Arizona and Health Care Reform

From the Wall Street Journal's coverage of the fascinating Proposition 101 in Arizona:

Proposition 101, the Freedom of Choice in Health Care Act, has set off a storm of opposition, though its language hardly seems controversial. It reads that "no law shall be passed that restricts a person's freedom of choice of private heath care systems or private plans of any type." Also: "No law shall interfere with a person's right to pay directly for lawful medical services . . ."

Who could be against an initiative that protects the right of patients to choose and pay for a doctor or a health plan? The answer is proponents of a health-care system run by the government. For them, enshrining into law protections for private health plans is anathema. Believe it or not, the Phoenix Chamber of Commerce also opposes the initiative. Its big health-insurance members want to protect their interests as contractors to the state's Medicaid plan.

Democratic Governor Janet Napolitano argues that Proposition 101 would limit future health-care reform options. Eric Novack, a physician and the chairman of Proposition 101, responds, "The only option that our initiative rules out is a mandatory single-payer system." Single-payer health-care systems, as in Canada, make it illegal in most cases for people to go outside the government's system and contract for their own medical services. Arizona's proposition forbids those kinds of restrictions.

More here.

Comments

[classwarrior]

"Single-payer health-care systems, as in Canada, make it illegal in most cases for people to go outside the government's system and contract for their own medical services."

Not quite. Doctors in Canada must opt out of the public health care system entirely if they are to bill patients privately, and there are a few who do. The other option is travel out of the country for treatment for those who can afford it.

[Paul]

Believe it or not, the Phoenix Chamber of Commerce also opposes the initiative. Its big health-insurance members want to protect their interests as contractors to the state's Medicaid plan.

Believe it. Corporations and big business are going to usher in a single-payer system in this country.

[MikeP]

Not quite.

So that whole Supreme Court of Canada's striking down of Quebec's law against private provision of medical services was part of some alternate reality that only I experienced?

If so, then what do you see at this link?

[Don Mynack]

Mexican hospitals are about to get a major infusion of patients if single payer ever goes through. In a related note, anybody want to invest in some Mexican hospitals?

[Mike Laursen]

Wasn't it the case that Quebec was more restrictive of private medical practice than the rest of Canada?

[Kyle]

It will be interesting to see how many of the ballot proposals (eg. relaxation of drug laws in Mass. or Prop. 8 in CA) will turn out. I think their results will be more telling of the sentiment in the country than who wins the White House.

[Mike Laursen]

I know folks in the southern part of New Mexico who, for years now, have had all of their prescriptions filled in Mexico.

[SugarFree]

I can recall just how many times I was at the DMV and said to myself, "Wow! I wish going to the doctor was just like this!"

[SugarFree]

Zero.

[Isaac Bartram]

One needs to be careful when talking about the "Canadian" system since there are, in fact, ten different provincial systems.

It is true that they all federally mandated and have to meet minimum federal regulations and that they are federally funded but rules can differ from province to province.

The extent that the system succeeds (and it is quite successful at delivering primary care) is, I suspect, largely due to this limited decentralization.

I am quite doubtful that the "Canadian system" or a "Scandinavian system" could be successfully administered in a country the size of the US. It might be interesting to see the states experiment though.

Naturally this is from a policy point of view considered independently of the implcations for individual liberty.

[Episiarch]

I love watching scumbag politicians and interest groups contort to find some way of opposing something so clearly positive. It just shows you how depraved they truly are.

[John]

This is the danger of both the McCain and the Obama health plans. Having the government pay your health insurance premiums is just as bad as single payer. Once the insurance companies become dependent on the government dole, the government will be able to control them and they will have a vested interest in the government continueing the payments.

As far as business, they don't want to pay medical benefits anymore. They would like to dump people onto the public dole and get out from under the cost. What do they care if the care sucks and it raises income taxes through the roof? All that matters to them is that they no longer have to pay insurance premiums anymore. Single payer medical care is nothing but a giveaway to big corporations and a way to ensure that working hard gets you absolutely nothing. Doesn't matter if you work your whole life or are a crack addicted bum, you get the same care.

[Isaac Bartram]

Sugarfree

In Canada doctors are still independent private practioners (admittedly subject to a boatload of regualations - as if US doctors aren't).

For the most part going to a primary care physician is much the same as going to one here with good insurance (the Canadian system does prohibit copays - one of the fed regulations). It is when you get into specialist care and treatment for serious illnesses that the problems start.

