But but but...waiting lists! Canada! Socialism!

>>Explain to me again why we're afraid of this?

Because large medical companies would be less inclined to contribute money to political parties?

Did they normalize for religion? Maybe god just likes Anglicans more than Baptists and Catholics?

And think of all those poor insurance executives, having to find new ways to support their American Dreams.

Why do you hate the American Dream, Kevin?

Honstly, from the conservatives I know, family and friends, as soon as you start talking about it, they start shouting that they don't want their tax dollars paying for someone's sex change operation. Seriously. And if the poor people can't afford to pay for their children's health care, well, they should have thought of that before they had so many children.
And you wonder why I avoid political discussions with them....

Bloody commies! Better dead than red I say!

"Healthcare that's as good as ours and delivered for about half the cost. Under a national healthcare system, when you get sick, all you have to worry about is getting well. Explain to me again why we're afraid of this?"

Isn't it obvious?

The point is to keep healthy people in fear of getting sick, and to keep sick people from getting well unless they have the right connections. That's how America works, and if you don't like it, then there are many fine health care systems available to American emigrants to other countries.

Mysticdog,

There was an article at MSNBC that compared patients who knew they were being prayed for to those who weren't prayed for. Turned out that knowing you're prayed for increases the likelihood of death. I don't they compared which flavor of xtianity God was being prayed for, though. Maybe you have a point.

People getting sick in the 55-64 range is the new Social Security Reform solution. Even better than dismantling it is just not having to pay any of it out to the people who paid in! Then we can build more bridges to nowhere and have more wars!

Everybody wins! Well, everyone who counts.

But richer Americans' health status resembled the health of the low-income British.

Oh, great! Now I can't even lord that over the low-income British anymore...

But it can't be true, because the unregulated market for a service will always produce a better outcome than any other system. So the study must be flawed.

Wait. Wait. Wait. You mean the more invisible hand isn't always best? I don't know what to believe now...

gq: Turned out that knowing you're prayed for increases the likelihood of death.

Careful with correlation and causation, there.

But Socialized Medicine is worse! I heard a coworker's brother's girlfriend's mechanic say that the heard on a talk radio show about a guy in Canada who got his arm chopped off on a farm and he had to carry it around for six months in a burlap sack because there was a huge waiting list to have it reattached.

True story.

The fact remains that a huge majority of Americans associate single-payer/national health systems with shortages, lines, poor service, and incompetent doctors (the good ones presumably going to where the money is). Until that misconception changes, 'socialized medicine' will remain a scare word among enough people to win elections.

In reading the article to which Kevin links, one finds the following which seems to contradict the thesis of Kevin's post.

"However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.

Both said it might explain better health for low-income citizens, but can't account for better health of England's more affluent residents.

Marmot cautioned against looking for explanations in the two countries' health-care systems.

"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said."

But, I suppose we don't want the facts to get in the way of a good story.

Regards,
Neil

To preempt the usual suspects, and save everybody time and effort, here are the standard conservative responses to any discussion of health care reform. Note that this this is a continuously refined list that I try to post every time Kevin mentions "health" and "care" in the same sentence; you should feel free to add more responses so that we can have a more comprehensive list for next time.

1. Single payer plans are socialistic and therefore ipso facto evil.
2. I know someone who knows someone who's related to someone from Canada who had to wait for tennis elbow surgery for months and months and came to the US and he had the surgery immediately and it saved his life.
3. Look what's happening in France right now; their health care is socialized and there are riots in the streets.
4. We have the best health care in the world and anyone who says otherwise is part of the blame-America-first liberal socialistic treasonous left.
5. Anybody who wants insurance coverage can get it, and the only reason some people don't it's because they don't want to.
6. People who get sick got sick because they weren't paying attention to their diets, etc. and they are therefore to blame for their problems; why should the taxpayer pay for lazy people who sit around eating hamburgers and watching TV and so get fat and sick?
7. Those who can't afford health care cannot do so because they are lazy and do not work hard enough to afford to pay for what they need in life and so they want me to pay for their expenses.
8. Those with children who cannot afford health care for their children shouldn't have had any children and to have done so was irresponsible; if we reward them with free health care they'll never become responsible.
9. Italians are disappearing because they don't reproduce enough, and they have socialized medicine, which obviously has not helped them to continue surviving as an ethnic group.
10. What we need is to promote preventive medicine so that nobody gets sick again.
11. All we need to do is make sure insurance companies do not have to pay any taxes whatsoever, which will undoubtedly lead to more competition, better care and lower prices.
12. Cuba has socialized medicine; you want to live in Cuba?
13. All statistics quoted by supporters of socialistic remedies to health care are false or faked, a priori; all anecdotes offered by opponents of health care are true and accurate, a priori.
14. With socialized medicine, research into new drugs and therapies will stop immediately, because it is the current healthy competition among our insurance companies that directly drives medical research.
15. Our problem is too much health care, and people tend to abuse the system by going to the doctor too often. With socialized care, we'll get even more abuse, while the market forces of free capitalism will discourage the slightly sick from tying up the system with complaints about sniffles.
16. The problem with health care is Medicaid and Medicare, which encourage the poor and the old to get sick more often.

It is just a plot to recruit them into the one fabulous socialized health care system we do have in the US-- the United States Military. Screw the draft, let's just offer healthcare.

WOW! That's Sir Michael Marmot. He's the guy that brought people's attention to social gradients in health (i.e. the really rich are healthier than the rich, who are healthier than the upper middle class, and so on down the ladder...).

