Our Craptacular Health Care System (And Why We Deserve It)

Americans want more health care for less money, and when they don't get it, they indict drug companies, insurers, trial lawyers and bureaucrats. Although these familiar scapegoats may not be blameless, the real problem is us. We demand the impossible. The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients, especially wealthier ones, should pay more of their bills. But these changes won't happen because people don't want to see the costs. We don't have the health care system we need, but we do have the one we deserve.

That's the Wash Post's Robert Samuelson on our craptacular health care system. His whole col, which lays out the inconsistencies in our various demands, is well worth reading. Take it twice and then call a doctor on the morning of the State of the Union Address, in which President Bush is expected to yap about an annoying new set of tax breaks for health care, thus making the system even less intelligible and transparent.

Comments

[jeffiek]

But after the easy efficiencies were adopted, overall costs would begin skyrocketing again.

Because there's a continuing increase in product and we would use more of it? In a free market that should bring prices down.

Look at the personal computer. It keeps doing more and more, faster and faster. More and more people have them. What is happening to their prices?

[jp]

It's obvious that we only need to kill more aristocrats -- then the millennium will arrive!

[happyjuggler0]

jeffiek,

If you had insurance to buy every new gadget that came on the market, and the number of new gadgets on the market kept getting larger, what would that do to your "total coverage" insurance premiums? Yes, they'd go up, which is what is happening in healthcare right now as more and more new drugs and treatments come out for things we have no drugs and treatments for now. Once they go off patent, the cost plummets to near zero which is what the effective cost of replicating drugs is. The price is in the patent, and the patent is necessary to get the invention in the first place.

If we had the same horrible non-free market in healthcare right now that we have, but everyone would somehow be prohibited from creating drugs and treatments for things which there is no drug or treatment now, then the price of comprehensive coverage would be going down right now,and they'd be going down at a faster rate with a more-free market.

But we keep adding new areas to the pool of medicine, and this costs money. what we have now is the equivalent of most companies in the US giving for "free" to their employees a new leased car to drive while they work for the company. But each year they upgrade the car with more and more features, and these features cost money, and whatever cost savings from the older features are swamped by the new features being added.

One could design a health insurance policy that covers everything medical treatment available today. You can also stipulate that no treatments for things that are currently are untreatable can be covered, but new treatments for things already covered will be covered. The cost of this insurance policy would be going down each year as more and more effeciencies were added by the market. But this policy would not be "comprehensive".

Medical costs for things already in the system are not the issue. It is for things that are untreatable right now that are being added to our "full", or "comprehensive" insurance in the current medical revolution that create the illusion that something bad is happening. These new things cost money, and they are being added each year at a rapid rate.

[xpanda]

Forgive my Canadian intrusion into the health care question ...

I have to admit that this is the absolute hardest part of Libertarianism to swallow, given the fact that universal health care in Canada enjoys theocratic status. I've not been remotely immune to this phenom.

In light of my 'kumbaya-ness' in this area, please forgive this question:

Prior to the advent of Medicare, just how efficient was the free market at creating charitable health care for those who cannot afford it?

[dpotts]

Prior to the advent of Medicare, just how efficient was the free market at creating charitable health care for those who cannot afford it?

Couldn't have been any more inefficient than Medicare itself...

[jeffiek]

But we keep adding new areas to the pool of medicine, and this costs money

So what? Improving pc's also cost money. Somehow, manufacturers found it. Without government handouts. They made them faster and more powerful. Added sound, video, and games just to list a few improvements. Oh, and look at the rate of improvement.

I said free market. Those company paid medical plans are not free market. Look at the tax structure, not to mention the insurance regulations. Ever ask yourself why companies provide medical insurance? Surprise, wage controls in the '40s ( or thereabout ) caused companies to add benefits that didn't count as wages. All those negatives about insurance that you correctly listed would disappear in a free market.

When people pay for what they use the picture changes entirely. I've just spent about $15k on dental implants and will spend about another $10k.
I could get dentures for a lot less, and yet I'm not complaining about the cost. It's my money and that's how I choose to spend it. I actually consider it quite cheap for the comfort they provide. This is an item unfunded by insurance companies and yet somehow people found a way to do the research and develope them. They didn't exist at all when I was a kid (read that as price = infinity) and I have no doubt the price will drop in the future.

xpanda:

I don't have any reference handy, but I have heard it was good. Not old enough to give first hand account. More importantly though is the fact that "cannot afford it" is largely (but not entirely) a matter of personal effort. Work hard and get rewarded. Provided of course your work isn't paying for someone else's benefit. And if it is, then those taxes actually create more people who can't afford medical care. Which makes the problem worse, not better.

[xpanda]

Thanks, jeffiek. The 'cannot afford it' argument of personal responsiblity generally goes out the window when you bring children into the equation. It's ironic, but people here can rationalise ending public housing and public welfare - both of which serve the most basic of needs - but try having the same conversation about health care and most people stop listening.

