Could National Health Care Be Behind Britain's Anti-Drinking Campaign?

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My friend Jonah Goldberg thinks it might be and explains why you should care. To wit:

The British government recently unveiled plans for a massive crackdown on "excessive drinking," particularly among the middle class. It will include all of the familiar tactics of public health officials: dire new warnings on wine bottles, public-awareness campaigns, scolding from men and women in lab coats…

Britain still subscribes to a system where health care is for the most part socialized. When the bureaucrat-priesthood of the National Health Service decides that a certain behavior is unacceptable, the consequences potentially involve more than scolding. For example, in 2005, Britain's health service started refusing certain surgeries for fat people. An official behind the decision conceded that one of the considerations was cost. Fat people would benefit from the surgery less, and so they deserved it less. As Tony Harrison, a British health-care expert, explained to the Toronto Sun at the time, "Rationing is a reality when funding is limited."

But it's impossible to distinguish such cost-cutting judgments from moral ones. The reasoning is obvious: Fat people, smokers and — soon — drinkers deserve less health care because they bring their problems on themselves. In short, they deserve it. This is a perfectly logical perspective, and if I were in charge of everybody's health care, I would probably resort to similar logic.

But I'm not in charge of everybody's health care. Nor should anyone else be. In a free-market system, bad behavior will still have high costs personally and financially, but those costs are more likely to borne by you and you alone. The more you socialize the costs of personal liberty, the more license you give others to regulate it.

Universal health care, once again all the rage in the United States, is an invitation for scolds to become nannies. I think many Brits understand this all too well, which is one reason why they want to fight the scolds here and now.

You think it can't happen here? Reason explains how wrong you are here and here. Whole Goldberg column here .

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  1. The bad thing about naitonal health care is that it inculcates bad spelling.

  2. Ron,

    There is a typo in your headline.

  3. Fat people, smokers and – soon – drinkers deserve less health care because they bring their problems on themselves. In short, they deserve it.

    Whereas we Americans all know that it’s poor people who deserve less health care.

  4. No Dan T.,
    It’s the intellectuals elitists that deserve it less. Don’t you know anything!?!?!

  5. bzial: ?

  6. Now, Ron, don’t go messin’ with bzial’s mind. I saw it before the correction, too. Good thing I had that eidetic memory module installed.

  7. PL: Must have been Reason’s superb and ever-vigilant editors. Kudos to them and bzial.

  8. Ron,

    It apparently was corrected. The original headline was “Could Naitonal Health Care Be Behind Britain’s Anti-Drinking Campaign?”

  9. Anyway, to further illustrate how dumb Goldberg’s piece is, first he tells us that under a national healthcare system, people who engage in unhealthy habits may not get healthcare.

    Then, he goes on to explain that in a free-market system, the same thing may happen. But it’s okay when it doesn’t happen here.

    Followed by the usual nonsense about “nannies” and “scolds”…like he’s not scolding and nannying us by telling us that we don’t need universal healthcare like every other civilized nation.

  10. Whereas we Americans all know that it’s poor people who deserve less health care.

    Of course, what anyone deserves and what they get are rarely one and the same.

    Anyone who arrogates to themselves the god-like powers of (a) knowing what anyone deserves and (b) seeing to it that they get it, good and hard, should be regarded with the utmost suspicion.

  11. Nor should anyone else be. In a free-market system, bad behavior will still have high costs personally and financially, but those costs are more likely to borne by you and you alone. The more you socialize the costs of personal liberty, the more license you give others to regulate it.

    While not disputing the validity of the statement, I don’t see why this statement follows the paragraph proceeding it.

    In the example provided, fat people are paying a cost, individually, for the choices they make. In fact, specifically in the case where a fat person is denied services because of their lifestyle choices, the cost is paid only by the fat person and not at all socialized (since the procedures are being denied). In essence the gov’t is saying that we will not socialize the costs if you make bad decisions.

    I don’t see how different this is from a private insurer choosing to charge you more or even potentially deny you coverage because of your lifestyle choices. In both cases you are giving someone the right to regulate your lief

    The difference, as I see it, is who gets to make the call. Now we can debate who should be making the call, but the logic in this particular article seems flawed. The point the author seems to be trying to make isn’t supported by the example provided.

    It reads like sloppy work of someone with an agenda.

  12. Then, he goes on to explain that in a free-market system, the same thing may happen.

    Dan T., can you comprehend the difference between, on the one hand:

    (a) me putting a thousand dollars in my pocket because I took it out of yours after knocking you to the ground in a dark alley and giving you a Russian mouthwash;

    and, on the other hand

    (b) me putting a thousand dollars in my pocket because I just cashed my paycheck?

    If you can, you might have a glimmer of why the same result can obtain under two different social systems, and be perfectly moral and just in one, and perfectly vile under the other.

  13. Could National Health Care Be Behind Britain’s Anti-Drinking Campaign?

    Yes.

    Did this require deep and excessive analysis?

  14. Jonah is quick to invoke ‘free-market’ ‘individual liberty’ arguments when they yield the same conclusions already residing in his fossilized head. But if you want to marry another man, smoke a little crack, not supply Israel with guns and bullets, etc. etc. etc. etc. “Too fucking bad scumbag, You will obey the law and I am the law, the law is right because I know right better than you I am infallible. The fact that you don’t recognize my superior moral compass, illustrates your inferiority and justifies my boot on your neck.”

  15. I don’t see how different this is from a private insurer choosing to charge you more or even potentially deny you coverage because of your lifestyle choices. In both cases you are giving someone the right to regulate your lief

    You have a point, Tom, but a private insurer can’t deny coverage, then take the cost of your premium anyway.

  16. Anyway, to further illustrate how dumb Goldberg’s piece is, first he tells us that under a national healthcare system, people who engage in unhealthy habits may not get healthcare.

    Then, he goes on to explain that in a free-market system, the same thing may happen. But it’s okay when it doesn’t happen here.

    For once, sadly, I agree with Dan T.

    This article is poorly thought out. The valid argument really should be why it is superior to give private insurers the ability to regulate behavior rather than the government. Or to talk about why you have more freedom with private insurers because of competition and whereas with the state you are stuck with whatever they decide and don’t have options.

    Instead though he pretends like the problem is the regulation itself and magically you wouldn’t get aspects of your life regulated in a free-market system — which is patently false

  17. And who, pray tell, is Pro Libertatet?

  18. Dan T., can you comprehend the difference between, on the one hand:

    (a) me putting a thousand dollars in my pocket because I took it out of yours after knocking you to the ground in a dark alley and giving you a Russian mouthwash;

    and, on the other hand

    (b) me putting a thousand dollars in my pocket because I just cashed my paycheck?

    If you can, you might have a glimmer of why the same result can obtain under two different social systems, and be perfectly moral and just in one, and perfectly vile under the other.

    What a bizarre analogy. And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.

  19. “Whereas we Americans all know that it’s poor people who deserve less health care.”

    I don’t know what planet you live on, Dan, but poor people get plenty of health care in America, always have even before Medicare.

  20. even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.

    ROFLMFAO!!!

  21. Seriously, ChicagoTom has it exactly right. NHS refusing services in some cases should be applauded by Jonah, becuase NHS is essentially de-socializing a little bit of Britain’s healthcare, throwing someone into the (glorious! free!) situation where they are responsible for paying personally for the consequences of their risky behavior. But instead Jonah sees this as “regulation?” No Jonah, there’s a difference between NHS not paying for something and forbidding it.

