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Tilting at Windmills

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June 14, 2006
By: Kevin Drum

ER BLUES....Best healthcare in the world, baby, best healthcare in the world. Just keep telling yourself that.

Kevin Drum 4:44 PM Permalink | Trackbacks | Comments (99)

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Comments

You commies would have us all die like that!

Posted by: Freedom Phukher on June 14, 2006 at 4:49 PM | PERMALINK

best healthcare in the world...
best healthcare in the world...
best healthcare in the world...
best healthcare in the world...
best healthcare in the world...
best healthcare in the world...

Posted by: da' Troll on June 14, 2006 at 4:59 PM | PERMALINK

Personally, since I jog every morning in my spandex, and am a vegan, and spend a lot of time breathing clean air at my house in the Hamptons, I'm not worried about how obsese couch-potato red america will be queued up in a state-run healtcare rationing system.

But I'm sure that the unionized civil servants that run the bureaucracy will continue to contribute to liberal politicians as long as liberal politicians support the bureaucracy.

Posted by: Liberal Strawman on June 14, 2006 at 5:00 PM | PERMALINK

Hey, whaddya want? This is a capitalist society, and the market solution to illness is death.

Posted by: S Ra on June 14, 2006 at 5:01 PM | PERMALINK

There goes Drum again with his "facts". Damn it, we have faith based policies (and may God save us from them).

Posted by: alex on June 14, 2006 at 5:01 PM | PERMALINK

Ah.. courtesy of the referenced Shakespear's Sister blog, I now understand why there is a crisis in the capacity of ER's at hospitals. It's because people are using them! And if we socialize medicine, people will use emergency rooms less because they will go mostly to primary care physicians.

Now the stretch here seems to be that people would prefer to go to "family" doctors rather than emergency rooms or clinics even if the latter might be more convenient because of hours open or location.

I'm not sure that I would buy into that conclusion without some data as to why that would be the case.

Posted by: pencarrow on June 14, 2006 at 5:02 PM | PERMALINK

of course i read the title as "Yer Blues", and now i'm singing that song...

Black cloud crossed my mind
Blue mist round my soul
Feel so suicidal
Even hate my rock and roll
Wanna die yeah wanna die
If I ain't dead already
Ooh girl you know the reason why

Posted by: cleek on June 14, 2006 at 5:04 PM | PERMALINK

pencarrow: it seems doubtful that you did read the referenced Shakespeare's Sister blog; had you done so, you might have noticed:

So why is demand for emergency care surging, anyway? Are we suddenly becoming a nation of accident-prone klutzes? Well, no. It more likely has something to do with the fact that since 1993, America has lost 703 hospitals and 425 ERsand that, according to the US Census Bureau, as of August 2005, nearly 46 million Americans (1 out of every 7) are uninsured. Six million have been added to the rolls of the uninsured just since Bush took office. When people dont have insurance, they tend to use the emergency room to seek treatment for many health issues for which insured people go to primary care providers, which puts an undue strain on emergency rooms, which by law must treat every patient who shows up.

Please note the reduction in hospitals and ERs, as well as the forty-six million people who now have no choice but to use the ER for any medical care whatsoever.

Or were you just trolling?

Posted by: S Ra on June 14, 2006 at 5:11 PM | PERMALINK

Please note the reduction in hospitals and ERs,Posted by: S Ra on June 14, 2006 at 5:11 PM | PERMALINK

Can some free-market fundamentalist please inform me on how an industry with record profits in "the best economy ever" be contracting in capacity?

I thought that free-market theory said that when an industry receives profit, that profit is re-invested in expansion in order to capture marketshare against competitors. So, I don't get it - why isn't that happening here?

Posted by: Osama_Been_Forgotten on June 14, 2006 at 5:14 PM | PERMALINK

O_B_F:

Companies can either take their massive profits and make capital investments (for example, build more hospitals), other kinds of investments, or disperse cash to shareholders (through dividends or stock buy-backs). The problem is that building more emergency rooms might not be provide the best return for a corporation. Indeed, as long as medical care is a scarce resource, medical providers have pricing power. The marginal return of providing more medical care (by building more emergency room) might simply be a bad investment from a financial point of view.

This is a perfectly acceptable way to run most businesses. But it is kind of a shitty way to run healthcare if you believe, as I do, that there are other things in this country to value beyond shareholder value. Like public health.

Posted by: RWB on June 14, 2006 at 5:29 PM | PERMALINK

Watch out!

If we're not careful, we will do some major reform of the system which will make the healthcare sytem not perfect, but more like it is in the rest of the world--cheaper, faster, and better. And pretty much universal.

Of course, we will all be miserable. Sure, healthcare will be better and cheaper, but people will call it "socialist" and we will all suffer horrifically because free-market ideologues are calling us names.

I'd MUCH rather go bankrupt and rot in an ER than be called "socialist." Being called names hurts much more than having no painkillers for your cancer.

Posted by: theorajones on June 14, 2006 at 5:30 PM | PERMALINK

"Now the stretch here seems to be that people would prefer to go to "family" doctors rather than emergency rooms or clinics even if the latter might be more convenient because of hours open or location."

I know half a dozen people who have gone to emergency rooms with not immediately life threatening conditions over the years. The common element of all thier stories is the hours spent in the waiting room with a bunch of other sick and injured people before treatment. I am quite confident that virtually nobody goes to the emergency room rather than thier doctor or a clinic because of the convenience.

Of course the "conservative" explination for why the uninsured go to the emergency room more often than the insured is quite simple: they are inferior.

Posted by: jefff on June 14, 2006 at 5:34 PM | PERMALINK

One of the things highlighted in a recent "report card" on disaster perparedness was the dramatically reduced number of fully functioning emergency rooms and full on trauma centers. The whole of the West Coast is lacking.

Posted by: JeffII on June 14, 2006 at 5:44 PM | PERMALINK

Indeed, as long as medical care is a scarce resource, medical providers have pricing power.

Yes - but if I ran a chain of hospitals, in an open, free, competitive market, and if my competitor felt this way, I'd build the fuck out of another 100 ERs or so - as much as I could get money for, and run his sorry ass out of business. Unless he was handing me money under the table or something.

If we're not careful, we will do some major reform of the system which will make the healthcare sytem not perfect, but more like it is in the rest of the world--cheaper, faster, and better. And pretty much universal.

I wouldn't go there. If any Republicans had anything to do with it, it would end up like the Medicare prescription benefit, and be little more than a massive handout to insurance companies and hospital chains (like Frist's HCA).
I think the Republican Strategy here is to hold out as long as possible until people are BEGGING for Universal Care, and then giving us Universal Care - for the Stockholders.

Posted by: Osama_Been_Forgotten on June 14, 2006 at 5:46 PM | PERMALINK

The post Kevin links to is a typical example of the standard argument for the proposition that we don't have the best health care in the world. The basic form of the argument is this:

(1). Recite some anecdote or cite some statistic or handful of statistics suggesting that the U.S. health care system has problems. Occasionally, but not usually, cite the corresponding statistic from one or a few other countries.

(2). Declare that, on the basis of (1), the U.S. health care system is clearly not the best in the world.