I think it's largely a matter of exerience (everyone uses health care, only lazy people use welfare, etc.) but it's a massive hurdle to libertarianism in Canada. Despite all of my 'conversions', this one still pains me, too.

[James Anderson Merritt]

Our Canadian friend, Xpanda, asks,

"Prior to the advent of Medicare, just how efficient was the free market at creating charitable health care for those who cannot afford it?"

Hard to say, as government distortion of the healthcare market began at least as early as WWII (a quarter century before Medicare). According to some accounts, it all began with FDR's wartime wage and price controls. Employers (especially during the immediate postwar years, when the controls were continued out of fear of runaway inflation) wanted to be able to offer perks to attract and retain good employees, they couldn't raise salaries/wages. They lobbied for, and got, permission to provide pre-tax healthcare benefits to employees, as well as favorable tax status for themselves. The original Kaiser health plan was set up to take advantage of the deal, becoming the prototype for HMO-style healthcare, including Medicare. By the mid-1960s, Kaiser and others were succeeding in positioning full-service healthcare as a desirable benefit -- so well, in fact, that people without employer-plans (or employers!) demanded the same thing. Our compassionate 1960s Congress and "Great Society" President Johnson obliged with Medicare, ostensibly only for the neediest among us. States created their own complementary, coycat plans. Finally, everyone else in between wanted what these several other recipient groups had, and we got the HMO Act in the 1970s.

Prior to WWII, doctors made house calls, families could afford hospital stays, heroic medical efforts of the type we now read about in the newspapers daily were very rare, poor and rural people could pay "in kind" with labor, livestock, or other barter, and "health insurance" was primarily for catastrophic coverage. After about 1980, the system we have now -- which started out as a way around wage and price controls, and taxes -- was the well-established tail that was wagging the healthcare industry dog.

When one adds to this the FDA's longstanding control over the pharmaceutical side of the industry, one must admit that there has been nothing like a real "free market" in healtcare for a good thirty years in the U.S., and arguably the last sixty.

[The Real Bill]

xpanda,

When confronted with the "some people can't afford it" argument, just remember how the government obtains its funding--government agents with guns take it. (If you don't agree with this, try not paying your taxes sometime.) Is it really moral to help people this way?

[joe]

Gotta love it when a rich writes an article telling poor people to suck it up.

[happyjuggler0]

Damn, I thought I was clear. In my opinion you are comparing apples and oranges.

You need to compare existing drugs with existing pc's. They both will fall in price over time.

Now imagine that your company paid you health coverage for everything on the market now and in the future, and that they also paid you technology insurance for everything on the market now and in the future, and that you'd throw out your existing technology products at home each year and get new stuff each year. Despite the fact that existing technology prices got cheaper each year, the techology insurance would get more expensive each year if the rate of new types of technology products, and the prices they cost, went up at a higher rate than the cost savings from things like pc's going down.

The same thing is happening in healthcare right now. Take drugs for example. There are more drugs going on patent and into the marketplace each year than are going off patent in the same year. If one assumes that the new drugs cover the same amount of illnesses or diseases that the ones going off patent do, then the drug component of comprehensive health insurance will go up. This is happening.

Now by no means does this mean that everyone will want to pay for insurance that covers every new thing that hits the market. For those people who are content to be served by the same coverage each year, their insurance costs will go down. For those who insist on the insurance that covers more stuff each year, their costs will go up.

I agree that our current system totally distorts this, and we wind up with a system where people damand total coverage, and if their employer can't afford it, then they basically can't either. Since we insist on full coverage when it seems free, then those times when our employer can't afford "full" health insurance, we get no health insurance.

Take the employer out of the equation by taking away the huge tax benefits of doing it via employer, and give the individual an equal playing field, and then we'll have individuals getting coverage for what they want to get covered for, and they'll decide that based on cost/benefit analysis, and this will be a good thing.

The initial transistion period of going from what we have now to a free market will probably have falling prices for "full" health coverage, but again, there will be diminishing returns on efficincies on the existing medical practices, and when that diminshing return diminshes enough, the price of comprehensive health care insurance will go up at at least the current rate, maybe higher since the base price will be lower.

No sane person would get full technology coverage insurance. But even in a free market people will get it for health care. And this is what people are missing when they complain about the rising cost of healthcare. Once upon a time doctors could do little for you because they didn't know how, and comprehensive health insurance was much cheaper because it didn't actually cover all that much. Now they know how to do much more, and the new ways of "fixing" patients cost money. And there are a lot of new parts of the human that are now "fixable", so it costs a lot more to "fix" everything they know how to fix.

By all means we should try to get a free market in health care, both in insurance and in the non-licensing of doctors and nurses and eliminate the FDA which kills people each year. The FDA kills people each year when it causes drugs to go on makret later than they would ahve otherwise. It is true they probably save lives by keeping some dangerous stuff off the market, but they also keep good stuff off the market too, at least for a while. And if the prodcut they are delaying saves perhaps 10,000 lives a year once it hits the market, and the FDA mandated delay is 5 years, then the FDA killed 50,000 people in those 5 years. All I am saying is that once we get the most signicant cost savings out of the way, that people who want to and can afford to get covered for "everything" will once again have their health insurance coverage go up by a large percent each year.

