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Tilting at Windmills

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March 8, 2006
By: Kevin Drum

HEALTHCARE HACKERY....Clive Crook takes a sledgehammer to single-payer national healthcare in the Atlantic this month, but here's all you need to read to know that you can safely ignore his rant. American healthcare has its problems, he says, but:

Wherever you look, you find no plainly superior system. Countless variants from the mainly government-run, single-provider, single-payer model at one extreme to America's semi-private, multi-provider, multi-payer approach at the other have been tried. None is widely popular. Canada, did somebody say? You must be joking. Rationing and gaps in coverage, necessary instruments of cost control in that system, are at the limit of what people will accept: they were an issue in the recent election, and helped get the previous government thrown out. Britain's National Health Service, once the country's pride, is today renowned for dirty hospitals that make you sicker than you were to begin with.

This is the grubbiest and most venerable trick in the arsenal of the lazy healthcare ideologue: pretend that Canada and Britain are the best benchmarks for comparison and then pick up your ball and go home. But if you're going to play that game, why not go whole hog and use North Korea and Afghanistan as your reference points instead?

Because, of course, your readers would catch on to that. But the fact is that no one who's serious about healthcare uses Canada or Britain as anything but cautionary tales. If you want to take a look at national healthcare systems that work, you'd pick, say, Sweden at the most centralized end of the scale, France in the middle, and Germany or the Netherlands at the least centralized end. These healthcare systems all have their good and bad points, but on the whole they're so much better than America's on so many different measures that to deny this fact is to drain virtually all meaning from the phrase "plainly superior." What's more, every one of them is far more popular among its own populace than America's system is with ours and far less expensive.

These healthcare systems also provide plenty of grist for honest arguments. Some of them require larger copays than others, some provide a bigger role for insurers than others, and some provide greater choice and flexibility than others. Crook is well aware of this.

But blandly suggesting that "the closer you get to the single-payer socialized alternative, the less appealing it looks" without even giving your readers a serious, honest look at the single-payer alternative is the work of a hack, something that Crook usually isn't. So what happened this time?

UPDATE: As Matt Yglesias points out, Crook also seriously overstates the problems with the Canadian and British healthcare systems. Decent funding levels would make both of them a lot better. My main goal, however, was to point out the Canada/Britain straw man that's so common in conversations about global healthcare. There are lots of examples of national healthcare systems that are far superior to either of them, and those are the models we ought to be discussing.

Kevin Drum 7:39 PM Permalink | Trackbacks | Comments (130)

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Comments

Umm.. Many of my friends from Canada have nothing but pride regarding their health care system. I can't say the same of the US back at'em.

Posted by: Cowmix on March 8, 2006 at 7:43 PM | PERMALINK

Anybody who advocates for national healthcare, like Kevin Drum, shouldn't be surprized when people look at Canada's system and England's system.

Posted by: Monkey See on March 8, 2006 at 7:46 PM | PERMALINK

Heck, Kevin, you posted a link to this study almost a year ago:

http://content.healthaffairs.org/cgi/reprint/20/3/10.pdf

If the Canadian and UK systems are so lousy, then why do their citizens have a higher satisfaction level with their health systems than the US?

Posted by: Leszek Pawlowicz on March 8, 2006 at 7:47 PM | PERMALINK

Cowmix: Canada and Britain are not widely admired among healthcare analysts, but you're right that their systems are still relatively popular. And Crook overstates their weaknesses, too, another sign of hackery. They've both got a lot of problems, but they're also poorly funded. Increase their funding by 30% to get them up to the standards of the rest of the world and they'd probably work pretty well.

Posted by: Kevin Drum on March 8, 2006 at 7:47 PM | PERMALINK

I suspect that the old Crook was eaten by a plant, and that this Crook is, in fact, a pod person.

Posted by: Monstertron on March 8, 2006 at 7:48 PM | PERMALINK

Kevin,

I'm not sure about Sweden but isn't picking Sweden as your universal healthcare model even more selective than picking Canada and the UK?
I mean picking small, Nordic countries is well and good but if you can't find universal healthcare working in a good size developed economy, how's it suppose to work for the US?

Argument like this earns liberals a well-deserved reputation for stupidity and intellectual dishonesty.

----------------
France - has massive heatstroke deaths (that have to be preventable), and doctors have been so poorly paid to go on strike (questioning their quality, you pay peanuts, you'll get monkeys)

Germany - has sustainability issues for the financing of its healthcare program, hence the new conservative PM

Sweden- I have no idea but heard that tax rates are >50%. Try selling that in America?

Canada and UK - by your own admission have issues

The third world - by personal experience it sucks but is cheap

Singapore/HK - pretty good, but with a clear gap in quality between free healthcare and private

Posted by: McA on March 8, 2006 at 7:49 PM | PERMALINK

Leszek: Practically every country has higher satisfaction levels than the U.S. However, that still doesn't mean that Canada and Britain are good benchmarks to use. If you want to make honest comparisons, you should compare to the best national systems, not the most mediocre.

Posted by: Kevin Drum on March 8, 2006 at 7:51 PM | PERMALINK

The statement that health-care was one of the reasons the Liberals were voted out in Canada is simply a lie. The opposite is true. The biggest reason the Consevatives could not get a majority is that people don't trust them with the health care system.

Cautionary tales? The only thing that happened to Canada's system is that Martin took billions out of it, to run massive surpluses.

But really, Drum, single-payer is a pipe-dream for America. You need a poulation possessing some intelligence and basic good will towards their fellow citizens. Maybe if someone comes up with The Creepy Fascist Free Medicare System, then it will be a fit for you guys.

Posted by: Finny on March 8, 2006 at 7:53 PM | PERMALINK

well, it seems my guess was right.

the new owner of the atlantic, whose name escapes me now, is trying to make it into the conservative versions of harper's. printing mark steyn, david brooks and p.j. o'rourke gave me a hint of what could be coming.

Posted by: harry near indy on March 8, 2006 at 8:00 PM | PERMALINK

A Crook by any other name would smell as sweet?

I grew up with a somewhat problematic moniker... but nothing like "Crook." If I were him, I'd take "Clive Hack" in an instant.

Posted by: larry birnbaum on March 8, 2006 at 8:11 PM | PERMALINK

Kevin, you're completely wrong on healthcare in Canada. It has its problems but it is immensely popular. I remember a guy in our office who was a gun nut -- hated Rock (the minister who brought in the gun registry) -- but when it came to healthcare he sang its praises. Why? His wife had chronic health problems and he had been through several layoffs. Healthcare was not a factor in the defeat of Paul Martin.

You say we have waiting lines? You guys do too --
lines with infinite wait times for those who can't afford it.


Posted by: Doug on March 8, 2006 at 8:13 PM | PERMALINK

OT: A Republican-dominated House committee approved an amendment that would block a President Bush approved deal under which a United Arab Emirates-based company is to assume operations of some terminals at U.S. ports in six cities.

Why is the GOP full of Arab/Muslim-hating bigots who are diverting attention from real issues about national security and slandering a "good ally" in the war on terror out of purely political motivations?

Posted by: UAE Monarchy on March 8, 2006 at 8:13 PM | PERMALINK

Isn't all of society necessarily about healthcare? It would be great if we could recognize that as a basic assumption of why we exist as a nation.

Posted by: cld on March 8, 2006 at 8:14 PM | PERMALINK

Creepy Fascist Free Medicare System, then it will be a fit for you guys.

Posted by: Finny on March 8, 2006 at 7:53 PM | PERMALINK

Fascist Healthcare

1. Doctors work at gun point or threat of jail for crappy wages

2. Lawyers and complaining patients are shot to cover up the evidence

3. The LA Times well tell the world your health care system

Isn't that Cuban healthcare?

I agree though Americans, don't have that community spirit.

Posted by: McA on March 8, 2006 at 8:14 PM | PERMALINK

don't forget rauch. he's a conservative too.

Posted by: c. on March 8, 2006 at 8:14 PM | PERMALINK

For the $1 trillion that we will piss down our collective legs in Iraq, we could have sterling cradle-to-grave health care.

It's a matter of will.

Posted by: Stephen Kriz on March 8, 2006 at 8:21 PM | PERMALINK

The Radicals must be _really_ worried by the idea that the Dems might use universal health care as a wedge issue - they are deploying all their trolls in full force on all the major liberal blogs. Not to mention the WSJ.

