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Tilting at Windmills

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March 10, 2006
By: Kevin Drum

TNR ON NATIONAL HEALTHCARE....It would be belaboring the obvious to say that the liberal blogosphere has its differences with The New Republic. Today, though, in Frank Foer's first issue as editor, they go a very long way toward redeeming themselves:

Since President Clinton's health care plan unraveled in 1994 a debacle that this magazine, regrettably, abetted liberals have grown chastened and confused, afraid to think big ideas. Such reticence had its proper time and place; large-scale political and substantive failures demand introspection, not to mention humility. But it is time to be ambitious again. And the place to begin is the very spot where liberalism left off a decade ago: Guaranteeing every American citizen access to affordable, high-quality medical care.

That's precisely right. Liberals need to be ambitious again, and guaranteed healthcare for all is a vision worth fighting for. As TNR points out, our current system is both enormously expensive and badly broken:

Perversely, our extra spending doesn't seem to buy us better medical care. According to virtually every meaningful statistic, from simple measures like infant mortality to more carefully constructed data like "potential years of life lost," Americans are no healthier (and are frequently unhealthier) than the citizens of countries with universal health care. Nor do Americans always get "more" medical care, as is commonly assumed.

The citizens of Japan, for example, have more CT scanners and MRI machines than we do. And the French, whose system the World Health Organization recently declared the planet's best, have more hospital beds. They get more doctor visits, too, perhaps because their access to physicians is nearly unfettered a privilege even most middle-class Americans surrendered with the spread of managed care. In fact, aside from cost, the measure on which the United States most conspicuously stands out from other advanced nations may be public opinion: In a series of polls a few years ago, just 40 percent of us said we were "fairly or very" satisfied with our health care system, fourth worst of the 17 nations surveyed.

Read the whole thing. As TNR's editorial implies, if we're going to join this battle it's critical that we cut through the scare tactics of the right and finally tell the American public the simple truth about national healthcare in other countries: that it works better than American healthcare. As our creaky private sector system increasingly sputters and breaks down, the seemingly "old" idea of universal healthcare is more relevant than it's ever been, and TNR's conclusion is exactly correct: "Government isn't the best way to provide all Americans with health security. It's the only way. And it's time for liberalism to say so openly."

Kevin Drum 12:39 AM Permalink | Trackbacks | Comments (67)

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Comments

First comment!!!!!!!!!!!!!!!

Posted by: peanut on March 10, 2006 at 12:44 AM | PERMALINK

Oh, about universal health care? Don't care. Never gonna happen in this country. Plus I grew up in a socialist country and had enough of that shit there.

So boring.........

ok, off to bed.

Posted by: peanut on March 10, 2006 at 12:45 AM | PERMALINK

As others have pointed out, that also means not letting wingers point to England & Canada as paradigms of fine care. They are both pretty lousy, although still better than the US.

As Kevin points out, France, as well as Switzerland, can be looked to as the way it ought to be done.

Posted by: SteveAudio on March 10, 2006 at 12:47 AM | PERMALINK

Thats 'Privatization' [wink wink] for ya skyrocketing costs,
Imagine this 'Privatized Social Security' under Bush. Scary Huh?


wooOoOoo!!!
Fun Facts of Yesteryears Rehashed;
n 1976, President Gerald R. Ford signed a directive that granted Iran the opportunity to purchase U.S. built reprocessing equipment and facilities designed to extract plutonium from nuclear reactor fuel.

And yet more Fun Facts;
When Gerald Ford assumed the Presidency in August 1974, the current Vice President of the United States, Richard B Cheney served on the transition team and later as Deputy Assistant to the President. In November 1975, he was named Assistant to the President and White House Chief of Staff, a position he held throughout the remainder of the Ford Administration.[1]

WoOOoOooOo!

Posted by: one eye buck tooth [X^B on March 10, 2006 at 12:47 AM | PERMALINK

Kevin,

You should stay on this subject...you're good this and it needs doing.

Posted by: S Brennan on March 10, 2006 at 12:49 AM | PERMALINK

The Democrats are always on the side of the majority opinion on most economic and social issues -- but they get swift-boated just before elections.

Yes, get ambitious again -- and develop a serious approach to deal with Republican demagoguery. What's needed is not just serious thought about the issues -- but defense against Rove.

Posted by: JS on March 10, 2006 at 12:50 AM | PERMALINK

Go RePublicans!
"The Nuclyeer Plan"
For IRAN!!