It's a stupid argument.

Posted by: GOP on June 14, 2006 at 5:49 PM | PERMALINK

S Ra,

Please note the reduction in hospitals and ERs, as well as the forty-six million people who now have no choice but to use the ER for any medical care whatsoever.

Tee hee hee. What forty-six million people would that be?

Posted by: GOP on June 14, 2006 at 5:54 PM | PERMALINK

Shorter GOP:

No fair using facts.

Posted by: jefff on June 14, 2006 at 5:54 PM | PERMALINK

shorter jefff:

Whether the facts support the conclusion is completely irrelevant.

Posted by: GOP on June 14, 2006 at 5:57 PM | PERMALINK

GOP,

Go to the OECD website for some cross-country comparisons. For instance, life expectancy at birth is lower for the US than the average for the OECD (http://titania.sourceoecd.org/vl=3440943/cl=13/nw=1/rpsv/factbook/10-01-01-g01.htm).

On the other hand, expenditures on healthcare are higher in the US than anywhere else, by far (http://titania.sourceoecd.org/vl=3440943/cl=13/nw=1/rpsv/factbook/10-01-04-g01.htm).

At best, we do about as well as average (and that's a generous interpretation) for all industrialized countries on most measureable healthcare outcomes, and spend tremendously more than anyone else. In terms of bang for the buck, something is wrong with the US system.

Posted by: cactus on June 14, 2006 at 6:08 PM | PERMALINK

Ann Coulter and Goerge Carlin on Jay Leno tonight.

Posted by: Now on June 14, 2006 at 6:09 PM | PERMALINK

I think GOP has eaten his own head.

Like the price of oil, the healthcare issue isn't going to go away, and magic Mr Market isn't going to fix it. Someday, ideology will get run over by reality - and there won't be an emergency room to fix that po' ol' ideology up.

Posted by: craigie on June 14, 2006 at 6:11 PM | PERMALINK

Ann Coulter and Goerge Carlin on Jay Leno tonight.

In a cage? I'd pay for that!

Posted by: craigie on June 14, 2006 at 6:12 PM | PERMALINK

jefff... The common element of all thier stories is the hours spent in the waiting room with a bunch of other sick and injured people before treatment. I am quite confident that virtually nobody goes to the emergency room rather than thier doctor or a clinic because of the convenience.

If you noted my earlier clarification of convenience as being hours or location, your example doesn't negate the issue. People seem to be willing to go to ER's late at night or because it's "down the street", even if they have to wait for hours with other "sick" people. Their family doctor may not be available when they need 'em.

Posted by: pencarrow on June 14, 2006 at 6:13 PM | PERMALINK

My guess is that George Carlin will make nice with Ann Coulter. Jay, of course, will be Jay the softball player. I would like to see Ann on the Daily Show. Stewart might be able to force her to swallow her Adam's apple.

Posted by: Ron Byers on June 14, 2006 at 6:14 PM | PERMALINK

"shorter jefff:

Whether the facts support the conclusion is completely irrelevant."

No, I did not say that. I said your claim that the "form of argument" of citing a statistic and saying it supports a conclusion is a "stupid argument" is stupid, and it is.

Statistics are a very powerful way to support a conclusion.

Particular uses of statistics may be stupid, but the form of argument is solid.

Posted by: jefff on June 14, 2006 at 6:21 PM | PERMALINK

Don't worry - finding an empty emergency room is going to get a whole lot easier

Posted by: craigie on June 14, 2006 at 6:28 PM | PERMALINK

I wonder how many transvestite jokes he has ?

Posted by: Now on June 14, 2006 at 6:31 PM | PERMALINK

"If you noted my earlier clarification of convenience as being hours or location, your example doesn't negate the issue. People seem to be willing to go to ER's late at night or because it's "down the street", even if they have to wait for hours with other "sick" people. Their family doctor may not be available when they need 'em."

People "seem to be"? On what basis do you make this claim? Do you work in an ER?

If treatment is needed urgently and the ER is the only available treatment people should go to the ER. That is one of it's purposes.

I don't think what you are saying makes any sense. Insurance status is correlated with ER use. If the ER is being overused because of convenience why would the uninsured use the ER more than the insured? I would argue that this is a causitive relationship: lack of insurance causes people to seek treatment in ERs. You seem to be arguing that conveninence causes people to seek treatment in ERs, but this does not explain why the uninsured would use ERs more. Perhaps you see some comon root cause for lack of insurance and ER use?

Posted by: jefff on June 14, 2006 at 6:34 PM | PERMALINK

Maybe if we quit treating the ultra rich for a runny nose there would be enough healthcare for everyone.

Posted by: Now on June 14, 2006 at 6:34 PM | PERMALINK

Or do you dispute the factual claim: that the uninsured use ERs more than the insured?

Posted by: jefff on June 14, 2006 at 6:36 PM | PERMALINK

Well this is where the Private Industrie has let us down. If there is 45 million people without Ins. they are letting 100's of million dollars slip through there fingers.

Posted by: Now on June 14, 2006 at 6:37 PM | PERMALINK

I am a Southern California physician. I know from experience that we have neither the best nor the worst healthcare system in the world. Its like out political system- we have an incompetent and corrupt Congress who seek only re-election and earmarks (yes, there are more corrupt Republicans but then think of Mollohan & Jefferson, two very corrupt Democrats plus Cynthia McKinney who went ballistic when security personnel failed to bow down at her feet- then the Black Caucus felt that their responsibility was to defend McKinney & Jefferson). However, we dont get stopped by police and shaken down for money as happens in Mexico or killed by police if were the wrong religion as happens in Iraq. I have seen demented 80 year olds in dialysis centers, kept alive on the public teat yes, there is unlimited government coverage of dialysis services. Meanwhile teenagers who are berserk with rage and confusion can only get psychiatric care after being jailed, and not always then, because theres no payment for psychiatric services.
One of our nurses was called at 10 PM by her sister whose eye was swollen shut and had a fever. She took her sister to an ER where they sat for 5 hours - kept waiting because she was able to walk and talk while the run, gun, drug OD and crash crowd kept all the ER staff busy. No, hospitals dont get paid for those services- thats why any MBA will tell Osama B F that it might be financially OK to open a new hospital, if and only if it has no ER. Our nurse finally realized that what she had to do was take her sister home and drive her to another ER in a wealthy area at 7 AM- thats how to get help for an ambulatory patient. This is disgraceful, but its better than healthcare in most parts of Mexico, Venezuela or Iraq and far better than in Bangladesh.

Well never have a one-payer system as long as hatred of homosexuals, immigrants, Muslims, African-Americans and nonwhites in general is such a strong theme of American culture. No country can afford to cover all healthcare needs. Our angry and divided populace is afraid that an immigrant or Muslim might get more than their share of healthcare. No sacrifices from modern Americans, hence no one payer system.

Posted by: Malvolio on June 14, 2006 at 6:51 PM | PERMALINK

But when big-time foreigners get surgery they always fly over here, not somewhere else! Remember the Shah of Iran? Persian guy... overthrown...? He came here for surgery because we have the best healthcare in the world!

Oh yeah, btw- I'm a complete and utter fucking douchebag.