More from the article (emphasis mine):

The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.

"Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" Marmot said.

"It's something of a mystery," said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.

The researchers looked for answers in the data, which came from government-sponsored health surveys. The research was supported by grants from government agencies in both countries. A U.S. researcher from the Rand Corp. was on the team.

But what would we tell the medical insurance companies???? Poor things - they would go out of business and throw thousands of people out of work. Plus what would happen to all the money they have invested in the markets?????

Single payer health care = complete chaos, don'tcha know that?

/snark

And here's an interesting point about how our increasingly frayed safety net and economic instability may be contributing to our ill health:

Marmot offered yet another explanation for the gap: Americans' financial insecurity. Improvements in household income have eluded all but the top fifth of Americans since the mid-1970s. Meanwhile, English citizens saw their incomes improve, he said.

Robert Blendon, a professor of health policy at the Harvard School of Public Health who was not involved in the study, said the stress of striving for the American dream may account for Americans' lousy health.

"The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans don't have a reliable government safety net like the English enjoy, Blendon said.

Addendum (thanks to Timewalker)

17. I don't want my tax dollars paying for someone else's sex change operation.

Actually, Neil, the thesis of Kevin's post was that the British are clearly not getting worse health care than the USA, despite paying half what we do per capita. I conclude the facts that they are healthier than us, and accepting the assertions as to costs as true, makes his prima facia case for him.

18. I don't want my tax dollars paying for some ho's abortion.

Aris: You forgot one. Lots of white folks are scared that a tax dollar will be spent to benefit a black person, and we can't have that.

How about people in the medical professions? How would they be impacted? That would be the only question I have not had answered on the topic. All the rest are clearly in favor of switching.

Honstly, from the conservatives I know, family and friends, as soon as you start talking about it, they start shouting that they don't want their tax dollars paying for someone's sex change operation. Seriously.

More or less, yes. If it's not someone's sex change operation, it's some poor black person they feel doesn't "deserve" to be treated by a national health care system.

If the country was predominantly white and much more homogeneous, some sort of national insurance plan would have been passed decades ago. However, there's an abiding fear by many voters that any national government service will in some way benefit those who those voters feel don't "deserve" any benefits they receive. The ultimate problem with promoting the "common good" is that for many people, the "common good" is "what benefits me and my tribe" and anything that will also benefit the other guy's tribe is something they don't want to pay for.

Although I agree with Kevin Drum's that the UK's system is free of the worries by individuals and pressures on companies that the US system has, this does not fully explain the difference in health outcomes. I have no numbers for this. It is more a gut feeling. And Mr. Colbert has explained to us how important that is.
Put it this way: why should wealthy Americans have the health outcomes of poor Britons? They can afford to pay for better insurance, can have a secretary or someone handle all the bill-paying, and if push comes to shove, any out-of-pocket expense is proportionally less significant than for middle-class people. So why are rich Americans as sick as poor Britons?
All I can think of is that our system must be actually warping the medical care itself in some way.

I dunno, if they controlled for obesity their sample size must have been pretty small...

[Stephen Colbert]You're missing the point, American health care is not more expensive.
It's just that the dollar is overvalued by 80%. Adjust for that, and everything is find and dandy.[/Stephen Colbert]

Apologies to invoking the great one, I am not worthy.

I think this study backs up my point that we are stuck with our insurance corporation enriching system beause of the selfishness of the upper middle classes. The upper middle classes do not want to wait for their elective medical procedures in order for more seriously ill folks to obtain healthcare first, even if it means having a healthcare system that does not provide services to them as well as that healthcare boogey man - Britain's socialized medicine.

Here's what I want explained to me:
Health care resources are limited. There needs to be some way to ration them. If we nationalize the healthcare system how is it decided who gets what?

If the country was predominantly white and much more homogeneous, some sort of national insurance plan would have been passed decades ago

Maybe. The UK is about 92% white at the moment, as compared to ~75% white in the US. But when the British NHS was founded in the late 1940s, the nation was "homogeneous" only by color. It contains four countries (and therefore four semi-independent NHSs), several languages, and ancient class distinctions that parallel racial distinctions in America (and gave rise to the same kinds of objections that we see in the US: I don't want my taxes paying for services for "them," "they" are improvident, marry on the dole, drink too much, &c.)

The major difference I'd suggest is that Britain had (much more in the 40s than now) a deep, committed, tireless working-class political movement, of the kind that has not existed in the US for many, many years, if ever.

"More or less, yes. If it's not someone's sex change operation, it's some poor black person they feel doesn't "deserve" to be treated by a national health care system.

If the country was predominantly white and much more homogeneous, some sort of national insurance plan would have been passed decades ago. However, there's an abiding fear by many voters that any national government service will in some way benefit those who those voters feel don't "deserve" any benefits they receive. The ultimate problem with promoting the "common good" is that for many people, the "common good" is "what benefits me and my tribe" and anything that will also benefit the other guy's tribe is something they don't want to pay for.

Posted by: Constantine on May 2, 2006 at 2:58 PM | PERMALINK
"

I just wanted to post this again so everybody could read it again. Because it's very important.

Where this tribalism came from, in my mind is actually from American religion, which has always, to some degree more or less encouraged tribalism, which makes it acceptable.

you should feel free to add more responses so that we can have a more comprehensive list for next time.

This is pretty much standard to any right-wing objection to anything:

"Liberals are for it? Then I'm against it."