Note that dental is not considered part of comprehensive health insurance, buta seperate insurance item that has no reason to exist but for tax distortions.

[h-dawg]

xpanda,

The growth of hospitals and public health initiatives began to take off shortly before the New Deal. Why? Because that's what every rich person from Rockefeller to Gates tends to fund with their excess wealth. So, how good was charity at providing health care for the poor? Just look at the plaques on every hospital wing in the country, if not the world.

Consider how much public health we aren't getting because the wealthiest have 50, 70, or 100 percent of their excess wealth taxed away, an increasing part of it to fund a health care bureacracy, including the part that's slowing down development (like the FDA), as opposed to real health care. It's hard to believe that even the poorest are better off with a system that siphons off so much from all of us, including the rich, and funnels it into the bureacratic mess we have now.

[Morat20]

Here's the problem you guys have with this: You're not going to have a pure free-market system -- which brings in all the free-market magic that makes this all cheap and plentiful and farted from unicorns and such -- unless you have a free-market system.

And having a pure free-market system means one thing: You turn away the dying if they can't pay.

That's the REAL problem. That's the drag on the system. The American public is currently UNWILLING to allow hospitals to turn away the dying if they can't pay. The public is unwilling to make the critically ill or injured wait for treatment until their ability to pay is determined.

And all the private charities and free hospitals in the US aren't going to be able to make a dent in it.

The free market would probably help -- especially when the elderly and ill got priced out of insurance, and couldn't afford care. Premiums would drop like a stone without those expensive bastards on it, and hospitals -- once they stopped eating it for the free-loading "poor" they treated just because they happened to be on the verge of death -- would instantly become not just less expensive, but more profitable.

If you want a "free market" health care -- instead of the single payer or socialized system we are slowly but inevietably moving towards -- that's the argument you WILL have to make.

Good luck. I think you're fucked on that one, mates.

[Karen Cox]

I'm not really sure traditional economic models apply very well to health care. For one thing, demand for the really expensive stuff is not elastic, because the consumers aren't going to shop around for the best deal on cancer treatment or the cheapest emergency room for their babies with high fevers. With computers, consumers could simply decide to wait another year or not buy at all, and the distinctions between products isn't so significant that they overwhelmed price as a factor. If it's your life, or God forbid your kid's life, you just ante up for whatever the doctor recommends.

That brings up another issue, which is the level of information. Most people can learn enough about what computers do to make a decent decision. With medicine, the consumer is relying on the treating doctor's opinion of what's going to work and really has no idea of what options are available. (Real options. I know there are fans of aromatherapy or faith healing, but I'm mainly talking about people who actually want to get well.) There often is only one drug or treatment that addresses the condition. Because the profit margin is so small for things like chemo for rare cancers or treatments for unusual metabolic disorders, and because at the stage where a person needs the $10,000 per pill stuff there often other complications, it's unlikely that any company could ever make a profit on that stuff.

Also, having insurance is generally the ticket to treatment. Few doctors take patients who don't have it, even when the policy doesn't cover much.

Finally, the causes of things like cancer and heart disease are so far removed from the consequences -- usually 30 years or so -- that the consequences don't serve as the kind of alarm that inspires more intelligent behavior. It's hard to make a 10 year old understand that eating nothing but candy will kill him in 40 years. Believe me, I know this from daily experience. Finally, what about people who end up with wildly expensive diseases at young ages? I had a friend in college, an athlete no less, who had a stroke when she was 23. No known causes or risk factors, and no time to build up any savings.

I honestly don't know any good answer to this one. What we've got costs a fortune and doesn't make us any healthier.

[h-dawg]

"And all the private charities and free hospitals in the US aren't going to be able to make a dent in it."

The point is, neither will socialized medicine. Anyone who thinks everyone will get equally good care in any system is already on unprescribed medication of some sort, and need to look up the word "rationing."

[xpanda]

Thanks for all the great replies.

I tend, however, to agree with Morat on the issue of selling this one to the public. It is just so painfully difficult for people in our very advanced world to deny health care to those who can't pay.

Another question: when do vaccines or treatments for things like SARS or the [potential] bird-flu become a matter of public defence, rather than simple individual health care? Can we envision scenarios in which we deny a poor person a vaccine knowing full well we are sending them off to infect more people?

And, does such a scenario impede the free market hopefuls?

[h-dawg]

"And all the private charities and free hospitals in the US aren't going to be able to make a dent in it."

The point is, that socialized medicine won't either. Can you say "rationing?" Anyone who thinks the choice is between equal, universal care or differentiated (and sometimes no) care is probably on unprescribed medication. The real choice is what mechanism we'll use to decide who gets what--market or non-market.

[h-dawg]

"It is just so painfully difficult for people in our very advanced world to deny health care to those who can't pay."