  22. And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.

    No one is preventing you from helping them, Dan.

  23. “Followed by the usual nonsense about “nannies” and “scolds”…like he’s not scolding and nannying us by telling us that we don’t need universal healthcare like every other civilized nation.”

    Is having to be put on long waiting lists an example of civilization?

  24. “even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.”

    That doesn’t happen in this country. People can always go to charity hospitals. However, in some countries with socialized medicine, the elderly are put at the bottom of waiting lists because it’s felt that they have lived their lives. There isn’t enough money to take care of everybody, so some people get rationed out of the system. In America with plenty of health care available, we make every effort to try to save everybody, regardless of age.

  25. [i]NHS refusing services in some cases should be applauded by Jonah, becuase NHS is essentially de-socializing a little bit of Britain’s healthcare, throwing someone into the (glorious! free!) situation where they are responsible for paying personally for the consequences of their risky behavior.[/i]

    The problem with this logic is that those being denied services are still paying into the system. Denying them social coverage isn’t making them more free, it’s unjustly increasing their burden.

  26. No one is preventing you from helping them, Dan.

    This line of reasoning/attack irks me.

    No one is preventing anyone else from helping anyone else, but what about the people who don’t get the benefit of the altruism of others?? What happens when no one volunteers to help certain poor people or the amount of charity isn’t enough to cover all who need it….is it moral to prevent them from getting quality care?

    That’s a very valid question and it should be addressed more seriously than “well no one stops you from helping them”.

  27. is it moral to prevent them from getting quality care?

    This should be:

    Is it moral to allow them to be denied quality care because of their financial situation

  28. @Bradford

    That’s not a problem — they’re paying into the system for all the other services that the system offers. NHS offers health services for all healthcare problems that you haven’t caused yourself. What’s wrong with that?

  29. “The British government recently unveiled plans for a massive crackdown on ‘excessive drinking,’ particularly among the middle class. It will include all of the familiar tactics of public health officials: dire new warnings on wine bottles, public-awareness campaigns, scolding from men and women in lab coats…”

    It’s worth pointing out that Goldberg’s support for the war on drugs (other than alcohol and pot) entails a good bit of dire new warnings, public-awareness campaigns, and scolding from men and women in lab coats.

  30. ChicagoTom,

    The problem of which you speak doesn’t happen in the US. The poor do have medical care provided for them.

    But, even if such were not the case, I could ask you whether it was moral to force health care providers to work for free.

  31. “I could ask you whether it was moral to force health care providers to work for free.”

    Making people work for free is slavery.

  32. Whereas we Americans all know that it’s poor people who deserve less health care.

    Did you know that the AMA was founded specificaly in order to increase the price of medical care? See here.

    And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.

    So, whose rights does not doing something violate? Shouldn’t we enslave doctors if it’s wrong to deny anyone treatment?

  33. That link doesn’t appear to be working, so:

    http://www.mises.org/story/1547

  34. Nobody is proposing that health care workers be forced to work for free.

  35. Nobody is proposing that health care workers be forced to work for free.

    But why isn’t that the logical conclusion of the universal healthcare proposition? After all, you’re making people pay for it against their will-why not make people do it against their will? By what principle do you say that this much violence is wrong, but that much violence isn’t?

  36. “That’s not a problem — they’re paying into the system for all the other services that the system offers. NHS offers health services for all healthcare problems that you haven’t caused yourself. What’s wrong with that?”

    What’s wrong with it is that it denies services to those who need it while damaging their ability to pay through taxation. It increases the cost of healthcare for those denied service way beyond the actual market value of the services they require.

    There’s also the problem that it forces them to pay for the services that they don’t need. A free visit to your physician doesn’t mean jack squat if you need a new liver.

  37. Dan T trolled:

    “Whereas we Americans all know that it’s poor people who deserve less health care.”

    You’re daft. The US spends more public dollars per citizen on health care than most countries with socialized medicine. I know a bit about this- I am not originally from the US, and I suffered from a large array of congenital life-threatening disorders as a child. I have been through the wringer of the Canadian system, and I cannot really recommend it. In fact, my medical status in Canada was affected by the fact that I am a bastard- this was 30 years ago, and I’m sure that would not be the case now.

    The US system does not require that people die because they are poor- the Canadian system requires them to if they are troublesome.

    That shouldn’t be read as an endorsement of the US system- to say that it is better than Canada’s is to praise it faintly.

  38. what about the people who don’t get the benefit of the altruism of others?? What happens when no one volunteers to help certain poor people or the amount of charity isn’t enough to cover all who need it?

    It sucks for them?

  39. Did I miss the chapter of The Gulag Archipelago that discusses the insidious totalitarian import of product warning labels and public service announcements?

    Everybody needs to relax. Have a … bottled water.

  40. so if over eating has terrible costs–and it does–why are we Americans getting fatter? Usually if something costs a lot, fewer people do it.

  41. Dan T.: “And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.”

    Here’s what, you creeping asshole: get yourself up on your hind legs and see if you can come steal my money to pay for them.

    I dare you.

  42. I’m afraid your free market blinkers are getting the better of you all.

    If you lived here in the UK it would be obvious that this has nothing to do with saving money.
    (In fact our relentless state “health” awareness campaigns could only have the effect of adding to demand – and this is often the stated intention.)

    But instead of savings it seems the people in charge would spend almost any amount of money in their derranged crusade to run our lives.

    Government minister Tessa Jowell has said that the “new politics of behaviour” is “one of the most fascinating challenges facing the government” (see http://society.guardian.co.uk/publichealth/comment/0,11098,1356821,00.html ). Sometimes I think of the money spent on all the propaganda as an entertainment subsidy for weirdos who seem to get a kick out of thinking it all up and then trying it out on the rest of us.

  43. “So, whose rights does not doing something violate? Shouldn’t we enslave doctors if it’s wrong to deny anyone treatment?”

    You shouldn’t force people to be moral, but actually you don’t have to. The poor have always received free care in this country, even before Medicare. Most doctors and hospitals have always provided it.

  44. so if over eating has terrible costs–and it does–why are we Americans getting fatter? Usually if something costs a lot, fewer people do it.

    Probably because the direct financial costs have been removed from the equation–via mandatory insurance coverage, government assistance for medical programs, whatt-have-you. There’s also government agricultural subsidies which favor unhealthy products like HFCS, as well as the extensive subsidization of free roads, meaning people exercise less and drive more.

  45. “so if over eating has terrible costs–and it does–why are we Americans getting fatter? Usually if something costs a lot, fewer people do it.”

    Because costs aren’t incurred until one becomes both aged and fat. Getting fat is easy, but the price of it doesn’t affect you until you actually are fat.

  46. It reads like sloppy work of someone with an agenda.

    Ten words that neatly sum up the career of Mr. Goldberg. Thanks, Tom!

    I know that’s not constructive, but I just couldn’t resist. I’ll go away now and learn more about the subject before I lob any more ad hominems.

  47. But why isn’t that the logical conclusion of the universal healthcare proposition? After all, you’re making people pay for it against their will-why not make people do it against their will? By what principle do you say that this much violence is wrong, but that much violence isn’t?

    Huh? Universial healthcare would be paid for with taxes.

    And if you’re going to take the “taxes are theft” road, then you’re proposing anarchy.

  48. Auto insurance is pretty much universal as the State requires it, but at least the State does not act as the actual insurer. They are private and subject to market forces and incentives.