YaY oh YaY Nukeleer Security!
Save Me Mr. Bush Save Us All

From You and the other Republicans that is.

Posted by: one eye buck tooth [X^B on March 10, 2006 at 12:53 AM | PERMALINK

If you want quality healthcare, rather than $/capita, it seems to me the focus shouldn't be on MRIs or whatever. The focus should be on reducing error, something no system I know of does with any real energy. Everyone expects to just pour money into treatment and machinery.

In engineering, say in aviation, every accident is analyzed for lessons to eliminate the next one. In aviation this has brought failure rates from the one per 10 hour level down to one per 100 million hours. Every accident is analysed for lessons to be learned to prevent the next one. Every regulation has deaths behind it, and careful work to deign the cause without as little regard to ego or personal blame as humanly possible.

Not so in health care. Doctors are demigods. As has been written up even in the MSM lately, autopsies are at an all-time low despite that they find the proported cause of death was incorrect a huge percentage of the time - "a difference of 44% in the pre- and postmortem diagnosis of cancer", for example, and equally large mistakes and missed factors otherwise.

Interns are still put through obscene shift densities, endangering patients and creating bad habits. Would you get in a jet where both pilots had slept four hours in the last 3 days? This is just an example.

Due to the high status the medical profession's members have, legal worries, and potentially angry relatives, they're not held to anything like the quality-improvement and post-mortem f@ckup analysis aviation or engineering generally are. It should be a matter of course. Every mistake should be found, not hidden.

And doctors should be regulated - with logbooks, peer reviews of their record, periodic re-testing, and hours of work limitations - with the same scrutiny as pilots or aviation mechanics. Additional training isn't enough. Or would that be too blue-collar?

Posted by: Bruce the Canuck on March 10, 2006 at 12:54 AM | PERMALINK

At least as far as pharma, I'm concerned that since the rest of the Western world free rides off of our drug discovery, we can't emulate the Swedish system without strangling medical development.

Posted by: Sebastian Holsclaw on March 10, 2006 at 1:00 AM | PERMALINK

Yeh Kevin I agree with other guy..

As others have pointed out, that also means not letting wingers point to England & Canada as paradigms of fine care. They are both pretty lousy, although still better than the US.

As Kevin points out, France, as well as Switzerland, can be looked to as the way it ought to be done.
Posted by: SteveAudio on March 10, 2006 at 12:47

You seem to know this Health Subject...

Yet min wage is still below poverty..I am not hopeful for a global economic nor health system.
Many are still too materialistic and see money or power and not humans.
Privatized Security like BlackWater USA is a good example of this could care less attitude of profit before mankind.

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:04 AM | PERMALINK

Bruce the Canuck >"...doctors should be regulated - with logbooks, peer reviews of their record, periodic re-testing, and hours of work limitations - with the same scrutiny as pilots or aviation mechanics..."

Smartest thing I`ve heard in a very long time

Thanks !

"Everyday reality now is a complete fiction, manufactured by the media landscape and we operate inside it." - JG Ballard

Posted by: daCascadian on March 10, 2006 at 1:06 AM | PERMALINK

Kevin: The only way you will get the middle to agree to this is if you detail out what you mean by Universal health care. Is everyone covered including illegal aliens? How will the quality of health care not drop for most people including wait times? Can people choose to pay for more health care if they have the means? How much will it cost? How will it be paid for? I suspect this will never get the vote from the middle to the middle right of the electorate until these and other questions can be answerd.

Posted by: SteveL on March 10, 2006 at 1:07 AM | PERMALINK

Heh. Nice suggestion Drum: Government isn't the best way, it's the only way.

Nice to see you libbies own up to what you really believe. It's not about Universal health care, or serving the under served, or the few uninsured, it's about letting the US Govt run the whole shop.

I also think you should stop being ashamed about
advocating for abortion rights. It's not about "choice" (what are ya choosing: your brand of breakfast cereal?) it's about abortion. If you can just own up to that always, you will feel better about it ultimately. Since honesty is always the easiest option.

Of course, it's also a great option for you guys to stay out of office indefinitely.

Which I can live with (giggles)

Posted by: cecce on March 10, 2006 at 1:10 AM | PERMALINK

What's needed is not just serious thought about the issues -- but defense against Rove.

Even if ROVE left I don't think it would slow down the slash and burn tactics of the Senate one bit.