C'mon folks. They deny health care in Canada and Europe every day. You keep pretending that the choice is between universal coverage and differentiated care. It's not. The choice is between what mechanism will do the differentiating--market or non-market.

[h-dawg]

sorry for the repitition. it's not obstinancy or tourettes, just a slow connection.

[Karen Cox]

On the vaccine question, I'd have to say that's a matter of public safety. Vaccines work because of "pool immunity," that is, they work on enough people enough of the time to keep the number of infected and contagious people small. That means that it becomes unlikely that a carrier will contact someone who isn't immune. Reduce the number of vaccinated people and increase the chances of said contagious and susceptible person coming together.

This gets into another deeply touchy issue. I live in Texas, and our economy depends on lots of undocumented workers, especially in agriculture. They are, naturally enough, suspicious of the authorities. What happens when a fruit-picker in the Rio Grande Valley gets something dreadful, but no one notices until he dies, after infecting dozens of people who in turn infect dozens, none of whom can be traced? That's not even worrying about all the food he contaminated. Believe me this is not an anti-immigrant diatribe but a rather desparate plea for someone to come up with a good idea.

[Karen Cox]

On the vaccine question, I'd have to say that's a matter of public safety. Vaccines work because of "pool immunity," that is, they work on enough people enough of the time to keep the number of infected and contagious people small. That means that it becomes unlikely that a carrier will contact someone who isn't immune. Reduce the number of vaccinated people and increase the chances of said contagious and susceptible person coming together.

This gets into another deeply touchy issue. I live in Texas, and our economy depends on lots of undocumented workers, especially in agriculture. They are, naturally enough, suspicious of the authorities. What happens when a fruit-picker in the Rio Grande Valley gets something dreadful, but no one notices until he dies, after infecting dozens of people who in turn infect dozens, none of whom can be traced? That's not even worrying about all the food he contaminated. Believe me this is not an anti-immigrant diatribe but a rather desparate plea for someone to come up with a good idea.

[xpanda]

h-dawg: can you explain what you mean by 'they deny health care in Canada and Europe every day'?

Thanks.

[AML]

Morat is right. The money problems with the healthcare system do not usually stem from the family doctor type scenarios that most people are familiar with and seem to be discussing here. Many of the problems in primary care medicine could be ameliorated simply by lowering the overhead costs of practice.

Where the system is really bleeding money is in a smaller handful of areas - trauma, and care for the poor, elderly and dying (and frequently all three at the same time).

A gang shooting can easily take $100,000 to treat, when you consider the transport, stabilization, surgery, intensive care costs and rehabilitation. But not many gangbangers are going to pay the bill. But you don't actually know if the person can pay when they first roll in the door... so what do you do? Stabilize the patient, then rifle their pockets for an insurance card, and failing to find one, throw them out on the street to die? I'm not making up a ridiculous situation, either - gang shootings come into our ED every night. As do stabbings and car accidents and sundry other life-threatening things that happen to people without money or insurance.

It's one thing to argue that people should be willing to pay more for the doctor to look at their ingrown tonail. It's another to argue that the wounded and bleeding should be left to die on the street for lack of insurance.

So, most people say that yeah, there should be some kind of support for trauma. But that's not where most of the money is spent (and lost). It's spent and lost in the last weeks of life in and elderly population - old men with pneumonia dying on ventilators, old women with urosepsis dying next to them, all lined up in the ICU, and needing everything from constant around-the-clock-care to $2,000 a dose drugs. And try to find someone who supports the "disconnect grandma from the ventilator if she can't pay her six digit hospital bill" position. Good luck. Then there's the general medicine wards - room after room of people with diabetes and infected wounds, AIDS, hypertensive heart disease, cirrhosis. Evict them out on the street, and they'll crump. There are a lot of elderly people out there with diabetes and gangrene that can't afford an amputation.

Doctors don't get into this business just to watch people die of things they can easily control. Who, as a patient, wants a doctor who would have no problem pulling the plug on you if you couldn't pay? And who goes to medical school dreaming of being that doctor?

So, we're stuck with a lot of people who can't pay for the care they need. Some time ago, in the past, someone got an idea - hey, you know, if we treat Aunt Sally's diabetes now, we can save on hospital rooms, surgery, cardiac catheterization, wheel chairs, etc., down the road... why don't we may it easier for Aunt Sally to go to her primary care doc so this won't happen? Voila, socialized medicine.

I like to think of myself as a libertarian, but it's hard to do so in the medical field. The free market works wonderfully for a great many things, but if you don't own the shiniest car, or the fastest computer, it won't kill you.

[h-dawg]

xpanada - "As a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority."

This was what your Supreme Court noted last June. I know from personal experience (I'm a French citizen) that the same kind of rationing goes on in Europe, too.

[jeffiek]

difficult for people in our very advanced world to deny health care to those who can't pay.