    The insurance industry is founded upon actuarial science, a branch of applied math that analizes various risk factors. Just as teens and old folks pay more for auto insurance (as they have a disporportinate share of the accidents) so fat people, alchoholics and diabetics should pay more for health insurance.

    The psychic twins have already said that Hillary will be the next Prrez. We will get universal health care whether we like it or not.

    Better to just pass a law requiring everyone to have coverage, then let the market sort it out, rather than have the State act as the insurer. Who knows, maybe GEICO will come up with a good medical insurance plan.

  49. Huh? Universial healthcare would be paid for with taxes.

    And if you’re going to take the “taxes are theft” road, then you’re proposing anarchy.

    If it looks like a duck, if it quacks like a duck, if it’s in the classification Anatidae like a duck…

  50. You’re daft. The US spends more public dollars per citizen on health care than most countries with socialized medicine.

    And we get worse results. Which makes our reluctance to improve our public health system even more puzzling.

  51. Well this begs the question, will our government will do as good a job with healthcare as it has done with immigration, national security and energy policy?

  52. If it looks like a duck, if it quacks like a duck, if it’s in the classification Anatidae like a duck…

    Fair enough, but it’s interesting that you favor anarchy but I’m guessing you aren’t moving to Iraq or some place like that.

  53. Dan T:
    Actually we don’t get worse results but we do pay more money.

    The question should be, with 15% of our population uninsured and so many of us underinsured, why aren’t our results at least 15% worse than any of those countries with national healthcare?

  54. Fair enough, but it’s interesting that you favor anarchy but I’m guessing you aren’t moving to Iraq or some place like that.

    No, I’d rather not live somewhere where they’re trying to impose a government and through that government siphon cash and power off to their buds. Not my cup o’ tea.

  55. The problem of which you speak doesn’t happen in the US. The poor do have medical care provided for them.

    As far as I know, emergency services can’t be denied, but someone who doesn’t have insurance nor the means to pay for non-emergency health care but doesn’t qualify for medicaid/medicare can and are denied services. Especially ones that are preventive and expensive tests. Furthermore, unless you qualify for some program getting access to the medicines you need is rather problematic without insurance as well. Unless acquiring medicine is not part of “health care”

    But, even if such were not the case, I could ask you whether it was moral to force health care providers to work for free.

    You can ask, but I don’t think its a relevant question. No one is asking them to work for free. If the government provides access to health care for all citizens, the government pays the doctors and hospitals similar to the way insurance does. Even in a worse case scenario — if there were government run clinics and hospitals and all health care providers were actually employed by the state, they would still provide paychecks. No one would be working for free.

    No one is being asked to work for free.

    The question being asked is is it moral to proivde quality health care (which kind of goes hand in hand with that whole right to life) to only those who have the financial means or is the proper course to find a way for everyone who needs it, regardless of their job/income/social standing/whatever to have access to quality health care.

    Personally I think it is

  56. “That shouldn’t be read as an endorsement of the US system- to say that it is better than Canada’s is to praise it faintly.”

    The health care system in the US has been damaged to the degree that the government has been involved in it, but anybody who thinks socialized medicine is the answer should ask themselves why so many Canadians come to the US to get care they would have to wait on in Canada.

  57. http://www.sciencemag.org/cgi/content/short/316/5831/1622

    A study of interest to the libertarian…

    “The Gift of Giving

    Figure 1 In Europe, taxation rates are high, and services are funded by government spending, whereas in the United States, low taxes and higher philanthropic donations are the norm. Harbaugh et al. (p. 1622) have carried out a neuroeconomic study to assess the degree of personal reward (as indexed by neural activation of reward-related brain areas) in response to mandatory (via taxation) and voluntary contributions to charity. Subjects experienced a hedonic reaction when tax revenues were transferred to a charity, and subjects who showed greater neural activation under this regime were more generous when charitable contributions were made voluntary. The sense of well-being in the voluntary giving condition surpassed that seen when subjects were taxed.

    CREDIT: HARBAUGH ET AL.”

  58. “what about the people who don’t get the benefit of the altruism of others?? What happens when no one volunteers to help certain poor people or the amount of charity isn’t enough to cover all who need it?”

    That has never been a problem in America, nor will it ever be.

  59. Auto insurance is pretty much universal as the State requires it, but at least the State does not act as the actual insurer. They are private and subject to market forces and incentives.

    I hate this comparison. Auto-Insurance is required in order to cover your liabilities should you cause an accident. No state requires collision insurance or uninsured/under insured coverage. They require liability covereage to reduce your ability to fuck over the victim of your mistakes.

    Mandatory health insurance is nothing like that. It would be like requiring you to have collision insurance instead.

  60. Personally I think it is

    should read:

    Personally I think it is NOT

  61. Auto insurance is pretty much universal as the State requires it, but at least the State does not act as the actual insurer. They are private and subject to market forces and incentives.

    What’s more, mandatory auto insurance is only to cover damage to *other people* caused by your driving; the state doesn’t require you to buy collision or comprehensive insurance to cover damage to your own car, which is what universal health care insurance would amount to.

  62. “so if over eating has terrible costs–and it does–why are we Americans getting fatter? Usually if something costs a lot, fewer people do it.”

    I guess the benefits outweigh the costs. People enjoy good tasting fattening food.

  63. ChicagoTom:

    The real question is: Is morality an acceptable basis for determining how tax dollars are to be spent?

    Personally, I think it isn’t.

  64. [T]he government pays the doctors and hospitals similar to the way insurance does.

    The government pays for healthcare the same way my house pays for property taxes: it gets the money from me. Neither the government nor my house is capable of earning money. My house gives me a nice roof over my head. My government bends me over and aims for penetration.

  65. “Fair enough, but it’s interesting that you favor anarchy but I’m guessing you aren’t moving to Iraq or some place like that.”

    It’s interesting you support socialized medicine and aren’t moving to Canada or some place like that.

  66. Dan T wrote: “And we get worse results. Which makes our reluctance to improve our public health system even more puzzling.”

    Oddly, I agree with you on this. But by your criterion we do a better job- part of the reason our healthcare is so expensive is that we do not tell some class of people to go home, lick their wounds, and die. Socialized systems do, and they have to. They also make receiving care as unpleasant as is feasible, and, again, they have to.

    I’m not a huge fan of the US system… if I had nothing to compare it to I would think it the worst system imaginable. Having something to compare it to, I think it might be the best system possible. well, again, that is faint praise.

  67. What a bizarre analogy. And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.

    I’m going to have to break something to you Dan T. I know your mommy told you differently at a very young age and so it might come as a bit of a shock but I feel you’re old enough to know. Your life does not have infinite value. There is a very real price tag on your existence. Every day hospitals and grown-ups decide who lives and who dies. I know it sucks man. It would be fantastic if kittens stayed kittens forever and the Charmin bear descended from a rainbow to heal the sick no matter how poor they are. But in real life it takes a lot of time and money to get the job done.

  68. “And if you’re going to take the “taxes are theft” road, then you’re proposing anarchy.”

    Taxes are theft when they’re taken from you to pay to others.

  69. Taxes are theft when they’re taken from you to pay to others.

    But not if the money is just locked up in a vault?

  70. “And we get worse results. Which makes our reluctance to improve our public health system even more puzzling.”

    Coincidentally as I’m writing this, I’m listening to Kelly Willis sing “What World Are You In”. We don’t get worse results in America. Our health care system is second to none. We have more hospital beds, more diagnostic equipment, and more research and development of medicine than any other country.

  71. “Well this begs the question, will our government will do as good a job with healthcare as it has done with immigration, national security and energy policy?”