The Cloture Club sits on its hands without Rove.
Your not Battling Rove here, your Battling a War against the Murdoch, Kristol, Monarch Media "newscorp" Pundit TV.
AKA the Echo Chamber.

Knock that sucker out and they are history.
Kristol and Perle are scurrying around as it as after Fukuyama did a Hatchet job and ran over to American Interest$$

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:12 AM | PERMALINK

Of course, it's also a great option for you guys to stay out of office indefinitely.

Which I can live with (giggles)
Posted by: cecce on March 10, 2006 at 1:10 AM |

Yeh its pretty funny to watch someone die when you dont profit from it right?
If I were you and Loved profits and hated people so much I think I would take my happy ass on over to Blackwater USA be a Mercenary and spill some Blood, go oover their and kill some people, have a good yukk.

I suppose you also think a One Million dollar missile used to Blow the hell out of Mud House, or a Tent is profitable or Fun? Sure you do.
Didnt you see what you typed?

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:17 AM | PERMALINK

One eye, "Rove" is an abstraction for Republican dirty tricks. He's not the only one doing them -- but he's the best at it. Elections are not about issues any more.

Posted by: JS on March 10, 2006 at 1:21 AM | PERMALINK

hey fuck booth, or whatever-your-name-is: I have no idea what you're whining on about, but if you want to yak yak yak endlessly about the war while simultaneously displaying your lack of knowledge or perspective, i'm sure there are other threads here where you can do that...

Or: you could just go to sleep.

It's obviously WAY past your bedtime.

Posted by: cecce on March 10, 2006 at 1:21 AM | PERMALINK

So killing a Baby with a Bomb in Iraq for a War based on WMD Fabrications and that will cost up to 2 trillion dollars, not to mention American Lives and Limbs lost, so you cecce, can GIGGLE about healthcare?

How so do you Rationalize this?
2 Trillion to Kill Men Women Children for FREEDOM?
to you thats 'Profitable' or Funny?
So a War that Profits the Republican Party and kills possibly a hundred thousand to keep 'YOUR' guy in office is worth it?

WOW.
2 TRILLION TO KILL PEOPLE
CECCE LAUGHS
about spending 2 trillion to cure people. Perhaps prevent (science) unwanted pregnancy with that money?

You are one cold hearted self hating Troll cecce.

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:27 AM | PERMALINK

Your Knowledge LOL
to giggle at dying poor people?
Thats Knowledge?

Thats funny. But I see I got your Goat.
Nice try with the third grade name calling BTW

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:29 AM | PERMALINK

As I said, fuck booth, sleepy-time...

Seriously, you need it.

Posted by: cecce on March 10, 2006 at 1:30 AM | PERMALINK

In the richest country in the world, you can walk into a store and see a jar on the counter collecting quarters and dollars for little Amys dialysis or Franks liver transplant.

The fact that so many have to beg for pocket change at 7-11 is a sure sign that the system is broken.

Posted by: Keith G on March 10, 2006 at 1:32 AM | PERMALINK

Aww whatss wrong cecce you didn't like my Preznit FORD, a Republican, mind you, Nuclear IRAN factoid?

Hurts don't it?

And I beat you to the name calling of myself myself =)

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:32 AM | PERMALINK

Waiting lists!
Moral hazard!
Free riders!

That is all

Posted by: Conservative KneeJerk on March 10, 2006 at 1:34 AM | PERMALINK

Oh Really Dr Frist?
Pray Tell.
this should be interesting.
I live in a Trailer Park Right?

You dont know do you?

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:34 AM | PERMALINK

Oh, please Keith, the propensity of Americans to give to charity has nothing to do with the quality of our health care.

Posted by: cecce on March 10, 2006 at 1:35 AM | PERMALINK

Who is this one-eye guy? Is he for real?

Posted by: lydia on March 10, 2006 at 1:37 AM | PERMALINK

I'm trying to see any facts that you posted Cecce?

Surely a self confessed genius as yourself would have posted something.
Me being a poor stoopid feck ya know mebbe I missed it. Enlighten me oh Giggle Box!

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:37 AM | PERMALINK

Yes Lydia
I really have one eye and buck teeth.
And 6 fingers on each hand
My Skin is yellow
WTF you think?
ITS A SILLY NAME

Sheesh
Goodnite cecce I love Yew!!

