Editore"s Note
Tilting at Windmills

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March 17, 2006
By: Kevin Drum

MORE TIRED HEALTHCARE FEARMONGERING....Kinsley's schtick sure gets tiresome sometimes. See Ezra and Max on his latest column about universal healthcare.

Let me just add this. Aside from the factual problems and shallow analysis that Ezra and Max point out, Kinsley acts as if single-payer healthcare is some kind of radical theoretical construct that no one understands very well. Better to take things slowly.

But various forms of single-payer have been in use in dozens of advanced countries for decades including Medicare right here in the United States. 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, private healthcare remains available to anyone who wants to pay for it, and people are generally far more satisfied than American healthcare consumers are. 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.

Kevin Drum 1:09 PM Permalink | Trackbacks | Comments (272)

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Comments

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.

Posted by: sluggo on March 17, 2006 at 1:14 PM | PERMALINK

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.

Posted by: abe on March 17, 2006 at 1:16 PM | PERMALINK

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.

Posted by: howard on March 17, 2006 at 1:18 PM | PERMALINK

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.

Posted by: Al on March 17, 2006 at 1:19 PM | PERMALINK

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

Posted by: tron on March 17, 2006 at 1:27 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 1:29 PM | PERMALINK

Economy go smash!

Posted by: Single Payer Hulk on March 17, 2006 at 1:31 PM | PERMALINK

"We most certainly do not know those things."

Then you need to learn them.

Posted by: Satan on March 17, 2006 at 1:32 PM | PERMALINK

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.

Posted by: coldhotel on March 17, 2006 at 1:39 PM | PERMALINK

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.

Posted by: S Ra on March 17, 2006 at 2:01 PM | PERMALINK

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

Posted by: Jon Karak on March 17, 2006 at 2:01 PM | PERMALINK

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

Posted by: God on March 17, 2006 at 2:02 PM | PERMALINK

"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."

Posted by: Jason on March 17, 2006 at 2:04 PM | PERMALINK
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.

Posted by: cmdicely on March 17, 2006 at 2:07 PM | PERMALINK

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.

Posted by: Highlander on March 17, 2006 at 2:07 PM | PERMALINK

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 ?

Posted by: cleek on March 17, 2006 at 2:07 PM | PERMALINK

"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.


Posted by: Jason on March 17, 2006 at 2:13 PM | PERMALINK

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.

Posted by: Stephen on March 17, 2006 at 2:14 PM | PERMALINK

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.

Posted by: EM on March 17, 2006 at 2:20 PM | PERMALINK

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

The nerve.

Posted by: theperegrine on March 17, 2006 at 2:21 PM | PERMALINK

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.

Posted by: Samuel Knight on March 17, 2006 at 2:23 PM | PERMALINK

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.

Posted by: cleek on March 17, 2006 at 2:27 PM | PERMALINK

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!

Posted by: grape_crush on March 17, 2006 at 2:29 PM | PERMALINK

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...

Posted by: grape_crush on March 17, 2006 at 2:37 PM | PERMALINK
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.

Posted by: cmdicely on March 17, 2006 at 2:40 PM | PERMALINK

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.

Posted by: Renate on March 17, 2006 at 2:42 PM | PERMALINK

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?

Posted by: Tripp on March 17, 2006 at 2:45 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 2:46 PM | PERMALINK

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?

Posted by: Jason on March 17, 2006 at 2:49 PM | PERMALINK

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?

Posted by: Samuel Knight on March 17, 2006 at 2:49 PM | PERMALINK

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.

Posted by: Tripp on March 17, 2006 at 2:51 PM | PERMALINK

"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.

Posted by: Jason on March 17, 2006 at 2:51 PM | PERMALINK

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.

Posted by: Mary Alice on March 17, 2006 at 2:53 PM | PERMALINK

Jason, some existent data for you:

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

Posted by: Lucy on March 17, 2006 at 2:53 PM | PERMALINK

"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?

Posted by: Jason on March 17, 2006 at 2:53 PM | PERMALINK

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.

Posted by: NotThatMo on March 17, 2006 at 2:57 PM | PERMALINK
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?

Posted by: cmdicely on March 17, 2006 at 2:58 PM | PERMALINK

Lucy,

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

Posted by: Jason on March 17, 2006 at 2:59 PM | PERMALINK

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!!

Posted by: Gregory on March 17, 2006 at 3:00 PM | PERMALINK

Jason,

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

Posted by: Lucy on March 17, 2006 at 3:04 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 3:13 PM | PERMALINK

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

What arguments? Arguments for what claim?

Posted by: Jason on March 17, 2006 at 3:15 PM | PERMALINK

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?

Posted by: cleek on March 17, 2006 at 3:16 PM | PERMALINK

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.)

Posted by: Jeffrey Davis on March 17, 2006 at 3:22 PM | PERMALINK

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 ...

Posted by: Alek Hidell on March 17, 2006 at 3:23 PM | PERMALINK

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?

Posted by: Jason on March 17, 2006 at 3:23 PM | PERMALINK

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.

Posted by: Lucy on March 17, 2006 at 3:25 PM | PERMALINK

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.

Posted by: cleek on March 17, 2006 at 3:28 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 3:28 PM | PERMALINK

"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.

Posted by: Cal on March 17, 2006 at 3:29 PM | PERMALINK

cleek,

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

Posted by: Jason on March 17, 2006 at 3:30 PM | PERMALINK

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

Posted by: Don p. on March 17, 2006 at 3:33 PM | PERMALINK

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

Why not?

Posted by: Lucy on March 17, 2006 at 3:33 PM | PERMALINK

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.

Posted by: grape_crush on March 17, 2006 at 3:36 PM | PERMALINK

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.

Posted by: theperegrine on March 17, 2006 at 3:48 PM | PERMALINK

"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.

Posted by: EM on March 17, 2006 at 3:48 PM | PERMALINK

"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.

Posted by: Ace Franze on March 17, 2006 at 3:53 PM | PERMALINK

Lucy:

"Why not?"

I don't know.

Posted by: Jason on March 17, 2006 at 3:57 PM | PERMALINK

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.

Posted by: Right minded on March 17, 2006 at 3:58 PM | PERMALINK

I see.

Posted by: Lucy on March 17, 2006 at 3:59 PM | PERMALINK

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.

Posted by: Yancey Ward on March 17, 2006 at 4:00 PM | PERMALINK

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.

Posted by: EM on March 17, 2006 at 4:02 PM | PERMALINK

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

Posted by: sohei on March 17, 2006 at 4:02 PM | PERMALINK

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!

Posted by: grape_crush on March 17, 2006 at 4:04 PM | PERMALINK

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...

Posted by: Stephen on March 17, 2006 at 4:04 PM | PERMALINK

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.


Posted by: Jason on March 17, 2006 at 4:09 PM | PERMALINK

Lucy,

What do you see?

Posted by: Jason on March 17, 2006 at 4:10 PM | PERMALINK

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.

Posted by: howard on March 17, 2006 at 4:11 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 4:12 PM | PERMALINK

> 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

Posted by: Cranky Observer on March 17, 2006 at 4:15 PM | PERMALINK

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.

Posted by: howard on March 17, 2006 at 4:16 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 4:16 PM | PERMALINK

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.

Posted by: kaptain kapital on March 17, 2006 at 4:17 PM | PERMALINK

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."

Posted by: peanut on March 17, 2006 at 4:20 PM | PERMALINK

> 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

Posted by: Cranky Observer on March 17, 2006 at 4:20 PM | PERMALINK

> 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

Posted by: Cranky Observer on March 17, 2006 at 4:25 PM | PERMALINK
"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.

Posted by: cmdicely on March 17, 2006 at 4:25 PM | PERMALINK

"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 capitaand 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'sand 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 counterpartswhile 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

Posted by: Stefan on March 17, 2006 at 4:27 PM | PERMALINK

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?

Posted by: Right minded on March 17, 2006 at 4:32 PM | PERMALINK

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?

Posted by: Stefan on March 17, 2006 at 4:33 PM | PERMALINK

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?

Posted by: kaptain kapital on March 17, 2006 at 4:33 PM | PERMALINK

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....

Posted by: Samuel Knight on March 17, 2006 at 4:37 PM | PERMALINK

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.

Posted by: cleek on March 17, 2006 at 4:37 PM | PERMALINK

'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

Posted by: Stefan on March 17, 2006 at 4:37 PM | PERMALINK

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?

Posted by: cleek on March 17, 2006 at 4:38 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 4:40 PM | PERMALINK

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?

Posted by: grape_crush on March 17, 2006 at 4:40 PM | PERMALINK

> 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

Posted by: Cranky Observer on March 17, 2006 at 4:42 PM | PERMALINK

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?

Posted by: Renate on March 17, 2006 at 4:42 PM | PERMALINK
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.

Posted by: cmdicely on March 17, 2006 at 4:43 PM | PERMALINK

> 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

Posted by: Cranky Observer on March 17, 2006 at 4:44 PM | PERMALINK

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.

Posted by: Stefan on March 17, 2006 at 4:46 PM | PERMALINK

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.


Posted by: Jason on March 17, 2006 at 4:50 PM | PERMALINK

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.

Posted by: Stefan on March 17, 2006 at 4:52 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 4:52 PM | PERMALINK

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....

Posted by: Stefan on March 17, 2006 at 4:55 PM | PERMALINK

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

Posted by: Don P. on March 17, 2006 at 5:01 PM | PERMALINK

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.

Posted by: cmdicely on March 17, 2006 at 5:05 PM | PERMALINK

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.

Posted by: Jason on March 17, 2006 at 5:07 PM | PERMALINK

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....

Posted by: howard on March 17, 2006 at 5:12 PM | PERMALINK

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.

Posted by: Samuel Knight on March 17, 2006 at 5:13 PM | PERMALINK

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.

Posted by: howard on March 17, 2006 at 5:15 PM | PERMALINK

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

Posted by: Cranky Observer on March 17, 2006 at 5:15 PM | PERMALINK

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

Posted by: Don P. on March 17, 2006 at 5:18 PM | PERMALINK

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

Posted by: Stefan on March 17, 2006 at 5:19 PM | PERMALINK

God Stefan what's your problem? Write much.

Posted by: Don p. on March 17, 2006 at 5:22 PM | PERMALINK

Stefan:

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

Posted by: Don P. on March 17, 2006 at 5:23 PM | PERMALINK

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 going to just repeat ad nauseum the same old nonsensical liberal argument that since America's infant mortality rate is higher than that of other countries, America's health care system must be worse.

"You can list any frickin' indicator you want"

Okay: Immunization rates by disease. Diagnosis rates by disease. Treatment rates by disease. Cure rates by disease. Survival rates by disease. Average wait to see a primary care physician. Average wait time to see a specialist, by specialty. Average wait time for emergency care. Average wait time for surgery, by type of surgery. Outcome of surgery, by type of surgery. Access to prescription drugs. Access to MRI scans. Access to CAT scans. Access to hospital beds. And so on and so forth. Show me your analysis of these and other health care indicators establishing the superiority of other nations' systems over ours.

You can't, of course. Because you don't have a clue what you're talking about, just like all the other people here who hold your position as an article of faith.

Posted by: Jason on March 17, 2006 at 5:25 PM | PERMALINK

Jason what are you a friggin oracle?

Posted by: Don p. on March 17, 2006 at 5:27 PM | PERMALINK

Don P. Nice try with misleading stats.

Stefan was showing overall health stats against health spending.

That's comparable. The tax rates you cite aren't. You're comparing US Federal Income tax rates to German overall tax rates. Leaving aside the fact that the income taxes in Germany pay for health care - and in the US they don't. etc.

Nice work - Stefan.

Posted by: Samuel Knight on March 17, 2006 at 5:28 PM | PERMALINK

Single payor estimate for costs is $100 billion annually. The latest report on costs for the military in Iraq is $10 billion per month.

Posted by: underseige on March 17, 2006 at 5:29 PM | PERMALINK

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

Are you trying to argue that, despite the lower per capita and per GDP costs, universal healthcare causes higher income tax rates? Care to provide some logic?

Posted by: cmdicely on March 17, 2006 at 5:32 PM | PERMALINK

Okay: Immunization rates by disease. yada yada yada

Cite?

Posted by: cleek on March 17, 2006 at 5:34 PM | PERMALINK

Thanks, Samuel - I could have also asked if you want the same people who run the DMV to run healthcare - but, if you don't think that's exactly how the GOP are going to oppose a single, nationalized system (the thread title is "More Tired Healthcare Fearmongering"), then you are in for one big shock.