Only when you refuse to acknowledge that all systems refuse care to those that can't pay. Different systems just shuffle the deck another way. The free market just lets the cards fall where they may. But by trying to reshuffle the deck, other systems deny care to those that could otherwise have afforded it.

Taxes prevent some people from being able to afford insurance and others from getting better insurance. And they stop everyone from affording what insurance doesn't cover.

And that doesn't even count the delay in medical advancements that would be expected in a free market. I specifically mentioned dental implants because they're not funded by insurance. Where did you think the advance in dentistry came from, the tooth fairy? Suppliers see a demand and find a way to meet it. It's that simple. And it works in medicine, dentistry, computers, cars, whatever.

I had a friend in college, an athlete no less, who had a stroke when she was 23.

That's exactly the type of care that charity is for. It's extremely rare ( doesn't create a burden to society ). It's obviously not that person's fault, creating a large amount of sympathy. And the young age is a potent reason for the lack of individual funds.

That brings up another issue, which is the level of information.

There's a lot more information out there than you think. How did the "one of the best surgeons" get there? Even in this lopsided medical system we have, you can tell the best simply by their price and/or availability. How do people learn enough to buy computers? They read reviews in magazines for one. People wanted the information, suppliers of information saw the demand, and they supplied it.
This doesn't mean they always make the best decision, they're human. So why aren't there reviews of doctors? It's not because people don't want it.

Finally, the causes of things like cancer and heart disease are so far removed from the consequences

Same could be said for career choice, spouse, level of education and any number of categories. It's called being human. We make decisions based on incomplete information, that may or may not affect us today and in the future. Presuming we even live for those 30 years. Remember the "and got hit by a bus"?

demand for the really expensive stuff is not elastic

That's an illusion. Granted, the elasticity often comes in the form of a coffin, but not always. Even then, people say "enough" it's time to go, no heroic measures. Other choices might concern hip replacement. Would you choose an expensive operation, or forgo it to better provide for your children?

In my opinion you are comparing apples and oranges.

Only in the sense that they're different colors. Not in the sense that they both grow on trees.

You're correct in that if companies provided technology insurance it would suffer that same problems as medical insurance. That's my point. The insurance system we have is not a free market system.

No sane person would get full technology coverage insurance

Sure they would. Lots of people have more money than brains (just wish I knew how they get it). If you don't believe me just look at all the extended warranties. They're a form of insurance, a very expensive form.

[AML]

jeffiek:Only when you refuse to acknowledge that all systems refuse care to those that can't pay. Different systems just shuffle the deck another way. The free market just lets the cards fall where they may.

No... let's be perfectly clear with this. The free market system does not just "let the cards fall where they may." It stratifies healthcare by individual wealth. A completely free market system would give a kidney transplant to a 70 year old man who could afford it, but deny one to a 10 year old boy who couldn't. I don't consider that a very pleasant realiy.

I consider msyelf a libertarian because I believe that individuals should be as free as possible from outside controls - whether they be corporate, governmental or instituational. In other words, I believe in choice. In economic terms, I don't deify the market. It's frequently brutal and amoral. I just think that it's the least-bad solution to distributing most resources. And I mean most, not all.

How many people are willing to live in a world where the value of your life is proportional to the amount in your bank account? Are you willing to discount all the ethical dimensions of medicine, and turn it completely into a financial transaction?

To return to our situation with the 70 year old, the 10 year old, and the kidney - who do you think is more likely to be able to afford the transplant? Which would benefit society more - giving a few more decades of life to a young man, or four or five more years to the older one? Here's a point where the free market doesn't create the best situation for the individual (in terms of adding the most lifespan) or society in general.

That's why our transplant system is non-market. A computer matches people up. And there is a bias in there - children get first dibs on organs. It actually works out beautifully, for the most part. I won't get into the buying/selling organs arugment.

That's exactly the type of care that charity is for. It's extremely rare ( doesn't create a burden to society ). It's obviously not that person's fault, creating a large amount of sympathy. And the young age is a potent reason for the lack of individual funds.

There are a large number of charity hospitals. There still aren't enough. And it's far, far from a rare situation. Strokes in 23 year olds are rare enough, true, but change it into, say, a head injury in an automobile accident, or a shooting. You only wish that young people with serious injuries were a rare occurance.

[RexRhino]

It's one thing to argue that people should be willing to pay more for the doctor to look at their ingrown tonail. It's another to argue that the wounded and bleeding should be left to die on the street for lack of insurance.
Why couldn't the hospital extend the person credit, and then charge them 10% of their paycheck until the total cost is repaid plus a premium to cover those in the system who will not end up paying it off?

That is just one idea. There are countless other ways we could make it work. It is a false choice between "No Health Care" vs. "Government Monopoly Health Care".