Cranky

Posted by: Cranky Observer on March 8, 2006 at 8:22 PM | PERMALINK

Considering how little we spend on it, the NHS is fantastic. If we spent, per capita, what the USA already pays for healthcare (3 times what we do), it would be substantially better.

The reason, despite the bitching, that we like the NHS is that it takes away the worry. If you're seriously ill, you'll get treated and you won't go bankrupt. If you're non-seriously ill, you'll get treated eventually and you don't have to consider not getting treated because you can't afford it. And, heck, if you want your MRI done in 2 days instead of 2 months and you can afford it, you can pay to have it done privately.

Posted by: Keith on March 8, 2006 at 8:22 PM | PERMALINK

I would like to highlight the Malaysian McA:

Because they aren't a culture of whiney assholes who can't appreciate their lifestyle?

Aside from the fact that you're a well-known troll, a quote like this is evidence that we should listen to your advice -- and run the other way. You obviously have issues with hatred of Americans.

Go away, troll.

Posted by: theo on March 8, 2006 at 8:25 PM | PERMALINK

kevin: "But blandly suggesting that "the closer you get to the single-payer socialized alternative, the less appealing it looks" without even giving your readers a serious, honest look at the single-payer alternative is the work of a hack, something that Crook usually isn't. So what happened this time?"

Um, maybe ideology got the better of him.

In any case, Canada is a fine model. We're got nothing to teach them and everything to learn.

I wouldn't be so dismissive -- especially in the fact of a hack like this.

Posted by: liberalMinded on March 8, 2006 at 8:29 PM | PERMALINK

You obviously have issues with hatred of Americans.

Posted by: theo on March 8, 2006 at 8:25 PM | PERMALINK

So you have to like Americans to have an opinion now? How 18th century nationalist...

So why model yourself on foreign counties when you aren't prepared to talk to foreigners?

I laugh at your nekulturny society!

Posted by: Mca on March 8, 2006 at 8:30 PM | PERMALINK

The biggest sign of hackery is that he dismisses the UK's NHS by appealing to a bunch of bogus tabloid scare stories about, I assume since he doesn't say, MRSA (Methicillin Resistant Staphylococcus Aureus).

As if we don't have MRSA in American hospitals.

And by the way, I read in the National Enquirer that someone in BatBoy's hospital ward acquired Ebola from him!

Posted by: theo on March 8, 2006 at 8:33 PM | PERMALINK

If you want to take a look at national healthcare systems that work, you'd pick, say, Sweden at the most centralized end of the scale, France in the middle, and Germany or the Netherlands at the least centralized end.

But none of those people speak English, Kevin - what use are they to us?

Posted by: dr sardonicus on March 8, 2006 at 8:41 PM | PERMALINK

So what happened this time?

Well, given the Bush regime's well-documented history of bribing and suborning journalists and planting fake stories in the press, I'd probably guess that somebody paid him off.

Posted by: Stefan on March 8, 2006 at 8:41 PM | PERMALINK

Canada and Britain, Drum, are both countries that are culturally, historically similar to ours. I find it extremely unpersuasive that something that may or may not have worked well in Sweden (!) of all places would work here.

Posted by: cranky on March 8, 2006 at 8:42 PM | PERMALINK

I am afraid that the Abramhof scandal is a cautionary tale about single payer. Defense spending is a relatively small part of GDP, especially compared to Health Care. If we have rent seeking lobbyists now- imagine the temptation of having your finger in the pie of 10%-15% of the economy. I am afraid of letting the idiots in Washington have control over that much of the economy. They do a bad enough job as is. And don't try to tell me that honest, peace loving Democrats would be better. I remember when they were the majority party.

Posted by: Tassled Loafered Leech on March 8, 2006 at 8:43 PM | PERMALINK

I'm not a know-it-all analyst/expert on the Canadian healthcare system but I do have family members who live there and actually have experience with the system in Ontario (by far the largest province) and to a lesser extent in Nova Scotia. My 84 y.o. mother as you might expect has, of all my Canadian relatives, made the most use of the system in the last few years. In the past six years, she has had both knees replaced as well as a heart attack requiring a stent. In each instance, she received as good care as I would receive here in Phoenix. There was no wait whatsoever for the stent she got after her heart attack. While she did wait for her knee replacments, any delays were in part due to her choice of the best surgeon, the fact that there was a recuperation period after her heart attack and finally, her stoic admission to the orthopedic surgeeon that her knee problem didn't really limit her activities much. She is also able to get to see her G.P. typically on the same day, an experience I have yet to enjoy here in the US. Instead, I'm told to go to an urgent care clinic where I pay more out of pocket. Of course, none of my mother's care costs her a dime out of pocket. Are there problems? Of course, but you have to keep in mind that the US spends 50% more per capita than Canada does on healthcare. And the assertion that the Conservatives won the last election in Canada due to problem with the healthcare system is so preposterous as to cast doubt on the validity of any other other point the "expert" might be trying to make.

As for waits here in the US, ha!: it took me four months to schedule a routine colonoscopy after I turned 50. My G.P. is always booked up, I had to wait weeks to see a podiatrist and you don't want to know how long it took for an initial consultation with a neurosurgeon regarding a pinched nerve in my neck. And I have GOOD health insurance. So excuse me if I take with a grain of salt any pronouncements of US "experts" on the Canadian healthcare system.

Posted by: Ian S on March 8, 2006 at 8:43 PM | PERMALINK

dr sardonicus: But none of those people speak English

Nonsense. They all speak English, but also make funny grunting noises for the sake of the tourist trade.

"American coming!"

"Ok, everybody make weird sounds and pretend it's a conversation."

Posted by: alex on March 8, 2006 at 8:45 PM | PERMALINK

The other way in which I'd say it's "the grubbiest and most venerable trick in the arsenal of the lazy healthcare ideologue" is: as many problems as Canada's and Britain's sytems have, they're still better than ours. It's not even close. People in Canada and Britain grumble about problems with their health cares systems, but people want to have the problems fixed, not to have the whole system replaced by American-style private insurance or managed care. Not even the right wing parties in those two countries propose privatizing health care financing.

Yes, it's possible for us to do better than the Canadian and British models, but it's also possible to do worse. So far we have done worse.

Posted by: Matt Austern on March 8, 2006 at 8:46 PM | PERMALINK

Canada and Britain, Drum, are both countries that are culturally, historically similar to ours. I find it extremely unpersuasive that something that may or may not have worked well in Sweden (!) of all places would work here.

No, Canada and Britain are not culturally and historically similar to us. We're a multi-ethnic, relatively unregulated, highly competitive and individualistic society while Canada and Britain are largely homogenous (until recently, that is) societies with a far more socialist and communitarian bent. They have far more similarities with a nation like Sweden than they do to us. The only reason they seem similar is because they speak English.

Posted by: Stefan on March 8, 2006 at 8:50 PM | PERMALINK

"They have far more similarities with a nation like Sweden than they do to us. " - stefan

Look, dumbass, the issue wasn't which of those countries are closest to each other but which are closest to the US. Sweden Germany France are not particlularly similar to us. Brits and Canadians are more so. Hence the greater relevance of the comparison.

Posted by: cranky on March 8, 2006 at 8:53 PM | PERMALINK

cranky - I used to think Americans were similar to us Brits, right up until I started to talk to Americans on the internet. You really aren't. The politics are different, the values are different, the degree of religiousness are poles apart. Only the language is similar.

Posted by: keith on March 8, 2006 at 8:58 PM | PERMALINK

Kevin, while I think it's cool that you are standing for something I would caution you that widespread liberal blogger support for single-payer may not imply widespread blog-reader support. You might say, well, who cares about the blog readers, but more importantly, it may not imply there's a real groundswell there, a mass of people willing to fight for it.

I'm definitely left-leaning on a lot of stuff but I am hesitant to say I'm totally gung ho on the single-payer thing.

I think I'd need to see a good plan, with a lot going for it, before I could get behind it. This becomes kind of chicken-and-egg because maybe the politicians won't give us a plan till we clamor for one.

But if they just give us a plan because we're clamoring for one, who's to say the plan will be a good plan? I think the plan should come before the clamoring, even though we have this problem of timid politicians.

Posted by: mk on March 8, 2006 at 8:59 PM | PERMALINK

1. Canuckastan's recent election was determined by two scandals and a "throw the bums out" sentiment. Health care was not a major factor in the voters' minds.

2. There are "issues" with our health care system. There are issues with all health care systems. But, IMO, our challenges are largely on the industrial organization side - labour relations, the way primary health care is organized and perhaps a issues re: treatment of chronic care. The only radically problematic costs driver are drugs (duh). Regardless, NONE of these are fundamentally caused by the (redistributive) public insurance system.