Posted by: Don P. on March 17, 2006 at 5:34 PM | PERMALINK

Stefan: Jason, that shark just bit off your foot.

Jason: No it didn't.

Stefan: Oh my gosh; it bit off your leg!

Jason: No it didn't.

Stefan: Jason, it bit off your other leg! Let me get you to a doctor.

Jason. No it didn't. And beside, we are in Germany. The doctors here are no good. Grover told me so.

Stefan: Jason, that shark is chomping on your neck! Let me get help!

Jason: No it isn't. And I will only accept /private/ help thank you - no charity.

Stefan: Arrrugh! It bit off your head!!

Jason: No it didn't.

Posted by: Cranky Observer on March 17, 2006 at 5:37 PM | PERMALINK

Jason,
I agree with Stefan, I too have experience with single payer health care.

I know people in the US WITH NO HEALTH INSURANCE, PEOPLE WHO HAD TO FILE FOR BANKRUPTCY, people who can't go to dentist.

All the years I lived in Germany I NEVER knew anyone without healthinsurance, NEVER knew anyone going BANKRUPT. NEVER knew anyone unable to see a dentist, or making huge medical payments.

All statistics show Germany spends a lower percentage of GDP than the US. And the healthcare is top nodge.

So, what is it you know.

By the way, do you notice how often the US gets compared to second or third world lately?

The standard of living keeps going down, the middle class is shrinking and the number of uninsured is going up, not down. Are we that poor?

Posted by: Renate on March 17, 2006 at 5:38 PM | PERMALINK

Because the U.S. government is not providing 100% healthcare coverage currently, cmdicely. Are you trying to argue that, once the federal government gets into the universal healthcare business, that will NOT require higher income tax rates and/or deficits?? Care to provide some logic?

Posted by: Don P. on March 17, 2006 at 5:40 PM | PERMALINK

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

A bit of an apples to oranges comparison since, as others have pointed out, Germany's income taxes go to pay for universal healthcare (as well as education, etc.) while that is not the case in the US. Or, in simpler terms, in Germay you pay more in taxes, but you also get more back in services.

Posted by: Stefan on March 17, 2006 at 5:40 PM | PERMALINK

Jason,

Is your premise that there is no compelling reason to provide basic healthcare for all US citizens?

Posted by: Lucy on March 17, 2006 at 5:41 PM | PERMALINK

Argh, edited version.

Is it your premise that there is no compelling reason to provide basic healthcare to all US citizens?

Posted by: Lucy on March 17, 2006 at 5:43 PM | PERMALINK

Or, in simpler terms, in Germay you pay more in taxes, but you also get more back in services.

Fine. If small words help you un-der-stand better, that's exactly what I am saying - try to sell tax hikes for November - see how far that gets you.

Posted by: Don P. on March 17, 2006 at 5:45 PM | PERMALINK

Is it your premise that there is no compelling reason to provide basic healthcare to all US citizens?

Please point out the Article and Section number in the Constitution where that is delegated to the FEDERAL government?

Posted by: Don P. on March 17, 2006 at 5:47 PM | PERMALINK

Don P,
dont combine incometax and payroll deduction for SS, health and unemployment. Do remember our property tax, where we pay thousands of $$ they pay a few hundred per year, they have no tuition at the universities. So as you can see you are comparing APPLES and ORANGES. sTICK TO HEALTHINSURANCE, THAT IS THE SUBJECT.

Posted by: Renate on March 17, 2006 at 5:48 PM | PERMALINK

Thanks, Samuel - I could have also asked if you want the same people who run the DMV to run healthcare - but, if you don't think that's exactly how the GOP are going to oppose a single, nationalized system (the thread title is "More Tired Healthcare Fearmongering"), then you are in for one big shock.

A more apt comparison would be if you want the people who run the VA and Medicare to run healthcare, and I'd have to say, why not?

And what's wrong with the DMV, anyway? Every few years I go down, fill out a form, wait about an hour, and I'm done. Anyone who's ever dealt with an HMO knows how that compares.

But let's imagine if the DMV was run the same way we now run health insurance. For starters, you wouldn't be issued a driver's license by the government, but by one of hundreds of private driver's license companies, and they'd only issue you the license if you had a job. No job, no license, and if you had a job and lost it, you'd have to give up your license. You could, of course, get a license privately, but it would cost you several thousands of dollars a year -- and even to have a license through your job would cost you hundreds a months.

Additionally, any of those license companies could deny you a license if you had a pre-existing condition of accidents -- so if you'd ever gotten a speeding ticket, or been in a crash, even if the crash wasn't your fault, they just wouldn't give you one.

Posted by: Stefan on March 17, 2006 at 5:48 PM | PERMALINK

try to sell tax hikes for November

look at your pay stub. see that line that says something like "Health Insurance : $xxx" ? change the label on that to "Fed Health Ins: $xxx". big woop.

and speaking of tax cuts, have we grown our way out of the defecit yet ?

Posted by: cleek on March 17, 2006 at 5:51 PM | PERMALINK

Renate:

How are YOU proposing to pay for the healthcare (although I thought the topic was "More Tired Healthcare Fearmongering")?

Stefan:

Good luck putting all that on a bumper sticker.

Posted by: Don P. on March 17, 2006 at 5:51 PM | PERMALINK

cleek:

There's no line item on my pay stub for the health insurance my work pays for - I have an HMO and only pay $10 if I have to see a doctor - if that $10 stays the same, then great, sign me up.

Posted by: Don P. on March 17, 2006 at 5:55 PM | PERMALINK

But let's imagine if the DMV was run the same way we now run health insurance.

and some DMVs wouldn't let you drive on certain roads. so if your employer switched DMVs, you might have to find a new way to work - once a year, probably.

Posted by: cleek on March 17, 2006 at 5:55 PM | PERMALINK

There's no line item on my pay stub for the health insurance my work pays for

lucky you - really. there's a line in your employer's books, though. and that's money you're not getting as salary.

Posted by: cleek on March 17, 2006 at 5:56 PM | PERMALINK

Please point out the Article and Section number in the Constitution where that is delegated to the FEDERAL government?

Its pretty clearly within the scope of the Spending Power as the Supreme Court has interpreted for quite some time.

Posted by: cmdicely on March 17, 2006 at 5:58 PM | PERMALINK

When I lived in Germany I did not pay more taxes than here in the USA. If my income tax is a little less I pay a lot more in property taxes and have a lot less services.

I say we pay as much taxes if we count all of our hidden taxes too. The difference is we blow our nations wealth in Iraq. Now we can't afford anything else.

Posted by: Renate on March 17, 2006 at 5:59 PM | PERMALINK

and some DMVs wouldn't let you drive on certain roads. so if your employer switched DMVs, you might have to find a new way to work - once a year, probably.

And every time you used your license to drive your car you'd have a $10-$20 copay.

Posted by: Stefan on March 17, 2006 at 6:01 PM | PERMALINK

cleek:

Allow me to quote then from the article Kevin linkled to: "Most lucky Americans with good insurance are doubly isolated from financial reality: They don't pay for their health care, and they don't even pay for most of their insurance -- their employer or the government pays." Try selling any increase out-of-pocket to THOSE Americans.

cmdicely:

As I've told you, just wait until the Roberts Court gets done with you.

Renate:

Was that supposed to somehow answer the question: "How are YOU proposing to pay for the healthcare"?

Posted by: Don P. on March 17, 2006 at 6:04 PM | PERMALINK

Don p.
It makes no difference if your employer pays your insurance or you pay, it is part of your wages, you have to work for it, your healthcare is not free in any system. I thought you knew that.

Posted by: Renate on March 17, 2006 at 6:04 PM | PERMALINK

cranky, brilliant at 5:37.

lucy, jason's point, such as it is, is that there must be a flaw in here somewhere, because it's not possible - it's not even conceivable - that the US crazy-quilt system could possibly not be number one. it's the typical college republican prattle.

jason, darling, not that it hasn't been swell, but you really do seem to have a reading comprehension problem. I'm not going to sit around and dig out reports that i've read over a couple of decades just because you're a know-nothing.

i can't summon up, right off the bat, why pi-r-squared gives you the area of a circle, nor can i provide you the proof of why f=ma, but that doesn't make them not true. and the same is the case for the us health care "system," to use the term loosely: it is not producing superior results, and your ability to produce a long list of relevant, semi-relevant, and irrelevant categories doesn't change that. do your own bleedin' homework, mate, and come back when you've learned something, if that's in your skill set (something i rather doubt).

Posted by: howard on March 17, 2006 at 6:07 PM | PERMALINK
There's no line item on my pay stub for the health insurance my work pays for

Its certainly a cost that figures into what your employer figures they are willing to pay for your labor, since they are paying for the insurance as part of their costs, whether or not there is a "line item" on your pay stub or not.

Because the U.S. government is not providing 100% healthcare coverage currently, cmdicely. Are you trying to argue that, once the federal government gets into the universal healthcare business, that will NOT require higher income tax rates and/or deficits?? Care to provide some logic?

The above stats on the costs, per capita and per GDP, of universal healthcare (and additional stats for other countries that have it), suggests that, the average increased tax burden, if any, will be less than the decrease in out of pocket medical expenses and insurance costs.

Certainly it won't require increases on the order of Germany's tax rates, because Germany provides a lot of other, non-healthcare public goods and services that the US does not provide, which affect tax rates but are not relevant to the healthcare discussion.

Posted by: cmdicely on March 17, 2006 at 6:09 PM | PERMALINK

Don P's comments remind me of Kerry bringing up a variety of homeland security measures, including improved port security, during one of the debates with bush and the dear leader responding, roughly paraphrased, "why, you'd have to raise taxes."

yes, we'd be seeing a transfer of some costs that are currently borne by employers (although we are down to under 60% of employees having some form of health-care coverage) to the public side. i'd pay for that through a combination of spending cuts and higher taxes, in return for which business would be far more competitive in the global marketplace, workers might actually see real income gains, and the overall system would take fewer resources from gdp, leaving more to be appied in other productive areas.

and no, you can't put that on a bumper sticker, the way you can "cut taxes," but bumper sticker slogans make pretty poor public policy, as perhaps you've noticed since January, 2001.

Posted by: howard on March 17, 2006 at 6:11 PM | PERMALINK

I never said my healthcare was "FREE", you idiots! I said mine, and most lucky Americans, are not paid directly but through our employers. So, try selling any increase out-of-pocket to THOSE Americans. Unless you really live in Fantasyland and think that whatever little employers do save (if anything) will be passed along to employees all of a sudden?

Posted by: Don P. on March 17, 2006 at 6:14 PM | PERMALINK

howard:

I'm certain the GOP Congress would be happy to get re-elected in November with "only" 60% of the voters.

Posted by: Don P. on March 17, 2006 at 6:16 PM | PERMALINK
I never said my healthcare was "FREE", you idiots! I said mine, and most lucky Americans, are not paid directly but through our employers.

You idiot, very many "lucky Americans" -- that is, very many of those lucky enough to have insurance -- do, unlike you, have a line item on their paycheck deducted for insurance.

And, of course, there's no guarantee that most Americans would see a tax increase, either, so there is no reason to assume they would see an out of pocket increase.

Posted by: cmdicely on March 17, 2006 at 6:22 PM | PERMALINK

so, don p, just to be sure: you favor a moronic system of tying health care to your job not because you actually have a credible argument as to why it's a good idea, but because you think that it would help the gop continue to control congress?

and we're supposed to take that seriously?

Posted by: howard on March 17, 2006 at 6:22 PM | PERMALINK
I'm certain the GOP Congress would be happy to get re-elected in November with "only" 60% of the voters.

60% of employees

Posted by: cmdicely on March 17, 2006 at 6:23 PM | PERMALINK

Nicely done Stefan (and others, since I first started this).

1. For those who haven't done enough reading on the subject already, you might visit the WHO's:

** The world health report 2000 - Health systems: improving performance **

Endless hours of fascinating reading, but here's the visual for those who prefer the Cliff Notes version:

http://www.who.int/whr/2000/media_centre/en/whr00_maps_en.pdf

2. Comparison of taxes paid in the US to those paid in any country with a single-payer healthcare system is a false comparison.

Either subtract the cost of health care from taxes paid outside the US, or add the cost of health care to the total amount paid by US residents.

(Wait. Does that make the lack of affordable healthcare coverage in the US tantamount to a *tax cut*??)