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:41 AM | PERMALINK

Hey one eye: I don't think it is a strong argument for your case that you grew up in a trailer park, or have buck teeth, or are stupid.

I'm sure you are but that doesn't help. There's no "affirmative action" here for lame arguments. You've either got good arguments or not.

You seem mostly confused.

Posted by: lydia on March 10, 2006 at 1:42 AM | PERMALINK

Since President Clinton's health care plan unraveled in 1994

Lemme see if I got it straight. Um, hacking defense, invading small countries in the name of something, um, universal health care, deficit-reduction perhaps, and oh, um Hillary!

So, based on some echo chamber theory of a 1994/1974 repeat in 2006, come the revolution, it's gonna be just like Dallas where what's-her-name woke up and found Bobby Ewing in the shower!

"And you were there, Stephen, and you were there John, and you were there Madeline, and this wicked grinch came along and stole all our contributors, and then the flying green footballs invaded Iraq but I found the ruby slippers after the hurricane came and carried away the Wizard Hussein and I managed to save Auntie Hillary from impeachment! But everything is ok now!"

Gonna party like it's 1993!

I mean, it's a stratergery.

ash
['Neurotics build castles in the air and psychotics move into them.']

Posted by: ash on March 10, 2006 at 1:45 AM | PERMALINK

Oh Puleeese, Cecce:

People having to beg for money to cover medical treatment, folks going bankrupt to fight their child's cancer has everything to do to with measuring the quality of our health care.

Posted by: Keith G on March 10, 2006 at 1:47 AM | PERMALINK

Turning left. I will out-left you. I will not rest until we pass laws forcing doctors to work for free or be jailed treating me for things I will pay.

Producers of medicine will keep shelves stocked for free or die.

Yes, that will make the world a better place.

Posted by: McA on March 10, 2006 at 1:55 AM | PERMALINK

lydia I dont see arguments here.
Its opinions. And you guys HAVE alot of those.

One cannot ever win Arguments based on opinion.
Its all Rhetoric.

Secondly you call what Cecce said an Argument or an Idea?

Nice to see you libbies own up to what you really believe. It's not about Universal health care, or serving the under served, or the few uninsured, it's about letting the US Govt run the whole shop.

I also think you should stop being ashamed about
advocating for abortion rights. It's not about "choice" (what are ya choosing: your brand of breakfast cereal?) it's about abortion. If you can just own up to that always, you will feel better about it ultimately. Since honesty is always the easiest option.

Of course, it's also a great option for you guys to stay out of office indefinitely.

Which I can live with (giggles)

TO continue;
One eye, "Rove" is an abstraction for Republican dirty tricks. He's not the only one doing them -- but he's the best at it. Elections are not about issues any more.
Posted by: JS on March 10, 2006 at 1:21 AM | PERMALINK

This is a FACT or an opinion?
It looks to me as OPINION stated as FACT.

elections ARE NOT about issues anymore.

So HOW do you PROVE that?
Is that AN IDEA?

Jeez Im on your guys Side. But im not a Journalist..I use facts about nuclear energy or facts about heavy water or Green Salts, or what I know of Technical stuff..Jet Engines, electronics, FACTUAL things..

Posted by: one eye buck tooth [X^B on March 10, 2006 at 1:59 AM | PERMALINK

Jeeez. All I know that whenever one-eye turns up this blog becomes like the special olympics of policy arguments...

Posted by: Unarmed Liberal on March 10, 2006 at 2:02 AM | PERMALINK

all i know is my own healthcare was changed recently. The provider proudly trumpeted how we have more choices than last year. Truthiness. Weasels. Yes there are three choices this year as opposed to two last year.

The trouble is, every single choice this year is worse than any of the prior two choices from last year. So now I have more choice in how I get screwed. A 30% increase in my costs.

Posted by: coltergeist on March 10, 2006 at 2:21 AM | PERMALINK

And the French, whose system the World Health Organization recently declared the planet's best, have more hospital beds. They get more doctor visits, too, perhaps because their access to physicians is nearly unfettered

We might go easy on that argument because the French system provides medical care to the people who are attacking it from within, and because the French system got a black eye during the heat wave.

A good thorough debate is doubtless in the public interest, but a dedicated effort by the Democratic party to enact universal health care is probably the only thing that can keep the Republicans in the majority in the 2006 elections. Those elections are only 8 months away, and I doubt that you can turn the tide your direction in that time.