Everything else is just rationalization. If something in some way shape or form seems to be touched by "The Left", it is automatically something to oppose. No thinking required.

No one seems to have considered the obvious alternative: it's not single-payer, it's that American doctors are the least competent in the developed world. Sounds right to me. So, paraphrasing Dick (the Butcher) in Shakespeare's Henry VI, Part 2, "The first thing we do, let's kill all the doctors."

Here's what I want explained to me:
Health care resources are limited. There needs to be some way to ration them. If we nationalize the healthcare system how is it decided who gets what?

Here's what I want explained to me: police and fire department resources are limited. There needs to be some way to ration them. If we let the government run the police and fire departments how is it decided who gets what?

Well we Americans are less healthy than the Brits because we're fat, because we eat like pigs, not to mention that the pharma industry fosters a culture of illness.

Why are we afraid of adopting universal health care? Follow the money.

Turned out that knowing you're prayed for increases the likelihood of death.

Quick, someone tell Cheney I pray for his health every day. Every day! Because he's the only thing standing between this administration and string of total fuckups.

Oh, wait...

"Explain to me again why we're afraid of this?"

Because it's socialism.

Kevin: "Put it this way: why should wealthy Americans have the health outcomes of poor Britons? ... All I can think of is that our system must be actually warping the medical care itself in some way."

It's self evident. Go to the doctor. You'll be stuck in a room, where a nurse will do 95% of the work. In the last 5 minutes, the doctor will pop his head in the door, ask a few questions, prescribe something, and leave. The next time you visit, he won't remember you.

The pressure to see as many clients as possible in as short a time as possible in order to maximize profit is warping the amount of time that the doctor spends with each patient. Health care in the US can be hasty and slipshod.

Here's what I want explained to me:
Health care resources are limited. There needs to be some way to ration them. If we nationalize the healthcare system how is it decided who gets what?

The basis for this is the belief that if medical care were free, everyone would spend all day at the doctor.

Maybe I don't get out much, but I don't know anyone who would say "let's see, should I play golf today, or should I go to the doctor, just in case. Hmm, decisions, decisions..."

Del: "Americans are less healthy than the Brits because we're fat"

They controlled for weight. In other words, they intentionally picked Americans who weighed the same as the Brits they picked. Yet, the Americans were sicker.

101. nationalized health care will attract all sorts of immigrants, legal and illegal, who would want to benefit from the system at our expense.

Americans are less healthy than Brits because of the Brits hate us for our Freedom Fries.

Explain to me again why we're afraid of this?

Maybe because a lot fewer people will be making six- and seven-figure incomes if they can't skim off the profits (insurers & administrators) or maintain godlike social & economic status (doctors- maybe not all, but enough)? And what about all of those poor paper-pushers we all know so well from our doctors' offices?

Seriously though, if we cut the dead weight and inflation from our healthcare system and treated it like an actual public good instead of a high-end consumable, a lot of not-terribly-useful, but still influential, people would make a lot less money. Can't have that.

Wrong comparison.

You have to compare two diferent industries. For example, if country A regulates and nationalizes health care; and country B regulates and nationalizes the shoelace industry, who has better shoelaces, and why?

There are a lot of things more valuable than good health, and liberals who suddenly think choosing worse health is not allowed have to explain why I am therefore allowed to wear tennis shoes without shoelaces.

Take a gander at yesterday's WSJ. The CEO of HealthUnited has 1.6 billion in unexercised stock options. $1.6 billion of the money we spend on "healthcare" is aimed at this one guy's pocket.
Republicans control the federal government and the public discourse. Ergo, this is considered good, and alternatives are considered to be bad.

Waits for breast cancer treatment are getting worse as the NHS battles to meet a key target to speed up access to care, new figures revealed yesterday.

In the period from July to September last year, only 81 per cent of patients urgently referred for treatment for breast cancer were treated within the Executive target of two months - down from 86 per cent in the previous quarter.

In some cases, patients were still waiting more than 200 days for treatment, with the longest wait being 291 days. Waits for all other cancers were either improving or staying the same.

...

In Shetland only 33 per cent of patients with breast cancer were treated within two months of urgent referral. In the Grampian and Highland areas 50 per cent were seen within two months.

http://news.scotsman.com/topics.cfm?tid=57&id=348832006

Yeah. That sounds really great.

Only Kevin and his unfathomable logic:

"The researchers are careful to say that their study doesn't prove that Britain's healthcare system is better than America's — something that would be nearly impossible to demonstrate conclusively with a study like this in any case. But that's not the point. The point is that it's obviously not worse even though the British spend about half as much as we do per capita."

The study doen's prove that the sly is bluer today, only that it is not less blue?

Yeah. That sounds really great.

You're assuming that it would be better in the US. But that very much depends on who needs the treatment, and how much money they've got.