3. In 2005, the annual average health insurance premium for a family of four rose to $10,880 - which was of course, *in addition to* taxes paid (Kaiser Family Foundation). That does not include deductibles and additional costs not covered by insurance.

4. According to numbers cited by Sen. Ron Wyden in conjuction with the 'Health Care That Works For All Americans' project, (www.citizenshealthcare.gov) the aggregate of health care money spent in this country equals roughly $25,000 per family of four.

His favorite, purposely simplistic example is this: For that same money, five families could hire their own doctor, pay that doctor a 6-figure annual salary, and have a private practitioner with an entire practice of 20 patients.

Any takers?

All: Individuals *and* businesses are strugging with these costs. More and more small businesses simply can't afford to offer health care coverage as a benefit for their employees.

And Americans who have done all the responsible, patriotic, and hard-working things they were supposed to do - are going without life-saving care - because the majority of those who can't afford health insurance are *working* - or children.

Our parents and grandparents are struggling with a ridiculous and needlessly confusing and punitive new Medicare Rx *insurance* plan - while hospital, pharmaceutical and insurance companies are raking in the profits. (Look up their annual reports.)

We need to find common-sense solutions -not free-market- to this crisis. Studying the best aspects of single payer systems around the world will not give us cooties.

Posted by: Trixie on March 17, 2006 at 6:24 PM | PERMALINK

It is true that most, I would say all, high income Americans have good health insurance. I think that Kinsley, and Kevin and Dell and Gates have no problem at all.

The people in the middle class have the risks. If you earn $1k you also have good insurance until you loose your job and you have to pay maybe $1k a month to cover your family. Most people don't earn that much and they lose their jobs too, and when they get another job they may have to wait maybe 6 m before insurance takes effect. Mr. Kinsley does not have to worry about that. He has parkinsons if I am not mistaken, if he were an average American he could have lots of problems to get any insurance. My guess is, he thinks everyone is as well off as he is.

Anyone as wealthy as he would not have to take part in a one payer system, let him keep his private insurance. I for one would not care.

As for our government, I believe the government is supposed to serve the people as best as possible, (see Katrina) I can't see why we have such lowe expectations of our government. Why do we pay so much for these guys and they provide welfare for the big corporations at the expense of the people. Just remember Halliburton and the money they get paid, even when we know they ripp us of.

And yes, it is the taxes from earned income, not capital gains.

We do have the government we deserve.

Posted by: Renate on March 17, 2006 at 6:28 PM | PERMALINK

Er, above I was attempting to note:

60% of employees << 60% of voters.

Posted by: cmdicely on March 17, 2006 at 6:29 PM | PERMALINK

howard:

Don't count me in as a Republican. As a group, they are almost as bad as the Democrats. I'm just stating a political fact.

cmdicely:

Did you mean to finish that sentence? And you call me an idiot? ROFL

Posted by: Don P. on March 17, 2006 at 6:30 PM | PERMALINK

Renate:

I am not wealthy - will I get to keep my same HMO?

cmdicely:

For once, I agree with you: "60% of employees" is less than "60% of voters". You were trying to make some larger point?

Posted by: Don P. on March 17, 2006 at 6:34 PM | PERMALINK

Stefan,

Your comparison of those aggregate German and U.S. statistics is meaningless. Take infant mortality. As I have already explained, different countries define and record infant mortality in different ways. The numbers are not directly comparable. The U.S. counts as infant mortalities deaths that in other countries, notably European ones, would be counted as perinatal deaths. This difference inflates the U.S. figure and prevents direct comparisons of IMR. You are comparing apples and oranges.

Here's how Wikipedia describes the problem:

"The method for calculating IMR often varies widely between countries based on the way they define a live birth. The World Health Organization defines a live birth as any born human being who demonstrates independent signs of life, including breathing, muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality."

In addition, infant mortality rates are affected by many factors other than quality of health care, such as rates of drug use, alcohol use, and other harmful behaviors by pregnant women, and rates of domestic violence against pregnant women by husbands and boyfriends.

A third problem is that the IMR rate is just an average, and thus provides no indication of distribution. Using IMR to measure overall quality of prenatal or neonatal health care is like using GDP per capita to measure the overall standard of living of Americans. The average is skewed by a relatively small number of outliers.

Similar problems exist with your comparison of average life expectancy.

Of course, we both know that you're not really interested in a serious, scientifically valid approach to comparing health care systems. You're just trawling the internet looking for bits and pieces of data that you think you can spin to support a predetermined belief you hold as a matter of faith.

Posted by: Jason on March 17, 2006 at 6:34 PM | PERMALINK
In addition, infant mortality rates are affected by many factors other than quality of health care, such as rates of drug use, alcohol use, and other harmful behaviors by pregnant women, and rates of domestic violence against pregnant women by husbands and boyfriends.

Drug and alcohol abuse are largely components of treatable conditions; high rates of those kinds of abuse are themselves a failure in the healthcare delivery system.

Posted by: cmdicely on March 17, 2006 at 6:36 PM | PERMALINK
Did you mean to finish that sentence?

Yeah, apparently preview has a problem that it replaces HTML entities with the characters they represent, making it a bad idea to use preview on a post that contains "less-than" signs.

And you call me an idiot?

Yes. Because you are an idiot.


For once, I agree with you: "60% of employees" is less than "60% of voters". You were trying to make some larger point?

The only thing in the thread that your "60% of voters" claim seemed to tie back to at all was an earlier mention of 60% of employees. It is, of course, also possible it was a complete non-sequitur and I was being overly generous in assuming you at least were trying to make a comment relevant to the discussion.

Posted by: cmdicely on March 17, 2006 at 6:40 PM | PERMALINK

Oh my goodness...

Charlie in drag as Don P?

Who knew?

Posted by: poot Smootley on March 17, 2006 at 6:41 PM | PERMALINK

Jason:

You're exactly right - hese people don't care about the facts - although I guess I'm "talking to myself" since they think you are Don P. and I am Charlie. Now watch the little pea under this shell . . .

Posted by: Don P. on March 17, 2006 at 6:45 PM | PERMALINK

Actually, in a way, Don P has a point. We all pay for healthcare, it's just that not all of us get it.

The employer adds the cost of healthcare to the cost of the product. Our tax dollars pay for the universities where the doctors are trained, the research is done, and the teaching hospitals are run. We pay taxes for public health to try to prevent epidemics that might result from our poor healthcare system. Our car insurance bills include the cost of treating accident victims.

So, every body is paying for healthcare, and in most states, because of regressive tax systems, the people who are least likely to receive care pay the biggest proportion of their income.

It's a lucky thing we can confidently expect improved care and lowered costs when universal healthcare is adopted. Otherwise, there would be some very disappointed 'free riders' among our proud 'self-made men'.

But I'm guessing there will still be complaints. After all, this is America, where white males think they are discriminated against.

Posted by: serial catowner on March 17, 2006 at 6:48 PM | PERMALINK

jesus, imagine that: the uneducated jason now reads something in wikipedia and that makes him an expert. yes, sweetums, we all know that stats are counted in different ways in different countries and this makes comparisons more difficult. shocking insight - would never have thought of such a thing wtihout your informed help.

and gosh and golly, average doesn't capture the whole picture. why i never.

so now jason has made it to kindergarten; let's see how he does once he advances to first grade....

Don P., fine, you're not a republican. what do i care? your point is that the status quo is easy to defend. i actually doubt that, but that's neither here nor there. we're not talking about how to sell change in the system; we're talking about whether the system needs changing.

do you believe it does or don't you? if you believe it does, than it doesn't matter if republicans would love to caricature change in their usual dishonest ways (other than when they're not, to quote the Dear Leader, "afraid of the future"). if you don't, then are you really joining with jason and defending the current mishmash?

Posted by: howard on March 17, 2006 at 6:50 PM | PERMALINK

As I said, if I get to keep my same service, for the same $10 cost, sign me up.

Posted by: Don P. on March 17, 2006 at 6:51 PM | PERMALINK
I am not wealthy - will I get to keep my same HMO?

That depends on the details of the plan; its conceivable that private plans with capitated subsidies could exist as an option in a universal system, with many of the features (both good and bad) of existing HMOs, so its quite possible your existing HMO would be unchanged (though, given the availability of the choice of coverage without many of the limits of HMOs -- including on provider selection -- even if allowed, they may not remain viable as there could be little rational reason to choose them.)

Then again, in many universal systems proposed, there would be no room for private insurers (except, perhaps, as supplementary insurers) at all, whether offering HMOs or traditional insurance.

Posted by: cmdicely on March 17, 2006 at 6:55 PM | PERMALINK

Don P.

A single payer system could be a payroll deduction, you may not have to pay $10.00 to see a Dr., your prescription would be covered, what good is it to see a Dr. if you can't afford the prescription. Most likely insurance costs less, it would go with you if you change jobs, no questions about existing healthproblems, no waiting period, choice of Dr.the Dr. says what treatment is required, not some desk person hundreds of miles away. You and your family would have dental care, even if you were unemployed you and your family would be insured. You would never have to sell your home to pay medical bills. You would not have to worry about ever loosing your coverage. Don't you think that would take lots of stress off your shoulders and improve your quality of life? Oh, not to forget your wife, all reproductive healthcare would be covered,, including contraceptives and maternity care.

Posted by: Renate on March 17, 2006 at 6:56 PM | PERMALINK

And hey, don't you guys get the joke? This is Jason, remember? The mindless thing that can't be killed and always gets back up and comes at you again, and nothing is strong enough to ward him off, until you just want to go insane and travel back in time and strangle Jamie Lee Curtis's parents before they breed.

The only thing that has a good chance of killing Jason is the American healthcare system.

Posted by: serial catowner on March 17, 2006 at 6:56 PM | PERMALINK

cmdicely:

On the third hand, we could just leave everything as is.

Renate:

I already don't like the sound of "A single payer system could be a payroll deduction . . ."

Posted by: Don P. on March 17, 2006 at 6:59 PM | PERMALINK

Short answer for Don P- if universal coverage comes from the Republicans, you can expect a hybrid with parts of Medicare Part D, Enron in California, and the war in Iraq.

If universal coverage comes from the Dems, it will probably be like Social Security and Medicare- quiet, efficient, and supported, as Medicare is now, by all the best doctors and hospitals in the country.

Posted by: serial catowner on March 17, 2006 at 7:03 PM | PERMALINK
On the third hand, we could just leave everything as is.

With lots of people uninsured, and healthcare costs spiralling out of control and the burden on employers of providing healthcare in the US system being frequently cited as a major drag on competitiveness -- the only people who benefit from the status quo are insurance companies, which is why they back massive expenditures on scare campaigns whenever their is any prospect for change.

Posted by: cmdicely on March 17, 2006 at 7:13 PM | PERMALINK

Don P., this is really very amusing: as long as you have yours, you truly don't give a good god-damn about whether the system makes any sense.

just to note, though: employers giveth, and employers taketh away. the reason that fewer and fewer workers (as a percentage) are covered at all, and the reason that most workers' coverage is going up in costs, is that business is being squeezed by higher energy input costs and global competition, and the offsetting savings need to come from somewhere.

so you're not going to get to keep whatever your "$10" deal is indefinitely either.

i did decide to take a little pity on poor jason, though: uwe reinhardt is a serious-minded economist who has studied health-care and health-care financing throughtout his career. he wrote this in 2004:

http://www.j-bradford-delong.net/movable_type/health/Reinhardt.pdf

you'll actually learn something if you read it, which, admittedly, probably makes it radioactive to you.

Posted by: howard on March 17, 2006 at 7:16 PM | PERMALINK

cmdicely,

"Drug and alcohol abuse are largely components of treatable conditions; high rates of those kinds of abuse are themselves a failure in the healthcare delivery system."

Nonsense. Rates of drug and alcohol abuse, and other harmful behaviors by pregnant women and mothers that are likely to increase the infant mortality rate, are a product of a variety of socioeconomic factors. A nation may have the best drug treatment services in the world and still have a higher rate of drug abuse than a nation with inferior services. The existence in the U.S. of a large urban underclass where drug use and other destructive behaviors are common likely contributes significantly to its infant mortality rate. That's not a failure of the health care system, it's a consequence of broader socioeconomic problems.

Posted by: Jason on March 17, 2006 at 7:34 PM | PERMALINK

Thanks for the primer, howard. I think it is fair to say I am in the "Healthcare-is-a-Private-Consumption-Good" school, just like food, housing, and clothing - seriously, is Universal Housing or Universal Clothing next?

