Contrary to what Kinsley implies about single-payer, we already have rationing. The rationing mechanism is a lottery/tournament where people with good jobs get the health insurance that goes with them and the other 20% get to fend for themselves.

Kinsley gets close with the economic efficiency argument, but misses a big point. Those who took econ 101 will know about deadweight loss -- the loss to society because of trades that didn't occur, or trades that occurred that shouldn't have. For example, if the government was in charge of producing beer, they wouldn't get the price right, and would produce too much or too little.

Well, we pretty much want everybody to treated when they're sick. And they usually do anyway, but often too late, and in emergency rooms. And that's why I think the government can provide the "right amount" of health care. And that's why single-payer works well in dozens of countries today.

sluggo beat me to it, but it's a point that can't be made often eough: rationing is here today. kinsley, who has Parkinson's and a wealthy wife, is perhaps afraid that rationing might affect him under other circumstances than our current mess.

Kinsley's schtick sure gets tiresome sometimes.

Kinsley makes very good points. Government controlled healthcare will have cause rationing to happen. This rationing may mean we are less healthy because we won't get the health care we need. This is why Bush's private accounts are superior. Bush's private accounts allow each of us to choose the level of health care we want without the big government mandating us to do what it wants. So each individual can shop around for the health care is best for him throught the free market instead of a one size fits all health care which everyone is required to have.

If the Al robot isn't quick enough to post first, he should at least have to address the points made before him that contradict his post.

"Government controlled healthcare will have cause rationing to happen. This rationing may mean we are less healthy because we won't get the health care we need."

BEEP BOOP BEEP 1100010101101010100010101011110110

Kevin writes,

"There are few social programs we know more about than single-payer, and what we know is that in a well constructed program costs are lower, the quality of healthcare is better, the amount of healthcare is higher ..."

We most certainly do not know those things.

Economy go smash!

"We most certainly do not know those things."

Then you need to learn them.

Actually I think Kinsley has a valid point: There is really very little cost savings that would come about due to changing to a single payer system alone. Our system does resemble a subsidy plan more than it resembles pooled risk. The U.S. is very different than other nations that have single payer plans and may not experience cost savings. In fact our total health care costs would probably increase, though it would be due to more people getting the health care that they are not getting presently.

The only argument going for single payer is that it guarantees better health care to those who are not wealthy enough to afford it. That is a sufficient argument for implementing it. Health care accounts would be a step backwards.

coldhotel: There is really very little cost savings that would come about due to changing to a single payer system alone. Our system does resemble a subsidy plan more than it resembles pooled risk. The U.S. is very different than other nations that have single payer plans and may not experience cost savings. In fact our total health care costs would probably increase, though it would be due to more people getting the health care that they are not getting presently.

Please back up even one of these assertions with plausible reasoning.

Al--listen to yourself--who wants to shop around when there's a ticking-time bomb of an embolism in your child's brain? Do you really expect people to make rational cost-conscious decisions at times like these?

Public health is a public good and the government has a responsibility for ensuring it.

Perhaps if all you can understand is $$$, then let me elaborate:
Healthy workers = Healthy profits

Satan, as we all know you're the king of lies.

"And that's why single-payer works well in dozens of countries today."

Single-payer doesn't work well in any country, let alone "dozens."

Single-payer doesn't work well in any country, let alone "dozens."

It provides care that produces results better, in many respects, than those in the US at far lower costs (either per capita or per GDP) than the US nightmare of a system.

Admittedly, if you raise the bar high enough, that might still far short of working "well", but it would certainly, for the US, be an improvement from the status quo.

A good friend of mine recently saw his five year old daughter through two and a half years of intense treatment for childhood leukemia. He couldn't have done it if he weren't living in Canada and using their single payer health care system. He wrote the whole thing up in detail here: http://miserableannalsoftheearth.blogspot.com/2006/03/katie-lived.html

If anyone is interestined in a real life account of single payer medicine in action, and how it really DOES make a difference, they should check it out.

on the other hand... do you really want a government staffed by the likes of BushCo in charge of who gets which drugs and when ?

"It provides care that produces results better, in many respects, than those in the US at far lower costs (either per capita or per GDP) than the US ... system."

It may produce better results than the current U.S. system in some respects, but that obviously doesn't mean either that it works well or that it is superior to the U.S. system.

"it would certainly, for the US, be an improvement from the status quo."

No it wouldn't.

Single-payer doesn't work well in any country, let alone "dozens."

The mess we have in the US doesn't work very well either.

Government controlled healthcare will have cause rationing to happen.

If you want to see rationing, show up at the emergency room and see how long it takes to get
treatment.

Al, even if you happen to be wealthy enough to AFFORD an HSA, that doesn't mean you can still get one. They have to be underwritten by insurance companies at this point who can turn you down for whatever reason. My parents tried to open an HSA and were turned down because my mother had breast cancer 4 years ago.

This is the first time Michael Kinsley has truly pissed me off.

The nerve.

The schtick is tiring and too bloody bad that Kinsley taught it to so many others: Kaus, Weisberg, Krauthammer, etc. Uninformed, un-researched observations, strung into some half baked arguments, normally with a non-sequitor or two.

And this example is just appalling, starting with the silly accusation that Krugman didn't spell out why single payer would be superior. Obviously, Krugman has spelled that out in numerous places. Because, every other developed country in the world has some form single payer. And every one of them pays less than the US in health care, both in % of GDP and in constant dollars. And most have better health statistics: longer life spans, lower infact mortality, etc.

And then of course, Kinsley doesn't spell out how his half-way measures would actually work. Again, Krugman has addressed that: since markets don't work terribly well in health care - almost any half way design quickly falls apart.

I have to say that I used to love Kinsley, but he really seems to have been transformed into the upper class twit from Monty Python. Just sad.

Government controlled healthcare will have cause rationing to happen.

do you have health insurance now ? can you go to any doctor you want, at any time, without paying a large percentage of the cost yourself ?

i can't. neither can anyone in any health plan i've ever been part of. none dare call that "rationing", but that's what it is.