That's why the vast majority of Canadians are happy with it.

If one is going to criticize something it is valuable to understand what one in criticizing.

[Russ R]

"Not quite. Doctors in Canada must opt out of the public health care system entirely if they are to bill patients privately, and there are a few who do."

It's not as simple as that. A practitioner is not allowed to bill patients privately for any service that is covered by the government (e.g. MRIs, physiotherapy, etc.). They can only offer services which are not covered (e.g. cosmetic surgery, LASIK, etc.).

The rationale is this. If a patient can pay a doctor directly, then they can skip the government wait-list, which is unfair to people who can't afford to pay. Canadians are almost universally and religiously opposed to such a "two-tier system".

Yes... health care truly sucks moose cock up here in Canada.

[R C Dean]

Democratic Governor Janet Napolitano argues that Proposition 101 would limit future health-care reform options.

Isn't that kind of the point? To keep these fuckers from "health care reform options" that tell us who we can go to for care?

Corporations and big business are going to usher in a single-payer system in this country.

You bet your ass. They would love to lay their current liabilities for health care off on the taxpayer.

Having the government pay your health insurance premiums is just as bad as single payer.

It will be nothing but disguised single payer, because with the government checks come the government regulations on what the plans have to offer, what they can charge, what they have to do, etc.

What will be really interesting will be the extent to which you can go outside the system for care. Initially, of course, you will be able to, but over time expect restrictions, most likely imposed on doctors and hospitals.

[New World Dan]

Corporations and big business are going to usher in a single-payer system in this country.

What they're really after is semi-subsidised employer provided health care. They want to keep control over health care because that gives them leverage over their employees while at the same time they want to shed the cost. I thought it was terribly funny (and sad) that during the debates McCain's health care plan was criticized because it would take us away from employer provided health care.

[SugarFree]

Isaac,

I'm sure that there are differing ways to implement a single-payer system that will have unique perks and drawbacks, but my point is more along the lines of "What is the general impression of the difference in private and governmental service ethics?" I have never dealt with any level of government that had a decent service ethic. I refuse to believe that government run health-care will be the exception to the rule.

[John]

"It is when you get into specialist care and treatment for serious illnesses that the problems start"

So the system works as long as I don't have a serious illness or any need for specialist care, which is pretty much the only times I would have any real interest in it working. Oh I feel so much better now.

[John]

"I refuse to believe that government run health-care will be the exception to the rule."

It won't be. Worse yet, it will be rife with corruption and chronyism. Do you think some important fuck like Barney Frank will ever be on a wait list? Hell no. Those who are connected will go right to the top of the list and the rest of us will just die. Take a look at single payer healthcare and then think about what they want to do the pharmaceutical industry and what a plaintiffs bar would do to the medical profession given the opportunity. You might as well get a wich doctor or figure out how to treat yourself because if those fanatics ever get a hold of our health system we are going back to the dark ages.

[John]

Just think Sugerfree once the government gets its paws on the healthcare system it can start descriminating against disfavored lifestyles. Weigh too much, they can tell you to go to a government mandated re-education and diet camp or kiss your healthcare goodbye. Smoke or drink? They can tell you to quit that or face losing your coverage. Since it will be a single payer system, it will be illegal for you to pay a premium to keep your freedom. You will either have to quit or be denied treatment.

[SIV]

What branch of the Federal Government will conduct the raids on private health care facilities in Arizona?

[SIV]

Sounds like a job for Obama's new Civilian National Security forces.

[Pro Libertate]

I'm for whatever gets me a dacha on the Black Sea.

[Lamar]

Oooh! Oooh!! What about Cuba? What about Cuba? Cuba Cuba Cuba?!! Man walks into a bar, CUBA!! Woohoo!

[Isaac Bartram]

John, I was presenting an analysis, not defending the system.

The system as it is is very good at keeping the vast majority satisfied. The small number of people who suffer with waiting lists and denial of service for treatment are seen as outliers who would "suffer in any system".

And on top of that the masses really don't give a shit about them as long as they perceive that they are getting their handout.

When one examines welfare states the myth of them as "compassionate societies" gets pretty much demolished.

It's really all about buying votes and maintaining power by keeping the hoi polloi placated.

[SugarFree]

John,

And anyone who says they won't try and influence lifestyle through health-care coverage is either a bald-faced liar or has the IQ of half-a-package of frozen spinach.