BTW: Just to deflate some of the neocon piss 'n' vinegar - many, many of our doctors operate *private* practices. But they are paid by a public insurance plan.

Posted by: Soviet Canuckastani on March 8, 2006 at 9:02 PM | PERMALINK

Increase their funding by 30% to get them up to the standards of the rest of the world and they'd probably work pretty well.

The first sign that a government program is in trouble is the constant refrain that "it would work if it just had more money." See also: education.

It's a bit cheesy to suddenly dismiss Canada and England as examples, considering that a few years back all I heard was how great their systems were. What happened?

You might also want to check and see what Sweden's been doing over the past ten years.

A good overall analysis of different systems was collected by Ezra Klein.

Posted by: tbrosz on March 8, 2006 at 9:04 PM | PERMALINK

Five-year colon cancer survival rates (WHO):

US: 60% Germany: 48% France: 45%

Five-year breast cancer survival rates (WHO):

US: 82% Germany: 68% France: 76%

Kevin is a little partisan dilettante playing
with things which he doesn't understand.

If this amateur has his way, large numbers of people will, umm, die.

Posted by: am on March 8, 2006 at 9:04 PM | PERMALINK

I'm just guessing, am, but maybe it's because France and Germany treat everyone who gets cancer. Not just people who can afford it (who are likely to be healthier and better informed to begin with).

Posted by: Soviet Canuckastani on March 8, 2006 at 9:08 PM | PERMALINK

Its pretty obvious that the entire electorate doesn't read Political Animal, so any anecdote based upon anthing going on here is not only "anecdotal" but technically obscure as well.

However, lately, I've noticed that the steam is finally dropping out of the knee-jerk "of course government sucks" line of attack.

Its never been particularly persuasive, its barely argumentative, becuase, I mean, talk about begging the question.

However, as we know, the "of course government sucks" assertion has worked with the "sitting on a barstool" voter, with, George Bush being the guy sitting on a barstoon president.

But, you repeat it enough, and it just doesn't hold up.

Posted by: hank on March 8, 2006 at 9:09 PM | PERMALINK

The Canadian system is THAT bad? Jesus, Kevin, you're buying the same wingnut bullshit the bushbots can't get enough of.

Posted by: Bejus on March 8, 2006 at 9:13 PM | PERMALINK

am:

Those supporting government health care tend to slap life expectancy rates up to show how different health care systems work, although in fact this assumes there is no other reason for differences in average life expectancy. Demographics, for one.

Your colon cancer survival rates, sorry to say, probably fall into that same category, unless you have information specifically linking the health care system to this instead of things like diet.

Posted by: tbrosz on March 8, 2006 at 9:15 PM | PERMALINK

Kevin,

You keep making negative comments about the Canadian Healthcare System witout actually identifying what is wrong with it - somewhat as if Instapundit criticised you for being a liberal. As a consumer of the system, I don't see too many problems.

By the way, the definition of a Canadian is an unarmed American with a health plan.

Posted by: lurcher on March 8, 2006 at 9:15 PM | PERMALINK

Found this link to a pretty good article while checking Ezra's site. Apologies if someone posted this before.

Posted by: tbrosz on March 8, 2006 at 9:17 PM | PERMALINK
I think I'd need to see a good plan

How about something like California's propsed single-payer system, SB840 (Text, Floor Analysis)?

Posted by: cmdicely on March 8, 2006 at 9:19 PM | PERMALINK

Why is the GOP full of Arab/Muslim-hating bigots who are diverting attention from real issues about national security and slandering a "good ally" in the war on terror out of purely political motivations?
Posted by: UAE Monarchy on March 8, 2006 at 8:13 PM | PERMALINK

Make no mistake.

This has everything to do with 06. . . and nothing else.

The Republicans have finally revealed their strategy. They're the "we don't like Bush anymore" party!

Posted by: Osama_Been_Forgotten on March 8, 2006 at 9:22 PM | PERMALINK

McA wrote:

Sweden- I have no idea but heard that tax rates are >50%. Try selling that in America?

*** I paid Swedish taxes and had an above average income. My tax rate was 30%.

neutrino

Posted by: neutrino on March 8, 2006 at 9:25 PM | PERMALINK


KEVIN DRUM: the fact is that no one who's serious about healthcare uses Canada or Britain as anything but cautionary tales.

Crook's dishonesty begins with using only Canada and Britain as comparisons, yes, but it goes on--as does yours--to include a false impression of those systems. "Anything but a cautionary tale?" How about the tale that there are millions of people in those countries who receive often very good care, but who, because they lack insurance, would have no access to it in this country except in emergency rooms?

In Crook's defense, it makes sense to compare the U.S. with Canada and Great Britain, as Americans are most likely to identify with their similar cultures and shared language. You should be less cowardly and more honest about facing that comparison.


Posted by: jayarbee on March 8, 2006 at 9:29 PM | PERMALINK

I'd guess 'AM' cherry-picked his survival stats. If they're accurate at all. Who know's? He didn't include a link to whatever WHO page.

But I wonder if he also knows how those 50 million Americans with no health insurance are getting along with their cancers and new kidneys and their bypasses?

Posted by: Bejus on March 8, 2006 at 9:30 PM | PERMALINK

Until this conundrum is resolved, America will never solve its healthcare problems:

1) Americans believe that they have the best health care in the industrialized world.

2) Americans have more complaints about their health care system of any industrialized nation.

These are the results from a survey conducted about a year or so ago -- I don't remember whether it was by Pew or the WHO. In any case, it clearly showed the problem: Americans know their HC problems are growing, yet are sold on the idea that they enjoy the best HC available.

In fact, they do -- so long as money is not an object. In reality, American HC is a disaster based on almost any objective measurement: life expectancy, infant mortality, fair access to treatment, etc.

Only the eventual collapse of the system for most users will lead to real reform -- and by then it will probably be too late.

Posted by: Dicksknee on March 8, 2006 at 9:30 PM | PERMALINK

1) Americans believe that they have the best health care in the industrialized world.

2) Americans have more complaints about their health care system of any industrialized nation.

This is not an isolated example. For instance:

1) Americans believe that they have the most social mobility in the industrialized world.

2) Americans have less chance of moving out of poverty, and/or staying out of poverty, than citizens in any industrialized nation.

Still, Australians are the same. For instance:

1) Australians believe that they work the least hours in the industrialized world (OECD).

2) Australians, as a whole, work the longest hours in the industrialized world (OECD).


Posted by: floopmeister on March 8, 2006 at 9:42 PM | PERMALINK

Dicksknee:

Americans have more complaints about EVERYTHING than anyone else in the world, justified or not.

Posted by: tbrosz on March 8, 2006 at 9:42 PM | PERMALINK

I'll contribute my two bits, as it could be relevant.

I am a Yank who has lived in the US, Australian, France, the USSR and Japan. My family and I have extensive experience with the US, Australian, and French medical systems (never got sick in Moscow or Kyoto). We are also now Australian citizens as well as Americans (but live in US).

The real comparison to make is with the Australian mixed public-private system. Everyone gets basic Medicare---which pays a fixed amt per dr office visit (typically 50-75% of charge, often 100% for kids and students who get charged less by the doctors) and covers emergency care totally and hospital coverage. All for 1.5% added to your income tax.

But there is an active private sector, too. ~70% of surgeries are covered by private insurance from non profit health funds (which use community rating----not individual risk). The premiums are given a tax credit of 30%, and moreover, if you sign up for private cover at age 20, you are guaranteed (for life) to have lower premiums than if you sign up at age 50. Basically, it is like employer group coverage in the US, but not linked to employment, and with higher copays generally. Typical premiums for us (family of 4) ran $2-3K per year. Many competing funds to choose from.

The advantage of private cover is you get to choose dr and don't have to wait as much for surgery. There are private and public hospitals,and some even adjacent to each other coordinate services.

Folks, this system works well. Service = to or better than the US.

THIS is a system that Hilary Clinton's team looked at very closely. And it bears more looking at. The fact that it actually involves both competition and cooperation helps keep it adapting to reality.

And last thing, Australia is a highly heterogeneous, multi cultural society, more like the US than like Scandinavia or even France.

Best regards

Jeffrey Harris

Posted by: Jeffrey Harris on March 8, 2006 at 9:44 PM | PERMALINK

The argument over US healthcare, like social mobility or work culture and sporting prowess in Australia (us Australians think we are the greatest sporting nation in the world, when we are the second most obese), is primarily conducted on the basis of long-cherished notions of national character.