I do not favor universal health insurance coverage that extends the peace of mind and unfettered access to needed health care -- taken so much for granted by well insured Americans -- also to the families of low-income, uninsured Americans. There's a system in place for them already.

Posted by: Don P. on March 17, 2006 at 7:39 PM | PERMALINK

howard,

I'm not sure what point you think you are making by citing that Reinhardt paper. It appears that you didn't even read it yourself. It doesn't advocate single-payer health care. It doesn't even claim that Kerry's health care reform proposal was better than Bush's.

Posted by: Jason on March 17, 2006 at 7:48 PM | PERMALINK
"Drug and alcohol abuse are largely components of treatable conditions; high rates of those kinds of abuse are themselves a failure in the healthcare delivery system."

Nonsense.

No, really, substance addictions are treatable conditions and failure to effectively treat them is, indeed, a failure of the healthcare delivery system.


Posted by: cmdicely on March 17, 2006 at 7:52 PM | PERMALINK

A bit of a rebel song for St. Paddy's Day song

'Oh, Paddy, dear, and did ye hear
the news that's goin' 'round.
The Shamrock is forbid by law
to grow on Irish ground.

No more St. Patrick's Day we'll keep,
his color can't be seen
For they're hangin' men and women
for the wearin' o' the green.

For the wearin' o' the green.
For the wearin' o' the green.
Aye, they're hangin' men and women
for the wearin' o' the green.'


WE now resume our regular programming.

Chris O'Shaughnessy RIP

Posted by: CFShep on March 17, 2006 at 8:01 PM | PERMALINK

Addictions are no more "treatable" conditiond than other genetic defects. All human behavior is complex and has many proximate determinants, but they all reduce to some combination of genes and environment. Traits that may superficially appear to be harmful (like addictions) may in fact on balance be beneficial. Whether they are harmful or beneficial may also depend on the environment in which they are expressed. A good example is the sickle cell mutation, which causes sickle cell anemia (harmful) but also protects against malaria (beneficial). In some areas where malaria is common, the benefit outweighs the harm, so the mutation has persisted amoung people who live in those areas, and in groups that trace their ancestry to those areas, such as some African-American groups.

In other cases, a trait may not itself be beneficial in any environment, but may be linked through a mechanism such as pleiotropy to a beneficial trait. As a different example, there is some evidence that male homosexuality is linked to increase fertility in women. That is, there may be a gene, or a combination of genes, that produce, or predispose for, homosexuality when they are passed on to men, but that also increase fertility when passed on to women. The benefit of increased female fertility outweighs the harm of male homosexuality, so the gene persists. I'm not claiming this account of homosexuality is correct, I'm just using it as an illustration of the complexity of the issue. I'm pretty sure we've gone through this before.

Posted by: Don P. on March 17, 2006 at 8:08 PM | PERMALINK

Jason,

Your hostility to a single-payer system is so palpable I wonder what convictions you do have about the best solutions to the health care crisis. You never identified what you admire about Kinsley's article, which I found obfuscatory and uninformative. Is this the argument you support:

It seems that access to healthcare for all Americans is not a priority for you.

Posted by: Lucy on March 17, 2006 at 8:11 PM | PERMALINK

Um, Kinsley's argument is:

"Give up your health care subsidy and you may opt out of any rationing-type restrictions that the system imposes. And if a few smaller reforms like that don't work, maybe it will be time for single-payer."

You've been coy. What is your position?

Posted by: Lucy on March 17, 2006 at 8:13 PM | PERMALINK

Stefan, quoting a book reviewer,

"According to the World Health Organization the United States is number one in health spending per capitaand thirty-seventh in the quality of its service."

No, the WHO does not claim that the U.S. is 37th in the "quality of its service." Like you, the reviewer doesn't know what he's talking about. The "37" figure refers to a "performance" ranking in WHO's World Health Report 2000. The "performance" value was derived by combining a single crude empirical measure of health (disability-adjusted life expectancy) with an ideological judgment about funding "fairness." Not surprisingly, the report has been attacked from both the left and the right. Vincente Navarro, a professor in the School of Public Health at Johns Hopkins, wrote a scathing critique of the report in the Lancet, noting the huge discrepancies between the WHO's "performance" rankings and other evidence, including public perceptions. With respect to Spain, he wrote:

"Something seemed profoundly wrong in the reports claiming that the performance of the Spanish system was the seventh best in the world. The reports conclusions certainly did not coincide with the perceptions of most Spanish people. In one of the most rigorous surveys of views of the Spanish population regarding health care, Spaniards expressed more discontent with their system than did the population of any other major country in the European Union, except Italy, whose health care was also listed among the best in the WHO report."

He also dispenses with the notions that life expectancy is strongly related to medical-care services and that good health indicators and life expectancy are meaningfully related to single-payer or publicly-financed health care systems:

"But it is wrong to explain a countrys level of mortality by its medical services. Not even public-health interventions (such as immunising against childhood diseases), which have been far more effective in reducing mortality than have medical-care interventions, can be considered the main reasons for the mortality decline in the 20th century. Social, economic, and political interventions are the primary reasons for this decline.

"This mistaken assumptionoverestimating the effectiveness of medical and health careexplains why some countries, such as the Mediterranean countries, Spain, Italy, Portugal, and Greece, which traditionally have good health indicators with long life expectancies, earn high marks in the WHOs classification of effectiveness. The report erroneously attributes the low mortality in these countries to the effectiveness of their medical care. Actually, these various Mediterranean countries have different types of health services, but all share the characteristic that public expenditures in the health-care system as a percentage of gross national product are among the lowest in the EU."


Posted by: Jason on March 17, 2006 at 8:18 PM | PERMALINK

There you go, Lucy. Universal access to healthcare for all Americans is not a high priority for some of us.

Posted by: Don P. on March 17, 2006 at 8:18 PM | PERMALINK

O.K., well those last 2 posts just proved that "Jason" and "Don P." are not the same person - as far as I know, these comments do not allow the same computer to post at the same exact timestamp - follow the shells carefully, folks.

Posted by: Don P. on March 17, 2006 at 8:30 PM | PERMALINK

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.

Worst Kevin Drum sentence in a long, long time.

a) Kevin: can you read Kinsley's mind? Did he email you to divulge his "disnonesty"? If the answer to these questions is "no" has it occurred to you that perhaps Kinsley's perception of and prescription for the healthcare crisis may simply be different from yours? Why can't we ever simply accuse someone of being wrong anymore? Why do arguments about policy always have to become so dissaprovingly moral in tone?

b) Kinsley doesn't present the problems of single payer in a "simplistic" way. They're very real, or at least they will be very real, if we try and graft single-payer onto America's titanically costly healthcare system. We'll need to impose massive government-fiat rationing. And rich folks will surely want to spend their money to jump queues and buy $100,000 pills. And this being the United States of America, they'll rightly be allowed to do so. So Kinsley's point is that, given that a lot of people will perceive this situation as being quite unfair, might it not make sense to withold the government-sponsored, taxpayer-funded universal health insurance from the wealthy people who go to expensive private clinics? It may seem more just to the masses to do something along these lines, and will therefore preserve social peace. And at the same time it will save us a great deal of money (and we'll need every penny we can get our hands on as the boomers retire).

Now, maybe one can make arguments against Kinsley's suggestion, but surely his ideas aren't so whacky as to be writen off as "tiresome". I think as usual Kinsley's being rather thoughtful and thought-provoking, and his points merit thoughtful replies.

Posted by: P.B. Almeida on March 17, 2006 at 8:33 PM | PERMALINK

O.K., well those last 2 posts just proved that "Jason" and "Don P." are not the same person - as far as I know, these comments do not allow the same computer to post at the same exact timestamp - follow the shells carefully, folks.

Fascinating isn't it, Charlie?

Posted by: poot Smootley on March 17, 2006 at 8:41 PM | PERMALINK

By the way, the original Don P., while often infuriatingly opinionated, obstinate and just plain obnoxious, was also a very good writer. This new guy is most definitely an imposter, else Don P. has lost quite a few brain cells since he last frequented these parts, or simply no longer gives a damn about the quality of his prose.

Posted by: anon on March 17, 2006 at 8:44 PM | PERMALINK

As much fun as it's been checking out this ping-pong match ("'tis! 'tisn't!"), how about somebody doing all this research on other nation's systems and coming up with a real, detailed plan for putting the United States under government-paid health care?

I want to see numbers. I want to see the real costs and who EXACTLY is going to pay them, including a smooth way to shunt a trillion dollars in funding from the private sector (mostly employers) to Washington. I want to see how people will still have choices. I want to see how competition between providers can be maintained under cost controls. Without any competition, you will end up with the "Yugo" of health care.

I want to see that private alternatives are not going to be made illegal.

Tell the Democrats to sit down and write something up.

If it turns out to be the usual vague detail-free gas like "(stands up) we will provide universal health care for everyone (sits down)" tell them to try again. Conversely, if it turns out to be eight hundred pages of fine-print "European Union Constitution" crap, roll it up, shove it up their butts, set the end on fire, and tell them to come back with something simpler.

Show me the plan. Something you can easily get a staple through. Then we can discuss the details. Right now both sides are blowing smoke, and not just because of that rolled-up paper.

Besides, think of the political issue you could make out of an easily-understandable plan.

BTW, of all the people who have declared that our "health costs" are highest, not one has itemized that number. Are investments in new drugs "health costs?" Development of new equipment? Does anyone even know?

Posted by: tbrosz on March 17, 2006 at 8:48 PM | PERMALINK

tbrosz:

Good questions.

anon:

I actually have a new web browser now that prevents extensive editing - thanks for the original compliment though.

Posted by: Don P. on March 17, 2006 at 9:05 PM | PERMALINK

TEST

Posted by: Don P. on March 17, 2006 at 9:06 PM | PERMALINK

Contrary to what Kinsley implies about single-payer, we already have rationing.

Kinsey neither implies nor states that we do not have rationing under today's system. What he predicts -- I'd guess correctly given the experience of other single-payer systems -- is that single-payer in the US will require widespread, government-fiat rationing. After all, if we move to a system where everybody's healthcare costs are paid by the other guy, what other mechanism could possibly keep healthcare costs in check?

I don't think a big healthcare sector is a bad thing, but I don't think we can allow it to consume the entire economy, either. Given cultural and economic realities in the US, we won't see one or two percent of the population occassionally using private clinics (like in Canada, where a tiny portion of the population occassionally heads to the US). We'll more likely see the richest 15 or 20 or 25% of the population using the private sector exclusively for all its healthcare needs, and everybody else making do with a heavily-rationed public sector. Mind you, I'm not necessarily saying that being stuck in the latter is such a bad thing (I mean, how bad can it be to wait for a hip operation if that's the price you've paid for an ironclad guarantee you'll always have healthcare). But I think Kinsley is thoughfully looking at some of the possible challenges we'll be dealing with at implementing single payer here. The US is not Britain or Canada or France or Sweden. We won't be able to snap our fingers and get all the benefits of these systems and few of the costs. The transition could well be messy. Indeed, I think we won't get there at all in the beginning. I confidently predict the first American UHC program won't be single-payer at all (though it may morph into that 15 or 20 years after its arrival), but will likely be some kind of play or pay system, perhaps along the lines of a universal mandate with subsidies.

But if we do eventually get to single payer, I think we'll have to at least look at the possibility of making that richest quartile of the population -- the people using the private hospitals -- opt out entirely of the government-paid insurance. I think this is all Kinsley is saying.

Posted by: P.B. Almeida on March 17, 2006 at 9:10 PM | PERMALINK

Jason on March 17, 2006 at 4:50 PM:

It's your responsibility to back up your own statements.

Agreed. Still waiting for you to make the attempt.

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 ..]"

Oh, I would if I actually wrote that. But I didn't, and you are being dishonest. You also tried that earlier with cleek, with an equal lack of success...

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

Again, you admit to having no support for your statements. I love the discussion tactic you are using: Make some broad statement, let the opposition refute it, attack the refutation as invalid/partisan/whatever, and declare some form of victory without ever having to prove the validity of your original statement...Maybe that is what passes for debate on the College Republican campaign circuit, but it doesn't hold water with the adults you are talking to here.

I don't have a list.

No shit. You don't have an argument, either.

It would have to be a large set of indicators...

So you do have a list...The WHO link I provided covers some of those items.