Jason on March 17, 2006 at 1:29 PM:

We most certainly do not know those things.

Actually, we do.

Jason again at 2:04 PM:

Single-payer doesn't work well in any country, let alone "dozens."

Yet it works better than what we have here in the US.

See, since Jason chooses to provide no information that backs up his assertions, then neither do I! Gee, this blog commenting thing gets easier all of the time!

Jason on March 17, 2006 at 2:13 PM:

No it wouldn't.

Yes, it would.

Man, that was easy! I didn't even have to put down my beer! Happy St. Beer day everybody!

Seriously, Jason...Do try to provide some data to back your intensely thoughtful statements up...

It may produce better results than the current U.S. system in some respects, but that obviously doesn't mean either that it works well or that it is superior to the U.S. system.

Well, given as how for the most part its as good where it isn't clearly better, I disagree.

Jason'
Please name names were single-payer healthcare does not work, or is inferior to our system.

Names please not just a general statement, PROOF.

Jason,

No it wouldn't.

It would for my highschool friend's wife.

She died from treatable cancer in her early forties. Her husband, my friend, was self employed and had no health insurance. Emergency rooms don't treat cancer. My friend lost his business and his house trying to get enough money for his wife's treatments. The church had bake sales and the community tried to raise money.

She was a vibrant, productive, tax paying woman who worked hard her whole life and left three children behind. I'm sure any money for treatment would have been paid back many fold.

Her big mistake was not being born into a rich family. I'm sure the Bush twins are well taken care of - and they give so much to society, don't you think?

Samuel Knight says,

"Uninformed, un-researched observations, strung into some half baked arguments, normally with a non-sequitor or two."

That's a good description of your post.

"Because, every other developed country in the world has some form single payer."

I don't know if that's true, and I note that you offer no evidence to support it, but the U.S. also has "some form [of] single payer." Medicare, for example.

"And every one of them pays less than the US in health care, both in % of GDP and in constant dollars."

The mere fact that other countries spend less on health care than the U.S. tells us nothing whatsoever about the relative merits of their health care systems versus ours. Countries tend to spend a higher proportion of their GDP as they get richer, because the relative value of health increases.

" And most have better health statistics: longer life spans, lower infact mortality, etc."

The idea that comparisons of two statistics--infant mortality rate and average life expectancy at birth--provide any kind of meaingful indicator of relative merits of different health care systems is idiotic.

grape says,

"Actually, we do."

Actually, we don't.

"Yet it works better than what we have here in the US."

No, it doesn't work better than what we have here in the U.S.

"Seriously, Jason...Do try to provide some data to back your intensely thoughtful statements up..."

Ha ha ha. Good one. You mean like the non-existent data you have provided to back up yours?

Continuing the Monty Python analogy. Anyone else notice that Jason and others don't make arguments - just contradictions?

This isn't an argument.

Yes it is.

No it isn't.

Seriously, Kinsley's pathetic column does raise the question: why are so many of the DC pundits and think tanks so bloody clueless? Why did all these institutions: AEI, Heritage, and the rest of the lot think that tax cuts were so great, and Iraq was a wonderful idea? When no-one else in the world, other than some fellow nut-cases in London, agreed?

And in case anyone thinks my friend is some low-life - he was a carpenter and then became a general contractor, working mostly on additions to existing homes. He worked his butt off and did good work. He was well-respected and fair and delivered on his contracts.

Now, since he lost his business, he is back to being a carpenter. When the housing bubble bursts I don't know what will happen to him, but we'll all be in a world of hurt then.

"Well, given as how for the most part its as good where it isn't clearly better, I disagree."

Yet another completely unsubstantiated assertion.

Who needs facts and evidence, after all. Let's all just make stuff up.

We should have naional health care and it ahould be run by Medicare. I am 76 years old and have used Medicare for 10 tears, I and all of the people I know who use it, and there are are many, have nothing but good to say about it. When it started under Lyndon Johnson there were only a small number of glitches that were easily remedied. Bush's drug thing is a wild fiasco from which only the drug companies profit. I have had cause to call Medicare over the years and they have ALWAYS been competent, knowledgeable nd have fixed whatever needed fixing quickly and with a minimum of fuss. On the other hand, when I called Earthlink recently to see what was wrong w/my iMac I spent 3 and a half hours being wrongly routed, disconnected and loaded up with advice that didn't work and talking to 8 different people in Asia in 8 different calls, none of whom had a clue as to what I was talking about. I have never had to spend more than 15 minutes w/Medicare on the knottiest problem, have never been disconnected and have never felt that my concerns weren't of absolutely no interest to the people to whom I was speaking. And my problems were always dealt with on the spot to my satisfaction.

Medicare should be available to verybody. Today there is a medical service called "concierge" where the people who have the money can pay $2,000-$3,000 a year to certain group practices and get premiun and speedy service. They still pay the same for care. I think that is just fine. If you have the money you should be able to do that. That being said, everybody in this country has the birthright to decent medical care. We have two things to be really ashamed of in this country, the lack of care for the most needy and George Bush. Remember, we're spending over %1,000,000,000 every week in Iraq. Yes, that's over one billion.

Jason, some existent data for you:

http://www.nybooks.com/articles/18802

"Anyone else notice that Jason and others don't make arguments - just contradictions?"

Anyone else notice that Samuel Knight doesn't provide any evidence to support his claims?

The idea that comparisons of two statistics--infant mortality rate and average life expectancy at birth--provide any kind of meaingful indicator of relative merits of different health care systems is idiotic.

They truly know nothing.

The idea that comparisons of two statistics--infant mortality rate and average life expectancy at birth--provide any kind of meaingful indicator of relative merits of different health care systems is idiotic.

Maybe you need to learn what "etc." means; other measures where universal systems tend to better include, among others, things like reported satisfaction of the population with healthcare.