People 'know' - they 'just know', you see - that these things are true.

Except they're not.

Posted by: floopmeister on March 8, 2006 at 9:47 PM | PERMALINK

You're right, Kevin. I worked in Europe, including a couple years in U.K. Their health care system is marginally good, rarely brilliant; many Brits go to South Africa to get the treatment they need in a timely fashion. On the other hand, they don't have families bankrupted by medical crises. It's a tradeoff. And,Cowmix, I don't know who your Canadian friends are, but MY Candadian friends view their health care with derision.

The fact is, our health care system works well for those who can pay...and there is evidence we are losing our edge on even that claim (nursing shortage; outrageous costs; hospital infections; shrinking worker benefits). Arguing our medical position relative to, say, Sweden, diverts attention from the real problem: The most technically advanced and wealthiest country in the history of the world can't provide good medical care for all of its citizens. Why not compare ourselves to Mexico? We're headed that way.

Posted by: carol on March 8, 2006 at 9:47 PM | PERMALINK

A word about Canada: not only do the Canadians have a better HC system than their neighbors to the South, they apparently play baseball better than their American neighbors.

Today, the Derek Jeters and Chipper Jones of the U.S. watched as Canada beat the U.S. at the World Baseball Classic. (Yikes, we even suck at baseball.)

Posted by: Dicksknee on March 8, 2006 at 9:51 PM | PERMALINK

By the way, at the next World Baseball Classic, the U.S. is recommending that the scoreboards be built by Diebold. It's our only hope.

Posted by: Dicksknee on March 8, 2006 at 9:52 PM | PERMALINK

Jeffrey Harris: Exactly. I earn enough to put me into the bracket that could afford private health cover, but my partner and I choose not to.

Why would we bother?

We're soon to have our first child - and we've stayed with the public system.

Hasn't cost us a brass razoo, beyond our income tax medicare levy. Free check ups, free stay in the maternity ward, free obstetrician.

You won't find me complaining.

Posted by: floopmeister on March 8, 2006 at 9:53 PM | PERMALINK

McA >"...I have no idea..."

Well, DUH !

Intuitively obvious to the most casual observer

How`s the troll pay these days ?

"The power of accurate observation is commonly called cynicism by those who have not got it." - George Bernard Shaw

Posted by: daCascadian on March 8, 2006 at 9:59 PM | PERMALINK

cranky: Canada and Britain, Drum, are both countries that are culturally, historically similar to ours.

me: No, Canada and Britain are not culturally and historically similar to us.

cranky, redux: Look, dumbass, the issue wasn't which of those countries are closest to each other but which are closest to the US. Sweden Germany France are not particlularly similar to us. Brits and Canadians are more so. Hence the greater relevance of the comparison.

No, as you said in your first post, the issue as you defined it was whether Canada and Britain are culturally and historically similar to us. They're not very similar to us at all, thought the fact that they appear so if you're not well-educated is largely due the accident that (i) Canada is next to us and (ii) both countries speak English. In terms of how they structure their societies, though (i.e. in terms of income distribution, communitarian ideologies, preference for national government-based solutions, etc.) Canada and Britain fall firmly in the Sweden/Germany/Canada camp.

Posted by: Stefan on March 8, 2006 at 10:07 PM | PERMALINK

carol >"...The...wealthiest country in the history of the world..."

Well, as measured in monetary terms anyway

Those externalities (real world measures) are a real bitch & yes, "We the people..." are headed downwards towards the level of Mexico instead of pulling Mexico (and all the related nation-states) up to our historical (pre reactionary ReThuglican) level

What a *mistake*

''The war on terror is not a clash of civilizations. It is a clash of civilization against chaos, of the best hopes of humanity against dogmatic fears of progress and the future.'' - John F. Kerry

Posted by: daCascadian on March 8, 2006 at 10:10 PM | PERMALINK

The main problem with selling national health care is many people in the populace aren't effected all that much. Until they are, they won't support national health care. Sure, they face higher premiums and some are losing employer sponsored health insurance.

Wait until it affects them directly and they will sing a different tune. That's what makes the bankruptcy bill the Rs passed so obnoxious. There was no exception for bankruptcy due to medical expenses.

We have good insurance at a rather expensive premium the runs around $11,000 a year. Even with decent insurance health care costs are a real problem and can bankrupt you overnight. As they say, we are all just one major health problem away from bankruptcy.

Even with an 80-20 co-pay the 20% after deductible can kill you economically when you have anything approaching a major health problem.

As long as it doesn't effect people directly they simply don't give a damn. That's why you can't get enough people to support it.

Posted by: K Ols on March 8, 2006 at 10:12 PM | PERMALINK

As I've said before, it will be completely impossible to reform the U.S. health care system without coming to huge changes of attitude regarding life and its limits. Otherwise we'll just keep squandering resources on pointless end-of-life care.

Posted by: Peter on March 8, 2006 at 10:15 PM | PERMALINK

Hasn't cost us a brass razoo, beyond our income tax medicare levy. Free check ups, free stay in the maternity ward, free obstetrician.

The next thing you'll be telling us is that this mythical paradise -- "Australia" -- is overflowing with beer and good looking women --

-- and has all the shrimp anyone could ever ask for.

Posted by: trex on March 8, 2006 at 10:21 PM | PERMALINK

As for Americans' conviction that our health care system is the best in the world: I think most people are aware that the system is seriously flawed. Most Americans will tell you that our health care system sucks. Problem is, most of them also believe that everyone else's system sucks worse.

Posted by: dr sardonicus on March 8, 2006 at 10:23 PM | PERMALINK

Interesting...until recently, Clive Crook was a senior staff member of the Economist. And they recently ran an editorial ("leader" in UK parlance) that said that some sort of single-payer system was inevitable, that "consumer-driven" is a nice concept, but given that 80% of the cost is spent on only 20% of the population, and that cherry-picking is liable to try and prevent insuring people who actually need it...you get the idea.

The Economist said they came to that conclusion reluctantly; certainly true for their views. They did say that having an opt-out component (like France has) is needed - also, it will calm the wealthier voters, I believe - and the details have to be settled with many interested parties.

So if Clive has left the Economist, the timing is certainly interesting.

Posted by: Ed Tracey on March 8, 2006 at 10:24 PM | PERMALINK

Question,

how many people here would be against Universal Health care if their employer suddenly stopped covering their insturance premiums?

Posted by: caren on March 8, 2006 at 10:29 PM | PERMALINK

The next thing you'll be telling us is that this mythical paradise -- "Australia" -- is overflowing with beer and good looking women --

-- and has all the shrimp anyone could ever ask for.

And the largest biomass of flies on this earth.

Apparently.

It's a battle between them and us for the shrimp...

;)

Posted by: floopmeister on March 8, 2006 at 10:38 PM | PERMALINK

So why model yourself on foreign counties when you aren't prepared to talk to foreigners?

nice strawman and false dilemma combo, dickweed.

Posted by: cleek on March 8, 2006 at 10:38 PM | PERMALINK

A majority of Americans say they would support a universal healthcare system - including one like the UK's.

And why not? Despite the mythology, the UK system gives you pretty good medical care. It was even better before Maggie Thatcher started under-funding it, and then Major and Blair started dicking around with it - but even having taken that damage, it's still good.

Of course, if I don't like it, I can get private health insurance and private care, but why bother? I had my surgery at one of the best eye hospitals in the world, all on the NHS. You can't beat the rates or the quality.

Posted by: Avedon on March 8, 2006 at 10:43 PM | PERMALINK

The German system had some changes but is breaking even and still delivering service you can only dream of in the US.

Now patients have a 10 euro payment per quarter. I does include dental care and eyeglasses.

Physicians negotiate their fees, just like they do here. So french physians went on strike and here they just don't take you as a patient. Some don't want to take MEDICARE patients.

In Germany has a payroll deduction, so when there are more people unemployed less money flows into the system. Unemployed are insured, don't forget. The insurance goes with the employee to other jobs without interruptions. An employee is insured from day one, no questions about previous illness, high blood pressure or whatever, and the family is insured for the same money regardless of size.

It goes all the way back to Bismarck and survived 2 lost WW. Not a bad system I would say.

Posted by: renate on March 8, 2006 at 10:56 PM | PERMALINK

Caren writes:

"how many people here would be against Universal Health care if their employer suddenly stopped covering their insturance premiums?"