    Does government ever do a better job than the private market?

  72. Seriously, ChicagoTom has it exactly right.

    No, he has it exactly wrong. As someone else pointed out, a private insurer isn’t denying coverage but still charging you anyway. People are glossing over the most important point here to waste time with a troll. (The troll being Dan T, not ChicagoTom, although Tom seems to have skipped this point because he was responding to Dan; either that or he’s conveniently ignoring it.)

    Britain’s health service started refusing certain surgeries for fat people. An official behind the decision conceded that one of the considerations was cost. Fat people would benefit from the surgery less, and so they deserved it less.

    Can’t this same logic be used for denying any coverage to anyone over 75? “You’ll likely only get 2 years of benefit from this procedure, so we’re going to deny it to you and perform the procedure on a 62-year old instead. But please continue to pay your support premiums since at some time in the future you may need health care for a condition that we can’t find an excuse to deny.”

  73. My skepticism about the whole ‘they did it to themselves by bad behavior’ stance is that there are sure to be selective exceptions based on other criteria. The major example that comes to mind is, of course, HIV/AIDS.

    HIV/AIDS is, with the rare exceptions of blood transfusions and passing it along to infants, almost totally preventable, right? Don’t do intravenous drugs, and don’t have promiscuous unprotected sex with people you aren’t sure of, right? Does anyone think Britain is going to cut off health care to AIDS patients? Not bloody likely. So are they implying that some types of pleasurable but risky behavior are morally superior to others? Is, say, having multiple partners of dubious safety somehow ‘better’, and supportable by public treatment funding, than the pleasurable activities of smoking a cigarette or eating doughnuts? Love to hear the inevitable spin that takes place with that argument.

  74. Taxes are theft when they’re taken from you to pay to others.

    Are insurance premiums also theft? They’re taken from you to pay others too.

    We don’t get worse results in America. Our health care system is second to none. We have more hospital beds, more diagnostic equipment, and more research and development of medicine than any other country.

    Diagnostic equipment, beds, research are not “results.” Results are life expectancy measures, infant mortality rates, etc. The amazing thing is that you’re right — we have more health care crap than anywhere else, but our actual results are worse. And look at what we pay! You can slag the big bad government all you want, but it’s getting to the point where I barely believe they’d do worse than the private sector.

    Face it, HMO customers have procedures rejected, wait for procedures, don’t get to see their preferred doctors etc. too.

  75. “As far as I know, emergency services can’t be denied, but someone who doesn’t have insurance nor the means to pay for non-emergency health care but doesn’t qualify for medicaid/medicare can and are denied services. Especially ones that are preventive and expensive tests. Furthermore, unless you qualify for some program getting access to the medicines you need is rather problematic without insurance as well. Unless acquiring medicine is not part of “health care”

    I get your point, Tom, but there are better solutions that national health care. I believe Giuliani’s proposal of a $15,000 tax break for buying medical insurance would be preferable. Also going to a system where insurance just covers catastrophic care would be good and encourage people to shop around for routine care of which the competition would bring down prices. The poor could be given vouchers for routine care which would serve the same purpose if they are allowed to keep the savings. You could cut the cost of medical care by means testing those receiving Medicare. We shouldn’t have to subsidize the wealthy elderly for routine care. Granted, these aren’t 100% free market, but they’re better alternatives to socialized medicine and all the problems it causes.

  76. “”so if over eating has terrible costs–and it does–why are we Americans getting fatter? Usually if something costs a lot, fewer people do it.”

    It doesn’t have costs to the consumer, at least in proportion to the damage they are doing to themselves. That is the problem with our current system. The insurance companies use a one size fits all approach which subsidizes those who are unhealthy at the expense of the healthy. Socialized medicine also does this, but on a far worse and far grander scale. The result is equally crappy health care for everyone.

    Right now getting your blood pressure taken basically costs the same amount as a CAT scan in the eyes of the consumer. The person in perfect health almost spends as much money as the person who pollutes themselves with drugs and alcohol and never exercises. Until we change direction on this, the cost will continue to increase and the quality decrease.

  77. As someone else pointed out, a private insurer isn’t denying coverage but still charging you anyway.

    Yes, they are. As I mentione above, HMOs reject procedures for patients all the time. Never do they follow the rejection up with “but don’t worry, now your premiums will go down.”

  78. Face it, HMO customers have procedures rejected, wait for procedures, don’t get to see their preferred doctors etc. too.

    People still use HMOs?

  79. Diagnostic equipment, beds, research are not “results.” Results are life expectancy measures, infant mortality rates, etc. The amazing thing is that you’re right — we have more health care crap than anywhere else, but our actual results are worse. And look at what we pay! You can slag the big bad government all you want, but it’s getting to the point where I barely believe they’d do worse than the private sector.

    I agree with you, but I think you might be making the mistake of thinking that because health care in the U.S. is not the same as in Canada or Sweden, and the U.S. doesn’t have socialized health care means that the US system is a free market system. It’s not: there are four lobbyists from the health care industry for every one member of congress. Not to mention the AMA, the FDA, Medicare, and goodness knows what else. No, the US system is weeded all throughout with the influence of the government.

  80. HMOs reject procedures for patients all the time.

    And most of those patients eventually leave the HMO and get another health insurance plan.

  81. Dan T. trolled: “Nobody is proposing that health care workers be forced to work for free.”

    We’re way past “proposing” — health care workers are already being forced to work for free. If you go into an emergency room and are indigent, the doctors and the hospital are required by law to treat you for free.

  82. Dan T. trolled: “What a bizarre analogy. And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.”

    Compact cars cause people to die at a higher rate in accidents than larger cars. Is it immoral that we aren’t taxing people so we can provide free full-size cars to everyone who couldn’t otherwise afford one (socialized driving)?

    Cheap McDonald’s food causes people to die at a higher rate than more expensive vegetables and fruit. Is it immoral that we aren’t taxing people so we can provide free healthy groceries to everyone who couldn’t otherwise afford them (socialized produce)?

    And so on, ad nauseam.

  83. I get your point, Tom, but there are better solutions that national health care….Granted, these aren’t 100% free market, but they’re better alternatives to socialized medicine and all the problems it causes.

    Rattlesnake Jake,

    I don’t pretend to know what the best solution is. There are much smarter people than me to come up with ideas that can work. ANd I am not convinced that simply making the government the payer/provider is the best option.

    The examples you listed aren’t bad ideas either. My main point is that the current situation is not cool and something needs to be done to put a better system in place. What we have right now is horrible all around. It’s bad for the business and its bad for consumers. It’s also bad for the poor and the out of work. The only people that seem to be making out in the current setup is the insurers and the health care providers.

  84. And most of those patients eventually leave the HMO and get another health insurance plan.

    Unless of course that is the only option their employer provides or that is all they can afford.

  85. Unless of course that is the only option their employer provides or that is all they can afford.

    Did you mean “and” instead of “or”? Because if not, you’re now suggesting we have a moral obligation to provide health care to people who are simply too lazy to seek out an alternative.

  86. The real question is: Is morality an acceptable basis for determining how tax dollars are to be spent?

    Son of A,
    Actually, to me the real question is : Does the government have an obligation to protect it’s citizenry’s right to life. I think it does. Access to quality health care, IMHO, is part of that right to life.

    The troll being Dan T, not ChicagoTom, although Tom seems to have skipped this point because he was responding to Dan; either that or he’s conveniently ignoring it.)