Under universal healthcare, people tend to live longer, see their children less likely to die in infancy, and be happier with their healthcare than in the US, all for less cost than the US system.

The advantages in the US system are...what?

Lucy,

I'm not sure why you think a book review qualifies as "data," but what assertion, exactly, are you claiming this "data" supports?

The problems Kinsley tries to scare us with flatly don't exist in the simplistic ways he presents them, and it's dishonest for him to pretend otherwise.

Dishonesty from an opponent of the progressive agenda? I'm shocked! Shocked!!

Jason,

Why don't you refute Krugman and Wells's arguments?

cmdicely says,

"Maybe you need to learn what "etc." means;"

Maybe you need to learn that "etc." isn't a substitute for actual facts and evidence.

" other measures where universal systems tend to better include, among others, things like reported satisfaction of the population with healthcare."

"Reported satisfaction" isn't a meaningful indicator of quality either, not least because it's dependent on expectations. I think Americans probably tend to have higher expectations for their health care than people in other countries do because they are richer and are used to having more and better products and services in general.

"Under universal healthcare, people tend to live longer, see their children less likely to die in infancy, and be happier with their healthcare than in the US, all for less cost than the US system."

No they don't. But as I said, average infant mortality and average life expectancy are basically meaningless as indicators of the overall quality of a health care system, both for statistical reasons (the limited usefulness of averages) and because there are so many factors other than the health care system that affect those statistics, such as diet and exercise. A country whose population has a poor diet and a sedentary lifestyle may have a lower average life expectancy than a country whose population has a good diet and good exercise habits despite having a superior health care system. Unless you control for these and other confounding factors, life expectancy and infant mortality numbers don't tell you anything meaningful at all.

"Why don't you refute Krugman and Wells's arguments?"

What arguments? Arguments for what claim?

I think Americans probably tend to have higher expectations for their health care than people in other countries do because they are richer and are used to having more and better products and services in general.

cite?

No they don't.

cite?

There is really very little cost savings that would come about due to changing to a single payer system alone.

Why not?

We have huge health care costs due to people NOT getting routine care when they first get sick. We have huge costs due to insurance companies spending lots of money so as not to spend more than someother insurance company. (Ask someone who has had to care for a senior in their last years about insurance companies having to be dragged kicking and screaming to pay an obvious bill the first time.)

Okay, what the hell's going on here? First we have Charlie assuming Don P.'s identity. Now I'll be damned if this "Jason" isn't the real Don P. He has exactly the same writing style - flat, unsupported assertions, a kind of almost scary, amoral pragmatism. Want to talk about abortion, "Jason"?

I'd never considered before that Don P. and Charlie could be in cahoots somehow, but ...

cleek,

There are few social programs we know more about than single-payer, and what we know is that in a well constructed program costs are lower, the quality of healthcare is better, the amount of healthcare is higher ...

Cite?

And that's why single-payer works well in dozens of countries today.

Cite?

It provides care that produces results better, in many respects, than those in the US at far lower costs

Cite?

The mess we have in the US doesn't work very well either.

Cite?

Under universal healthcare, people tend to live longer, see their children less likely to die in infancy, and be happier with their healthcare than in the US, all for less cost than the US system.

Cite?

Jason,

You are against single-payer healthcare("Single-payer doesn't work well in any country, let alone "dozens," etc.).

Krugman and Wells have made a powerful case on behalf of a single-payer system.

It's your turn at bat.

Jason, i didn't write any of that, so i don't feel obligated to back it up.

i'm still waiting for your cites on your assertions, though.

Lucy,

No, Krugman and Wells have not made a powerful case on behalf of a single-payer system.

Michael Kinsley has made a powerful case for alternatives to single-payer.

It's your turn at bat.

"do you have health insurance now ? can you go to any doctor you want, at any time, without paying a large percentage of the cost yourself ? "

Is that what "health insurance" is? The ability to go to any doctor we want, at any time, without paying for it?

Oh, my god. I never realized. My entire life is rationed. My car purchases are rationed! My food is rationed! The clothes on my back--rationed.

Man. Life sucks.

Kevin, a week or so ago you mentioned that it was time for the Dem party to get serious about proposing single payer. I trust by now you realize that it's not fear that stops them. It's disagreement. Many Dems and moderates think single payer is a disastrously bad idea.

cleek,

Why aren't you waiting for the authors of the quotes I provided to back up their assertions?

Jason your simply talking out your ass boy give it a rest.

>No, Krugman and Wells have not made a powerful case on behalf of a single-payer system.

Why not?

Jason on March 17, 2006 at 2:46 PM:

That's a good description of your post.

Yours as well!

I don't know if that's true

Then do some research, then get back to us.

and I note that you offer no evidence to support it

And you are supporting your statements...how?

but the U.S. also has "some form [of] single payer." Medicare, for example.

Or the VA health system, for example.

The mere fact that other countries spend less...systems versus ours.

True...Then can you identify the strengths and weaknesses of both other countries' health systems versus the US?. I'll start:

Other countries: Everyone's covered.
US: Not so much.

Care to continue?

Countries tend to spend a higher proportion of their GDP as they get richer, because the relative value of health increases.

Or the value of health services is overly inflated due to the additionial wealth floating around.

The idea that comparisons of two statistics--infant mortality rate and average life expectancy at birth--

Don't forget mortality rates due to cancer.

provide any kind of meaingful indicator of relative merits of different health care systems is idiotic.

And what are the valid metrics you are proposing to act as 'meaningful indicators of relative merits'? To dismiss mortality rates without offering alternatives is in itself, idiotic.

John,

Al--listen to yourself--who wants to shop around when there's a ticking-time bomb of an embolism in your child's brain? Do you really expect people to make rational cost-conscious decisions at times like these?

No one outside of the health care industry is fully qualified to shop for medical care. If laypeople knew enough about medicine to make decisions like that, they'd be doctors.