敬啟者，您好：請問一下雨 傘的用途是什麼？是否是用 來遮風避雨的庇謢所，但帶 著庇謢所的面具把遮風避雨 的雨傘打斷呢？還是打在寄 養童身上呢？ 2000年五月 小女她說：『在她小時後阿 媽用雨傘打她，一直打一直 打，打到雨傘斷掉』，『在 一老人會』(場所)。 [Family Violence Prevention];[家暴];[家暴中心];[taipei7.tripod.com]

敬啟者，您好：請問一下雨 傘的用途是什麼？是否是用 來遮風避雨的庇謢所，但帶 著庇謢所的面具把遮風避雨 的雨傘打斷呢？還是打在寄 養童身上呢？ 2000年五月 小女她說：『在她小時後阿 媽用雨傘打她，一直打一直 打，打到雨傘斷掉』，『在 一老人會』(場所)。 [Family Violence Prevention];[家暴];[家暴中心];[taipei7.tripod.com]

Several observations. First, I think marcel nails it in suggesting that Britons have better health than us because their doctors are better. Perhaps not at golf, investing, retiring early or cranking out charges, but in treating patients. The reason is also obvious. We have a system where the number of physicians is controlled so there is not too much competition. As a result there is very intense competition to get into medical school with the result that the winners are those who are most competitive, not the best healers. Further those same competitive types want to win the game by accumulating as much money as possible as quickly as possible. And many of them have to do this because unless they are wealthy to begin with, they will come out of medical school with horrendous debt. Do not get me wrong. There are many fine doctors in this country who work long hours for little pay or knowledge that their patients can not or will not pay. My point is simply that the way the selection process is set up does not place a premium on recruiting good physicians, but merely on selecting highly competitive people. A recent headline indicated that some study showed that the wrong medical protocols were followed 57% of the time with the V.A.--ie government doctors- doing somewhat better.
With respect to the question about rationing, you can still require a co-pay with the result that you would discourage overutilization by poor people and the idea of waiting times for elective medical care serves the same purpose.
For those upper middle class folk who do not think they should have to wait for anything or want to be sure that they are getting the "best" (richest) doctors, you can see a "private" physician in Britain as long as you are willing to pay for it and I imagine the same system would arise here.
One of the issues which does arise under the British system which also appears here, but to a lesser degree, is "closed practices" where physicians no longer accept new patients. Whether the single payor system contributes to this phenomena, I do not know.
Finally, while a single payor system would undoubtedly throw millions out of work in the insurance industry, it would also result in millions of hours of time being spent productively rather than fighting with those soon to be unemployed insurance employees.

Did they control for diet? It's my intention that Americans diets are much worse than the rest of the world. Obesity indicates that you aren't eating right. But being thin doesn't indicate that you are eating right. I was 5'10" 160 pounds when the doctor told me I had high chloresterol.

Did our health care system make me have high chlorestorel? I would say no. My suspicion is it was all the fries and chick-fil-a chicken sandwiches.

Are you guys proposing that everyone should have to take a health course in high school to educate them on healthy lifestyle choices, esp. dietary? No, you're proposing a complete overhaul of 1/5th of the US economy.

First - "culture of illness?" yeah, that's why the death rate in the US went down by 4% last year, primarily driven by drug therapy. Because we foster a culture of illness.

Second - our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations. Not just NMEs (drugs), but all of the equipment and software and other stuff that goes along with medical practice.

Your gut may tell you that NHC will not decrease the rate of medical innovation. I say that 90+ years of communist and socialist experimentation has demonstrated that there are only two countries that have been highly innovative over the last century - the US and Japan. Dampening profits dampens innovation. I will admit to being dogmatic about that, because I have yet to see any compelling evidence to the contrary.

You may point out individual inventions created in socialist economies. And I will simply say that I didn't say all inventions occur in the US and Japan, just most.

You may say 'the rate of medical innovation isn't that high right now.' And I will say "As compared to what?" - what magical socialist wand is going to force people to find new ways to creatively come up with drugs? Because so far it doesn't exist. Wishing will not make it so.

You may say "We don't need all that innovation, really." And I will say "Tell that to my mother, who died of Multiple Sclerosis just a few years before they came out with some of the excellent new treatments."

The US medical innovation engine is incredibly messy, wasteful and unpleasant to look at. But if you want to replace it, you had best have compelling reasons why the replacement will be no worse on the innovation side. Because I think that innovation is more important than cost.

If they account for obesity, the difference in health may come down to the fact they simply walk more than we do. Also a much higher proportion of people continue playing active sports (soccer, rugby) for a considerable time after leaving school.

I've said it before, so I'll say it again, health care is not market driven. It doesn't respond that way; it's not set up that way.

Garble: rationing. In this country there is a shortage of livers for transplant. We put people on a list and also require that they be alcohol free (if that's an asociated problem) for six months, then they wait for a suitable liver to turn up when it's their turn. In this country we raise deductibles, co-pays and minimum caps to marginalize the poorer members of our society.

In the UK, GPs manage their practices and refer as needed. If the treatment is non-urgent then, yes, there are waiting lists and the debate in society at large (yes, it comes up as a political issue) is what's acceptable. The present labor government has just gone through the usual cycle of expanding expenditure and is now reining it in. But it's still cheaper! For the richer, private insurance is also available or they can pay outright to jump most lines. Life critical (like livers, hearts, etc.) not included as far as I know.

Kevin ponders: Explain to me again why we're afraid of this?

A medical care system that is not designed to enrich the rich has no place in America.

The sole and entire purpose of the American way of life is to enrich and empower the rich and powerful.

If its just that we pay doctors more, then why not propose increasing the number of medical students versus a complete overhaul. It seems to me a lot of this boils down to you guys having a position of wanting single payer, but my interest and the American people's interest is in having better health at lower costs. My interests can be meet by means other than single payer.

Finally, while a single payor system would undoubtedly throw millions out of work in the insurance industry, it would also result in millions of hours of time being spent productively rather than fighting with those soon to be unemployed insurance employees.
Posted by: terry

I would suggest that THIS, as opposed to med school selection criteria, makes them better docs. You'd be amazed at how much more we would invest in patient care if we didn't have to deal with paperwork, insurance companies, refusals for payment and denial of service, appeals, change of plans, etc. ... Frankly, I would love more patient time.