About cost savings: people spend an awful lot of money keeping their loved ones alive a few more hours, a few more days, a few more weeks. I doubt that they'll easily give up the right to continue doing so; the net effect of a new national health care system is likely to be a large increase in federal spending without a reduction in the private sector. Before you start a national campaign, make sure that you have thorough arguments on this and other issues (why should illegal immigrants qualify for taxpayer funded health care, etc?)

Also, you probably want to avoid citing WHO as an authority. They are wrong at least as often as anybody else in the UN; they get their statistics from national governments, and do not have independent evidence.

Posted by: republicrat on March 10, 2006 at 2:37 AM | PERMALINK

Dont you GET it.
I'm left of centerside.
The tone taken here with me was one of Scoff and Disregard.

I encouraged that emnity. =)

Alot of the bloggers here come off as elitist assholes to anyone else but themselves or the 'click' of likeminded individuals.
I ask
How are you going to get majority votes with that?
You aren't speaking to yourselves are you?
You want to speak to the majority right?
People like me?

well lemme tell you something smarty pants

YOUR propensity for extravagant dialectic negates that which you are proposing to accomplish
Extravagant words are often seen as deceptive
ergo you are not trusted in the eyes of the majority.

You may well come to hate me, many do already, but thats only because they project that image of what I am or Am not upon these words typed.

I gave you misspelling and Idiotic Names.
You gave yourself the image of what or Who I am.

I am no one.


Posted by: one eye buck tooth [X^B on March 10, 2006 at 2:54 AM | PERMALINK

Bruce the Canuck,


Ultimately, the reason that pilots go along with intensive safety regulations and doctors don't is that when a resident fucks up, he's not the first one to fly into the mountain.

One point to be considered from both a cost and physician availibility standpoint is that Europe has far more physicians per capita than we do. German ambulances have a doc riding along and French doctors still do house calls. American medical schools aren't keeping up with population growth. This is made worse by tighter immigration rules that make it harder for American trained foreign doctors stay.

Also since half of all medical students now are females, you have a lot of young doctors finishing training and then either working limited hours or not practicing for a few years to raise children. There's nothing wrong with that, but medical school class sizes haven't been increased to reflect this. There are a LOT of qualified pre-med students who don't get into any med school. You could double the number of med students accepted without degrading the quality.

About 10 years ago, there was a study that documented that the pool of white candidates, on average, rejected for med school had higher paper qualifications than the average pool of minority candidates who were accepted. It was a plot point in medical dramas for a while-- patients refusing care from an "affirmative action doctor".

Which misses the point, if a student, minority or otherwise, can't keep up with medical school or can't pass their boards, they're out. The real issue isn't the minority doctors (who all passed their boards or they wouldn't be practicing), but rather the large number of potential doctors who never get a chance.

Posted by: beowulf on March 10, 2006 at 3:02 AM | PERMALINK

You GottDamn naysaying feckin ninnie bobs are worried about what chocolate starfish terdblossom ROVE wore at the feckin teaparty?

Yew pink soft fleshy palmed mental masturbationists and yer extravagant bullshit.

Posted by: one eye buck tooth [X^B on March 10, 2006 at 3:30 AM | PERMALINK

Dear Earth Please Swallow these lunatics up.

Did it ever occur to any here that your just rehashing the same old shit?

How many years? Decades? Centuries?
Why can't you see that all this, this Bias, these opinions, these learned likes and dislikes, party or non party, that you cant escape from may be what's stopping you from reaching a rational decision?

Posted by: one eye buck tooth [X^B on March 10, 2006 at 3:37 AM | PERMALINK

instead of Health care its Rove, or Poltical move, or a business deal, democrat libruls, a free ride, lazy poor.

min wage is below poverty level.
If you continue to have poverty wages then does it not follow we will always need have some free form of health care available?

Posted by: one eye buck tooth [X^B on March 10, 2006 at 3:41 AM | PERMALINK

TNR: liberals have grown chastened and confused, afraid to think big ideas....But it is time to be ambitious again.

Indeed. Better to lose with big ideas than small ones - one might actually win some converts with big ideas.

Posted by: RT on March 10, 2006 at 5:46 AM | PERMALINK

Let's get real. Republicans don't care if there's a better system that would cover more people, cheaper and with better care. Even if health care were somehow magically free, they wouldn't want it to be given out to the poor and needy. Where's the profit in that? Same thing with education.