Health care is a weighted market. It can never operate on free market principles because health care consumers don't act freely. In most cases, they can't decide 'not to buy'. A choice between $100,000-a-year pills and death is a false choice...humans are biologically wired never to choose death. So someone, or something, has to choose death for them...the 'rationing' Kinsley references. Currently it's taking place under the aegis of private-sector profiteers who answer to no one. I would prefer the responsibility be transferred to the government, which answers to me.

"I think Americans probably tend to have higher expectations for their health care than people in other countries do because they are richer and are used to having more and better products and services in general."

Really, Jason, because I think a lot of us who go without health insurance would think ANY coverage would be better than what we have now. I don't expect healthcare because I don't qualify as a "rich" American. I'm merely middle class. Those "poor" Europeans are doing better than I am.

"Why don't you refute Krugman and Wells's arguments?"

It seems pretty plain that he can't refute them, or he would have done so.

Lucy:

"Why not?"

I don't know.

So can someone give me a number as to what is a fair price per month for your average Health Ins. with a $2000 ded.

I see.

Lets be clear on one thing- rationing occurs with all goods and services, even in a free market. There are no produced goods or provided services that are in supply to satisfy the desire for such goods and services. Price is how these are rationed.

Having established that rationing already occurs in healthcare (you can't afford it you don't get it), then it is easy to see that government provided healthcare, single-payer and/or single provider will ration healthcare. Will Americans be happy having government tell them that they or their loved ones can't have that expensive cancer treatment that provides a 10% chance of saving a life? I don't know the answer to that question, but I do know that they don't like insurance companies telling them this.

The claim, that The United States will spend less than we do today once we opt for some version of single payer/single provider, is simply an assertion. The countries that have adopted such systems have health provider systems that have evolved for decades under such conditions. In addition, the populations of these countries have expectations that have developed and evolved under these conditions. Single-payer/provider in the US will be unlike any of these other systems that are lauded as cost effective models because the medical infrastructure and history of the US, and the expectations of it's citizens are unlike those of these other countries.

Incidentally, here is a really good essay on what is fundamentally wrong with people's expectations for healthcare, universal healthcare, and rationing.

that's a good question, Right-minded. when i was up to around $435 for a $2500 deductible and most of my conditions weren't covered because they were considered pre-existing, i decided that was not a fair price. plus, i just plain couldn't afford to pay it AND pay for my actual health care.

Dishonest conservatives!?! Has the world GONE MAD!!!

Samuel Knight on March 17, 2006 at 2:49 PM:

This isn't an argument.

That's the point I was trying to make. Sorry if it wasn't clear.

Jason on March 17, 2006 at 2:49 PM:

You mean like the non-existent data you have provided to back up yours?

You show me yours, I'll show you mine...From the looks of it, a few of the other commentors are wondering on what you are basing your opinion.

Again on March 17, 2006 at 2:51 PM:

Who needs facts and evidence, after all. Let's all just make stuff up.

Merely stating your personal philosophy doesn't make it valid.

Jason on March 17, 2006 at 3:28 PM:

Michael Kinsley has made a powerful case for alternatives to single-payer.

Hardly. All Kinsley has done is try to refute Krugman and Wells with a mishmash of conservative talking points and the half-assed offering of a solution.

Happy St. Beer Day!

Cite?

"The United States continues to spend significantly more on health care than any country in the world. In 2002, Americans spent 53 percent per capita more than the next highest country, Switzerland, and 140 percent above the median industrialized country, according to new research from the Johns Hopkins Bloomberg School of Public Health. "

http://www.jhsph.edu/publichealthnews/press_releases/2005/anderson_healthspending.html

Cite?

“As in previous years, it comes back to the fact that we are paying much higher prices for health care goods and services in the United States. Paying more is okay if our outcomes were better than other countries. But we are paying more for comparable outcomes,” said Anderson, who is also the director of the Johns Hopkins Center for Hospital Finance and Management.

http://www.jhsph.edu/publichealthnews/press_releases/2005/anderson_healthspending.html

Free market to the rescue...

grape,

"Then do some research, then get back to us."

No. It's not my responsibility to substantiate someone else's assertion.

"And you are supporting your statements...how?"

I'll support mine just as soon as he supports his and you support yours.

"Or the VA health system, for example."

Yes, that's another example.

"Then can you identify the strengths and weaknesses of both other countries' health systems versus the US?. I'll start: Other countries: Everyone's covered. US: Not so much."

You're confusing universal coverage with single-payer.

"Or the value of health services is overly inflated due to the additionial wealth floating around."

The value of health services may be "overly-inflated" without regard to a country's wealth. If you think you have evidence that the value of health services are "overly-inflated" in the U.S. in comparison to other countries, please present it.

"Don't forget mortality rates due to cancer."

Okay, I won't. What about mortality rates due to cancer?

"And what are the valid metrics you are proposing to act as 'meaningful indicators of relative merits'?"

A broad range of indicators that would collectively measure the performance of a health care system as a whole.

Lucy,

What do you see?

Yancey, although unlike our new close, personal friend Jason, you actually advance discussion points that make sense, the biggest single argument that a more universal health care system in america would lower costs is that a significant amount of cost in the US healthcare system consists of people cost-shifting. In our current mixed system, the incentives favor paying people to look for cost-shifting. Under medicare, as kevin notes, we know that costs are lower, and a good part of that is that there is no incentive for cost-shifting (although we're going to see higher costs, of course, with the awful prescription drug bill, which i know you loathe as much as i do).

so while it's not an absolute given that costs will be lower, because you are right that expectations of performance do influenc the way in which alternate systems deliver the goods, there's an extremely strong likelihood that - as in any sucessful corporate merger - we can eliminate overhead and redundancies without changing anything else.

Ace Franze,

"It seems pretty plain that he can't refute them, or he would have done so."

It seems pretty plain that you can't refute Kinsley, or you would have done so.

> on the other hand... do you really want a
> government staffed by the likes of BushCo in
> charge of who gets which drugs and when ?