Posted by: The Tim on June 14, 2006 at 6:52 PM | PERMALINK

As a Canadian, I have to say that an GOP scare stories about our health care system are just that. There are localities and pockets of users with problems in Canada, to be sure, but problems are not systemic.

The only times I've been sick, I've just shown my card and that is it. Nothing more. The system works that easily.

I can't imagine living with fellow citizens who are denied decent health care. To me the question is: What comes first, the US health care propagandizing the GOP types to be indifferent to the uninsured, or the GOP types propagandizing the US health care system to be indifferent to the uninsured?

Either way, how do they sleep at night? They really seem like propagandized zombies.

Posted by: Bob M on June 14, 2006 at 6:56 PM | PERMALINK

...because theres no payment for psychiatric services.

That's because religious fundamentalists don't believe in psychiatric services. They believe either:
- the person is faking it to suck money off the government teat
- the person is posessed by the devil, and just needs to pray more
- psychiatrists aren't "real" doctors, because all they do is talk

In this regard, they share a lot with the Scientologists.

Our angry and divided populace is afraid that an immigrant or Muslim might get more than their share of healthcare.

That's really the basis for all conservative politics, isn't it?

I've heard our own wingnut trolls here, when we compare how screwed up the US is next to a nice progressive (->socialist->communist->stalinist) country like Sweden, they'll invariably say that's because they're racially pure. (or a more neutral code-word like "homologous").

Posted by: Liberal Strawman on June 14, 2006 at 6:58 PM | PERMALINK

Anyone who thinks the healthcare system in this country works does not really use it.

Posted by: roscoe on June 14, 2006 at 7:01 PM | PERMALINK

What a weird concept--for profit medicine. Our system is failing one ER, one rural doctor, and one hospital at a time. The reality is, we have a burgeoning population who need useful things to do. Meeting the needs of an immense population, with huge chunks otherwise sedentary, unemployed or underemployed is not a flight of fantasy--it is the near future. It is best that we put service to others and the planet above short-term profit taking. Or else. There should be no unemployment with people dying alone, in their own fluids, stuck in nursing homes or homeless shelters. Universal health care is expensive, but it is money well-spent. For all the productivity increases the American worker has contributed over the last two decades, wages keep falling. I think it is time we start looking to the needs of the people. Insurance is becoming more unaffordable every year in response to dwinding roles of insured patients. More and more hospitals will have to close to satisfy investors.


Posted by: Sparko on June 14, 2006 at 7:07 PM | PERMALINK

Doctors say they are getting screwed also.Is there a way to threaten the insurance companies or the health for profit ind. Why not split let the rich have there health for profit and let the rest of us have uni. health care.

Posted by: Now on June 14, 2006 at 7:16 PM | PERMALINK

jefff:

I said your claim that the "form of argument" of citing a statistic and saying it supports a conclusion is a "stupid argument" is stupid, and it is.

No, I said it's stupid to argue that the conclusion "the U.S. health care system is not the best in the world" is supported by an anecdote or a handful of statistics. And that argument most definitely is stupid. But I see it over and again. This is just the latest example. More often, the statistic cited is infant mortality rate, or average life expectancy at birth, but the form of the argument is the same.

Statistics are a very powerful way to support a conclusion.

Yes they are. But a conclusion that would need a large amount of statistical data to support it, such as "the U.S. health care system is not the best in the world" cannot be supported by a single statistic related to only a single facet of health care, such as a statistic about the rate of emergency room visits.


In order to show that the U.S. health care system is better or worse than the health care system of Canada or France or Britain or some other country, you would need a massive quantitative study involving hundreds or thousands of metrics covering all dimensions of the health care systems. Do you have such a study? No. Does such a study even exist? Probably not. And even if we had the necessary body of empirical data, any conclusion would also inevitably involve subjective value judgments about issues of fairness and about the relative importance of various kinds of diseases and disorders.

Posted by: GOP on June 14, 2006 at 7:17 PM | PERMALINK

craigie,

I think GOP has eaten his own head.

I think you've been at those magic mushrooms again.

Like the price of oil, the healthcare issue isn't going to go away,

Probably not, no. All countries are having problems with their health care systems, not just the U.S. Countries with single-payer health care systems tend to have serious funding and rationing problems.

and magic Mr Market isn't going to fix it.

Neither is Mr Big Government Takeover.

Posted by: GOP on June 14, 2006 at 7:27 PM | PERMALINK

"In order to show that the U.S. health care system is better or worse than the health care system of Canada or France or Britain or some other country, you would need a massive quantitative study involving hundreds or thousands of metrics covering all dimensions of the health care systems. Do you have such a study? No. Does such a study even exist? Probably not. And even if we had the necessary body of empirical data, any conclusion would also inevitably involve subjective value judgments about issues of fairness and about the relative importance of various kinds of diseases and disorders."

Such a study does exist and has existed for years, you typical, disappointing troll. The world health organization did a study in 2000 covering a huge number of variables and the US did quite poorly in most and in the aggregate.

http://www.who.int/health-systems-performance/whr2000.htm

Why do you have such a loud, firm opinion on something you clearly have no substantial knowledge of? Why does this seem to be a requisite for every Republican who opens their mouth? Are you stupid? Seriously, are you so incompetent you lack the meta-cognitive skills necessary to evaluate your own incompetence?

http://www.apa.org/journals/features/psp7761121.pdf

Posted by: The Tim on June 14, 2006 at 7:27 PM | PERMALINK

Cheers for The Tim.

Posted by: Bob M on June 14, 2006 at 7:40 PM | PERMALINK

The Tim,

Such a study does exist and has existed for years, you typical, disappointing troll.

No it hasn't, you ignorant buffoon. The WHO study you refer to relies on a single health-related statistic--disability-adjusted life expectancy--and its rankings are based in part on evaluations of funding "fairness" that are political judgments, not medical ones. The study has been strongly criticized from both the left and the right, and some of its conclusions are so implausible they're basically considered a joke in the public health community, such as its conclusion that Spain has the third-best health care system in Europe. I've been over all this in other threads.

Posted by: GOP on June 14, 2006 at 7:40 PM | PERMALINK

Now, GOP, that's just lemon juice on your face. It doesn't make you invisible. :-)

Posted by: Bob M on June 14, 2006 at 7:56 PM | PERMALINK

Bob M,

As a Canadian, I have to say that an GOP scare stories about our health care system are just that. There are localities and pockets of users with problems in Canada, to be sure, but problems are not systemic.

That doesn't seem to be the opinion of the Canadian courts or medical professionals. In a landmark ruling last year, the Supreme Court of Quebec struck down a provincial law banning private health insurance for services covered by Canada's Medicare system.

The court found that Canada's public health care system does not provide health care of a reasonable standard in a reasonable time, and that "the evidence adduced in the lower courts established beyond doubt that many Quebec residents face significant delays in obtaining treatment in the public health care system resulting in adverse physical and psychological consequences."

It also stated:

"Access to a waiting list is not access to health care.[T]here is unchallenged evidence that in some serious cases patients die as a result of waiting lists for public health care. ... The evidence here demonstrates that the prohibition on health insurance results in physical and psychological suffering that meets the threshold requirement of seriousness."