Jason on March 17, 2006 at 6:34 PM:

you're not really interested in a serious, scientifically valid approach to comparing health care systems.

And you are? At the time of this post of yours, you haven't provided any data to support anything instead, preferring to trawl the web, looking for any tidbit that may put the validity of the collected data into question...All while providing no support for anything you've pulled out of your ass.

You made a statement, Jason. Stop your weaseling and support it.

Jason on March 17, 2006 at 7:34 PM:

The existence in the U.S. of a large urban underclass

Black people, you mean.

where drug use and other destructive behaviors are common

Unlike the drug use and other destructive behaviors that takes place in the caucasian 'burbs, right?

likely contributes significantly to its infant mortality rate.

You could say that it's a consequence of broader socioeconomic problems...Such as the inability to pay for prenatal care. Or is every child born in the 'urban underclass' you mention a crack baby or suffers from fetal alcohol syndrome as a result of 'destructive behaviors'?

That's not a failure of the health care system

Kudos for cmdicely for easily handling this bit.

Again, Jason: What evidence do you have to support your statement that: "Single-payer doesn't work well in any country, let alone dozens."

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

Of course the rich will be philosophical about having to pay for their own insurance in addition to funding public healthcare through their taxes.

Posted by: Lucy on March 17, 2006 at 9:18 PM | PERMALINK

grape_crush:

Perhaps I missed it - can you point to me WHERE cmdicely supported his assertion: "Drug and alcohol abuse are largely components of treatable conditions; high rates of those kinds of abuse are themselves a failure in the healthcare delivery system"?

Posted by: Don P. on March 17, 2006 at 9:30 PM | PERMALINK

I shall repeat my support for the opposite position (in case you missed that the first time):

"Addictions are no more "treatable" conditiond than other genetic defects. All human behavior is complex and has many proximate determinants, but they all reduce to some combination of genes and environment. Traits that may superficially appear to be harmful (like addictions) may in fact on balance be beneficial. Whether they are harmful or beneficial may also depend on the environment in which they are expressed. A good example is the sickle cell mutation, which causes sickle cell anemia (harmful) but also protects against malaria (beneficial). In some areas where malaria is common, the benefit outweighs the harm, so the mutation has persisted amoung people who live in those areas, and in groups that trace their ancestry to those areas, such as some African-American groups.

In other cases, a trait may not itself be beneficial in any environment, but may be linked through a mechanism such as pleiotropy to a beneficial trait. As a different example, there is some evidence that male homosexuality is linked to increase fertility in women. That is, there may be a gene, or a combination of genes, that produce, or predispose for, homosexuality when they are passed on to men, but that also increase fertility when passed on to women. The benefit of increased female fertility outweighs the harm of male homosexuality, so the gene persists. I'm not claiming this account of homosexuality is correct, I'm just using it as an illustration of the complexity of the issue."

Posted by: Don P. on March 17, 2006 at 9:32 PM | PERMALINK

I'm getting bored. The last new thread Kevin started was this morning. Where is he? Did he get on "Jeopardy"?

Posted by: Don P. on March 17, 2006 at 9:39 PM | PERMALINK

tbrosz on March 17, 2006 at 8:48 PM:

how about somebody doing all this research on other nation's systems and coming up with a real, detailed plan for putting the United States under government-paid health care?

Exactly. That's what I'm waiting for as well.

A fairly good post, tbrosz...Thanks.

Posted by: grape_crush on March 17, 2006 at 9:39 PM | PERMALINK

tbrosz on March 17, 2006 at 8:48 PM:

how about somebody doing all this research on other nation's systems and coming up with a real, detailed plan for putting the United States under government-paid health care?

Exactly. That's what I'm waiting for as well.

A fairly good post, tbrosz...Thanks.

Posted by: grape_crush on March 17, 2006 at 9:39 PM | PERMALINK

Ah grape, you're back. Time to play you again.

"Agreed."

Good. Then back up the statement of yours I quoted.

"Oh, I would if I actually wrote that. But I didn't, "

Yes you did. You wrote it in your post of 2:29pm: "Actually, we do."

"Again, you admit to having no support for your statements."

No, I don't. But I'm glad you just admitted you are making things up out of thin air. I know how hard that must have been for you.

"No shit. You don't have an argument, either."

You don't have a single coherent thought, let alone an actual argument.

"So you do have a list"

No. Still waiting for you to substantiate your claims.

"And you are?"

Of course. You're just being a child, though. So I'm treating you as one.

"Black people, you mean."

No, I don't mean black people. Why do you think black people are inherently inferior? Do you also feel that way about Jews?

"Unlike the drug use and other destructive behaviors that takes place in the caucasian 'burbs, right?"

No, not really. But they're probably more common amoung the urban underclass, and the infant mortality rate is therefore probably higher in that population.

"You could say that it's a consequence of broader socioeconomic problems...Such as the inability to pay for prenatal care."

I could say it and I did say it. An inability to pay for prenatal care might be one such socioeconomic problem, yes.

Posted by: Jason on March 17, 2006 at 9:41 PM | PERMALINK

"Again, Jason ..."

Again, grape, what evidence do you have for your statement: "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 ..]"?

Posted by: Jason on March 17, 2006 at 9:46 PM | PERMALINK

Tell the Democrats to sit down and write something up.

What's the point, tbrosz? Like a dishonest hack like you is persuadable. Who gives a damn what you want to see? (Though if you imagine that "that private alternatives are going to be made illegal," you're even more paranoid than the average loony libertarian.)

Posted by: Gregory on March 17, 2006 at 9:48 PM | PERMALINK

Addictions are no more "treatable" conditiond than other genetic defects.

Tendency toward addiction has some genetic component (indeed, there are few, if any, behavioral tendencies that don't), but they are not a "genetic defect" as that term is usually used. Further, its rather well demonstrated that, while some degree of relapse is, perhaps, unavoidable, addiction is very much treatable.

Of course, this rather stupid comment was just an attempt to try to mimic the original Don P. by making a statement that was distantly related to an earlier Don P. post so that you could cut and paste that post here. The remainder of your post was cut and pasted from the Don P post at 9:45p on October 21, 2005 in this thread.

Clearly, you think that by cut and pasting bits of old Don P. posts and attaching them to bits of material that are tangentially relevant to both them and the discussion at hand, you can do a better job than you have been so far at simulating the old Don P., as your disguise has already been penetrated.

But, you know, that's pretty easy to catch, too.

Posted by: cmdicely on March 17, 2006 at 9:48 PM | PERMALINK

So, does that mean I am, or I am not, consistent?

Posted by: Don P. on March 17, 2006 at 9:52 PM | PERMALINK

how about somebody doing all this research on other nation's systems and coming up with a real, detailed plan for putting the United States under government-paid health care?

A real, detailed plan? Here's one that's already been put together, passed the California State Senate, and is pending before the California State Assembly to establish a universal, single-payer system in the State of California. Admittedly, its for "California" not "the United States", which makes it somewhat more complicated, since it has to interface with existing federal programs and federal mandates designed for the status quo environment.

Posted by: cmdicely on March 17, 2006 at 9:53 PM | PERMALINK

I was wondering where that stuff came from.

Thank you for nipping a third paste in the bud.

Posted by: Lucy on March 17, 2006 at 9:53 PM | PERMALINK

I already told you I took 6 months off.

Posted by: Don P. on March 17, 2006 at 9:53 PM | PERMALINK

Don P. on March 17, 2006 at 9:30 PM:

can you point to me WHERE...

I don't have a dog in that hunt, Don. I'm sure that cmdicely can respond to that, and will if he chooses to.

Don P. on March 17, 2006 at 9:39 PM:

I'm getting bored.

Then do something else. Nobody hangs around here for the purpose of waiting for the chance to entertain you.

Posted by: grape_crush on March 17, 2006 at 9:54 PM | PERMALINK

So, does that mean I am, or I am not, consistent?

Your dishonesty and attempts to evade the derision that attaches to each of your newly-adopted aliases here is consistent.

Posted by: cmdicely on March 17, 2006 at 9:56 PM | PERMALINK

If anyone is really questioning whether there is evidence that addiction is treatable, there are mountains of evidence available.

One example regarding cocaine use is here.

Posted by: cmdicely on March 17, 2006 at 10:00 PM | PERMALINK

Lucy:

Did you see my point above about universal access to healthcare for all Americans is not a high priority for some of us?

grape_crush:

I doubt he will respond substantively. Whether he does or not, it is still entertaining.

cmdicely:

You can believe whatever fantasy you'd like - reality hasn't prevented you from being a Catholic.

Posted by: Don P. on March 17, 2006 at 10:00 PM | PERMALINK

Yes, I saw your point.

Posted by: Lucy on March 17, 2006 at 10:01 PM | PERMALINK

"But I think Kinsley is thoughfully looking at some of the possible challenges we'll be dealing with at implementing single payer here."

I think there's a more basic problem with single-payer in the U.S. than problems of implementation. Whatever its merits or lack of them, it's just not remotely politically feasible. There are simply too many powerful groups--insurance companies, doctors and other medical staff, middle-class and wealthy Americans with good private insurance--with a strong vested interest in opposing it. Medical insurers would go out of business, doctors would lose income, and well-insured people would justifiably fear their choice and quality of care would decline. The only kind of universal-coverage reform that has a chance of being passed into law is some kind of multi-payer, public-private hybrid like ClintonCare, and even that would be a huge fight. Clinton himself now says he favors an incremental approach to attaining universal coverage that builds on and gradually reforms existing components of our health care system, instead of some grandiose top-down redesign of the whole health care economy.

Posted by: Jason on March 17, 2006 at 10:03 PM | PERMALINK

LOL - 5-Year Outcomes of a tiny subset of all addicts are hardly significant from an evolutionary timeframe - who knows what other addictive (if more socially and legally acceptable) behavior was substituted. I am talking BIG picture here, cmdicely.

Posted by: Don P. on March 17, 2006 at 10:05 PM | PERMALINK

grape_crush:

That wasn't "substance" FYI.

Lucy:

O.K., good.

Posted by: Don P. on March 17, 2006 at 10:06 PM | PERMALINK

grape_crush:

Kev's back - new thread: http://www.washingtonmonthly.com/mt/mt-comments.cgi?entry_id=8447

Posted by: Don P. on March 17, 2006 at 10:19 PM | PERMALINK

Just posted a long item from an ordinary Canadian on his personal experience with their universal healthcare system. It sort of works.

URL: http://apavlik0.tripod.com/sunsetblog/index.blog?entry_id=1438339

Posted by: Alan on March 17, 2006 at 10:32 PM | PERMALINK

Yes, powerful interest groups are a formidable obstacle to single-payer.

Although I was surprised to find, for example, on the American Medical Association's site, a Proposal of the Physicians' Working Group for Single-Payer National Health Insurance. It makes Krugman and Wells's argument in a nutshell before concluding:

An NHI program is the only affordable option for universal, comprehensive coverage.

http://jama.ama-assn.org/cgi/content/abstract/290/6/798

For some reason I thought the AMA would be implacably opposed to single-payer. I guess not.

Posted by: Lucy on March 17, 2006 at 10:43 PM | PERMALINK

cmdicely,

"No, really, substance addictions are treatable conditions and failure to effectively treat them is, indeed, a failure of the healthcare delivery system."

Nonsense. First, not every case of substance addition (or any other illness) is necessarily treatable, and second, no real-world health care system is expected to "effectively treat" even every treatable case of an illness.

Posted by: Jason on March 17, 2006 at 10:51 PM | PERMALINK

Don P.

As I said before, healthcare is not free. You can payin form of a tax, your employer can pay and you don't know how much he pays, you would not really know what your wages are since he certainly considers it part of your wages.
The form of payment makes no difference, you will pay. It is taken out of the economical pie, no matter what.
WHAT DIFFERENCE DOES IT MAKE HOW YOU PAY? THE THING THAT COUNTS IS HOW MUCH YOU PAY AND WHAT YOU GET IN RETURN. IS THAT SO HARD TO COMPREHEND?

YOU ARE A CEMENT HEAD. BE A LITTLE FLEXIBLE, MAKE YOUR BRAIN SPIN A LITTLE.THINK, THINK.

Posted by: Renate on March 17, 2006 at 10:52 PM | PERMALINK

Lucy, the AMA used to be opposed to NHI for a long time. Things have changed even for them.