That does give me pause. What _would_ happen to a national single-payer system if a Cheney or Frist were elected President?

Cranky

Jason, just to return to you - after reading yancey's intelligent remarks, it's such a comedown to return to nitwittery - the indicators that represent the performance of the health care system as a whole are, oddly enough, all derived from examinations of things like lifespans and child mortality and other measures of people's, you know, health.

they are readily available and have been for years, and that you don't choose to inform yourself of them is your shortcoming, not a responsibility of other commenters.

the bottom line is, there is nothing special about the health of the american people that would suggest in the slightest the health-care system is worth the higher level of gdp that goes into it: we're not first in hardly any (maybe any, it's actually been a little while since i looked myself) significant health indicator.

now, who knows, it's likely that we are highest in things like use of emergency rooms for non-emergencies or shortness of time for elective plastic surgery or stuff like that, but those aren't indications of healthful outcomes.

grape,

"You show me yours, I'll show you mine"

No, you show me yours, I'll show you mine

"Hardly. All Kinsley has done is try to refute Krugman and Wells with a mishmash of conservative talking points and the half-assed offering of a solution."

No, all Krugman and Wells have done is to try to support single-payer with a mishmash of liberal talking points and the half-assed offering of a solution.

The idea that comparisons of two statistics--infant mortality rate and average life expectancy at birth--provide any kind of meaingful indicator of relative merits of different health care systems is idiotic.

Wow, Jason. That cinches it for me. Sheer brilliance. That'll teach these nanny state socialists, yup, yup, yup.

Jeez, Kevin. Kinsley's "schtick"??

Kinsley? Kinsley? Of all people? HE is a right-winger now? And this is all just scaremongering? No substance to his contention that there might just be a teensy little bit of a problem with handing the whole sausage shop over to the government?

What about answering his argument? In particular, his charge that Krugman is going for not just a single-payer system but is at least on a pretty slippery slope towards single-provider care is a fairly valid objection. And this paragraph is obviously true, and really points out the lazy thinking among people who excel in pointing out the supposed "inefficiencies" of the current US system:

"Krugman and Wells are persuasive -- it's not a hard sell -- about the nightmarish complexity and administrative costs of the current fragmented system. But they don't do much more than simply assert that a single, government-run insurance program would be more efficient. Even the most competitive industry can seem wasteful and inefficient when described on paper. Dozens of computer companies making hundreds of different, incompatible models, millions spent on advertising: Wouldn't a single, government-run computer agency producing a few standard models be more efficient? No, it wouldn't."

> I'd never considered before that Don P. and
> Charlie could be in cahoots somehow, but ...

Those personas are part of the same organization: a paid counter-blogging effort. They pollute discussions, push talking points, and perhaps most importantly test Radical memes against fairly good liberal thinkers using the spaghetti method. When they find some that stick they are used at other blogs, given to Powerline and Drudge, and then pushed into the traditional media.

Right now it appears that they are testing the "you don't have the facts" meme (always a good one as Dems tend to internalize it) and the "there is great dissention among moderates on this topic" ( a good general-purpose meme that I bet we will see in the traditional media within two weeks).

They really do have an organized effort guys.

Cranky

> Dozens of computer companies making hundreds of
> different, incompatible models, millions spent on
> advertising: Wouldn't a single, government-run
> computer agency producing a few standard models be
> more efficient? No, it wouldn't."

Nice topic-changing meme there - is that one being tested also? Of course, while there are hundreds of computer makers (just as in the German system there are 10,000s of health care providers) the DISTRIBUTION system has coalesced into a few very large distributors (and the ever-hidden Ingram Micro which sits behind most of the large distributors themselves). Krugman's argument is that a single-DISTRIBUTOR model to multiple PROVIDERS would be more efficient. You neatly slide that over into the "government will force you to buy Soviet computers" arguement, which is NOT what Krugman said and NOT what any liberal I know is advocating.

Nice try though.

Cranky

"Reported satisfaction" isn't a meaningful indicator of quality either,

If subjective utility isn't a meaningful indicator of quality, democracy and market economics are a load of bunk.

"A privileged minority has access to the best medical treatment in the world. But 45 million Americans have no health insurance at all (of the world's developed countries only the US and South Africa offer no universal medical coverage). According to the World Health Organization the United States is number one in health spending per capita—and thirty-seventh in the quality of its service.

"As a consequence, Americans live shorter lives than West Europeans. Their children are more likely to die in infancy: the US ranks twenty-sixth among industrial nations in infant mortality, with a rate double that of Sweden, higher than Slovenia's, and only just ahead of Lithuania's—and this despite spending 15 percent of US gross domestic product on 'health care' (much of it siphoned off in the administrative costs of for-profit private networks). Sweden, by contrast, devotes just 8 percent of its GDP to health.

"...Note, too, that the steadily rising cost of private medical insurance in the US puts at least as much of a burden on American firms as social taxation and welfare privileges place upon their European counterparts—while providing none of the attendant social benefits."

http://72.14.203.104/search?q=cache:mNxYsdejD0EJ:www.nybooks.com/articles/17726+america+versus+europe+healthcare+costs&hl=en&gl=us&ct=clnk&cd=8

We just got offord ins. For my wife and I they want $605. And a $150 pres. med. ded.There is no way I can afford this,So maybe all the great minds out there have a answer?

Dozens of computer companies making hundreds of different, incompatible models, millions spent on advertising: Wouldn't a single, government-run computer agency producing a few standard models be more efficient? No, it wouldn't.

Then wouldn't it make more sense to have dozens of private mercenary armies in competetion with each other rather than one single, government run US Army producing one standard model of soldier? If competition and efficiency are the panaceas for everything then why don't we get rid of our centralized, top-down, government run Army and Navy and Air Force? Or is it indeed the case that there are certain things that don't work well when subjected to market forces?

Jason: Go to MaxSpeak.com. Read his critique of Kinsley. Get back to us. I want to see more of your demonstrated brilliance.