In their world, the working poor and lower classes deserve to be eating sh*t and dying in the streets like dogs. A healthy, educated citizenry is dangerous to their hegemony. Sick and ignorant consumers are a lot easier to control and make a profit off of--and will never be politically powerful.

Their private profit over the social good. Always been that way, always will be that way.

History teaches us that the only way to change it is with socialist government, taxing the rich and reinvesting in the citizenry. Republicans know this which is why they hate liberals worse than poison.

Vicious propaganda, stealing elections and suppression of poor voters is just the beginning of what they'll do to keep this modern plantation system going strong.

Posted by: Chip Pringle on March 10, 2006 at 5:48 AM | PERMALINK

Does this mean Hillary was right? Is big business tired of subsidizing Big Pharma? Can the US pension system that is imploding due to exploding health care costs be saved?

Posted by: aline on March 10, 2006 at 6:49 AM | PERMALINK

In the richest country in the world, you can walk into a store and see a jar on the counter collecting quarters and dollars for little Amys dialysis or Franks liver transplant.

The fact that so many have to beg for pocket change at 7-11 is a sure sign that the system is broken.

Word. Keith G has written the first commercial for this campaign.

Posted by: Gregory on March 10, 2006 at 9:08 AM | PERMALINK

The insurance companies are the evil empire, always have been always will be. They are virtually unregulated and consumer's are baring the brunt of their profits. Antitrust relief remains a high priority for physicians. Legislation is needed to enable physicians and other health care professionals to effectively negotiate with health plans without fear of violating antitrust laws. Physicians should be allowed to negotiate contract terms that increase patient choice and improve quality of care. Patients and their physicians should make informed decisions about their health care needs, not insurers. Keep it in the inner circle of the family and physician.
MM

Posted by: magicallymerlin on March 10, 2006 at 11:27 AM | PERMALINK

"According to virtually every meaningful statistic, from simple measures like infant mortality to more carefully constructed data like "potential years of life lost," Americans are no healthier (and are frequently unhealthier) than the citizens of countries with universal health care."

I'd like to see the evidence for this extremely implausible claim. Show me a study or set of studies from reputable sources that establish that Americans do no better, or worse, than citizens of countries with universal health care "according to virtually every meaningful statistic."

Posted by: Avatar on March 10, 2006 at 11:54 AM | PERMALINK

Kevin, I basically agree with you. But, to succeed here, Democrats have to acknowledge one point that plays to many voters' fears, which I'll sum up with an example:

If you have, say, Pancreatic cancer and you need a whipple operation, where do you want to go:

A) Johns Hopkins
B) Anywhere in the world outside of US borders

Point being, there really are areas of US Healthcare that are superior to that of every other country. That has to be acknowledged and addressed by any Democratic plan. To make a blanket statement that US healthcare is terrible leads to an instant loss of credibility. And there are an awful lot of voters that appreciate the example above, and are at least as worried that they or their loved ones will get cancer one day than that they will lose their health insurance.

Posted by: lewp on March 10, 2006 at 11:57 AM | PERMALINK

Bruce the Canuck,

And doctors should be regulated - with logbooks, peer reviews of their record, periodic re-testing, and hours of work limitations - with the same scrutiny as pilots or aviation mechanics. Additional training isn't enough. Or would that be too blue-collar?

Not "too blue collar," but probably too restrictive. Your proposal would make an already limited resource even scarcer. Instead of having to wait 2 days to see a primary care physician, people will have to wait a week. Instead of waiting 6 hours in the ER to see a doctor, people will have to wait 12. It seems rather likely that that would produce adverse health outcomes too.

Posted by: Avatar on March 10, 2006 at 12:00 PM | PERMALINK

Avatar, I don't have a link right now, but there was a recent study that showed exactly that (I'll say "most" meaningful stats, not "virtually every"). The US Health Care system falls down on a number of levels, and particularly in the aggregate. Part of the point of my other post, however, is that "in the aggregate" doesn't tell the whole story. If you're rich, well-located and well-informed, you may well receive the best health care in the world in this country. And voters view healthcare as a personal thing. They look at health care as individuals, not in the aggregate. They worry about themselves, not the population as a whole.

Posted by: lewp on March 10, 2006 at 12:06 PM | PERMALINK

"Avatar, I don't have a link right now, but there was a recent study that showed exactly that"

What was it called, then? Just give me the name of the study and I'll google it.