No, you're proposing a complete overhaul of 1/5th of the US economy.
Posted by: Chad

we're the only developed country where it even approaches 20% ... most educated people see this alone as a problem requiring resolution.

Because I think that innovation is more important than cost.
Posted by: jb

ah, but you likely have some sort of insurance. The 30 million lacking any insurance, and the millions more who are underinsured, would really just to not go bankrupt in the setting of normal, known illnesses with proven therapies.

Innovation is an important, but ultimately separate, question. Addressing insurance company profiteering with single payer can easily co-exist alongside continued support and funding for biomedical research, as well as private pharm company/biotech initiatives.

Are you guys proposing that everyone should have to take a health course in high school to educate them on healthy lifestyle choices, esp. dietary? No, you're proposing a complete overhaul of 1/5th of the US economy.

The dietary habits of the English are not dissimilar to the dietary habits of Americans, in particular their intact of such things as chips.

Besides, I'd bet were "we" to advocate such a course, people like you would rail against it too.

"Our high schoolers should be learning the three R's, not wasting their time on health classes taught by pantywaists!"

Did they adjust for American destructive(self & others) tendencies?

Kevin writes,

The researchers are careful to say that their study doesn't prove that Britain's healthcare system is better than America's — something that would be nearly impossible to demonstrate conclusively with a study like this in any case. But that's not the point. The point is that it's obviously not worse even though the British spend about half as much as we do per capita.

Utter nonsense. How is it "obvious," from this study or any other, that the British health care system is not worse than the American one?

Ooh, there comes the tired argument again:

Waits for breast cancer treatment are getting worse as the NHS battles to meet a key target to speed up access to care, new figures revealed yesterday.

In the period from July to September last year, only 81 per cent of patients urgently referred for treatment for breast cancer were treated within the Executive target of two months - down from 86 per cent in the previous quarter.

In some cases, patients were still waiting more than 200 days for treatment, with the longest wait being 291 days. Waits for all other cancers were either improving or staying the same.

Meanwhile, waits for breast cancer treatment in the United States, for the 48 million Americans who were uninsured last year, were infinite. Well, until they got some emergency room care shortly before dying.

So let's see, that's 28% of Americans without insurance... 100-28... only 72% of Americans were able to have insured breast cancer treatment at all!

Yeah. That sounds really great.

It's so much better than what we've got it's not even funny, and it's among the worst of the many countries whose plans we might use.

Dumbass.

...but my interest and the American people's interest is in having better health at lower costs.

Sadly, this cannot be achieved within the current construct, in particular using your proposals of more health education and an expanded supply of MDs. The primary source of the inefficiency is the insurance companies, which unnecessarily raise transaction costs.

Because I think that innovation is more important than cost.
Posted by: jb

I bet you wouldn't feel that way if you couldn't afford medical care for you child ?

How much is a new version of Viagra or
latest cure for Restless Leg Syndrome worth if
you can't afford chemo ?

Michael784: Did they adjust for American destructive(self & others) tendencies?

Are you implying that the 2000 and 2004 elections could have long-term health risks attached? You may be right...hmmm....

My interests can be meet by means other than single payer.

Hasn't happened yet. Maybe it's time you got started...

Though I'm generally in favor of a single payor system, there is a major flaw in this argument: increased access to medical care does not lead to lower rates of illness (or longer life) except in situations like those of developing countries. Above a certain minimum level of health care availability, increased care may lead to improved quality of life (Viagra), reduced quality of life (receiving ineffective back fusion therapy for back pain, or reduced anxiety (getting lots of reassuring, expensive tests), but not necessarily to better health. I was just discussing this today with a colleague in orthopedics who has calculated that eliminating back fusion surgery in our county (a form of surgery probably doesn't work in any but a minority of cases) would pay for all the local uninsured population.

Steven Bratman, MD

jb: Second - our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations. Not just NMEs (drugs), but all of the equipment and software and other stuff that goes along with medical practice.

That's because this is where you can make a killing. It is not, however, necessary for a killing to be made for medical innovation to happen.

Your gut may tell you that NHC will not decrease the rate of medical innovation. I say that 90+ years of communist and socialist experimentation has demonstrated that there are only two countries that have been highly innovative over the last century - the US and Japan. Dampening profits dampens innovation. I will admit to being dogmatic about that, because I have yet to see any compelling evidence to the contrary.

Um. Yeah. Well, let's see. Japan, you may notice, has universal health coverage.

Secondly, how much of that innovation was government-funded, i.e. socialist? A whole damn lot of it. NASA. DARPA. NIH. The American University system.

You may point out individual inventions created in socialist economies. And I will simply say that I didn't say all inventions occur in the US and Japan, just most.

And you're able to prove that with some sort of actual data? Or just your dogma?

You may say 'the rate of medical innovation isn't that high right now.' And I will say "As compared to what?" - what magical socialist wand is going to force people to find new ways to creatively come up with drugs? Because so far it doesn't exist. Wishing will not make it so.

All that is necessary for innovation in the provate sector is profit. Not ridiculous profit. Profit at all. Larger profits do not lead to more innovation.

Further, as I say, a huge chunk of the innovation in this country is government funded. Universities, the National Institutes of Health - these are the people coming up with life-saving treatments.