The implicit premise is that the employer does pick up the premiums. I have a stable job, and my employer pays part of my premium, but I pay a large chunk, about $4,500 per year, for myself, my wife, and our two kids. That's about 9% of my salary, just for the premiums. Copays on appointments and prescriptions add about another $1,000 per year, so I'm up to about 11% of my income going out-of-pocket for my family's health care. Then there's the Medicare tax (another $800 or so), and portions of my federal, state, and county taxes that go toward Medicare, Medicaid, Veterans' Administration, and our household probably puts 12% or 13% of our income towards healthcare. In other words, we pay about the same proportion as the nation does -- and that ignores my employer's contribution to my insurance premiums and to Medicare.

So yeah, I'd happily give up having my employer pay what they do of my premiums in return for a universal system. Cut the 30% administrative overhead of our current system down to the 2% that "socialized" programs like VA and Medicare achieve, give us our income-prorated portion of the bill, and I stand to save an easy $1,000 per year, if not more.

The employer contribution to insurance premiums comes, in the end, from the employee's salary, even if the bookkeeping doesn't look at it that way. There are companies that ask only small contributions from their employees toward insurance; if the insurance market works at all, those companies must be paying fairly large amounts on their workers' behalf. If they were relieved of that burden by a national health system, they (or their employees) would easily be able to pay the resulting tax increases adn still save money.

Posted by: Karl on March 8, 2006 at 11:09 PM | PERMALINK

All for 1.5% added to your income tax.

Posted by: Jeffrey Harris on March 8, 2006 at 9:44 PM | PERMALINK

I think you'll find the Medicare Levy doesn't cover the cost of Medicare and their is substantial spending from normal tax income to pay for medicare.

Posted by: McA on March 8, 2006 at 11:11 PM | PERMALINK

THIS is a system that Hilary Clinton's team looked at very closely.
Posted by: Jeffrey Harris on March 8, 2006 at 9:44 PM | PERMALINK

Plus the private component of health insurance came in well after Clinton's Hillarycare days so that can't be right.

If I remember rightly, those who bought private care were getting screwed because they were paying (in taxes) for those who don't have insurance as well their own (with only a 30% credit). In fact, there was a tax penalty if you don't get cover which forced participation up.

Posted by: McA on March 8, 2006 at 11:14 PM | PERMALINK

The German system had some changes but is breaking even and still delivering service you can only dream of in the US.

Posted by: renate on March 8, 2006 at 10:56 PM | PERMALINK

I'm not sure if its breaking even. But a health system that breaks even now is going to bleed into bankrupcy because your population is aging.

And as part of the EU, you are going to learn the American lesson. Jobs will move to avoid taxes.

Posted by: Mca on March 8, 2006 at 11:18 PM | PERMALINK
The next thing you'll be telling us is that this mythical paradise -- "Australia" -- is overflowing with beer and good looking women --

-- and has all the shrimp anyone could ever ask for.

And venomous, egg-laying mammals. With bills. And ten, rather than the rather more normal two, sex chromosomes.

Paradise, I dunno, but this "Australia" place is obviously mythical, or at least fictional...

Posted by: cmdicely on March 8, 2006 at 11:20 PM | PERMALINK

against Universal Health care if their employer suddenly stopped covering their insturance premiums?

Posted by: caren on March 8, 2006 at 10:29 PM | PERMALINK

Depends who pays for it.

I'd like to have a personal chef to help my diet, but no one is offering me universal personal chefs.

Posted by: Mca on March 8, 2006 at 11:22 PM | PERMALINK

I think you'll find the Medicare Levy doesn't cover the cost of Medicare and their is substantial spending from normal tax income to pay for medicare.

Yeah, and is the cost of our national defense paid by a 'defense levy'?

Of course it's not. It's a bogus argument.

It doesn't really matter if medicare is paid by a mix of income tax, Medicare levy or even a slice of gambling revenue - as long as the government and social programs run in the black.

Which, by and large, they do.

Posted by: floopmeister on March 8, 2006 at 11:24 PM | PERMALINK

So why model yourself on foreign counties when you aren't prepared to talk to foreigners?

nice strawman and false dilemma combo, dickweed.

Posted by: cleek on March 8, 2006 at 10:38 PM | PERMALINK

No. I'm pointing out that using nationalism to criticise a poster when the site is a liberal bunch of nut jobs who keeps screaming 'Look at Europe' is inconsistent.

Posted by: McA on March 8, 2006 at 11:24 PM | PERMALINK

And venomous, egg-laying mammals. With bills. And ten, rather than the rather more normal two, sex chromosomes.

Don't go slurring Australia's 'good looking women', now - or they'll poison you.

Posted by: floopmeister on March 8, 2006 at 11:26 PM | PERMALINK

And why not? Despite the mythology, the UK system gives you pretty good medical care. It was even better before Maggie Thatcher started under-funding it, and then Major and Blair started dicking around with it - but even having taken that damage, it's still good...? I had my surgery at one of the best eye hospitals in the world, all on the NHS. You can't beat the rates or the quality.

Avedon: nobody (besides the trolls) is arguing that Britain's or Canada's healthcare systems are inferior to America's. We all know the USA's healthcare system is bloated, costly, incredibly inefficient, and simply delivers poor macro results. Canada and Britain's plans are significantly superior in lots of ways. But most of the analysis would indicate that Canada and Britain's systems, albeit better than the USA's, nonetheless don't deliver the results seen in Japan or France or Australia or Germany or...just about everywhere else in the rich world. I agree the US needs to adopt a universal healthcare plan. But clearly there are better alternatives than what London or Ottawa can provide.

Posted by: Aprilesque on March 8, 2006 at 11:38 PM | PERMALINK

If Canada is a mere cautionary tale, then sign me up for single payer. It looks hella good from here in Texas, and I have much better coverage than most. It's nice to have health care when you have a job. But if you lose your job or have to go part time, like say for health reasons, it would be nice to know you could have basic health care then, you know, when you actually need it most. Even if your employer has to keep you on the plan for a few months after you leave a job, if you don't have a job, there is no way to pay the premiums, plus the out of pocket health costs.

Posted by: jussumbody on March 8, 2006 at 11:38 PM | PERMALINK

Okay, I found sources for the claims regarding relative cancer survival rates. The base claim is from this article, but I went ahead and checked out the article's sources.

The rates from the US are from this article, from cancer statistics in the US for women diagnosed from 1986-1993.

The rates from Europe are from this article, from cancer statistics in European countries for women diagnosed from 1983-1985.

There's been some technological change between 1983 and 1993. The numbers posted comparing European countries to each other are vaguely meaningful. The numbers comparing Europeans to the US are meaningless.

Posted by: Kimmitt on March 8, 2006 at 11:42 PM | PERMALINK

Well. Hell. Jus Kompare whut kinda care da Soldiers git if'n you wanna go runnin with ah ball. Sheet.
AX yew sum Vets whut they think of theer 'Health kare'

Mark Twain meets the PC user

The Keys being placed familiar fashion lends itself to ease of use. The function of the device is somewhat unclear however as to why high technology is needed for two apparent fools to converse across continents when another fool assuredly exists nearby within yelling distance.

Posted by: one eye buck tooth [X^B on March 8, 2006 at 11:53 PM | PERMALINK

But if you lose your job or have to go part time, like say for health reasons, it would be nice to know you could have basic health care then, you know, when you actually need it most.

Yup. I don't have health insurance; I can't obtain individual health insurance for any price. If I need medical care beyond the very limited amount I can pay for directly, I don't get it. With the exception of an injury so serious that the hospital can't get away with turning me away (or accepts me before they know I don't have insurance.) If I get cancer, I die.

So, you know, even that 'crappy' Canadian system looks pretty good from here.

Posted by: tavella on March 9, 2006 at 12:05 AM | PERMALINK

that 'crappy' Canadian system looks pretty good from here.

Posted by: tavella on March 9, 2006 at 12:05 AM | PERMALINK

But that 'crappy' Canadian system has a process to keep you out when your costs will exceed the taxes you will pay. Its called immigration policy. Does the United States have an equivalent?

Posted by: McA on March 9, 2006 at 12:08 AM | PERMALINK

Decent funding levels would make both of them a lot better.

whatever.

Posted by: republicrat on March 9, 2006 at 12:09 AM | PERMALINK

Karl,

I can't say how much an employer pays per employee per month for health care benifits (and yes they are paying you less every month to cover this)that would take someone from HR to answer.