No... let's be perfectly clear with this. The free market system does not just "let the cards fall where they may." It stratifies healthcare by individual wealth. A completely free market system would give a kidney transplant to a 70 year old man who could afford it, but deny one to a 10 year old boy who couldn't. I don't consider that a very pleasant realiy.
Welcome to Canada. Where do you think the government is going to build that new high-tech trauma center? In Newfoundland? In Nunavut? (people are disproportionatly poor in those areas) Do you think they are going to build it in Parkdale (the poor neighborhood in Toronto Canada)? The best medical facilities are going to go to the people with the most political power (and you can debate if rich people have more political power, or people with more political power become rich, but it is all the same in the end), to the rich. Do you think the child of a campaign donor to a political party, or someone well connected in government, is going to have to wait for an operation the same as some poor factory worker? Why do aboriginal people in Canada have such a higher mortality rate for diseases than white folk? Is it because they are geneticly inferior (I certainly don't think so)... or is it because far too many are low income, and they are an oppressed ethnic minority, and the "universal" health care in Canada is not as "universal" as people imagine.

As for people dying without medical care, there is no garantee of medical care in Canada. They say there is a "garantee", but what they really mean is that they garantee you will never recieve a bill. If you die waiting for health care, your family cannot sue the government for not helping you in time. There is no garantee that you will ever recieve the medical treatment you need (a distant relative of mine found that even without any insurance, and property or assets, and no money to his name, that he could get treatments for his skin cancer in the U.S. that were decades ahead of the death sentence that he was given in Canada).

And don't worry about the absolute paranoia about health care in Canada. Not too long ago a kid in Montreal got turnned away from a hospital after he came to the hospital with appendicitis, but forgot his precious health card. See, health care is "universal", but apparently "universal" doesn't mean it includes everyone... because they are absolutly terrified that you might not have a health card... You had better hope nothing happens to you at the beach when you don't have your wallet, cause if you drown they aren't gonna give you CPR until you pull out that little card... anyway, the kid didn't have his health card, and because they must have thought he was one of the many fluently-French-speaking Americans making a 10 hour journey to Montreal for emergency treatment for an exploded organ, they sent the kid home in a cab (on his dime of course) to get the card, and of course he died in the back of a taxi. So much for not turning people away to die in the street!

In Canada, there is no debate - there is an almost McCarthyist attitude, that if you question in the slightest way the health care system, you will be accused of "letting the Americans take over the country!". What the hell that has anything to do with healthcare, I don't know. But from childhood in the government schools, to government universites, to the government run news media (the CBC), to the the multimillion dollar prime time TV spots that the Ontario Ministry of Health just ran (the OMH is a government monopoly, it is illegal to compete with them so it is not like there was any justification whatsoever to spend millions of taxpayer money on TV ads - I guess they just felt like spending those millions to let Canadians know what a great job they were doing, and it was pure coincidence that it was right before the election!), there is a non-stop propoganda barage promoting the government monopoly on healthcare as some sort of sacred form of national identity.

And it isn't even like in Europe, were most places you are allowed to go to purchase your own insurance and go to private hospitals... it is illegal! They say it "promotes a 2 tier system" - never mind that we all know that the prime minister or parlament and THEIR families are not going to have to wait for health care!

[radioactive]

lived & worked in Upper US (Canada) for about 18 months...was part & parcel of their health care system...be very very careful what you wish for...all those in favor of a Canadian style system should be required to use it for an extended period of time.

[Native NYer]

I scannned the comments and didn't see any about the fact that US insurance companies went for profit in the 1990s. They can only give out dividends to investors by taking 10 or 15 cents of every premium dollar paid into their system. This doesn't include the 8 to 10 cent overhead for administrative costs.

I don't understand why anyone would want their health care dollars to sudsidize millionaires but I guess many people don't have a not for profit choice in their areas?

[gaijin]

How we treat end-of-life healthcare decisions (e.g., spending 70% of our healthcare dollars on the last 2 years of life) might be a start...certainly you can spend your own money on whatever you can afford, but government entitlements should let people die with dignity...so that the others can afford to live until their turn comes up.

[Matt Welch (Not Really)]

Those who glibly assert that socialized medicine is a disaster compared to our system (or even the much more reasonable but still completely wrong position that ours at least isn't any WORSE) need to read Matt Welch's comments about the French vs. US system at:

http://mattwelch.com/archives/week_2005_04_03.html#003088

[Pro Libertate]

Native NYer, I never cast stones about typos in comment threads--I mean, big deal, right?--but I have to note with favor your use of the word, "sudsidize". I believe that's what parents do when they send their kids money for college. "Hey, guys, Mom and Dad sent me some money to sudsidize our purchase of a keg of beer".

[David Ross]

Rex: Why do aboriginal people in Canada have such a higher mortality rate for diseases than white folk? Is it because they are geneticly inferior (I certainly don't think so)...

Old World pathogens beg to disagree. Otherwise, how come we fellow North Americans are using the English language instead of Mohawk or Siouxan?