You may say "We don't need all that innovation, really." And I will say "Tell that to my mother, who died of Multiple Sclerosis just a few years before they came out with some of the excellent new treatments."

I'm sorry for your loss. However, I daresay those excellent new treatments are from university and government researchers.

I'm going to let you in on a little secret here: the for-profit medical industry doesn't want you to get better. They don't want to cure you. They want your money. The vast bulk of their research dollars are spent on chronic conditions that you will have to take medicine for the rest of your life. A cure for MS will not make them big bucks. Viagra makes them big bucks. They are not interested in cures, and they are especially not interested in cheap cures.

Which should be obvious. Because they're not out to help you. They are out to make money for their owners. That's their stated and overt goal.

The US medical innovation engine is incredibly messy, wasteful and unpleasant to look at. But if you want to replace it, you had best have compelling reasons why the replacement will be no worse on the innovation side. Because I think that innovation is more important than cost.

I think that innovation and cost are both important, and given the numbers I have seen and previously posted here there is no reason to believe that a single-payer system of national health insurance will impact innovation in the slightest. In fact, by freeing up a huge sum of money which currently is used for paperwork and overhead, more money will actually be available for research.

S Ra,

Meanwhile, waits for breast cancer treatment in the United States, for the 48 million Americans who were uninsured last year, were infinite.

More nonsense. Do you even understand the meaning of the word "infinite?"

Dumbass.

Did they control for rain?

Did they control for the fact the British drive on the wrong side of the street?

Did they control for non-spherical errors?

Did they use a maximum likelihood estimator?

Did they control for the general lack of Bush-worshipping proto-fascists in Britain?

If all of these factors weren't accounted for, and another 300 can I pull out of the air, I won't believe any of this!!!!!!!! We have the greatest health care system in the WORLD!!!!!!!

Chad: "If its just that we pay doctors more. . ."

It's not. Its endemic to the whole system because the bottom line is not to provide health care, it's to make money.

jb:"Because I think that innovation is more important than cost."

Surely we should be more interested in health outcome than innovation for innovation's sake. That is just a diversion and the belief that behind every problem is a technological solution. Not saying innovation isn't a good thing, but outcomes is tha actual product of a healthcare system. It might be cheaper and more cost effective to tweak the production line rather than replace it. Wasn't there just an article about how many new drugs are NOT an improvement over previous drugs, but, since the research is done by the manufacturer, adverse results are supressed. Way to go FDA! There's a joke.

DelBoy: might want to look up the figures for the US, and how many poeople go untreated, or get a diagnosis too late, period.

No one here addresses the awkward issue that having more doctors actually raises health care costs so while we might lower individual MD salaries by increasing supply, the system is hurt by a rise in aggregate cost due to more referrals to each other and tests (and this is not even counting increased training costs, etc. which the govt, through residency programs shoulders the cost of)...matt yglesias brought this up in the past when pointing out that Miami (I think--bear with me since this is based on recollection) has a ton of doctors but Medicare's costs are still a lot higher because doctors tend to defer to one another if they feel there is more specialized knowledge available, which of course there would be with more docs around...now if there was some overall health benefit to having more doctors around, this increased cost due to more supply might be justifiable but that seems unproven to say the least...

GOP: More nonsense. Do you even understand the meaning of the word "infinite?"

I'd say "let me know when you finish reading that paragraph", but I don't really care.

Yes, what is S Ra talking about?

Has this program been shut down? http://www.ny.gov/governor/press/02/oct1_4_02.htm

I guess it's a lot easier to type the word "Dumbass" than it is to actually do some research.

And why do people post personal insults in the comments anyway? Do they think it helps advance their argument?

Do you even understand the meaning of the word "infinite?"

I can't speak for his understanding of the word infinite. I do note, however, that based on your earlier posting, you clearly do not understand the meaning or concept of inference.

Another thing one doesn't need to worry about is the
lawsuit when you slip and fall at the pool. If you are covered completely, you don't need to sue for medical expensences... Countries with Socialized medical have far fewer lawsuits of this nature.

SavageView,

I do note, however, that based on your earlier posting, you clearly do not understand the meaning or concept of inference.

I understand it perfectly well. You clearly have no idea what it means.

But there are always two ways to look at this:

One, the commie liberal perspective: this is the result of the health care system (government), and that the only solution is a government one -- universal health care.

Two, the rational conservative perspective: this is the result of the obviously genetic inferiority of the American populace (individual), and that the only solution is the eliminate the genetically weak American race from the gene pool.

There, I think that just about covers it. Any questions?

Stefan,

I notice that you conveniently neglected to include the following statement in your carefully-selected set of quotes from the WaPo article:

"However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed."

DelBoy:
And just so peole know, The Shetlands are the most isolated part of the UK along with The Hebrides, and the Grampians the second most isolated mountain range after the Western Highlands.

As mentioned above, waiting lists are a constant topic of debate in the UK, unlike, until very recently, the poor and uninsured here. And this only because the vast middle class is seeing its coverage eroded.

Like everything, you pay for what you get and you set priorities as we have here. We pay more and we get less.

Kevin
Daily KOS has a frightening post on the "ENZI" Bill. Here it is. Is it this bad? and why havn't anyone else blogged on it?http://www.dailykos.com/story/2006/5/2/151127/2173

Utter nonsense. How is it "obvious," from this study or any other, that the British health care system is not worse than the American one?

Given the observations in Kevin's post, you cannot make this statement and possibly understand the concept of inference. Go back to school.