I very seriously doubt there's any study that has found that the U.S. is no better or worse than countries with universal health care on even "most" measures of health and health care, let alone "virtually all" of them.

Partly this a problem of the inadequacy of aggregate statistics, especially averages. Just as "average income" or "GDP per capita" may be a very poor indicator of the economic situation of most people, measures like "average life expectancy at birth" or "infant mortality rate" may be very poor indicators of the life expectancy of most Americans, or of the health of most babies.

Posted by: Avatar on March 10, 2006 at 12:25 PM | PERMALINK

Yeah, but their still doing the one thing that annoys me most -- conflating elite "liberal" media outlets and the leadership of the Democratic party with the group known as liberals, as here:

Since President Clinton's health care plan unraveled in 1994 a debacle that this magazine, regrettably, abetted liberals have grown chastened and confused, afraid to think big ideas.

This is not, in my experience, even remotely true of liberals in general, though it certainly seems very true of the inside-the-beltway (literally or by inclination) "elites" of the Democratic Party.

Generalizing from them to "liberals" is about as valid as generalizing from the College of Cardinals to "Catholics".

Posted by: cmdicely on March 10, 2006 at 1:09 PM | PERMALINK

so TNR should prove that they're serious by posting the famous "No Exit" piece with a key to the falsehoods and misrepresentations it contained. (I've never been able to find a copy of the piece on the web). Let's see a real mea culpa!

Posted by: David on March 10, 2006 at 1:37 PM | PERMALINK

We have to give up our conceit that we have the best of everything. No one in the whole wide world has anything better than we have. Choice is the most important thing, even when we don't have it we insist we have more choices. I can choose between one physician within a radius of 45 minutes away or have another choice if I am willing to travel more than 45 minutes.
With a single payer system I can choose any physician in town.

Other nations have strong pharma industries too, France, Switzerland, Germany, and others. Get off the BS only the US has new products. The day after pill for example comes from France, remember? Penecillin was discovered by a Brit, Ex-rays are from a German and the first heart transplant was performed in South Africa. Just a few examples.

Yes, Kevin should keep it up. Even when we keep repeating, we need to be relentless and put the heat on the Democrats.

Posted by: renate on March 10, 2006 at 2:20 PM | PERMALINK

"With a single payer system I can choose any physician in town."

Not true. "Single payer" just means there's a single source of funding. It doesn't imply anything about one's ability to choose a doctor. Under Britain's single-payer NHS, choice of doctor is severely constrained. That is especially true for specialists, but it applies to primary care physicians too.

Posted by: Avatar on March 10, 2006 at 2:55 PM | PERMALINK

I agree, in principle, with the idea of a single-payer system. However, I have a concern that is based on pure reflexion, not on any data or information. Do you think that this can stifle inovation and medical research? I think the private market is more efficient on this than the government, any government, as it is naturally more dinamic and less constrained. But would government be responsible for all research on such a system? Or the entities that currently fund medical care in the US are not the ones who work on such R&D, which means they are separate things? Does anyone has any idea on what those european single-payer systems did to their medical research?

Posted by: Brazil Connection on March 10, 2006 at 4:15 PM | PERMALINK
Or the entities that currently fund medical care in the US are not the ones who work on such R&D, which means they are separate things?

Insurance companies do not, by design, fund research, though they are the main direct payors for medical care, aside from state and federal governments (which bear a lot of the costs, and do, at least the fds, also pay intentionally for research, though separately.)

Much research funding is just built into drug costs; though much less than marketing costs. How much either of those change depends on the details of the model of single-payor chosen, though there is certainly (contrary to much of the scare mongering) no necessary elimination of research funding, quality, or progress with single payor.

Posted by: cmdicely on March 10, 2006 at 4:27 PM | PERMALINK

...though there is certainly (contrary to much of the scare mongering) no necessary elimination of research funding, quality, or progress with single payor - posted by cmdicely

That's how I see it too. It looks to me like what is being proposed is that funding for medical care gets shifted from insurers, employers or citizens to the government, so I don't see how this would affect medical R&D. Unless insurance companies fund a lot of research, specially on preventive medicine - something I think they should do, but don't know if they do.

I understand, at least in its basics, how drug pricing works (but I'm no expert neither work with it), and I do believe that, unless this single-payor government forces drug companies to waive patent rights for lack of a customer (which it would naturally have to do at their own peril) or shifts to generics (which aren't always available), drug R&D would still be funded by this single-payor who would purchase them. Does the idea of a single-payor, by the way, covers everything, including drugs?