I do know that my sister and her husband (who was laid off 3 years ago,at 50, with a degree and 25 years of experiance)have run out of COBRA, are looking for insurance. The best price they have recieved so far is $800.00 per month with a $35,000.00 dedutible for a family of two. That makes $375.oo dollars a month for a family of four quite a bargain. I know my husband and I pay
$350.00 a month before taxes for our insurance with a $15.00 dollar copay for doctor visits. My husband has also had 4 surgeries over the past 20 years(piss poor bones,genic problems, blame the parents)that have cost us about $200.00 out of pocket each. If we didn't have health care through his employer we would have been bankrupt a month after we got married (one month later)

Posted by: Caren on March 9, 2006 at 12:11 AM | PERMALINK

But that 'crappy' Canadian system has a process to keep you out when your costs will exceed the taxes you will pay. Its called immigration policy. Does the United States have an equivalent?

Cue the "Give me your poor huddled masses..." speech.

Like any country, including Canada and Aus, the US has an immigration policy by which it regulates (often on the basis of future economic output) who is given access and/or citizenship.

Or am I entirely misreading the purpose of the Green card?

Not to mention the fenced border with Mexico.

Bogus argument.

Posted by: floopmeister on March 9, 2006 at 12:15 AM | PERMALINK

Aprilesque: nobody (besides the trolls) is arguing that Britain's or Canada's healthcare systems are inferior to America's.

Kevin is saying that. Otherwise, why would looking at the Canadian and British systems be cautionary tales? His point is that the US would have a much worse system if it followed a Canadian or British example.

I've used the US and Canadian systems and I sure don't think the Canadian system is worse. In fact, my wife, who's American, has MS, but doesn't want to move back to the US because she's perfectly happy with the Canadian system and scared of American healthcare.

Re. that last Canadian election: healthcare probably hurt the Liberals a little, but only because enough left-wing voters abandoned the Liberals in favour of the NDP (a socialist party). They did this because they weren't confident that the Liberal leader would stand up for the public healtcare system.

Posted by: otherpaul on March 9, 2006 at 12:15 AM | PERMALINK

Mca,

That is a really stupid comment. You don't need a personal cheif to stay alive, buy a can opener and a can of beans. If you need a life saving operation buy yourself a knife and go for it. Hope you live.

Posted by: Caren on March 9, 2006 at 12:22 AM | PERMALINK

But that 'crappy' Canadian system has a process to keep you out when your costs will exceed the taxes you will pay. Its called immigration policy. Does the United States have an equivalent?

I'm fairly sure the US has an immigration policy, troll.

Now, why don't you deal with the point that other countries get better health results cheaper than the US?

Posted by: Phoenician in a time of Romans on March 9, 2006 at 12:26 AM | PERMALINK

If you go looking for statistics, instead of the anecdotes listed here, you will find that we pay more per capita, by far, than any other country on earth for health care, and by objective measures (healthy years, life expectancy, infant mortality) we do worse than about 20 other countries. If you include all the little statistically insignificant countries, we're number 48. Specifically, we do worse than Andorra (+6 years), Macau, San Marino (+4), Japan, Singapore, Australia (+3), Guernsey, Switzerland, Sweden, Hong Kong, Canada, Iceland, Cayman Islands, Italy, Gibraltar, France, Monaco, Lichtenstein, Spain (+2), Norway, Israel, Jersey, Faroe Islands, Greece, Aruba, Netherlands, Martinique, Virgin Islands, Malta, Germany, Montserrat, New Zealand, Belgium, Guam, Austra, United Kingdom (+1), Saint Pierre and Miquelon, Isle of Man, Finland, Jordan, Luxembourg, Guadeloupe, Bermuda, Saint Helena, Ireland, Cyprus, and Puerto Rico. (Source: CIA World Factbook 28 July 2005, via Nationmaster.com)

Except for Monaco, any other country on earth could increase their medical spending by 1/3 and still spend less than we do. So yes, it is perfectly reasonable to consider whether someone else's system could be improved by spending more money. Snarky remarks about "throwing money at the problem" or "taxes in Sweden" only show your ignorance -- WE are the country that spends the most, by far.

I think, if this were widely known, that we would generally NOT be more satisfied with our health care system.

As for "who pays", if I recall the standard whine about taxes on corporations, we all do, one way or another. Plus, we pay a "death tax" of somewhere between 2 and 3 years of life.

Again, this is all laid out in gory detail at nationmaster.com, and it is worth a visit.

Posted by: dr2chase on March 9, 2006 at 12:29 AM | PERMALINK

The Aussie Medicare system is indeed subsidized by general revenues over and above the Medicare tax levy, and people do worry about it some.

This is true also of the FRench and (as of the addition of the Medicare drug plan) very likely to be true of the US system, too. I don't see that as a big issue.

[Income tax rates in Australia are higher than US. People complain less though, I think because they think they get reasonable services for their tax dollar.]

But the Oz system is very helpful for the young in a way that the US system is not. Someone just starting out in the work force does not have to worry about medical coverage. Employers don't have to worry about medical coverage and administration of their plans.

As Australia opens its markets and develops new exports, its Medicare system could well be one of the things that helps it become a larger international economic player.

And I think the US--with its car companies spending as much on health care as steel---ought to think this sort of thing thru rationally and pragmatically (as it does in so many other areas, but notably not health care or energy policy).

Jeffrey Harris

Posted by: Jeffrey Harris on March 9, 2006 at 12:40 AM | PERMALINK

dr2chase >"...Plus, we pay a "death tax" of somewhere between 2 and 3 years of life..."

Probably the deal clincher if "We the people..." understood that

Education in these matters is key

Thanks for the research !

"Practical men, who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist." - John Maynard Keynes

Posted by: daCascadian on March 9, 2006 at 1:05 AM | PERMALINK

Jeffery Harris,

I have to disagree with your comment thaqt people just starting out in the work force do not have to worry about health care. My husband was 24 when he had his first surgery. At 25 we had our first child who had jaundice and was in the hospital for 5 days. Two years later we had twins aqt which point I was put in the hospital for a week for pre exclamcia. One twin was in icu for one day (lots of bucks even for one day)and had to have henia surgery at 5 weeks. Medical bills are not just for the old. I am assuming you and your family have beenn lucky.

Posted by: Caren on March 9, 2006 at 1:14 AM | PERMALINK

Caren,
I think Jeffrey Harris meant that in Australia people just starting out in the work force do not have to worry about medical coverage, as such coverage is provided by the nationalized healthcare system. Here in the US, no such luck, as you and many others have sadly found out.

Posted by: Stefan on March 9, 2006 at 1:17 AM | PERMALINK

dr2chase:

Just curious: How much of the world's medical technology and development flow out of the countries you listed?

I'm beginning to think that comparing health costs for other nations and ours is kind of like comparing the costs of buying something off the shelf versus building the factory that makes it. Nobody ever actually itemizes "health costs."

I suspect defense costs for countries that buy U.S. fighters are a bit less than we spend developing and manufacturing them, too.

Even pharmaceutical companies in other countries have a lot of their sales in the U.S., and sometimes their research.

Posted by: tbrosz on March 9, 2006 at 2:56 AM | PERMALINK

Usually the people who refer to single-payer systems as Hillary care, can't afford decent health care, but they somehow identify with the Rush Limbaugh bamboozlement so strongly that they forget that he is almost a billionaire (largely as a result of his poor listeners' meager but hard earned incomes) and they are poor shnucks.

Posted by: Rich on March 9, 2006 at 3:18 AM | PERMALINK

I suspect defense costs for countries that buy U.S. fighters are a bit less than we spend developing and manufacturing them, too.

Once again we see the laughable tbrosz argument boiled down to its essential silliness. This is, in fact, why it is so hard to parody this "contributor." Tbrosz, how many fighter jets have been used in the defense of those nations? Whose fighter jets have they been defending their nation against? Can you explain why we need to build these fighter jets in the first place? For example, can you give an example of when the last time an American fighter jet was used in a purely defensive manner?

What tbrosz so eloquently demonstrates here is the "trillions for military contractor welfare but fuck all for those who might benefit from a rational health care system" mentality that is so pervasive in the scared of its own shadow right wing asylum that is the Republican Party (as well as the faux libertarians who are really little more than low-tax jihadists).

Posted by: heavy on March 9, 2006 at 4:29 AM | PERMALINK

Of course everyone knows the insurance industry spent $400 million (the largest private propaganda campaign in American history) to defeat Hillary's health care plan. One of their bromides was that Hillary's plan would "consume one-seventh of the GDP" of the U.S.