    I skipped it because it’s not true. There are plenty of cases where insurance refuses to provide coverage after you’ve paid your premiums without getting a refund/rebate. My insurance has a whole slew of procedures that aren’t covered because they failed the cost benefit analysis, or because the insurance company decided it isn’t necessary or there is another procedure that is just as good or whatever.

    So I prefer to spend my time discussing valid points rather than invalid ones. Let us not pretend that private policies don’t prevent us from having certain procedures while at the same time taking my premium payments.

  87. Dan T. trolled: “And if you’re going to take the “taxes are theft” road, then you’re proposing anarchy.”

    No, it’s perfectly possible for a government to run on voluntary payments for services rendered by the government, with private competitors being allowed. The post office competes with FedEx and others on certain classes of mail, and charges the people who actually use the service (albeit subsidizing the rate with their monopoly on first class mail.) Most if not all the government could be run on the basis of voluntary payment for services rendered with no subsidies, and voluntary additional payments if you want to help the poor who can’t afford those services. How is any of that anarchy?

  88. Did you mean “and” instead of “or”? Because if not, you’re now suggesting we have a moral obligation to provide health care to people who are simply too lazy to seek out an alternative.

    No I meant “or”. I don’t know how you infer “too lazy to seek an alternative” from “can’t afford better”.

    Unless you meant they are lazy because they don’t want to leave their job. Which makes less sense.

    In fact your whole comment didn’t make any sense. Many people don’t have the means to get better coverage. But fuck em right? Lazy pricks

  89. Dan T. trolls: “You’re daft. The US spends more public dollars per citizen on health care than most countries with socialized medicine.

    And we get worse results. Which makes our reluctance to improve our public health system even more puzzling.”

    No, we get results based on the ability to pay, distorted by the large degree of socialized medicine in our country (Medicare, Medicaid, compulsory treatment in emergency room of the indigent, etc). Socialized medicine results in everyone getting crappy care across the board. The people who have private insurance in our country get way better care than under socialized medicine. The people with socialized medical coverage in our country get the crappy care you’d expect. The people who can’t afford health insurance because the government takes such a big chunk of their pay in taxes, but aren’t eligible for the socialized medicine, get terrible care, and drive down the statistical averages.

  90. And even more bizarre is this idea that it’s perfectly moral to allow people to die because they don’t have enough money.

    Here’s the problem with people bitching about people dying because they don’t have enough money: health care is a limited good. There are only so many doctors, nurses, offices, clinics, hospital beds, etc. Given that, we have to find some way of rationing them.

    The way I see, there are three choices. First, the free market approach: let those who can pay buy health care. Socialized health care can take one of two approaches: let an expert/bureaucrat decide who gets health care, or go to a first come/first served basis. The problem comes because none of these alternatives is particularly attractive. Each has its benefits; each has its problems. All are fundamentally unfair, in that some get health care and others don’t.

    This is the problem I see with a lot of critiques of “free market” health care. They assume the difference is between universal health care and some people being denied health care. Until we have an infinite amount of health care resources, that won’t happen. There are good reasons for thinking that a free market approach is preferable to the political process that would prevail under socialized medicine, but that’s a long, detailed analysis that I won’t attempt here. Maybe I’ll blog it (though given my blogging record, don’t hold your breath).

  91. ChicagoTom says: “Actually, to me the real question is : Does the government have an obligation to protect it’s citizenry’s right to life. I think it does.”

    They had a funny way of showing that in the Roe v. Wade ruling.

    (Not trying to threadjack here, but try to phrase things a bit more precisely, OK?)

  92. Socialized medicine results in everyone getting crappy care across the board. The people who have private insurance in our country get way better care than under socialized medicine. The people with socialized medical coverage in our country get the crappy care you’d expect.

    I’d like to know what exactly you mean by this. Most doctors who accept Medicare/Medicaid also accept private insurance and also take self-pay patients as well.

    So is the implication that doctors are treating Medicare/Medicaid patients worse or giving them worse care? How exactly are the people with socialized coverage getting “worse care”?

    Or is your point that less and less doctors are accepting medicare to the point that only the worse doctors are accepting it or that there is a shortage of doctors who take medicare. If this is what you meant I suppose some citation would be in order to prove that this is actually happening.

  93. Unless you meant they are lazy because they don’t want to leave their job. Which makes less sense.

    People aren’t required to accept the health care offered by their employer. Some can get on their spouse’s plan. Others can buy their own health insurance. By sticking with “or”, you’ve already conceded that for some people, their employer’s plan is not “all they can afford.”

    So, yeah: Just because someone has a crappy HMO, doesn’t automatically mean there’s a moral obligation to Do Something.[TM] In some cases, they’re just being lazy pricks.

  94. They had a funny way of showing that in the Roe v. Wade ruling.

    Right—because the born and the unborn are exactly the same. I don’t want to get into an abortion discussion with you, but I don’t think there is anything contradictory about treating an a fetus (which is equivalent to a parasite until it can be viable on its own) differently than a born human being.

    I don’t think I worded anything sloppily. I never said the right to potential life. That’s all a fetus is in my opinion. A POTENTIAL life. Once it is born and can survive on its own it too has a right to life and deserves any medical attention it needs to stay that way.

  95. People aren’t required to accept the health care offered by their employer. Some can get on their spouse’s plan. Others can buy their own health insurance. By sticking with “or”, you’ve already conceded that for some people, their employer’s plan is not “all they can afford.”

    And what of the people who don’t have a spouse? Or if they have pre-existing conditions. The thing about employer plans is that it affords one the luxury of being part of a group and keeping premiums lower than a private policy would be. Since the law bars me from joining or putting together my own group to help spread the risk leaving my employers plan isn’t a very simple solution unless I am quite well off.

    So yeah, in some cases maybe they can technically afford a better policy, but they would have to start paying out of pocket when they might be getting it for free via their employer — or at a deep discount since the employer is paying a large chunk of the cost.

    It isn’t laziness that makes someone stick with the employers insurance, it’s the fact that to leave means to take on an added expense. Unwillingness to do that (and potentially sacrafice in other areas of life) does not constitute laziness.

    Furthermore, many companies don’t pass the

    In some cases, they’re just being lazy pricks.

    In most cases they are not. I’d rather fix it for the most and let some of the lazy ones enjoy a free ride rather than not fix it because “some lazy people” might benefit as well.

    But that’s just me. I don’t have contempt for people and their well being, and I feel that affordable quality health care is a right and not a luxury that shouldn’t depend on how much you are willing to sacrifice or work for it to show you deserve it.

  96. Actually, to me the real question is : Does the government have an obligation to protect its citizenry’s right to life. I think it does.

    What is the “right to life”? Why does that allow stealing from others?

    I don’t have contempt for people and their well being, and I feel that affordable quality health care is a right and not a luxury…/i>

    Affordable health care is a right? So, there’s no problem with enslaving people to be doctors then?

  97. Chicago Tom, asks: “So is the implication that doctors are treating Medicare/Medicaid patients worse or giving them worse care? How exactly are the people with socialized coverage getting “worse care”?

    Or is your point that less and less doctors are accepting medicare to the point that only the worse doctors are accepting it or that there is a shortage of doctors who take medicare. If this is what you meant I suppose some citation would be in order to prove that this is actually happening.”

    My wife is an orthopedic surgeon. She’s one of the best on our island, so she’s insanely busy. As her practice built up, she started shedding the socialized medicine patients — first the Medicaid and related stuff, then Medicare. Unless you have private insurance, or go into the emergency room while she’s on call, or are a personal friend, you have to go to a less capable doctor. And while you still have some doctor selection with Medicare albeit not the best ones, if you have the crappy Medicaid or Quest plans, you’re likely to get someone pretty scary.