The case has already had a significant effect on Canada's Medicare system, and seems likely to lead to major reform. The president of the Canadian Medical Association, Albert Schumacher, said the ruling "could substantially change the very foundations of Medicare as we know it."


Posted by: GOP on June 14, 2006 at 7:58 PM | PERMALINK

If illegal immigrants couldn't get free healthcare by going to the ER, this woludn't be a problem. Fix that, then I bet the problem goes away.

Posted by: American Hawk on June 14, 2006 at 8:01 PM | PERMALINK

If illegal immigrants couldn't get free healthcare by going to the ER, this woludn't be a problem. Fix that, then I bet the problem goes away.
Posted by: American Hawk on June 14, 2006 at 8:01 PM | PERMALINK

Along that same vein, let's enforce the laws that say that people who employ illegal immigrants are committing a felony. Then we wouldn't have to worry about illegal immigrants being in this country in such large numbers.

Posted by: Osama_Been_Forgotten on June 14, 2006 at 8:30 PM | PERMALINK

GOP, you really are a lemon juicer. You scramble into Google to prate about "Canadian" courts, not to mention Canadian medical professionals, based on some spud article.

Don't Google for this. Read the second article about from The Tim about those with difficulties recognizing their own incompetence. It's an url. You don't have to Google it. Then you might even get the lemon juice insult.

Geez, do American liberals have to explain even insults to the GOP spuds down there just to make them get them. If you can't get an insult, what does that say about your knowledge -- true knowledge, one that is less the, pant-pant, Google factor.

Google "clotpoll", for that's what Shakespeare would have you as. Lemon juicer, clotpoll, spud. Do you begin to see a pattern here?

Posted by: Bob M on June 14, 2006 at 8:30 PM | PERMALINK

people seem to be willing to go to ER's late at night or because it's "down the street", even if they have to wait for hours with other "sick" people. Their family doctor may not be available when they need 'em.
Posted by: pencarrow

This is a moronic statement ... people go to the ER for non-emergent issues when they have no other viable option. when they have a primary, they CALL us at 2:30am, and after a nursing triage, the call gets through to a covering MD.

If illegal immigrants couldn't get free healthcare by going to the ER, this woludn't be a problem. Fix that, then I bet the problem goes away.
Posted by: American Hawk

It amuses me that the immigrant wingnut posting this is so bothered by this.

Posted by: Nads on June 14, 2006 at 8:45 PM | PERMALINK

"Someday, ideology will get run over by reality - and there won't be an emergency room to fix that po' ol' ideology up."

brilliant @ craigie

Posted by: koreyel on June 14, 2006 at 8:48 PM | PERMALINK

Let me issue a challenge to those who think we have the best health care available and don't understand the importance of the uninsured utilizing the emergency room as their primary health care provider. Take a couple of days off and spend 10 to 14 hours sitting in the emergency room doing nothing more that observing and taking some notes on what happens around you. It's not illegal immigrants who are the primary customers in the ER, but ordinary American citizens with no insurance.

I happen to have good insurance and on January 23, 1998 my wife was in a devestating accident. She spent 2 months in the hospital, 5 weeks of that in a coma, and another 2 months in the local rehab hospital (which is private and not available if one has no insurance). My wife is doing well, but she will always have a brain injury and each day is a struggle for us.

I came home one afternoon to a hospital bill for over $268,000 dollars (which they allow you to pay with a credit card) and the rehab bill was roughly another $65,000. Because I had good insurance my portion that I had to pay was less than $300.

When you spend time in Neurological Intensive Care with a patient you quickly learn that the families of patients become close and that happened to us. I met several families with no insurance, with devestating bills, and with no long term options other than bankruptcy, which the repugs have made more difficult.

So let's talk about prescription medication. My plan changed a couple of months ago and what I pay for our medication increased by 50% or so depending on the medication. I am in a health savings account plan whereby I have a certain amount of pretax dollars taken each month and as I utilize the service of the Dr. and the Pharmacist I file a claim and get my co-pays back (this also works for some over-the-counter drugs). Last year I was almost dead on on my 12 month projection and I kept the same withdrawal this year anticipating that the result would be nearly the same. Boy was I wrong and I'll hit my limit in just a couple of months.

So, what do those without any prescription benefit do when they need to fill a prescription? I think they probably do without or cut their dosage in half.

A couple of months ago I ran a total on what I had spent on one months supply of prescription drugs for J. and myself. I spent $185 in co-pays, but if I had had to pay full price the cost would have been approximately $1350. I have been using the same pharmacy for years and I asked if these numbers were accurate and I was assured that they were.

We must go to a national health care plan and we must take care of all of the American citizens, but I'm not optimistic that this will happen in my lifetime.

Posted by: fred on June 14, 2006 at 8:50 PM | PERMALINK

Thank you, fred. Best of luck.

Posted by: Bob M on June 14, 2006 at 9:00 PM | PERMALINK

Ditto: Best of luck Fred.
And thanks for that profound post.

Unfortunately -- for Cheney, Bush, Frist, and Big Denny-- the people who could most benefit from the truth you speak... it won't make one whit of difference.

After all... when it comes to healthcare... they are on the public dole.

They don't give a fuck about you and yours.

Posted by: koreyel on June 14, 2006 at 9:12 PM | PERMALINK

Bob M,

I love your post of 8:30pm. It's wonderfully loopy.

Posted by: GOP on June 14, 2006 at 9:34 PM | PERMALINK

I've said it before: healthcare does not work on market principles.

A little while ago I spent some time trying to find our senators and representatives health coverage with no luck. Everybody I know has seen their coverage eroded and co-pays go up, etc. Just wondering if this has been reflected on our wonderful representatives so they might have some idea of what everyone else is going through.

Any directions?

Fred, good luck. But there are so many more stories just the same. It's a mess.

The Tim: because you live in the US and hear of foreigners flying in here for care doesn't mean that they don't go other places too with first class facilities: Paris, London, etc. Also, for more routine but expensive care, it doesn't mean that US citizens aren't going outside the US: Eurtope, South America, Singapore, etc.

Shah is kind of old hat so I wonder if you remember where the first heart transplants were done?

Posted by: notthere on June 14, 2006 at 10:15 PM | PERMALINK

I've said it before: healthcare does not work on market principles.

It's a service. In what way don't market principles apply to it?

Posted by: GOP on June 14, 2006 at 10:22 PM | PERMALINK

Bob M,

I love your post of 8:30pm. It's wonderfully loopy.

And yours have a charming parfum des citrons.

Do I have to explain that to you?

Posted by: Bob M on June 14, 2006 at 10:58 PM | PERMALINK

GOP --
You are a lazy troll. There are more studies out there comparing health care provision, outcomes and costs than you can shake a stick at. The fact that you find none of them come close to providing any resonable conclusion shows your position of bias.

As someone who accepts lies as a basis for war so others can go die for you undercuts any need to satisfy your reqwuirements of reasoned and justified argument.