Recent projections show that health care will cost Americans about one-seventh of our GDP in 2007. And everyone would have been covered under Hillary's plan!

One more example of how private interests are less efficient and more expensive than government programs.

Posted by: Stephen Kriz on March 9, 2006 at 5:51 AM | PERMALINK

Not one mention of this great article, "The Health Care Crisis and What to Do About It", by Paul Krugman and Robin Wells in NYRB (March 23, 2006 issue)?

Posted by: Theo on March 9, 2006 at 7:44 AM | PERMALINK

Over and over again on this thread and elsewhere, ideologues who don't live in the real world and hacks from the insurance industry, repeat the same mantra--the American people are afraid to change their health care plans, the American people don't want to give up "choice." Clue for all you ideologues and warning for all you hacks, this isn't 1994. Twelve years of MSAs and HMOs and job instability have utterly disabused rank and file Americans of the notion that their health care plans are any good, that they are stability and that users have real choice. This is an issue that sounds deeply with every American who has to provide for a family while worrying about his job rushing off to Canada. In short, I don't think the same old Harry and Louise propaganda is going to work. In fact I envision a series of Tom and Mary commercials having the opposite effect of galvanizing America for health care reform.

Posted by: Ron Byers on March 9, 2006 at 7:58 AM | PERMALINK

The most subtly dishonest statement in that excerpt is the first sentence: "Wherever you look, you find no plainly superior system."

This implies that America's current lack-of-a-system system is somehow on par with the rest of the industrialized world, which it is not. Canada and Britain's healthcare systems have flaws and may be inferior to other national systems, but they are clearly superior to what we have in America, both in terms of cost and in terms of coverage.

An honest statement would have been: "Wherever you look, you find no plainly superior system. There is, however, a plainly inferior system - and we've got it."

Also, Mr. Brosz: as I have stated before, medical technology and development are not dependent on the huge profit margins currently garnered in America, the vast bulk of which do not even go to R&D.

It was not the profits of the telephone companies that led to the Internet.

R&D is focused in America rather than other countries because of those profit margins; however, any profit is enough to drive innovation. If you are worried that new medicines will be discovered in Europe or Canada or Japan rather than here, you have a leg to stand on. But implying that health breakthroughs will not be made without the cash-bleeding SNAFU that is the American "system" is simply incorrect.

Posted by: S Ra on March 9, 2006 at 8:32 AM | PERMALINK

I'm from Canada and I like our health system just fine. I know anyone here, even the most rabid ideologues, would like it personally, too. Ideologically, that is a different story.

I admire the US. If you want, I am sure you could improve on our system, and we could learn from you. So it is a pity for all of us.

The real payoff from a single-payer system is freedom from worry about financial disaster for the common person. Anything that lessens worry is a good thing, right? For others, too, I mean.

Posted by: Bob M on March 9, 2006 at 8:55 AM | PERMALINK

Just curious: How much of the world's medical technology and development flow out of the countries you listed?

If you want an answer of the same quality as the statistics I posted, I must say that I do not know. However, I have heard that more industry money is spent on marketing than on research, and I also know, that game theory predicts that drug companies would have no interest in many practices that would help improve our health. For example -- careful (as opposed to profligate) use of antibiotics, so as to preserve the usefulness of the ones that we have. For example, how many different boner pills do we need? (Keep in mind that all the blood-flow-enhancing erection pills are merely alleviating a symptom of an underlying problem, though for many people it may be an intractable problem. We don't all have good arteries.)

Sometimes, improved outcomes are the result of boring, large scale process improvement -- I've heard that the best place in the world for a hernia operation is some hospital in Canada, because that's the one and only thing they do there, and they have become extremely good at it. Yes, you might need to travel. Yes, you might need to wait for a slot. But you'll get the best possible hernia operation.

My brother works on PET scanners. He told me some of the costs -- the cost of the box, the cost of the maintenance contract, the cost of the on-site cyclotron for making hot tracers. This equipment, if you want it to be cost-effective, should be in use 24 hours per day. Maintaining that sort of utilization requires a line, meaning that you will wait. (If I were to devise a system with co-pays, I would arrange that the co-pays were for convenience, and could always be avoided if you were willing to take the 2AM MRI appointment.)

Posted by: dr2chase on March 9, 2006 at 9:08 AM | PERMALINK

cough,cough,sneeze.excuse me I'm allergic to bullshit.is there anything that slithers out of the mouth of McA that doesn't closely resemble the fecal matter of the bovine species?

Posted by: gandalf on March 9, 2006 at 9:33 AM | PERMALINK

Shorter tbrosz: we must continue to tax our sick and old for the benefit of other countries.

Posted by: ajay on March 9, 2006 at 9:53 AM | PERMALINK

Britain's NHS has centres of excellence in some fields that rival or exceed the best hospitals in the US. Fertility clinics, for example; the sort of clinical embryological research going on in the UK is sometimes outlawed in the US. Avendon has already mentioned her eye surgery at an NHS hospital with an international reputation for quality treatment, and it dodn't cost her a penny in copays or other paper-shuffling foofaraw.

I'm a UK citizen and I've been healthy for the past twenty-odd years, not requiring the services of a doctor or medical treatment. I still find it immensely reassuring that the NHS will be there for me if I need it and I don't have to worry about whether I'm covered or not.

Posted by: Robert Sneddon on March 9, 2006 at 10:19 AM | PERMALINK

This is the grubbiest and most venerable trick in the arsenal of the lazy healthcare ideologue: pretend that Canada and Britain are the best benchmarks for comparison and then pick up your ball and go home.

No, the grubbiest trick is for the left to use Britian and Canada as examples (the right didn't pick those out of the blue - the left chose them as examples way back when) until those systems have been debated enough here for us to see their shortcomings, then move on to new examples. When the French system implodes, you'll just move on to some shiny new program as an example of how wonderful govt healthcare until that one blows up too.

Posted by: Scott on March 9, 2006 at 10:46 AM | PERMALINK

Has anyone mentioned Japan? I haven't read extensively about their system, which seems from what I have read to be fairly comprehensive and efficient.

They're facing an even gloomier demographic shift than the US in terms of a large and growing geriatric population.

Posted by: CFShep on March 9, 2006 at 10:51 AM | PERMALINK

The Canadian Health CareSystem is superb. Even when skiing accidents happen to US citizens in Canada, they often receive Canadian Health Care with no cost to them to get their broken legs or arms set. The only thing comparable to the Canadian System in the U.S. is the Veterans Administration. I have heard that the new budget will now underfund the U.S. Veterans Administration health care system, in the interesdt of balancing the budget. I hope that that rumor is wrong.

Posted by: Post-Toll on March 9, 2006 at 11:25 AM | PERMALINK

When the French system implodes

Get back to me when the French system implodes. The US one already has.

Posted by: brooksfoe on March 9, 2006 at 12:04 PM | PERMALINK

for the left to use Britian and Canada as examples (the right didn't pick those out of the blue - the left chose them as examples way back when)

The British NHS has not been a model anyone in the US held up for emulation at any time since I have been politically aware, i.e. since about 1978. The right picked them, though not "out of the blue", obviously; it picked them because they are the systems in the Western world which most closely resemble pure socialized medicine, and are thus easiest for laissez-faire ideologists to demonize. It's a lot harder to demonize the German model, which is basically like the US model, except that regulation ensures that everyone is covered and it costs 40% less.

Posted by: brooksfoe on March 9, 2006 at 12:08 PM | PERMALINK

Stefan --- homogeneous, I think you mean.......

Nothing is going to happen until the Big Donors, ie corporations, tell both Parties to get on with a universal system.

I repeat from a couple of days ago -------- the Netherlands has the most efficient system in that the premium charges are about the lowest, administrative percentage is the lowest, life expectancies are longer than here, and wait lists are shorter, outcomes as good or better.

Pretty well everyone speaks English (and I mean English, not the semi-literate ill-taught version we and the British speak!), and the Netherlands, having a large immigrant and immigrant-descended population, is quite a polyglot society.

We should hire the best Dutch team we can get and tell them to get on with it.

Do any pols read the blogs?

Posted by: maunga on March 9, 2006 at 12:13 PM | PERMALINK

I'd like to know why Cranky thinks Britain and Canada are much more similar to the U.S. than Sweden is? With the exception of the language, I don't think that is necessarily true. I've a couple decades experience with Sweden and find it overall to be surprisingly similar to the US. Except of course, if you get cancer, you don't have to worry about having to keep your job to continue your treatments.