    I was diagnosed with metastatic melanoma a few years ago. The first doctor I had screwed things up — misdiagnosed it, dinked around for a few months, then when he finally realized what I had, he tried surgery and bailed out halfway through when he realized nerve endings were involved and he didn’t have the expertise to save my right arm. And this was someone covered by private insurance, not some socialized medicine only doctor. Then, I had the best surgeon in the state remove a lump of cancer the size of your fist. To get that doctor’s services, I had to go non-par, which means he charged the price he wanted and I had to pay the difference between that and what my private insurance paid. I’d probably be dead or lost the use of my right arm if I went to a lesser doctor.

    You combine the restriction in choice of doctors with the less generous insurance in Medicare and especially Medicaid, and yeah, socialized medicine results in worse outcomes.

    If you prefer statistical studies over real life anecdotes, try googling it.

  98. ChicagoTom: Again, not trying to threadjack here, but to respond to your post — I can understand your POV about an unborn child not being alive, while still politely disagreeing with that assessment. That’s why abortion is such a tricky matter for libertarians, since reasonable people can have drastically different interpretations of when life begins, from right after conception, to somewhat later (my POV), to late in pregnancy, to “not until the child is completely outside the mother’s body” (your POV, and the legal definition in the state where I reside). I have three kids, and I felt the baby kick well before birth, and as far as I was concerned they were human beings deserving of love and protection at that point, the enveloping layer of mother around them notwithstanding.

  99. An anti-drinking campaign in Britain?

    My God, we are much closer to the NWO and the subsequent Apocalypse than I thought. Time to start repenting.

  100. jh:

    re: the diminished care (and I’m being brief cuz I gotta go home) —

    There are some Orthopods who aren’t worth shit and some that are rock stars. The guy who replaced my ACL was a rock star in the field. Then there is the middle range which makes up the majority of them. They may not be gods in their fields but they are competent and succesful in what they do. Most of them continue to take medicare and medicaid. That’s quality care in my mind, and I haven’t seen reports of a mass shortage of medicaid accepting doctors in many fields.

    I think you are confusing getting shitty care with not getting the best doctor possible.

    in your second example, I don’t see how that relates to socialized medicine at all. In fact there is no difference between what socialized patients v private patients. Both of them have to pay the difference if they want to go with him. How is that a problem that is exclusive to socialized medicine?

    Re: Abortion — I don’t want to debate it really — I would like to agree to disagree. I respect your beliefs whole-heartedly, but as a matter of law, I prefer giving mothers the choice to terminate a pregnancy before the point of viability no matter how “alive” the fetus is perceived by others.

  101. We also seem in the US to be going towards a private insurance robber baron system, i.e., “Hi, you’re going to pay a lot of money for insurance and then when you get sick we’ll refuse to pay anything because we’ll claim it’s a “Pre-existing condition” and you won’t get ANYTHING unless you have a $500K legal battle with us ha ha.”

    You don’t need that many cases like that to convince the electorate that NHS may have its problems, but at least you don’t have to run the “pre-existing condition and 5 years of lawsuits to get paid” gamut.

    If I were running the whole thing, I’d have an NHS which is paid for by extra taxes; it can be opted out of once you reach 21 (with an accompanying lowering of one taxes), and you can move back on at any point provided you have a recent health checkup and show that you are at least as healthy as other people of your age. Private insurance can provide insurance to anyone who wants to purchase it, also if you want to supplement your NHS health services.

    If libertarians don’t want to see NHS coming within a very short time, then FIX THE PRESENT SYSTEM before the government does it for you.

  102. Here is an example of the great results we can expect from the government healthcare program Dan T and C want. Also a good example of what we can expect if Grumpr Realist gets his way and the government comes in and “fixes” healthcare.

    It’s like paying the lowest bidder to keep you alive!

    Imagine you need a life saving cardiac operation for your severely diseased and failing heart. Then imagine your surprise when you find out that your Medicare government health insurance pays less than 40% of what private insurance reimburse anesthesiologists for the same procedure! Now imagine your concern when you learn that because of such poor reimbursement rates only a scant few anesthesiologists in your area will provide services for cardiac surgical cases when the insurer is Medicare!

    Yet another example of government healthcare being worse then private healthcare

  103. If libertarians don’t want to see NHS coming within a very short time, then FIX THE PRESENT SYSTEM before the government does it for you.

    Oh, shit, you’re right, grumpy…us very politically-powerful libertarians have been sitting on our hands too long! Quick, Libertarians, to the (Privately-Owned) Freedom Cave! There’s no time to waste!

    “Boy, that’s a really nice health care system you got there…sure would be a shame if government came along and ‘fixed’ it.”

    Go peddle stupid somewhere else, grumpy…we’re all stocked up here.

  104. “If I were running the whole thing, I’d have an NHS which is paid for by extra taxes; it can be opted out of once you reach 21 (with an accompanying lowering of one taxes), and you can move back on at any point provided you have a recent health checkup and show that you are at least as healthy as other people of your age. Private insurance can provide insurance to anyone who wants to purchase it, also if you want to supplement your NHS health services.”

    grumpy — You’re proposing that the government form its own insurance company in competition with private insurers. I see two scenarios there: the unlikely scenario — the gummint gets their ass kicked by private insurers and goes belly-up. The likely scenario — the gummint gets their ass kicked by private insurers and changes the rules of the game, using lots and lots of coercion, so they can “compete”.

  105. The situation with national health care is that it increases demand for simple services, while capping prices. Doctors are underpaid, nurses go on strike. Hospitals are dependent on legistative funding for capitol improvements. Doctors and pharmaceuticals cannot profit, so they too lack updated equipment and research. While simple care is freely given, more complicated care is rationed. People live for months and years in pain, waiting in ques for their turn at hip replacements, CAT scans, MRI’s, Heart procedures, etc. Many in fact are sent home to wait and simply die. The very young (premature babies, for example) and the very old receive less care, as the bell curve favors the middle ages. And the nanny state now looks for reasons to avoid giving care.

  106. Why would the average person below 30 want to have health insurance? Self insure, pay out of pocket for the little care you need, and invest your money in your ventures. If you go get big time sick, let the state take what little you have and get the best of care until you get well, if you do.

    Once YOU take on the responsibility of another you naturally assume some control over their behavior. All lose some of their freedom. Don’t ride your bike without a helmet. Wear your seat belt. Don’t, don’t, don’t, and do, do, do.

    We are letting people starve and thirst to death in Africa, die from lack of resources, every day all my life. We do a little, but not enough. We spend more on clothes, dog food, fun, and extras than we do on ‘those unfortunate people.’

    No one in our house, our family, our neighborhood, our city, our state, our country, is really starving to death. Get the camera put it on youtube.com.

    So, if I drink too much, you’re going to say don’t drive. No one should have a problem with that. But if I eat nothing but McDonald’s #1 combo, go large, it isn’t so easy to say I’m costing you anything. I might still outlive you and have one sudden heart attack that kills me. Where is the balance? Is it all or nothing?

  107. Remember that episode of Survival when they had five contestants: a libertarian, a socialist, a republican, a democrat, and an anarchist.

    Of those five was a Christian, an Islamist, a Jew, an atheist and a Unitarian?

    Also, there was at least: one straight man and woman, one homosexual man and woman, and one undecided.