As to market forces and healthcare, see my prior posts. Try April 4th, I think, for starters. As an employee I have no choice but to accept the very limited alternatives offered by my employer. That's a significant market friction right there. By definition HMOs ration and direct care. Uninsured get care they cannot pay for because we accept they can't be turned away, but it's OK to close the Emergency unit and make care unaccessible -- somewhat a moral contradiction. People don't get to pick (buy) their illness, or necessarily choose their doctor or treatment but they have to accept it and the associated cost that varies extraordinarily widely depending on whether you're insured or not -- gouging comes to mind. I could go on, and on, and on ....

But really, with you, it's not worth it.

Posted by: notthere on June 14, 2006 at 11:05 PM | PERMALINK

I've been hanging around Ezra Klein's blog and he has wonked the hell out of this issue. He recommends Healthy Policy as one information source on the health issue.
I'm another Canuck with no real problem with our healthcare system. It's there, it's real, it works.
The symptoms we're most concerned about up here is the appetite for expansion of U.S. companies. I'll pass, thanks.

Posted by: opit on June 14, 2006 at 11:16 PM | PERMALINK

"Maybe if we quit treating illegal aliens for colds at the ER's there would be room for American citizens."

Posted by: Fat White Guy on June 14, 2006 at 6:20 PM

"If illegal immigrants couldn't get free healthcare by going to the ER, this woludn't be a problem. Fix that, then I bet the problem goes away."

Posted by: American Hawk on June 14, 2006 at 8:01 PM

Are you guys the same person?

Posted by: BongCrosby on June 14, 2006 at 11:19 PM | PERMALINK

It's a service. In what way don't market principles apply to it?

Police and fire are services. In what way don't market principles apply to them?

Posted by: craigie on June 14, 2006 at 11:34 PM | PERMALINK

I think I can sum up GOP and his ilk on healthcare . . . maybe.

It's like a Cadillac and a VW. The US has this great comfortable, complex vehicle that is not really very reliable and not everyone can have one, but it's "better" than the VW. Everyone can own a VW even if they don't fit in it very well and it will get them where they have to go.

Even though anyone who wants a Cadillac can still own one, the repugs just don't want everyone to have a VW even though the country would be better off health-wise and financially if they did. Probably because it wasn't designed here.

It has something to do with party donations from Mr. Cadillac, not logic or common sense.

Posted by: notthere on June 14, 2006 at 11:47 PM | PERMALINK

craigie,

Police and fire are services. In what way don't market principles apply to them?

They do. In what way don't market principles apply to health care?

Posted by: GOP on June 14, 2006 at 11:49 PM | PERMALINK

GOP --
there you go again. Everyone else has to revolve around you. You really are a pathetic attention seeker.

craigie asked a decent question. Answer it.

Posted by: notthere on June 14, 2006 at 11:54 PM | PERMALINK

notthere,

You are a lazy troll.

You are a blithering idiot.

There are more studies out there comparing health care provision, outcomes and costs than you can shake a stick at.

Great. Then you should have no trouble citing a selection of these numerous studies to support whatever claims about health care you are making. Please do so.

As an employee I have no choice but to accept the very limited alternatives offered by my employer. That's a significant market friction right there. By definition HMOs ration and direct care. Uninsured get care they cannot pay for because we accept they can't be turned away, but it's OK to close the Emergency unit and make care unaccessible -- somewhat a moral contradiction. People don't get to pick (buy) their illness, or necessarily choose their doctor or treatment but they have to accept it and the associated cost that varies extraordinarily widely depending on whether you're insured or not -- gouging comes to mind. I could go on, and on, and on ....

I have no idea how you think any of these claims and observations support the assertion that market principles don't apply to health care. For example, you first say that "As an employee I have no choice but to accept the very limited alternatives offered by my employer." This claim is obviously false as a factual matter. You don't have to accept the health care services offered by your employer, and your employer cannot stop you from purchasing other health care services available on the health care market. If your compensation package also included, say, a company car, but your choice was restricted to certain models, that wouldn't mean market principles don't apply to car sales, either.


Posted by: GOP on June 15, 2006 at 12:05 AM | PERMALINK

craigie asked a decent question. Answer it.

I already did, in the post immediately preceding yours.

Posted by: GOP on June 15, 2006 at 12:07 AM | PERMALINK

GOP--
You have already expressed how you have so avidly read all the research out there and none of it fullfills your extraordinarily strict criteria of covering asbsolutely all and every variable (quote: "massive quantative study"). Only the pentagon can afford that (a very unmarket-driven buyer).

i.e. set the bar so impossibly high no possible research could satisfy your criteria.

As to lazy troll, you just proved it.

You raised the market/service argument and craigie reposted on your own point. Answer it, as clearly we have decided not to treat police and fire services in a market driven manner, and this for quite some time.

==============
craigie asked a decent question. Answer it.

I already did, in the post immediately preceding yours.

Posted by: GOP on June 15, 2006 at 12:07 AM | PERMALINK

==============
craigie,

Police and fire are services. In what way don't market principles apply to them?

They do. In what way don't market principles apply to health care?

Posted by: GOP on June 14, 2006 at 11:49 PM | PERMALINK

Fine answer. "They do." As I said: LAZY TROLL.
And you want us to heap arguments up for you.

F' off.

Posted by: notthere on June 15, 2006 at 12:22 AM | PERMALINK

notthere,

Fine answer. "They do."

What part of "They do", meaning "Market principles do apply to police and fire services" don't you understand?

As I said: LAZY TROLL.

And as I said in response: BLITHERING IDIOT.

Have you figured out yet that the fact that many employers offer health coverage to their employees does not mean that market principles don't apply to health care? An employer could purchase any kind of goods or services and offer them to its employees as part of their compensation package. That has absolutely nothing to do with whether market principles apply to those goods or services.

Posted by: GOP on June 15, 2006 at 12:32 AM | PERMALINK

GOP --
Obviously news to you: "They do" doesn't count as an argument. We all left the playground a long time ago.

And this from someone who wants a "massive quantative study".

And I'm "the idiot"?

Posted by: notthere on June 15, 2006 at 12:40 AM | PERMALINK

They do" doesn't count as an argument.

It wasn't intended to be an argument. It's an assertion that market principles apply to the police and fire services.

Have you figured out yet that the fact that many employers offer health coverage to their employees does not mean that market principles don't apply to health care? An employer could purchase any kind of goods or services and offer them to its employees as part of their compensation package. That has absolutely nothing to do with whether market principles apply to those goods or services.

Posted by: GOP on June 15, 2006 at 12:50 AM | PERMALINK

You liberals makes an issue out of everything. If something isn't really broken, then don't tinker or point at it.

Our healthcare is, of course, one of the better ones in the world. It's still far better to be in US, than in say, Baghdad, or any third world countries, where emergency doesn't officially exist, if at all. There is a big difference there.

Better healthcare or tax breaks. If I have my pick, I'll take the tax breaks, thank you very much. Besides, you can't fix your body when you are dead, so you might as well be dead when your are sick.

Posted by: Mini Al on June 15, 2006 at 12:52 AM | PERMALINK

They do. In what way don't market principles apply to health care

Well, that's a tad disingenuous, n'est pas?