God, you're good. You a free agent next year?

Wow is Jason a good troll. Thanks for backing up my Monty Python analogy. How many non-arguments can you string in post after post?

And then to claim basic ignorance of world-wide health statistics. I mean cmdicely and others are reciting basic facts about health care. And Jason just says no.

Oh, please, we can expect a basic level of education in these discussions, can't we?

Oh yeah, maybe not, since even the Post's op-ed page doesn't seem to require that....

Is that what "health insurance" is? The ability to go to any doctor we want, at any time, without paying for it?

Oh, my god. I never realized. My entire life is rationed. My car purchases are rationed! My food is rationed! The clothes on my back--rationed.

yes, that's precisely why it's silly to scream "rationing!" when it comes to health care. thanks for getting it.

'According to Dr. Gerard Anderson, lead author of a report just issued by John Hopkins Bloomberg School of Public Health, "We pay for drugs and hospital stays and doctor visits 2 to 2.5 times as much as other countries pay."

'And why, you ask? Malpractice suits? Nope. According to the study, lawsuits add less than 1% to health care overhead. Another 8% in increases come from so-called "defensive" medicine -- doing lots of unnecessary tests to avoid being sued.

'The remaining 91% of increases are price, not cost increases. Americans are being financially disemboweled by the pharmaceutical/health care industries. The average American paid $5,267 on health care in 2002, compared with an average $1,821 in other industrialized nations.'

http://72.14.203.104/search?q=cache:QYkVUeDQeR0J:www.alternet.org/story/23549%3Fcomments%3Dview%26cID%3D16410%26pID%3D16385+america+europe+healthcare+costs+comparison+johns+hopkins&hl=en&gl=us&ct=clnk&cd=11

Why aren't you waiting for the authors of the quotes I provided to back up their assertions?

why is every request that you do so met with complaint about someone else ? why aren't you just backing up what you claim?

Howard,

"Jason, just to return to you - after reading yancey's intelligent remarks, it's such a comedown to return to nitwittery - the indicators that represent the performance of the health care system as a whole are, oddly enough, all derived from examinations of things like lifespans and child mortality and other measures of people's, you know, health."

You're the nitwit. The point is not that infant mortality rate and life expectancy have no value at all, but that any serious evaluation of the overall merits of different health care systems must examine a much greater set of indicators than just those two. A second point is that factors other than health care may substantially influence statistics such as life expectancy and infant mortality, and that these other factors must be controlled for if international comparisons of even just those metrics are to be meaningful in the context of a health care system debate. I already mentioned diet and exercise. Another factor, that pertains to the infant mortality rate specifically, is definitional and recording differences. The U.S. appears to use a broader definition of infant mortality than most other countries, and deaths that would be counted as stillbirths or miscarriages in other countries are counted as infant mortalities in the U.S.

"the bottom line is, there is nothing special about the health of the american people that would suggest in the slightest the health-care system is worth the higher level of gdp that goes into it: the bottom line is, there is nothing special about the health of the american people that would suggest in the slightest the health-care system is worth the higher level of gdp that goes into it: we're not first in hardly any (maybe any, it's actually been a little while since i looked myself) significant health indicator."

Yet another utterly unsubstantiated statement. Where is your evidence regarding "the health of the American people" in comparison to the health of people in other countries? And even if it's true that "we're not first in hardly any ... significant health indicator," that would not support your conclusion anyway. We may be close to first in many categories, perhaps more than any other nation, and a population that does well, but not exceptionally, in most measures of health may be considered more healthy overall than a population that does exceptionally in a few and averagely in most. It is precisely this kind of comprehensive and nuanced analysis that is missing from idiotic arguments that presume a couple of raw health-related statistics can give us a comprehensive picture of the performance of a nation's health care system.

Jason on March 17, 2006 at 4:09 PM:

It's not my responsibility to substantiate someone else's assertion.

But it is your responsibility to back up your own statements. Start with this one: "Single-payer doesn't work well in any country, let alone "dozens."

I'll support mine just as soon as he supports his and you support yours.

In other words, you concede that you have no valid argument. Weak...Here's mine, BTW...Have fun, and look forward to hearing your supporting information!

A broad range of indicators that would collectively measure the performance of a health care system as a whole.

Such as mortality rates? Cost to level of service? What exactly are these indicators that you allude to?

> Wow is Jason a good troll. Thanks for backing
> up my Monty Python analogy. How many
> non-arguments can you string in post after post?
>
> And then to claim basic ignorance of world-wide
> health statistics.

Based on the counteraction I see in the blogs, the political mags, the WSJ, etc, the Radicals are _really_ worried about the health care theme. They seem to actually fear what would happen if the Dems got together and pushed on it. If we see Rove announce that he plans to "run against imposing the Canadian system in the US" then we can consider it proven.

Luckily for the Radicals the chances of the Dems actually taking advantage of this opportunity are twofold: slim and none.

Cranky

Jason,

If infant mortality and life expectancy don't count, what would you say should be used to judge quality of healthcare?

Do you know people who have used healthcare systems in other advanced nations?

Have you used any other system and which one?

Krugman is an economist and by all accounts did his research, Kinsley is a columnist and surely has excellent health insurance and is a generalist. So I would say Krugman if anything is more expert than Kinsley.

Since you don't back up anything you assert I believe you don't know anything and you just mouth the line of the insurance companies and the republican party line. You just don't know what you are talking about.

Many people with experience with other healthcare systems have posted here and found the systems better than our system. I would like to hear from someone who had troubles in other systems.

Also the Democrats created SS and MEDICARE and both benefits work because the Democrats wanted them to work. What did the Republicans do?

No substance to his contention that there might just be a teensy little bit of a problem with handing the whole sausage shop over to the government?

Well, if there is substance to that argument, Kinsley's pile of fallacies, strawmen, and unsupported conclusions doesn't point to it.