Posted by: Renate on March 17, 2006 at 10:56 PM | PERMALINK

YOU ARE A CEMENT HEAD. BE A LITTLE FLEXIBLE, MAKE YOUR BRAIN SPIN A LITTLE.THINK, THINK.

Ha! Words to live by.

Posted by: Lucy on March 17, 2006 at 11:00 PM | PERMALINK

Thanks Alan for that first-hand perspective.

Lucy:

The AMA (like the ABA) is a pretty liberal organization, despite the fact that some doctors (and lawyers) are very conservative - that small minority finally prevailed enough to change policy positions.

Jason:

Add to that, the fact that addictions are no more "treatable" than any other genetic defect.

Renate:

The "form of payment" certainly matters to me. I will try my questions one last time

1) How are YOU proposing to pay for the healthcare?

2) Will I get to keep my same HMO?

Posted by: Don P. on March 17, 2006 at 11:02 PM | PERMALINK

Lucy,

Both the AMA and JAMA strongly oppose single-payer health care reform. The article you cite was written by an independent group of physicians, not representing the AMA or JAMA. You can find the AMA's proposal for health care reform here.

Posted by: Jason on March 17, 2006 at 11:02 PM | PERMALINK

Yes, I realized that the proposal wasn't an AMA editorial, and I should have made that clear.

But I was surprised to find such a declaration in the pages of the JAMA at all, and it suggested to me that the healthcare debate within the medical profession is more diverse than I assumed.

Thanks for the link.

Posted by: Lucy on March 17, 2006 at 11:13 PM | PERMALINK

Jason on March 17, 2006 at 9:41 PM:

Time to play you again.

This coming from someone who's had no valid argument and had his ass handed to him over and over again on this thread...Heh. Fire away, Corky...

Good. Then back up the statement of yours I quoted.

Nah. If you don't have to back this earlier statement up

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

then I don't feel a strong desire to provide any justification either. You got called for pushing unsubstantiated bullshit and you know it...Unless, you know, have some reason for making that statement, which I would be happy to hear.

But I'm glad you just admitted you are making things up out of thin air.

There's ample commentary here from multiple posters that shows that I'm not making things up; data and documentation. Do you have anything similar?

I know how hard that must have been for you.

Actually, it's easy to argue as you do...It's also intellectually lazy and dishonest. Do you have anything that validates your comments?

You don't have a single coherent thought, let alone an actual argument.

Your inability to comprehend thought does not prove that the thought lacks coherence. As for not having an argument, consider that I am mimicking (and mocking) your debating style.

No. ["So you do have a list"]

But you did provide a list of possible metrics for comparison of health systems in your 5:25 PM post. Given your behavior, I'm not suprised that you are lying about your own post.

You're just being a child, though. So I'm treating you as one.

Again, consider that I am mimicking (and mocking) your debating style.

No, I don't mean black people.

Then what exactly do you mean by 'urban underclass'?

Why do you think black people are inherently inferior?

Echoing an earlier sentiment: Why is access to healthcare for an 'urban underclass' not a priority for you? What is the source of your animosity towards this 'urban underclass' that you have not yet defined?

Do you also feel that way about Jews?

Are Jews part of your definition of 'urban underclass'? If so, then why do you have animosity toward Jews?

But they're probably more common amoung the urban underclass, and the infant mortality rate is therefore probably higher in that population.

'Probably'...When in doubt, you weasel.

Jason on March 17, 2006 at 9:46 PM:

Again, grape, what evidence do you have for your statement: "Actually, we do

That part I wrote in response to your 1:29 PM post

We most certainly do not know those things.

which you apparently can't back up. Other commenters gave you enough information that contradicts that statement; I gave you the link to the WHO site that allows you to view the available data so you can do your own investigation. You seem to lack the intellectual honesty to deal with the invalidation of your statement or the intellectual capacity to understand the information invalidating your statement. Which one is it in your case?

Also, consider that I am mimicking (and mocking) your debating style.

[know that in a well constructed single-payer program costs are lower, the quality of healthcare is better, the amount of healthcare is higher ..]"?

That part, I did not write.

Posted by: grape_crush on March 17, 2006 at 11:20 PM | PERMALINK

So, wait - is "Jason" really "Don P.", or not?

Posted by: Don P. on March 17, 2006 at 11:31 PM | PERMALINK

grape,

What evidence do you have for your statement:

"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 ..]"?


Posted by: Jason on March 17, 2006 at 11:32 PM | PERMALINK

grape,

Why do you think blacks and Jews should not receive health care?

And why do you think black people are inherently inferior?

Posted by: Jason on March 17, 2006 at 11:34 PM | PERMALINK

Don P.

Yes you could keep your HMO but you would not be able to change and join the system even if you would loose your job and you would not qualify for MEDICARE ever.
MEDICARE, VA and other government systems could all be combined including our concressmen and soldiers and family members.

By the way, who do you think pays for all the medical expenses of casualties from Iraq?

Posted by: Renate on March 17, 2006 at 11:39 PM | PERMALINK

Lucy,

Medical and scientific journals often publish opinion pieces that conflict with their editorial positions. There's nothing particularly unusual about it. Given the national debate over health care reform, it would have been surprising if a major medical journal did not publish a piece arguing for single-payer.

Posted by: Jason on March 17, 2006 at 11:48 PM | PERMALINK

Renate:

Is that just some special punishment for me re: my HMO? As for who pays for the medical expenses of "casualties" that's a trick question, right? Assuming you don't mean actual fatalities, the Constitution rightly authorizes the federal government to pay for those medical expenses. So, the answer to your question is - we, the taxpayers.

Jason:

Thanks for the info.

Posted by: Don P. on March 17, 2006 at 11:51 PM | PERMALINK

Lucy,

By the way, in case you're also under the impression that no insurance means no health care, it isn't true. There is abundant evidence that the uninsured in America do receive health care, just less of it, and sometimes lower quality care, than the insured. The National Academy of Science's Institute of Medicine studied the question extensively in 2004. They found that uninsured Americans receive about half the medical care of insured Americans. The RAND corporation also studied the issue last year, and they found that a large proportion of the uninsured are healthy young workers who could certainly afford to purchase health insurance, but choose to spend the money on other things instead.

Posted by: Jason on March 17, 2006 at 11:57 PM | PERMALINK

As I said, Jason, these people don't care about the facts - they think you and I are the same person.

Posted by: Don P. on March 18, 2006 at 12:01 AM | PERMALINK

It's time for Kevin's next thread . . .

Posted by: Don P. on March 18, 2006 at 12:02 AM | PERMALINK

grape_crush, why don't you just go away? You're obviously not interested in a serious discussion.

Posted by: Avatar on March 18, 2006 at 12:04 AM | PERMALINK

Jason,

Nonetheless I was surprised to find such an unequivocal statement in a journal that I always understood to be very conservative and speculated that maybe the profession had liberalized somewhat since I last encountered JAMA (many years ago).

And I am aware that uninsured people get healthcare. Still, I think it's a scandal that the richest country on earth doesn't provide basic healthcare to all its citizens.

Posted by: Lucy on March 18, 2006 at 12:18 AM | PERMALINK

The richest country on earth DOES provide basic healthcare to not just its citizens, but millions of other country's citizens.

Posted by: Don P. on March 18, 2006 at 12:22 AM | PERMALINK

Man, get out of your apartment.

Posted by: Lucy on March 18, 2006 at 12:23 AM | PERMALINK

I hope those healthy young workers are lucky.

But hope is not a plan.

Posted by: Lucy on March 18, 2006 at 12:26 AM | PERMALINK

I have wireless Internet now.

Posted by: Don P. on March 18, 2006 at 12:30 AM | PERMALINK

Avatar on March 18, 2006 at 12:04 AM:

You're obviously not interested in a serious discussion.

Please...With a few exceptions, any serious discussion on this thread died a five hours ago. I'm always interested in a serious discussion; instead, we get Jason and/or his imitators...

Jason stated that part of Kevin's original post was wrong but has refused to provide any rationale why. When it became apparent that he would rather not engage in an honest discussion, I stopped having one with him.

Jason stuck his figurative foot in his mouth...And is in denial that it's still lodged in there...

Posted by: grape_crush on March 18, 2006 at 1:52 AM | PERMALINK

As usual, Kevin is right on target in nailing the aggressive ignorance of some prominent commentators who tackle health care reform. In my experience working in this area in New York back when we thought Cuomo was going to run for president, it was the political commentators who understood nothing about other national health care systems and who refused to sit still to learn why partial or incremental reform not only doesn't work,it often makes things worse. I have more to say about this at: http://talesofcoppercity.com.

Posted by: Dan Beauchamp on March 18, 2006 at 5:52 AM | PERMALINK

Total expenditure on health, per cap (2000):
US 4540, OECD Average: 2240
Public exped. per cap:
US 2005, OECD Av: $1671

Note that the PUBLIC US expenditure is about the same as the Average OECD exp.

Acute care beds/1000 pop:
US: 2.9 OECD av 4.26: Number of 16 OECD less than this:2

This was one of the numbers that Jason explicitely asked for.

Doctors 1999/1000 pop
US: 2.7 OECD avg: 2.85
Specialists
US: 1.4 OECD avg: 1.56
(Australia & Canada do worse than us)

Hip replacements/100000
US: 102, OECD:138

Knee replacements/100000
US: 116, OECD:76
(Finally, something we win at!! Or at least beat the average.)

Prostatectomy/100000
US: 133, OECD: 211

Hysterectomy/100000
US: 143, OECD 143

Elderly %/pop
US: 12.3, OECD: 15

All based on OECD data, of course.

Posted by: mcdruid on March 18, 2006 at 6:05 AM | PERMALINK

Total expenditure on health, per cap (2000):
US 4540, OECD Average: 2240
Public exped. per cap:
US 2005, OECD Av: $1671

Note that the PUBLIC US expenditure is about the same as the Average OECD exp.

Acute care beds/1000 pop:
US: 2.9 OECD av 4.26: Number of 16 OECD less than this:2

This was one of the numbers that Jason explicitely asked for.

Doctors 1999/1000 pop
US: 2.7 OECD avg: 2.85
Specialists
US: 1.4 OECD avg: 1.56
(Australia & Canada do worse than us)

Hip replacements/100000
US: 102, OECD:138

Knee replacements/100000
US: 116, OECD:76
(Finally, something we win at!! Or at least beat the average.)

Prostatectomy/100000
US: 133, OECD: 211

Hysterectomy/100000
US: 143, OECD 143

Elderly %/pop
US: 12.3, OECD: 15

All based on OECD data, of course.

Posted by: mcdruid on March 18, 2006 at 6:09 AM | PERMALINK

Total expenditure on health, per cap (2000):
US 4540, OECD Average: 2240
Public exped. per cap:
US 2005, OECD Av: $1671

Note that the PUBLIC US expenditure is about the same as the Average OECD exp.

Acute care beds/1000 pop:
US: 2.9 OECD av 4.26: Number of 16 OECD less than this:2

This was one of the numbers that Jason explicitely asked for.

Doctors 1999/1000 pop
US: 2.7 OECD avg: 2.85
Specialists
US: 1.4 OECD avg: 1.56
(Australia & Canada do worse than us)

Hip replacements/100000
US: 102, OECD:138

Knee replacements/100000
US: 116, OECD:76
(Finally, something we win at!! Or at least beat the average.)

Prostatectomy/100000
US: 133, OECD: 211

Hysterectomy/100000
US: 143, OECD 143

Elderly %/pop
US: 12.3, OECD: 15

All based on OECD data, of course.

Posted by: mcdruid on March 18, 2006 at 6:11 AM | PERMALINK

Looking further, I see that the US also lags behind the OECD in CT and MRI machines. Jason also asked for the latter, ne? And also for childhood vaccination, where again, we are below average.

Offsetting this is that we are the least-smoking country, which makes our poor showing even more pathetic.

Posted by: mcdruid on March 18, 2006 at 6:33 AM | PERMALINK

OK Jason, I've shown you mine, put up or shut up.

Posted by: mcdruid on March 18, 2006 at 6:34 AM | PERMALINK

Last night when I was stoned on crack I fantastized that the AMA had been infiltrated by revolutionaries intent on dragging the old boys club into a beautiful future of health care for all. My hopes were dashed after reading some stuff on the internets. The AMA remains solidly conservative. Its membership, however, is in decline--about 1/4 of physicians in the US. The Center for Responsive Politics reports that the AMA has started to shift some of its support to the Democrats, but in 2004 it gave a whopping $1,777,150 to the Republicans and but $549,110 to the Democrats.