Posted by: Brazil Connection on March 10, 2006 at 4:42 PM | PERMALINK

I meant that "it would have to do it at ITS own peril", meaning the government. Awkward very much the English of me can be times some.

Posted by: Brazil Connection on March 10, 2006 at 4:44 PM | PERMALINK
It looks to me like what is being proposed is that funding for medical care gets shifted from insurers, employers or citizens to the government, so I don't see how this would affect medical R&D.

I think the general idea behind the arguments is that lower negotiated prices would cut out the profit and leave less resources for R&D. Its certainly not inconceivable, though there are ways to avoid or mitigate the risk of that.

I understand, at least in its basics, how drug pricing works (but I'm no expert neither work with it), and I do believe that, unless this single-payor government forces drug companies to waive patent rights for lack of a customer (which it would naturally have to do at their own peril) or shifts to generics (which aren't always available), drug R&D would still be funded by this single-payor who would purchase them. Does the idea of a single-payor, by the way, covers everything, including drugs?

Usually in broad outline, though I suspect, as it is now with insurance, coverage might be generally limited to prescription-only drugs, and drugs available OTC, even when directed by a physician to treat a diagnosed condition, might generally be paid for by the consumer (though I've always thought that was irrational under the private insurance model, so perhaps in a rational single-payor model this would not always be the case.)

Posted by: cmdicely on March 10, 2006 at 5:01 PM | PERMALINK

Avatar, maybe in England you can't choose, in Germany you can, I know it for a fact.

Posted by: Renate on March 10, 2006 at 5:14 PM | PERMALINK

I suspect that the high prices paid for pharmaceutical drugs by Americans do indeed subsidize those drugs for people in other countries, and that if health care reform in the U.S. reduces that subsidy either people in other countries will end up paying more or getting less.

Posted by: Avatar on March 10, 2006 at 5:24 PM | PERMALINK

It's also interesting that the TNR editorial effectively represents a veiled slap at Andrew Sullivan, who as editor ran the cover-story jeremiad against the Clinton plan penned by Elizabeth "I Read the Whole Thing" McCaughey -- later the hapless lieutenant governor of New York.

Posted by: SP on March 10, 2006 at 6:58 PM | PERMALINK

It's funny. One of my relatives just had a long chat the other day with one of the best doctors in the state, and he seems reasonably the system will collapse in the next decade. And he had only charitable things to say about the French and Canadian systems.

Posted by: Blue Nomad on March 11, 2006 at 1:27 AM | PERMALINK

Why is it that the police and fire departments are tax payer funded and are among the finest on the planet -- yet critics claim that tax payer funded healthcare would fail?

Our police and fire depts are among the most technologically advanced and highest trained on the planet and its all paid for by taxes. Every single citizen in this country regardless of income or employments status as equal access to police and fire services 24 hours a day. So why not healthcare?

No police officer runs a credit check on you before he saves you from a mugger, nor do they send you a bill for $5,000 after he saves your life.

Can you image a police officer pointing a gun at a rapist and then demanding the women in danger provide her 10 digit "Police Coverage" account number???

"Stay calm ma'am" orders the police officer. "Your insurance will cover 40% of this police action after you pay your $100 deductible. The fee schedule for stopping a rape in progress is $5,000. So if you'll just write me a check for $100 I can arrest this scum bag and you'll get a bill for the rest in the mail!"

As the women gets dressed and tries to write out a check a call comes through to the cop. Turns out the woman is 90 days past due on her Police Insurance payment. The cops informs her that her police protection has been suspeded until she pays her bills in full and then walks away letting the rapist continue.

How is this scenario different from refusing someone chemotherpay or heart medicine or physical rehabilitation after a stroke just because they can't pay the bribes, er, I mean the insurance premiums?

Letting someone get raped or letting someone die of cancer just because their broke? What's the difference?

Being protected from muggers is a "right" but getting chemotherapy is considered a "consumer choice"?? Are you kidding me?

And we're all buying into how the Republicans have framed it, haven't we?

Posted by: Chris on March 11, 2006 at 9:50 AM | PERMALINK

Good post, Chris.

Privatizing the police and fire departments and running the kinds of services you suggest is the next logical step in the annihilation of our country.

Posted by: glasnost on March 11, 2006 at 1:53 PM | PERMALINK




 

 

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