S Ra,

I'd say "let me know when you finish reading that paragraph", but I don't really care.

Anyone who thinks a year = "infinity" is clearly so ignorant of basic vocabulary that nothing he says need be taken seriously.

SavageView,

Given the observations in Kevin's post, you cannot make this statement and possibly understand the concept of inference. Go back to school.

No, it's quite obvious that you don't understand the meaning of inference.

Go back to kindergarten.

notthere,

Like everything, you pay for what you get and you set priorities as we have here. We pay more and we get less.

No, we pay more and we get more.

The reason Brits have better health than you Yanks is so obvious I can't believe no one's mentioned it yet: it's the TEA!! My old Mum is 90, and is still swigging tea and she's healthy as a horse! Cor blimey.

jb on May 2, 2006 at 3:57 PM:

that's why the death rate in the US went down by 4% last year, primarily driven by drug therapy.

Cite, please.

Second - our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations.

Novartis, Roche, Schering, Akzo Nobel...All American companies, right?

Your gut may tell you that NHC will not decrease the rate of medical innovation.

And my gut is usually right, except when it comes to women...Then I'm a glorious fool.

I say that 90+ years of...blah blah blah.

The search to find the cures for the common cold, cancer, and AIDS will still go on...The only difference is that people will be able to afford the treatment.

I will admit to being dogmatic about that, because I have yet to see any compelling evidence to the contrary.

Yet those horrible socialist Canadians manage to rank around 4th in the world in healthcare technology development...Can't remember the source; sorry.

And I will simply say that I didn't say all inventions occur in the US and Japan, just most.

So your earlier point is, well, invalid?

...what magical socialist wand is going to force people to find new ways to creatively come up with drugs?

Same way a lot of research is funded currently - government grants.

You may say "We don't need all that innovation, really."

Sorry about your Mom, but apparently the idea of trying to cure illnesses without a profit motive eludes you. Must really suck to go around always asking 'What's in it for me?' all the time.

The US medical innovation engine is incredibly messy, wasteful and unpleasant to look at. But if you want to replace it..

No one wants to replace 'innovation', just the system that uses the product of that innovation.

Because I think that innovation is more important than cost.

All the innovation in the world will do you no good if you can't afford to use it.

Matt: There are a lot of things more valuable than good health, and liberals who suddenly think choosing worse health is not allowed have to explain why I am therefore allowed to wear tennis shoes without shoelaces.

Having read many of your posts, I think that, for your own safety, you should never be allowed to have shoelaces.

Kevin, you really are a moron.

1. Your cite states:

However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed. Both said it might explain better health for low-income citizens, but can't account for better health of Britain's more affluent residents. Marmot cautioned against looking for explanations in the two countries' health-care systems. "It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.

2. All white people really don't look (or age) alike.

The stupidity of this article (and your touting of same) is that white white people in Great Britain are NOT the same as white people in America. We have a far more varied genetic pool of white citizens.

Now, if the study isolated for that (WASPs of English descent, only), then it might be interesting.

The only thing we can learn from this article and your post, is that you're a moron.

But, we knew that.

jb wrote: "...our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations. Not just NMEs (drugs), but all of the equipment and software and other stuff that goes along with medical practice."

Wrong. That's our formerly excellent (and incredibly socialistic) National Institutes of Health, not our medical care practicioners.

Of course, as the Bush cabal ratchets back NIH spending, the ratio of US to European papers in top journals is declining.

"Explain to me again why we're afraid of this?"

Come on Kevin, you know the answer is profits.

white white people in Great Britain are NOT the same as white people in America. We have a far more varied genetic pool of white citizens.

Oh, I see. Our white population is diseased and inferior, because it contains more Jews, Polocks, Italians and other undesirables. That's why our health care system costs more.

Kevin: the reason we're still debating this is that the GOP is still paying trolls to "debate" it.

One of the most irritating arguments about medical innovation and profits is it implication that innovators are in it primarily for the money. This is true for some business people, but not for many medical researchers and other scientists. Perhps the best example was Jonas Salk who devloped a polio vaccine and refused to patent it, so it could quickly be employed against that disease. Most scientists do not do science for the bucks. And the importance of shareware and the like in the net is further evidence that innovators in general often do not seek lots of money, though they rarely turn it down.

Public funs are an excellent way to fund medical research - and have the added advantage of not needing to grant monopoly patents to the companies claiming discovery.

Innovation?

How many of the major research labs are in England (like Glaxo SmithKline's is) of Belgium (GSK again), or France (SanofiAventis) or Switzerland (Roche)? Not to mention Norway (NovoNordisk).

How many of them are in universities(too many to list here).

How many of them are publicly funded (NIH, to name just one of many).

Do a little research, and you find out that many of the wonder drugs sold by major pharma are in fact products they licensed from university labs, or got from the government. If you read the small print in the annual report, you can trace the money. While you're doing that, look at the advertising budget. It's almost always larger than the research budget.

Norman wrote: "The stupidity of this article (and your touting of same) is that white white people in Great Britain are NOT the same as white people in America. We have a far more varied genetic pool of white citizens."

Then, according to what we know about genetics, the expected result is that our hybrid vigor would make us healthier than the more inbred Brits.

Sorry, Norman, but correcting for genetics just makes the US healthcare system look even worse.

I am also relieved to find that GOP is still unable to assimilate or process actual information. As Stephen Colbert puts it, just go with your gut, GOP - ignore all those stupid facts.