You will be gratified to know, however, that just the other day the AMA issued "a warning to girls not to go wild over spring break."

You heard the man! Behave!

Posted by: Lucy on March 18, 2006 at 8:56 AM | PERMALINK

Bottom line:

Our current insurance system spends nearly a quarter (~25%) of our healthcare dollars on overhead. Medicare spends just three percent (3%) on overhead.

This alone is a good argument for a single-payer system.

Do you want to spend your healthcare dollars paying people to find ways not to pay your hospital bill, advertising and lining the pockets of CEO's and shareholders?

Or do you want that money spent on say... actual healthcare.

Posted by: tripoley on March 18, 2006 at 10:05 AM | PERMALINK

What nobody seems to realize is that we already have a government-monopoly healthcare system. The product it delivers is not care, however, but profits.

We can't see just anyone as a "doctor", we can only buy the drugs and use the treatments that are approved, and we can only buy them from the licensed sources.

For the public, the rules are quite stern. For the providers, they're very elastic- when Frontline reported on medicine in 1995, they found that over a half of the surgeries performed had never been proved to be effective.

The public has a simple right to demand that the monopoly deliver the goods.

You can phrase that historically- the corn laws had to feed the people as well as maintain the price. You can say it morally, that we do not license people to do the wrong thing. Economically, the government must not maintain a monopoly that harms the polity. Politically, we have a right to force universal coverage. Sociologically, it is essential to the health of our social institutions. Ecologically, we need to stop flooding our water sources with antibiotics and tranquilizers. Scientifically, you don't have good health if one out of six is a disease reservoir, and one out of four is a victim of malpractice.

Or, you can just look at the results- a once-powerful America in economic and social freefall, and no soft landing in sight.

DonP, get a clue. The only way things are going to stay the same for you is under universal coverage. Your ten-dollar co-pay is an endangered species. Every year your employer asks if you're worth it, and if they knew how much time you spend surfing the web, you know what the answer would be.

Unless, of course, you're a paid troll. A thought that must surely occur to anyone who knows how modern Republicanism works.

Posted by: serial catowner on March 18, 2006 at 10:43 AM | PERMALINK

"That is, if the system (private or single-payer) won't pay for the $100,000 pill, should you be able to pay for it yourself?"

This statement by Kinsley is very confusing to me. Is it serious? Explain it to me. I have never heard a health care proposal where this would be an issue at all. Isn't the answer not only "yes!", but "yes, man why are you even asking such a foolish question"?

I will now go read through the comments above to count how many people I have repeated.

Posted by: little ole jim from red country on March 18, 2006 at 11:36 AM | PERMALINK

mcdruid, you need to post the URL where your getting those numbers. Or did you just invent them.

Posted by: abel on March 18, 2006 at 2:03 PM | PERMALINK

If mcdruid isn't making his numbers up, he's cherrypicking them to try to create a false impression.

Percentage of patients waiting for elective surgery for more than 4 months, 2001:

Australia: 23
Canada: 27
New Zealand: 26
United Kingdom: 38
United States: 5

"Waiting for publicly funded, elective surgery is seen as one of the most important health system problems in many OECD countries. Part of the reason for that is that general public opinion surveys (surveys not confined to people with recent experience of using health services) suggest that waiting for elective surgery is very unpopular. In the United Kingdom, a regular public opinion survey has indicated for several years that waiting for specialist assessment and waiting for elective surgery are perceived, respectively, as the first and second most important failings of the health care system (see Jowell et al., 2000). In Spain, a public opinion barometer has identified waiting times for elective surgery as the leading source of public dissatisfaction with inpatient services1....

"The figures suggest that lengthy waits ... were negligible in the USA."


Convince me that single-payer health care will not make me have to wait months or years for surgery, like people do in other countries, and I might consider it....

Posted by: Patient Zero on March 18, 2006 at 2:48 PM | PERMALINK

Unable Abel,
You don't have kindergarden on Saturday, that is why you are allowed on the internet?

There is this thing called Google. Before you call someone a liar, please learn how to use it. Or you could, if you can spell it, go to the OECD site and look there. I gave the reference, I don't need to give the link.

Posted by: mcdruid on March 18, 2006 at 2:51 PM | PERMALINK

Patient Zero,
A little more patience and you could find the more complete paper instead of the cut-down version that you link to.(DELSA/ELSA/WD/HEA(2003)7 instead of #6)

In any event, the data you cite are limited. They do not include the infinite wait time for those without insurance. That is why the rate of specific surgeries is preferable.

Posted by: mcdruid on March 18, 2006 at 3:07 PM | PERMALINK

mcdipshit, it's time for your mommy to change your diaper. You obviously don't have a link. You just made the numbers up, didn't you?

Posted by: abel on March 18, 2006 at 3:27 PM | PERMALINK

patient Zero,

The leading cause of public dissatisfaction is the WAITING TIME for ELECTIVE SURGERY. LOL

That shows you how spoiled these people are, waiting for ELECTIVE SURGERY. We should be that lucky.

When we moved to Ill. some years ago our son was ill, I could not see a Dr. with him because the Dr.s in town did not take new patients anymore. We did have insurance. When I called and said I thought he had the mumps I was told to take him to the emergency room which I did.

And they complain because they have to wait for ELECTIVE surgery.

At the time I saw for the first time in my life a sign in a hospital that said " no treatment if you still owe money " late 60s

Posted by: Renate on March 18, 2006 at 3:35 PM | PERMALINK

Unabel my dear whining child,
You are the one who can't figure out how to do an internet search.

If I publish the link, you will, of course, apologize for calling me names?

Posted by: mcdruid on March 18, 2006 at 3:55 PM | PERMALINK

mcdipshit, it's time for your mommy to change your diaper. You obviously don't have a link. You just made the numbers up, didn't you?

abel: one doesn't need to cite statistics to point out the fact that yours are fatally flawed. Sure, US "patients", who pay much more for healthcare, often get surgeries scheduled more quickly than residents of other rich democracies. But this is surely cherrypicking of the most useless variety, since nearly 50 million Americans, or about a sixth of the US population, cannot become "patients" at all, as they don't possess health insurance, and no surgeon will touch them with a ten foot pole unless they're literally brought in the emergency room from, say, a car accident.

Just an observation, but it occurs to me there's an incredible quantity of talking past one another with this whole healthcare debate. Advocates of single payer refuse to even discuss the possibility that their favored solution may be impossibly difficult -- especially from a political standpoint -- to adapt to fit the U.S. Advocates of the status quo on the other hand seem to be positively ostrich-like in their jingoistic refusal to acknowledge our current system's deep, and likely fatal, flaws.

Kinsley's clearly not overly enamored of the status quo. And that's what makes his careful, thought-out views, and those of somebody like (yup) Newt Gingrich, so credible, and so welcome. When people want to discuss healthcare reform, they ought to check their ideological blinders at the door

Posted by: P.B. Almeida on March 18, 2006 at 4:05 PM | PERMALINK

mcdruid "In any event, the data you cite are limited. They do not include the infinite wait time for those without insurance."

The above statement proves you don't know what you're talking about.

1. The data indicating that "lengthy waits ... were negligible in the USA" include both insured and uninsured patients.

2. Uninsured people receive surgeries and other health care services by paying for them out of pocket, or through publicly and privately-funded free clinics and hospitals.

3. Being involuntarily uninsured is a temporary condition typically lasting a few months.

Posted by: Patient Zero on March 18, 2006 at 4:29 PM | PERMALINK

P.B. Almeida,

"But this is surely cherrypicking of the most useless variety, since nearly 50 million Americans, or about a sixth of the US population, cannot become "patients" at all, as they don't possess health insurance, and no surgeon will touch them with a ten foot pole unless they're literally brought in the emergency room from, say, a car accident."

No, that is not true. You seem to be another one who falsely thinks "no insurance" = "no health care." The uninsured receive health care services, including surgeries, by paying for it themselves or through a network of free clinics and hospitals.

Many healthy, young working people who could afford health insurance choose not to buy it, on the basis of a rational cost-benefit calculation that their risk of needing expensive medical treatment is low, and that the cost of monthly health insurance premiums would therefore probably exceed the cost of paying out-of-pocket for whatever health care they are likely to need.

Furthermore, going without insurance involuntarily is usually a temporary condition. The 15% of the population that is uninsured at any one time is not a static group of people, it's a revolving door, mostly comprised of people who are between jobs or who are waiting for their health care benefits to kick in after starting a new job. A person who lacks insurance today will probably have insurance a year from now.

Posted by: Patient Zero on March 18, 2006 at 4:49 PM | PERMALINK

PZ, you are misrepresenting your own citation.
"The figures show the percentage
of respondents to two telephone surveys, in 1998 and 2001 respectively, who had experienced elective
surgery in the past two years and who said they waited longer than four months (about 17 weeks) for surgery."

So it is only of people who had elective surgery. Since most insurance doesn't pay for e.s. this number probably only reflects the people who both have insurance and can afford to pay extra for elective surgery. So I did misspeak, what I should have said is infinite wait time for those that can't afford it.
In any event, the rate of specific surgeries is a better measure, particularly if the procedures are not elective.

Posted by: mcdruid on March 18, 2006 at 4:54 PM | PERMALINK

"The figures suggest that lengthy waits ... were negligible in the USA."

Not quite true. You have to factor in the average waiting times of the uninsured who will never receive medical treatment, which time is effectively infinity. Once you factor in that 20% of your population has an infinite waiting time your average doesn't look that good.

Comparison of average wait times between the US and other developed countries is a bit of an apples to oranges comparison, since the US average only counts the 80% of people in the system and leaves out 20%. In other developed countries, though, they cover everyone, 100%. I could make any average look good if I cut out the bottom-performing 20%.

Posted by: Stefan on March 18, 2006 at 5:06 PM | PERMALINK

mcdruid,

"you are misrepresenting your own citation."

No, you are misrepresenting it. The data were collected without regard to insurance status.

"So it is only of people who had elective surgery."

Yes, it is of people who had elective surgery. Not "insured" people who had elective surgery, as you falsely claimed.

"Since most insurance doesn't pay for e.s."

Utter nonsense. The typical HMO or POS health care plan most definitely includes coverage for elective surgery, everything from removing an in-grown toenail to replacing a hip. There is usually some kind of out-of-pocket co-pay if the patient chooses to use a health care provider outside the insurer's network, but all or most of the cost of the surgery is paid for by the insurer, not by the patient. Have you ever even belonged to a U.S. health care plan?

Posted by: Patient Zero on March 18, 2006 at 5:08 PM | PERMALINK

A person who lacks insurance today will probably have insurance a year from now.

And what's a year, after all, when you have breast or lung or bone cancer, or kidney failure, or severe asthma, or when you've been in a severe car crash, or are having a heart attack? Surely anyone who suffers from any of these conditions doesn't mind waiting a year to receive treatment, do they?

Posted by: Stefan on March 18, 2006 at 5:10 PM | PERMALINK

"You have to factor in the average waiting times of the uninsured who will never receive medical treatment, which time is effectively infinity"

No, no, no. You're yet another one who falsely thinks being uninsured is a lifelong condition, and who falsely equates "no insurance" with "no health care." Go and read my posts of 4:29pm amd 4:49pm.

Posted by: Patient Zero on March 18, 2006 at 5:10 PM | PERMALINK

You're yet another one who falsely thinks being uninsured is a lifelong condition, and who falsely equates "no insurance" with "no health care."

When you die as a lack of not being treated because you have no insurance, then it is effectively a lifelong condition.

And while you can receive some health care if you have no insurance, you do not receive the same quantity or quality of it. First, if you do receive care hospitals will often try to bill you for it, so they will treat you but at the cost of forcing you into ruinous debt and/or bankruptcy.

Second, ERs and other stopgaps measures for the uninsured will treat immediate lifethreatening conditions, but are not good at providing either (i) preventative care or (ii) long-term treatment for chronic conditions. Try showing up at your local hospital and tell them you'd like for them to give your chemo for your cancer and see how well that works.

Posted by: Stefan on March 18, 2006 at 5:20 PM | PERMALINK

stefan,

"And what's a year, after all, when you have breast or lung or bone cancer, or kidney failure, or severe asthma, or when you've been in a severe car crash, or are having a heart attack?"

The right to receive emergency medical care regardless of ability to pay is guaranteed to everyone in America, even illegal immigrants, by federal law. So your "car crash" and "heart attack" scenarios are irrelevant.