[downstater]

in my short stay in a hospital in a country where healthcare is free, i spent 3 days in there with an older guy who had been there for a week with hemorrhoids.

it got me to wonder if part of the problem with socialized medicine is the willingness to have people stay in a hospital for conditions that would just be taken care of and then discharged in the states.

as a foreigner, i had to pay for my stay (but not the er part of it). 3 days in the hospital got me a bill of 300 euros. the hospital was a dump - and i cannot exaggerate that enough (blood on floor, mosquitos everywhere inside) - but i don't have enough experience with the systems there to determine if it was that way because it is part of a socialized system or if it was in a rural location - as rural healthcare sucks here too.

[Dave W.]

Because the quantity is going up. We are in the midst of a fabulous revolution in medicine, and it is giving us great new drugs and treatments.

Is the average life extectancy really still going up. I think it has gone up about 8 years in the last 40 years, but if you looked at the last 10 years or 5 years, is it still increasing? Does anyone here know? (I don't, but curious.)

I get the feeling that most of the life expectancy increases occurred when we were shovelling less GDP into the system. If that is true then I don't think things are so great as what Happy The Jaguar says.

[R C Dean]

I never cease to be amazed at the people who can't afford to spend a few bucks a month on health insurance, but spend more than that on their cable bill.

Or the folks who don't have a $500 deductible for their health care, but seem to find the money when the car needs to be fixed.

IOW - take the whole "can't afford to pay for their own health care" routine with a grain of salt for the vast, vast majority of the population.

[Don Mynack]

I think "Craptacular" is way too strong to describe the American Health Care System, if that term really applies. Yes, it is flawed, yes, we have way too much gov't support, yes, private insurance could end up in trouble is we continue in this direction, but, really, with few exceptions, there is really no place else I would rather get sick.

I really wish I could have a lot more choice with an employer-paid plan, including not only the level of coverage, but exactly what I want covered. It differs state to state, but here in Texas I have to have mental health converage and substance abuse coverage, even if I don't want it and never plan to use it.

[nmg]

Gotta love it when a rich writes an article telling poor people to suck it up.

Gotta love it when leftists can't understand an issue and resort to the old tried and true demogoguery of class warfare because, hey, when it comes to policy, it is the sentiment that matters, not results. Nice.

nmg

[Dave W.]

RCD,

when I lost my job, the COBRA coverage to continue my insurance for my wife and me was $565 a month. We had no substantial medical needs, no substantial medical needs. I think all we got out of the plan was a visit to the eyedoctor for each of us (still paid 30% or so of that with co-pay). Our premiums were not a free market number. That $565 per month had zero to do with actuarial science. It was a real problem and our largest expense. It was a hardship. It was not conducive to us trying to live out our libertarian dreams out in the desert. It did not give me a comfortable time cushion to build a small business as we had hoped to do before I had to go back to work for an employer.

[Dave W.]

should be:

--no substantial medical needs, no substantial medical costs in our histories--

[downstater]

just because you can afford the $500 car repair or the $500 deductible - doesn't mean that you can afford the $1000 to do both.

you need that $500 car repair to get to work if you're even to have a chance at paying that $500 deductible.

i wouldn't underestimate the tightness of a LOT of people's personal finances. not all poor people are lazy sloths who'd rather pay for cable and bad/irrational decision makers.

[Dave W.]

Good point downstater.

I know that when times were tight we got rid of our cable, but had to keep our car because it was 13 miles to 29 Palms to get drinking water and food. However, we did keep the cost of our housing down by living 13 miles away from the water.

[ChrisO]

The way I see it, there are a LOT of unrelated issues that people here are conflating:

1. MediCARE does not subsidize health care for po' folks. That's MediCAID. Medicare subsidizes health care for old folks regardless of their financial position or health problems. Both programs have their problems, but Medicare seems to have bigger ones, for quite a few reasons related to ever-increasing demand for an ever-larger number of very expensive treatments. Since the recipient doesn't pay all of the costs, demand is, naturally, unlimited.

2. The insurance model is ineffective for comprehensive health care. The idea of insurance is spreading risk. In other words, health insurance works if it covers nothing but traumatic injury and illness that happens to only a small percentage of the population. But applying "insurance" to cover routine medical care we all use destroys the concept. To me, the best way to rationalize health care and reduce premiums would be to limit insurance to catastrophic injury/illness, and make us pay for routine care on the open market. After all, we end up paying for it either way because of all of the money that our employers are paying to health plans rather than us in salary. Obviously, the definition of "routine" could be a matter of debate, but it is simply immoral for a person to expect that other folks should be forced to pay for their healthcare. There is no such thing as a free lunch. Life's a bitch.

3. The issue of health care for the poor is small and relatively manageable, by comparison. A means-tested system of managed care can provide basic, quality health care for the poor. Will they get the royal treatment? No. Hey, life's a bitch.

[happyjuggler0]

Dave W.,

I suspect you are right (shudder, did I just say that?) that in terms of life expectancy the gains in medicine now are having diminishing returns compared to the gains from perhaps 100 years ago of improved nutrition and calorie intake.