[John]

SIV,

If you ever talk to someone who actually lived under Communism ask them about how it really worked. The way it really worked is that no one did any work at their real jobs and then did everything for a price after hours. For example, teachers never taught during school hours but instead offered under the table tutoring sessions after class.

Socialism can only work if you have the socialist man who works hard for the collective and never for himself. Once someone starts to work for themselves and grow tomatoes in their backyard and sell them or work after hours tutoring, the system breaks down because people stop working for the collective and only work for themselves on the side.

That is why socialism always ends in totalitarianism and the death of freedom. Since socialist man will never exist, the only way to get people to work for the collective and not themselves is to force them.

In the example of government mandated healthcare, people will start running illegal pay for service businesses. There will be a lot of demand for it because the government system will suck so bad. Of course as more and more doctors make money on the side, the government system will suck worse creating more demand for the illegal on the side business. How do you prevent that? The government way to prevent that is to kick in the door and throw any doctor who practices on the side in prison. That is where this shit leads. It always ends with someone going to jail or getting shot. It is just how leftists function. They have to be that way.

[Neu Mejican]

"They" are sure to "try to influence" you.

The details matter.

How is the influencing done.
Who are they.
What power do they have over you if their influence fails.

It is important to note that "we" have power over "them" as well. We can influence them as well.

So, since we are in hypothetical land.

If the government run system included financial penalties for "choices" made by an individual that increased their risk/cost profile, is that an example of control, or a way to get personal responsibility back into the system?

To get more concrete, in a national healthcare system that gave a tax credit to non-smokers to influence people by rewarding non-smoking, is the person who decides to continue smoking responsible for the difference in their tax burden, or is the state?

[John]

Isaac,

Whenever people talk about government healthcare I always think of my sister. She is developmentally handicapped and has an IQ of about 80. She had a stroke and went to the emergency room and the doctor didn't get to her quickly enough to administer the drugs that could have reversed some of the effects. She told my other sister that "she was kind of slow anyway."

That right there will be the attitude of the government health bureaucrat. The sick, the disabled, the less fortuneate will be outliers who were screwed anyway and are not entitled to care from the socialist paradise.

[Neu Mejican]

John,

It is just how leftists function. They have to be that way.

So it is a fight between good people and bad people and not a discussion about how to create good versus bad policy?

Really?

[Mike Laursen]

The system as it is is very good at keeping the vast majority satisfied. The small number of people who suffer with waiting lists and denial of service for treatment are seen as outliers who would "suffer in any system".

You're on to something. It's rarely acknowledged in the health care debates that basic day-to-day medical treatment isn't that hard to do. You could have a system where most mundane healthcare is administered by local Boy Scout troops and they'd do a pretty good job of it.

It's not just universal health care advocates who don't want the public to see this. It's the AMA, too.

[John]

"So it is a fight between good people and bad people and not a discussion about how to create good versus bad policy?

Really?"

In this case yes. I think people who support single payer healthcare are either unimaginably ignorant dupes or legitmately awful people who just want control. When I look at the results in places like the UK and Canada, I can't see how anyone could support it in good conscience.

[sage]

Oooh! Oooh!! What about Cuba? What about Cuba? Cuba Cuba Cuba?!! Man walks into a bar, CUBA!! Woohoo!

I've got to be honest with you. I'm not too familiar with Cuba's healthcare system - is it a government run system?

[Neu Mejican]

John,

Questions:

Does your sister have health insurance?

How was the situation you describe the result of a failure in government run healthcare?

[John]

"You could have a system where most mundane healthcare is administered by local Boy Scout troops and they'd do a pretty good job of it."

Very true. It is also why places like Wall Mart and CVS getting into the healthcare business is a great thing. Most basic stuff can be done easily and cheaply. But, good luck getting the AMA to buy that.

[sage]

In this case yes. I think people who support single payer healthcare are either unimaginably ignorant dupes or legitmately awful people who just want control.

Both of whom probably view health care as a "right."

[John]

"Questions:

Does your sister have health insurance?

How was the situation you describe the result of a failure in government run healthcare?"

Yes she did. It is not the result of government run healthcare. It is an example of the very kind of failure that will happen in such a system. Whenever bureaucrats run things they will make decisions based on rules and matrixes and money. Why spend money to help this person who is slow anyway? Wouldn't it be more efficient to spend it on healthy productive people? That will be the logic.

[Neu Mejican]

John,

Just so I can keep up.

The AMA are among the bad people?