Posted by: karin on March 9, 2006 at 12:22 PM | PERMALINK

maunga, you are in the early stages of the virus known as dutchophilia. i'm in the terminal stage (i.e. i now host the virus without experiencing many deleterious symptoms), and i can advise you to take any conclusions you may reach about things dutch in this initial feverish period with a big grain of salt.

that said, my dutch health care plan is the shizzum.

Posted by: brooksfoe on March 9, 2006 at 12:29 PM | PERMALINK

Karin is right. While English is a second language in Sweden, they speak better English than the folks in Northern England. In Manchester I needed a translator to order a hamburger. In Gothenburg the folks spoke flawless English, and no translator was needed to order off a McDonalds menu.

Posted by: Ron Byers on March 9, 2006 at 1:33 PM | PERMALINK

the u.s. healthcare nonsystem demonstrates its 'gaps and rationing' by simply eliminating 15% of the population from having healthcare coverage. most people seem to think that if you don't have insurance, you can still get care in public hospitals or in er's. as a former hospital employee, i urge them to try it...other than immediate emergency care, it doesn't happen..

Posted by: ross on March 9, 2006 at 1:50 PM | PERMALINK

*How many Americans can afford to move out of home and buy a car on their first job out of college?
Almost all. That's not true of the rest of the world.

Posted by: McAristotle on March 8, 2006 at 7:51 PM*

If you have to borrow money (i.e. loans,Credit cards, etc) to buy a car, then no, you can't afford it.

This is the problem. People spend more than they can afford. If you cannot pay for it with the money you already have, then you cannot afford it.

Based on that preface, how many can afford to move out and get a car on their first job? Not many....

Posted by: senrik on March 9, 2006 at 3:07 PM | PERMALINK

All of this is more like moving the deck chairs on the titanic, in that is is merely changing the view as we slowly go under.

Medical insurance rate have gone up an average of 15% the past 5 years running. Inflation hasn't. Neither have our Cost of living raises.

For those that are paying 350/month for insurance, how will you like it when you are more than $1200/month for lesser service? at the current rate, your premium will triple (325%)
What about those who are currently paying 800/month? are you ready for $2600/month whopper of a bill? And then still be open to complete financial ruin?

I question the alleged high rates of survival of these diseases in the US.... are those for all of those people that are in the US? or the lucky few that can afford medical care? And on which side of the fence will *YOU* be on ten years from now?

Posted by: senrik on March 9, 2006 at 3:34 PM | PERMALINK

If the Canadian helath care system is so bad, then why do so many Americans living near the border head north and pretend to be Canadians when they're sick? That line about the ills of the Candian health system is a Limbaugh/Hannity/wingnut lie aimed at people living too far south to know much about Canada.

Don't give me the line about long waiting lists and lack of choice because anyone with any experience of the American system knows that our choice is routinely limited by our insurers (anyone check the cost of seeing an "out of network" provider lately?). Although procedures are scheduled more quickly in this country than in Britain, just try to find a specialist who is taking new patients and has a waiting list of less than 3-4 months!

Posted by: Chesire11 on March 9, 2006 at 5:09 PM | PERMALINK

maunga, you are in the early stages of the virus known as dutchophilia. i'm in the terminal stage (i.e. i now host the virus without experiencing many deleterious symptoms), and i can advise you to take any conclusions you may reach about things dutch in this initial feverish period with a big grain of salt.

that said, my dutch health care plan is the shizzum.
Posted by: brooksfoe

Just don't bet the bank on tulips.

heh

Posted by: CFShep on March 9, 2006 at 6:16 PM | PERMALINK

An antidotal story:

A friend, who is an Italian National (late 20s no known medical issues) recently went through health care in Italy and the United States for the same problem. Being interested in this issue I asked him what he thought. In Italy there wait to see a doctor was shorter. He was immediately given a hospital bed. The cost was near non-existent for a moderately long hospital stay. The downside was that few test where run and the Italian Doctor never found the problem. In the US the wait was longer. Even with insurance it cost much more. The upside was that after a lengthy testing process the problem was discovered.

Posted by: james on March 9, 2006 at 6:54 PM | PERMALINK

I agree the US health system is an abomination. [I'd add the US legal/criminal justice system. If I were innocent of a crime, I'd much rather be tried under the Napoleanic Code, if guilty the rococo US system.] That said, I have a few quibbles/questions for those that advocate single payer. Are we willing to sacrifice the "civil liberties" of it's recipients? Locking up a pregnant crack whore so her baby can be born healthy? A druggie/boozer with a contagious disease that can't take his medicine as prescribed? How do we ration care for the hypochondriac? Will we accept a national ID card if that is determined to be necessary? Will these ancillary issues be honestly put forward during the debate?

Posted by: wks on March 9, 2006 at 7:06 PM | PERMALINK

I am Dual citizen, living in Canada.

The Canadian health care system is utterly horrible...And LIGHT YEARS ahead of the American system.

I have many friends and family on both sides of the border, and believe me, Americans are far worse off.

Posted by: charles parr on March 9, 2006 at 8:27 PM | PERMALINK

One of the big problems with single or private systems is that to stave off bankruptcy for those with terribly big bills you have to either pay whatever the market wants (could be enormous) and bankrupt the system, either private or single-payer, or you have to control costs. Medicare controls costs to some extent, but a larger system would have to control more. Nobody really wants price controls (a la Nixon), but nobody knows how to introduce competition into the market to bring them down that way either.

Competition is a wonderful thing. Too bad most American corporations avoid it like the plague.

What's to keep all the doctors from getting together and setting their prices?

Posted by: MarkH on March 9, 2006 at 8:38 PM | PERMALINK

Bob M writes up thread:
"The real payoff from a single-payer system is freedom from worry about financial disaster for the common person."
I'm Canadian, my boss had a heart problem at the gym. He was in an operating room next day. My hip hurts and will eventually need replacement but it is a much longer wait. So what? I can't wait for heart surgery, my hip is less important than my heart.

What I don't see from American commentators is the pernicious effect of employer provided health care on innovation. In Canada, Finland, Germany etc., if you've got an idea and want to quit your job to pursue it, and your wife gets sick, she'll be covered. You can concentrate on the risks of business building without the distraction of having your family without healthcare.

Posted by: Theophilus on March 9, 2006 at 10:53 PM | PERMALINK

wks, what dumb ass questions.

Posted by: renate on March 9, 2006 at 10:53 PM | PERMALINK

brooksfoe --- what is a "shizzum"?

I was delighted with the care we had in the early 70s in Germany. I have been trumpoeting the Dutch because my Public Health mates tell me the Netherlands is a little cheaper and a little more efficient than the German.

Is our mutual point not that Anybody Else's healthcare system which is universal is better than ours?

I have just hung up from a conversation with an East Coaster researching in public health who has assured me he/they are positive that a system founded on Medicaid and the VA systems could work, but predicated upon the providers being mandated into line as in Europe/Canada. They lament Hillary's ham-fisted presentation and are already muttering to corporations that they should be bullying Congress.

Posted by: maunga on March 9, 2006 at 11:17 PM | PERMALINK

You know, as I fought the respiratory infection I picked up sometime last weekend ALL THIS WEEK, as I battled a three day fever spiking up to 102.9 then plunging to a cool 97.7, coughing up wads of phlegm the size bottle caps through an esophagus swollen and in excruciating pain, I thought "Wow, am I lucky to live in a country where NO health care can be rationalized as superior with a simple 'no system is perfect' argument." Of course three days without sleep MIGHT have affected my thinking.

Better yet is my next dilemma, have my lower left 1st molar pulled because it cracked through the enamel and shed a cusp or gamble that I get a job with dental and try to save it? I love being forced to make these decisions, rent or health, car payment or dental... What a country!

Posted by: Eric Paulsen on March 10, 2006 at 1:10 AM | PERMALINK
How many Americans can afford to move out of home and buy a car on their first job out of college? Almost all. That's not true of the rest of the world. -- McA

Almost all UK students can move out and buy a car after leaving college - you are saddled with less debt on average than in the US when leaving college. Which planet do you live on?

I've experienced both UK and US health systems. The company I work for provides health insurance on both sides of the pond. And my verdict - the US system sucks big hairy ones compared to the UK equivalent (NHS plus company provided private medical). I've never had to use the private cover, but I've used the NHS quite a bit.

Posted by: royalblue_tom on March 10, 2006 at 9:27 AM | PERMALINK




 

 

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