If you have evidence that a significant number of people in America are denied medical treatment for cancer or kidney failure or some other life-threatening condition because they do not have insurance, please present it.

You do know, I take it, that in countries with single-payer health care like Britain and Canada, people are denied life-saving medical treatment by the governement if they are deemed to be too old?

Posted by: Patient Zero on March 18, 2006 at 5:30 PM | PERMALINK

stefan

So let's review: If someone has a "long-term chronic condition," AND they don't have insurance, AND they cannot afford to buy insurance, AND they have to go without insurance for a long time, AND they do not qualify for care under any of the myriad federal, state and local health programs targetted to the uninsured, AND they cannot they receive care from a privately-funded free or subsidized clinic or hospital, then, yeah, they might have a problem getting health care they need. But it seems rather unlikely that a significant number of people are in that situation. The fact that you have to keep narrowing your scare-mongering scenarios to more and more unlikely combinations of circumstances illustrates just how much you are exaggerating the problem.

Posted by: Patient Zero on March 18, 2006 at 5:45 PM | PERMALINK

The fact that the Radical counterbloggers are still posting on this thread 30 hours after the original essay was posted, and have apparently brought in a second shift of nyms and arguments, tells you all you need to know about how badly the Radicals fear the Dems using this issue in 2006 and 2008.

Cranky

Posted by: Cranky Observer on March 18, 2006 at 6:03 PM | PERMALINK

Jason/Patient Zero,

>If you have evidence that a significant number of people in America are denied medical treatment for cancer or kidney failure or some other life-threatening condition because they do not have insurance, please present it.

We have anecdotal evidence right here at March 17, 2006 at 2:45 PM. Yes, I know, one anecdote does not a significant number make. Got any advice for people like Tripp's friends?

>Being involuntarily uninsured is a temporary condition typically lasting a few months.

I'll pass along your assurances to my middle-aged hair guy, a decent, hardworking, tax-paying, small-business owner who hasn't been able to afford health insurance for well over a year. But he must be an anomaly.

Posted by: Lucy on March 18, 2006 at 6:10 PM | PERMALINK

The right to receive emergency medical care regardless of ability to pay is guaranteed to everyone in America, even illegal immigrants, by federal law. So your "car crash" and "heart attack" scenarios are irrelevant.

You may be treated, but at ruinous cost. The hospital will save your life (and that's all they're required to do -- save your life, not provide any follow-up care or rehabilitative therapy) but will then bill you for the cost of the treatment, which most people cannot afford. So yes, they'll get minimal life-saving care, but at the cost of steep personal debt and/or bankruptcy. In other developed countries, by contrast, citizens are not required to bankrupt themselves if they get into an accident.


If you have evidence that a significant number of people in America are denied medical treatment for cancer or kidney failure or some other life-threatening condition because they do not have insurance, please present it.

The evidence is the system itself. The only way to be treated for many of these conditions such as cancer, diabetes, kidney failure, asthma, depression, etc. is with long-term intensive care, often involving lots of medication, therapy and multiple surgeries. We know that ERs don't provide such care. We know that local free clinics don't provide such care. So if, say, a woman without insurance and without any savings develops breast cancer, where is she supposed to go for the mastectomy? Where is she supposed to go for the chemotherapy?

Posted by: Stefan on March 18, 2006 at 6:46 PM | PERMALINK

You do know, I take it, that in countries with single-payer health care like Britain and Canada, people are denied life-saving medical treatment by the governement if they are deemed to be too old?

You do know, I take it, that in countries without single-payer health care such as the United States, people are denied life-saving medical treatment by hospitals and private insurance companies if they cannot pay?

Remember the following case earlier this year?:

HOUSTON - A critically ill 5-month-old was taken off life support and died Tuesday, a day after a judge cleared the way for doctors to halt care they believed to be futile. The infants mother had fought to keep him alive.

Sun Hudson had been diagnosed with a fatal genetic disorder called thanatophoric dysplasia, a condition characterized by a tiny chest and lungs too small to support life. He had been on a ventilator since birth.

Wanda Hudson unsuccessfully fought to continue her sons medical care. She believed he needed time to grow and could eventually be weaned off the ventilator.

Texas law allows hospitals to end life support in cases such as this but requires that families be given 10 days to find another facility to care for the patient. No hospital was found to take the baby.

The ethics committee at Texas Childrens Hospital reviewed Suns case before recommending that life support be stopped. Hospital officials also recommended the case be taken to court and offered to pay Hudsons attorney fees.


Posted by: Stefan on March 18, 2006 at 6:51 PM | PERMALINK

So let's review: If someone has a "long-term chronic condition," AND they don't have insurance, AND they cannot afford to buy insurance, AND they have to go without insurance for a long time, AND they do not qualify for care under any of the myriad federal, state and local health programs targetted to the uninsured, AND they cannot they receive care from a privately-funded free or subsidized clinic or hospital, then, yeah, they might have a problem getting health care they need. But it seems rather unlikely that a significant number of people are in that situation.

So unlikely, in fact, that it describes about 40-60 million people in the United States. But I don't know if that's considered a "significant" number....

AND they do not qualify for care under any of the myriad federal, state and local health programs targetted to the uninsured,

Those programs are generally not targeted to the uninsured, but to the poor. The middle-class uninsured or underinsured, of whom there are many, are left out in the cold.

Posted by: Stefan on March 18, 2006 at 6:56 PM | PERMALINK

3. Being involuntarily uninsured is a temporary condition typically lasting a few months.

I am expecting a cite on that, of course. And, by your own reasoning, you are a liar until you can provide it.

Posted by: mcdruid on March 18, 2006 at 7:53 PM | PERMALINK

Back in the real world. Elective Surgery, almost by definition, is generally not covered by insurance. My wife works at Kaiser and our insurance is stunningly comprehensive (It even covered one-third the costs of three dental implants). But they told us that it would cost us something like $3,000 for a post-natal circumcision.

Replacing a hip may be a different type of beast, but you will then have to explain why hip replacement (which is YOUR EXAMPLE)in OECD countries are ONE-THIRD HIGHER than here. That number is in the self-same study that you cited, so I don't want to hear any namby-pamby "give a link" whining.

Posted by: mcdruid on March 18, 2006 at 8:57 PM | PERMALINK

mcdruid,

"Back in the real world. Elective Surgery, almost by definition, is generally not covered by insurance."


Utter, complete, total nonsense. Once again, you prove that you don't have a clue what you're talking about. Virtually all HMO, PPS and PPO health care plans in the U.S. cover elective surgery for medical conditions. What they don't generally cover is elective cosmetic surgery that is not medically indicated, such as circumcisions and breast implants.

And we're still waiting for you to provide a URL for your alleged OECD data.

Posted by: Patient Zero on March 19, 2006 at 7:34 PM | PERMALINK

stefan,

"The only way to be treated for many of these conditions such as cancer, diabetes, kidney failure, asthma, depression, etc. is with long-term intensive care, often involving lots of medication, therapy and multiple surgeries. We know that ERs don't provide such care. We know that local free clinics don't provide such care."

No, we most certainly do not know that. They may receive treatment for any of those conditions at one of the government's Community Health Centers, a national network of clinics that provide health care services to the uninsured, regardless of their ability to pay. The Department of Health and Human Services estimates that in 2006, over 16 million people will receive medical treatment at Community Health Centers. And that's just one example of a way in which uninsured, indigent people receive health care.

"So if, say, a woman without insurance and without any savings develops breast cancer, where is she supposed to go for the mastectomy? Where is she supposed to go for the chemotherapy?"

To cite just one example of the numerous public and private programs and agencies that provide free or subsidized health care for uninsured cancer patients, she could be covered by the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA). The Act entitles women who do not have health insurance and are not otherwise eligible for Medcaid or Medicare to prevention and treatment for their cancer or pre-cancerous conditions.

Posted by: Patient Zero on March 19, 2006 at 8:09 PM | PERMALINK

Zero,
I already (twice) pointed out that many of my numbers are from the SAME study (it is actually the second part of the study) that you gave a link to. (Siciliani, L. and Hurst, J. (2003) Explaining Waiting Times Variations for Elective Surgery across OECD Countries. OECD Health Working Papers No. 7.)

I see you have decided to redefine what you mean by elective surgery to specify only those for "medical conditions." The term "Elective Surgery" in general use includes, and is sometimes synonymous for, cosmetic surgery. The primary distinction made is between elective surgery and emergency surgery. The difference here is that, in elective surgery "the time when a surgical procedure is performed may be elective. The procedure is beneficial to the patient but does not need be done at a particular time." (http://www.medterms.com/script/main/art.asp?articlekey=14367)

From that perspective, obviously, waiting times in general are a poor measure of anything, and often irrelevant. As I stated again and again, the rate of specific surgeries is a better measure, and the US lags here.

(A further problem with your claims about insurance is that it may only cover a small amount of the bill: $2,000 in the case of implants, or only $500/day of a hospital stay.)

Now, since you are obviously avoiding a citation, link or other evidence for any of your statements, particularly "Being involuntarily uninsured is a temporary condition typically lasting a few months," the reasonable conclusion is that you are lying.

Posted by: mcdruid on March 20, 2006 at 5:19 AM | PERMALINK

mcdruid,

Cosmetic surgery is irrelevant to the comparison, since it isn't generally covered by either American private insurance plans or the health care systems of countries with universal coverage. You wouldn't get a cosmetic "post-natal circumcision" under Britain's NHS or Canada's Medicare any more than you would get it under most private American health care plans.

"From that perspective, obviously, waiting times in general are a poor measure of anything,"

Nonsense. Wait times for elective surgery are a strong indicator of the effectiveness of a health care system. People in Britain, Canada and other countries with single-payer health care have to suffer months or years of chronic pain or disability while waiting for surgery that in the U.S. they would receive immediately.

Posted by: Patient Zero on March 20, 2006 at 12:03 PM | PERMALINK

budget.senate.gov/republican/analysis/2000/bb3-2000.pdf

"According to the Census Bureau, over a 36 month period between 1993 and 1996, only 4% of the population lacked health insurance for the entire 36 month period, and only 6% of the population was without insurance for at least 30 months. During this period, the median length of time without health insurance was 5.3 months."

In the bizarro parallel universe that mcdruid/stefan inhabit, 5.3 months is an "infinite" amount of time.

Oh, and mcdruid, I'm still waiting for that link to your alleged OECD data.

Posted by: Patient Zero on March 20, 2006 at 12:17 PM | PERMALINK

Zero,
Again, as with inabel, you seem to be incapable of performing a simple Google search. Those of us who got through high school understand what a valid citation is, which I gave. I see no reason why I should have to print out my pdf, FedEx it to you and then, no doubt go to your office and read it (explaining the big words as I go.) It is also telling that you make no effort to rebut the figures, just to mire yourself in the usual Republican nonsense of implicitly trying to discredit them.

On top of that, you offer in support of your numbers, partisan Republican talking points! Can't you even find a real study; such as the Medical Expenditure Panel Survey (MEPS), which found 63 Million people ever uninsured in 2003, or the Survey of Income and Program Participation (SIPP), which pegged it at 66M, or the National Health Interview Survey (NHIS), which found 52M? If you want to know those uninsured for more than a "few months" you can also refer to those surveys or to the Current Population Survey (CPS) (produced, as is SIPP, by the census department) which found 46 Million without insurance for over a year. (http://aspe.hhs.gov/health/reports/05/uninsured-understanding-ib/index.htm for the googling-impaired)

Posted by: mcdruid on March 20, 2006 at 1:35 PM | PERMALINK

... suffer months or years of chronic pain or disability while waiting for surgery ...

Not true. Since there are different types of elective surgery, then one would expect to see different wait times depending on the severity. Some statistics collections actually divide according to severity and have a goal of 30-day admittance for urgent cases. The broad brush survey you cite did not distinguish between urgent and non-urgent, nor did it seem to distinguish between cosmetic and medically necessary care.

The study you cite (I hope I don't have to give a link) has 5 surgeries where US data is available: Hip replacement, knee replacement, Prostatectomy, Hysterectomy, and CABG. In 3 of those 5, the US substantially under performs the OECD average, and it is better in only 1.

Also, given your obsession with waiting times, why do you ignore data showing that the US is at the bottom of those 5 countries when considering same-day access to a doctor when sick?

Posted by: mcdruid on March 20, 2006 at 2:23 PM | PERMALINK




 

 

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