> why is every request that you do so met with
> complaint about someone else ? why aren't you
> just backing up what you claim?

That is standard Radical counter-blogging procedure. They can keep it up for hours and I have seen them cause some good liberal posters to internalize the counterattack and start to doubt that they in fact posted the first question/challenge (to which the counter-blogger has never responded of course).

Cranky

We may be close to first in many categories, perhaps more than any other nation, and a population that does well, but not exceptionally, in most measures of health may be considered more healthy overall than a population that does exceptionally in a few and averagely in most.

We "may" be...or we may not be. If you have any evidence that we actually do well in most measures of health care please present it.

grape,

"But it is your responsibility to back up your own statements. Start with this one:"

It's your responsibility to back up your own statements. Start with this one: "Actually, we do [know that in a well constructed single-payer program costs are lower, the quality of healthcare is better, the amount of healthcare is higher ..]"

"In other words, you concede that you have no valid argument."

No, in the same words, I'll support mine just as soon as he supports his and you support yours.

"Such as mortality rates? Cost to level of service? What exactly are these indicators that you allude to?"

I don't have a list. It would have to be a large set of indicators that collectively cover the whole range of health and health care services--primary care, preventive care, emergency care, specialist care, pediatric care, geriatric care, access to surgery, access to drugs, access to tests, immunization rates, diagnosis rates, treatment rates, cure rates, and so on.

Many people with experience with other healthcare systems have posted here and found the systems better than our system. I would like to hear from someone who had troubles in other systems.

I've been sick on most every continent on Earth, and have had occasion to see doctors in the US, Venezuela, Germany, Britain, France, Norway, Sweden, Singapore, Thailand, Australia, and Israel. I can quite honestly say that the country I most fear getting sick in is the US -- not so much for quality of care, which is generally good -- but for cost. I have health insurance, and yet it's still true that any sort of long illness could wipe me out financially.

Stefan,

"We "may" be...or we may not be. If you have any evidence that we actually do well in most measures of health care please present it."

If you have evidence that we do badly, or even just less well than most countries with single-payer health care, in most measures of health care, please present it.

If you have evidence that we do badly, or even just less well than most countries with single-payer health care, in most measures of health care, please present it.

I have. Upthread.

As Cranky observed, Jason is indulging in the trolls' favorite "I'll show you mine when you show me yours" tactic -- except I keep showing him mine and I get to see nothing, nothing, in return....

Alek:

I am the only "Don P." around here. I have no idea what you guys are saying about Jason or Charlie. Plenty of people bring up FDR on these threads - Kevin does all the time - is he "Charlie" too?

http://www.washingtonmonthly.com/archives/individual/2004_06/004131.php#191777

"The Marketeer" has before - was he "Charlie"?

http://www.washingtonmonthly.com/archives/individual/2005_06/006414.php#608859

The "X does something different than what I was accused of; is he Charlie too" line is very typical of the Charlie-aliases.

Whereas the new "Don P." has none of the distinct posting habits or even apparent preferences of our old friend "Don P." (he's made a few attempts to tweak me about Catholicism, but even in that not much in the way the old "Don P." would), but has all the typical habits of Charlie and his clones.

Stefan,

"I have. Upthread."

No you haven't. You haven't produced a shred of evidence that the U.S. does badly, or even just less well than most countries with single-payer health care, in most measures of health care. You haven't even said what you think those measures are.

Samuel Knight, excellent takedown of Jason's style.

listen, Jason, my adorable little nitwit, just because you're new to the party doesn't mean that some of us haven't done our homework over the years. We've looked at the stats, we've read the reports, and the fact that life is short and we're not going to spend the afternoon seeking out the necessary reading for your remdial education is just something you're going to have to live with.

You can list any frickin' indicator you want: sooner or later, you're going to have to come to a scoresheet. and when you do, you're going to discover, when you do your homework, that the US does not lead the world in good health, or in good health service. Frankly, some of the evidence is staring you right in the face, since in your own list of potential indicators, you keep talking about "access."

Well, there are tens of millions of americans who have no access to the health-care system outside of the emergency room. That's an inordinately expensive, inappropriate way for people's basic health-care needs to be met. No other advanced industrial country suffers from that access problem.

and that's what you'll discover, over and over. Sure, there are many individually brilliant doctors and fantastic health-care facilities in america, but like so many things in america, these are disproportionately available to the eocnomic elite (including, thanks to his wife, michael kinsley). for everyone else, it's much more hit or miss, and that'w what's reflected in any stat of substance you care to dig up.

in addition, of course, there's only one advanced country in the world where important health-care needs (not elective surgeries) can plunge you into bankruptcy, and that would be this country, again because of our half-assed system.

;laying the "why haven't you backed this up" game doesn't cut any mustard with me, because as i noted, i've been doing my homework on this matter for decades. go do some remedial education yourself, then come back and show us what you've learned, because we aren't going to do your learning for you to play little college republican debate game tricks with. that wows 'em on campus but it doesn't cut any mustard in adult society....

Guys I held back slamming Jason, before, but I'm not now.

Jason, please educate yourself on the basics of international health care before jumping on others in this discussion.

If people cite basic statistics, you are welcome to refute them. But, don't just expect us to lead you to every single basic fact. You can find them yourself - like at the OECD for example - or in Krugman's writings (dont' bother with Kinsley, though.)

Cmdicely carved me up for making mistakes before - that's OK. Because he knew what he was talking about.

But really, it's annoying to read constant challenges from you, coupled with your repeated admissions that you don't know the basic facts about health care.

Please come back when you've learned the basic facts. Until then - please go away or pay for your ten-minute argument.

wow, jason demonstrates, at 5:07, that he couldn't comprehend stefan's 4:04, 4:27, and 4:37 postings.

i take it all back, sweetie: don't bother with any remedial reading. it wouldn't penetrate anyhow.

Jason,
Your current persona has jumped the shark; with howard's 5:12 comment the shark also leapt up and chomped on parts of your anatomy . Might as well retire "jason" and try another one.