Sure, they do in the sense that the fire department has to pay wages that compete in the real world, and they have to buy their equipment there. But that isn't what I meant, and I think you know that.

The point is, we could demand that lazy, inefficient government not provide police and fire and emergency services, but we don't. And it's beyond the pale to criticize the military, yet that is also a government monopoly. What's so special about them?

The same is true for health care. When your wife goes to the hospital with a massive head trauma, is that really the moment to be saying "well, the Blue Cross hospital costs $10,000/minute, but they serve wine in the rooms and their success rate, as determined in Consumer Reports, is 93%. On the other hand, the Wal-Mart hospital only costs $8,000/minute, but their success rate is 82%. How much health care can I afford?"

Not to mention the fact that health care isn't like entertainment or transportation - there are no easy substitutes. And (dare I go on) there is something immoral about saying to people "sorry, but you didn't manage to get a job paying $250K per year, so you'll just have to die there in the street." That might be market forces but we'd like to be better than that.

Annnnddddd.... health care isn't just a personal good. It matters to me if my neighbor decides that he can't afford to go to the hospital get treated for plague, or malaria, or tuberculosis. I am affected by that. So are you. You want that person treated.

Oh, and this: Neither is Mr Big Government Takeover. is inane. It comes from a bumper-sticker-based mindset, where "the government" is shorthand for mendacious incompetence (which, at the current federal level, I have to concede is true). But to me, "the government" is an abstraction of society as a whole, not an occupying force from outer space.

Posted by: craigie on June 15, 2006 at 12:53 AM | PERMALINK

Have you figured out yet that the fact that many employers offer health coverage . . . blah, blah, blah . . . .

If you bother to put up one decent argument to answer your bland assertions I might get involved. Until then I really can't be bothered. I've made my arguments before as have others and I've seen you retain nothing and argue the same empty way. I've argued with you before. You're quite willing to demand the most rigorous argument but never offer any.

You are empty and valueless.

Meanwhile, you raised the services/market force argument. Show how it applies to police and fire services.

Oh, and by the way, supply cites and a "massive quantative study".

Posted by: notthere on June 15, 2006 at 1:14 AM | PERMALINK

craigie,

Sure, they do in the sense that the fire department has to pay wages that compete in the real world, and they have to buy their equipment there. But that isn't what I meant, and I think you know that.

I didn't assume you meant it only in that way. Market principles apply to fire and police services in other ways too, in addition to their involvement in the labor and equipment markets.

The point is, we could demand that lazy, inefficient government not provide police and fire and emergency services, but we don't. And it's beyond the pale to criticize the military, yet that is also a government monopoly. What's so special about them? The same is true for health care.

What "same thing" thing is true for health care? You don't say. Answer your own question. What is "so special" about the police, fire, military and health care services that we should rely on the government to provide each of those things, or even give the government a monopoly on providing them?

When your wife goes to the hospital with a massive head trauma, is that really the moment to be saying "well, the Blue Cross hospital costs $10,000/minute, but they serve wine in the rooms and their success rate, as determined in Consumer Reports, is 93%. On the other hand, the Wal-Mart hospital only costs $8,000/minute, but their success rate is 82%. How much health care can I afford?"

No, probably not. If your wife has a massive head trauma, it's probably best to take her to the nearest hospital and worry about a detailed cost/benefit analysis later, after the emergency has passed. I have no idea what you think this bizarre question has to do with your apparent belief that market principles don't apply to health care, or why you think the government should provide health care just as it provides fire, police and military services. Do you have an actual argument or point to make that addresses the questions in debate?

Not to mention the fact that health care isn't like entertainment or transportation - there are no easy substitutes.

It's hard to know what this means, or why you think it's relevant. There aren't really "substitutes" for transportation, either. There are sometimes different types of available transportation to the same destination. Is that what you mean by "substitutes?" Yes, sometimes you have the choice of taking a car or a bus, a boat or a plane. So what? How does that imply that transportation should be provided by the market but not health care (if that is indeed what you're suggesting--it's hard to tell).

And (dare I go on) there is something immoral about saying to people "sorry, but you didn't manage to get a job paying $250K per year, so you'll just have to die there in the street." That might be market forces but we'd like to be better than that.

Er, no one is suggesting that we say that to people. Again, this seems like a complete nonsequitur. Do you have a point?

Posted by: GOP on June 15, 2006 at 1:17 AM | PERMALINK

GOP

Are you one of those libertarian types who think that police and fire services are best provided by the "market?" Well "for profit" fire services were tried in Edwardian England. The English nearly burned their damn country down before they realized that saving houses that paid for fire protection while ignoring houses that didn't is not a functioning fire prevention delivery model. As to "for profit police departments," well they seem to be popular in Mexico. What do you think? Do you prefer American police or Mexican police? Do you want to have to pay a fee to keep from being robbed. In some neighborhoods that is called extortion. By the way "for profit" police was popular during the days of Al Capone. He paid a lot of cops. He even had "for profit" Judges. Want those GOP? Justice to the highest bidder? That would pretty much end America and the old fashioned notion that Americans have the rights to life, liberty and the pursuit of happiness. I am not sure even you want to go back to those days. Do you?

The reality is that for reasons having to do with the need to provide protection to both those who have paid and those who haven't (inorder to protect those who have paid) the market approach is ineffective when it comes to both fire and police protection.

The same can be said for medical services. Limiting medical care only to those who can afford to pay for it is ineffective. In order to remain healthy (both physically and financially) we all have an interest in providing medical services to everybody in the society. As a result most first world countries recognize the need for universal health care. They realize that they need to make sure everybody receives some basic level of care. A healthy work force is a productive work force. A healthy underclass means rich SOB's like you are subject to fewer communicable diseases.

Anyway, a lot of other folks have provided even better arguments for universal health care.

Posted by: Ron Byers on June 15, 2006 at 1:20 AM | PERMALINK

craigie,

Annnnddddd.... health care isn't just a personal good. It matters to me if my neighbor decides that he can't afford to go to the hospital get treated for plague, or malaria, or tuberculosis. I am affected by that. So are you. You want that person treated.

Finally, something from you that looks like an actual argument. I agree that some aspects of health are a public good, the aspects generally referred to by the term "public health." These include things like sanitation and sewage disposal, immunizations against common and serious infectious diseases, and public health campaigns like the importance of healthy eating. And because those things are public goods, it is appropriate for the government to provide them, or at least to guarantee them. But the vast majority of services provided by a nation's health care system are not public health interventions, they are medical care interventions whose benefits are restricted mostly or entirely to a single individual. Why should we rely on the government to provide or guarantee these services? We don't rely on the government to provide food, or clothing, or shelter, so why health care?

Oh, and this: Neither is Mr Big Government Takeover. is inane.

No more so than your "Mr Market" inanity, which it was spoofing, in case you didn't realize.

Posted by: GOP on June 15, 2006 at 1:29 AM | PERMALINK

Ron Byers,

Are you one of those libertarian types who think that police and fire services are best provided by the "market?"

No. Or, rather, not entirely.

The same can be said for medical services.

No it can't. How are medical services a public good, as police and fire services are a public good?

Limiting medical care only to those who can afford to pay for it is ineffective.