However, anyone who has followed what has happened in medicne since we kissed the 70's goodbye can't deny that there has been a revolution in medicine. Doctors used to have a lucrative specialty in ulcer treatment, with debatable utility for their prescriptions. Today, and for a long time now actually, there are several affordable drugs that do a greta job of treating ulcers. There are a lot of things like that, many of which "save" (i.e. prolong) lives and many of which increase quality of life, or at least decrease the pains and problems of people's medical problems.

This doesn't show any sign of slowing down, and the people who are making it happen want to be paid. Stop paying them,and advances in new areas that were previously untreatabel will slow to a crawl again. Therefore anything like national healthcare that claims it can stop the constant large increase in costs for anyone who is "totally" covered is simply lying, or ignorant.

The best we can do about costs is figure out which system will cut costs for existing treatable stuff without also diminishing the incentive for those who would create ways to treat the currently untreatable.

All those nationalized healthcare systems the left likes to proclaim as awesome have price ceilings of one sort or another, and ABC economics means that they will get lines. This is what is happening.

[Pirate Jo]

"I really wish I could have a lot more choice with an employer-paid plan, including not only the level of coverage, but exactly what I want covered."

Amen. I don't want my insurance premiums to cover childbirth costs, for example. I completely agree with ChrisO's comment that insurance should be reserved for catastrophic injuries or illnesses. In that light, since people can plan pregnancies, is that something that should EVER be covered by insurance? Well, maybe, if there are unexpected complications. Otherwise, you should be able to opt out of that coverage if you want.

I've heard people bitch and moan because their insurance won't cover tens of thousands of dollars in fertility treatments. Hello, people - the inability to get pregnant is not equivalent to getting cancer! Of course if more insurance plans covered these treatments, those same people would complain about how much higher the insurance premiums were.

[NathanB]

Canada has a two tiered health care system: One tier for those who can afford medical care in the US and another tier for grandmas who have to wait 12 months for a hip implant.

If your health care system has to make it illegal to seek other treatment, enforced by men with guns, is your system really so hot?

I say, have all the socialized medicine (education, whatever) you want, as long as I can opt out. The problem is that socialized services MUST use coercion or else they will collapse.

[Dave W.]

HappyJugalar:

I think the quality is a pretty serious mixed bag, too. Ulcers down. Diabetes way up. AIDS down. Asthma way up.

It might be okay to have a mixed bag if healthcare had remained as a relatively constant proportion of GDP, but it hasn't. When we go from spending 10% of GDP to 15% (or whatever the true numbers are), I would not expect such mixed results.

[The Real Bill]

Dave W.

Why did you pay COBRA instead of getting a catastrophic plan? I got a catastrophic plan that was far cheaper than my COBRA plan for insurance that was chosen by my former employer. It was ridiculous--$10 co-pays for visits and meds.

[Dave W.]

Real Bill,

Lack of confidence in insurance companies. I was more nervous that the catastrophic would not cover whatever it was I happened to need. I would have felt more comfortable if I had known some ppl with experiences with catastrophic insurance, but it was an unknown quantity and I have just heard too many insurance horror stories (eg, auto insurance, flood insurance).

That said, you make a good point. If my wife weren't such a worrywart I would have switched. If she had been willing to go work parttime at WAL*MART, we could have paid the COBRA without depleting our money. So, in some ways, this could have been handled better.

But my point remains:

Our $565 a month was not capitalism in the sense of being competitively based on actuarial data (we were 34-36 at the time). This was a big booming market failure that had a pretty big negative impact on my life just because I wanted to keep a comprehensive insurance plan that we would probably never use and basically never did. there really, really should have been a fairer, more fitting option for me. Some old people got a hell of a lot of treatment from those premiums we paid. That was pretty predictable at the outset and it stinks.

[Dave W.]

Further to previous:

about the time we moved to Canada, IIRC, they cranked it up to $665.

[King Canute]

When it comes to the tides, we can command they don't wax, but they do anyway.
When it come to insurance, we can command they violate the "principles of insurance," and lo and behold, they get violated... and so do we.

[The Real Bill]

Dave W.

I understand your situation. Personally, I don't trust any insurance companies. Although it might sound un-libertarian, I'm glad that the State of California goes after "deadbeat" insurance companies. I'm no anarchist. I like laws concerning fraud and contracts. If I were an anarchist, I'd have to kill (or threaten to kill) the employee of my insurance company if they shot down my valid claim. I told the truth on my application for the insurance and pay my premiums. I damn well better receive what I'm contractually owed.

I think that if an employee of an insurance company denies a claim that is "undeniable" with respect to the contract, then that employee should be prosecuted for theft. They are essentially taking from me what I'm owed. (I also consider not paying back a loan theft. I have little sympathy for those that file bankruptcy.)

[Jason Ligon]

Most single payor systems would be viewed by their participants with considerable skepticism if they had to pay a fraction of the real cost of development.

I will admit that if I could get 'universal' healthcare access using roughly cutting edge technology, and I could have Martians fund 75% of the cost of developing medical technology and pharmeceuticals, it would seem more attractive to me, too.