Nice try though.

Cranky

That's right, folks - I am "Charlie" and Jason is "Don P." - keep your eye on this shell with the pea under it.

Compare and contrast the following data for the United States and Germany, as compiled by the World Health Organization. By almost every measure Germany outperforms and underspends the US, all while covering 100% of the population as compared to the US's 80%.

United States of America
Indicator Value Latest Year
Infant mortality rate, both sexes (per 1000 live births) (?) 7.2 2000
Under-five mortality rate, both sexes (per 1000 live births) (?) 8.0 2003
Under-five mortality rate, males (per 1000 live births) (?) 9 2003
Under-five mortality rate, females (per 1000 live births) (?) 7 2003
Adult mortality (per 1000) males (?) 139 2003
Adult mortality (per 1000) females (?) 82 2003
Maternal mortality ratio (per 100 000 live births) (?) 14 2000
Number of adults and children living with HIV (?) 950,000 2003
HIV prevalence among 15-49-year-olds (%) (?) 0.6 2003
Number of polio cases (?) 0 2004
TB: new smear positive cases (per 100 000 population) (?) 2 2003
Newborns with low birth weight (%) (?) 8 2002
Percentage of total life expectancy lost females (?) 10.7 2002
Life expectancy at birth (years) total population (?) 77.0 2003
Life expectancy at birth (years) males (?) 75.0 2003
Life expectancy at birth (years) females (?) 80.0 2003
Healthy life expectancy at birth (years) total population (?) 69.3 2002
Healthy life expectancy at birth (years) males (?) 67.2 2002
Healthy life expectancy at birth (years) females (?) 71.3 2002
Healthy life expectancy at age 60 (years) females (?) 17.9 2002
Expectation of lost healthy years at birth males (?) 7.4 2002
Expectation of lost healthy years at birth females (?) 8.5 2002
Percentage of total life expectancy lost males (?) 9.9 2002
Total expenditure on health as % of GDP (?) 14.6 2002
Per capita GDP in international dollars (?) 36,056 2002
General Government expenditure on health as % of total expenditure on health (?) 44.9 2002
Private expenditure on health as % of total expenditure on health (?) 55.1 2002
General Government expenditure on health as % of total general government expenditure (?) 23.1 2002
External resources for health as % of total expenditure on health (?) 0.0 2002
Social security expenditure on health as % of general government expenditure on health (?) 30.8 2002
Out-of-pocket expenditure on health as % of private expenditure on health (?) 25.40 2002
Prepaid plans as % of private expenditure on health (?) 65.7 2002
Per capita total expenditure on health at average exchange rate (US$) (?) 5,274 2002
Per capita total expenditure on health in international dollars (?) 5,274 2002
Per capita government expenditure on health at average exchange rate (US$) (?) 2,368 2002
Per capita government expenditure on health in international dollars (?) 2,368 2002

Germany
Indicator Value Latest Year
Infant mortality rate, both sexes (per 1000 live births) (?) 4.4 2000
Under-five mortality rate, both sexes (per 1000 live births) (?) 5.0 2003
Under-five mortality rate, males (per 1000 live births) (?) 5 2003
Under-five mortality rate, females (per 1000 live births) (?) 4 2003
Adult mortality (per 1000) males (?) 115 2003
Adult mortality (per 1000) females (?) 59 2003
Maternal mortality ratio (per 100 000 live births) (?) 9 2000
Number of adults and children living with HIV (?) 43,000 2003
HIV prevalence among 15-49-year-olds (%) (?) 0.1 2003
Number of polio cases (?) 0 2004
TB: new smear positive cases (per 100 000 population) (?) 4 2003
Newborns with low birth weight (%) (?) 7 2002
Percentage of total life expectancy lost females (?) 9.3 2002
Life expectancy at birth (years) total population (?) 79.0 2003
Life expectancy at birth (years) males (?) 76.0 2003
Life expectancy at birth (years) females (?) 82.0 2003
Healthy life expectancy at birth (years) total population (?) 71.8 2002
Healthy life expectancy at birth (years) males (?) 69.6 2002
Healthy life expectancy at birth (years) females (?) 74.0 2002
Healthy life expectancy at age 60 (years) females (?) 19.0 2002
Expectation of lost healthy years at birth males (?) 5.9 2002
Expectation of lost healthy years at birth females (?) 7.6 2002
Percentage of total life expectancy lost males (?) 7.8 2002
Total expenditure on health as % of GDP (?) 10.9 2002
Per capita GDP in international dollars (?) 25,842 2002
General Government expenditure on health as % of total expenditure on health (?) 78.5 2002
Private expenditure on health as % of total expenditure on health (?) 21.5 2002
General Government expenditure on health as % of total general government expenditure (?) 17.6 2002
External resources for health as % of total expenditure on health (?) 0.0 2002
Social security expenditure on health as % of general government expenditure on health (?) 87.4 2002
Out-of-pocket expenditure on health as % of private expenditure on health (?) 48.20 2002
Prepaid plans as % of private expenditure on health (?) 39.9 2002
Per capita total expenditure on health at average exchange rate (US$) (?) 2,631 2002
Per capita total expenditure on health in international dollars (?) 2,817 2002
Per capita government expenditure on health at average exchange rate (US$) (?) 2,066 2002
Per capita government expenditure on health in international dollars (?) 2,212 2002

God Stefan what's your problem? Write much.

Stefan:

Compare and contrast Germany's income tax rates which ranged from 19.9% to 48.5% in 2002 with the U.S.

Howard,

"listen, Jason, my adorable little nitwit, just because you're new to the party doesn't mean that some of us haven't done our homework over the years."

Listen, Howard, you pompous little moron, you wouldn't know "homework" on this subject if it hit you upside the head.

"We've looked at the stats, we've read the reports,"

Great. Then you should be able to present the "stats" and cite the "reports" that support your claims. Please do so. Or are you