Or not since the AMA doesn't support single-payer?

http://www.pnhp.org/blog/2008/10/31/ama-position-on-single-payer/

[Neu Mejican]

John,

Whenever bureaucrats run things they will make decisions based on rules and matrixes and money. Why spend money to help this person who is slow anyway? Wouldn't it be more efficient to spend it on healthy productive people? That will be the logic.

How do you, then, explain all the money spent by the government on programs to support those with developmental disabilities. Both at the state and federal level?

[Lamar]

"I've got to be honest with you. I'm not too familiar with Cuba's healthcare system - is it a government run system?"

It's awesome. There was this movie that everybody went and saw, and it proved that Cuba's system was the best in the world even though the people aren't into, like, material things. And I don't know what "government run system" means, but I know what I saw.

[Neu Mejican]

John,

It is not the result of government run healthcare. It is an example of the very kind of failure that will happen in such a system.

It is a better example of the kind of failure that occurs in our current system. A system which often conflates financial criteria into medical decision making.

I am not sure why you see this conflation increasing in the hypothetical single-payer system.

[Malto Dextrin]

Compulsory "single payer" health care systems will only force poor and lower middle class people to use the government's monopoly health care system. Politically powerful and/or wealthy patients will always be able to threaten and/or bribe their way to the head of the line, and rich and even middle class people will be able to leave the country and get their surgeries and other care in places like India or Thailand, and even be able to visit doctors online. "Medical tourism" is already a booming business.

[sage]

From NM's link:

Single-payer systems are plagued with an undersupply of medical personnel, long waiting periods and a lack of patient choice.

Sounds like just the ticket.

[John]

"How do you, then, explain all the money spent by the government on programs to support those with developmental disabilities. Both at the state and federal level?"

They spend surprisingly little and a lot less than you would think. Further, it is a case of the right hand not knowing what the left hand is doing. Sure we will spend billions on developmental disabilities but when someone who fits that mold or is old or some other way defective needs care, all the programs in the world are not going to stop the health care bureaucrat from looking at them and saying "too bad" in the name of efficiency.

[John]

"It is a better example of the kind of failure that occurs in our current system. A system which often conflates financial criteria into medical decision making."

No. My sister had insurance and money. It wasn't a quesiton of money.

[Mike Laursen]

The AMA are among the bad people?

If we have to categorize everyone in terms of good and bad, then the AMA is mixed good and bad. It's more useful, though, to put aside questions of good and bad, and simply acknowledge that the AMA is promoting its own interests.

[Neu Mejican]

John,

They spend surprisingly little and a lot less than you would think.

Well, maybe less than someone else would think (you may not recall that I work in Developmental Disabilities). I appreciate your support of greater government funding for disability services.

Further, it is a case of the right hand not knowing what the left hand is doing. Sure we will spend billions on developmental disabilities but when someone who fits that mold or is old or some other way defective needs care, all the programs in the world are not going to stop the health care bureaucrat from looking at them and saying "too bad" in the name of efficiency.

But health benefits are one of the primary mechanisms for access that is utilized by those with developmental disabilities. There is, in fact, an incentive to seek out a diagnosis as developmentally disabled as it provides access to resources that are unavailable to others who are similarly functional, but not developmentally disabled. These services are provided as part of the health care system, for the most part. When the services fall outside of that system, it is common for a healthcare provider of some type to manage/coordinate those services.

No. My sister had insurance and money. It wasn't a quesiton of money.

I think you are confused.
The decisions about how to staff the emergency room involved money. The amount of wait time that was acceptable involved money...yadda yadda.

[SIV]

John,

I wasn't being sarcastic.Usually the confusion runs the other way.

[SIV]

The AMA are among the bad people?

Fuck yeah, they are rent-seeking scum.
National Socialists opposed International Socialists but they are both evil.

[P Brooks]

Believe it or not, the Phoenix Chamber of Commerce also opposes the initiative.

Chambers of Commerce should not, except in rare cases, be mistaken for free market enthusiasts.

And the AMA can stick it in their ear; restricting the supply of healthcare, in order to keep costs high, is not how you improve it.

[R C Dean]

It is a better example of the kind of failure that occurs in our current system. A system which often conflates financial criteria into medical decision making.

Actually, I think this is an example of what happens when you have an undersupply of care resulting in wait times. The harm here was a result of the wait for care. The doctor's callous remark is more a way of trying to excuse the bad outcome.