How is it "ineffective?" Ineffective for what purpose? And we don't limit medical care only to those who can afford to pay for it, anyway.

In order to remain healthy (both physically and financially) we all have an interest in providing medical services to everybody in the society.

How is our interest in providing someone else with health care services any greater than our interest in providing them with food, clothing, shelter, or employment? Are you suggesting the government should provide those things too? If not, why should it provide health care?

Posted by: GOP on June 15, 2006 at 1:37 AM | PERMALINK

...I didn't assume you meant it only in that way. Market principles apply to fire and police services in other ways too, in addition to their involvement in the labor and equipment markets....

Posted by: GOP on June 15, 2006 at 1:17 AM | PERMALINK

Yeah, but craigie asked the question first and you still haven't supplied one argument to support your point of view.

What other ways? Pray continue. Cites and data.

Ron Byers, thanks for chipping in but I really think that GOP only comes for obtuse argument. There is no seeking of truth, only confrontation. Personally, I'm convinced (s)he was ignored by parents, siblings, school-fellows, etc. Attention is his/her only goal.

============
craigie,
...
Finally, something from you that looks like an actual argument....

Posted by: GOP on June 15, 2006 at 1:29 AM | PERMALINK

Something you might want to supply?

Posted by: nothere on June 15, 2006 at 1:40 AM | PERMALINK

GOP --
...How are medical services a public good, as police and fire services are a public good?...

Just another exposition of your complete ignorance and bias on the subject. Please refer to all the public health studies you say you have read. Also refer to 200 years of public health care records and policies.

Please supply an argument why they are not.

Posted by: notthere on June 15, 2006 at 1:47 AM | PERMALINK

notthere:

Here, let me make it easy for you.

Here's a list of some important goods/services that we fund and/or provide primarily or exclusively through the government:

National Defense.
Police protection.
Criminal Justice (courts, prisons, etc.)
Fire service.

And here's a list of some important goods/services that we fund and/or provide primarily through the market:

Employment.
Housing.
Food.
Health care.
Clothing.
Insurance (home, car, life, etc.)

Now explain to me why health care, and only health care, should be moved from the second list to the first list.

Posted by: GOP on June 15, 2006 at 1:55 AM | PERMALINK

Now explain to me why health care, and only health care, should be moved from the second list to the first list.

1. It's a public good, like the others.

2. It's immoral to deny people health care just because they have no job / the wrong job. Conservatives, presumably, disagree.

3. Health care isn't like food, clothing, etc, because people can get food at many different levels of quality without having a problem. Indeed, they might want to. We just care that people have access to some food (or, possibly, you don't).

4. We don't think of telling people "I'm sorry, your house isn't worth enough to bother coming to put out the fire." Why would we say to people "I'm sorry, you don't earn enough to be worth treating." Well, I don't want to say that. You seem to think it's fine.

5. Everyone else does it that way, and everyone else gets better results than we do. As good or better care, for less money, with everyone covered.

Posted by: craigie on June 15, 2006 at 2:37 AM | PERMALINK

...
Now explain to me why health care, and only health care, should be moved from the second list to the first list.

Posted by: GOP on June 15, 2006 at 1:55 AM | PERMALINK

NOOoooo!
As I said, craigie asked the question and you've refused to answer.

You are an argumentative coward.

You explain why health care is market driven not a public service.

You never substantiate your arguments. Do so or F' off!

Posted by: notthere on June 15, 2006 at 2:41 AM | PERMALINK

oh, and:

Healthcare belongs in the first group because all of those things are life and death services.

The other stuff isn't.

Posted by: craigie on June 15, 2006 at 2:48 AM | PERMALINK

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Posted by: cxmmc on June 15, 2006 at 5:45 AM | PERMALINK
How is our interest in providing someone else with health care services any greater than our interest in providing them with food, clothing, shelter, or employment? Are you suggesting the government should provide those things too?

In the case of food, clothing, and shelter it may not be; government probably ought to provide minimum guarantees there, as well. OTOH, unlike with healthcare, there is little evidence in historical or international experience that the most efficient way to provide such a minimum guarantee is to provide universal service except with healthcare, so need-based aid programs are probably the best way to provide that guarantee for the other three.

Why?

Posted by: cmdicely on June 15, 2006 at 10:44 AM | PERMALINK

Check it out:
http://www.npr.org/templates/story/story.php?storyId=5486114
http://www.nap.edu/catalog/11629.html#toc

Posted by: ecoboz on June 15, 2006 at 12:09 PM | PERMALINK

Proposition:

Those who would oppose universal healthcare for everyone have no right ( regardless of income, etc. ) to healthcare themselves.

Posted by: Thinker on June 15, 2006 at 12:25 PM | PERMALINK

craigie,

1. It's a public good, like the others.

No it isn't. Why is health care a public good any more than food, housing, clothing, employment or insurance? As I said, there are health-related public goods (public sanitation, mass immunization, consumer product safety, etc.), but the government already provides or guarantees those services. The vast majority of medical care interventions are private goods whose primary or sole beneficiary is an individual human being.

2. It's immoral to deny people health care just because they have no job / the wrong job.

No one's proposing to "deny" people health care. Why should the government provide health care? It doesn't provide jobs, housing, clothing, or food.

3. Health care isn't like food, clothing, etc, because people can get food at many different levels of quality without having a problem.

Huh? What are you talking about? The quality of food a person can obtain depends very much on how much money he has. The rich can dine in expensive restaurants on lobster and champagne while the poor have to make do with spam and wonderbread at home. Ditto for the quality of housing, the quality of clothing, and the quality of most other goods and services we rely on the market to provide.

4. We don't think of telling people "I'm sorry, your house isn't worth enough to bother coming to put out the fire." Why would we say to people "I'm sorry, you don't earn enough to be worth treating."

The fire service is a public good. If your house catches fire and we don't put the fire out, it is likely to spread to other houses or areas. The benefits of the fire service are collective, not individual. But the government doesn't provide or guarantee you with fire insurance. That's your responsibility. If your house burns to the ground, the government will extinguish the blaze, but it won't build another house for you. So why should it provide you with health care?

Posted by: GOP on June 15, 2006 at 12:43 PM | PERMALINK

craigie,

Healthcare belongs in the first group because all of those things are life and death services. The other stuff isn't

Huh? Your life doesn't depend on your being able to get food, clothing and shelter? What planet are you living on? Try living naked, on the streets, without any food, during a Chicago winter, and see how long you last.

Posted by: GOP on June 15, 2006 at 12:48 PM | PERMALINK

cmdicely,

In the case of food, clothing, and shelter it may not be; government probably ought to provide minimum guarantees there, as well.

It already does. It also already provides certain minimum guarantees with respect to health care.

OTOH, unlike with healthcare, there is little evidence in historical or international experience that the most efficient way to provide such a minimum guarantee is to provide universal service except with healthcare, so need-based aid programs are probably the best way to provide that guarantee for the other three.