Doesn't pass the sniff test. British lower class has betetr health than American upper class? That doesn't make any sense based on any comparison of the two health systems. No one denies that the affluent get great care in the US. Where are they conceivably lacking where the British lower class gets better care?

So something else is going on here, something that is quite possibly contaminating the other results as well.

Particularly since my experience of English lower class was how many chain smokers they have, which has to have a devastating impact on their health in the long run. (Which points to the flaw in "it obviously isn't worse" arguments. I could use the exact same logic to "prove" as a result of this study that higher smoking don't lead to more deaths".)

The main explanation that jump out at me is exercize. Brits walk a lot - they have to. Even the affluent. I dropped 15 pounds living in London for four months just because of all the walking I had to do every day, even living in a tonier part of London. Towns aren't designed well for traffic. And mass transit goes almost everywhere you want.

Plus, the BBC sucks, cable/satellite access is more limited and homes are cramped spaces with no room or design for things like home theaters. So the typical entertainment experience involves walking somewhere.

Meanwhile, most Americans are quite sedentary. Even if you control for obesity you aren't controlling for the amount of exercize, which has a substantial impact on major killers like heart disease.

Not that I am opposed a single payer system. I am increasingly convinced that we don't have another choice. But I wouldn't hang your hat on one study that raises more questions than it answers.

Enough with the "limited resources" B-S.

Near Seattle, two local hospital empires are battling public authorities because the empires want to build more hospitals, and the law says they can't.

This law was passed because when there are too many hospital beds, they mainly sit empty, and the cost is imposed on the actual patients, making their stay more expensive than it need be.

Now, whatever you call it when private enterprise healthcare wants to build too many hospitals, it ain't "limited resources".

Do the world a favor and whenever you see that "limited resource" meme pop up, club it in the head with the nearest available facts. I know, it's like pulling dandelions, but every litle bit helps.

Though I'm generally in favor of a single payor system, there is a major flaw in this argument: increased access to medical care does not lead to lower rates of illness (or longer life) except in situations like those of developing countries.

I defer to Steven Bratman, MD's presumably greater knowledge of the US healthcare system. But if more healthcare doesn't much improve health, isn't it all the more imperative that we get it as cheaply as possible - i.e. via a single-payer system?

I'm very skeptical of NHC. Tell me again how it saves money?

If everyone has health care how do you separate the people with money from the riff-raff?

Also... getting ill is natural.

If we had less illness what would that do to our economy?

Also.... all white people aren't created equal.
The less equal ones are the ones that get sick.

I don't think we owe them a living.
Or even medicine.

Everybody has a right to get sick and die.

You shouldn't ask others to help them get healthy.

That's worse than trying to play policeman to the world.

That's like trying to tell other countries what kind of government they should have.

No, we pay more and we get more.

Posted by: GOP on May 2, 2006 at 4:43 PM | PERMALINK

If you can bring yourself to agree that health outcome is what we need from a healthcare system (not profits. If not, define what) then what "more" do we get?

Innovation? Nothing wrong with the drug companies in Europe last time I looked. Also teaching/research hospitals seem also to make the news.

And why do these creeps immediately associate universal health care with socialism when they then go on to talk as if it's communism? Talk about non-sequiturs and ill-defined word use.

I have't seen it brought up the couple of months I've been writing here, but there is also the economic benefit to the nation from better health care. A healthier work force is more productive, less lost production, etc.

Explain to me again why we're afraid of this?

It will cost the Americans Who Matter lots of money, which is why some will be taught to say that it's a bad idea, others will listen to them, and most will go on be misinformed and confused.

The problem isn't meant to be solved, it's meant to be profitable. And that is enough.
.

"Explain to me again why we're afraid of this?"

Because the Politic of Fear (tm Republican't Party) extend to health care policy?

The only thing we can learn from this article and your post, is that you're a moron.

But, we knew that.

Posted by: Norman Rogers on May 2, 2006 at 4:58 PM | PERMALINK

Er . . . better look in the mirror.

Britain is a bunch of mongrels just like us. Read their history and look at recent immigration. If the researchers did isolate for racial purity or semi-purity, we would likely come out even worse against French, Germans and Nordics, who, though not quite as cheap as the UK, have even better outcomes.

I have a chronic illness that is under control (Type I Diabetes).

I have work-provided health insurance under which I am covered, which provide extensive coverage. I have no problem paying co-pays (I make good money) and am happy to pay extra for better service. I happily pay EXTRA to have enhanced insurance. I don't expect 100% coverage of my costs, only some cost relief.

As a result of my (genetic, not lifestyle) condition, I must see doctors frequently for PREVENTITAVE care (Endocrinologist 4x per year, Eye exam by Opthamologist 1x per year, Cardiologist semiannually, annual Physical). I eat right, exercise, and keep my body in good shape. My diabetes is completely under control. I am a model patient.

The health care system in this country is utter shit. It still takes MONTHS in advance to arrange for doctors appointments. Yes, months. I cannot see any doctor in my area, a major city, without making an appointment 4 weeks in advance or more. When people tell me you 'have to wait' in Canada, I laugh my ass off. They obviously never try to see a doctor here and assume they waltz right in. WRONG. I can't tell you how many times I have made an appointment 4 months in advance, had the doctor cancel on me, then be told I could see the doctor three months later.

Prescriptions? For a long time they paid in full for insulin ($0 copay) but completely refused to pay for NEEDLES for the insulin (you must have needles to inject the