what the
left hand is doing. Sure we will spend billions on developmental
disabilities but when someone who fits that mold or is old or some
other way defective needs care, all the programs in the world are
not going to stop the health care bureaucrat from looking at them
and saying "too bad" in the name of efficiency.
But health benefits are one of the primary mechanisms for access
that is utilized by those with developmental disabilities. There
is, in fact, an incentive to seek out a diagnosis as
developmentally disabled as it provides access to resources that
are unavailable to others who are similarly functional, but not
developmentally disabled. These services are provided as part of
the health care system, for the most part. When the services fall
outside of that system, it is common for a healthcare provider of
some type to manage/coordinate those services.
No. My sister had insurance and money. It wasn't a quesiton of
money.
I think you are confused.
The decisions about how to staff the emergency room involved money.
The amount of wait time that was acceptable involved money...yadda
yadda.
SIV|11.3.08 @ 5:46PM|#
The AMA are among the bad people?
Fuck yeah, they are rent-seeking scum.
National Socialists opposed International Socialists but they are
both evil.
|11.3.08 @ 5:59PM|#
Believe it or not, the Phoenix Chamber of Commerce also
opposes the initiative.
Chambers of Commerce should not, except in rare cases, be mistaken
for free market enthusiasts.
And the AMA can stick it in their ear; restricting the supply of
healthcare, in order to keep costs high, is not how you improve
it.
|11.3.08 @ 6:02PM|#
It is a better example of the kind of failure that occurs in
our current system. A system which often conflates financial
criteria into medical decision making.
Actually, I think this is an example of what happens when you have
an undersupply of care resulting in wait times. The harm here was a
result of the wait for care. The doctor's callous remark is more a
way of trying to excuse the bad outcome.
I might note that, depending on the hospital, wait times in ER are
in no small part the result of federal mandates on emergency care
that have turned ERs into primary care clinics.
I am not sure why you see this conflation increasing in the
hypothetical single-payer system.
The undersupply that leads to bad results will increase, I think
that's pretty plain.
|11.3.08 @ 6:06PM|#
The AMA are among the bad people?
Or not since the AMA doesn't support single-payer?
http://www.pnhp.org/blog/2008/10/31/ama-position-on-single-payer/
They sure look good by comparison to the hosting .org.
|11.3.08 @ 6:08PM|#
Go Arizona Prop. 101. I wonder if there are any good polls to see which way public support is leaning on this issue.
No Name Guy|11.3.08 @ 6:11PM|#
Single payer in health care will have the same smashing success
as "single payer" in public education.
The rich and powerful send their kids to private school and the
extra cost doesn't really affect them all that much. Same thing
will happen in a public health care system. The rich will find a
way to get quality care with no problems.
The poor will, as with schools today, be stuck taking what they can
get since there's no other choice. Just as inner city kids get
screwed by crappy public schools which are nothing more than union
money machines, the poor will get screwed with 2nd rate public
health care. The thing is, the poor can always show up at a
hospital today and get all the care they need for free.
As is par for the course, the middle classes are the ones that will
REALLY get screwed. Following the schools parallel: Taxed up the
ass for crappy schools, they struggle to send their kids to private
schools to ensure they get a decent education. In a similar vein,
when solid employers of skilled trades and professionals (think
welders, longshoremen, engineers and the like) dump the middle
classes off on the crappy public system, they'll have to endure the
shit that poor folks on welfare have to put up with, without the
ability (since they'll be taxed up the ass a second time for this
financial abortion) to engage in medical tourism that the wealthy
can do.
And the kicker of it: It just makes the sheeple all the more
dependent on sugar daddy government. Ah yes, what better ways to
insure continuing votes of the idiot classes than to make their
health care dependent on a handout. Hell, look how paranoid the
AARP gets with even the slightest talk of reforming that sinkhole
called socialist security. Now quadruple it if single payer ever
gets done.
Neu Mejican|11.3.08 @ 6:31PM|#
RC Dean,
Actually, I think this is an example of what happens when you
have an undersupply of care resulting in wait times.
And money plays no role in the allocation of resources (i.e.,
undersupply)?
The doctor's callous remark is more a way of trying to excuse
the bad outcome.
I had to go back and read John's comment. I didn't read the "she"
in "she said she was kind of slow" as the doctor...but John's
sister talking. He can correct me if I am wrong.
I might note that, depending on the hospital, wait times in ER
are in no small part the result of federal mandates on emergency
care that have turned ERs into primary care clinics.
This seems chicken and the egg to me.
The regulations were probably a response to a need not being
met.
The undersupply that leads to bad results will increase, I
think that's pretty plain.
To some it is plain.
To others, evidence that contradicts it is readily available. The
US is not ranked above all single payer systems in terms of access
to healthcare. It just ain't.
Neu Mejican|11.3.08 @ 7:29PM|#
In 2001 France was rated as having the best health system in the
world.
Anyone have more up to date rankings?
A concise description of the French system.
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/
|11.3.08 @ 7:41PM|#
A concise description of the French system.
Knowing what I know of the French system, the two findings I
expected are cited...
That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine."
...
However, the average American physician earns more than five times the average US wage while the average French physician makes only about two times the average earnings of his or her compatriots.
I did not, however, expect to see this editorial aside when
discussing the greatest perceived problem in the French
system...
American advocates of mandates on employers to provide health insurance should take note. The link between employment and health security is a historical artifact whose disadvantages now far outweigh its advantages. Economists estimate that between 25 and 45 percent of the US labor force is now job-locked. That is, employees make career decisions based on their need to maintain affordable health coverage or avoid exclusion based on a preexisting condition.
...since this is the greatest problem with the American system as
well.
Neu Mejican|11.3.08 @ 7:49PM|#
MikeP,
...since this is the greatest problem with the American system
as well.
Well, perhaps the greatest problem with the way the American system
links employment and healthcare coverage, but I agree that it is
one of the more important problems.
|11.4.08 @ 9:07AM|#
Question: How much would it cost to insure every American
citizen with a 'gold plated' plan? By 'gold plated,' I mean a plan
that would pay 100% of the cost of the treatment/check-up/test
recommended by the patient's doctor, and agreed to by the patient,
in every situation?
I would think that this cost could be estimated by multiplying the
premiums (employer plus employee) for such a plan today (I assume
there are some people who have this type of plan) by the number of
Americans in each relevant demographic group (I assume the premiums
for such a plan would differ significantly by demographic group).
For the sake of argument, let's assume that the current provider
system could rapidly expand to accomodate this additional care at
current costs.
Site comments/questions:
Media Inquiries and Reprint Permissions:
(310) 367-6109
Editorial & Production Offices:
3415 S. Sepulveda Blvd.
Suite 400
Los Angeles, CA 90034
(310) 391-2245