    There was at least one each of a doctor, politican, media person and teacher.

    Meanwhile the show was cancelled, and without funding, they decided to forget they had put them on the island. The five were left to survive. Truly.

    What did the film show had happened twenty years later? How had things worked out. What was the outcome? By the way, a sixth person, a crew member, had been left on the island by mistake.

  108. What I’m saying is that the present health care system in the US is considered broken by more and more Americans. Too many of us don’t have health insurance. Too many of us have horror stories about being denied coverage for the silliest of reasons, had our coverage yanked, or had health insurers reneg on the contracts they signed, claiming “pre-existing conditions.”

    And with Michael Moore’s movie SICKO just coming out, I don’t see this an issue that is going to be of any less interest to the general public in the future.

    Populace screams enough about it to their congresscritters, congresscritters feel they “need to do something”–> ergo, pass some legislation. Enough pressure, we’re going to get a NHS.

    Running around babbling about how Wonderful the Free Market Is isn’t going to convince the general populace. They want the problems fixed and they want it fixed NOW. You ignore these needs at your peril.

  109. “The people with socialized medical coverage in our country get the crappy care you’d expect. The people who can’t afford health insurance because the government takes such a big chunk of their pay in taxes, but aren’t eligible for the socialized medicine, get terrible care, and drive down the statistical averages.”

    Except for the fact that in most surveys customers with medicare/medicaid rate their service higher than customers with private insurance … and let us not forget the fact that medicare/medicaid beats private insurance on efficiency…meaning that more of the money that goes into the system is wasted on overhead in private insurance.

    Kudos to your wife for her ethics.

    Oh and what Chicago Tom said.
    And your personal anecdote… exciting, but pointless in the discussion…

  110. “based on data gathered by Princeton Survey Research Associates from April through July 2001. Interviews were conducted with a random national sample of 3,457 adults age 19 and older.

    In their report, Davis and coauthors find that elderly Medicare beneficiaries are more likely than enrollees in employer-sponsored plans to rate their health insurance as excellent (32% vs. 20%) and less likely to report negative experiences with their insurance plans (43% vs. 61%). Medicare beneficiaries are also less likely than those with private insurance to go without needed care owing to costs (18% vs. 22%). The survey also finds that elderly Medicare beneficiaries are more likely to report being very satisfied with the care they received compared with those with private insurance (62% vs. 51%).

    As the chart below illustrates, private insurance holders are actually less satisfied with health care and more concerned about costs than Medicare beneficiaries. The fact that Medicare was systematically more likely than employer coverage to be rated as excellent across income and health status categories challenges the received wisdom that Medicare is “out of date,” and should “catch up” with the private insurance model. “Would-be Medicare reformers need to be cautious if they want to make the program more like the private sector,” the authors conclude. ”

    * Twenty-two percent of privately insured people found that their plan did not pay for care that they thought was covered, compared with 9 percent of elderly Medicare beneficiaries.
    * Nine percent of privately insured people had difficulty getting a referral to a specialist, compared with 2 percent of elderly Medicare beneficiaries.
    * Medicare beneficiaries were more likely to be very confident in their ability to get care in the future as those covered by employer plans (60% vs. 37%).
    * Thirty-three percent of privately insured people were unable to pay their bills or had been contacted by a collection agency, compared with 18 percent of elderly Medicare beneficiaries.

    Citation

    “Medicare vs. Private Insurance: Rhetoric and Reality,” Karen Davis, Cathy Schoen, Michelle Doty et al., Health Affairs Web Exclusive (October 9, 2002): W311-324

  111. “The American Journal of Medicine
    Volume 118, Issue 12, December 2005, Pages 1392-1400

    Copyright ? 2005 Elsevier Inc. All rights reserved.

    Clinical research study

    Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries

    These results were presented at the Society for General Internal Medicine, 2003, Vancouver, BC.

    Eric C. Schneider MD, MSca, Corresponding Author Contact Information, E-mail The Corresponding Author, Alan M. Zaslavsky PhDb and Arnold M. Epstein MD, MAa
    aDepartment of Health Policy and Management, Harvard School of Public Health
    bDepartment of Health Care Policy, Harvard Medical School, Boston, Mass
    Received 13 January 2005; revised 4 May 2005; accepted 4 May 2005. Available online 25 December 2005.

    Abstract

    Background

    For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care.

    Objective

    The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare Health Plan Employer Data and Information Set (HEDIS) clinical measures.

    Research design

    This was an observational study comparing HEDIS scores in for-profit and not-for-profit health plans that enrolled Medicare beneficiaries in the United States during 1997.

    Outcome measures

    Outcome measures included health plan quality scores on each of 4 clinical services assessed by HEDIS: breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness.

    Results

    The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 of the HEDIS measures we studied (67.5% vs 74.8% for breast cancer screening, 43.7% vs 57.7% for diabetic eye examination, 63.1% vs 75.2% for beta-blocker medication after myocardial infarction, and 42.1% vs 60.4% for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures (not beta-blocker medication after myocardial infarction). Different geographic locations of for-profit and not-for-profit health plans did not explain these differences.

    Conclusion

    By using standardized performance measures applied in a mandatory measurement program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. Special efforts to monitor and improve the quality of for-profit health plans may be warranted. “

  112. Nice job of cherry-picking your studies, random statist. I googled “medicare vs. private insurance outcomes” and here’s the first item on the list:

    “PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1405-1408

    Access to Orthopedic Care for Children With Medicaid Versus Private Insurance in California

    David L. Skaggs, MD, Samantha M. Clemens, Michael G. Vitale, MD, MPH, J. D. Femino, MD, and Robert M. Kay, MD

    From the Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California.

    ABSTRACT

    Objective. To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by private insurance.

    Study Design. Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: “My 10-year-old son broke his arm last week during a vacation” followed by a request for an appointment that week. Each office was called twice with an identical script except for insurance status: once with Medi-Cal and once with private insurance.

    Results. All 50 offices offered an appointment to see the child with private insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal.

    Conclusions. Timely access to orthopedic care was available in 100% of offices polled to a child with private insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less access to timely orthopedic care.”

    Or another study from that same search: “Conclusions. Medicaid patients presenting with NSTE ACS
    were less likely to receive evidence-based therapies and had
    worse in-hospital outcomes, including mortality, as com-
    pared with HMO or private insurance patients.”

    OR yet another study from that search:

    “The finding that patients with Medicare-
    only coverage were more likely than patients
    in the other insurance groups to remain in
    the hospital more than 7 days was consistent
    with an earlier report indicating that, in com-
    parison with patients with good access to
    health care, those with poor access exhibit
    significantly longer hospital stays and poorer
    health outcomes in regard to the condition re-
    quiring hospitalization.”

    Still saying my orthopedic surgeon wife’s experience over years of practice is “exciting, but pointless” compared to your no doubt expert opinion based on years in the field? Socialized medicine sucks.

  113. jh,

    Cherry picking is cherry picking.
    Nice to see you can do the tit for tat.

    The result of looking at all the studies will tell you that sometimes socialized medicine provides better care while sometimes for profit care is better. This, by itself, refutes the idea that socialized medicine is a model that can’t work. It is an idea, like all in the real world, that can be implemented effectively, but only if properly designed, supported, and monitored.

    The anecdote I was referring to was yours, not your wife’s…an individual case never tells you much about an issue…it is the aggregate that matters. Although I do note that you got less that ideal care in the non-socialized system.

    My only comment about your wife was that she deserves kudos for choosing her patients based on income/connections rather than need. A clearly ethical choice for a doctor.