I might note that, depending on the hospital, wait times in ER are in no small part the result of federal mandates on emergency care that have turned ERs into primary care clinics.

I am not sure why you see this conflation increasing in the hypothetical single-payer system.

The undersupply that leads to bad results will increase, I think that's pretty plain.

[JW]

The AMA are among the bad people?

Or not since the AMA doesn't support single-payer?

http://www.pnhp.org/blog/2008/10/31/ama-position-on-single-payer/

They sure look good by comparison to the hosting .org.

[Tim Cleland]

Go Arizona Prop. 101. I wonder if there are any good polls to see which way public support is leaning on this issue.

[No Name Guy]

Single payer in health care will have the same smashing success as "single payer" in public education.

The rich and powerful send their kids to private school and the extra cost doesn't really affect them all that much. Same thing will happen in a public health care system. The rich will find a way to get quality care with no problems.

The poor will, as with schools today, be stuck taking what they can get since there's no other choice. Just as inner city kids get screwed by crappy public schools which are nothing more than union money machines, the poor will get screwed with 2nd rate public health care. The thing is, the poor can always show up at a hospital today and get all the care they need for free.

As is par for the course, the middle classes are the ones that will REALLY get screwed. Following the schools parallel: Taxed up the ass for crappy schools, they struggle to send their kids to private schools to ensure they get a decent education. In a similar vein, when solid employers of skilled trades and professionals (think welders, longshoremen, engineers and the like) dump the middle classes off on the crappy public system, they'll have to endure the shit that poor folks on welfare have to put up with, without the ability (since they'll be taxed up the ass a second time for this financial abortion) to engage in medical tourism that the wealthy can do.

And the kicker of it: It just makes the sheeple all the more dependent on sugar daddy government. Ah yes, what better ways to insure continuing votes of the idiot classes than to make their health care dependent on a handout. Hell, look how paranoid the AARP gets with even the slightest talk of reforming that sinkhole called socialist security. Now quadruple it if single payer ever gets done.

[Neu Mejican]

RC Dean,

Actually, I think this is an example of what happens when you have an undersupply of care resulting in wait times.

And money plays no role in the allocation of resources (i.e., undersupply)?

The doctor's callous remark is more a way of trying to excuse the bad outcome.

I had to go back and read John's comment. I didn't read the "she" in "she said she was kind of slow" as the doctor...but John's sister talking. He can correct me if I am wrong.

I might note that, depending on the hospital, wait times in ER are in no small part the result of federal mandates on emergency care that have turned ERs into primary care clinics.

This seems chicken and the egg to me.
The regulations were probably a response to a need not being met.

The undersupply that leads to bad results will increase, I think that's pretty plain.

To some it is plain.
To others, evidence that contradicts it is readily available. The US is not ranked above all single payer systems in terms of access to healthcare. It just ain't.

[Neu Mejican]

In 2001 France was rated as having the best health system in the world.

Anyone have more up to date rankings?

A concise description of the French system.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/

[MikeP]

A concise description of the French system.

Knowing what I know of the French system, the two findings I expected are cited...

That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine."
...
However, the average American physician earns more than five times the average US wage while the average French physician makes only about two times the average earnings of his or her compatriots.

I did not, however, expect to see this editorial aside when discussing the greatest perceived problem in the French system...

American advocates of mandates on employers to provide health insurance should take note. The link between employment and health security is a historical artifact whose disadvantages now far outweigh its advantages. Economists estimate that between 25 and 45 percent of the US labor force is now job-locked. That is, employees make career decisions based on their need to maintain affordable health coverage or avoid exclusion based on a preexisting condition.

...since this is the greatest problem with the American system as well.

[Neu Mejican]

MikeP,

...since this is the greatest problem with the American system as well.

Well, perhaps the greatest problem with the way the American system links employment and healthcare coverage, but I agree that it is one of the more important problems.

[Adam]

Question: How much would it cost to insure every American citizen with a 'gold plated' plan? By 'gold plated,' I mean a plan that would pay 100% of the cost of the treatment/check-up/test recommended by the patient's doctor, and agreed to by the patient, in every situation?

I would think that this cost could be estimated by multiplying the premiums (employer plus employee) for such a plan today (I assume there are some people who have this type of plan) by the number of Americans in each relevant demographic group (I assume the premiums for such a plan would differ significantly by demographic group). For the sake of argument, let's assume that the current provider system could rapidly expand to accomodate this additional care at current costs.