Huh? What evidence is there that "the most efficient way to provide a minimum guarantee" of health care--but not food, clothing, housing, insurance, etc.--is through "universal service" provided by the government? (I assume "universal service" is intended to mean health care services overall, not just the "minimum guaranteed" service. If this assumption is incorrect, explain what you mean by "universal service.") And even if that were the most efficient way of providing a minimum guarantee of health care, it may be a very inefficient way of providing health care beyond that minimum, in which case the most efficient system would be government provision of the "minimum guaranteed" health care, and market provision of all health care beyond that minimum. But you haven't provided any evidence for your efficiency claim, anyway, so until you do it's all just hypothetical.

Why?

Why what?

Posted by: GOP on June 15, 2006 at 1:13 PM | PERMALINK

What is different about healthcare? In most human contexts it is considered appropriate for all able bodied people to be productive, i.e. work for a living. I should be able to take care of all those other necessities of life through my own effort. If I am injured or seriously ill on the other hand, then it becomes the responsibility of the collective to step forward and provide assistance according to the limits of its resources. What I am describing here is the basic social contract that has been in existence since hunter-gatherer times. And of course in hunter-gatherer times resources were very limited, and life and death decisions were made accordingly. Maybe the real issue here is how we define the word "collective". This was also very clear in hunter-gatherer times. You knew who your people were. If our idea of "collective" embraces the concept of the modern state, then universal healthcare is the obvious answer. The libertarian view OTH, (which GOP flirts with) would break all that down, and with it any sense of collective responsibility for the misfortune of someone we don't know.

Posted by: haydar on June 15, 2006 at 3:22 PM | PERMALINK

What is different about healthcare? In most human contexts it is considered appropriate for all able bodied people to be productive, i.e. work for a living.

To be a produtive member of a society, you need food, clothing and shelter, amoung other things, as well as health care. In fact, food, clothing and shelter are probably the three most basic things a human being needs to be productive, so I don't understand how you think you have identified something different about health care here.

I should be able to take care of all those other necessities of life through my own effort.

And you should also be able to take care of your health care needs through your own efforts. Most Americans do. Again, you haven't explained why health care should be treated differently from the other necessities of life in this respect.

If I am injured or seriously ill on the other hand, then it becomes the responsibility of the collective to step forward and provide assistance according to the limits of its resources.

Well, the "collective" (sounds ominously like the Borg from Star Trek) does provide some assistance on health care if you really need it. Just as it provides some assistance if your house burns down or you lose your job or your husband dies leaving you to raise four children by yourself. But the primary responsibility for dealing with these unfortunate circumstances is yours. That is why we have a huge private homeowner's insurance industry, and a huge private life insurance industry, and a huge private health insurance industry.

What I am describing here is the basic social contract that has been in existence since hunter-gatherer times.

Huh? In hunter-gatherer times, you could count on even less help from the "collective." There were no government social welfare programs and no private insurance industry. If you were sick or disabled, you basically had to rely on yourself and your immediate family.

Posted by: GOP on June 15, 2006 at 3:48 PM | PERMALINK

I think you miss my point, GOP. It all depends on how you define your "collective". My state of health directly affects my productivity, or my ability to obtain my needs. That's why my employer pays for health insurance. In a modern sense, my place of employment has become my "collective", no matter how far removed from my social life. If I become unemployed I am basically shit out of luck, as modern techno medicine is far too expensive to be able to afford without insurance. By creating universal coverage, we are socializing the entire population, and defining it as the "collective". Having just gone through a spell of unemployment, that option makes sense to me. Obviously, even under a universal scenario there are limits to resources and choices have to be made. If I remember correctly, they have been experimenting with that approach in Oregon. Health care at a basic level is not a product of choice, but one of need, and the half way solution the government provides is in some ways worse than no solution at all. In a libertarian world we would get what we pay for and there would be no illusions or expections of anything else.

Posted by: haydar on June 15, 2006 at 4:55 PM | PERMALINK

haydar,

I think it's you who doesn't get the point. Obviously, food, clothing, and shelter, amoung other things, are also needs of yours and also affect your productivity. So why aren't you proposing to "socialize" those, too? What's different about health care such that it should be "socialized," but not any of the other things I have described? You keep claiming there is such a difference, but you don't seem to be able to figure out what it is.

Posted by: GOP on June 15, 2006 at 5:10 PM | PERMALINK

I'm probably getting into this argument way too late, but here's my thoughts on how healthcare is "different" and therefore shouldn't be appropriated through a market-based system.

I don't pretend to be an economist, but it seems reasonable to me that in order for a business to succeed, it must take in more money than it pays out. In the healthcare business, the people who cost the most money (and therefore are the biggest threats to healthcare companies profits) are the sickest patients. Thus, in order to keep profit margins high, companies must either minimize payouts to the sick and/or enroll as many healthy people (who won't use the services) as possible.

Guess what? They do both. Healthcare companies' admin costs are 30% higher than Medicare's because they need to figure out who they can deny. Thus, care is denied to those who most need it, while the company appeals to healthy people who need it least (and therefore are least likely to force the company to pay up). This, in my opinion, is how healthcare is different from other fields in which market-based systems work spectacularly.

The most successful companies selling food, clothing and shelter sell those items at prices people will pay while still being able to make a profit. Healthcare companies actually DENY services to those who need it most while courting those who need (and use) it least. The fact that profits depend on denying services to people is a fundamental paradox in healthcare delivery which distinguishes it from any other field and is one of many reasons why we need a single payer sysytem. That and the fact that single payer is more efficient, leads to better health outcomes AND WOULD INSURE 46 MILLION MORE PEOPLE. People tend to forget (or maybe not care about) that last fact when discussing single payer. Maybe that exposes me as a bleeding heart.

Let's not forget that the purpose of healthcare is to DELIVER HEALTHCARE, not to figure out ways to deny it to people. Sorry for the extensive use of caps, but i feel strongly about the issue.

Posted by: ram3 on June 16, 2006 at 2:16 AM | PERMALINK

ram3,

The fact that profits depend on denying services to people is a fundamental paradox in healthcare delivery which distinguishes it from any other field and is one of many reasons why we need a single payer system.

No it isn't. This supposed "difference" you describe applies to any kind of insurance. All insurance providers have an incentive to maximize revenues from premiums and minimize payouts for claims. That's why they employ actuaries to calculate risks and premiums. It's why 16-year-old boys pay much higher car insurance premiums than 40-year-old married women. It's why a 50-year-old smoker in poor health will pay much higher life insurance premiums than a 20-year-old non-smoker in good health. There's nothing special about health insurance with respect to the economic incentives for the insurer. To protect the right of people at the margins to obtain health insurance, state and federal law severely limits the ability of health insurers to exclude or charge higher premiums based on age and health status.

Posted by: GOP on June 16, 2006 at 3:34 AM | PERMALINK

GOP insists that NONE of the studies, anecdotes or metrics that show that the U.S. healthcare system is less efficient and provides generally poorer outcomes than the universal care systems of almost all other industrialized nations are "comprehensive" enough to prove the point.

Yet nowhere in this thread has he provided ANY argument in favor of the current system. Additionally, when supporters of the status quo are challenged to do so, all they can provide are either vague, unsupported bleatings about the value of market forces or anecdotal evidence and studies that are far more limited in scope that those GOP is dismissing here.

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