    Thus ends the life of random statist.

  114. Random Statist provides a good look into the mind set of many random statists / universal health care / single payer health care advocates.

    He does not know a thing about the wife of jh or her practice. Yet he is more then happy to tell her how to practice medicine.

    Yet another reason (it is the weekend so drink) to be scared of government run health care. We will end up with gullible tools like Random Statist in charge of it.

    Except this time they will have the force of law, fines and prison sentences to allow them to make sure medicine is practiced the way they feel it should be practiced.

  115. It gets old watching people like Random Statist, C, Grumpy Realist, Dan T, et al keep making the default assumption that throwing more government at the healthcare problem will fix it.

    Especially when there is abundant evidence that government run healthcare produces worse results then free market healthcare does.

    Doctors admit: NHS treatments must be rationed

    Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling.

    So the vaunted single payer programs these guys pine for rations medicine and denies care to patients.

    On top of this the single payer programs have long wait times for diagnostic and surgical procedures that are readily available in the US.

  116. “while the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing.”

    Apparently rationing is one alternative; an even more hideous outcome might be .. gasp .. increased expenditure to meet increased demand for health care! What a wacky system they must have over there. Apparently the government allocates what’s known as ‘budget’, the size of which, this doctor seems to suggest, may have a correlation with quality and availability of care!

    Why didn’t the doctor just come out and say what they really think, which is surely: “single payer, universal health care is doomed; let’s switch to the US model where the insurance companies handle everything and treatment is never rationed and no one is ever denied care!”

  117. Here’s a puzzling article from the New York Times. It seems to show an inverse correlation between spending cuts in Medicaid and infant mortality – that is, as Medicaid spending decreased, infant mortality increased.

    link (sorry about the advertisement you have to endure)

    I find this a bit counterintuitive – as Medicaid recipients were freed from the oppressive big government programs, shouldn’t the newly-empowered parents have found all the superior market-based prenatal health care options that are out there? (I’m guessing it’s just that they can’t find out about them because they can’t read, having gone to public schools – hopefully we can cut funding to those schools to improve the reading ability of their surviving kids).

  118. e,

    We get told over and over again that single payer is superior because it takes care of people and there won’t be any denial of care.

    However, my link to a British paper, talking about British single payer health care shows they are having problems with rationing and denial of care.

    I have a hard time seeing why single payer is a superior system then the free market when it gives the same care rationing and denial of care single payer advocates complain about.

    On top of this a consistent feature of the single payer programs is single payer programs have significant wait times for diagnostic tests and treatments that are readily available in the free market US health care system.

    More power to the single payer advocates if they think that sounds like a good system. Most rational people are not going to find that to be a better system.

  119. “However, my link to a British paper, talking about British single payer health care shows they are having problems with rationing and denial of care.”

    Another interpretation is that of Dr. Wilks, one of the contributors to the study that you cite. He said “either increase NHS funding, or we’ll have to (continue to) ration”. In other words, he supports increasing funding for NHS; crazy talk eh?

  120. random statist said: The result of looking at all the studies will tell you that sometimes socialized medicine provides better care while sometimes for profit care is better. This, by itself, refutes the idea that socialized medicine is a model that can’t work. It is an idea, like all in the real world, that can be implemented effectively, but only if properly designed, supported, and monitored.

    Ummm, no, what the data shows is:

    1)that reimbursement matters — if socialized medicine (like the California Medicaid plan study I cited) pays a pitifully small amount, doctors won’t treat patients with that illusory coverage unless they are forced to, or unless the doctor is so bad that nobody with any choices will see them

    2) that researchers whose political beliefs lead them to want socialized medicine can use statistics to mislead — socialized medicine tends to take care of the small, cheap problems relatively well, but good luck getting treated for the expensive stuff that socialized medicine rations. To exaggerate to make my point: if you find that the 70% of the people who had minor problems had a slight preference for their treatment under socialized medicine, and the 30% of the people with serious stuff like cancer, broken limbs, etc. were much happier with their care under free-market medicine, it is either sloppy analysis or outright lying to conclude that socialized medicine worked better.

    What the data doesn’t show is what socialized medicine would be like here if most competitive pressures were removed — if that was what everyone but the ultra-wealthy had for coverage. It might start off not sucking too much, but government would keep cutting back, and the brightest young people would find other professions to enter. Socialized medicine is to free-market medicine what public schools are to private schools.

    random statist said: My only comment about your wife was that she deserves kudos for choosing her patients based on income/connections rather than need. A clearly ethical choice for a doctor.

    You’re right, random statist. If doctor has far more patients than time available to treat them all, and has to choose who to treat and who to refer to less busy physicians, clearly the only ethical choice would be to treat just the patients with the worst-paying, most paperwork-intensive government insurance. Clearly the only ethical choice would be to further take only patients who have surly attitudes, or are litigious and will drag you into court, or are complete strangers rather than close friends who would be hurt if you didn’t treat them.

    Thank you for clearing up for me that my wife, who’ve you’ve never met, is a bad person who needs a statist like you administering a government-run health monopoly to keep her unethical behavior in check.

  121. It might start off not sucking too much, but government would keep cutting back

    woah..slow down..are you saying Government-run health care would work if Government didn’t cut back on it? If it was funded enough to be successful? If so, then we are in agreement. But then, that train of thinking might lead one to think that public schools might also work to the extent that they are funded well, too.

  122. As a practicing medical provider with more patients than time available to treat them all, I triage/prioritize based on prognosis with/without treatment, length of time they have been a patient…things like that. Source of reimbursement does not enter into the picture, but that’s just one way I do it.

    No one should criticize jh’s wife without knowing the details.

  123. e says : It might start off not sucking too much, but government would keep cutting back

    woah..slow down..are you saying Government-run health care would work if Government didn’t cut back on it? If it was funded enough to be successful? If so, then we are in agreement. But then, that train of thinking might lead one to think that public schools might also work to the extent that they are funded well, too.

    I’m saying that if you throw enough money at socialized medicine or public schools, for a while they can achieve parity with private medicine or private schools, albeit at at much higher cost. What I’m emphatically not implying is that for the same amount of money, a government-run monopoly will work as well as a competitive private sector market. And, since if you give away something for “free” (i.e., highly subsidized by the government), people will want to overutilize it, leading to either an ever-escalating budget for an excessively costly service, or the cutbacks I was referring to.

    So, I suspect we’ll have to agree to disagree on the advisability of socialized medicine or public schools.

  124. I’m saying that if you throw enough money at socialized medicine or public schools, for a while they can achieve parity with private medicine or private schools, albeit at at much higher cost. What I’m emphatically not implying is that for the same amount of money, a government-run monopoly will work as well as a competitive private sector market. And, since if you give away something for “free” (i.e., highly subsidized by the government), people will want to overutilize it, leading to either an ever-escalating budget for an excessively costly service, or the cutbacks I was referring to.

    What is your evidence that the government program would cost more at a specific phase in this progression? It seems that I have seen analysis that indicates lower costs/overhead in socialized programs in this country such as medicare/medicaid/VA. The arguments that socialized medicine my lead to a lack of incentive make sense, but what you say above seems incoherent.

  125. I ask this of all proponents of socialized medicine:

    Why would you put someone like George Bush in charge of my healthcare?

  126. I ask this of all proponents of socialized medicine constitutional republic:

    Why would you put someone like George Bush in charge of my healthcare common defence / general welfare ?

    Iron chef, fixed that for you.

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